UDATES ON COVID-19 JABS Particularly For Parents❗Especially Young Caucasian Men In America! October 22, 2025

on

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🥶😰😨🥵😳😤😠😡🤬🤯😱😓😥😰😨🫣🤔🤥🫥🫡🙄😬😪😮‍💨😴🥱😯😐🫤😑😬😶🫠🤫😫😩🥺😭😢😖😣☹️🙁😕😟🧐🤨 Guess What?  The Heart Health Has A Corresponding Relationship With Overall Health Especially In The Male Reproduction Department and ED or Healthy Erectile Function.  

Because Covid-19 in virus form or from Covid-19 jab are one and the same animal with the jab being worse of the two.  

Both made in labs both aimed to maim and worse.  Covid-19 was a drill and millions upon millions of people globally including America died in this drill.  Some people who did not die are getting sick and seriously ill for some time through all time in their lifetime.  So to do the math no matter how it’s calculated it comes out a bad deal for the trusting Americans who believed in one or the other and everyone suffers one way or another from Covid-19.



UDATES ON COVID-19 JABS❗Especially Young Caucasian Men In America!  As You Read Realize AI Is Adopting News Such As This As Truth.  With AI Being 50% True, and Using Data Below In The Fact Check Article, That Leaves AI 100% Wrong All Of The Time!  

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COVID-19 mRNA vaccine linked to myocardial scarring in adolescents and young adults



New study uncovers a higher prevalence of heart scarring in young males after COVID-19 mRNA vaccination, raising concerns about long-term outcomes despite mild initial symptoms of vaccine-associated myocarditis.

Study: Cardiac manifestations and outcomes of COVID-19 vaccine-associated myocarditis in the young in the USA: longitudinal results from the Myocarditis After COVID Vaccination (MACiV) multicenter study. Image Credit: pedro7merino/Shutterstock.com
In a recent study published in EClinicalMedicine, a team of scientists from the United States (U.S.) examined the longitudinal outcomes and clinical characteristics of coronavirus disease 2019 (COVID-19) vaccine-associated myocarditis or C-VAM and evaluated the risk of myocardial injury and cardiovascular outcomes due to C-VAM in the pediatric population and young adults.




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Yes the manufacturers knew very well about this condition that still affects a great percent of American populations!

FDA requires updated warning about rare heart risk with COVID shots




WASHINGTON (AP) — The Food and Drug Administration said Wednesday it has expanded existing warnings on the two leading COVID-19 vaccines about a rare heart side effect mainly seen in young men. 

Special Note:  Myocarditis is not only a rampant heart side effect it was a known side effect before the vaccine was mass produced and it was said to have been held back in the FDA review of the vaccine Covid-19.  The FDA in all liklihood knew about the myocarditis in any case they know now and want to keep jabbing people as they did initially.  Only YHWH knows how debilitating the Covid-19 jabs truly are and how they transgress the Laws of YHWH to the nth degree!


Myocarditis, a type of heart inflammation that is usually mild, emerged as a complication after the first shots became widely available in 2021. Prescribing information from both Pfizer and Moderna already advises doctors about the issue.
In April, the FDA sent letters to both drugmakers asking them to update and expand the warnings to add more detail about the problem and to cover a larger group of patients. While the FDA can mandate label changes, the process is often more of a negotiation with companies.

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October 22, 2025

Please review the fact check article and remember that everything said in the article is part of the trillions of taxpayer dollars used for infra-brain-restructuring, not a penny to replace or repair damaged highways, railroads, airports, country roads and bridges and any other material structure other than SOFTWARE IN PEOPLE'S BRAINS!  Reader be objective to realizing when a nation is being brain washed all around!


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Can COVID-19 Cause Erectile Dysfunction?


https://health.clevelandclinic.org/yes-covid-19-can-cause-erectile-dysfunctionResearch shows the virus can affect your ability to get or maintain an erection

