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Maternal Vs. Fetal Rights

Forcing Pregnant Women to do as They're Told:Maternal vs. Fetal Rights

By Claire Andre and Manuel Velasquez

Janet Rowen may be incarcerated because she is pregnant. Her doctor, Marion Smyth, thinks Janet drinks too much alcohol and has repeatedly advised her of the risks her drinking poses to the child she has chosen to have. Heavy alcohol use during pregnancy can result in "fetal alcohol syndrome." Infants with this syndrome suffer from mental retardation and physical deformities and have an increased chance of dying shortly after birth. Janet is unwilling to cut down on her drinking. Dr. Smyth is seeking a court order that would incarcerate Janet for the duration of her pregnancy, forcing her to follow Dr. Smyth's medical advice.

Research in medicine continues to reveal more and more ways in which a baby's health can be jeopardized by what a woman does during pregnancy. And, developments in genetics and obstetrics continue to provide us with more and more prenatal diagnostic tests and medical treatments that enable us to prevent birth defects. Most women welcome these developments. There are some, however, who are unwilling to avoid those activities or behaviors that could harm their offspring and who refuse to undergo medical treatments that would prevent birth defects.

As our knowledge of prevention and prenatal harm grows, so too has public pressure to change the behavior of "non-compliant" pregnant women. Almost half of the maternal-fetal specialists surveyed in a recent national study thought that pregnant women who refused medical advice and thereby endangered their future children should be detained in hospitals and forced to "follow doctors orders." A growing number of legal cases throughout the U.S. Show a trend toward forced treatment of pregnant women--court ordered Caesarean sections, mandatory diet restrictions and, as in Janet's case, incarceration for failing to follow medical advice. But does society have a right to control the behavior of pregnant women? Moral opinion is sharply divided on the matter.

Those opposed to forced treatment of pregnant women argue that every person has a fundamental right to freedom of choice and control over his or her own life. Forcing a pregnant woman to undergo medical treatment against her will or to behave in ways she does not freely choose violates this right. The decisions a woman makes during pregnancy are based on her own circumstances, her own values, and her own preferences. Others have no right to impose on her their own judgments about what they think is best for her and her fetus, depriving her of her freedom to make her own choices and to control her own life.

The threat to freedom posed by forced treatment of pregnant women is not a minor threat, either. It is rare for a woman to refuse medical advice that promises to benefit her fetus and poses little risk to her, and it is troubling when it happens. But if we allow society to intervene in these cases, what will prevent us from assuming wholesale control of women's lives during pregnancy? If pregnant women are incarcerated to prevent them from heavy drinking, will we also seize them for drinking coffee or exercising too little, each of which could pose some risk to a fetus according to some doctors. If pregnant women are compelled to undergo surgery that would prevent their future child from being born with handicaps, will they also be compelled to undergo amniocentesis or genetic screening in order to detect those handicaps that could be prevented by such surgery?

Furthermore, forcing pregnant women to submit to medical treatment for the sake of their fetuses is to impose an obligation on them that we do not impose on others. And, justice requires that all persons be treated equally. In our society, we allow people the right to refuse medical treatment and the right to refuse to subordinate their desires or needs to the needs of others. We don't, for example, force some people to donate their kidneys, bone marrow or blood in order to benefit or even to save the lives of other people. Why, then, should pregnant women be forced to undergo surgery or to change their lifestyles in order to benefit a fetus? To require this of pregnant women is to demand from them something over and above what we demand from the rest of society.

Finally, compelling a pregnant woman to follow medical advice in order to benefit her fetus will only cause more harm than good. To avoid being treated against their will or to avoid being incarcerated, women with high-risk pregnancies and therefore the greatest need for prenatal care, will avoid doctors or will withhold important information from their doctors concerning their health. As a result, the health of the fetus will be placed in even greater jeopardy.

