A class lecture and exercise in ethical, legal, and emotional aspects of a societal problem

1. Substance Abuse During
Pregnancy
An Adventure into the realms of
Ethics, Bioethics, and Law
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2. Review of Relevant Definitions
• Ethics – Personal and/or professional guidelines
to help an individual decide what to do when
moral ideas conflict.
• Bioethics – Ethics that deal with health care.
• Laws – Societal standards that are published and
enforced by the government. These standards
govern people, relationships, behaviors, and
interactions with the state, society, and federal
government.
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3. Background of the Issue
According to the Guttmacher Institute of Public
Policy, U.S. policymakers have been debating the
question as to how society should deal with the
problem of women’s substance abuse during
pregnancy since the late 1980’s. At this time,
substance abuse during pregnancy is not a crime
in any state. Different states have taken
different approaches to this issue.
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4. What is the Potential Harm of Prenatal
Alcohol Abuse?
Videos:
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5. Babies Affected by Street and
Prescription drugs
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6. Five Possible Solutions
• Use criminal laws and convict pregnant substance
abusers for criminal child abuse(Whitner v. State).
• Use child welfare laws to terminate parental
rights.
• Use Mental Health statutes to commit pregnant
abusers forcibly to inpatient drug rehab
programs.
• Use public health laws and require health care
professionals to test for and report prenatal drug
exposure to use in child welfare proceedings.
• Make it a priority to provide drug treatment for
pregnant women.
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8. Breaking it Down. . .
Ethical Issues for the Pregnant Substance Abuser:
-Is there a conflict between what she
thinks is the “right” thing to do and what she
is actually doing?
-What might she be thinking?
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9. Alice
30 year-old professional woman with a “good” job
and insurance benefits. Alice had a car accident
two years ago with severe back injuries.
Unbeknownst to her physician, she developed a
chemical dependency to Oxycontin.
Alice has a “perfect life” and is aware that her daily
Oxycontin use isn’t good for her unborn baby. But
she is ashamed and doesn’t want anybody to know
about her addiction.
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10. Alice
Identify Alice’s ethical conflict(s).
Identify her legal conflict(s). Assume that Alice
lives in a state that does not criminalize prenatal
substance abuse, but fast-tracks pregnant
substance abusers to rehab programs.
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11. Darlene
Darlene is 16 years old and goes to high school.
She started on marijuana at 13 and uses cocaine
on weekends with her friends to party. About 6
weeks ago, she and her friends had a
pharmaceutical party and Darlene took many
drugs that she could not identify. She does not
remember most of that evening. Now, her
period is late and she suspects that she may be
pregnant. Darlene’s parents have a “no
tolerance” drug policy.
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12. Darlene
What are Darlene’s ethical issues?
-About the drug use
-About the pregnancy
What are Darlene’s legal issues?
-Assume that Darlene lives in Pennsylvania,
where she does not need parental consent for
birth control and pregnancy health
procedures.
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13. Darlene
Now, assume that Darlene lives in South
Carolina, where it is a crime to expose a fetus to
substance abuse in the third trimester.
What kind of thoughts may Darlene be having?
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14. Breaking it Down. . .
Ethical issues for the Health Care Providers who
know about the potential harm for the fetus and
also know that the pregnant woman is a user.
-Is there a conflict between what is the
“right” thing to do and what is permitted?
-How much intervention is “ethical”, and
how much is “legal”?
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15. Dr. Good
Dr. Good is an obstetrician and his patient is Mrs.
User. Dr. Good knows that Mrs. User has been an
active alcoholic for years because his teenage
daughter is friends with Mrs. User’s daughter and
he has heard stories.
When Dr. Good asks Mrs. User about ETOH use, she
denies any alcohol use, although the signs are
obvious that she is still drinking during her
pregnancy.
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16. Dr. Good
What ethical issues may Dr. Good have about
caring for Unborn User? What can he do to help
Unborn avoid being born with Fetal Alcohol
Syndrome?
What legal restraints may prevent Dr. Good from
saving Unborn User despite Mrs. User’s denial?
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17. Breaking it Down. . .
Ethical issues for lawmakers who have the big
picture—how many babies are born with damage
due to substance abuse during pregnancy in the
United States, costs to the taxpayer in medical care
for these people, special education, lifelong support
for people born with damage and cannot support
themselves. . .
-How much can they actually control by
creating laws, without compromising an
individual’s constitutional rights?
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18. Legal Parameters
1. The Fourth Amendment of the U.S.
Constitution prohibits unreasonable search
and seizure. Specifically, health care
providers are not permitted to test pregnant
women for drug use without the woman’s
permission. Case in Point: Ferguson v. City of
Charleston.
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19. Legal Parameters
2. According to the government-mandated
Patients Bill of Rights, health care providers may
only treat a patient for a condition (i.e.,
addiction,) with the patient’s informed consent.
So, if the patient doesn’t want her prenatal
substance abuse discovered and treated, the health
care provider may not act on the desire to help the
unborn child with Mother’s issues. In fact, to do so
would violate Mother’s constitutional right to
privacy.
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20. The Bottom Line
Because of the freedoms that are constitutionally
guaranteed in this country, lawmakers are very
limited in their ability to craft laws that intervene in
the decisions made by a prenatal substance abuser.
Therefore, health care providers are limited to the
degree in which they can legally intervene, although
they may experience ethical desires to curtail the
pregnant user’s right to decide for herself.
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21. What about Pennsylvania?
PA Cons. Statute, Title 18, Chapter 26
“Crimes Against the Unborn Child”
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22. PA C.S. 18 § 2606
AGGRAVATED ASSAULT OF UNBORN CHILD
(a) Offense – A person commits aggravated
assault of an unborn child if he attempts to
cause serious bodily injury to the unborn child
OR causes such injury knowingly or recklessly
under circumstances manifesting extreme
indifference to the life of the unborn child
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23. PA C.S. 18 § 2606
EXCEPTIONS or Nonliability
(1) Abortion procedure in which the pregnant
woman consented OR
(2) A medical procedure practiced in good faith
(example: IUD or other birth control device.)
OR
(3) Upon the pregnant woman, in regards to
crimes against her unborn child.
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24. PA C.S. 18 § 2606
(b) DEFENSES – In any prosecution pursuant to
this chapter, it shall be a defense that:
(1) the use of force that caused death or
serious bodily injury to the unborn child
would have been justified pursuant to
Chapter 5 (justifications of the use of force
in protection of self or others) if it caused
serious bodily injury or injury to mother
AND
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25. PA C.S. 18 § 2606
(2) Such force was justified by law and was used
upon or towards the Mother.
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26. “Unborn Child”
Pa C.S. 18 § 3203 – The Unborn Child is an
individual of the species Homo Sapiens from
fertilization until live birth.
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27. So, What does All That MEAN?
In Pennsylvania, it is not defined as a crime against
the unborn child for a pregnant woman to abuse
substances.
There are child welfare statutes that may result in
loss of parental rights after the birth.
It IS a crime, however, to manufacture meth around
children in Pennsylvania. PA C.S. 35 § 780-113.
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28. You’re DONE Here!
Questions. . .
Comments. . .
?
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