sou · GNB32 · 2000-01-01 00:00:00 — Utredningen kommer att till nämnden överlämna samtliga de ansök- ningar om ersättning som kommit till utredningen eller som utredning- en fått överlämnat till sig från regeringen. För att få överblick på de administrativa kostnaderna skall den före- slagna lagen endast tillämpas på ansökningar som kommit in från det lagen börjar gälla. Skulle antalet ärenden som kommer in vara stort vid slutet av är det möjligt att förlänga la- gens tillämpningstid. Det är alternativt möjligt för regeringen att även sedan lagen upphävts bevilja ersättning ex för senare ansökning- ar utifrån de kriterier utredningen angett i lagförslaget. Ett särskilt ansökningsformulär bör upprättas där alla väsentliga uppgifter skall föras in för att det skall vara enklare att ta fram äldre journalmaterial m.m. Det innefattar även uppgift om efternamn vid det tillfälle ansökan om sterilisering skedde, när och var åtgärden vidtogs samt andra uppgifter om den enskildes personliga förhållanden då som kan ge stöd för ersättning. Den som begär ersättning kan själv begära in äldre arkivmaterial. Den handläggande organisationen bör också var behjälplig med det. Överhuvudtaget bör nämnden ha en långtgående service- och under- sökningsskyldighet i syfte att hjälpa enskilda sökande. Den ersättning utredningen föreslår är avsedd att vara en personlig upprättelse för den enskilde. Det medför att anhöriga inte skall kunna ansöka om ersättning för den som redan avlidit. Om någon avlider in- nan nämnden fattat beslut i ärendet skall inte heller ersättning utgå med hänsyn till ersättningens personliga karaktär. Utredningen föreslår att den som är berättigad till ersättning enligt de kriterier utredningen satt upp i lagförslaget skall få en ersättning med . Utredningen har cirka 200 ärenden som med säkerhet kommer att prövas. Av dessa uppskattar utredningen att huvuddelen också efter kompletteringar av underlagsmaterial kommer att kunna beviljas ersättning. Det innebär en kostnad för ersättningar på . Hur många som därutöver kommer att begära ersättning är mycket svårt att nu uppskatta. Men efter att utredning- ens förslag offentliggjorts och regering och riksdag behandlat frågan kommer det på ett säkrare sätt vara möjligt att uppskatta hur många som totalt kommer att begära ersättning. Utredningen föreslår därför att det i tilläggsbudgeten avsätts tillräckliga medel för att med marginal täcka ersättningen till dem som redan nu ansökt men att man sedan avvaktar utvecklingen innan ytterli- gare medel avsätts. Kostnaderna för den administrativa hanteringen av ersättningsfrågan dvs. PSR:s handläggningskostnader och kostnader för nämnden bör kunna stanna på knappt en och . När kan lagstiftningen träda i kraft? Det är självfallet mycket angeläget att de som steriliserats mot sin vilja eller på någon annans initiativ får ersättning så fort som möjligt. Med hänsyn till att utredningen föreslår en särskild lag om ersättning gör re- geringskansliets och beslutsprocesser att lagen av tidsskäl inte kan träda i kraft tidigare än . Den nämnd utredning- en föreslår skall besluta om ersättning kan därför inte börja arbeta före detta datum. Däremot bör det vara möjligt för PSR att redan tidigare förbereda de ärenden som redan kommit in till utred- ningen. Utredningen kommer under hand att på alla sätt hjälpa till med dessa förberedelser så att ersättningsfrågan kan lösas snabbt efter riks- dagens beslut. Det ingår i utredningens uppdrag att ta ställning till vissa kommittédi- rektiv som gäller alla utredningar. Det gäller prövning av offentliga åtaganden, regionalpolitiska konsekvenser, jämställdhetspolitiska kon- sekvenser samt effekterna för det brottsförebyggande arbetet. Enligt direktivet om prövning av offentliga åtaganden skall utred- ningen förutsättningslöst pröva om det offentliga åtagande som utred- ningen är satt att utreda bör vara en offentlig angelägenhet samt om så är fallet och förslaget innebär kostnadsökningar föreslå en finansiering. Om utredningen skulle följa direktivet om offentliga åtaganden skulle konkreta förslag till effektiviseringar, omprioriteringar eller be- sparingar inom samma politikerområde lämnas motsvarande de kostna- der som ersättningen till de steriliserade skulle innebära, dvs. inom so- cialdepartementets område och då främst inom hälso- och sjukvården och det medicinsk-etiska området. Enligt utredningens uppfattning är det varken rimligt att utredningen nu eller regering och riksdag senare när det slutliga beslutet tas föreslår besparingar inom t.ex. hälso- och sjukvården för att finansiera en gott- görelse till dem som steriliserats mot sin vilja. Det skulle vara stötande att på sådant sätt ställa de steriliserade mot andra utsatta grupper eller verksamheter. Utredningen avstår därför från att föreslå någon konkret finansiering utan föreslår istället att kostnaderna får tas från ett gene- rellt ekonomiskt utrymme. Om ett sådant ekonomiskt utrymme saknas får besparingar göras generellt i budgeten. Utredningen ser inga direkta regionalpolitiska konsekvenser av ut- redningens förslag. Inte heller har de - i generella termer - några effek- ter på det brottsförebyggande arbetet. Det är tydligt att steriliseringsfrågan som sådan är en i stora delar könsrelaterad fråga. av de steriliserade var kvinnor. Vad gäller jämställdhetspolitiska konsekvenser innebär utredningens ersättningsförslag att samma belopp ges till alla, oberoende av kön. Ut- redningen kommer i den historiska analysen bl.a. ta upp de könsrelate- rade aspekterna på steriliseringspolitiken. Utredningens slutbetänkande beräknas vara klart . I det kommer även utred- ningens kartläggning att presenteras. The terms of reference The assignment can be divided into three parts. Firstly, the investigator shall clarify the history of the deliberations underlying the formulation of the 1934 and 1941 Sterilization Acts. This part involves elucidating how the Acts were implemented and presenting and analysing the debate