[Care for addicted, pregnant women: justification for pressure and coercion]

The care of addicted, pregnant women and the protection of the newborn child and its future wellbeing have long been issues of considerable concern and require further attention.

To reflect upon current practice and to consider whether it is justified, and to draw up an agenda for further ethical discussion and research.

We performed an ethical analysis on the basis of criteria for pressure and coercion.

Measures involving pressure or coercion constitute an infringement of the pregnant woman’s freedom of action to make personal choices. This requires a more explicit moral justification than is actually provided in the current practice.

A moral justification needs to be more firmly based on the proportionality and the subsidiarity of specific forms of pressure and coercion. The routine application for prenatal supervision by a guardian seems to be at odds with these conditions. A major problem is that according to Dutch law coercive measures (that are in the interests of the child) cannot be taken within the first 24 weeks of a pregnancy.