ethical and policy issues

Two women have been in labor for most of the day in the Labor and Delivery unit.  Two nurses who are involved in both patients’ care, talk outside the birthing center after both births are complete.

Anna Jiang: How’s Crystal doing?

Brittany Clinton: Okay, I guess. I mean, medically, just fine. But this is her eighth child! And she already can’t afford the other seven. She works at Walmart and her husband is a police officer, and they are just pushed to the limit. How about Elizabeth?

Jiang: [Sighs] She’s fine, but the baby isn’t. She lived for about 14 minutes. She was in respiratory distress right from the beginning and they just couldn’t get her stabilized.

Clinton: Oh, that’s so sad. This was her first, wasn’t it?

Jiang: It was. She’s sleeping now but she’s got a hard road ahead of her. She wanted that baby so much, and it’s going to take awhile to get used to the fact that she’s not going home with her.

Clinton: It’s such a shame. Meanwhile, Crystal is going home with a baby she’s just not excited about. I saw the crowd waiting for Elizabeth. But Crystal was alone—not even her husband came in with her! It’s a really awful thing to say, but I’ll bet Crystal would change places with Elizabeth in a heartbeat.

Jiang: Wait a minute! What if she could? If she’s really not that invested, what if Elizabeth adopted Crystal’s baby?

Clinton: Whoa. I didn’t even think of that!

Jiang: I’ll bet it wouldn’t be hard to get all the paperwork coordinated for them. If they agree, I mean. Wouldn’t that be amazing if it worked out? It’s such a win-win!

The proposal is made to both mothers, and the adoption proceeds. But a week after the adoption is initiated, the hospital’s Ethics Committee meets to discuss what happened. While the two mothers both seem satisfied and no questions about their medical treatment have been raised, the committee wants to consider whether proposing the adoption was ethical.

Faith

Nurse Manager, Labor and Delivery

She looked so relieved when we suggested this to her. I have to say, when I saw that, I felt like we’d really taken a bad situation and turned it into a good one.

Emilia

Patient Advocate, Labor and Delivery

But this woman was vulnerable in more than one way. We know she’s living near the poverty line, but what do we know about her husband? The other children? What’s going to be the effect on them, and what might happen to her as a result?

Tammy

Chaplain

I know this will sound strange coming from me, but what about the hospital’s liability if the mother who adopted changes her mind? This won’t be an easy situation to unravel if either mother decides that (a) she made the wrong decision and (b) the hospital put her in a position of making that decision when she wasn’t able to.

Emily

Social Worker

I’m equally concerned about the mother whose baby died. She may be in better shape economically, with a better support system, but she had such a serious loss that she may or not be able to grieve appropriately. She may feel guilty about replacing her own baby with another one, or resent the baby she adopted, or both. And she was in an emotional state too, following the loss. Are we sure that she was in a mental state that would enable her to make an informed decision?

Harold

Vice President of Medical Service

The first thing that troubles me about this is the woman who gave up her baby. Was there an effort made to assess her emotional state? Her ability to make such a significant decision while recovering from delivery?