If you’re suddenly experiencing erectile dysfunction (ED) (https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction), it might be connected to something you wouldn’t necessarily expect — a recent COVID-19 (https://my.clevelandclinic.org/health/diseases/21214-coronavirus-covid-19) infection.
Studies show that COVID-19 may increase your risk of ED (https://pmc.ncbi.nlm.nih.gov/articles/PMC8673874/) or worsen the condition if you’re already dealing with an inability to get or maintain an erection. Why is this? Let’s look at the possible factors with urologist Ryan Berglund, MD (https://my.clevelandclinic.org/staff/5708-ryan-berglund).
How does COVID-19 affect erections?
Research points to three factors that could lead to the onset of ED after getting COVID-19:
1 Vascular effects. Erections are powered by blood flow to the penis. COVID-19 can cause cell damage in blood vessels that restricts blood flow and reduces erections, says Dr. Berglund. (Inflammation caused by COVID-19 is also a contributing factor.)
2 Psychological impact. Sexual activity is closely associated with mental health. Stress, anxiety and depression linked to COVID-19 could also be a driving force (https://link.springer.com/article/10.1007/s40618-022-01945-w) behind sexual dysfunction.
3 Overall health. ED is often a symptom of an underlying health issue, like heart disease or diabetes. COVID-19 can worsen those issues and weaken your erection. “It can be a sign of something more serious going on, particularly in young and healthy people who abruptly develop ED after having COVID-19,” notes Dr. Berglund.
Age is also an important aspect to consider, as it’s a risk factor for developing both ED and a more severe case of COVID-19.
“We know there are several different ways that the virus could cause erectile dysfunction, but much more research is needed before we know for sure and if there are long-term effects,” he adds.
Can COVID-19 affect testosterone?
Studies show that testosterone levels often drop (https://pubmed.ncbi.nlm.nih.gov/34409772/) following a COVID-19 infection and may stay down for months before rebounding. In severe cases, the virus can cause testicular damage (https://pmc.ncbi.nlm.nih.gov/articles/PMC10338913/) and dysfunction.
But low testosterone doesn’t necessarily lead to ED. While there are connections, low T and ED are separate health issues involving different systems in your body. (Learn more about the relationship between low T and ED (https://health.clevelandclinic.org/low-testosterone-and-ed).)
Can you prevent COVID-19-related ED?
Protecting yourself against COVID-19 is the b
est way to avoid issues related to the virus, says Dr. Berglund. That means 
staying up to date (https://health.clevelandclinic.org/what-is-considered-fully-vaccinated-for-covid)
 on your COVID-19 vaccinations as 
new variants and subvariants (https://health.clevelandclinic.org/what-does-it-mean-that-the-coronavirus-is-mutating)
 emerge.
Other prevention strategies include:
•
Washing your hands regularly. Hand sanitizer works in a pinch, too.
•
Avoiding contact with people who are sick. (On the same note, keep to yourself if you’re not feeling well.)
•
Maintaining a healthy lifestyle when it comes to diet, exercise and sleep to help boost your immune system.
Treatment for COVID-19-related ED
First, the good news: According to Dr. Berglund, it does appear that COVID-19-related ED improves over time, so the situation may be temporary. 
Researchers found (https://pmc.ncbi.nlm.nih.gov/articles/PMC9584530/)
 that erections often return to their regular stiffness within three months.
In the meantime, talk to your doctor about your options, including ED medications. They may check for underlying causes (such as 
cardiovascular issues (https://health.clevelandclinic.org/erectile-dysfunction-may-signal-cardiovascular-problems)
) that may be contributing to your ED.
Final thoughts
While COVID-19 is a respiratory illness, we know it extends far beyond our lungs when it comes to harming our bodies. ED is just one example.
The virus also has been connected to an 
increased risk of blood clots (https://health.clevelandclinic.org/should-you-be-worried-about-blood-clots-with-covid-19)
. There’s evidence it may contribute to the 
development of Type 2 diabetes (https://health.clevelandclinic.org/can-covid-cause-diabetes)
, too. And it has been linked to seizures, 
sleep disorders (https://health.clevelandclinic.org/covid-insomnia)
, 
tinnitus (https://health.clevelandclinic.org/can-covid-19-cause-tinnitus)
 (ringing in your ears) and many more issues.
“All of these are examples of possible long-term effects of COVID,” states Dr. Berglund. “Time and more research is needed to give us a better understanding of what the virus can do.”

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The impact of COVID-19 vaccination on the sexual health of male healthcare professionals


Hülya Yılmaz Başer 1, Ahmet Güzel 2, Aykut Başer 3
Affiliations 

Findings:  Overall sexual relations decreased and ED erectile dysfunction increased post COVID-19 Jabs!!

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic negatively affected the mental and sexual health of individuals, especially healthcare professionals. In this study, we aimed to investigate the changes in anxiety and sexual activity of male healthcare professionals following vaccination.
Methodology: This prospective cross-sectional and descriptive online survey was conducted between July 1, 2021 and November 1, 2021, involving a total of 170 healthcare professionals. Socio-demographic characteristics, pre- and post-vaccination anxiety and sexual activity levels of the participants were compared.
Results: There was a significant increase in only the intercourse times of the participants post vaccination (p = 0.034). The Beck anxiety inventory score decreased from median: 19 (minimum (min): 16, maximum (max): 47) before vaccination to median: 17, (min: 10, max: 43) after vaccination (p < 0.001). Likewise, Arizona Sexual Experiences Scale (ASEX) scores decreased after vaccination (median: 10, min: 5, max: 20) compared to before vaccination (median: 12, min: 5, max: 18) (p < 0.001). International Index of Erectile Function (IIEF) score also increased after vaccination (25.49 ± 6.50) compared to before vaccination (24.71 ± 7.10) (p < 0.001). Orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction scores also improved (p = 0.013, p < 0.001, p = 0.027, p < 0.001).


Conclusions: Mental and sexual disorders increased with the COVID-19 pandemic. In addition to immunity, the vaccine also had positive effects on anxiety and sexual activity.

ASIDE:  Special Note...in the above article it addresses the positive effects on anxiety and sexual activity, in which case this must mean positive effects to mean positive in the affirmative that post Covid-19 jabs people were greatly affected by the jabs and their anxiety increased as their libido and sexual activity because both still pose problems and worse post Covid-19 jabs.  Many young men suffer from inflammation of the heart and though with lots of pills, perhaps over the course of the lifetime of the jabbed, the heart once damaged is just that, damaged for life.


Keywords: COVID-19; sexual dysfunction; sexual function; sexuality; vaccine.  

