0
November 28, 1990, Vol 264, No. 20 >
ARTICLE | November 28, 1990

Legal Interventions During Pregnancy: Title and subTitle BreakCourt-Ordered Medical Treatments and Legal Penalties for Potentially Harmful Behavior by Pregnant Women FREE

[+] Author Affiliations

From the Board of Trustees, American Medical Association, Chicago, Ill.

This report was adopted as Report 00 by the House of Delegates of the American Medical Association at the Annual Meeting, June 1990.

Reprint requests to the Board of Trustees, American Medical Association, 515 N State St, Chicago, IL 60610 (Dr Orentlicher).


JAMA. 1990;264(20):2663-2670. doi:10.1001/jama.1990.03450200071034
Text Size: A A A
Published online
Article
References

ORDINARILY, the pregnant woman, in consultation with her physician, acts in all reasonable ways to enhance the health of her fetus. Indeed, clinicians are frequently impressed with the amount of personal health risk undertaken and voluntary self-restraint exhibited by the pregnant woman for the sake of her fetus and to help ensure that her child will be as healthy as possible.1 In a limited number of situations, however, a pregnant woman may reject a medical treatment or procedure that her physician believes would benefit the health of her fetus. For instance, she may refuse to submit to a cesarean section when her physician believes that a cesarean section is in the best interests of the fetus. Or a pregnant woman may behave in ways that are potentially detrimental to fetal well-being, for example, taking illegal drugs while pregnant.

