STERILIZATION OFFER TO ADDICTS REOPENS ETHICS ISSUE

A flier hanging on a pole in Brooklyn looks, at first glance, as if it
might offer a room for rent or a job. There are phone numbers, dollar signs
and tabs for people to tear off and take with them.

But the offer is intended for a specific group: drug-addicted men and
women. "Get birth control, get cash," the flier reads. "If you are addicted
to drugs and/or alcohol then this offer is for you."

While offers of birth control to drug addicts are common - distribution of
condoms in particular, as a means not only for birth control but also to
stem the spread of AIDS - this offer is much more radical. It offers men
and women $200 to be sterilized or put on long-term birth control.

The group making the offer, Children Requiring a Caring Kommunity, or
Crack, contends that the program is a humane effort to keep children from
being born to women ill-equipped to raise them. Critics counter that it is
little more than a bribe to women to make an irreversible decision, and
argue that counseling is the best method for both ending drug use and
promoting responsible parenthood.

So far, the presence of the group in New York is minimal; it is based in
California, and its only chapter here consists of a 27-year-old office
worker from Brooklyn, who with the help of her husband and another
volunteer has posted fliers across the city and held meetings with
hospitals and community groups. But if Crack's reception in other cities is
any indication, there is likely to be heated debate about the efficacy and
the ethics of its offer.

Brookdale University Hospital and Medical Center in Brooklyn has plans to
refer patients recovering in the psychiatric emergency room to Crack,
officials there said. The director of chemical dependency services at
Lutheran Medical Center in Brooklyn said he was reviewing the program.

Dr. Attilio Rizzo Jr., a social worker in Brookdale's psychiatric emergency
room, said that the program was "a godsend" and that he had already
referred one woman, who did not respond to his offer. "A lot of them are
homeless and have H.I.V. and are on drugs and they don't want to have any
more babies," Dr. Rizzo said. "I believe it's up to the individual to make
that decision."

"The program is fundamentally incompatible with a health care policy that
respects a woman's right to choose," said Donna Lieberman, executive
director of the New York Civil Liberties Union. "It certainly raises policy
concerns for government entities to be providing referrals to this program
or endorsing it in any way."

The organization was started in Orange County, Calif., in 1997 by Barbara
Harris, a housewife and former waitress, after she adopted four children
from the same drug-addicted mother. Children born to drug addicts regularly
suffer emotional scars and medical disabilities and end up in foster care
at taxpayers' expense, she said.

"It's common sense," she said. "Why should a drug or alcohol addict get
pregnant? I watched how my children suffered when I brought them home from
the hospital, and no child should go through that."

Critics, however, say that Crack's stance is aimed not at helping children
but at selective breeding. They point to comments like those Mrs. Harris
made in 1998, when she was quoted in the British edition of Marie Claire
magazine saying: "We don't allow dogs to breed. We spay them. We neuter
them. We try to keep them from having unwanted puppies, and yet these women
are literally having litters of children." The organization has softened
its message, and now refers to itself as Project Prevention as often as it
calls itself Crack.

But opponents say Crack's $200 offer misses the real issue, which is
helping people get treatment for their addiction.

"What she's doing is suggesting there are certain neighborhoods where it is
dangerous for some people to be reproducing," said Lynn Paltrow, executive
director of National Advocates for Pregnant Women. "It suggests they are
not worthy of reproducing. It is very much like the eugenics history in
America. The Nazis said if you just sterilized the sick people and Jews you
would improve the economy."

When it first started, Crack offered payments on a sliding scale, giving
more money to women who chose tubal ligations and men who chose vasectomies
than to those who chose long-term birth control like intrauterine devices,
Norplant or Depo-Provera.

But the criticism was so harsh that the group changed its policy and began
offering a flat payment of $200. Women submit such documents as an arrest
report or doctor's letter to prove they use drugs. They have the procedure
done, usually paid for with government assistance, and then they send Crack
written proof.