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November 7, 2024/Health Conditions/Infectious Disease

Can COVID-19 Cause Erectile Dysfunction?

Research shows the virus can affect your ability to get or maintain an erection

Fact-check: Erectile dysfunction, swollen testicles and sperm count after COVID-19 vaccination or infection
One of the most repeated myths of COVID-19 vaccination concerns fertility. Do the COVID-19 vaccines cause swollen testicles, erectile dysfunction (ED) and lower sperm count? No, but COVID-19 infection can cause each of these issues.
Nebraska Medicine Urologist Chris Deibert, MD, who treats ED and other men's health conditions, walks through the research on this issue.
Swollen testicles
After COVID-19 infection
Many people with testicles will experience testicular swelling or swelling of the epididymisafter symptomatic COVID-19 infection. A recent review estimates that "10% to 22% of men with acute COVID-19 infection develop orchitis or epididymo-orchitis." Orchitis is the medical term for testicular swelling or inflammation. COVID-19 isn't the first infection to cause swollen testicles. A lot of infections can cause testicular swelling, including E. coli bacteria, gonorrhea, chlamydia and mumps.
After vaccination
Except for unconfirmed reports on social media, there's no evidence that the COVID-19 vaccination is linked to testicular swelling. It's important to treat personal stories differently than scientific research. Dr. Deibert says he hasn't seen any evidence locally or nationally linking swollen testicles and COVID-19 vaccination. If you're curious about how mRNA vaccination works, find out how long spike proteins last in the body.
Erectile dysfunction
After COVID-19 infection
A small, self-reported survey of Italian men suggests a link between ED and COVID-19 infection. This study found that reported ED was higher in COVID-19 positive people.People reporting erectile dysfunction with prior COVID-19 infection was 28% while those with no COVID-19 infection was 9%.
It appears that the virus can go to all parts of the body when someone is symptomatically ill. Dead virus has been found in erectile tissues after severe, acute infection, but it's not totally clear if or how the virus causes erection issues.
Researchers found viral particles in penis biopsies, taken from two people who previously had COVID-19. Both had "normal erectile function" before their COVID-19 infections. See the images here. The researchers did not find viral particles in penis biopsies of two other people with no history of COVID-19 infection.
After vaccination
Dr. Deibert has not seen any patients who developed erectile issues after vaccination alone, and he hasn’t heard any reports of that happening. After reviewing research databases, the American Society for Reproductive Medicine says, "No evidence of any connection between COVID-19 vaccines and male infertility was found, but there were 50 reviews, 17 commentaries/letters to editors and nine original articles on how COVID-19 disease could possibly impact male fertility."
Sperm count
After COVID-19 infection
COVID-19 infection can lower sperm counts, at least temporarily. A small study compared the median sperm counts of COVID-19-positive men with sperm counts of COVID-19-negative men. The median sperm count of those without infection was 21.5 million and with infection was 12.5 million.
After vaccination
There is some reassuring data that the vaccine doesn't change sperm count. 
A small, peer-reviewed study measured 45 people's sperm counts before and after COVID-19 mRNA vaccination. The study reported that there were "no significant decreases in any sperm parameter among this small cohort of healthy men" after two doses of either Moderna or Pfizer vaccines.
In summary, COVID-19 vaccines do not affect men’s fertility, but COVID-19 infection does. To sum up what we know so far:
  • COVID-19 vaccines are not linked to swollen testicles, erectile dysfunction or lower sperm counts
  • COVID-19 infection can cause swollen testicles, erectile dysfunction and lower sperm counts

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 NIH Trying to spike 30 year old man with Down syndrome- Man and his mom both don’t want Covid-19 jab…but NIH is being forceful!  Who would ever suspect this?  The Supreme Court declared forced Covid-19 jabs are not mandatory in 2924. Biden Harris Admin. try to force Covid-19 jabs, then backpedal saying that they never did.

https://m.youtube.com/watch?v=TWBEnVYxWJ0


⭐️⭐️⭐️   

Biden announces sweeping vaccine mandates affecting millions of workers


The administration said the new mandates could affect around 100 million people, more than two-thirds of the U.S. workforce. 
https://www.nbcnews.com/politics/white-house/biden-announce-additional-vaccine-mandates-he-unveils-new-covid-strategy-n1278735

By Shannon Pettypiece, Heidi Przybyla and Lauren Egan

WASHINGTON — President Joe Biden on Thursday issued two executive orders mandating vaccines for federal workers and contractors and announced new requirements for large employers and health care providers that he said would affect around 100 million workers, more than two-thirds of the U.S. workforce.

"We've been patient, but our patience is wearing thin," Biden said, making a direct appeal to the 80 million people who he said were still unvaccinated. "Your refusal has cost all of us."

Biden also announced that he asked the Department of Labor to issue an emergency rule requiring all employers with 100 or more employees to ensure their workforce is fully vaccinated or require any unvaccinated workers to produce a negative Covid test at least once a week. The requirement could carry a $14,000 fine per violation and would affect two-thirds of the country's workforce, a senior administration official said.

Employees working in health care facilities that receive Medicare or Medicaid reimbursement will also be required to be vaccinated, Biden said, a move that will impact 7 million workers at 50,000 health care providers.

