Compulsory Treatment Orders - Patient's Rights Issues - FROM RONNIE Falcão's MIDWIFE ARCHIVES

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Compulsory Treatment Orders - Patient's Rights Issues

Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.

Considering the "G" Case:
What Are the Costs of Compulsory Treatment Orders for Women, their Families and Society?
Sidebar: An overview of the "G" case

Last August Winnipeg Child and Family Services applied to the Court of Queen's Bench for an order forcing a pregnant women - "G" - into treatment for solvent abuse. The Judge granted the order on the grounds that G (as she is referred to in the decision) was incompetent and incapable of making decisions for herself, even though psychiatric evidence did not support this conclusion. The case was appealed to the Manitoba Court of Appeal which denied the Winnipeg Child and Family Services' request. In October, they appealed the case to the Supreme Court of Canada. Although "G" has had her baby, the court has agreed to hear the appeal to consider the policy issues at stake. A wide variety of groups are seeking to appear as intervenors as well. They include other child and family services, human rights groups, groups with religious affiliations, and women's groups. It is expected the case will be heard sometime in June. A coalition of local community based groups, including Native Women's Transition Center, The Metis Women's Association, Manitoba Association of Rights and Liberties and the Women's Health Clinic will presenting/intervening. CARAL and LEAF are also presenting.

Untangling the Issues

In August, 1996, a young pregnant woman with a six year history of solvent abuse was ordered by a Winnipeg judge to enter a treatment programmers. It was widely reported that two of her previous children had been damaged by her addiction and all three were in provincial care but not that she previously sought treatment and was put on a waiting list. We were all well aware of the impact solvent and alcohol abuse was having on communities, families and individuals. This story is profoundly tragic.

Ensuring that babies are born healthy and with a fair chance in life is a long-standing goal of our health care system and a deeply held value of women, their partners and other members of our society. It is difficult to look the other way when we see pregnant women, such as G, persist in using toxic substances which will most certainly affect her health and the well-being of the fetus she is carrying. Under these circumstances, the idea of forcing the woman into treatment is compelling. But, before we accept such a drastic solution, we must consider the long-term implications and assure ourselves that there are no other options which address this problem.

Does forced treatment work?

In the U.S., many states authorize the forcible confinement and treatment of pregnant women known to be addicted to drugs or alcohol and misusing solvents. Studies show that where such legislation exists, women with drug and alcohol problems tend to avoid getting proper prenatal and postnatal care. They fear they will be forced into treatment or their babies will be taken away by the authorities. Obviously, this undermines the health and security of the woman and her fetus. We have heard isolated stories that this has occurred in Winnipeg as well. Therefore, we are concerned that the threat of forced treatment will have precisely the opposite of its intended effect. Rather than encouraging women to seek good health care early in their pregnancy, the threat of forced treatment will keep them from seeking services and support.

Will policies like this be equally applied to all women?

Studies show that the majority of women apprehended under legislation such as that in the U.S. are women who are poor and members of racial minorities. Alcohol and other addictions are misused by all social classes and groups in society. The law is therefore unfairly applied. The fact that G is aboriginal and on social assistance raises questions about whether similar patterns could occur in Canada.

Will a law and order response deal with the systemic and social causes of the problem or is it an expensive quick fix solution?

For many women, violence, sexual abuse, poverty, poor self esteem and lack of control over their lives often underlay substance abuse. Racism and other forms of discrimination make the situation for aboriginal women even worse. Researchers and workers in the area of women and addictions have repeatedly called for programs and resources that address these root issues. Yet few such programs are available.

Will a "slippery slope" develop for pregnant women or all women who are of childbearing age?

There are many substances and activities that will or could affect the well being of mother and child. Will smoking, poor nutrition, working in polluted and hazardous environments, or even refusing medical treatment also become criteria for court-ordered interventions? Many substances are most harmful in the very first days and weeks of pregnancy, often before a woman knows she is pregnant. Real prevention would mean addressing these problems before conception. How early would we be prepared to intervene? What kind of society would we then become?

Should Child and Family Services, or any other government agency have this mandate?

