Here's a particularly thorny ethical question: How do we deal with pregnant women who are dependent on or addicted to drugs? I carefully chose the phrase "deal with" as opposed to "treat" because whether and how we "treat" these women is among the fundamental questions we need to answer as a society. Do we "treat" them like criminals? Or do we "treat" them like patients? What role should doctors and nurses play in involving state agencies like child protection services? Should they be legally required to report expectant mothers that are misusing, abusing, or simply 'taking as prescribed' medications like opioids? And if child protection services become involved, might these agencies remove the child from the care of the mother? Or should they be legally prohibited from doing so, thus removing a potential ethical barrier to mandatory reporting?
If you care about these questions and want to get closer to answers that might make sense, then this series of pieces from Reuters is required reading for you. Leaving aside for the moment that Duff Wilson and John Shiffman deserve a Pulitzer for this work, it's the first in-depth analysis I've seen that combines public health data, public policy critique, heart-wrenching anecdote, and journalistic discipline. Read the stories, study the graphics, watch the videos.
We need new legislation in this area. And we need to be enforcing legislation that already exists (like the Keeping Children and Families Safe Act of 2003, which most states and hospitals are either ignoring or they're adhering to state legislation which directly conflicts with the federal law).
As I've written in the past, newborns suffering from Neonatal Abstinence Syndrome (NAS) are perhaps the saddest cost of the opioid epidemic. But it's now clear the risk to these babies extends beyond the neonatal intensive care unit and into their homes, where accidental and preventable deaths are occurring at an alarming rate. To think that a newborn can painfully but successfully deal with the effects of mom's drug use and yet still risk death at the hands of the very mother who gave them life, whose responsibility it is to care for the child, who would, under any normal circumstances, likely sacrifice her own life for the life of the child - this is tragedy, writ... small. Even the smallest among us.
These moms need help, not handcuffs. They need assistance, not punishment. They need psychological and emotional support, not the psychological and emotional destruction of having a child taken away.
We can do better. We have to do better.
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