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Substance Abuse During      PregnancyAn Adventure into the realms of   Ethics, Bioethics, and Law                         ...
Review of Relevant Definitions• Ethics – Personal and/or professional guidelines  to help an individual decide what to do ...
Background of the IssueAccording to the Guttmacher Institute of PublicPolicy, U.S. policymakers have been debating theques...
What is the Potential Harm of Prenatal           Alcohol Abuse?Videos:                                     4
Babies Affected by Street and     Prescription drugs                                5
Five Possible Solutions• Use criminal laws and convict pregnant substance  abusers for criminal child abuse(Whitner v. Sta...
7
Breaking it Down. . .Ethical Issues for the Pregnant Substance Abuser:      -Is there a conflict between what she      thi...
Alice30 year-old professional woman with a “good” joband insurance benefits. Alice had a car accidenttwo years ago with se...
AliceIdentify Alice’s ethical conflict(s).Identify her legal conflict(s). Assume that Alicelives in a state that does not ...
DarleneDarlene is 16 years old and goes to high school.She started on marijuana at 13 and uses cocaineon weekends with her...
DarleneWhat are Darlene’s ethical issues?     -About the drug use     -About the pregnancyWhat are Darlene’s legal issues?...
DarleneNow, assume that Darlene lives in SouthCarolina, where it is a crime to expose a fetus tosubstance abuse in the thi...
Breaking it Down. . .Ethical issues for the Health Care Providers whoknow about the potential harm for the fetus andalso k...
Dr. GoodDr. Good is an obstetrician and his patient is Mrs.User. Dr. Good knows that Mrs. User has been anactive alcoholic...
Dr. GoodWhat ethical issues may Dr. Good have aboutcaring for Unborn User? What can he do to helpUnborn avoid being born w...
Breaking it Down. . .Ethical issues for lawmakers who have the bigpicture—how many babies are born with damagedue to subst...
Legal Parameters1. The Fourth Amendment of the U.S.   Constitution prohibits unreasonable search   and seizure. Specifical...
Legal Parameters2. According to the government-mandated    Patients Bill of Rights, health care providers may    only trea...
The Bottom LineBecause of the freedoms that are constitutionallyguaranteed in this country, lawmakers are verylimited in t...
What about Pennsylvania?PA Cons. Statute, Title 18, Chapter 26 “Crimes Against the Unborn Child”                          ...
PA C.S. 18 § 2606AGGRAVATED ASSAULT OF UNBORN CHILD(a) Offense – A person commits aggravatedassault of an unborn child if ...
PA C.S. 18 § 2606           EXCEPTIONS or Nonliability(1) Abortion procedure in which the pregnant    woman consented OR(2...
PA C.S. 18 § 2606(b) DEFENSES – In any prosecution pursuant tothis chapter, it shall be a defense that:      (1) the use o...
PA C.S. 18 § 2606(2) Such force was justified by law and was usedupon or towards the Mother.                              ...
“Unborn Child”Pa C.S. 18 § 3203 – The Unborn Child is anindividual of the species Homo Sapiens fromfertilization until liv...
So, What does All That MEAN?In Pennsylvania, it is not defined as a crime againstthe unborn child for a pregnant woman to ...
You’re DONE Here!Questions. . .           Comments. . .                     ?                                28
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Substance abuse during pregnancy

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

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Substance abuse during pregnancy

