Forcing Pregnant Women to do as They're Told:
Maternal vs. Fetal Rights
By Claire Andre and Manuel Velasquez
Janet Rowen may be incarcerated because she is pregnant. Her
doctor, Marion Smyth, thinks Janet drinks too much alcohol and
has repeatedly advised her of the risks her drinking poses to
the child she has chosen to have. Heavy alcohol use during pregnancy
can result in "fetal alcohol syndrome." Infants with this syndrome
suffer from mental retardation and physical deformities and
have an increased chance of dying shortly after birth. Janet
is unwilling to cut down on her drinking. Dr. Smyth is seeking
a court order that would incarcerate Janet for the duration
of her pregnancy, forcing her to follow Dr. Smyth's medical
advice.
Research in medicine continues to reveal more and more ways
in which a baby's health can be jeopardized by what a woman
does during pregnancy. And, developments in genetics and obstetrics
continue to provide us with more and more prenatal diagnostic
tests and medical treatments that enable us to prevent birth
defects. Most women welcome these developments. There are some,
however, who are unwilling to avoid those activities or behaviors
that could harm their offspring and who refuse to undergo medical
treatments that would prevent birth defects.
As our knowledge of prevention and prenatal harm grows, so
too has public pressure to change the behavior of "non-compliant"
pregnant women. Almost half of the maternal-fetal specialists
surveyed in a recent national study thought that pregnant women
who refused medical advice and thereby endangered their future
children should be detained in hospitals and forced to "follow
doctors orders." A growing number of legal cases throughout
the U.S. show a trend toward forced treatment of pregnant women--court
ordered Caesarean sections, mandatory diet restrictions and,
as in Janet's case, incarceration for failing to follow medical
advice. But does society have a right to control the behavior
of pregnant women? Moral opinion is sharply divided on the matter.
Those opposed to forced treatment of pregnant women argue
that every person has a fundamental right to freedom of choice
and control over his or her own life. Forcing a pregnant woman
to undergo medical treatment against her will or to behave in
ways she does not freely choose violates this right. The decisions
a woman makes during pregnancy are based on her own circumstances,
her own values, and her own preferences. Others have no right
to impose on her their own judgments about what they think is
best for her and her fetus, depriving her of her freedom to
make her own choices and to control her own life.
The threat to freedom posed by forced treatment of pregnant
women is not a minor threat, either. It is rare for a woman
to refuse medical advice that promises to benefit her fetus
and poses little risk to her, and it is troubling when it happens.
But if we allow society to intervene in these cases, what will
prevent us from assuming wholesale control of women's lives
during pregnancy? If pregnant women are incarcerated to prevent
them from heavy drinking, will we also seize them for drinking
coffee or exercising too little, each of which could pose some
risk to a fetus according to some doctors. If pregnant women
are compelled to undergo surgery that would prevent their future
child from being born with handicaps, will they also be compelled
to undergo amniocentesis or genetic screening in order to detect
those handicaps that could be prevented by such surgery?
Furthermore, forcing pregnant women to submit to medical treatment
for the sake of their fetuses is to impose an obligation on
them that we do not impose on others. And, justice requires
that all persons be treated equally. In our society, we allow
people the right to refuse medical treatment and the right to
refuse to subordinate their desires or needs to the needs of
others. We don't, for example, force some people to donate their
kidneys, bone marrow or blood in order to benefit or even to
save the lives of other people. Why, then, should pregnant women
be forced to undergo surgery or to change their lifestyles in
order to benefit a fetus? To require this of pregnant women
is to demand from them something over and above what we demand
from the rest of society.
Finally, compelling a pregnant woman to follow medical advice
in order to benefit her fetus will only cause more harm than
good. To avoid being treated against their will or to avoid
being incarcerated, women with high-risk pregnancies and therefore
the greatest need for prenatal care, will avoid doctors or will
withhold important information from their doctors concerning
their health. As a result, the health of the fetus will be placed
in even greater jeopardy.
Those who support forced treatment of pregnant women agree
that every person has a right to freedom of choice. But when
a woman decides to carry her pregnancy to term, we can expect
that a child will be born, and this future child has a right
to be protected from avoidable harm. Certain behaviors during
pregnancy are known to cause harm to offspring. Poor nutrition
can retard fetal growth and impair brain development. Use of
heroin can result in fetal addiction. Heavy alcohol use can
cause mental retardation and physical malformations. Altering
one's diet or refraining from alcohol or drugs presents no serious
risk to a pregnant woman's life or health. When a pregnant woman
who has decided to give birth to a child engages in activities
that she could reasonably avoid and that will damage that child,
society has a duty to protect the future child, even if this
means forcing the pregnant woman to change her behavior.
Furthermore, it is argued, there are cases in which a pregnant
woman's right to freedom of choice must be weighed against a
child's right to be born in a healthy state. There are a number
of established prenatal medical treatments to prevent birth
defects that pose little risk to pregnant women, including the
administration of certain drugs or low-risk in-utero surgery.
The discomfort or inconvenience of taking a medication or undergoing
a low-risk surgical procedure is a small price to pay to prevent
a child from being born with handicaps. Society has a right
to prevent pregnant women who choose to have children from refusing
to undergo medical treatments that would prevent birth defects
when such treatments pose little risk to their own lives or
health.
And, supporters contend, we need not fear that forced treatment
of pregnant women will lead to the public assuming wholesale
control of women's lives during pregnancy. Just as we draw lines
as to what does or doesn't constitute child abuse and thus are
grounds for taking a child from his or her parents, so we can
distinguish between what does or doesn't constitute harmful
prenatal conduct, and thus are grounds for forced treatment
of pregnant women.
Mother or fetus? Where do our obligations lie? Our answer
will require a careful balancing of the values of freedom and
self-determination, and the value we place on the right to be
protected from harm.
For further reading:
Dawn Johnson, "A New Threat to Pregnant Women's Autonomy,"
Hastings Center Report, Volume 17 (August/September 1987),
pp. 33-40.
"When a Pregnant Women Endangers Her Fetus" (commentaries
by Thomas B. MacEnzie and Theodore Nagel, and Barbara Katz Rothman)
Hastings Center Report, Volume 16 (February 1986), pp.
24-25.
John A. Robertson and Joseph D. Schulman, "Pregnancy and Prenatal
Harm to Offspring: The Case of Mothers with PKU," Hastings
Center Report, Volume 17 (August/September 1987), pp. 23-33.
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