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The Charleston Policy on Cocaine Use During Pregnancy: A Cautionary Tale

Published online by Cambridge University Press:  01 January 2021

Philip H. Jos ,
Mary Faith Marshall  and
Martin Perlmutter
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Extract

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's controversial treatment program for pregnant women addicted to cocaine.

In October 1989, the Medical University of South Carolina (MUSC) instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy (Interagency Policy), designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 23 , Issue 2 , Summer 1995 , pp. 120 - 128
Copyright
Copyright © American Society of Law, Medicine and Ethics 1995

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References

Medical University of South Carolina, Policy II-7 Management of Drug Abuse During Pregnancy (Charleston: The Medical University, Oct. 1989).Google Scholar
Letter From the Compliance Oversight Branch, Division of Human Subjects Protections, Office of Protection from Research Risks, Office of Extramural Research, and Office of the Director to MUSC Officials, Sept. 30, 1994.Google Scholar
Ferguson and Roe et al. v. City of Charleston et al., No. 2-93-26242-2 (D.S.C. filed Oct. 5, 1993).Google Scholar
See Medical University of South Carolina, supra note 1.Google Scholar
Id.Google Scholar
Id. (original emphasis).Google Scholar
Id.Google Scholar
S.C. Code of Laws § 44-53-370.Google Scholar
S.C. Code of Laws § 44-53-370 and § 44-53-440.Google Scholar
S.C. Code of Laws § 20-7-50. This section provides that: Any person having legal custody of any child or helpless person, who shall, without lawful excuse, refuse or neglect to provide, as divined in § 20-7-490, the proper care and attention for such child or helpless person, so that the life, health or comfort of such child or helpless is endangered or likely to be endangered, shall be guilty of a misdemeanor and shall be punished within the discretion of the court.Google Scholar
Chasnoff, I.J., “Drug Use and Women: Establishing a Standard of Care,” Annual of the New York Academy of Science, 562 (1989): 208–10, as cited in Horger, E.O., Brown, S.B. and Condon, C.M., “Cocaine in Pregnancy: Confronting the Problem,” Journal of the South Carolina Medical Association, 86 (1990): 527–31.CrossRefGoogle Scholar
Horger, , Brown, , and Condon, , supra note 11.Google Scholar
Siegel, B., “In the Name of the Children,” Los Angeles Times Magazine, Aug. 7, 1994, at 15.Google Scholar
Id.Google Scholar
Id.Google Scholar
See memorandum from Solicitor Charles M. Condon in Ferguson and Roe, No. 2-93-26242-2, at App. 1:4 (D.S.C. filed Oct. 5, 1993).Google Scholar
See Siegel, , supra note 13.Google Scholar
Daniels, C.R., At Women's Expense: State Power and the Politics of Fetal Rights (Cambridge: Harvard University Press, 1993).Google Scholar
See Chasnoff, , supra note 11.Google Scholar
Nelson, L.J. and Milliken, N., “Compelled Medical Treatment of Pregnant Women,” JAMA, 259 (1988): 1060–66; Blank, R.H., “The Maternal Fetal Relationship: The Courts and Social Policy,” Journal of Legal Medicine, 14 (1993): 73–92; and Merrick, J., “Maternal Substance Abuse During Pregnancy: Policy Implications in the United States,” Journal of Legal Medicine, 14 (1993): 57–71.CrossRefGoogle Scholar
See Blank, , supra note 20.Google Scholar
Id.Google Scholar
See Merrick, , supra note 20.Google Scholar
See Nelson, and Milliken, , supra note 20.Google Scholar
Colautti v. Franklin, 439 U.S. 379 (1979).Google Scholar
Thornberg v. American College of Obstetricians and Gynecologists, S. Ct. 2101 (1986).Google Scholar
See Nelson, and Milliken, , supra note 20.Google Scholar
See Merrick, , supra note 20.Google Scholar
Florida v. Johnson, No. E89-890-CFA slip op. (Cir. Ct., Seminole County, Fla. 1989).Google Scholar
State v. Gray, WL 124695 (Ohio App. 1990) (unreported).Google Scholar
Tolliver v. South Carolina, 90-CP-23-5178 (Cir. Ct., Manning County, S.C. 1992).Google Scholar
Circuit Court Judge Thomas W. Cooper Jr. relied on Bryant v. City of Charleston (295 S.C. 408, 411, 368 S.E.2d 899, 900 (1988)), and observed that:Google Scholar