  1. 1. Substance Abuse During PregnancyAn Adventure into the realms of Ethics, Bioethics, and Law 1
  2. 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. 2
  3. 3. Background of the IssueAccording to the Guttmacher Institute of PublicPolicy, U.S. policymakers have been debating thequestion as to how society should deal with theproblem of women’s substance abuse duringpregnancy since the late 1980’s. At this time,substance abuse during pregnancy is not a crimein any state. Different states have takendifferent approaches to this issue. 3
  4. 4. What is the Potential Harm of Prenatal Alcohol Abuse?Videos: 4
  5. 5. Babies Affected by Street and Prescription drugs 5
  6. 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. 6
  7. 7. 7
  8. 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? 8
  9. 9. Alice30 year-old professional woman with a “good” joband insurance benefits. Alice had a car accidenttwo years ago with severe back injuries.Unbeknownst to her physician, she developed achemical dependency to Oxycontin.Alice has a “perfect life” and is aware that her dailyOxycontin use isn’t good for her unborn baby. Butshe is ashamed and doesn’t want anybody to knowabout her addiction. 9
  10. 10. AliceIdentify Alice’s ethical conflict(s).Identify her legal conflict(s). Assume that Alicelives in a state that does not criminalize prenatalsubstance abuse, but fast-tracks pregnantsubstance abusers to rehab programs. 10
  11. 11. DarleneDarlene is 16 years old and goes to high school.She started on marijuana at 13 and uses cocaineon weekends with her friends to party. About 6weeks ago, she and her friends had apharmaceutical party and Darlene took manydrugs that she could not identify. She does notremember most of that evening. Now, herperiod is late and she suspects that she may bepregnant. Darlene’s parents have a “notolerance” drug policy. 11
  12. 12. DarleneWhat are Darlene’s ethical issues? -About the drug use -About the pregnancyWhat 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. 12
  13. 13. DarleneNow, assume that Darlene lives in SouthCarolina, where it is a crime to expose a fetus tosubstance abuse in the third trimester.What kind of thoughts may Darlene be having? 13
  14. 14. Breaking it Down. . .Ethical issues for the Health Care Providers whoknow about the potential harm for the fetus andalso 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”? 14
  15. 15. Dr. GoodDr. Good is an obstetrician and his patient is Mrs.User. Dr. Good knows that Mrs. User has been anactive alcoholic for years because his teenagedaughter is friends with Mrs. User’s daughter andhe has heard stories.When Dr. Good asks Mrs. User about ETOH use, shedenies any alcohol use, although the signs areobvious that she is still drinking during herpregnancy. 15
  16. 16. Dr. GoodWhat ethical issues may Dr. Good have aboutcaring for Unborn User? What can he do to helpUnborn avoid being born with Fetal AlcoholSyndrome?What legal restraints may prevent Dr. Good fromsaving Unborn User despite Mrs. User’s denial? 16
  17. 17. Breaking it Down. . .Ethical issues for lawmakers who have the bigpicture—how many babies are born with damagedue to substance abuse during pregnancy in theUnited States, costs to the taxpayer in medical carefor these people, special education, lifelong supportfor people born with damage and cannot supportthemselves. . . -How much can they actually control by creating laws, without compromising an individual’s constitutional rights? 17
  18. 18. Legal Parameters1. 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. 18
  19. 19. Legal Parameters2. 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 prenatalsubstance abuse discovered and treated, the healthcare provider may not act on the desire to help theunborn child with Mother’s issues. In fact, to do sowould violate Mother’s constitutional right toprivacy. 19
  20. 20. The Bottom LineBecause of the freedoms that are constitutionallyguaranteed in this country, lawmakers are verylimited in their ability to craft laws that intervene inthe decisions made by a prenatal substance abuser.Therefore, health care providers are limited to thedegree in which they can legally intervene, althoughthey may experience ethical desires to curtail thepregnant user’s right to decide for herself. 20
  21. 21. What about Pennsylvania?PA Cons. Statute, Title 18, Chapter 26 “Crimes Against the Unborn Child” 21
  22. 22. PA C.S. 18 § 2606AGGRAVATED ASSAULT OF UNBORN CHILD(a) Offense – A person commits aggravatedassault of an unborn child if he attempts tocause serious bodily injury to the unborn childOR causes such injury knowingly or recklesslyunder circumstances manifesting extremeindifference to the life of the unborn child 22
  23. 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. 23
  24. 24. PA C.S. 18 § 2606(b) DEFENSES – In any prosecution pursuant tothis 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 24
  25. 25. PA C.S. 18 § 2606(2) Such force was justified by law and was usedupon or towards the Mother. 25
  26. 26. “Unborn Child”Pa C.S. 18 § 3203 – The Unborn Child is anindividual of the species Homo Sapiens fromfertilization until live birth. 26
  27. 27. So, What does All That MEAN?In Pennsylvania, it is not defined as a crime againstthe unborn child for a pregnant woman to abusesubstances.There are child welfare statutes that may result inloss of parental rights after the birth.It IS a crime, however, to manufacture meth aroundchildren in Pennsylvania. PA C.S. 35 § 780-113. 27
  28. 28. You’re DONE Here!Questions. . . Comments. . . ? 28

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