As of July, 27 percent of the country's health care workers were unvaccinated, according to a study by the Covid States Project.⭐️⭐️⭐️⭐️

After demoralizing and dehumanizing and victimizing American people… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC479215/

Dot gov

The .gov means it’s official. 
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure. 
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Sterilisation of incompetent mentally handicapped persons: a model for decision making.

Abstract

Doctors are regularly confronted with requests for sterilisation of mentally handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a model for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select and classify certain factors which could enable us to arrive at an ethically justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting competence, and six minor criteria: conception risk, IQ, age, personality, medical aspects and prognosis and finally support and guidance for the mentally handicapped person. The major criteria give rise to a "situation of necessity". In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical order. They can only be considered once the major criteria have created a "situation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, where efficient contraception is the end and irreversible sterilisation is the means.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article(787K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

 
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 Sterilisationofincompetentmentally handicapped persons: a model for decision

making

JokePM Denekens,HermanNysandHugoStuerUniversityofAntwerp,UniversityofLeuvenandUniversity ofAntwerp,Belgiumrespectively

entifichypothesisthatalformsofmentalretarda- tionwerehereditary.'

Inthefirstpartofthiscenturyeugenicsterilisa- tionstookplaceinmany countries,aloverthe world.

Applebaum wrote about the United States of America:

Inthisarticleamodelfordecisionmakingis

proposed,basedonareviewoftheliteratureandour

own researchdata. We have attemptedtoselectand

clasifycertainfactorswhichcouldenableustoarrive geography.By1935,backedupbyBuckvBell atanethicalyjustifiablemethodofmakinga decrying 'three generations of imbeciles' as medicaldecision. enough, 30 states had passed sterilisation laws,

Indoingsowedistinguishtwomajorcriteria: hopingtoimprovethepopulationasawhole".2 heredityandparentingcompetence,andsixminor

criteria:conceptionrisk,IQ,age,personality,medical Asaresultoftheselawssome60,000personswith aspectsandprognosisandfinallysupportand mental illness and mental retardation were guidanceforthementallyhandicappedperson.The involuntarilysterilisedduringthefirstpartofthis majorcriteriagiverisetoa "situationofnecesity".

Abstract Doctorsareregularlyconfrontedwithrequestsfor sterilisationofmentallyhandicappedpeoplewho cannotgiveconsentforthemselves.Theyoughttoact inamedicalvacuum becausetheredoesn'texista consensus about a modelfor decision making on this matter.

Inthissituationthephysicianisconfrontedwitha conflictofvaluesandinterests.Theminorcriteriaare ofanentirelydiferentethicalorder.Theycanonlybe consideredoncethemajorcriteriahavecreateda

"situationofnecesity". Ultimatelyitcomesdowntodecidingwhetherthe

benefitsofsterilisationoutweighthedrawbacksand whetherthemeansareappropriatetotheend,where eficientcontraceptionistheendandireversible sterilisationisthemeans.

(7ournalofMedical Ethics 1999;25:237-241)

Keywords: Sterilisation;mentallyhandicappedpersons; decisionmaking

century.3 By 1937 225,000 people had been steri- lised in Germany.4 New understanding has progressivelyunderminedtheheredityargument.5

1.Introduction

The theme of sterilisation of the mentally

handicappediscurrentlyverymuchinthenews.

Theworldwasrecentlydismayedtolearnthat

thousandsofwomenweresterilisedinSweden modelfordecisionmakinginthisarea. between1935and1976becausetheirbehaviour By drawing on the data available in the wasregardedas"unacceptable". literature, and drawing on our own research

Thesesterilisationstookplaceinasocial data,'0wehaveattemptedtoselectandclassify context,whereitwasassumedonthebasisofsci- certainfactorswhichcouldenableustoarriveat

JournalofMedicalEthics1999;25:237-241

"Eugenicsterilisationandthelawsthatallowedits practice are not distant, either in time or

Moreovernew developmentsinspecialeduca- tion and training such as normalisation6 and mainstreaming7havebroughtaboutafundamen- tal change in how mental retardation is viewed. The Declaration on the Rights of Mentally Retarded Persons in 1971 by the United Nations Assembly, proclaims that the mentally retarded personhas,tothemaximum degreeoffeasibility, the same rights as other human beings.8

Mostmentallyhandicappedpersonsnowlivein a mixed environment. Consequently the question offertilitycontrolisincreasinglyrelevant.Moreover asuitableformofconceptioncontrolformentally handicapped people is not always easy to find.9 Doctorsareregularlyconfrontedwithrequestsfor thesterilisationofmentallyhandicappedpeople.In themedicalworldthereisnoconsensusabouta


 238 Sterilisationofincompetentmentallyhandicappedpersons:amodelfordecisionmaking

anethicallyjustifiablemethodofmedicaldecision mentalretardation.Intheothercasesitisimpos- makingwhenconfrontedwitharequestforthe sibletopinpointacause.'4

sterilisation of an incompetent mentally retarded person.