which may have been conducted in (the parliament), within the political parties, by the research community or otherwise during the years in which the Acts were in force and until they were finally repealed. Another prime concern has been to shed comprehensive light on the standpoints and responsibilities of the political decision-makers, public authorities, the research community and the profession. This also includes placing how the Acts came into existence, their implementation and the reasons for their ultimate repeal in their historical context and illuminating conditions in in an international perspective. Secondly, the investigator is to show how many persons were sterilised under the Acts and with reference to the various indications, which those persons were and how their lives were affected. This includes giving an account of the number of sterilizations which were performed following application by a third party. The investigator is also to indicate any changes occurring in the implementation of the Acts while they were in force and the underlying causes of such changes. Thirdly, the investigator is to put forward proposals concerning compensation for those persons who were sterilised against their own will or at the initiative of a third party, with regard to the principles to apply to such compensation and concerning the in which handling procedure and decisions in compensation questions are to be organised. The investigator shall cost the proposals put forward. The remit does not include the making of decisions in individual cases. The investigator shall present a final report not later than 1st, 1999. The proposals regarding compensation for the persons affected and concerning related questions shall, in with the terms of reference, have priority of presentation. That present report deals with this part. "ACKGROUND AND PURPOSE OF THE TERMS OF REFERENCE IN THE MATTER OF COMPENSATION The terms of reference for the investigation set out the Governments basic reasons for the remit. They state partly as follows. Up until 1976, a large number of people were sterilized in under the authority of the sterilizations laws in force at the time. The formulation of those laws and the of their practical application were partly characterised by a racial hygiene perspective and a belief in eugenics which were prevalent among many policy-makers, researchers and physicians during the first half of the 20th century in , as in other countries. Many of the people who were sterilised fell victim to this belief, since long firmly rejected by the Swedish society. (-----)It is of great importance that the persons who at that time were sterilised against their own will or on the initiative of a third party should receive compensation, even though the State is under no formal obligation to pay compensation. Proposals should be put forward with regard to compensation for the persons affected and the principles to apply to such compensation and the way in which handling procedures and decision-making in matters of compensation are to be organised. It is the view of the investigator that the financial compensation or remedy is intended as an attempt by the State to make good the measures and decisions which have affected individual persons in the past and which today, to paraphrase the terms of reference, are firmly rejected. Based on the terms of reference the investigator has not seen it as a part of the mandate to include any closer consideration of possible reasons for or against introducing compensation of the kind now contemplated, or of the justifiability of special treatment in this respect for sterilised persons rather than other groups of injured parties, such as lobotomy patients. The task of presenting a survey and a historical account can above all be said to have the purposes of providing supportive documentation for a discussion concerning the values of the Society and State actions during the years when the Sterilization Acts were in force including a discussion about our values today. The charge of proposing compensation for sterilised persons presents a more concrete task, namely that of indicating the and amount of compensation to be paid by the State for injuries and suffering caused in the past to sterilised persons as a result of decisions and measures which we today consider wrong. The investigators proposals, taken as a whole, can perhaps also furnish some basis for a debate concerning other subjects closely related to the sterilization issue, above all in the perspective of moral philosophy. From that perspective it would have been more appropriate if the various parts of the report could have been completed and published simultaneously. At the same time, the investigator fully appreciates the Governments wish for priority to be given to the compensation question. With few exceptions, the persons who may be eligible for compensation are now of advanced age, which makes it essential that any financial compensation should be extended to them as soon as possible. This report, consequently, framed in relatively juridical and technical terms. It does not address the political, ethical and historical aspects which the investigator has also been asked to consider. The historical sections of this report are based exclusively on previously published research, except where otherwise indicated. Many readers may perhaps find it remarkable that analyses of the kind mentioned above, as well as conclusions and value judgements concerning the implementation of the Sterilization Acts in a broader perspective, are to a great extent lacking in the present report. The investigator is well aware of this and want to stress that the final report will contain research findings and analyses, both on the Swedish and the international situation, which, it is hoped, will shed deeper light on Swedish sterilization policy, so that, on the basis of that material, the past will be made to yield