Paige Fowler Feb. 10, 2022 Bioethics Case: Pregnant Mother Addicted to Heroin MEMORANDUM 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 Introduction 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. Background 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. Options 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. Conclusion 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, https://www.scu.edu/ethics/focus-areas/bioethics/resources/obey-law-on-criminal-reporti ng-for-a-pregnant-mother-addicted-to-heroin/.