by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012)
Rennie Gibbs was 15 years old when she found out she was pregnant. In late 2006, then 16 and pregnant 36 weeks, she was admitted to a hospital in Lowndes County, MS, diagnosed with fetal demise and induced to gave birth to a stillborn baby named Samiya. A urine test detected marijuana and cocaine in Ms. Gibbs’ system upon admission. An autopsy revealed that Samiya’s death was most likely due to the umbilical cord wrapping around Samiya’s neck, causing blood supply to be cut off. But that interpretation of the autopsy report is not what was given days after Samiya’s death, when Samiya’s death was ruled a homicide and Ms. Gibbs was subsequently indicted for murder. The claim was that, because Rennie had smoked crack during her pregnancy, she had caused the death of her baby. Under Mississippi statute, that constitutes murder if one’s acts are “eminently dangerous to others and evincing a depraved heart, regardless of human life, although without any premeditated design to effect the death of any particular individual”. A judge is expected to rule later this week as to whether the case will continue or be dismissed.
On its face, the legal perspective would seem laughable were it not real. The case highlights the problems of Mississippi’s medical examinations and the ‘medical examiner’, Steven Hayne. I use quotations because of Hayne’s reputation for being, well, spectacularly corrupt. For example,
(Much more on Hayne has been excellently written by Radley Balko; it is interestingly infuriating, but you may wish to shower after. Mississippi seems to have improved since severing ties with Hayne in 2008 and contracting services out to a company from Tennessee).
Perhaps more interestingly, Ms. Gibbs’ attorneys appear poised to challenge the medical evidence associating prenatal cocaine use with fetal harm, which may further bolster their case. Researcher Deborah A. Frank’s affadavit indicates there is “no consistent association between cocaine use during pregnancy and serious fetal harms; … no convincing evidence that prenatal cocaine exposure is more strongly associated … than exposure to… tobacco and alcohol”. Their argument: there simply is no causal connection between the drugs in in Ms. Gibbs’ system and the Sayima’s death. Besides that, there were only trace amounts of a derivative of cocaine, which is a significant departure from the “cocaine toxicity” indicated by Hayne in the autopsy report.
But I am less interested in the legal perspective of the case than I am about the ethical ones. For example, what if anything does this case say about reproductive rights in Mississippi?
It may be relevant to consider Ms. Gibbs’ actions from one of two perspectives. First, what if Ms. Gibbs did not want to have a baby? Second, what if she did want to have the baby? This puts her case into a sort of discussion about abortion rights, and focuses on her actions as a function of her intent. While intent does not seem to matter in terms of Mississippi law, it can matter ethically.
Let’s consider first if Ms. Gibbs did not want to continue her pregnancy. As a teen, consideration is often given to parents’ wishes for their children. Children do not yet have the capacity to make decisions for themselves and we thus seek the decision from parents. This autonomy is something that emerges over time, congruous with a person’s development to adulthood when decisions can be made independently and autonomously. As children begin to demonstrate this ability to consider their own decisions and their impact, the decision-making process moves from assent (parents consenting, and the child agreeing) to consent (child consenting). Ms. Gibbs was at that threshold when this transition typically occurs, meaning she would likely have had the ability to make the decision about her pregnancy autonomously.
If we are to assume that Ms. Gibbs did not want to continue the pregnancy, but could not get an abortion, then her options may have been further limited. Could Ms. Gibbs’ drug use constitute actions taken to terminate the pregnancy on her own? It would be difficult for anyone to legally prove her intent, but from an ethical perspective it matters. If she were trying to terminate the pregnancy on her own by using or abusing drugs, then her situation could be considered similar to an abortion. This is at least plausible, since abortion would have been rather difficult for Ms. Gibbs at the time. Lowndes County sits on the eastern border with Alabama, about 120 miles west of Birmingham. The closest clinic is in Tuscaloosa, AL, 60 miles away. While they appear to address the needs of MS women, the mere fact of having to cross state lines to get an abortion may be a barrier. There is exactly one clinic that provides abortion in Mississippi, 150 miles away in Jackson. It seems to face consistent pressure and scrutiny to even keep its doors open. Her age would have been a barrier, though; in Mississippi consent is required by both parents, with exceptions for judicial permission or medical emergency (threatening the life of the mother). If she were attempting to abort the fetus in the absence of professional assistance, it would likely be ethically justified, although not recommended. The risk of harms would be much greater than a clinically assisted abortion – both to Ms. Gibbs and to a potential baby that essentially survives an abortion attempt with likely significant health problems. But justified still, since Ms. Gibbs could evaluate the benefits and harms of continuing the pregnancy versus ending it in this way. Autonomy allows a person to make choices that appear unwise and even sometimes unsafe based on this evaluation of benefits and harms.
Perhaps it is wrong to construct a narrative around Ms. Gibbs’ actions that indicates her desire to end the pregnancy. Perhaps she did indeed wish to have the baby, meaning that her actions tell a different story. For an autonomous individual (if we presume she is) to make decisions that definitively add risk to a situation, there are a couple of likely reasons. The first and most likely is a lack of understanding that the specified action (drug use during pregnancy) can cause harms. In this regard, there could be a entire volume of reasons for why Ms. Gibbs was not educated on these matters, none of which matter except for noting that they exist. The second reason that may have compelled Ms. Gibbs to her actions is also likely, in my opinion: She was a teenager, and teenagers (in addition to gaining autonomous capabilities) tend to test the limits imposed on them, and this can often be expressed in using various drugs. Even if there was some correlation between her drug use and her stillborn baby (remember, there is not), it is difficult to see how charging a teenager with murder would improve anything, except as perhaps some ‘cautionary tale’ to warn other teens not to do drugs or get pregnant. Except that doesn’t work.
I cannot say that a better health care system, or better schools that teach responsible sexuality, or better access to abortion, or any other broad factor could have avoided this scenario. But I do envision a situation in which we do have all of those things, and I imagine if this would then be a ‘cautionary tale’ for others. Instead, in reality, I fear that it represents ‘more of the same’.
[This blog entry was originally posted in a slightly different form on Mr. Dahlke’s blog on March 19, 2014. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]