The Karnataka High Court allowed hysterectomy for a 23-year-old woman with severe intellectual disabilities after finding she could not make an informed decision. Justice Suraj Govindaraj held that medical evidence showed the procedure was in her best interests, protecting her welfare, dignity and safety.
The Karnataka High Court granted permission for a hysterectomy for a 23-year-old woman who has severe intellectual disabilities. The court concluded that she is unable to make an informed decision and that the proposed surgery is in her best interests.
In an order dated June 17, Justice Suraj Govindaraj observed:
“It is only because the patient is demonstrably incapable of exercising informed decision-making and because the overwhelming medical evidence indicates that the proposed intervention would serve her welfare, health, dignity and safety that this Court considers it appropriate to grant the permission sought.”
The court clarified that its decision was based on a “best interests” evaluation supported by independent medical assessments. It said the ruling should not be understood as allowing invasive procedures solely because a person has a disability.
Advocate Zulfi Sultana, appearing for the woman’s parents, relied on medical and psychological evaluations showing that although the woman is 23 years old, her cognitive, developmental, and adaptive functioning remains severely affected.
Sultana stated that the woman is fully dependent on her parents for daily needs and personal care because she cannot “c”ommunicate effectively about physical discomfort, medical problems, or menstrual difficulties.
She added,
“Her inability to maintain personal hygiene during such periods has resulted in recurring infections, intermittent episodes of fever and prolonged medical complications. The situation has not only exposed (daughter) to repeated health risks but has also imposed considerable physical, emotional, and psychological strain upon the petitioners, who are advancing in age and continue to remain her sole caregivers,”
In their petition, the parents said the procedure is “intended solely to safeguard the health, dignity, comfort and long-term welfare of (X) and not for any collateral purpose.”
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The court ordered the formation of a medical board to examine the woman at Vanivilas Hospital. The board was tasked with independently evaluating her medical condition, assessing her capacity, and determining whether the proposed procedure is medically necessary and advisable.
After the examination, the medical board concluded that the woman has Global Developmental Delay linked with Moderate Permanent Intellectual and Developmental Disability. It assessed her social age at around 5 years and 4 months, her IQ at 36, and her permanent disability at 75%.
The psychiatrist on the board stated that she cannot independently maintain menstrual hygiene. The neurologist reported she has cerebral palsy, associated with intellectual disability and a seizure disorder, and that she has been receiving treatment for more than 13 years.
The obstetrician and gynaecologist stated that she is unable to independently manage menstrual hygiene and recommended that she may be “considered for Total Abdominal Hysterectomy.”
Based on the medical board report, the High Court held that the woman lacks the cognitive and intellectual capacity to make an informed decision about the proposed procedure.
The court explained that it must weigh the woman’s bodily integrity and autonomy against the realities arising from her condition, including her medical needs, intellectual limitations, quality of life, health concerns, and long-term welfare. It noted that her parents and primary caregivers have been providing ongoing care and support throughout her life.
It said,
“There is nothing on record to indicate that they are motivated by any collateral consideration. On the contrary, the materials on record indicate that they have approached this court solely out of concern for the welfare, dignity, comfort and long-term well-being of their daughter.”
It Said,
“The present case does not concern sterilisation for eugenic purposes, population control measures or any attempt to curtail the rights of the patient on account of her disability. The recommendation is founded entirely upon considerations relating to health, hygiene, dignity, safety and quality of life.”
“The permission is granted only after judicial scrutiny, independent medical evaluation by specialists from multiple disciplines, consideration of the patient’s inability to provide informed consent, examination of the absence of any contraindication to the proposed procedure and a determination that the proposed intervention is in the best interests of the patient.”
It said,
“This Court is satisfied that the proposed procedure is intended to advance the welfare, health, dignity and best interests of (X).”