Those who support forced treatment of pregnant women agree that every person has a right to freedom of choice. But when a woman decides to carry her pregnancy to term, we can expect that a child will be born, and this future child has a right to be protected from avoidable harm. Certain behaviors during pregnancy are known to cause harm to offspring. Poor nutrition can retard fetal growth and impair brain development. Use of heroin can result in fetal addiction. Heavy alcohol use can cause mental retardation and physical malformations. Altering one's diet or refraining from alcohol or drugs presents no serious risk to a pregnant woman's life or health. When a pregnant woman who has decided to give birth to a child engages in activities that she could reasonably avoid and that will damage that child, society has a duty to protect the future child, even if this means forcing the pregnant woman to change her behavior.

Furthermore, it is argued, there are cases in which a pregnant woman's right to freedom of choice must be weighed against a child's right to be born in a healthy state. There are a number of established prenatal medical treatments to prevent birth defects that pose little risk to pregnant women, including the administration of certain drugs or low-risk in-utero surgery. The discomfort or inconvenience of taking a medication or undergoing a low-risk surgical procedure is a small price to pay to prevent a child from being born with handicaps. Society has a right to prevent pregnant women who choose to have children from refusing to undergo medical treatments that would prevent birth defects when such treatments pose little risk to their own lives or health.

And, supporters contend, we need not fear that forced treatment of pregnant women will lead to the public assuming wholesale control of women's lives during pregnancy. Just as we draw lines as to what does or doesn't constitute child abuse and thus are grounds for taking a child from his or her parents, so we can distinguish between what does or doesn't constitute harmful prenatal conduct, and thus are grounds for forced treatment of pregnant women.

Mother or fetus? Where do our obligations lie? Our answer will require a careful balancing of the values of freedom and self-determination, and the value we place on the right to be protected from harm.

For further reading:

Dawn Johnson, "A New Threat to Pregnant Women's Autonomy," Hastings Center Report, Volume 17 (August/September 1987), pp. 33-40.

"When a Pregnant Women Endangers Her Fetus" (commentaries by Thomas B. MacEnzie and Theodore Nagel, and Barbara Katz Rothman) Hastings Center Report, Volume 16 (February 1986), pp. 24-25.

John A. Robertson and Joseph D. Schulman, "Pregnancy and Prenatal Harm to Offspring: The Case of Mothers with PKU," Hastings Center Report, Volume 17 (August/September 1987), pp. 23-33.


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Acne On Your Arms: What Is And Isn't Causing Breakouts

Medically reviewed by Brendan Camp, MD

Acne doesn't just appear on the face but also on different parts of the body, including the arms. Arm acne may show as pimples, whiteheads, or blackheads on the upper arms, back of the arms, or shoulders.

There are a variety of reasons that might make you prone to acne on your arms, though more research is needed to better understand what may be causing acne to show up on the arms in particular.

This article talks about potential causes of acne on arms, tips on how to manage it naturally, and when to speak to a dermatologist.

Acne vs. Keratosis Pilaris

Acne on arms differs from keratosis pilaris, characterized by little bumps, usually on the upper arms, that may appear rough and dry, like goosebumps, and aren't painful to the touch.

Acne on Arms: A Breakout or Something Else?

Acne breakouts are oftentimes thought about in relation to the face, but they can happen on the arms too. More research is needed on causes of acne on arms in particular, but there are some factors that may increase the potential of acne showing up on the arms.

Hormones

Hormones play a role in the development of acne in general. Although there is a lack of research on hormones and acne on arms, generally speaking, changes in hormone levels during puberty, menstrual cycles, and pregnancy can cause the sebaceous glands to produce more oil and subsequently lead to acne.

And even though acne is often associated with puberty and the teen years because of hormonal changes, acne can also persist into adulthood or show up for the first time as an adult.

Some of the hormones related to the development of acne include:

  • Estrogens

  • Progesterone

  • Androgens

  • Insulin and insulin-like growth factor-1

  • Corticotropin-releasing hormone

  • Glucocorticoids

  • Melanocortin

  • Pituitary hormones

  • Sweat

    Sweating can also cause breakouts of acne. Excessive sweating, such as during or after exercise, can lead to a buildup of bacteria, dirt, and oil on your skin, which in turn can lead to clogged pores and subsequent acne.

    Tight clothing, such as on the arms, may also trigger acne on acne-prone skin. Tight clothing can trap sweat and heat, causing irritation when the clothing rubs against the warm, sweaty skin.