See Ferguson and Roe, No. 2-93-26242-2 (D.S.C. filed Oct. 5, 1993); 42 U.S.C. § 290dd-2 (1944); 42 C.F.R. § 2.32 (1987). For a general discussion of issues surrounding such lawsuits, see Chavkin, W., “Drug Addiction and Pregnancy: Policy Crossroads,” American Journal of Public Health, 80 (1990): 483–87.CrossRefGoogle Scholar
Skinner v. Railway Labor Executives Assn., 109 S. Ct. 1402, 1413 (1989).Google Scholar
See Nelson, and Milliken, , supra note 20; see Chavkin, , supra note 33.Google Scholar
Center for Reproductive Law & Policy, “Punishing Women for Their Behavior During Pregnancy,” Reproductive Freedom in Focus (New York: Center for Reproductive Law & Policy, 1994): at 5–6.Google Scholar
Robertson, J.A., “Procreative Liberty and the Control of Conception, Pregnancy, and Childbirth,” Virginia Law Review, 69 (1983): 405–64; see also Blank, , supra note 20; and Overall, C., Ethics and Human Reproduction: A Feminist Analysis (Boston: Allen and Unwin, 1987).Google Scholar
60 Minutes News Magazine, New York, Nov. 20, 1994.Google Scholar
See Siegel, , supra note 13.Google Scholar
See Daniels, , supra note 18.Google Scholar
Id.Google Scholar
Id.Google Scholar
Schneider, A. and Ingram, H., “Social Construction of Target Populations: Implications for Politics and Policy,” American Political Science Review, 87 (1993): 334–47; and Alford, R.R., Health Care Politics: Ideological and Interest Group Barriers to Reform (Chicago: University of Chicago Press, 1975).CrossRefGoogle Scholar
Sherman, R., “Bioethics Debates,” The National Law Journal, 13 (1991): 1.Google Scholar
See Schneider, and Ingram, , supra note 43.Google Scholar
On the importance of such support for effective treatment, see Chavkin, , supra note 33; Chavkin, W., “Mandatory Treatment for Drug Use During Pregnancy,” JAMA, 266 (1991): 1556–61; Chavkin, W. et al., “Reframing the Debate: Toward Effective Treatment for Inner City Drug-Abusing Mothers,” Bulletin of the New York Academy of Medicine, 70 (1993): 50–68; and The Southern Regional Project on Infant Mortality, A Step Toward Recovery: Improving Access to Substance Abuse Treatment for Pregnant and Parenting Women (Washington: Southern Regional Project on Infant Mortality, Mar. 1993).CrossRefGoogle Scholar
Child care services and women only substance abuse treatment programs (such as “New Life” operated by the Charleston County Substance Abuse Commission) were not available in Charleston until November 1994.Google Scholar
See Horger, , Brown, , and Condon, , supra note 11.Google Scholar
Id.Google Scholar
See Chavkin, et al., supra note 46; see the Southern Regional Project on Infant Mortality, supra note 46.Google Scholar
Stone, D., “Clinical Authority in the Construction of Citizenship,” in Ingram, H. and Smith, S.R., eds., Public Policy for Democracy (Washington: Brookings Institution Press, 1993): 45–67.Google Scholar
Id.Google Scholar
Waitzkin, H., The Politics of Medical Encounters (New Haven: Yale University Press, 1991).Google Scholar
See Stone, , supra note 51.Google Scholar
See Siegel, , supra note 13.Google Scholar
Halpern, R., “Poverty and Infant Development,” in Zeanah, C. H. Jr., ed., Handbook of Infant Mental Health (New York: Guilford Press, 1993): 73–85.Google Scholar
Frank, D.A. et al., “Cocaine Use During Pregnancy: Prevalence and Correlates,” Pediatrics, 82 (1988): 888–95; and Zuckerman, F. et al., “Effects of Maternal Marijuana and Cocaine Use on Fetal Growth,” N. Engl. J. Med., 329 (1989): 762–68.Google Scholar
See Chasnoff, , supra note 11.Google Scholar
Id.; see also Robertson, , supra note 37; and Blank, , supra note 20.Google Scholar
See Overall, , supra note 37.Google Scholar
See Nelson, and Milliken, , supra note 20; see also Chavkin, , supra note 46.Google Scholar
See Chavkin, , supra notes 33 and 46; see also Chavkin, et al. , supra note 46; and the Southern Regional Project on Infant Mortality, supra note 46.Google Scholar
Charles, C. and DeMaio, S., “Lay Participation in Health Care Decision Making: A Conceptual Framework,” Journal of Health Politics, Policy and Law, 18 (1993): 881–904.CrossRefGoogle Scholar
Gerteis, M. et al, eds., Through the Patient's Eyes: Understanding and Promoting Patient Centered Care (San Francisco: Jossey Bass Publishers, 1993).Google Scholar
Bok, S., Lying: Moral Choice in Public and Private Life (New York: Vintage Books, 1978).Google Scholar