Passing Judgment on Pregnant Drug-Abusers

There is a strong social stigma against pregnant women who abuse drugs. Charles and Shivas (2002) noted, "Women who use illegal drugs when pregnant have been called unfit, coerced into sterilization, and have even faced criminal charges for causing harm to their fetus" (p. 143). Nurses who take care of these new mothers have the unique responsibility of providing healing interventions and giving emotional support, while putting aside personal bias and societal stigmas. Although most nurses assume a supportive role with many of their patients, it is often difficult for health care providers to provide the same type of support for pregnant women who have abused drugs during their pregnancy. Many nurses find it hard to overlook the danger the mother is imposing upon the fetus and feel that the woman is an inadequate care-giver for her child (Lowdermilk & Perry, 2007). While substance abuse is a real danger and problem for some pregnant mothers, these woman are still in need of support and quality care, even if society believes they have made bad decisions. The purpose of this paper is to discuss the principles of justice and nonmaleficence in relation to the care of drug- abusing pregnant women, and to illustrate how nurses can avoid the Is-Ought Fallacy by applying the Ethics of Care theory to these patients.

Background

While I was doing my clinical rotation on the mother-baby floor of the hospital, I was assigned to a patient who had been a drug- abuser during her pregnancy. Although her new baby girl appeared fine, the doctors were still testing the baby for withdrawal symptoms. It was very hard for me to witness the circumstances this newborn was brought into. I instantly felt a sense of rage when I saw the perfect little child and thought of how her own mother could take a substance that could adversely affect the baby. As I entered the mother's room to assess her, my enraged heart softened as I talked with this woman. She was a fairly young, beautiful girl. She was very excited about her new-born and constantly asked if I could get her from the nursery. When I saw this mother holding her sweet baby, I could tell she truly did love her. The judgmental feelings I had felt towards my patient turned to feelings of pity and concern. While I still felt strongly opposed to her drug-taking behaviors, I was able to see past my own beliefs and display some sympathy and compassion for the woman's situation. When I was finished assessing the woman, I walked back to the nurse's station to find the registered nurse (RN) I was paired with for the day talking about my patient to a fellow RN. The nurse was telling the other RN about how my patient was a drug-user and had been divorced. My nurse was hesitating to give my patient pain medication because she felt the mother just wanted a fix. The other nurse seemed to echo these opinions as well. Eventually, my assigned nurse did give the patient the pain pill Percocet, although she did not feel very good about it. I realized at that moment how judgmental people can be of each other. Not only had I previously judged my patient rashly, but now her unpleasant decisions were being spread to other health-care workers that did not need to know about them. My patient was mistrusted when she was in pain based on her past. This presented a true ethical dilemma for me because I know that nurses are supposed to advocate for their patients needs and privacy regardless of any personal opinions or bias.

Discussion

Ethical Principles

The nurse in this situation was faced with the principles of justice and nonmaleficence while trying to cope with her judgmental attitudes towards this mother. To apply justice to her profession would have entailed the nurse giving the same care to the drug-abusing mother as she gave to all other mothers on the floor (Lassetter, 2006a). Although the RN eventually did give the patient the pain medication, the nurse suspected her of wanting to get a high, rather than believing the mother wanted to get out of pain. The nurse may have been trying to use caution in light of the patient's history of recent substance abuse, yet justice in this situation would demand the RN give this woman her medication without reservation just as she had done with other patients.

In exercising nonmaleficence towards this patient, the nurse's prime obligation would be to do no harm to her (Lassetter, 2006a). This nurse did nothing to harm her patient physically, but non- maleficence extends beyond the mere physical. The RN unintentionally harmed the patient's reputation by spreading confidential information to other health-care workers. People that were not directly involved with the mother's care had no business knowing about her life choices. The RN may have had a question about how to care for the patient, but she should have collaborated with the doctor in a private manner. Information spread about the patient's past affected how people thought of her and how some of her care-takers treated her. Had the nurse kept the mother's life-story to herself, the patient would have been looked at by other nurses on the floor as a healthy, new mom.