up experience of value for the future. The Sterilization Acts and their implementation In this report the investigator describes, very briefly, the background to the passing of the 1934 and 1941 Sterilization Acts. Concerning the legal, political and scientific discussion underlying the legislation, and also the general public debate on the matter, the investigator refers to the official government reports preceding the legislation, to earlier research on these subjects and to the investigators forthcoming final report. The 1934 Sterilization Act (THE !CT OF -AY TH ON STERILIZATION OF CERTAIN MENTALLY ILL MENTALLY RETARDED OR OTHERWISE MENTALLY INCAPACITATED PERSONS) had, as the title implies, a limited range of application. applied solely to certain - legally incompetent - persons who were incapable of giving consent to sterilization. In other words, the Act made it possible to sterilise persons who were considered to have no insight into or understanding of the meaning of sterilization. In order to avoid misunderstandings the investigator uses the terms and concepts appearing in the contemporary text, e.g. sinnesslö (mentally retarded och feebleminded) which today has no scientific meaning and has a strong negative value. Thus nobody sterilised under the 1934 Act had personally applied for or consented to sterilization. The Act did NOT deal with sterilization at the request of or with the consent of the individual concerned, either as with regard to sterilization of healthy individuals or mentally retarded or other persons who understood the implications of the operation. The standpoint adopted by the legislature at this time was that sterilization of such individuals at their own request or by their own consent was permissible without specific legal authority. This applies, initially, to sterilization on medico- therapeutic grounds, which was considered permissible to the same extent as other treatment. Otherwise sterilization was considered permissible if performed with the consent of the individual concerned and if justified by what at the time were described as good causes of a eugenic, social, humanitarian or penal nature. On the other hand, legislation was considered necessary in order for sterilization to be permissible in the case of a person who was incapable of giving such consent. This was ONE reason for the legislation. Sterilization using physical coercion was not permitted at all. An inquiry into the conditions on which voluntary sterilization of legally competent persons could be performed was already requested at the passing of the 1934 Act. The remit was entrusted to the previously appointed Population Commission, whose recommendations, presented in 1936, formed the principal basis of the 1941 Act. The 3TERILIZATION !CT governed, in principle, all sterilization procedure not having a purely medico-therapeutic purpose, i.e. including sterilization at the request of the person concerned. The basic principle adopted was that sterilization could not be performed without permission from . The principal rule of the Act was that sterilization could only take place after the individual concerned had applied for it or, if the application was made by somebody else, had consented to it in writing. Thus, according to the preparatory works, the Act was based on the principle of voluntary consent. Sterilization was possible on several grounds - indications, viz. eugenic, social or . The eugenic indication (also race-hygiene) implied that sterilization could take place if there is reason to assume that a person will transfer hereditary characteristic such as mental illness or mental retardation, other severe illnesses or severe defects to their children. The social indication meant that sterilization could take place if a person by reason of mental illness, mental retardation or other mental impairment or because of an antisocial way of life was clearly unsuitable to have custody of children in the future. The indication meant that a woman suffering from illness, physical defect or weakness could be sterilised in order to prevent a pregnancy that would seriously endanger her life or her health. The eugenic and social indication was applicable to both men and women, while the indication, as has already been made clear, only applied to women. Under Section 2, a person who, by reason of mental disorder, was incapable of giving valid consent could nevertheless be sterilised if the conditions laid down in Section 1 were satisfied. As stated in the 1934 Act, the preparatory works of the 1941 Act excluded the use of physical coercion. On the other hand there was no declared restriction of verbal persuasion or pressure. Influence of this kind, especially from the institutional staff, was on the contrary encouraged in the directions issued by . About 63 000 persons were sterilised in while the 1934 and 1941 Sterilization Acts were in force, i.e. between 1935 and 1975. To the best of the investigators understanding, many of these sterilizations were genuinely voluntary. This is shown in important post- examinations and follow up studies performed at the end of the 1950s and the beginning of the 1960s. According to those studies performed 5-10 years after the operation, nearly 80 per cent of the patients were perfectly satisfied with their sterilization and did not regret it. The negative reactions mainly occurred among women who in connection with the operation had been subjected to coercion or very strong persuasion or among women who had no children. On the whole, the material indicates that particularly in the 1960´s and 1970´s most of the sterilizations based on consent seem to have been genuinely voluntary; however, no certain statements on this matter can be made at this stage of the investigation. The fact that many persons underwent perfectly voluntary sterilization under the 1941 Sterilization Act, at least during the last 10 or 15 years when it was in force, is, in the