Increasingly, legal interventions are being sought in cases in which the

REFERENCES

1 +
Nelson LJ, Milliken NM.  Compelled medical treatment of pregnant women . JAMA . 1988;;259:1060-1066.
2 +
Annas GJ.  The impact of medical technology on the pregnant woman's right to privacy . Am J Law Med. 1989;;13:213-232.
3 +
Council on Ethical and Judicial Affairs. Current Opinions . Chicago, Ill: American Medical Association; 1989;.
4 +
Winston v Lee, 470 US 753 (1985).
5 +
Skinner v Railway Labor Executives' Ass'n, 109 SCt 1402 (1989).
6 +
Schmerber v California, 384 US 757 (1966).
7 +
Raleigh Fitkin-Paul Morgan Memorial Hospital v Anderson, 201 A2d 537, cert denied, 377 US 985 (1964).
8 +
Application of President and Director's of Georgetown College, 331 F2d 1000 (App DC 1964).
9 +
Kolder VE, Gallagher J, Parsons MT.  Court-ordered obstetrical interventions . N Engl J Med. 1987;;316:1192-1196.
10 +
In re A.C., 573 A2d 1235 (DC 1990).
11 +
Jefferson v Griffin Spalding County Hospital Authority, 274 SE2d 457 (1981).
12 +
Keeton W, Dobbs D, Keeton R, Owen D, eds. Prosserand Keeton on Torts . St Paul, Minn: West Publishing Co; 1984;:  sect 56 .
13 +
McFall v Shimp, 10 Pa D&C 3d 90 (1978).
14 +
 Reporting child abuse and neglect: state laws . In: Sloan IJ, ed. Protection for Abused Victims: State Laws and Decisions . New York, NY: Oceana Publications; 1982;:19.
15 +
Roe v Wade,410US 113(1973).
16 +
Thornburgh v American College of Obstetricians and Gynecologists, 476 US 747 (1986).
17 +
Johnsen D.  The creation of fetal rights: conflicts with women's constitutional rights to liberty, privacy, and equal protection . Yale Law J. 1986;;95:599-625.
18 +
Murray TH.  Moral obligations to the not-yet-born: the fetus as patient . Clin Perinatol. 1987;;14:329-343.
19 +
Committee on Ethics. Patient Choice: Maternal/Fetal Conflict . Washington, DC: American College of Obstetricians and Gynecologists; 1987;.
20 +
Annas GJ.  Protecting the liberty of pregnant patients . N Engl J Med. 1987;;316:1213-1214.
21 +
Kirkwood KS, Luthy DA, Bennett FC, et al.  Effects of electronic fetal-heart—rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants . N Engl J Med. 1990;;322:588-593.
22 +
Freeman R.  Intrapartum fetal monitoring: a disappointing story . N Engl J Med. 1990;;322:624-625.
23 +
Annas GJ.  Forced cesareans: the most unkindest cut of all . Hastings Cent Rep. (June) 1982;;12:16-17,45.
24 +
Field MA.  Controlling the woman to protect the fetus . Law Med Health Care. 1989;;17:114-129.
25 +
Chasnoff IJ.  Drug use and women: establishing a standard of care . Ann NY Acad Sci. 1989;;562:208-210.
26 +
 Cocaine babies: issue for the courts? Am Med News. 1989;;3:41.
27 +
American Medical Association Board of Trustees Report. Drug Abuse in the United States: The Next Generation . Interim 1989;.
28 +
Chasnoff IJ, Burns WJ, Schnoff SH, et al.  Cocaine use in pregnancy . N Engl J Med. 1985;;313:666.
29 +
Acker D, Sachs BP, Tracey KJ, Wise WE.  Abruptio placentae associated with cocaine use . Am J Obstet Gynecol. 1983;;146:220-221.
30 +
Revkin AC.  Crack in the cradle . Discover . (September) 1989;;10:63-69.
31 +
Zuckerman B, Frank DA, Hingson R, et al.  Effects of maternal marijuana and cocaine use on fetal growth . N Engl J Med. 1989;;320:762-768.
32 +
Chasnoff IJ, Griffith DR, MacGregor S, et al.  Temporal patterns of cocaine use in pregnancy . JAMA . 1989;;261:1741-1744.
33 +
Dixon SD.  Effects of transplacental exposure to cocaine and methamphetamine on the neonate . West J Med. 1989;;150:436-442.
34 +
Chasnoff IJ.  Drug use in pregnancy: parameters of risk . Pediatr Clin North Am. 1988;;82:888-895.
35 +
Pritchard J, MacDonald P, Gant N, eds. Williams Obstetrics . Norwalk, Conn: Appleton-Century-Crofts; 1985;.