The physician must therefore determine, as far asispossible,whatthecauseofthementalretar- dation is and what is the chance that progeny could inherit the same disease.'3 Individualising everycaseisveryimportant.Itisalsoimportantto obtain a genetic opinion when prenatal diagnosis isinvolvedandtodiscusstheresultswiththepar-

2. Major criteria for the evaluation of a

request for sterilisation

Thepointsofdeparturefortheevaluationofa

request to sterilise a mentally handicapped tiesconcerned.Thereisnoreasontoconfusethis person,unabletodecideforherselforhimself,are witheugenics,assometimesoccurs. theideasof"respect"forandthe"bestinterest"of

thementallyhandicappedsubject.Theimplica- 2.2.PARENTINGCOMPETENCE tionhereisthatthementallyhandicappedperson Thedegreetowhichsomebodyisacompetent must,asfaraspossible,beinvolvedinthedecision parentcanbeseenasbeingonacontinuumrang- makingprocess."3

Insofarasthementallyhandicappedpersonis competenttogiveinformedconsent,thedecision oftheindividualshouldberespected.Whena requestforsterilisationismadebytheparentsor theguardianofthementallyhandicappedperson, thephysicianisconfrontedwithaconflictof valuesandinterests.Firstofalthephysicianhas adutytohelpthepatienttoreachfuldevelop- ment,includingpossibleparenthood,ontheother handhemaynotneglecthisdutytomakesure thatthepatienthastheabilitytoraiseandcarefor afuturechild.

Ifthere are good and sound reasons for believ- ingthatthelikelihoodofasignificanthandicapof thefuturechildisverygreatand/orthequalityof theparentalcarewouldbeminimal,aconflict arisesbetweenthesenegativefactorsandthe legallyprotectedrighttohavechildren.

Thisinturnmeansthatthehereditarynatureof thehandicapandtheparentingabilitymustbe properlydocumentedinordertoarriveatanethi- callyacceptabledecision.

Weconsiderheredityandparentingabilitytobe majorcriteriabecausetheyrelatetotheoptimisa- tionofprocreationandthepropagationoflife. The presence of one or both major criteria gives risetoasocalled"situationofnecessity".

Let us now examine these major criteria.

2.1. HEREDITY Mentalretardationcanhavevariousaetiologies, hereditaryoracquired:prenatal(singlegene defects,chromosomaldisorders,complexmalfor- mationsyndromes),perinatal(complicationsof prematurity,hypoxic-ischemicinsults,infection), and postnatal (infections, toxins such as lead, metabolicdisorders,trauma,severedeprivation andotherfactors).Inabout60%to75%ofchil- drenwithseverementalretardationandinabout 38% to 55% of children with mild mental retardationwecanestablishanaetiologyforthe

ing from 100% competent to 100% incompetent. Everyindividual,includingthenon-handicapped, canbelocatedonthiscontinuum.Somewhere alongthishorizontallinethereisatransitionfrom competenttoincompetent.

Assessing parenting competence is a dificult task,particularlywhentheassessorisrequiredto makethisassessmentwhenthepersonconcerned isstiladolescent.Anopinionbasedonathorough psychologicalandsocialstudyisdesirable.Here chartingtheindividual'sabilitytomanageonhis orherown(socialviability),usingexistingscales, may be ofsome asistance.13

As the child grows up the caring aspects of parentinggivewaytomorecomplicatedtasks.

Theconsequencemaybethatthechildrenleave theirparents'home,whichcanbehighlydisturb- ingtothementallyhandicappedparent.Inthis connection Macklin and others have formulated sixcharacteristicsforassessingparentalcompe- tence:lackofverbalskils;obtrusivedeformation ofreality;persistentmalicetowardschildren; inconsistent value system; inability to transmit essentialsurvivalinformationoramodelforlife, andfailuretoestablishandmaintaininterpersonal relationships."

3.Minor criteria Apartfromthemajorcriteria,therearesixminor criteria which should be considered during the decisionmakingprocess.Theminorcriteriaareof anentirelydifferentethicalorderfromthemajor criteria.Thesecriteriacanreallyonlybeconsid- eredoncethemajorcriteriahavecreateda"situa- tionofnecessity".Theirpurposeistohelpwith theassessmentofeveryindividualsituation.

3.1.RISKOFCONCEPTION Thefirstminorcriterionistheriskofconception. Many authors215 18212 refer to "risk of conception"asanimportantelementinthedeci- sionmakingprocess.


 Herevariousaspectsareinvolved,including alternativesinthefuture,particularlyforadoles- fertility,thepresenceofmembersoftheopposite centgirls.Alternativemethodstosterilisation sex, sexual interest and sexual knowledge. must have been tried and found unsatisfactory2'

Thefirstelementisthefertilityofthementally beforedecidingforasterilisation. handicappedindividual.Whenthereisnofertility, Itisobviousthatthesituationismuch more obviously,sterilisationisnotneeded.Anotherele- complicatedforboys/menthanforgirls/women, mentisknowingwhetherthementallyhandi- becauseofthenon-existenceofacceptable cappedpersonlivesorwillliveinamixed-sex reversiblemethodsofcontraception. environment. The expectations of the parents of

thementallyhandicappedregardingthefutureof 3.4.PERSONALITYOFTHEMENTALLYHANDICAPPED theirchildinconnectionwithmarriageand PARENT parenthoodorinconnectionwithbuildingan Theevidenceisthatchildrenbenefitwhentheir independentexistencearelikewiseimportantele- parentshavestablepersonalities.Lowself-esteem ments.Theappraisalofthefuturebyprofessional andfeelingsofinferioritymakethetaskofraising supervisorscangiveanindicationofwhetherthe childrenmoredificult.Itisalsoimportanttohave mentallyhandicappedpersonislikelytobe aconsistentsystemofvalues.Thewayinwhich supervisedthroughouthisorherlife. the parents experience and assess the external

