Safe haven for addicted mothers
Online posting: July 25, 1997
Published in print: November 1, 1997 (CMAJ 1997;157:1201)
Re: Bioethics for clinicians: 12. Ethical dilemmas that
arise in the care of pregnant women: rethinking "maternal–fetal
conflicts", by Elizabeth Flagler, Françoise Baylis and Sanda
Rodgers, CMAJ 1997;156:1729-32 [full text / résumé]
See response from: E. Flagler
Flagler and associates outline several dilemmas in pregnancy and
an approach to working out what is right in such instances. They
conclude that "coercion of the woman is not permissible no matter
what appears to be in the best interest of the fetus." I have no
disagreement with this statement. Personal autonomy needs to be
vigorously protected. However, we have not been given clear
insight into the right thing to do when a medical intervention
can benefit both the fetus and the mother, as in the case of a
mother addicted to or abusing drugs.
In which situations may autonomy and consent be superseded by
other considerations? A mother may not be able make a decision
because of mental incompetence. Or a mother may be addicted to a
substance and may be slowly destroying her own health and that of
her fetus, contributing enormous costs to the community for the
long-term care of the damaged child. In these situations, medical
intervention can benefit all, even if the woman's autonomy is
temporarily removed. This is not coercion. To leave women in
these desperate situations without therapeutic intervention is,
in effect, abandonment. To what end? A downward spiral into the
early death of the mother, the lifelong disability of the child,
and millions of dollars spent for minimal return?
Treatment needs to be made readily available and desirable to
such women so that a court order is required only rarely. These
women are already imprisoned by their addiction; they need a
safe, therapeutic haven.
I was disappointed to see a lack of balance in the ethical
analysis. It is not enlightening to suggest that the term
"maternal" be discarded because the pregnant woman is yet to
become a mother. It is acceptable in the English language, and in
medical practice, to use the term "mother" for a pregnant woman,
as denoting a mother-to-be.
Clearly the debate needs to continue, and fair and just
principles for each of the situations have to be established. Let
us not think the analysis is complete or universally acceptable.
This particular issue is growing; as a society we need to
dedicate more resources to treatment and prevention programs for
women who find themselves addicted and pregnant.
Albert E. Chudley, MD
Professor of Pediatrics and Human Genetics
University of Manitoba
Winnipeg, Man.
chudley@cc.umanitoba.ca
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