36 +
Sachs BP.  Sharing the cigarette: the effects of smoking in pregnancy . In: Rosenberg MJ, ed. Smoking and Reproductive Health . Littleton, Mass: PSG Publishing Co; 1985;:144.
37 +
Murphy JF, Mulcahy R.  Cigarette smoking and spontaneous abortion . BMJ . 1978;;1:1988.
38 +
Shaw MW.  Conditional prospective rights of the fetus . J Leg Med. 1984;;5:63-116.
39 +
Colsher PL, Wallace RB.  Is modest alcohol consumption better than none at all? Ann Rev Public Health . 1989;;10:203-221.
40 +
Streissguth AP, Landesman-Dwyer S, Martin JC, et al.  Teratogenic effects of alcohol in humans and laboratory animals . Science . 1980;;209:353.
41 +
Hadi HA, Hill JA, Castillo RA.  Alcohol and reproduction: a review . Obstet Gynecol Surv. 1987;;42:69.
42 +
Council on Scientific Affairs. Fetal Effects of Maternal Alcohol Abuse . Chicago, Ill: American Medical Association; 1989;.
43 +
American Civil Liberties Union.  Criminal prosecutions for fetal abuse increasing at alarming rate . Reprod Rights Update . (September 1) , 1989;;1:2.
44 +
California v Stewart, Civ No. 575396 (Mun Ct Calif, San Diego County, 1987).
45 +
Florida v Johnson, Case No. E89-890-CFA (Seminole County Cir Ct, July 13,1989).
46 +
Moss DC.  Pregnant? go directly to jail . ABA J. (November 1) , 1988;;74:20.
47 +
New York Times . (January 9) , 1989;;col 1:A1.
48 +
Nurmi J, LeClair V.  Fetal rights prompts judge's decision . Potomac Gazette . (February 14) , 1990; sect A:2.
49 +
Matter of Steven S., 126 Cal App 3d 23,178 Cal Rptr 525 (1981).
50 +
Reyes v Superior Court of California, 75 Cal App 3d 214,141 Cal Rptr 912 (Cal Ct App 1977).
51 +
Coordinating Federal and Drug Policy for Women, Infants, and Children. Hearings before the Senate Committee on Governmental Affairs, 101st Cong, 1st Sess (1989).
52 +
American Civil Liberties Union. Reproduct Rights Update . February 3, 1990;; 2 (no. (3) ).
53 +
Barry EM.  Pregnant prisoners . Harvard Women's Law J. 1989;;12:189-205.
54 +
 Drug use at Lorton 'disturbing': increased demand by prisoners feared . Wash Post , (July 3) , 1989;; sect B:1.
55 +
 Drug Abuse in the United States: a policy report . In: Proceedings of the House of Delegates, 137th annual meeting of the Board of Trustees of the American Medical Association; June 26-30,1988 ;
56 +
Chasnoff IJ, Landress HJ, Barrett ME.  The prevalance of illicit drug use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida . N Engl J Med. 1990;;322:1202-1206.
57 +
Hughes D, Johnson K, Rosenbaum S, Simons J.  The health of America's mothers: trends in access to care . Clearinghouse Rev. 1986;;20:472.
58 +
Gold K.  Paying for maternity care . Fam Plann Perspect. 1985;;17:103-111.
59 +
 Pregnancy police: the health policy and legal implications of punishing pregnant women for harm to their fetuses . Rev Law Soc Change . 1987;-1988;16:277-319.
60 +
Robertson JA.  Procreative liberty and the control of contraception, pregnancy, and childbirth . Va Law Rev. 1983;;69:405-464.
61 +
 Baby's drug death stirs mothers' rights flap . Chicago Tribune . (May 10) , 1989;; sect 1:1.
62 +
California v Stewart, Civ No. 575396 (Mun Ct Calif, San Diego County, 1987). Testimony of Gladden V. Elliott, MD, president, California Medical Association. (This statement constitutes the public policy position of CMA on the propriety of using criminal law to enforce a prenatal duty of care.)
63 +
Note.  Maternal rights and fetal wrongs: the case against the criminalization of'fetal abuse.' Harv L Rev. 1988;;101:994.
64 +
Regan DO, Ehrlich SM, Finnegan LP.  Infants of drug addicts: at risk for child abuse, neglect, and placement in foster care . Neurotoxicol Teratol. 1987;;9:315-317.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Nelson LJ, Milliken NM.  Compelled medical treatment of pregnant women . JAMA . 1988;;259:1060-1066.
