1. Competency VII: RELATED ISSUES IN FAS © NORTHEAST REGIONAL FAS EDUCATION AND TRAINING CENTER. 2006

2. “Make a habit of two things –to help; or at least do no harm” -Hippocrates in Epidemics -Hippocrates in Epidemics

3. ETHICAL CONCERNS Confidentiality Basic right to privacy (Exceptions: patient in danger to self, community or third party; patient gives consent) Basic right of competent individuals to be self-determining We have an obligation to our families to: Beneficence: Do good/benefit Nonmaleficience: To at least do no harm Justice: To treat equals equally, act fairly, and avoid discrimination HIPAA compliance Use of tobacco, alcohol, and illicit drugs are NOT fundamental rights

4. Maternal-fetal conflict (consider the health of the mother and baby) : ?? When does a fetus become a person ?? People have rights – does a fetus ?? What if maternal decisions are based on unusual beliefs, or religious beliefs ?? Should you use court orders to force pregnant women to comply with medical needs ?? Does a woman have the right to control what happens to herself and her body, free from intrusions, discrimination (Self Determination)

5. WHAT CAN YOU DO?? Know your state and national laws and issues Care must always be culturally-competent and patient-centered There is a responsibility to save and preserve life, relieve and minimize suffering and avoid harm that is met by diagnosis and treatment

6. LEGAL/POLICY ISSUES All major medical associations and organizations have policy issues relating to prenatal alcohol use and some have policy statements relating to FAS AMA, AAP, ANA, ACOG, ASAM, CDC, NIAAA, SAMHSA, American Public Health Association, March of Dimes, NCADD: all have issued statements against a punitive approach when dealing with prenatal alcohol use in women

7. Many states have signage laws that must be posted in all establishments licensed to sell or serve alcohol Texas reports FASDs regardless of the affected person’s age, collected under the Health and Safety Code (87.021-f), of the statute providing for passive data collection

8. Some states have attempted to reduce the numbers of babies born with FAS in several ways: - Some require warnings posted in public places (IL,GA,NJ,NV,TN,WA,WV) -Some created programs to track FAS, provide research and/or direct services (CA,KS, GA, MO, MN, NH, NJ, NV, SD, WA)

9. - - Some states have funded prevention and education programs, some requiring that FAS pamphlets be distributed to marriage license applicants (AK, IL, ME, MN, NH, NJ, NV, OR, RI, WI, WA) -Some states require reporting incidences of FAS to state or human services and/or include a diagnosis of FAS as part of the Birth Defects Registry, or as a reason to suspect child abuse/neglect (IL, NJ, SC, TX, UT, VA, Canada) -Some states have a “fetal homicide law” that may influence punitive approaches to women who expose the fetus to drugs and alcohol (AK, IO, WI, WA) Americans with Disabilities Act (1990) only covers individuals with FAS if they have a disability (Part C)

10. WHAT CAN YOU DO TO PROTECT YOUR FAMILIES? Track state activities Keep up-to-date on local laws and mandates Advocate for better laws and write/meet with your state representatives Develop a website on the dangers of prenatal alcohol use and FAS

11.   Screen all women of child-bearing age for alcohol and drug use   Discuss your values with the patient up-front   Clearly explain the damage alcohol can do to the developing fetus in a NON-JUDEGMENTAL WAY   SCARE TACTICS DO NOT WORK

12.   Know alcohol and drug treatment options in your community   Remember: the patient maintains the right to refuse consent, start/continue treatment and the right to ignore advice (Tillett and Osbourne, 2004)   Perception of illness and disease varies by culture

13. MEDIA OUTREACH There are three approaches to prevention: Primary – prevention before a problem occurs, through alcohol cessation activities; through media and policy changes Secondary – identification of at-risk populations; target at-risk groups, and provide screening and early detection for alcohol use and FAS Tertiary – prevention of reoccurrence and lessening of the impact of a health problem – decrease adverse pregnancy outcomes in women who continue to drink and secondary disabilities in individuals affected with FAS

14. A leading substance-abuse center…urged the nation’s doctors to focus more closely on alcohol and drug use by their patients after finding that more than nine out of ten physicians did not diagnose alcohol abuse when presented with the early symptoms (Associated Press, May 2000). (Associated Press, May 2000).

15. Health professionals should inquire routinely about alcohol consumption by women of childbearing age, inform them of the risks of alcohol consumption during pregnancy, and advise them not to drink alcoholic beverages during pregnancy - Advisory on Alcohol Use in Pregnancy, - Advisory on Alcohol Use in Pregnancy, US Surgeon General, 2005 US Surgeon General, 2005

16. Some prevention activities can include:   Media campaign, such as NJ’s “Be in the kNOw “ about alcohol and drugs, using national public posters and brochures;   Provide community with written material resources   Develop a website   Use radio and TV PSA’s

17.  Use a targeted media campaign, using local DJ’s, celebrities, and sports figures  Have a “Pregnant Pause” event: an entertainment and social event which includes information on a healthy pregnancy  Have a one day training on prenatal alcohol use and FAS; CEU workshops  Use multiple education strategies: didactics, clinical guidelines, case presentations, videos, focus groups  Create and market a speaker’s bureau

18. Always remember  Cultural diversity  Drinking is integrated into religious rites and social customs  Some ethnic groups are more tolerant of extreme behaviors  Culture influences attitudes and actions