Britney, age 17, has been referred because of problems at school and a shoplifting charge. She admits to “smoking some dope” every now and then and having a drink or two with her friends. She is dressed in black with pierced ears, nose, and lip. Her appearance is disheveled and her hygiene poor. She appears to be overly thin. Britney’s parents were divorced when she was 5 years old. She has a brother who is 5 years older. They used to live with their mother in the same town as their father.
Britney saw him frequently, although she says he was “always busy with work” and she could never talk to him about much of anything. Britney states that her mother was also busy but would “usually” stop and listen. She reports that her mother has a temper and is stressed all the time about money and work. She also reports that her mom and dad still fight about money and “us kids. ” She feels like she is in the middle and is always being asked to choose. Britney feels caught in the middle of conflict between her parents. She interprets their being too busy for her as not being wanted by them.
Britney’s rebellion serves to distract her mother and father from their fighting and to unite them as they attempt to control her behavior. It also serves to help solve the dilemma of whether she should leave home, leaving her mother alone. She distances herself by using drugs and alcohol but cannot really leave home and her mother because of her irresponsible behavior. Her brother has the role of doing well in the family, being responsible while the parents are in conflict. Through the use of their roles, the estranged family continues to function, albeit less than satisfactorily.
Britney and her mother and brother recently moved to a new area, and Britney is at a new school this year. She is currently in 10th grade and has average grades. Her new friends are “different” from her old friends, but they “accept her for what she is. ” Britney found acceptance in a counterculture when she felt rejection at home. With divorced parents, a distant father, overly stressed mother, and parents arguing over the kids, Britney has poor self-esteem and feels that she is the cause of some of the problems. She finds that using drugs with other kids relieves boredom, fear, and loneliness.
She feels accepted and acceptable when she is using with them. The main ethical concerns presented in the dilemma with references to the ethics Britney uses cocaine when with friends. She learned that using helps her fit in—be “one of the gang. ” She described a new, well-defined group of peers who “I like to hang out with and party with. ” She is even supplied by a male classmate at school who impregnated her while they are high on drugs and sex. In addition, she has had some moderate school-related problems (e. g. , lateness) and a shoplifting charge.
She entered a guilty plea for shoplifting. But approximately two weeks before her sentencing hearing, Britney inform the judge and her substance abuse counselor that she was pregnant and is still on drugs. Hence, the complexity of this ethical dilemma arises. This case taps into the substance abuse counselor many layers of personal and professional beliefs. However, careful reading of the case reveals a firm commitment to consider – not ignore – fetal interests within the framework of respect for the autonomy of the competent pregnant teenager.
The case presented clearly relate to situations in which the pregnant teenager is deemed incompetent. Hence, the counselor needs a clear insight into the right approach to take when a medical intervention can benefit both fetus and mother, as in the case of Britney who is a teenager and is addicted to or abuses drugs. Application of human service profession theories and techniques In this analysis, I bring some issues and concepts of feminist ethics, post-modernism, and critical theory to reflect on an important child’s issue-policy approaches to pregnant teenager who is polysubstance user.
Many people, including many law enforcement officials, child protection agents, and legislators, think that teenagers who use drugs during pregnancy should be punished for the harm or risks of harm they bring to their babies. I analyze this punishment approach and argue that the situation of pregnant teenager addicts does not satisfy the conditions usually articulated by philosophers to justify punishment. A punishment approach, moreover, may have sexist and racist implications and ultimately operates more to maintain a social distinction between insiders and deviants than to protect children.
Most of those who criticize a punishment approach to policy for pregnant addicts call for meaningful treatment programs as an alternative. I interpret this treatment approach as a version of a feminist ethic of care. For the most part, theorizing about the ethics of care has remained at the level of ontology and epistemology, with little discussion of how the ethics of care interprets concrete moral issues differently from more traditional approaches to ethics.
By conceptualizing a treatment approach to pregnant teenage addict as justified by an ethics of care, I propose to understand this ethics of care as a moral framework for social policy. Although I agree with a treatment approach to policy for pregnant teenage addicts, from a feminist point of view there are reasons to be suspicious of many aspects of typical drug treatment. Relying on Michel Foucault’s notions of disciplinary power and the operation of “confessional” discourse in therapy, I argue that treatment often operates to adjust women to dominant gender, race, and class structures and depoliticizes and individualizes their situations.
Thus, I conclude by offering a distinction between two meanings of empowerment in service provision, one that remains individualizing, and one that develops social solidarity through consciousness raising and the possibility of collective action. Punishment Punitive legislation regarding pregnant addicts has been considered in more than thirty states and by the U. S. Congress. Although the testimony of legal and medical experts appears to have succeeded in preventing the passage of congressional legislation, at least eight states now include drug exposure in utero in their definition of child abuse and neglect.
