Uploaded by paigecfowler

Ethics Advisory Memo (3)

Paige Fowler
Feb. 10, 2022
Bioethics Case: Pregnant Mother Addicted to Heroin
To:​Attorney A. Craig Eiland (Medical Ethics Lawyer)
From:​Paige Fowler,​Medical Ethics Legal Advisor
Date:​February 10,​2022
Subject:​Bioethical Case: Pregnant Mother Addicted to Heroin
This case is trying to decide whether or not a doctor should admit her pregnant patient to a drug
abuse treatment for her heroin addiction.
A 27-year-old single mother in her first trimester of pregnancy visits her physician. She admits to
having a history of heroin addiction, that she is still using, and that she has made multiple
unsuccessful attempts to quit using heroin. Despite her heroin addiction, she has no criminal record.
Heroin usage endangers the fetus's development and increases the likelihood of prenatal addiction.
She declares that she will "do whatever right now to help my baby." She previously thought she was
infertile and regards the pregnancy as a gift from God. "All I want in life is to be a good Mom," she
says. The law classifies drug misuse while pregnant as criminal child endangerment, requiring
obligatory reporting and treatment. Following the law means that the mother will be prioritized for
immediate access to an inpatient drug treatment program that provides medically-supported heroin
withdrawal for mother and fetus, but she will receive a criminal record and her baby may be taken
away from her after birth regardless of whether or not she quits heroin. The obstetrician feels she is
extremely motivated to become drug-free for the sake of her fetus, and that with sufficient medical
and social assistance, she may succeed without pressure.
In this situation, you have three choices. The first step is to report the mother in accordance with the
law and hope that she receives obligatory treatment. However, if the patient is reported, the mother
will assume you opted to obey the law above patient autonomy and confidentiality. You would
present to authorities your case for not prosecuting your patient-mother with a crime, as well as your
view that she has the capacity to succeed in drug treatment and parenting.
The second option is to refrain from reporting the mother. If you choose to defy the law and refrain
from reporting because you believe the legislation breaches your patient's autonomy and/or the
physician-patient relationship: Report that you have declined to report a case because you feel the
law is unfair, using the reasoning of civil disobedience. Your willingness to risk your personal legal
penalty demonstrates respect for the overall rule of law, even if you break the specific statute you
believe is unfair.
Paige Fowler
Feb. 10, 2022
The third choice is to not report the mother and do everything you can to assist her to get into an
appropriate drug treatment program as soon as possible. This alternative follows the same logic as
the second but adds the layer of trying to persuade the patient to obtain her own drug therapy.
Ethical Considerations
There are various ethical and medical-legal issues with each alternative. The Vermont Ethics
Network defines ethics as "a collection of moral principles, beliefs, and values that guide us in
making medical care decisions." Our sense of right and wrong, as well as our ideas about the rights
we have and the obligations we owe others, are at the heart of health care ethics. Thinking about the
ethical dimensions of health-care decisions allows us to make judgments that are right, good, fair,
and just." HG Legal Resources defines medical law as "the corpus of laws governing the rights and
duties of medical practitioners and their patients." Medical law's key areas of concern include
confidentiality, carelessness and other torts relating to medical treatment (particularly medical
malpractice), and criminal law and ethics."
If the doctor chooses the first option, she will be prioritized for rapid admittance to an inpatient drug
treatment facility that provides medically assisted heroin withdrawal for both mother and fetus. She
may, however, end up with a criminal record. Alternatively, she may be referred to child protective
services prior to treatment, treatment outcome, or pregnancy outcome, increasing the likelihood that
her baby will be taken from her regardless of treatment outcome. The doctor may not consider this
choice moral since she believes the lady is capable of stopping heroin for the sake of her child.
However, in the case of the pregnancy, this may be the most moral decision because continuing to
use heroin might potentially damage the fetus. There is also a moral quandary of whether one's duty
is to the patient or to the public. In this scenario, the doctor must choose between her obligation to
the public and her duty to the patient. Assuming this patient does not want to be reported to
authorities, the importance of preserving autonomy, as well as maintaining confidentiality and trust,
plainly weighs in favor of not reporting. At the same time, obeying the law is a moral obligation. In
terms of beneficence, reporting may improve the mother's access to substance-abuse treatment, but at
a great cost in terms of other bad repercussions for her, in addition to intruding on her autonomy.
If the doctor chooses the second option, trusting the mother to do her best to stop using heroin and
take care of her baby, she would be breaking medical law because the mother is classified as an
addict, putting the doctor in a position to contact CPS (child protective services) because she is
pregnant. To put it simply, suggesting that this would be an immoral option for the kid because it may
be injured if the mother did not quit using heroin is foolish. The law's premise is for the benefit of the
fetus. You feel that any technique of preventing drug misuse would be beneficial to prenatal
development. However, you may be concerned if fetal interest is unclear since reporting might result
in a hasty choice to remove a baby from a loving and perhaps competent mother in favor of a
dysfunctional foster care system defined by dramatically variable caregiver quality.
Paige Fowler
Feb. 10, 2022
The third option would be for the doctor not to contact CPS (Child Protective Services) and to trust
the mother in getting off of heroin, but to include a factor in which the doctor would strongly
recommend a drug treatment program and would do everything in their power to help the patient get
into it. If the woman was still using heroin in her second trimester, the doctor would contact CPS.
This is still a violation of medical law at first, but there are moral implications for both the mother
and the kid in this case. However, there is still a danger that the mother may continue to use heroin,
but this is mitigated by the doctor contacting CPS, which provides the mother still another incentive
to cease using. However, this might be unethical because it effectively deprives the mother of her
option while also potentially intimidating the mother to become clean "or else."
Conclusions and Recommendation
If it isn't obvious, the third choice is the best approach in term of medical ethics. This allows the
mother to become unaddicted without involving CPS (child protective services) or forcing the mother
to do something she would not otherwise do, keeps a criminal record off of the mother, and allows
the baby to be kept with its mother after birth rather than being placed in foster care.
Thank you for your time, and please do not hesitate to contact me if you have any more questions
about this choice.
Paige Fowler
Feb. 10, 2022
Works Cited
“Medical Law.” Hg.org, https://www.hg.org/medical-law.html.
“Overview of Medical Ethics.” Vermont Ethics Network | Advancing Health Care Ethics, 21
Mar. 2019, https://vtethicsnetwork.org/medical-ethics/overview.
University, Santa Clara. “Obey Law on Criminal Reporting for a Pregnant Mother Addicted to
Heroin?” Markkula Center for Applied Ethics, 2020,