This is probably not going to end well. A Tennessee statue allows law enforcement to charge pregnant women with assault if their behavior causes injury to a fetus. I can’t imagine how it wouldn’t discourage women from seeking treatment for their substance use challenges as well as becoming a barrier to prenatal care. If I think I’m doing alright during my pregnancy and I don’t feel badly, maybe I shouldn’t take the risk that my obstetrician will turn me in to the police. The other concern I have is that it doesn’t seem to say “how” pregnant a woman must be before she can be charged with assault. Do police need to check every woman’s pregnancy status at any stop involving a suspicion of drug use? What if the woman didn’t know she was pregnant at the time? Frankly, could an officer decide that pregnancy tests for women in restaurants with a glass of wine were in order so that society could protect a fetus?

Does driving recklessly involve “endangerment of a child” if you’re pregnant? Does every woman stopped for speeding need a urine pregnancy test to decide if she’s actually endangering a child?

Time and again some of our puritanical instincts rise up in health care. The debate over contraceptives is one example. This is another. I see it most often in the arena of treatment for substance use disorders. There’s almost always a current of moral approbation when people come forward for treatment. There’s a disapproval I don’t see when people develop adult onset diabetes mellitus or other “lifestyle” illnesses.

If we truly believe that substance use disorder is an illness, then we have to learn to rise above that inclination and welcome people into care and treatment. Countless times I’ve had people very sheepishly say, “I don’t want to lie to you doc, but…” The urge to withhold information in order to avoid my anticipated disapproval might mean I don’t hear about critical parts of the life of the person I’m working for.

We know that our drug laws have driven our incarceration rates to be among the highest in the world. It’s had a particularly devastating effect on communities of color and those who are economically disadvantaged. Let’s hope that in our urge to protect a fetus we don’t start adding women to that community as well.