"The intangible is often more real than the tangible to a person who is mentally ill."
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With neither an unseen microbe nor a mismatched nucleotide pair as the cause of Fetal Alcohol Syndrome, it is at once disheartening and encouraging that the disease is entirely the product of human behavior. On the one hand, it seems ethically devastating that children can be born with an inability to control their impulses, an intellectual age permanently far below their chronological one, and a warped perception of judgment, all because of their mothers’ ill-timed binging. On the other hand, Fetal Alcohol Syndrome is one hundred percent preventable, which, considering its severity, presents an extremely rare and promising opportunity for eradication of a worldwide scourge.
It is crucial that education and awareness programs emphasize the dangers of consuming any amount of alcohol at a time when pregnancy is possible. Programs to reduce FAS must disseminate this message of prescribed abstinence to all socioeconomic and ethnic groups, and to men and women alike. One means to this end is assuring that all alcoholic beverages are slapped with warning labels that are prominently placed and pointedly clear. To educate underage drinkers, alcohol and drug abuse prevention programs in secondary and post-secondary institutions should include a curricular component on FAS. In the same vein, sex education initiatives should acknowledge the very pertinent topic of in utero alcohol exposure; it only makes sense to pair this with instruction about safe sexual practices.
Perhaps it is unsurprising that the women most at risk of bearing children with FAS are often the most difficult to reach. Locating, identifying, and implementing treatment and intervention for alcohol-abusing women presents a medical and moral challenge. Alcohol dependency, especially when sustained by poverty, depression, or an unsupportive community, can prove to be all but intractable. Abstinence from alcohol often represents little more than an unattainable ideal, rather than a realistic goal. Also, if social and healthcare workers manage to track down a high-risk mother, their guidance and support may not be welcome: the woman may not want or may not be able to attend the nutritional counseling meetings, after-school care programs, and detoxification measures prescribed by well-meaning clinicians. While few would argue against hospitalizing a pregnant woman with extreme alcohol dependency, few cases are so straightforward. The clinician is often forced to choose between prospective harm to the child (who will then be forced to live with the consequences) and the liberty of the mother.
When does a pregnant woman’s alcohol abuse constitute fetal abuse? Can a treating physician ethically let an alcohol-dependent mother-to-be leave his office without an effort at intervention? When is enforced detoxification treatment or hospitalization warranted – if ever? And if implemented, in what ways would systematic coercive policies act as a deterrent against alcohol abuse by pregnant women? As the American debate on abortion demonstrates, in the United States, the bodily autonomy of the mother and the gestational rights of the child are extremely difficult to reconcile. The moral and legal dilemma of forced intervention and treatment for fetal alcohol exposure is further complicated by unavoidable uncertainties: whether a high-risk pregnant woman would in fact consume excessive alcohol if not detained; whether this potential consumption would harm her child; and whether the largely subjective assessment of high- versus low-risk women is itself even reliable. It is in the intimacy of a family doctor’s office, the heated atmosphere of a governmental policy meeting, and the foreword of legal documents and medical articles that these issues will continue to be disputed. All the while, infants continue to emerge from the womb already stunted before they can even take their first breath of hospital air.
Carolyn Chau, a 2003 graduate of Yale Divinity School, is a chaplaincy resident at the University Health Network (UHN) in Toronto, Canada. She is responsible for meeting the spiritual needs of patients on the Cardiology unit, as well as on the Ear, Nose, and Throat Oncology and Head and Neck Plastics units.