2 +
Annas GJ.  The impact of medical technology on the pregnant woman's right to privacy . Am J Law Med. 1989;;13:213-232.
3 +
Council on Ethical and Judicial Affairs. Current Opinions . Chicago, Ill: American Medical Association; 1989;.
4 +
Winston v Lee, 470 US 753 (1985).
5 +
Skinner v Railway Labor Executives' Ass'n, 109 SCt 1402 (1989).
6 +
Schmerber v California, 384 US 757 (1966).
7 +
Raleigh Fitkin-Paul Morgan Memorial Hospital v Anderson, 201 A2d 537, cert denied, 377 US 985 (1964).
8 +
Application of President and Director's of Georgetown College, 331 F2d 1000 (App DC 1964).
9 +
Kolder VE, Gallagher J, Parsons MT.  Court-ordered obstetrical interventions . N Engl J Med. 1987;;316:1192-1196.
10 +
In re A.C., 573 A2d 1235 (DC 1990).
11 +
Jefferson v Griffin Spalding County Hospital Authority, 274 SE2d 457 (1981).
12 +
Keeton W, Dobbs D, Keeton R, Owen D, eds. Prosserand Keeton on Torts . St Paul, Minn: West Publishing Co; 1984;:  sect 56 .
13 +
McFall v Shimp, 10 Pa D&C 3d 90 (1978).
14 +
 Reporting child abuse and neglect: state laws . In: Sloan IJ, ed. Protection for Abused Victims: State Laws and Decisions . New York, NY: Oceana Publications; 1982;:19.
15 +
Roe v Wade,410US 113(1973).
16 +
Thornburgh v American College of Obstetricians and Gynecologists, 476 US 747 (1986).
17 +
Johnsen D.  The creation of fetal rights: conflicts with women's constitutional rights to liberty, privacy, and equal protection . Yale Law J. 1986;;95:599-625.
18 +
Murray TH.  Moral obligations to the not-yet-born: the fetus as patient . Clin Perinatol. 1987;;14:329-343.
19 +
Committee on Ethics. Patient Choice: Maternal/Fetal Conflict . Washington, DC: American College of Obstetricians and Gynecologists; 1987;.
20 +
Annas GJ.  Protecting the liberty of pregnant patients . N Engl J Med. 1987;;316:1213-1214.
21 +
Kirkwood KS, Luthy DA, Bennett FC, et al.  Effects of electronic fetal-heart—rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants . N Engl J Med. 1990;;322:588-593.
22 +
Freeman R.  Intrapartum fetal monitoring: a disappointing story . N Engl J Med. 1990;;322:624-625.
23 +
Annas GJ.  Forced cesareans: the most unkindest cut of all . Hastings Cent Rep. (June) 1982;;12:16-17,45.
24 +
Field MA.  Controlling the woman to protect the fetus . Law Med Health Care. 1989;;17:114-129.
25 +
Chasnoff IJ.  Drug use and women: establishing a standard of care . Ann NY Acad Sci. 1989;;562:208-210.
26 +
 Cocaine babies: issue for the courts? Am Med News. 1989;;3:41.
27 +
American Medical Association Board of Trustees Report. Drug Abuse in the United States: The Next Generation . Interim 1989;.
28 +
Chasnoff IJ, Burns WJ, Schnoff SH, et al.  Cocaine use in pregnancy . N Engl J Med. 1985;;313:666.
29 +
Acker D, Sachs BP, Tracey KJ, Wise WE.  Abruptio placentae associated with cocaine use . Am J Obstet Gynecol. 1983;;146:220-221.
30 +
Revkin AC.  Crack in the cradle . Discover . (September) 1989;;10:63-69.
31 +
Zuckerman B, Frank DA, Hingson R, et al.  Effects of maternal marijuana and cocaine use on fetal growth . N Engl J Med. 1989;;320:762-768.
32 +
Chasnoff IJ, Griffith DR, MacGregor S, et al.  Temporal patterns of cocaine use in pregnancy . JAMA . 1989;;261:1741-1744.
33 +
Dixon SD.  Effects of transplacental exposure to cocaine and methamphetamine on the neonate . West J Med. 1989;;150:436-442.
34 +
Chasnoff IJ.  Drug use in pregnancy: parameters of risk . Pediatr Clin North Am. 1988;;82:888-895.
35 +
Pritchard J, MacDonald P, Gant N, eds. Williams Obstetrics . Norwalk, Conn: Appleton-Century-Crofts; 1985;.
36 +
