Pregnancy & Privacy
Is a Woman's Pregnancy the Government's Business?
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For the most part, people believe that their medical issues are and should remain private. The status of your health is not something that should be made public record or revealed to anyone not involved in your health care (like doctors, nurses, and insurance companies). But does pregnancy qualify as a health matter that should be kept private? Perhaps it should, but there are many who have argued that it does not.
The question of whether pregnancy is something that should be kept private was put to the test in 2002 when the body of an infant was discovered at a recycling plant in Iowa. In an effort to locate the mother, police asked for medical records from local hospitals and clinics in order to identify who was pregnant during the time of the baby's gestation; one, Planned Parenthood, refused to turn over their records, citing patient-doctor confidentiality and patient privacy.
A district court judge ordered Planned Parenthood to provide the information to the police but the Iowa Supreme Court dismissed the case when the county government dropped out due to an inability to fund what promised to be a lengthy and complicated legal battle. The records (estimated at nearly 1,000 women) remained sealed, but the legal question of wether they *should remain sealed was never resolved.
Why is privacy important when it comes to our medical records? Doctors and other medical professionals need patients to be completely open and honest in order to best understand and evaluate both their physical and their mental conditions; that, in turn, is necessary in order to create the best course of treatment necessary to restore the patient to good health. A doctor's primary, if not sole, concern is to the physical and mental well-being of the patient, after all.
Sometimes, the needed honesty is only possible so long as the information is kept private. Medical issues are often embarrassing or socially problematic, and people don't want that information broadcast to family, friends, neighbors, coworkers, employers, or the government. People may not want details about sexually transmitted diseases, alcohol and drug abuse, mental illness, abortions, and even pregnancy itself to be placed where others might have access to them.
Even relatively minor medical issues can be embarrassing enough that people don't want their condition to become general knowledge - how many people would you tell about warts or boils that developed in rather private areas of your body? Doctors themselves are only told these things because that information is necessary for the patient's medical treatment - for everyone else, it should be off-limits.
Very serious ethical problems are raised if we abandon the notion of privacy and patient-doctor confidentiality when it comes to a woman's pregnancy, and instead assume that the police should be allowed to access the pregnancy records of thousands of women, none of whom may actually be guilty of any wrongdoing. First and perhaps most obvious is the question of what happens to the material once the investigation was completed - would the pregnancy records of thousands of women be put in the public domain, accessible to anyone who asks?
But that is not all: even if we could trust that no one outside of authorized government agents would ever have access to the information, there are still difficult questions to answer. Would the women have to produce a baby or proof of a miscarriage or abortion to the government in order to be taken off of the list of suspects? What would happen to any women who refused to be interviewed - would police then start interviewing family, neighbors, and friends? Such interviews would reveal that the woman was, at one time, likely pregnant - information she may have kept to herself but which is now being broadcast to the entire community.
This issue also has obvious implications for the debate over abortion. If abortion were to be made illegal, it would be very difficult for the police to find and prosecute women who obtain abortions without knowing for sure if the women were pregnant to begin with - after all, without a pregnancy, no actual abortion can occur. This dilemma is solvable if we place pregnancy records outside the normal domain of privacy accorded to other medical information.
As a consequence, anti-abortion laws might depend upon pregnancy no longer being a private matter. If anti-abortion laws are based upon the principle the the fetus is a human being with its own moral and legal rights, then arguably pregnancy *isn't a private matter. Police can require that clinics and hospitals submit the results of *all pregnancy tests to the government so that they can track pregnant women and, if a baby is not born, require proof of a miscarriage in order to stave off prosecution for an illegal abortion. Maybe private home pregnancy tests would have to be taken off the market, just to ensure that no women are hiding anything.
Of course, neither privacy nor patient-doctor confidentiality are absolutes. If someone reveals to a doctor that they plan on killing someone, the doctor has an obligation to tell authorities. Similarly, if the police have a valid reason to suspect an individual of a crime and have probable cause to believe that certain medical information may provide evidence that will either exonerate or implicate him, then they can justifiably expect a doctor to obey a court order and hand over those records.
None of that, however, can be said to apply when there exists no specific reason to suspect a given person of any wrongdoing, or that specific medical records can provide information relevant to a criminal case. Ethically, doctors and other medical professionals should be obligated to keep their patients' records private when government authorities are on little more than a fishing expedition, seeking large numbers of records for people who, as individuals, are suspected of no crimes whatsoever.
The needs of the government to solve a crime do not outweigh the need of innocent individuals to be assured that what they reveal to their doctor will not be passed along to unauthorized persons who are not involved in the care of the individual's physical or mental health. The ethical principle of patient-doctor confidentiality is important and cannot be broken except for very good and very scrupulous reasons.
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