Is Medical Advice On Prenatal Alcohol Use Really Accurate?

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Main Category: Pregnancy / Obstetrics
Also Included In: Alcohol / Addiction / Illegal Drugs
Article Date: 01 May 2009 - 0:00 PDT

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A medico-legal professional in the Journal of Medical Ethics states that advice given by many doctors on drinking during pregnancy is condescending and morally uncertain, including the recommendations of the Chief Medical Officer for England and the British Medical Association (BMA).

Unlike heavy drinking, when consumption is reasonable and moderate, studies still do not conclude that it can cause harm to the developing fetus according to Colin Gavaghan, of the School of Law at the University of Glasgow.

Regardless of lack of new evidence, the UK government and the BMA changed their recommendations radically in 2007, advising total abstinence during pregnancy.

Nonetheless, a year later, the National Institute for Health and Clinical Excellence (NICE), and researchers from The University of London claimed that there was no support of proof of damage, as long as women drank no more than one or two units per week.

The investigation even established that the children of mothers who drank moderately during gestation had fewer behavioral and developmental problems than those whose mothers abstained entirely.

Unfortunately, when in doubt, most doctors advice abstinence, but for several reasons Dr Gavaghan argues that this simply should not be the case.

He remarks that healthcare in general has changed from paternalism to choice and autonomy, a vital part of which is supplying information to allow patients to make educated decisions.

When there is uncertainty in the evidence, doctors should disclose it, rather than taking the easy option and avoid trying to clarify it, he argues. "It is not reasonable to replace more accurate information with less accurate merely because it is simpler to communicate," he writes.

"The days where doctors routinely withheld information... on the grounds that patients would become confused and make bad decisions are, supposedly, consigned to history," he points out. "It is far from clear why a paternalistic exception is permitted in the case of pregnant women."

During pregnancy, a stressful time for women when they are surrounded by demands to change their behavior, sometimes one or two drinks consumed per week may be pleasant and help them unwind. This is another important issue to consider.

He explains: "For an increasing number of people, however, it seems as though the quality of life of the pregnant woman is so far behind the interests of the future child in any scale of ethical relevance as to be beneath consideration altogether."

Dr. Gavaghan continues by explaining that the time of abstinence could be rather long, since many doctors also advise women to refrain from drinking when trying to get pregnant.

"It may be thought that, at the very least, we should require some reasonably compelling ethical justification for what is, on the face of it, a straightforward sexist policy. To date, the evidence suggests that we have no such justification," he says.

He suggests that such methods might go wrong and have negative effects in the long run. "If [doctors] are seen to be exaggerating risks that recent studies have shown to be negligible, their advice on genuine risks will carry less authority."

"You can't handle the truth: medical paternalism and prenatal alcohol use."
J Med Ethics 2009; 35: 300-303
http://jme.bmj.com/

Written by Stephanie Brunner (B.A.)
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