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Substance Abuse During Pregnancy

An Adventure into the realms of Ethics, Bioethics, and Law

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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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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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What is the Potential Harm of Prenatal Alcohol Abuse?

Videos:

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Babies Affected by Street and Prescription drugs

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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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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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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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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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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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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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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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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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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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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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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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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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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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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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What about Pennsylvania?

PA Cons. Statute, Title 18, Chapter 26“Crimes Against the Unborn Child”

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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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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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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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PA C.S. 18 § 2606

(2) Such force was justified by law and was used upon or towards the Mother.

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“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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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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You’re DONE Here!

Questions. . .

Comments. . .

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