As I thought it might, the Ethics Quiz about “The Ethicist’s” position that a nurse practitioner was obligated to help an unemployed, unmarried, 16-year-old high school drop-out get pregnant provoked a lot of discussion. Here is how the poll results on the issue are running:
It is seldom that I strongly disagree with NYU philosophy professor Kwame Anthony Appiah, “The Ethicist” of the New York Times Magazine’s long-running advice column. A month ago I did, and emphatically so.
The question posed to him involved a professional ethics dilemma, and “The Ethicist” was so certain he had the correct answer that he was uncharacteristically terse about it. I’m pretty certain about the answer too, except that my certainty is that he’s wrong. But I have some doubts, based on my ethical positions in related situations.
The inquirer was a a nurse practitioner working at a primary care clinic for low-income patients. She said that a 16-year-old patient told her that she had stopped coming by the clinic to have her birth control pills replenished because she and her partner were trying to have a baby together. She had been having unprotected sex for a while, and she was concerned that she might have some physical problem preventing her from conceiving. The nurse practitioner asked, “Would it be ethical for me to steer her away from trying to get pregnant? …Or, as her health care provider, do I have an ethical duty to try to help her conceive?”
Appiah doesn’t see any wiggle room. He says,
“You’re her health care provider. You should certainly tell her about the medical consequences of pregnancy. But the social and economic consequences don’t fall within your professional competence. An intervention about her life choices may seem moralizing and intrusive to her, and it could drive her away; and then she’d be losing your guidance on the things you are trained to help her with.”
Yikes. I know you hold Appiah in high regard, and your previous posts about his work make clear why. But I agree with you – he’s very much in the wrong on this one.
Many years ago, I worked in a group home for adjudicated teenagers. We had several 15 and 16 year old girls who, like the girl in question, actually wanted to become pregnant (thank God none of them managed to achieve this goal on our watch).
I recognize that my sample size is small enough that this is nothing more than anecdotal – but as far as I’m concerned, well-adjusted 16-year-old girls may adore babies and kids but understand that now’s not the time. To desire pregnancy at that age requires one or more underlying pathologies. Continue reading →