    Similarly, sports equipment may be a culprit of acne on arms as it can also trap heat and sweat, leading to irritation and breakouts on acne-prone skin. Sports equipment like shoulder pads or tight tops made of material that isn't breathable could breed an environment for arm acne to appear.

    Wash Regularly to Prevent Future Breakouts

    Proper hygiene is important for helping your skin stay acne-free. Washing your body removes dead skin cells and oils that could clog pores. Showering or bathing once or twice a day may be necessary to keep arm acne at bay, depending on how acne-prone your skin is and how much you sweat.

    For example, showering immediately after exercising can help clear your skin of any buildup of oil, sweat, or dirt that could potentially cause acne on the arms. 

    When choosing a bodywash, be sure to avoid products with lots of oils as using oily skin-care products can trigger breakouts.

    Heat and Humidity

    Research has suggested that heat and humidity may also trigger acne breakouts. Some studies have found that people living in hot and humid climates get acne more frequently than those in dry or cooler climates.

    Although it's unclear if heat and humidity are risk factors for acne on arms specifically, studies have shown that being in a hot environment leads to more sebum secretion, which causes acne to worsen in general. If you're prone to acne on your arms, increased sebum secretion on hot days may mean a breakout of arm acne.

    Humidity can also irritate the skin, which may be worsened by tight clothing, such as a tight shirt that leaves the arms susceptible to a buildup of sweat and heat.

    How to Naturally Heal Acne on Arms

    Acne on arms may be managed without using specialized skin-care products or medications by keeping your skin clean and—as hard as it may be—keeping your hands off the affected area.

    As acne on arms can be caused by clogged pores, washing your skin regularly may prevent acne. Wash once or twice a day to help ensure any excess skin oils, sweat, or dirt is rinsed off your skin, decreasing the chances that your pores get clogged. It's especially important to wash your skin after sweating a lot, such as after exercising or being outside on a hot day.

    Be sure to use gentle, nonabrasive soap that doesn't have any alcohol in it.

    Try not to touch the affected area. It can be tempting to pick or pop any zits or pimples on your arms, but it's important to leave them be, as picking, popping, or squeezing the acne can mean longer healing times and increase the risk that the acne leaves scars or dark spots.

    Skin-Care Ingredients to Target Arm Acne

    There are many skin-care products that claim to clear acne. It's important to remember that not every product will work for your skin, and it's best to consult a dermatologist to help you navigate the skin-care aisle more confidently.

    Certain ingredients in skin-care products can help promote acne healing. For example, soaps with salicylic acid or benzoyl may help with acne on arms if you have oily skin prone to acne. Products with benzoyl peroxide may help by killing bacteria that could potentially clog pores.

    A healthcare provider, such as a dermatologist, may recommend topical ointments to treat acne on arms. Common ingredients in topical acne ointments include:

  • Azelaic acid

  • Dapsone

  • Salicylic acid

  • Tazarotene

  • Clindamycin

  • Tretinoin

  • It's important to talk with a healthcare provider or dermatologist before trying out new skin-care products to ensure they don't contain ingredients that could worsen your arm acne or otherwise irritate your skin.

    Seeing a Dermatologist for Prescription Treatment

    Sometimes acne on arms or elsewhere is stubborn. If you find that acne on your arms is persisting despite appropriate care, and it's bothering you, it may be time to talk to a dermatologist.

    A dermatologist may ask you about your history of acne and lifestyle habits to get to the bottom of what might be causing the acne to persist. They may suggest over-the-counter (OTC) treatments to try first to see if that helps clear the acne. Be sure to ask about any skin-care product ingredients you should avoid.

    A dermatologist may recommend prescription treatment, including a topical medication (such as a cream or gel) or an oral antibiotic for acne that isn't responding to OTC treatments.

    Summary

    Acne on arms happens when sebaceous glands become clogged with oil, dirt, or bacteria. There are a variety of potential causes of acne on arms, including hormones, sweat, and heat and humidity. Certain sports equipment or tight clothing may also make the arms more prone to acne.

    Washing regularly and avoiding touching acne on arms may help prevent and heal acne. Acne that persists may be treated with special skin-care products or prescription medication at the recommendation of a dermatologist.

    Read the original article on Verywell Health.

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