Sachs BP.  Sharing the cigarette: the effects of smoking in pregnancy . In: Rosenberg MJ, ed. Smoking and Reproductive Health . Littleton, Mass: PSG Publishing Co; 1985;:144.
37 +
Murphy JF, Mulcahy R.  Cigarette smoking and spontaneous abortion . BMJ . 1978;;1:1988.
38 +
Shaw MW.  Conditional prospective rights of the fetus . J Leg Med. 1984;;5:63-116.
39 +
Colsher PL, Wallace RB.  Is modest alcohol consumption better than none at all? Ann Rev Public Health . 1989;;10:203-221.
40 +
Streissguth AP, Landesman-Dwyer S, Martin JC, et al.  Teratogenic effects of alcohol in humans and laboratory animals . Science . 1980;;209:353.
41 +
Hadi HA, Hill JA, Castillo RA.  Alcohol and reproduction: a review . Obstet Gynecol Surv. 1987;;42:69.
42 +
Council on Scientific Affairs. Fetal Effects of Maternal Alcohol Abuse . Chicago, Ill: American Medical Association; 1989;.
43 +
American Civil Liberties Union.  Criminal prosecutions for fetal abuse increasing at alarming rate . Reprod Rights Update . (September 1) , 1989;;1:2.
44 +
California v Stewart, Civ No. 575396 (Mun Ct Calif, San Diego County, 1987).
45 +
Florida v Johnson, Case No. E89-890-CFA (Seminole County Cir Ct, July 13,1989).
46 +
Moss DC.  Pregnant? go directly to jail . ABA J. (November 1) , 1988;;74:20.
47 +
New York Times . (January 9) , 1989;;col 1:A1.
48 +
Nurmi J, LeClair V.  Fetal rights prompts judge's decision . Potomac Gazette . (February 14) , 1990; sect A:2.
49 +
Matter of Steven S., 126 Cal App 3d 23,178 Cal Rptr 525 (1981).
50 +
Reyes v Superior Court of California, 75 Cal App 3d 214,141 Cal Rptr 912 (Cal Ct App 1977).
51 +
Coordinating Federal and Drug Policy for Women, Infants, and Children. Hearings before the Senate Committee on Governmental Affairs, 101st Cong, 1st Sess (1989).
52 +
American Civil Liberties Union. Reproduct Rights Update . February 3, 1990;; 2 (no. (3) ).
53 +
Barry EM.  Pregnant prisoners . Harvard Women's Law J. 1989;;12:189-205.
54 +
 Drug use at Lorton 'disturbing': increased demand by prisoners feared . Wash Post , (July 3) , 1989;; sect B:1.
55 +
 Drug Abuse in the United States: a policy report . In: Proceedings of the House of Delegates, 137th annual meeting of the Board of Trustees of the American Medical Association; June 26-30,1988 ;
56 +
Chasnoff IJ, Landress HJ, Barrett ME.  The prevalance of illicit drug use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida . N Engl J Med. 1990;;322:1202-1206.
57 +
Hughes D, Johnson K, Rosenbaum S, Simons J.  The health of America's mothers: trends in access to care . Clearinghouse Rev. 1986;;20:472.
58 +
Gold K.  Paying for maternity care . Fam Plann Perspect. 1985;;17:103-111.
59 +
 Pregnancy police: the health policy and legal implications of punishing pregnant women for harm to their fetuses . Rev Law Soc Change . 1987;-1988;16:277-319.
60 +
Robertson JA.  Procreative liberty and the control of contraception, pregnancy, and childbirth . Va Law Rev. 1983;;69:405-464.
61 +
 Baby's drug death stirs mothers' rights flap . Chicago Tribune . (May 10) , 1989;; sect 1:1.
62 +
California v Stewart, Civ No. 575396 (Mun Ct Calif, San Diego County, 1987). Testimony of Gladden V. Elliott, MD, president, California Medical Association. (This statement constitutes the public policy position of CMA on the propriety of using criminal law to enforce a prenatal duty of care.)
63 +
Note.  Maternal rights and fetal wrongs: the case against the criminalization of'fetal abuse.' Harv L Rev. 1988;;101:994.
64 +
Regan DO, Ehrlich SM, Finnegan LP.  Infants of drug addicts: at risk for child abuse, neglect, and placement in foster care . Neurotoxicol Teratol. 1987;;9:315-317.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems