The foregoing discussion was intended as a review of the pertinent literature of involuntary sterilization. It is by no means all-inclusive (the number of cases precludes an exhaustive compendium) but does include those cases that, in the authors' opinion, are most representative of the contemporary attitude of the courts. The discussion has been confined primarily to the legal aspects of involuntary sterilization. We have omitted any substantial discussion of the moral and ethical aspects of this complex topic but acknowledge the intimate role these issues may play in any decision to undertake involuntary sterilization. As outlined, the presence or absence of statutory guidelines mandates in part the legal channels to be pursued. In the presence of statutes for involuntary sterilization, strict adherence to the specified requirements provides the optimal means of protecting the legal interests of all involved parties. In the absence of statutory guidelines, extreme caution must be exercised. In these circumstances, a validly executed court order observing procedural due process should provide optimal protection of patient and physician interests. The decisions of New Jersey and Alaska courts represent one potential method of securing a consent by use of the parens patriae doctrine. Recent notable efforts at a state level to dispense with lengthy hearings and implement committee review have been encouraging and await further trials to determine their ultimate role in authorizing sterilization of mental incompetents. Given the current legal climate and available avenues, parental substituted consent without adequate hearing and due process should not be considered a fulfillment of legal responsibilities.