1. Fetal Alcohol Spectrum Disorders: Competency VII – Ethical, Legal, and Policy Issues The Arctic FASD Regional Training Center is a project of the UAA Center for Behavioral Health Research & Services. Funding for this project is provided by CDC Cooperative Agreement #U84DD000886-01.

2. Ethical Issues Legal & Policy Issues Road Map for Presentation

3. ETHICAL ISSUES

4. Basic Principles Respect for Persons Confidentiality Ethical Issues

5. Autonomy Beneficence Nonmaleficence Justice Basic Principles

6. Encompasses all of the basic principles Asks care providers to honor each person’s dignity and interests Respect for individuals with FASD Respect for Persons

7. Essential to the health provider- patient relationship Protection of privacy Acknowledge limitations Confidentiality

8. LEGAL AND POLICY ISSUES

9. Fetal rights and the maternal-fetal relationship Limitations of coercive and punitive approaches A public health approach Legal and Policy Issues

10. Ethical perspective Personhood Legal perspective Federal law State law Well-being Fetal Rights and the Maternal-Fetal Relationship

11. Law enforcement measures Examples from states Legal decisions Whitner v. State of SC (1997) Ferguson v. City of Charleston (2001) Limitations of Coercive and Punitive Approaches

12. Autonomy and justice compromised Women may not have enough time to prepare their cases Courts may make their decisions too late to protect the fetus Does not optimize beneficence (benefit) Does not avoid undue harm (nonmalficence) Might contribute to mistrust of health care providers Limitations of Coercive and Punitive Approaches

13. 1.Coercive and punitive legal approaches to pregnant women who refuse medical advice fail to recognize that all competent adults are entitled to informed consent and bodily integrity. 2.Court-ordered interventions in cases of informed refusal, as well as punishment of pregnant women for their behavior that might put a fetus at risk, neglect the fact that medical knowledge and predictions of outcomes in obstetrics have limitations. Six Objections to Coercive and Punitive Approaches

14. 3.Coercive and punitive policies treat medical problems such as addiction and psychiatric illness as if they were moral failings. 4.Coercive and punitive policies are potentially counterproductive in that they are likely to discourage prenatal care and successful treatment, adversely affect infant mortality rates, and undermine the physician- patient relationship. Six Objections….

15. 5.Coercive and punitive policies directed toward pregnant women unjustly single out the most vulnerable women. 6.Coercive and punitive policies create the potential for criminalization of many types of otherwise legal maternal behavior. Six Objections….

16. Education/prevention vs. punishment Drug and alcohol treatment Health provider screening Public health interventions for FASD Public Health Approach

17. Ethical concerns related to FASD Legal and Policy Issues In Closing….

18. Arctic FASD Regional Training Center www.uaa.alaska.edu/arcticfasdrtc arcticfasdrtc@uaa.alaska.edu 907.786.6381 The Arctic FASD Regional Training Center is a project of the UAA Center for Behavioral Health Research & Services. Funding for this project is provided by CDC Cooperative Agreement #U84DD000886-01.