Is-Ought Fallacy

The Is-Ought Fallacy is committed when someone assumes generalizations about a group of people or a situation. This fallacy plays into the ethical dilemma at hand in that the nurse assumed because the mother was a drug-user, the patient wanted pain pills to get a high instead of to alleviate real pain. The nurse made an assumption about the patient that interfered with her ability to provide adequate pain relief for the mother. Although the nurse may have had previous negative experiences with drug-abusing mothers, she should not have made a generalization about the patient. The 2005 revision of the International Council of Nurses Code of Ethics for Nurses outlines the primary responsibility of an RN as being to the people requiring nursing care. Whether or not the mother was in real pain was beside the point, she was requiring nursing care, and the nurse's primary responsibility is to give care to the patient.

Ethics of Care theory

The nurse could have avoided committing the Is-Ought fallacy by applying the Ethics of Care theory to her practice. This theory deals with emphasizing values such as compassion, love, and sympathy when dealing with patients. The Ethics of Care theory also encompasses an "insight and understanding of the circumstances, thoughts, and needs of others" (Lassetter, 2006b). Many women who abuse drugs during their pregnancy feel the social stigma that is ascribed to them by healthcare workers, and this stigma in many cases discourages these women from seeking prenatal care (Carter, 2002). Clearly, if the nurse could have seen past her own bias to obtain a greater insight and understanding of her patient, she would have transcended making the broad generalizations that so many healthcare workers do. The nurse could have been instrumental in making a difference in the mother's life by treating her with kindness. A deeper knowledge of the patient's needs would have enabled the nurse to establish a relationship of trust between nurse and client. Instead, the nurse chose to break the trust of confidentiality by sharing the patient's private life at the nursing station.

Implications for Clinical Practice

I have learned many things through pondering about this ethical dilemma which will greatly aid me in my nursing practice. I now know that I do have the ability and the responsibility to provide quality care to every patient in my charge, regardless of their individual lifestyle choices, religion, or race. My role as a nurse is to help lift those who are suffering from an illness, be it a physical illness or a spiritual and emotional plight. If I am truly seeking to heal others, I must remember the words and example of the Savior when he said, "man shall not... judge; for judgment is mine" (Mormon 8:20 Book of Mormon). The Savior illustrated the life of a master Healer as He went forth having compassion towards people, regardless of their past or present sins. There will be many times in my practice when I will be faced with a patient who lives contrary to my beliefs. Such a conflict does not give me license to go against ethical principles and treat these people sub-standard, or reveal the details of their personal lives to my co-workers. My first responsibility is to the patient requiring my nursing care, without reservation. I resolve to learn from this situation and do better in the future to exercise compassion and sympathy for those people entrusted to my care, without passing judgment.

Conclusion

Ethics and nursing go hand in hand. When dealing with such delicate matters as a person's private life, nurses must be aware of and strongly committed to ethical principles to guide them. Countless situations will occur in which the values of the nurse and patient conflict. When times such as these arise, nurses need to remember that they are advocates for their patients, not judges of their clients. Nurses can appropriately provide care without compromising their own beliefs by remembering to apply justice and nonmaleficence to their practice. Through living by the Ethics of Care theory, nurses will gain insight into their patient's situation which will help to eliminate personal bias. Nurses will be able to view things from the patient's very individual perspective, instead of committing the Is-Ought Fallacy by making assumptions. The exercise of ethics in nursing practice instead of harsh judgment will bring about trust with patients, allowing nurses to correctly define their patient's needs and to meet them to the best of the nurse's ability.

References

Carter, C.S. (2002). Prenatal care for women who are addicted: implications for gender-sensitive practice.

Journal of Women & Social Work, 17(3), 299-313.

Charles, S., Sivas, T. (2002). Pediatric ethics, issues, & commentary. Mothers in the media: blamed and celebrated -- an examination of drug abuse and multiple births.

Pediatric Nursing, 28(2), 142-145.

International Council of Nurses. (2006).

The ICN code of ethics for nurses. Retrieved January 21,

2007 from http://www.icn.ch/icncode.pdf

Lassetter, J. (2006a).

Summary of ethical principles. Unpublished manuscript, Brigham Young

University, Provo, UT.

Lassetter, J. (2006b).

Summary of ethical theories. Unpublished manuscript, Brigham Young

University, Provo, UT.

Lowdermilk, D., Perry, S., (2007).

Maternity and women's health care, ninthedition

(p.905). Philadelphia: Elsevier's Health Sciences Rights Department.