Pregnant women and the law

Alicia Beltran is famous for her recent Kafka-esque pregnancy experience. She had stopped using painkillers and weaned herself off the antiaddiction medication. She provided full information to her health care provider. But instead of receiving prenatal care, she was ordered by the state to resume using antiaddiction medication. When she declined, she was arrested and, although she screened negative for all evidence of drug dependence or abuse, was committed to a facility for months before finally being released after a federal complaint was filed on her behalf.¹

In a Perspective piece in the January 16 edition of The New England Journal of Medicine, R. Alta Charo, JD, discusses the Beltran case and others involving women who have been punished for actions during their pregnancies that were thought to have the potential to harm their unborn children. “It is the latest example of a disturbing pattern of legislative and judicial misrepresentation and misuse of medical information in the pursuit of partisan aims focused on women and pregnancy,” Charo writes. (Charo is a professor of law and bioethics at the University of Wisconsin at Madison. She served on President Obama’s transition team in 2008.)

She claims that “legislatures have been encroaching on the realm of medicine” for 2 decades, in part in attempts to limit the availability and frequency of abortion. Although lawmakers act “under the guise of protecting women,” she writes, laws are being passed that penalize them for their legally protected choices.

Commentary by Joshua A. Copel, MD:

It seems surreal: A woman who has a past history of drug abuse but is now totally clean, proven by negative toxicology tests, is actually sent to prison for refusing to take completely unnecessary anti-addiction medication. Left unclear in the commentary in The New England Journal of Medicine: Where were this patient’s doctors? Should the State be able to force us as physicians to do things that are medically unindicated, unnecessary, and possibly frankly harmful? After all, most of us counsel our pregnant patients to take only necessary medications and avoid anything unnecessary.

Sadly, many state legislatures are passing paternalistic laws that predominantly affect women and children. Mandatory ultrasounds before abortions, fetal pain laws unsupported by any facts, incarceration of pregnant women to coerce use of medications-all are documented in Attorney Charo’s far-reaching editorial. One need only look at recent news for further signs of inappropriate intervention in medical care by lawmakers. The case of a “brain-dead” woman in Texas being kept on life support against her family’s wishes because she was pregnant at the time of her death has sparked debate and outrage across the nation.²

It may seem ironic that I, a liberal who is predisposed to favor government intervention, am horrified by these laws, but it is not inconsistent. The actions documented in this Perspective piece are all jarringly at odds with good medical practice (ie, evidence-based, relying on scientifically valid data).

Would we tolerate a law saying that all men with chest pain must have a cardiac drug-eluting stent placed? I thought not.

References

1. Charo, RA. Perspective: Physicians and the (women’s) body politic. N Engl J Med. www.nejm.org/doi/full/10.1056/NEJMp1313499. Accessed January 17, 2014.

2. Fernandez M, Eckholm E. Pregnant, and forced to stay on life support. The New York Times. www.nytimes.com/2014/01/08/us/pregnant-and-forced-to-stay-on-life-support.html?_r=0. Accessed January 17, 2014.

Dr. Copel is Professor of Obstetrics, Gynecology, and Reproductive Sciences, and Pediatrics at Yale University School of Medicine, New Haven, Connecticut. He is also a member of the Contemporary OB/GYN editorial board.