Thethirdelementrelatestosexualinterest. worldisaguidingfactor.Behaviourmaybe Thiscanbeappraisedbyquestionssuchasthe sociallyacceptableorviolentanddestructive." following: does the mental handicapped person

havesexualrelationsoristherereasontobelieve 3.5.MEDICALASPECTSANDPROGNOSIS thatheorshewillhavesexualrelationsinthenear Medicalassessmentshoulddetermineifthereare future; does the subject have a permanent otherproblems,suchasepilepsy,depression,psy- relationshipordoesthesubjecthavefleetingrela- chiatricsymptomsorhandicapsthatinterferewith tionships;isthereinappropriatesexualbehaviour; sensoryormotorfunctionorbothsothatself-care istheresexualabuse;haspregnancyalready canbecompromised.'3Itisalsoworthfindingout occurred,andhasthesubjectalreadyundergone ifmedicinesmustberegularlytakenwhichinter- an abortion? act with contraceptive drugs2' or which would

Thefourthfactorrelatestoanysexeducation harmthefetusintheeventofpregnancy. whichthementallyhandicappedpersonmayhave A fulprognosisisalsoimportant,particularly received.Anunderstandingoftheanatomyand fortheassessmentofadolescentswhenthereisa physiologyofthereproductiveorgansandtherela- likelihoodthattheirconditionmayimprove. tionship between coitus and pregnancy is essential

ifthesubjectistobetaughtaboutcontraceptives 3.6.SUPPORTANDGUIDANCE andtheiruseeitherunaidedorwithassistance.20A Itisalsowisetofindoutiftherewillbeenough morebroadlybasedapproachcoulddiscusssexual supportandguidancefortherelationshipofthe experienceandpersonalrelationships. mentalhandicappedpersonandforanychildren.

Parents and/or family and/or those in the the 3.2. IQ immediate environment must be asked ifthey are

Theintelligencequotientisarelativecriterionand preparedtoprovidesuitablesupportandguid-

ismostcertainlynotthemostimportant.Farfrom

alsocietiesattachasmuchimportancetointeli-

gence criteria as we do. Intelligence quotient can

changeovertheyears.ArecentIQisneededas foroutsideaninstitutionandusuallybyparents.If wellasIQvaluesrecordedoverperiodoftime. thereisariskofconception,particularlyifheor This will help in assessing possible change.'3 she is promiscuous, the parents are faced with

whatisoftenanethicallydemandingissueofwhat

todoiftheresultisanunwantedpregnancy.Their Ifotherwaysofcontrollingfertilityareavailable, viewonthismattershouldbeatleastasimportant

sterilisationcanbedelayeduntiltheadolescent astherightsofthehandicapped. reaches majority, or until his or her future is

3.3. AGE

clearer.20 The presence of a partner is, for

example,asignificantdevelopmentasthecouple

maythendecidewhethertoadoptcontraceptive

measures and what these should be. Pharmaceuti-

caldevelopments,suchastheadministrationof 1.Beforeproceedingtotheassessmentofa subcutaneous gestagens, could offer attractive requestforsterilisationwithconsentgivenin

Denekens,Nys,Stuer 239

ancebothinemotionalandmaterialtermsaswell aspurelyfinancialy.'6

Oftenthementallyhandicappedpersoniscared

4.Conclusions Inconclusionwewishtoproposethefollowing sevenguidelines:


 240 Sterilisationofincompetentmentallyhandicappedpersons:amodelfordecisionmaking

thepatient'sstead,itmustfirstbedetermined theend,whereefficientcontraceptionistheend whetherthementallyhandicappedpersonis andirreversiblesterilisationisthemeans. capableofdecidingforhim orherself.Should Finallywe wishtomake itperfectlyclearwhat thisbethecase,thepatientwillbeallowedto thedifferenceisbetweenthesemedicalandethical decideandthestandardsoftheinformedcon- proposalsandanyarrangementsimposedbylaw.

Lawmakers cannot take account of the specific 2.Theevaluationonwhichthedecisiontosteri- characteristicsoftheindividualcase.Wedonot

sentprocedurewillbeapplied.

lise will be based will always be made on an

individual basis in the context of the

supporta"sterilisationlaw". Theindividualapproach,sofundamentaltothe

physician(team)/patientrelationshiponthe problemsunderconsiderationhere,islostthe basisofoneorbothmajorcriteria:istherea momentitbecomesenshrinedinlegalrules.None

hereditaryfactorand/oristherealackof thelesslegislationisneededinordertoputanend

tothelegaluncertaintysurroundingthisproblem. 3.Inviewofthemedical,psychological,social, Societalcontroloftheethicsofthemedicalaction educational,ethicalandlegalaspectsofthe takenisessential.Anylegislationshoulddeter-

decisionamultidisciplinaryapproachisessen- minetheprocedurewherebythedecisionistaken, tial. who shouldrepresentthementallyhandicapped

4.Thementallyhandicappedpersonmustbe person,whogivesconsentonhisorherbehalf, involvedinthedecisionmakingprocessasfar andfinalyitshouldofferawayofreviewingthe asthisispossible. decisionintheeventofdispute.

