Digital Scrapbook #6

From The American Journal of Bioethics “Substance Abuse in Pregnancy: Where Does the Blame Lie? How do health care providers, and society at large, approach a pregnant woman who is substance abusing? By Jennifer M. Cohn

Our medical system is rooted in patriarchy and hierarchy. Dr. Northrup, in “The Patriarchal Myth and the Addictive System”, writes that “our culture gives girls the message that their bodies, their lives, and their femaleness demand an apology…If we must apologize for our very existence from the day we are born, we can assume that our society’s medical system will deny us the wisdom of our “second-class” bodies. In essence, patriarchy blares out the message that women’s bodies are inferior and must be controlled” (4). Furthermore, Cynthia Downing tells us in “Sex Role Setups and Alcoholism” that “literature in the mental health field has empirically documented characteristics associated with femaleness to be seen as less healthy than those considered masculine. Consequently, women can be considered as a kind of deviant group in that they possess characteristics that are negatively valued and stigmatized” (47). And because reproduction is the responsibility of the woman, any behavior seen as irresponsible on the part of the pregnant woman is seen as a prime example of a woman’s deviance. And if the pregnant woman is also an addict, she is viewed as the lowest of the low and deserves to be punished. Such punishment is justified as a way to protect the child, but the goal of punishment is not to protect the child, rather, punishment “operates more to maintain a social distinction between insiders and deviants” according to Iris Marion Young in her piece titled “Punishment, Treatment, Empowerment: Three Approaches to Policy for Pregnant Addicts”. Jennifer M. Cohn argues that in putting the needs of the fetus before the needs of the woman, society and the medical system has compromised a woman’s control over her own body. While mother and baby are two lives they are one being. But because there are two lives, society has shown a “willingness to criminalize substance abuse during pregnancy” according to Cohn.

Cohn points out that in order “for an act to constitute a crime, it must be both harmful and intentional” and it can be difficult to prove “harm that was caused directly by drugs” and “intentional harm is even more difficult to prove…the consequences of drug taking during pregnancy are rarely anticipated by the mothers”.

Cohn also sees a double standard in how our society expects mothers to preserve their fetus’s life but we allow women to go without access to medical care, which can counteract the effects of drug abuse, as we offer little community aid to the pregnant woman. We also allow women to be exposed to toxic fumes and chemicals in the workplace. Where are the anti-abortion activists when the pregnant woman attempts to leave an abusive relationship, when she is at greater risk of being murdered by the abuser?

Cohn and Young seem to be very much on the same page. Punishment doesn’t work. Treatment isn’t always accessible. What does work is referred to as empowerment by Young, and the role Cohn believes the physician must play goes hand in hand with empowerment.