“It was shocking to learn about the doctors' lack of knowledge during the interviews for the documentary. There was not enough awareness on their part of the legal and ethical issues,” journalist Ramona Arzberger from andererseits explained to us.

In Austria and Germany, forced sterilisation is officially prohibited under national law and is supposed to depend on the informed and self-determined consent of the individual. Guardians or legal representatives can support the person, not decide for them. In reality, however, this creates a legal grey zone.

Sterilisation decisions often depend on whether doctors consider a person capable of giving informed consent, meaning that they understand the procedure and its consequences. Even people under legal guardianship can decide on sterilisation themselves if they are deemed capable of making an informed decision.

But disability rights experts argue these assessments are highly sensitive and can be shaped by how information is presented to patients. Women with learning difficulties, for example, may be pushed towards sterilisation through one-sided counselling that focuses heavily on the difficulties of pregnancy and parenthood.

Under Austrian law, if a person is considered capable, their choice can't be overriden. But if a person is considered incapable, sterilisation requires court approval and expert assessments.

Since 2018, this must come from an independent advocacy organisation. In the seven years since, VertretungsNetz has only been appointed in eleven sterilisation proceedings. “I find it very hard to believe that these are the only cases,” Marlovits said. “I think it points to a bigger number of unreported cases.”

“I strongly believe that many people with learning difficulties can be supported in a way that enables them to make their own decisions”, Martin Marlovits, legal expert at VertretungsNetz, an Austrian advocacy organisation, said.

Even if a procedure is carried out without legally valid consent, people with disabilities rarely pursue legal action themselves. Meanwhile legal guardians or family members may have supported the intervention in the first place – making accountability difficult in practice.

When healthcare professionals already assume that a person is incapable of making decisions, accessible communication and genuine consultation become even less likely.

“People with Down syndrome are often immediately underestimated because they seem different,” Marlovits said. “There is a huge gap between what people are actually capable of and what society assumes they are capable of.”

The same stigma carries through their personal lives. Both Arzberger and Marlovits point to deeply paternalistic assumptions about disability and parenthood. Especially, that people with disabilities are inherently unable to care for children, combined with widespread misunderstandings among medical professionals about the legal rights of disabled patients.

Arzberger argues that the focus should shift away from questioning whether disabled people are capable of deciding at all. “The focus should be on removing the barriers faced by people with disabilities so that they can make their own decisions – instead of imposing decisions on them.”