5.Thebestpossibleuseshouldbemadeof JokePMDenekens,MD,PhD,isProfessorinGeneral opportunities for sexual education. Practice, and Head of the Department of General 6.Thedecisionmakingprocessregardingsterili- Practice,UniversityofAntwerp,Belgium.Herman sationmustneverbeallowedtobecomeamat- Nys,ML,PhD,isProfessorinMedicalLawand ter of urgency. Co-director of the Centre of Biomedical Ethics and 7.Counsellingtheparentscancontributeto Law,UniversityofLeuven,Belgium.HugoStuer, ensuringthatthecontraceptionproblemissat- MD,isaGeneralPractitionerandAssistantinthe

isfactory resolved. A more broadly based Department of General Practice, University of approachcoulddiscusssexualexperienceand Antwerp,Belgium.Correspondenceaddress:ProfDr

parentingcapability

personalrelationships.

JfPM Denekens,UniversityofAntwerp,Department

of General Practice, Universiteitsplein 1, 2610 Wegranttheauthoritytotakethedecisiontogo Antwerpen(Wilrijk),Belgium.

ahead with sterilisation to the parent or the legal

representativeofthementallyhandicappedper- References sonafteraprocessofmultidisciplinaryconsulta- 1BourguignonHJ.Mentalretardation:therealitybehindthe

tionbetweentheparentorlegalrepresentativeand the patient's physician and his or her team. The mentallyhandicappedpersonwillasfaraspossi- ble be involved in this process. The underlying philosophyisarespectforprivatedecisionmaking in the family. There are other possibilities, but we do not discuss them here because this is not the purpose of our paper.

Partners in the multidisciplinary consultation process might include a (neuro)psychiatrist or psychologist, a special educationalist, the general practitioner, a social worker, and a specialist in a discipline such as paediatrics, genetics, internal medicine,gynaecology,urologyetc,dependingon thecaseathand.""3

The file on which the decision is based will contain a medical report, a psychological report andasocialassessment.'3172

label. Cambridge Quarterly ofHealthcare Ethics 1994;3:179-94. 2 Applebaum GM, La Puma J. Sterilization and a mentally handicapped minor: providing consent for one who cannot.

CambridgeQuarterlyofHealthcareEthics1994;3:209-15.

3 ReillyPR. Thesurgicalsolution-ahistoryofinvoluntarysteriliza- tion in the United States. Baltimore, Maryland: Johns Hopkins

UniversityPress,1991.

4 Spann W. Rechtsgrundlagen der operativen Sterilization beim

Mann undbeiderFrauinderBundesrepublikDeutschland.

Geburtzhilfe Frauenheilkunde 1975;35: 501-3.

5 GarberHL. TheMilwaukeeproject,preventingmentalretardation

in children at risk. Washington DC: American Association on

Mental Retardation, 1988.

6 Nirje B. The normalization principle and its human manage-

mentimplications.In:KugelRB,WofensburgerW,eds.Chang- ingpatternsinresidentialservicesforthementallyretarded.Wash- ington DC: President's Committee on Mental Retardation, 1969.

7 De LionSiantzML. Human valuesindeterminingthefateof persons with mental retardation. Nursing Clinics of North America 1979;14:57-67.

8 United Nations Organisation. Declaration on the rights of mentallyretardedpersons.UN GeneralAssembly2027thPlenary Meeting, 1971 Dec 20.New York:UNO, 1971.

9 Chamberlain A, Rauh J, Passer A, McGrath M, Burkit R. Issues in fertility control for mentally retarded female adolescents:I.Sexualactivity,sexualabuseandcontraception. Pediatrics1984;73:445-50.

Ultimatelyitcomesdowntodecidingwhether 10DenekensJPM.Sterilisatieenmentaalgehandicapten:wiebeslist?

(Sterilization of the mentally handicapped: who can give

the benefits of sterilisation outweigh the draw-

backs and whether the means are appropriate to 1992.

consent?)Antwerp,Belgium,academicdissertation(inDutch),


 11 Rauh JL, Dine MS, Biro FM, Rauh TD. Sterilization for the mentally retarded adolescent. Balancing the equities/the Cincinnati experience. Jrournal of Adolescent Health Care 1989;10:467-72.

12 Eser A. Contraception and abortion of mentally handicapped femaleadolescentsunderGermanlaw.MedicineandLaw 1985; 4:499-513.

13 Perrin JC, Sands CR, Tinker DE, Dominguez BC, Dingle JT, ThomasMJ.A consideredapproachtosterilizationofmentally retarded youth. American Journal of Diseases of Children

1976;130:288-290.

14 PalmerFB,CaputeAJ.Mentalretardation.PediatricsinReview

1994;15:473-9.

15 Karp LE. Sterilization of the retarded. American J7ournal of

Medical Genetics 1981; 9:1-3.

16 Nash ES, Navias M. The therapeutic sterilization of the men-

talyhandicapped.ExperiencewiththeAbortionandSteriliza- tion Act of 1975. South Africa Medical Journal 1992;82:437-9.