The child and family service system has been criticized by many over the years. Professionals and families have expressed concern about the conflicting mandates of these agencies. Legal responsibility for the supervision and apprehension of children as well as working preventively with families can create competing priorities. Already women involved with the CFS system try to hide their pregnancies because they fear their babies will be apprehended when born.

This is particularly problematic for aboriginal peoples. Kathy Mallet of the Original Women's Network summarized the concerns recently when she said, "The child welfare system has been very detrimental for Aboriginal families for many years. They have been apprehending our children for years. They have not been that friendly to our communities. Child welfare has always been our enemy, not our friend; this will just give them more power. Now it will be seen not as a place to get help, but as a place for them to put women into treatment and take away their kids. It will just make things worse, not better."

What's the Alternative? What works for Women?

The old midwifery saying, "Mother the mother and she will mother the child" captures the spirit of what we believe is needed. It reflects a philosophy and approach that seeks to support and enhance a mother's capacity for caring for her child before, during or after birth.

Services to assist pregnant women and their families to overcome drug and alcohol problems are woefully inadequate in Manitoba. Treatment facilities for women and their children, women only programs and longer term sheltered housing are lacking. The focus on strict cessation of all drug or alcohol use and rigid rules in programs can be real deterrents to seeking care. What is needed is a truly woman-centered approach that builds on strengths and respects the needs of women who are seeking treatment.

Women with addiction problems need holistic approaches that build their sense of self-worth. Outreach programs are needed that allow gradual reduction and use of "less unhealthy" drugs and access to nutritious food. Short term treatment programs don't help women cope with complex problems or deal with more fundamental issues of poverty, violence and abuse. This situation is further compounded by the lack of culturally appropriate services for Aboriginal women. We must create opportunities for aboriginal women to develop models that serve their needs.

Models for appropriate rehabilitation services for pregnant women do exist. For over a year, Dr. Oscar Casiro and others have requested the Province of Manitoba fund a peer-based program to help mothers overcome solvent and alcohol abuse, but the province has been slow to respond. Based on a successful program run in Seattle, Washington since 1991, his proposal is an example of an alternative to court-ordered remedies. The program uses a mentoring model to teach life skills and address complex issues such as violence.

As well, Child and Family Services has experienced cutbacks. Their requests for resources to offer preventive and early intervention programs in the face of increasing demands have been denied or ignored.

The current fascination of governments with legislation and regulation in the absence of resources for health promotion programs and services raises concerns. Although supportive of the recent legislative plans regarding tobacco and new reproductive technologies, we are concerned that there is little commitment to education and other programs. The "G" case raises the same worries.

What Are We Doing About It?

These inconsistencies and alarming implications have moved us to act. The Board of the Women's Health Clinic takes very seriously its commitment to having women's voices heard in all arenas where women's health issues are being considered. We want to ensure that public policy is healthy for women.

We have been meeting with a coalition of groups and individuals including the Native Women's Transition Center, the Metis Women's Association and the Manitoba Association of Rights and Liberties to discuss what should be done. As a group, we realize that chemical addiction is a serious and widespread problem in Manitoba which demands a serious response. But we see compulsory treatment as a legal band-aid which will not only be ineffective but obscure the real problems and waste our limited resources.

To this end, our coalition applied to the Supreme Court for intervenor status where we will argue that the court not allow Child and Family services to be able to order compulsory treatment. We just heard that our request has been granted and now look forward to a busy few months as we prepare!

Our coalition's central message will be that the government has an obligation to provide appropriate and effective supports, services and resources to ensure the health and well being of pregnant women and their fetuses. Before we turn to coercive measures we must ensure that women have access to good health care, proper nutrition, adequate housing, economic independence and a supportive community. Measures must be put in place to help women overcome issues of poverty, violence, abuse and social inequality. Enforced treatment is counterproductive to our goals as a humane society. We will ask the members of the Supreme Court of Canada to consider, "What are the human, social and financial costs of seeking a court order to force a pregnant woman into treatment versus providing adequate preventive and support services?" Ultimately we must all answer this question.

Madeline Boscoe,
Women's Health Clinic
3rd floor, 419 Graham Ave
Winnipeg, Manitoba, R3C 0M3
phone: 204-947-2422 ext 122 fax 204-943-3844
E-mail: whc@web.net