investigators view, supported by the fact that many people opted for sterilization when the present legislation began to be applied. Between the mid-1950s and 1975, for example, an average of between 1,500 and 1,800 persons were sterilised annually, nearly all of them women and for reasons. During the first ten years of the present Sterilization Act, nearly 8,000 persons, of them men, were sterilised annually. Between 1976 and 1996, a total of 166,000 persons were sterilised in , 40,000 of them men. This can be compared with the 63,000 or so sterilizations performed under the earlier legislation between 1935 and 1975, more than 90 per cent of them on women. The present legislation, which came into force in 1976, is based entirely on voluntary consent and does not as a rule require the sanction of any public authority. The one prerequisite for sterilization is that the person concerned must be over and that the individual must have been carefully informed of the implications and consequences of the operation and, where relevant, of other possibilities of avoid pregnancy. Sterilization of persons between the ages of 18 and 25, on the other hand, is subject to permission being granted by . Although the 1941 Act in principle was based on voluntary consent, the investigator has been able to establish that many sterilizations in reality were performed against the will of the individual. Here follows are examples of sterilizations which were performed after the individual concerned having signed the application or consented to it, but where it can be questioned if they were in fact voluntary. (1)In several cases, sterilization was made a strict condition for discharge from penal and other institutions, but also for the award of benefits during institutional . That procedure was strongly criticised in the annual report of the Parliamentary Commission for the Judiciary and the (ombudsman) as early as 1947. (2)The legislation also applied to minors and to legally incompetent persons. The majority age was 21 until 1969. Between 1969 and 1973 it was 20. Since 1974 it has been 18. The preparatory work of the 1941 Act stated that it was not necessary to define a minimum age limit for sterilization. Instead the Minister took it for granted that, even without such a provision, an examining authority should take the necessary consideration with regard to the age of the person in question. The Minister also recognized a guarantee against abusers in the fact that a minor as a rule could not be sterilised unless the person having custody of him had been given the opportunity of a hearing. Sterilization, however, was not made subject to a custodians consent. Moreover, according to the directions issued by , the person whom a request for sterilization was applicable to was always authorized to sign it personally, regardless of age and legal capacity. Moreover, many of the persons who were sterilised while in penal or other institutions were minors or legal incapacitated. have shown that several sterilizations were performed against custodians wishes. (3)One relatively common ground for sterilization, at least until the 1950s, was a person being classed by a physician as mentally retarded. In that case, sterilization could be performed on both eugenic and social grounds, subject to other prerequisites being satisfied. Mental retardation, at the same time, was a diffuse term, which also was applied to other problems of a social character and often appears to have been used in a routine and on the basis of very limited and dubious documentation. (4)Through a special provision of the 1938 Abortion Act, the latter was interlinked with the Sterilization Act. The provision laid down that a pregnancy could not be terminated on eugenic grounds without the woman being sterilised at the same time. In practice, there where cases of sterilization being made a precondition for abortion in other situations as well. (5)Under provisions of the 1920 Marriage Code, persons who suffered from epilepsy and mental illness or who were mentally retarded were disqualified from marrying. Exemptions could be granted in certain cases. Sterilization could be a prerequisite for permission to marry. The provisions concerning disqualification from marriage were repealed for epileptics in 1969 and for the mentally retarded and mentally ill in 1973. (6)Sometimes sterilization was also made a condition for the receipt of certain national benefits. Thus during the 1940s at least, maternity assistance, a needs-tested allowance preceding child allowance, was in certain cases granted only if the woman would agree to sterilization. The investigators conclusions and proposals The investigator has been instructed to propose compensation for those who were sterilised against their will or at the initiative of a third party. As previous sections of this report have shown, the 1941 Sterilization Act was, formally speaking, based on voluntary consent and on the individual concerned applying for or consenting in writing to sterilization. So far the investigators inquiry shows that over of applications for sterilization were actually signed by the individual concerned. The great majority of the persons who have hitherto requested compensation have also stated that, one way or another, they signed an application for sterilization. Thus one cannot automatically infer, from the signature on the sterilization application, whether an individual person was sterilised against his or her will. 0ERSONS STERILISED UNDER THE !CT ETC In the case of persons sterilised under the 1934 Act, a different situation applies. The reason why they were sterilised under that Act was that they where considered to have no insight into the implications of consent or of the implications of sterilization and, accordingly, were incapable of consenting to sterilization. The same applies to those who were sterilised under the corresponding provision (Section 2) of the 1941 Act.