Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
A Midwestern state is very concerned about the number of children born to methamphetamine-addicted mothers. Methamphetamine use by pregnant women can result in babies with significant developmental abnormalities and heart and brain abnormalities.
Moreover, children raised in homes where methamphetamine is used run a higher risk of exposure to violence. To deter such behavior, the state wants every newborn baby to be tested for methamphetamine in the bloodstream.
The state asks hospitals to turn over the results, intending to place infants found to have the drug in their bloodstream in foster care and to charge their mothers with the misdemeanor of child endangerment. However, the state’s request is not legally binding, and doctors are permitted discretion regarding whether or not to turn over these test results.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases: