A Liberal Dilemma: Respecting Autonomy While Also Protecting Inchoate Children from Prenatal Substance Abuse

William & Mary Bill of Rights Journal Volume 24 | Issue 3 Article 6 A Liberal Dilemma: Respecting Autonomy While Also Protecting Inchoate Children from Prenatal Substance Abuse Andrew J. Weisberg Frank E. Vandervort Repository Citation Andrew J. Weisberg and Frank E. Vandervort, A Liberal Dilemma: Respecting Autonomy While Also Protecting Inchoate Children from Prenatal Substance Abuse, 24 Wm. & Mary Bill Rts. J. 659 (2016), https://scholarship.law.wm.edu/wmborj/vol24/iss3/6 Copyright c 2016 by the authors. This article is brought to you by the William & Mary Law School Scholarship Repository. https://scholarship.law.wm.edu/wmborj A LIBERAL DILEMMA: RESPECTING AUTONOMY WHILE ALSO PROTECTING INCHOATE CHILDREN FROM PRENATAL SUBSTANCE ABUSE ** Andrew J.Wei sberg* andFrankE.Vandervort 1 Subst anceabusei sasigni fi cantsoci alproblem inAmeri ca. Itisest imat edthat someei ght eenmi ll i onAmericanshaveanal coholabuseprobl em andt hatal most 2 fi vemil l i onhaveadrugabuseprobl em. Accordi ngt ot heNat ionalInst i t ut eon 3 DrugAbuse,substanceabusecost ssome$700bil li onperyear. Subst anceabusei samajorcontri butort ochi l dmal t reat ment.4 Iti sesti mat ed t hatbet weenone-andt wo-t hi rdsofcasesi nwhi chchildrenenterfost ercareare 5 l inkedt oparent alsubst anceabuse. Unfort unatel y,t hi smaybeanunderesti mat eas * Associat e,O’Melveny& MeyersLLP;J. D. ,Universit yofMichiganLaw School, 2015;B. A. ,WashingtonUni versi tyi nSt.Loui s,2010. ** Cli ni calProfessorofLaw,Universi tyofMichiganLaw School .Theaut horswisht o thankDr.CarenStal burg,M. D. ,M. A. ,forherhelpfulrevi ew ofPartII ofanearli erdraftof t hisArti cl e. 1 See FrankE.Vandervort ,Legal Rights of Fetuses and Young Children,in PRINCIPLES OF ADDICTIONS AND THE LAW:APPLICATIONS IN FORENSIC,MENTAL HEALTH,AND MEDICAL PRACTICE 229,229(NormanS.Millered. ,2010);see also Seet haShankaranetal. ,Impact of Maternal Substance Use During Pregnancy on Childhood Outcome,12SEMINARS FETAL & NEONATAL MED.143,143(2007)(not ingt hatsomeoft hei mpact sofsubst anceabuse incl udecrime,increasedhealt hcarecosts,andreducedproduct ivit y). 2 See SCHNEIDER INST.FOR HEALTH POL’Y,SUBSTANCE ABUSE:THENATION’S NUMBER ONE HEALTH PROBLEM 75,104(2001). 3 Trends & Statistics: Costs of Substance Abuse,NAT’L INST.ON DRUG ABUSE,ht tp: / / www. drugabuse. gov/ rel at ed-topics/ trends-stat i st i cs[ht tp: // perma. cc/S68V-5TE4](lastupdat edAug.2015). 4 See JudyFenst er,Substance Abuse Issues in the Family,in CHILD WELFAREFOR THE 21ST CENTURY:A HANDBOOK OF PRACTICES,POLICIES,AND PROGRAMS 335(Geral dP. Mall on& PegMcCart tHesseds. ,2005)(notingthatal coholandotherdrugabuseaccount s forsevenintencasesofchil dmalt reat ment);NANCY K.YOUNG & SIDNEY L.GARDNER,U. S. DEP’T OF HEALTH & HUMAN SERVS. ,NAVIGATING THE PATHWAYS:LESSONS AND PROMISING PRACTICES IN LINKING ALCOHOL AND DRUG SERVICES WITH CHILD WELFARE 3( 2002), ht tp:/ /www. cffut ures. org/fil es/publ icat ions/Navi gati ng%20t he%20Pat hways-Tap%2027. pdf [ht t p: / / perma. cc/ Y3SS-89BT](not i ngt hat“[s]ubst anceusei sgeneral l ybel i evedt obeassoci atedwit ht heabuseandneglectofchil dren”). 5 U. S.DEP’T OF HEALTH & HUMAN SERVS. ,BLENDING PERSPECTIVES AND BUILDING COMMON GROUND:A REPORT TO CONGRESS ON SUBSTANCEABUSEAND CHILD PROTECTION 41(1999)[herei nafterBLENDING PERSPECTIVES](“[A]tleast50 percentofsubstantiated childabuseandneglectreportsinvolveparentalabuseofal coholorotherdrugs,andfully 80percentofSt atesreportedthatsubstanceabuseandpovert yarethetoptwoissuescontribut ingt oabuseandnegl ecti nt hei rSt ates. ”(ci tat ionomi tt ed)). 659 660 WILLIAM & MARY BILL OF RIGHTS JOURNAL [Vol .24: 659 recentresearchsuggest sthatmanycases,part i cul arl ycasesi nwhi chchi l drenhave 6 beenexposedtoal coholin utero,aremi ssedori mproperl ydi agnosed.Ofparti cular 7 concerni ssubst anceabusebypregnantwomen. Eachi nst anceofsubst anceabuse i ncreasestheri skofi nfl i cti ngseri ousandl asti ngharm ont hefut urechi ld.8 Threeparti es’interest sareatissuewhendet ermininghow t oaddresssubst ance use orabuse by pregnantwomen:the pregnantwoman’s i nt erest,t he i nchoat e 9 chi l d’si nt erest ,andtheStat e’si nt erest .Beforethei nt ersecti onoft hesei nt erestscan beproperl yexplored,however,afew defi ni t i onsmustbeest abl i shed. Thesepart ies’i nt erest si nt hedebat eoverprenat alsubst anceabuseareoft en l oosel yreferred t o as“rights. ”10 ThisArt icl eavoi dsconfusionbyempl oyi ngt hat t erm i nal i mi t ed,speci fi cmanner.AsWesl eyNewcombHohfel dnot edi nhi snowcl assi cformul at i on,si mpl ybecauseonehasani nt eresti ndoi ngsomet hi ngdoesnotmean 11 t hatonehasa“ri ght ”t odoi t . Usi ngt hi sapproach,“ri ght s”onl yexi stwhent hel aw 12 pl acesadut yonothersnott oint erferewi t ht heexerci seofani nt erest . Thatduty, i nt urn,givest heri ght-beareracorrespondi nglegall yenforceabl ecl aim againstsuch 13 i nt erference. Whent hel aw accommodat esaperson’si nt erestbutdoesnotcreat e 14 acorrespondi ngdutyt hatothersnoti nt erfere,thati nt eresti smerel ya“privi l ege. ” 16 A “privil ege”i sbestt houghtofasa“l i bert y”15 oraphysicalorpersonalfreedom. 6 See IraJ.Chasnoffetal. ,Misdiagnosis and Missed Diagnoses in Foster and Adopted Children with Prenatal Alcohol Exposure,135PEDIATRICS 264,264–67(2015)(fi ndi ngt hat i nasampl eof547chi l drenwhowereinthechi ldwel faresystem,156chi l drenmett hedi agnost iccrit eriaforfetalal coholspect rum andt hat125ofthosechi ldrenhadneverpreviousl y beendi agnosed);Ji m Henryetal. ,Neurobiology and Neurodevelopmental Impact of Childhood Traumatic Stress and Prenatal Alcohol Exposure,38LANGUAGE SPEECH & HEARING SERVICES SCHOOLS 99,100(2007)(di scussi ngthedi ffi cult yinassessi ngprenatalexposure toal cohol ). 7 See YOUNG & GARDNER,supra note4,at3;see also Shankaranetal. ,supra not e1, at143–44(noti ngnumerousi mpactsofsubstanceuseandabusebypregnantwoman). 8 See Vandervort ,supra not e1,at230–31. 9 See generally ROBERT H.MNOOKIN & D.KELLY WEISBERG,CHILD,FAMILY,AND STATE:PROBLEMS AND MATERIALS ON CHILDREN AND THE LAW (7thed.2014). 10 See, e.g.,About NAPW,NAT’L ADVOCATES FOR PREGNANT WOMEN,htt p: //www . advocat esforpregnant women. org/ mai n/ about _us/ about _us. php[ht t p: / / perma. cc/ LH2P-M5DZ] (referringt othe“rightofself-determi nati on”andthe“righttobodi lyintegrit y”). 11 Wesl eyNewcombHohfeld,Some Fundamental Legal Conceptions as Applied in Judicial Reasoning,23YALE L. J.16,28–29(1913–1914). 12 Id. at32(“A dut yoral egalobl i gat i oni st hatwhi choneoughtoroughtnott odo.‘Dut y’ and‘ri ght ’arecorrel at i vet erms.Whenari ghti si nvaded,adut yi svi ol at ed. ”(foot not eomi t t ed)). 13 Id. at30–31(not i ngt hat“cl ai m”isanappropri at esynonym fort heterm “ri ght ”). 14 See id. at55(“A rightisone’saffi rmativecl aim agai nstanother,andaprivi legeis one’sfreedom from t herightorclaim ofanother. ”). 15 Id. at36(“A ‘l ibert y’consi deredasal egalrelat ion(or‘ri ght ’inthelooseandgeneri c senseofthatterm)mustmean,i fi thave[sic]anydefi (...truncated)