Foster Cited Caution on Surgeries : Nomination: Choice for surgeon general warned in 1976 article against ‘injudicious, indiscriminate’ use of hysterectomies. He urged ‘informed consent.’

Surgeon General nominee Henry W. Foster Jr.’s 1976 medical journal article that acknowledges he performed hysterectomies on severely mentally retarded patients also warns against “injudicious and indiscriminate” use of the surgery and urges “informed consent” for patients, a relatively new medical doctrine at the time.

The tone of the article could be interpreted in a way that puts Foster somewhat ahead of mainstream medical beliefs in recognizing potential for abuse in performing hysterectomies on mentally disabled women without permission, mental health experts and others said Monday. Foster’s medical opinions appear closer to medical beliefs today, when such practices are regarded as unethical and often result in litigation, they said.

“Obstetricians and gynecologists must guard vigorously against the injudicious and indiscriminate removal of the normal uterus,” Foster wrote in the January, 1976, issue of the Southern Medical Journal. “Failure to do so will only serve to reinforce much of the hostility and suspicion currently directed toward our discipline.”

Much of that suspicion exists “because there is a failure to communicate the concept that removal of the anatomically normal uterus can be completely justifiable,” he wrote. Consequently, “efforts must be made to inform patients and uninformed critics.”

Taking those positions put Foster ahead of most physicians at the time, said Arthur Caplan, director of the center for bioethics at the University of Pennsylvania.

“He was not taking the older stance which was: Doctors can sterilize whichever incompetent people they choose without permission or apology--he said it has a limited use for a small number of women and only if you notify a guardian or parent,” Caplan said. “Was it enough? No. But he was ahead of where everyone else was at the time.”

Foster has been under attack by anti-abortion groups and other critics for his record in performing abortions. Although he first said that he had performed fewer than a dozen, he acknowledged last week that he is the doctor of record on 39 abortions since 1973.

The White House has responded by stepping up its defense of the nominee and by releasing documents that portray Foster as dedicated to improving the health of poor people. Those documents include the 1976 article that mentioned hysterectomies on the mentally retarded, a practice that White House officials conceded could raise new complaints about Foster, although there actually has been little criticism of that aspect of his career.

Monday, Vice President Al Gore, traveling in Nashville with Foster, denounced opponents of Foster’s confirmation. “We’re not going to let the extremists win,” he said.

The White House also charged that Republicans were leading the anti-Foster campaign as a pay-back for the contributions and votes of anti-abortion groups. White House Press Secretary Mike McCurry seized on reports that the National Republican Senatorial Committee, which raises money for Senate candidates, gave $175,000 to the anti-abortion National Right to Life Committee before the November, 1994, elections.

McCurry said that anti-abortion groups have “the Republican Party by the nose and they’re dragging them around.”

Despite the vigorous defense, a leading Democrat predicted that Foster’s nomination would be defeated if a vote were to occur now.

“You’d probably get almost no Republicans going for it,” said Sen. John B. Breaux (D-La.), chief deputy Democratic whip. And, he said in an interview, even among Democrats “you’d probably have some that are not going to vote for it.”

The 1976 article by Foster generally was not about performing the procedure on the mentally disabled, but about medical conditions under which an otherwise normal uterus could be removed.

The White House confirmed that Foster performed involuntary hysterectomies, but said that he had been involved in only a small number. Experts, describing the climate at the time, said that such medical procedures were routine and that laws and attitudes regarding patients’ rights--particularly those of the mentally disabled--were being widely debated and evolving during the early 1970s.

Times Washington Bureau researcher D’Jamila Salem contributed to this story.