Chavkin W, Breitbart V
The Center for Population and Family Health, Columbia University School of Public Health, New York, USA.
Womens Health Issues. 1996 Mar-Apr;6(2):89-96. doi: 10.1016/1049-3867(95)00078-X.
We recognize that many of the issues raised are not simple. Our proposal calls for the same thoughtful deliberation applied in other settings to be brought to bear on reproductive health care. Some have already tried alternative approaches. In Albuquerque, New Mexico, a university hospital neonatologist and the district attorney have collaborated to create an alternative to sentencing program for women who are arrested for drug-related crimes and found to be both pregnant and drug addicted. Rather than proceed with criminal sanctions, these women are offered entry into a drug treatment program that is geared to families with young children and run by the pediatrics department. Here, the physician and the district attorney collaboratively responded in ways congruent with the professional integrity of each. In another example in Portland, Oregon, physicians, drug treatment providers, and child protective social service representatives cooperatively defeated a legislative proposal to mandatorily test and report pregnant women for illicit drug use and, instead, formed a task force to jointly develop state policy regarding the issue. Drug use, HIV infection, child abuse, and poverty are all cause for alarm. Yet it is critical that our frustration about these difficult problems not be translated into blaming individuals for "deviance," or into short-term inadequate responses. In developing policy we should consider the impact on the legal and ethical rights and obligations of both patient and physician. For every course, we should evaluate both immediate and long-term efficacy, the consequences for the doctor-patient relationship, and the consequences for medical integrity. In the midst of the present regulatory and fiscal turmoil affecting health care, we urge physicians to be careful and deliberate in the policies they embrace and the actions they take.
我们认识到所提出的许多问题并不简单。我们的提议要求将在其他情况下进行的深思熟虑应用于生殖保健领域。一些人已经尝试了替代方法。在新墨西哥州的阿尔伯克基，一名大学医院的新生儿科医生与地方检察官合作，为因与毒品相关犯罪被捕且被发现怀孕并吸毒成瘾的女性创建了一个替代量刑计划。这些女性不会受到刑事制裁，而是被提供进入一个针对有幼儿家庭的戒毒治疗项目，该项目由儿科部门运营。在这里，医生和地方检察官以符合各自职业操守的方式共同做出了回应。在俄勒冈州波特兰的另一个例子中，医生、戒毒治疗提供者和儿童保护社会服务代表共同挫败了一项关于强制检测并报告孕妇非法使用毒品的立法提案，取而代之的是成立了一个特别工作组，共同制定该州关于这个问题的政策。吸毒、艾滋病毒感染、虐待儿童和贫困都是令人担忧的问题。然而，至关重要的是，我们对这些难题的沮丧情绪不能转化为指责个人的“越轨行为”，也不能转化为短期的不充分应对措施。在制定政策时，我们应该考虑对患者和医生的法律及道德权利与义务的影响。对于每一项措施，我们都应该评估其即时和长期效果、对医患关系的影响以及对医疗诚信的影响。在当前影响医疗保健的监管和财政动荡之中，我们敦促医生在他们所接受的政策和采取的行动中要谨慎和深思熟虑。
