Panic in the ER: Maternal Drug Use, the Right to Bodily Integrity, Privacy, and Informed Consent

Abstract

In the early 1980s, the U.S. government began to address the issue of substance use during pregnancy. Attention to this issue was ushered to the forefront of health‐care debates due to the belief that the nation was gripped in an epidemic of “crack babies” (children born addicted to crack cocaine). Many involved in developing policy addressing this issue called for harsh measures as an attempt to curtail a possible crisis involving thousands of children. This case study expands existing research through examining the events which led to two significant court cases in South Carolina. The first involves the establishment of fetal rights in the state and the other resulted in the strengthening of an individual's right to privacy and bodily integrity in the United States. The study also outlines the effectiveness of the creation of a moral panic to adopt politically controversial and questionably constitutional social policy. A principios de 1980 el gobierno de los Estado Unidos comenzó a tomar medidas respecto al uso de sustancias durante el embarazo. La atención a este tema fue dirigida al frente de los debates sobre salud pública debido a que la nación fue tomada por una epidemia de “bebes del crack:” niños adictos al crack desde el nacimiento. Muchas de las personas encargadas de desarrollar políticas para resolver el problema solicitaron medidas más estrictas en un esfuerzo por contener una posible crisis que involucraría a miles de niños. Este estudio expande la literatura existente analizando los eventos que dieron pauta a dos casos de corte en Carolina del Sur. El primero involucra el establecimiento de derechos del feto en dicho estado y el segundo resultó en el fortalecimiento de los derechos de privacidad e integridad física del individuo en los Estados Unidos. Así mismo, este estudio hace un planteamiento sobre la efectividad de crear pánico moral para adoptar políticas sociales controversiales y constitucionalmente cuestionables.

Screening for Substance Abuse in Women's Health: A Public Health Imperative

“…This approach is haphazard, as indicators are easily missed, may be absent, or hidden under other disease manifestations. It is also potentially discriminatory because of provider bias …”

“…Despite the significance of substance abuse in women's lives, most health care providers receive little training regarding the issue. Wide variation in practice exists with regard to screening women for alcohol and drug use, probably because of a combination of lack of education about the nature of addiction, lack of training in intervention techniques, and negative attitudes about addiction . Lack of confidence regarding follow‐up on positive screens is cited as an important factor preventing primary care providers from screening for alcohol and drug use .…”

“…Over the past 30 years, a legal and policy debate has raged regarding the role of individual states in detecting, punishing, or treating substance abuse during pregnancy . In the mid‐1980s, shortly after policy makers began to address the issue of perinatal substance use in the United States, many states adopted a punitive approach, ostensibly to protect fetal health and development.…”

“…In the mid‐1980s, shortly after policy makers began to address the issue of perinatal substance use in the United States, many states adopted a punitive approach, ostensibly to protect fetal health and development. Some of these interventions have included mandatory drug testing, reduction or elimination of public assistance benefits, incarceration, and the removal of children from their mothers . In some instances, such efforts to curb women's behavior have been determined to be unconstitutional …”

A Legal and Ethical Analysis of the Effects of Triggering Conditions on Surrogate Decision-Making in End-of-Life Care in the US

“…Pregnant bodies, along with women's reproductive status and health, have long been sites of enormous contest and moral panic (Wolff 2011;Bell et al 2009;Heilborn et al 2007;Armstrong and Abel 2000;Stabile 1992). Given these contests, it is unsurprising that there is some variety even among the states that treat pregnant women differently from other persons who lack capacity for medical decision-making.…”