Should hospitals test pregnant women for drug use without their coQUESTION: Should hospitals test pregnant women for drug use without their consent? ANSWER this moral question in terms of the utilitarian considerations, who will be helped and who hurt over the long term, and the matters of rights for all involved (e.g., the right to privacy, warrantless search and seizure) AND deontological considerations, I have to right for the greater good. USE the basics of UTILITARIAN and DEONTOLOGICAL reasoning below in order to make out your point. Utilitarianism “ when we make a moral choice we must do a cost/benefit analysis where the common denominator is human happiness. An action is good if it creates more happiness than unhappiness. We are concerned here with everyone who might be involved. Each person?s welfare must be considered, and considered equally. Utilitarian?s are concerned with everyone’s happiness equally. No one person’s happiness is more important than any other person’s pleasure. Furthermore, Utilitarian always looks to the long term. Utility is never maximized for now. Rather, we attempt to see how the greatest good for the greatest number can be affected over time. STEP 1: PLEASE ANSWER THIS IN SPREADSHEET FORM: When making a moral decision, take the time to think of everyone that might be hurt or helped by the action. MAKE a simple “FOR” column and “AGAINST” column. On each side note how much each person involved (society as a whole included if that is relevant) will be helped or hurt by the action that pregnant women are tested for drugs without their consent. Total it up. The action will be right if the greatest number of people is better off by taking that action. The action is wrong if the greatest number of people will be harmed. Deontological “ here we assess the rights people have and what duties might go along with them without consideration given to consequences. I have a right to speak my mind, for example, especially when it is not for the greater good. STEP 2: PLEASE ANSWER THIS IN MS WORD (ESSAY) FORM: Decide in this case whose rights are to be respected. Were basic human rights violated? Did the company have a contractual duty to provide something that they did not, e.g., a safe workplace, or a safe product? Was a civil right violated, e.g., the right to privacy via drug testing? On both sides of the issue you will see rights correlating to duties. Be clear who has an obligation or duty, and to whom. Are the rights positive or negative? Lay them out one at a time on both sides of the issue and see which are most important to you. REFERENCE: USE American Medical News; Chicago; Foubister, V. Drug tests of non-consenting pregnant women quashed. (April 9, 2001; located below in Abstract) Abstract: The Supreme Court has ruled that physicians and other employees of public hospitals cannot perform drug tests on pregnant women without their consent and report the results to the police. The policy for testing pregnant women developed by the Medical University of South Carolina in Charleston violates the Fourth Amendment. Supreme Court rules hospital’s policy is unconstitutional, but leaves unanswered whether there are conditions under which medical privacy can be justifiably invaded. PHYSICIANS AND OTHER EMPLOYEES of public hospitals cannot perform drug tests on pregnant women without their consent and report the results to the police, the U.S. Supreme Court ruled last month. In a 6-3decision, the court found that a policy developed by the Medical University of South Carolina in Charleston that led to the arrest of pregnant women and new mothers who tested positive for cocaine use violates the Fourth Amendment. “The ruling substantiates the confidential relationship between a patient and physician,” said Timothy T. Flaherty, MD, chair-elect of the American Medical Association, one of a number of medical organizations that wrote or signed onto amicus curiae briefs challenging the policy’s public health benefits. Two lower courts had held that a pregnant woman’s use of cocaine creates a special need beyond normal law enforcement goals and that the Charleston policy advanced this public interest with minimal intrusion. But Justice John Paul Stevens, writing the majority opinion, said that the special-needs exception does not apply to a policy that has as its “central and indispensable feature” the use of law enforcement. “While the ultimate goal of the program may well have been to get the women ¦ into substance abuse treatment and off drugs, the immediate objective of the searches was to generate evidence for law enforcement purposes in order to reach that goal,” he said. Unanswered questions Medical Professionals emphasized that the court’s finding in this case strengthens the fiduciary relationship of doctors to their patients. “The physician really is required to be the agent of the patient, and responsibilities of law enforcement are simply incompatible with that role,” explained Robert Sade, MD, director of the Institute of Human Valuesin Health Care at MUSC and a member of the AMA’s Council on Ethical and Judicial Affairs. But the decision also left many questions unanswered. It did not resolve whether the 10 women who brought the case consented to the drug tests when they gave broad consent to receive care and instead remanded this decision to the U.S. Court of Appeals for the Fourth Circuit in Richmond, Va. How much detail needs to be spelled out for adequate informed consent is a “very important question from a clinical point,” Dr. Sade said. “For example, what is the purpose of taking a urine specimen and what is the intended use of the information?” Further, the court did not address whether there are conditions under which medical privacy can be justifiably invaded or if harming a fetus is the same thing as harming a child. South Carolina law regards a viable fetus as a person. Further, the state Supreme Court held in1995 that a woman’s use of cocaine during the third trimester of pregnancy constitutes criminal child neglect. Attorney General Charlie Condon appears determined to continue prosecuting these cases. “We will notify law enforcement that the usual search and seizure requirements must be followed and that the drug tests cannot be performed without either obtaining a search warrant or the individual’s consent,” he said in a statement responding to the court’s decision. Misdirected policy MUSC’S DRUG TESTING PROGRAM was initiated in 1989 and then discontinued five years later. The university developed the policy “in good faith” with other governmental agencies, “to reduce risks from illegal drug use during pregnancy and thereby protect the children of those pregnancies,” according to a March 21 statement. Most health professionals now agree that the habitual use of alcohol and tobacco, two substances that were not part of the testing program, pose a significantly greater risk to fetal health than cocaine. Further, the threat of incarceration has not been shown to counter drug use among pregnant women. Its more likely effect is to deter these women from seeking necessary prenatal care. “When somebody takes illicit drugs, we need to treat them with compassion and respect and maintain their dignity,” said Mohammad N. Akhter, MD, MPH, executive director of the American Public Health Assn. “They need treatment not jail.”
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