Should we be testing pregnant patients' urine for drugs? An applied ethics approach

Urine toxicology testing among birthing people in the United States remains a clinical practice often informed more by personal values and conscious and unconscious biases, than by medical evidence and ethical obligations. As empirical evidence addressing harms and benefits of toxicology testing in pregnancy grows, and national organizations are taking a moral stance around clinical practice, no published structure explicitly positions the evolving data within an ethical framework. We draw on a model of applied ethics to inform a set of concrete recommendations about what clinicians ought to do with regards to the practice of urine toxicology testing of pregnant patients. These methods facilitate a relationship between empirical data regarding toxicology testing in pregnancy and ethical norms. Our findings serve as a practical guide for clinicians and policymakers seeking clinical guidance around urine toxicology testing in pregnancy as well as a model for future translation of theoretical approaches into clinical action.