Pregnancy and substance use -the Norwegian § 10-3 solution. 1 Ethical and clinical reflections related to incarceration of pregnant women to protect the foetus from harmful substances Research report Introduction Maternal substance addiction imposes several risks on the offspring from conception on. Most chemical components of the substances pass the placental barrier and represent a developmental hazard to the growing foetus (Moe et al. 2010). Pregnant women often find themselves torn between the wish to protect the foetus and failure to do so (Söderström 2011). The situation causes worry as well as moral in-dignation, and the welfare system is urged to act. In 1996, Norway passed a unique piece of legislation, at the time § 6-2a in the Social Service Act, now § 10-3, which made it possible to incarcerate pregnant drug-addicted women in order to protect the foetus. Although the paragraph is grounded on the ethical principle of nonmaleficence, there has been raised concern for unintended negative effects such ABSTRACT AIMS -This article highlights ethical and clinical dilemmas of incarceration of pregnant drug addicts mandated by § 10-3 of the Norwegian Municipal Health and Care Services act. MATERIAL -The material consists of two cases, Siri and Anna, and the ethical dilemmas posed by the use of § 10-3 in these cases.METHODS -Semi-structured in-depth individual interviews were conducted, audio-recorded and transcribed word for word. Transcripts were coded according to converging interests and possible ethical dilemmas and described in a case format. The practical and experiential consequences of the law are discussed in relation to the four main bioethical principles: respect for autonomy, nonmaleficence, beneficence and social justice. These are supplemented by the principles of relational ethics. RESULTS -The application of § 10-3 may lead to situations which distort the psychological preparation for parenthood and strains the helping relationship. The four principles approach seems to be an insufficient tool in grasping the complexity of the situation. CONCLUSIONS -Interventions to protect the foetus from the pregnant woman's use of substances demand elevated professional awareness of ethical and relational challenges and dilemmas. Relational ethics provides a framework to enhance reflexivity and a trusting therapeutic alliance. The potential for psychological change during pregnancy should be invested in. Hence, we suggest that during incarceration according to § 10-3, foetal protection and the promotion of parental competences should be given equal priority. KEY WORDS -Addiction, coercive treatment, ethical dilemmas, motherhood, pregnancy, relational ethics.