–Introduction. Jessica Porten is a woman who sought help for what she felt might be post partum depression. She went to an OB/GYN clinic and started discussing her case with a nurse. At some point the nurse felt Jessica was at risk of harming her child and called the police. Jessica was taken to an emergency room against her will, and was released home after hours of waiting for help. Would hearing this encourage other mothers suffering from post partum depression to seek help? Why am I an authority on this subject? I had post partum depression with my first child and was miserable and terrified to seek help because I thought I would be taken away from my family. Because of this fear I did not seek treatment for over three months, and I can honestly say, those were the worst months of my life.
–Thesis.Involuntary hospitalization of mothers with post partum depression should only be an optionafter a complete and thorough history and exam indicate that the mother is a risk to herself or others.
–Argument one: Kantianism. Immanuel Kant was a philosopher in the 1700’s who used a method called the Categorical Imperative to determine if an action is right. He takes a situation where an action is taken by an individual, then makes it a rule that all people will follow. If something seems admissible to one person doing this action, it may have a different outcome if everyone were to always do it. This generalization is called “universalizability”. Another version of the Categorical Imperative highlights that humans are rational beings that have worth and are deserving of dignity. In assuming that someone has less worth then another and using them as a tool for your own plotting, you are violating that portion of the Categorical Imperative, which makes what you are doing morally wrong.
Kantianism is a valuable theory because it often sheds a new light on actions of one small specific casewhen it is shown on a bigger scale. It allows for a larger picture to be placed in front of us to help decide if actions are right. Also, in giving every human being the same level of worth as all others, it evens the playing field and makes using a person as a tool a bigger, brighter red flag that what you are doing is wrong.
Kant gives the example of lying to healthy patients and telling them they are ill and need treatment to increase profits. He says this may seem beneficial to the doctor initially, but if all doctors did this, patients would soon not trust their doctors and stop seeking medical treatment (911). This relates to the case of Jessica Porten because if all women were involuntarily hospitalized for post partum depression with any violent thoughts,taken away from their children and made to sit in emergency rooms for hours (sometimes it can be as much as 72 hours), an outcome might be that no one would seek help for their depression.Therefore, instances of women committing suicide or killing their children due to untreated post partum depression could be much higher.
-Argument two: Care Ethics. Developed by Carol Gilligan, Care Ethicstakes the stand that when dealing with ethical dilemmas, broad principles are too vague and impersonal to help determine what to do. She states that the use of empathy and grasping the details of a persons circumstances is key in resolving ethical conflict (954). Gilligan says that health care providers must form relationships with patients to truly provide the care they need. Trying to make medical or moral decisions in a detached and impartial way undermines the very reasons why these choices are important in the first place.
Care Ethics has great importance in the medical world because there are many situations where a black or white blanket answer to a conflict can leave a lot of people with sub par care. An example given in our text shows the importance of considering the individual circumstances of a situation to guide a caregiver to make moral decisions. A doctor proclaims that a child is beyond help and orders only comfort care after being born with severe defects. The doctor may feel it is better to let the child die, rather then live a potentially short and painful life, which will cause a lot of stress to the parents. But, in talking with the parents, the doctor learns that the parents do not mind that the child would be disabled and that they spent years trying to conceive the child (956). The text does not say how the story ends, only that everyone is now on the same page and that a decision can better be made knowing the details behind the parents decision.
Care Ethics relates to the article with Jessica Porten by pointing out the short comings of the nurse she was talking to about her post partum depression symptoms. The story states that after Jessica confessed to having some violent thoughts, not about harming herself or her child, the nurse stopped listening. The provider felt Jessica fit into a blanket category that all mothers having violent thoughts with post partum depression are a danger to themselves or others. Instead of listening to Jessica’s full story and asking about her support structure at home and willingness to take medication or receive therapy, the nurse called the police, had Jessica hauled away to an ER for many hours and potentially added additional stressors of hospitalization costs and how she was going to continue to care for her child. Care Ethics believes that abstract principles are not moral because everyone has their own specific circumstances, and ignoring them seems cold and inappropriate. Care Ethics would dub what Porten’s nurse did as wrong because she applied a blanket judgement to Porten without learning the specifics of her situation.
-Objection. Some people may object to these ways of thinking by mentioning the instances where women who do not receive care for their post partum depression can go on to kill their children.According to the article about Jessica’s experience, one in very seven women is effected by post partum depression. The Harm Principle is a restriction of autonomy and used to restrict ones freedoms to keep them from doing harm to others (945). Some might feel that Jessica Porten’s providers acted justly in sending Jessica to the hospital against her will because she was perceived as a risk to the health and well being of her baby. Another risk is that Jessica feels so guilty for the symptoms she is experiencing that she commits suicide. People supporting Jessica being forced into emergency care would be agreeing with the Principle of Paternalism. This is basically the Harm Principle, but directed towards the person’s self harm, rather then others (945). Both of these principles can be applied when a peace officer or health care provider feel a patient needs emergent care, and a mental health hold is signed. Basically, it is a legal document that forces a person to be seen for medical evaluation against their will.
-Response. I am grateful to those who take the safety and well being of newborns and their mothers seriously, but in Jessica Porten’s situation it went too far. Jessica was seeking help for an illness she thought she might have, but when she confided in a trained professional for help, she was taken to the hospital againsther will, and made to feel like a criminal. The major moral principle of Nomaleficence says that “we ought to act in ways that do not cause needless harm or injury to others”(933). This includes neglect and failure to provide due care. Jessica’s nurse not taking a full history of her thoughts and symptoms caused her needless stress which may have caused further emotional harm. The nurse at the clinic may not have known that calling the police and having Jessica hospitalized could have caused harm to Jessica, but this does not matter. She was negligent in her actions of not learning Jessica’s full situation and then making a decision after having all the facts. Because of the nurse’s actions, Jessica was put through needless psychological harm.
-Conclusion. Does this mean I feel that new mothers should not be hospitalized for post partum depression? No, my main arguments are that a thorough exam and interview of the patient should be preformed, every patient has an inherent right as a human being to be treated with respect and dignity, abstract principles in health care are lacking and do not consider the needs, interests and values of all involved, and needlessly involuntarily hospitalizing a patient can cause emotional and psychological harm.