Bucks Montgomery Physician Summer 2021 - 10

Many of us have seen the morbidity and mortality resulting
from illegal, unsafe abortions. This is an example of disregard
for the rights and health of women. There was no legal remedy
for women who bear an unwanted child, except for adoption.
For many children, especially those disabled or of color, this
resulted in serial foster care. According to Justia.com, a legal
non-profit, it depends upon the age of the parents, whether
the mother can get child support, and times when she might
have to hire a lawyer at her own expense to go to court if
there is non-payment. Participation in childcare by the male,
who bears 50% of the responsibility for the conception, is not
legally required. State or federal support is not required for the
woman. Affordable, accessible childcare is scarce. There are
few services provided by the state or federal government for
the extreme needs of disabled children including children with
Down Syndrome.
Where is the justice for the unwanted child who is actually
born? Why is the fetus valued more than the child or the mother?
Where is the justice for women who must care for children
they love, but cannot afford or cannot meet their special needs?
What about women who must stay home during the pandemic
and have no childcare support? Children who attend school
may not have access to after school care or may come home to
an empty home when a woman is working. I personally have
been there! And who supports most of these restrictive laws?
The vast majority are male religious leaders, legislators, or
bosses. And the vast majority of victimized women are poorer,
and women of color or ethnic minorities. So, are these laws a
matter of ethics, or power? I believe a lot is the latter.
The second bill introduced that I wish to discuss is HB 275.
HB 275 proposes to amend the definition of child abuse in
Pennsylvania Statute Title 23 Domestic Relations ยง 6303 (b.1)
to include a child born with fetal alcohol spectrum disorder or
tests positive at birth for a controlled substance for which the
biological mother did not, during the pregnancy, have a valid
prescription or a certification under the Medical Marijuana
Act. Title 23 already requires a provider to make a report to
social services if a child was born affected by illegal substances,
withdrawal symptoms from prenatal drug exposure, or fetal
alcohol spectrum disorder. I have mentioned before that there
are states that incarcerate pregnant women for use of illegal
substances, and that the health of the woman and the fetus are
endangered by this practice. ACOG (Guidelines on Opioid Use
in Pregnancy Released by ACOG - Medscape - Jul 25, 2017)
recommends medication-associated withdrawal, since sudden
withdrawal endangers both the fetus and woman. Physicians
in Philadelphia have been required to report pregnant or
post-partum women who use illegal drugs, however many of
my colleagues " forget " to do so. We do not discount the harm
of illicit drugs to both mother and fetus, but outcomes are
better if there is medical help and rehabilitation that prevents
sudden withdrawal and does not separate mother and baby,
especially for the child. Removing the child from the mother's
care unless other abuse occurs, deprives the infant of bonding
and breast-feeding.
There are 23 states in the US that still allow shackling women
in labor (Equal Justice Initiative 2020) although legislation
prevents it in Federal prisons. (AMA Advocacy Report
2015). There are incarcerated women who deliver without any
medical assistance. These are inhumane, health-threatening
situations. And more women who are poor, women of color,
and ethnic minorities are incarcerated than wealthier white
women. Where is the justice?
In a book by philosopher Susan
Moller Okin, Justice, Gender, and
the Family (Basic Books, 1989), her
" Conclusion: Toward a Humanist
Justice " poses some solutions to
the injustice women experience.
She critiques division into two
different spheres of life: the public
domain such as political, legal
and employment rights, and the
family domain. She believes that
we are making progress in the
former spheres, but not in the
latter. She proposes a rational,
feminist solution that opposes
the gender-structured family.
She writes that our failure to apply theories
of justice to the family undermines democratic values.
She posits that equality of responsibility of the partners in a
family includes shared income, regardless of whoever brings in
more money, stating that work at home has similar value to the
family as work outside the home. She believes that childcare
should be shared equally, and that neither partner should have
to sacrifice career opportunities for the other. There was consensus
at the last Governance Council meeting of the Women's
Physicians Section (WPS) that for women to succeed as
physicians and mothers, the father of the children is expected
to fully share in childcare and household duties, as he shared in
Some benefits of this approach include the ability of a woman
who is divorced or widowed to support herself and her children.
This option is unavailable globally in so many places, and
unavailable for so many women in our country. I believe that
this is beneficial to women, children, and all of society because
the greater society has less fiscal responsibility for those who
can support themselves in a just structure, as opposed to those
living with injustice.
While there are liberal philosophers such as John Rawls (A
Theory of Justice, 1971), who believe that justice in the political
sphere will also " trickle down " to the family, in reality this

Bucks Montgomery Physician Summer 2021

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