Procreative Responsibility

Module 10: Procreative Responsibility

Reading:

Haack in Steinbock et al., “Case Study: Melissa Rowland,” pp. 595-596.

Minkoff and Paltrow in Steinbock et al., “Melissa Rowland and the Rights of pregnant Women,” pp. 596-599.

Haack in Steinbock et al., “The Rights and Responsibilities of Pregnant Women,” pp. 599-602.

Buchanan et al. in Steinbock et al., “Reproductive Freedom and Prevention of Genetically Transmitted Harmful Conditions,” pp. 602-608.

Asch in Steinbock et al., “Prenatal Diagnosis and Selective Abortion,” pp. 609-619.

Steinbock in Steinbock et al., “Disability, Prenatal Testing, and Selective Abortion,” pp. 619-627.

Overview

The chapter on procreative responsibility begins with the case study of Melissa Rowland, 28, who was charged with murder and child endangerment (later convicted of the lesser crime of child endangerment) for ignoring physician advise to have a cesarean section which resulted in the death of one of the twins she was caring. The case study cites several facts about Ms. Rowland that incline the reader to think of her as an individual of questionable character—she had mental problems (oppositional defiant disorder), she had a criminal record (grand larceny and endangerment of other child). Her other children were given up for adoption.

In addition to these non-medical facts, Ms. Rowland did not seek prenatal care for the twins she was carrying. She refused physician’s recommendation to report to the hospital immediately when she reported no fetal movement, and when she did report two days later she refused physician’s recommendation to have an emergency cesarean. Mrs. Rowland left the hospital against physician advice. She returned a week later to see if the twins were still alive. No fetal heartbeat was found in one of the twins. Again, she ignored physician advise for an immediate cesarean and left the hospital. She returned to one of the hospitals four days later and then agreed to a cesarean. One of twins was stillborn. The other tested positive for cocaine and alcohol. Mrs. Roland escaped the charge of murder by pleading guilty to the lesser crime of child endangerment.

The core question in this module is this: To what extent can a woman be held accountable for preventable harm to her unborn child? Does a pregnant woman have the right to refuse treatment when her refusal would endanger her unborn child? If pregnant women do not have the right to refuse treatment in cases in which refusal is likely to endanger their unborn children, what do we make of the notion of informed consent?

Minkoff and Paltrow argue that the conviction of Mrs. Rowland sets an unfortunate precedent by denying the right to informed consent. On their view, pregnant women should not be compelled to undergo surgery against their will. I wish to pause here and ask a question: how much of your position on the case of Mrs. Rowland is the result of the description of Mrs. Roland (as a person of questionable character) and how much of position is based on the fact that she refused an invasive medical procedure that resulted in the death of the fetus?

Suppose we tell the story of Mrs. Smith, a happily married mother of two boys. She was excited because tests revealed she was pregnant with twin girls. Suppose Mr. and Mrs. Smith evaluate the physician’s recommendation to have an immediate cesarean but after deliberation they choose natural childbirth. As a result of their decision, one of the twins is stillborn. Should one expect charges of murder to be forthcoming?

Suppose next we tell the story of Mrs. Jones, who is also pregnant with twins. Because of complications, the doctor recommends Mrs. Jones undergo an emergency abortion—if she does not remove one of the twins, the other will very likely die. Mrs. Jones is very religious and believes abortion is immoral. As a result of her refusal to undergo the recommended medical procedure, both twins die. Would you expect charges of murder to be filed?

In “The Rights and Responsibilities of Pegnant Women” Susan Haack criticizes the position advanced by Minkoff and Paltrow. Haack argues that the woman’s decision to carry a fetus to term places special obligations on her that limit autonomy. Her basic argument is that autonomy is not a right or an absolute moral principle. There are limits on individual autonomy.

At this point Buchanan et al. introduce a twist: if a woman refuses prenatal genetic testing and the fetus is born with a genetic abnormality, has the woman harmed the fetus? Buchanan et al. suggest that there may be some cases in which bringing a genetically defective fetus to term may be morally wrong.

In the next reading Asch questions the routine use of pre-natal genetic testing. She notes that women do not universally accept such tests, and often may be negatively affected by having to make decisions on the basis of test results. For example, should physicians recommend tests such as amniocentesis as a matter of routine care? Ash suggests that if the tests indicate a high probability of Down’s Syndrone, the woman may not welcome the decision of whether to continue with the pregnancy. Asch questions the prevailing view in medicine that the elimination of disability is a noble pursuit. In many cases, disability may be a natural variability of trait in the human population. The attempt to eliminate this natural variability is an affront to those suffering disability, for it sends the message “people like you are unwanted.”

In the final reading for this module Bonnie Steinbock criticizes the view advanced by Asch. Steinbock argues that the decision to undergo pre-natal genetic testing is a personal one. The fact that some parents choose not to bring an impaired fetus to term in no way disrespect individuals living with disability.

Objectives

By the end of this unit, I will be able to:

· Appreciate the difficulties applying the principles of autonomy and informed consent to cases involving pregnant women

· Discuss whether the principles of autonomy and informed consent are absolute or prima facie duties

· Distinguish between invasive surgical procedures and routine medical care

· Appreciate the moral issues surrounding prenatal genetic testing

· Assess the implications of prenatal genetic testing with selective discard for those living with disability

Key Concepts

· Principle of autonomy

· Informed Consent

· Child Endangerment

· Human Genome Project

· Prenatal Genetic Testing

· Selective Discard

Review Questions

[1] Describe the central features of the case of Mrs. Rowland.

[2] Describe the central features of the case of Mrs. Smith.

[3] Describe the central features of the case of Mrs. Jones.

[4] Do you think any of the women in these cases should be charged with the crime of endangerment to the life of their unborn child? Should they be charged with murder?

[5] Minkoff and Paltrow argue that charging Mrs. Rowland sets a dangerous precedent curtailing the rights of pregnant women. Discuss.

[6] Haack criticizes the viewpoint advanced by Minkoff and Paltrow, arguing that the principle of autonomy is not absolute. Discuss.

[7] What is prenatal genetic testing? What diseases can geneticists currently screen for? What is a probable diagnosis?

[8] Do an Internet search using the key term “Human Genome Project.” Briefly explain the implication of this research for biomedical ethics.

[9] Consider the argument advanced by Buchanan. Do you think there are cases in which couples are morally obligated to utilize prenatal genetic testing and selective discard?

[10] Asch is critical of the routine use of prenatal genetic testing. Discuss.

[11] Asch contends that disability is a naturally occurring expression of genetic diversity and hence not something to be stamped out by the progressive advance medicine. Do you agree with her assessment?

[12] Asch argues that the drive eradicate disability creates the image that disabled persons lack worth. Discuss.

[13] Do you think the goal of eradicating disability is inherently discriminatory? How does Steinbock answer this question?

Discussion Question

Is autonomy an absolute moral principle? Discuss this question within the context of Mrs. Rowland, Mrs. Smith and Mrs. Jones. Do you think it is wrong for a pregnant woman to refuse medical advise in cases in which her refusal endangers the fetus? If so, do you think it is equally wrong for couples at risk for conceiving genetically defective offspring to refuse prenatal genetic testing and selective abortion? Do an Internet search for “Hallopeau Siemens Syndrome.” Describe this syndrome. Do you think it is morally wrong for a coupe at risk to refuse prenatal genetic testing? Do you think it is morally wrong for a woman to bring a fetus with Hallopeau Siemens Syndrome to term?

(Minimum Word Count: 500 Words)