In several states without such laws, prosecutors have used existing drug-trafficking laws to file criminal charges against women who use cocaine or other controlled substances during pregnancy. By July 1992 at least 167 women in twenty-six states had been arrested and charged criminally because of their use of drugs during pregnancy or because of some other prenatal risk. A number of these women have been found guilty and sentenced to as many as ten years in prison. The majority of these cases have involved women of color, even though white women also use illegal drugs.
The controversy that has been boiling about this punishment approach to policy for pregnant addicts appears in some of the appeals of these convictions. As of November 1992, twenty-one cases had been challenged or appealed, and all of these were dismissed or overturned (Roberts, 1991) As a result of increasing controversy over such punitive policies, some state and local governments have encouraged treatment as a complement or alternative to criminal punishment or child removal. Thus, California has enacted a law that requires drug treatment programs to give priority to pregnant women.
The state of Connecticut has mandated that outreach workers seek out addicted mothers and mothers-to-be to encourage them to get treatment. In the fall of 1991, the city of New York instituted a program that allows addicted women to take their babies home after birth, provided that they enter treatment and agree to weekly visits from a social worker (Larson1991). This program and many others that emphasize treatment over punishment nevertheless retain a punitive tendency to the degree that they are coercing women to have treatment.
Most prosecutors and policymakers who have pursued a punishment approach to pregnant addicts would deny that racist and sexist biases inform their practices. They claim instead that they are exercising their obligations as state agents to protect infants from harm and to hold accountable those responsible for such harms when they occur. Women who take cocaine or heroin while pregnant are wantonly and knowingly risking the lives or health of future persons and deserve to pay for such immoral harm.
Punishing women who give birth to drug-affected babies serves notice to others that the state considers this a grave wrong and will thus deter such behavior. As with most punishments, the primary justifications for punitive policies toward pregnant addicts are deterrence and retribution. Neither justification, however, is well grounded. A deterrence theory of punishment relies on an assumption that people engage in some kind of cost benefit calculation before taking the actions the policies are aimed at. In some contexts this makes sense.
If a city wishes to discourage illegal parking, it raises the fines and threatens to tow, and these policies usually do work to reduce infractions. The idea that a pregnant addict weighs the benefits of taking drugs against the costs of possible punishment, however, is implausible, because it assumes that it is within her power to refrain from taking drugs if she judges that the costs are too high. Many health professionals argue that punitive policies toward pregnant addicts does deter them from seeking prenatal care (Mann, 1991).
Women are likely to avoid contact with healthcare providers if they believe that their drug use will be reported to state authorities who will punish them. Because drug-using pregnant women’s fetuses and babies are often at particularly high risk, they need prenatal attention even more than most. Experts claim that the harmful effects of drug use on infants can be offset, at least in part, by good prenatal care, when health professionals are aware of a woman’s drug use in a supportive nonpunitive atmosphere (Paltrow, 1990)
I think that retribution is most often implicitly or explicitly the operative justification for punitive approaches to pregnant addicts. These women ought to be punished and threatened with punishment because their wrongful actions deserve sanction. Such a retributive justification for a punitive approach to pregnant addicts must assume that these women are responsible both for their drug use and for their pregnancies; if freedom is a condition for assigning responsibility, however, these are problematic assumptions.
Most states where punitive policies toward pregnant addicts have been pursued do not prosecute people for drug use alone. Especially where this is so, women are essentially being punished for carrying a pregnancy to term. Such punishment must presuppose that women are responsible for being pregnant, but there are several social conditions that limit women’s choice to be or not be pregnant. Ours is still a society where women often are not really free in their sexual relations with men.
Access to contraception, moreover, is not easy for many women, especially poor or young women. And, of course, even when they have it, the contraception sometimes does not work. With rapidly decreasing access to abortion for all women in the United States, but especially for young or poor women, finally, fewer and fewer women have a choice about whether to carry a pregnancy to term (Lewin, 1992). Some prosecutors and policies claim to use a punishment approach primarily as means of encouraging or forcing women into drug treatment.
In line with the above arguments, one might say that a pregnant addict is morally blameworthy for harming her child only if she does not seek help in dealing with her drug use. In recent years some small steps have been taken to increase the availability of drug treatment for pregnant women, and to design programs specifically for their needs; for the most part, however, access to more than perfunctory drug treatment is limited. Most programs either do not accept pregnant women or have waiting lists that extend long beyond their due dates.
Most private health insurance programs offer only partial reimbursement for treatment, and in many states Medicaid will reimburse only a portion of the cost of drug treatment. Most treatment programs are designed with men’s lives in mind, and very few have childcare options. Mandatory reporting laws or other procedures that force women into treatment, moreover, create an adversary and policing relation between healthcare providers and the women they are supposed to serve, thereby precluding the trust relationship most providers believe is necessary for effective drug therapy( Chavkin, 1991).
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