Chronicles of communication and power: informed consent to sterilisation in the Namibian Supreme Court’s LM judgment of 2015
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The 2015 judgment of the Namibia Supreme Court in Government of the Republic of Namibia v LM and Others set an important precedent on informed consent in a case involving the coercive sterilisation of HIV-positive women. This article analyses the reasoning and factual narratives of the judgment by applying Neil Manson and Onora O’Neill’s approach to informed consent as a communicative process. This is done in an effort to understand the practical import of the judgment in the particular context of resource constrained public healthcare facilities through which many women in southern Africa access reproductive healthcare. While the judgment affirms certain established tenets in informed consent to surgical procedures, aspects of the reasoning in context demand more particularised applications of what it means for a patient to have capacity and to be informed, and to appropriately accommodate the disruptive role of power dynamics in the communicative process.
KeywordsInformed consent Sterilisation HIV/AIDS Human rights Namibia Southern Africa
Compliance with ethical standards
Conflict of interest
One of the authors of this study was involved in the litigation at the Namibian Supreme Court in support of the three respondents.
- 1.Government of the Republic of Namibia v LM and Others  NASC 19. http://www.saflii.org/na/cases/NASC/2014/19.html. Accessed 1 March 2017.
- 2.International Community of Women Living with HIV. 2015. Forced and coerced sterilization of women living with HIV. Issue Paper 3. http://www.iamicw.org/resources/document-library/forced-and-coerced-sterilization-of-women-living-with-hiv. Accessed 22 Feb 2016.
- 3.Lombard, Anna-Marie. 2010. South-Africa: HIV-positive women sterilised against their will. City Press, June 7. http://www.southernafricalitigationcentre.org/2010/06/07/south-africa-hiv-positive-women-sterilised-against-their-will/. Accessed 22 Feb 2016.
- 4.Zaynab, Essack, and Ann Strode. 2012. ‘I feel like half a woman all the time’: The impacts of coerced and forced sterilisations on HIV-positive women in South Africa. Agenda: Empowering Women for Gender Equity 26 (2): 24–34.Google Scholar
- 6.Washington, Laura, and Vicci Tallis. 2012. Sexual and reproductive health and rights: A useful discourse for feminist analysis and activism? BUWA: Sex and Health 2 (1): 6–10.Google Scholar
- 7.Global Commission on HIV and the Law. 2012. HIV and the law: Risks, rights & health. http://www.hivlawcommission.org/index.php/report. Accessed 22 Feb 2016.
- 8.African Commission on Human and Peoples’ Rights. 2013. Resolution on involuntary sterilisation and the protection of human rights in access to HIV services. Resolution taken at the 54th Ordinary Session, November 5. http://www.achpr.org/sessions/54th/resolutions/260/. Accessed 22 Feb 2016.
- 10.LM and Others v Government of the Republic of Namibia (I 1603/2008, I 3518/2008, I 3007/2008)  NAHC 211. http://www.saflii.org/na/cases/NAHC/2012/211.html. Accessed 1 March 2017.
- 11.Van der Walt, J.C., and J.R. Midgley. 2005. Principles of delict. 3rd ed. LexisNexis: Cape Town.Google Scholar
- 12.Castell v De Greef 1994 (4) SA 408.Google Scholar
- 13.Stoffberg v Elliot 1923 CPD 148.Google Scholar
- 14.Esterhuizen v Administrator, Transvaal 1957 (3) SA 710 (T).Google Scholar
- 15.Pandie v Isaacs  ZAWCHC 123.Google Scholar
- 16.Republic of South Africa. Sterilisation Act 44 of 1998.Google Scholar
- 17.Lillicrap, Wassenaar and Partners v Pilkington Brother (SA) (Pty) Ltd. 1985 (1) SA 475 (A).Google Scholar
- 18.Van Wyk v Lewis 1924 AD 438.Google Scholar
- 19.Administrator, Natal v Edouard  ZASCA 60; 1990 (3) SA 581 (A).Google Scholar
- 20.Stadsraad van Pretoria v Pretoria Pools 1990 (1) SA 1005 (T).Google Scholar
- 21.Lindegger, G., and L. Richter. 2000. HIV vaccine trials: Critical issues in informed consent. South African Journal of Science 96: 313–317.Google Scholar
- 23.Waring and Gillow Ltd v Sherborne 1904 TS 340.Google Scholar
- 25.Southern Africa Litigation Centre. 2015. Submission to the Human Rights Committee regarding the forced and coerced sterilisation of women living with HIV/AIDS in Namibia. http://www.southernafricalitigationcentre.org/1/wp-content/uploads/2015/04/Submission-to-the-Human-Rights-Committee-on-NAMIBIA.pdf. Accessed 22 Feb 2016.
- 27.Pace, Eric. 1997. P.G. Gebhard, 69, developer of the term ‘informed consent’. New York Times, August 26. http://www.nytimes.com/1997/08/26/us/p-g-gebhard-69-developer-of-the-term-informed-consent.html. Accessed 21 Sept 2015.
- 28.Salgo v Leland Stanfor d etc. Bd. Trustees, 154 Cal.App.2d 560 [Civ. No. 17045. First Dist., Div. One. Oct. 22, 1957].Google Scholar
- 30.Veriava, F. 2004. Ought the notion of ‘informed consent’ to be cast in stone? VRM v the Health Professions Council of South Africa. South African Journal on Human Rights 20 (2): 309–320.Google Scholar
- 31.Health Professions Councils of Namibia. 2010. Ethical guidelines for health professionals. http://www.hpcna.com/images/councils-images/Ethical%20Document%20-%20Final%20Draft%201.pdf. Accessed 21 Oct 2010.
- 32.Bolam v Friern Hospital Committee  1 WLR 583.Google Scholar
- 33.Sidaway v Governors of the Bethlehem Royal Hospital  1 All ER 643 (HL).Google Scholar
- 34.Rodgers v Whitaker (1993) 67 ALJR 47.Google Scholar
- 35.Reibl v Hughes (1980) 114 DLR (3d) 1.Google Scholar
- 39.Patel, Priti. 2008. How did we get here and where to now? The coerced sterilisation of HIV-positive women in Namibia. Agenda Empowering Women for Gender Equity 75: 38–44.Google Scholar