17 McManus R. Sterilization and the mentally handicapped person.NorthCarolinaMedicalJournal1983;44:92-3.

18 McLachlanR,PeppinP.Sexualityandcontraceptionfordevel- opmentally handicapped persons. Canadian Family Physician 1986;32:1631-7.

19 MacklinR,GaylinW,eds.Mentalretardationandsterilization.A problemofcompetencyandpaternalism.New YorkandLondon: The Hastings Center Series in Ethics, Plenum Press, 1981.

20 Vining E, Freeman J. Sterilization and the retarded female: is advocacydeprivingindividualsoftheirrights?Pediatrics1978; 62:850-3.

21 Hein K, Coupez SM, Cohen MI. Special considerations in pregnancy prevention for the mentally subnormal adolescent female. Journal ofAdolescent Health Care 1980;1:46-9.

22 Elkins TE, Gafford LS, Wilks CS, Muram D, Golden G. A model clinic approach to the reproductive health concerns of thementallyhandicapped. Obstetricsand Gynecology 1986;68: 185-8.

News and notes

European Commission: call for research proposals

TheEuropeanCommissionispublishingcalsfor proposalsforresearchintheareaofbiomedicalethics and bioethics in 1999, 2000 and 2001 under the Fifth FrameworkProgrammeforResearchandtheSpecific Programmefor"QualityofLifeandManagementof LivingResources".

Thesecallsareopentoteamswishingtopropose either research projects or concerted actions, research networksorconferences.

Thefirstcal'sclosingdateisJune1999.Asecondcal

shouldbepublishedwithaclosingdateinOctober 1999.

This cal will be covering areas such as: Ethical aspectsofscientificandtechnologicaldevelopments; Ethicalframeworkforthelifesciences;Publicpolicies, law and bioethics, and Bioethics infrastructures and methodologies.

For more details or an information pack please contactMr MaurizioSalviat:fax:32-2.299.58.88orby email:maurizio.salvi(dgl2.cec.be

Denekens,Nys,Stuer 241


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  • Bourguignon HJ. Mental retardation: the reality behind the label. Camb Q Healthc Ethics. 1994 Spring;3(2):179–194. [PubMed] []
  • Applebaum GM, La Puma J. Sterilization and a mentally handicapped minor: providing consent for one who cannot. Camb Q Healthc Ethics. 1994 Spring;3(2):209–215. [PubMed] []
  • Spann W. Rechtsgrundiagen der operativen Sterilisation beim Mann und bei der Frau in der Bundesrepublik Deutschland. Geburtshilfe Frauenheilkd. 1975 Jul;35(7):501–503.[PubMed] []
  • de Leon Siantz ML. Human values in determining the fate of persons with mental retardation. Nurs Clin North Am. 1979 Mar;14(1):57–67. [PubMed] []
  • Chamberlain A, Rauh J, Passer A, McGrath M, Burket R. Issues in fertility control for mentally retarded female adolescents: I. Sexual activity, sexual abuse, and contraception. Pediatrics. 1984 Apr;73(4):445–450. [PubMed] []
  • Rauh JL, Dine MS, Biro FM, Rauh TD. Sterilization for the mentally retarded adolescent. Balancing the equities/the Cincinnati experience. J Adolesc Health Care. 1989 Nov;10(6):467–472. [PubMed] []
  • Eser A. Contraception and abortion of mentally handicapped female adolescents under German law. Med Law. 1985;4(6):499–513. [PubMed] []
  • Perrin JC, Sands CR, Tinker DE, Dominguez BC, Dingle JT, Thomas MJ. A considered approach to sterilization of mentally retarded youth. Am J Dis Child. 1976 Mar;130(3):288–290. [PubMed] []
  • Palmer FB, Capute AJ. Mental retardation. Pediatr Rev. 1994 Dec;15(12):473–479.[PubMed] []
  • Nash ES, Navias M. The therapeutic sterilisation of the mentally handicapped. Experience with the Abortion and Sterilisation Act of 1975. S Afr Med J. 1992 Dec;82(6):437–440. [PubMed] []
  • McManus R. Sterilization and the mentally handicapped person. N C Med J. 1983 Feb;44(2):92–93. [PubMed] []
  • Vining EP, Freeman JM. Sterilization and the retarded female: is advocacy depriving individuals of their rights? Pediatrics. 1978 Nov;62(5):850–853. [PubMed] []
  • Hein K, Coupey SM, Cohen MI. Special considerations in pregnancy prevention for the mentally subnormal adolescent female. J Adolesc Health Care. 1980 Sep;1(1):46–49.[PubMed] []
  • Elkins TE, Gafford LS, Wilks CS, Muram D, Golden G. A model clinic approach to the reproductive health concerns of the mentally handicapped. Obstet Gynecol. 1986 Aug;68(2):185–188. [PubMed] []
Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group


Wikipedia

Child euthanasia in Nazi Germany

Child Euthanasia (German: Kinder-Euthanasie) was the name given to the organized killing of severely mentally and physically disabled children and young people up to 16 years old during the Nazi erain over 30 so-called special children's wards. At least 5,000 children were victims of the program, which was a precursor to the subsequent murder of children in the concentration camps.







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