Moral responsibility for prenatal harm to children : the case of fetal alcohol syndrome

Gardner, Jillian (2016-03)

Thesis (PhD)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: This dissertation deals with the problem of Fetal Alcohol Syndrome (FAS) and the moral responsibility of pregnant women who carry fetuses to term, as well as the rest of society, to try and prevent children from suffering from this condition. From the perspective of behaviour, most pregnant women who plan to carry a fetus to term, act in ways that are conducive to the normal development and welfare of their future children. With the intent to deliver a normal, healthy birth baby, a pregnant woman will alter her lifestyle accordingly. On the other hand, some pregnant women behave in ways that are not conducive to the birth of normal healthy children. Drinking during pregnancy is associated with a range of negative pregnancy outcomes including spontaneous abortion, breech presentations, fetal growth retardation and premature delivery. A range of disorders and disabilities can occur in varying degrees in the child exposed to alcohol prenatally. Fetal alcohol syndrome (FAS) is the most severe diagnosable condition, along a spectrum of disorders, collectively termed fetal alcohol spectrum disorders (FASD) that can occur in children who were exposed to alcohol prenatally. In the Western world, FAS is a leading preventable cause of mental retardation (Hackler 2011). It is a major public health issue in countries where alcohol is widely used. There is no cure for FAS. Affected individuals suffer a range of permanent primary and secondary disabilities. Surgery can repair some of the physical problems and services can be made available to improve mental and physical development so that children may lead relatively normal lives, but they remain below average in physical and mental development throughout their lives. FAS and its associated social and economic costs can be avoided if a woman abstains from alcohol for the duration of her pregnancy. This dissertation firstly sets out to establish whether and what moral obligations pregnant women who choose to continue their pregnancies (i.e. prospective mothers) may have towards their future children. I argue that women choose to continue a pregnancy when they have the option of terminating their pregnancies and that they are prospective mothers when they do so, to distinguish them from pregnant women who choose to terminate their pregnancies. I argue that prospective mothers, even those who are alcoholics, have prima facie moral obligations to benefit and not to harm their future children and, can be held morally responsible for their actions. Having considered a prospective mother’s moral responsibility for drinking during pregnancy, I then investigate society’s interest in these issues. I argue that even though women have primary responsibility for FAS prevention, that they are not solely responsible for it. I offer reasons why punitive approaches are undesirable, and propose what I consider to constitute an ethically appropriate social response to prevent FAS. Finally, I consider whether children with FAS can and should be allowed to sue their mothers for damages under South African law. I argue that even though children can theoretically sue their mothers for damages that this too may be ineffective at preventing FAS.

AFRIKAANSE OPSOMMING: Hierdie proefskrif handel oor die probleem van Fetale Alkoholsindroom (FAS) en die morele verantwoordelikheid van swanger vroue om te probeer verhoed dat hul kinders aan hierdie toestand ly. Vanuit die perspektief van menslike gedrag tree die meeste swanger vroue wat beoog om aan hul fetusse geboorte te skenk op op maniere wat bevorderlik is vir die normale ontwikkeling en welstand van hul toekomstige kinders. ‘n Swanger vrou sal haar lewenstyl verander met die oog op die totstandkoming van ‘n normale, gesonde baba. Aan die ander kant, is dit so dat sommige swanger vroue optree op maniere wat nie bevorderlik is vir die geboorte van normale, gesonde kinders nie. Alkoholgebruik gedurende swangerskap gaan gepaard met ‘n reeks negatiewe swangerskapuitkomste, insluitende spontane aborsie, problematiese verlossings, fetale groei belemmeringe en voortydige verlossings. ‘n Reeks van siektetoestande en gestremdhede kan, in variërende grade, voorkom in ‘n kind wat prenataal aan alkohol blootgestel is. Hierdie reeks van defekte word bestempel as ‘n ernstige openbare gesondheidsprobleem waar ook al in die wêreld alkohol vryelik gebruik word. FAS is die ernstigste diagnoseerbare toestand van ‘n spektrum van gebreke wat kollektief fetale alkohol spektrum gebreke genoem word en wat voorkom kan word in kinders wat voorgeboortelik aan alkohol blootgestel is. In die Westerse wêreld is FAS ‘n toonaangewende, voorkombare oorsaak van verstandelike gestremdheid in kinders. Daar is geen kuur vir FAS nie. Geaffekteerde kinders ly aan ‘n reeks permanente primêre en sekondêre gestremdhede. Chirurgie kan sekere van die fisiese probleme regstel. Sekere dienste wat besikbaar is, kan verstandelike en fisiese probleme verbeter sodat hierdie kinders relatief normale lewens kan ly, maar hulle bly lewenslank onder-gemiddeld in hul fisiese en verstandelike ontwikkeling. FAS en die sosiale en ekonomiese koste daaraan verbonde kan volledig voorkom word as ‘n swanger vrou bloot geen alkohol tydens haar swangerskap gebruik nie. In hierdie proefskrif word daar eerstens vasgestel óf, en dien wel, wátter, morele verpligtinge swanger vroue (d.i. toekomstige moeders) wat kies om hul swangerskappe te kontinueer, teenoor hul toekomstige kinders het. Ek argumenteer dat vroue kies om ‘n swangerskap voort te sit wanneer hulle die opsie het (soos in SA) om hul swangerskappe te termineer. Wanneer hulle dus kies om nie te termineer nie, is hulle toekomstige moeders, in onderskeiding van swanger vroue wat kies om hul swangerskappe te beëindig. My argument is dat prospektiewe moeders – selfs diesulkes wat alkoholiste is – het prima facie morele verpligtinge om hul toekomstige kinders te bevoordeel en nie skade aan te doen nie. Sodanige vroue kan bepaald verantwoordelik gehou word vir hul dade. Nadat ek ‘n voornemende moeder se morele verantwoordelikheid om nie te drink tydens swangerskap nie (dus ook haar verantwoordelikheid om FAS te voorkom) oorweeg het, ondersoek ek die samelewing se belang by hierdie kwessies. My argument is dat selfs al het swanger vroue ‘n primêre verantwoordelikheid vir FAS-voorkoming, is hulle nie alleen daarvoor verantwoordelik nie. Ek ontwikkel redes waarom strafeisende maatreëls teen sodanige vroue onwenslik is, en ek stel voor wat ek meen ‘n eties vanpaste sosiale respons is om FAS te voorkom. Ten slotte oorweeg ek of kinders met FAS onder Suid-Afrikaanse wetgewing toegelaat behoort te word om regsgedinge teen hul moeders aanhanging te maak ten einde vergoeding te ontvang. My argument is dat al kan kinders teoreties sulke eise teen hul moeders instel, dit waarskynlik oneffektief sal wees met die oog op die voorkoming van FAS.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/98445
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