From: Healthcare Administrator, Alabama
Date: 19th
October 2017
Subject: Ethical Dilemma: Conducting Drug Tests without Consent in Alabama
In many states of the U.S., the use of drugs during pregnancy is illegal under the chemical endangerment to the newborns as they may grow dependent on the same (Martin, 2015). As a result, the hospital bills are high as evident in the increase between the year 2009 and 2012 by double, where $1.5 billion was used for withdrawal treatment in children (Martin, 2015). However, different states differ regarding the legislation of law enforcement on the culpability of the mother, if drug tests reveal usage of drugs during pregnancy. In the case of Alabama, the punishment is among the stiffest since a mother can serve up to ten years in prison if traces of drugs are found, up to 20 if found on the baby, and up to 99 if it leads to the death of the baby (Martin, 2015). In other states, they recognize the usage of drugs during pregnancy as child abuse, but they do not hold charges against them. Instead, they use the opportunity to develop a clinical intervention to increase prenatal care and increase the level of awareness regarding the use of drugs (Haug et al., 2014).
In the survey by Martin (2015), the individual found out that in addition to running drug tests on mothers and newborn babies without the explicit consent of the patient by Alabama hospitals, most of the counties have enacted a requirement that the hospital report such cases to enforce the law. In light of this, the state accounts for most court cases involving child services and the mothers using drugs. However, some argument from the professional standards of the healthcare individuals, compliance with state laws, and provisions of the fourth amendment oppose such laws. The hospital staff is presented with an ethical dilemma of the nature of consent by the patient, sharing hospital records without the approval of a patient which is against their code of conduct, and the primary role of caregiving through an explicit explanation of the purpose of the tests (Hosek & Straus, 2013). In light of this situation, the memo addresses the ethical issues involved, proposes alternative ways of solving the drug test problem, and suggests recommendation in the capacity of a healthcare administrator which is helpful to mitigate the escalation of the looming conflict of patient rights, code of conduct, and compliance with laws.
There are three critical ethical issues under the moral practice of healthcare providers which include privacy of personal information, patient consent for the use of their data by a third party, and the search and seizure of the fourth federal amendment (Hosek & Straus, 2013). Professionally, the physicians have a code of conduct which is compliance with the national and federal standards of healthcare. In the discharge of their duties, therefore, they are not allowed to share information that can personally identify a patient to a third party unless at the patient's request, or a guardian in the case of a child. On the other side, the state of Alabama has an existing law requiring them to report the same to enforce the law (Martin, 2015). The move does not only contradict the conduct of caregivers but also goes against beliefs such as a mother should not be separated from a child due to healthy growth. Of more importance is the consent issue whereby patients sign forms with vague information about the nature of tests hence staff run drug tests without the knowledge of the patient (Hosek & Straus, 2013). Submitting such information obtained without knowledge of an individual, and further criminal culpability is against the provisions of the fourth amendment regarding illegal search and seizure (Martin, 2015). Therefore, the healthcare professionals have an ethical dilemma of what is the right decision to take.
In light of this, the following alternative solutions and recommendations towards solving the problem of drug use during pregnancy are through my role as the healthcare administrator of the hospital, responsible for its management.
One of the alternatives is the community is the policing agents to seek community policing strategies to help reduce rates of addiction, and control the availability of drugs. Also, through collaboration with health institutions in Alabama, the healthcare programs can be enrolled to encourage prenatal care hence prevention of drug use during pregnancy rather than putting them in fear of being arrested (Haug et al., 2014).
The recommendations include clarity in consent to drug tests, repealing the law of mandatory reporting by healthcare providers to protect the profession, and collaboration in community nursing and health programs aimed at not only reduction and stoppage of drug use but also the accessibility of prenatal care especially on expectant mothers. Through arresting and charging new mothers for chemical endangerment, the process negates the real problem. Some mothers may not come to the hospital to give birth for fear of going to jail. Besides some of the approaches such as lack of prenatal care do not imply usage of drugs as some cannot afford insurance, or poor. Further, there is a case of Shehi, a patient charged with drug usage though it was found out it was the use of valium to help her sleep (Martin, 2015). Therefore, in discharging its ethical practice, punishing the offenders or forcing tests on people does not yield results. Instead, addressing the prenatal care and health education to the public can change the perception of the mothers, and encourage seeking medical help to ensure a healthy baby is born.
The evaluation of the success of the recommendations is through assessing the achievement of reduced cases of drug use during pregnancy by using the performance indicators. They include an increased number of mothers assessing medical care, positive reception of the community towards drug tests, and improved commitment of hospital staff through clarity in consent forms and seeking approvals of patients before sharing information with third parties.
References
Haug, N., Duffy, M., & McCaul, M. (2014). Substance Abuse Treatment Services for Pregnant Women.Obstetrics And Gynecology Clinics Of North America, 41(2), 267-296. http://dx.doi.org/10.1016/j.ogc.2014.03.001
Hosek, S., & Straus, S. (2013). Patient Privacy, Consent, and Identity Management in Health Information Exchange. Rand Health Quarterly, 3(2). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945174/
Martin, N. (2015). How Some Alabama Hospitals Quietly Drug Test New Mothers Without Their Consent. ProPublica. Retrieved 19 October 2017, from https://www.propublica.org/article/how-some-alabama-hospitals-drug-test-new-mothers-without-their-consent
