Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD)—diagnosis and moral policing; an ethical dilemma for paediatricians

We certainly live in interesting times; advertisements in the media and even in emergency departments enjoin those who have suffered injury to claim legal compensation from those who have wronged them, often on a ‘no win no fee’ basis. Although UK paediatrics has, thus far, been largely immune to this cultural shift, it has been argued that children should be able to sue parents for illnesses that might have been prevented by vaccination,1 for wrongful birth2 or for illness caused by passive smoking.3 No such cases have succeeded in the UK, perhaps reflecting the importance the legal system attaches to the integrity of the family as a social unit. Contrast the US, where, by 2005 more than 20 states had enacted laws criminalising women for behaviours in pregnancy considered harmful to the fetus, for example, drinking excessive alcohol.4 In the UK, considerable license is afforded to pregnant women over behaviours that may affect the welfare of their unborn children; but could this be about to change? A recent case, heard by the upper tribunal of the Criminal Injuries Compensation Authority (CICA),5 has drawn attention to duties that might be owed to a fetus, and how competing moral claims between the mother and her fetus might be balanced. This has implications for paediatricians who may be involved in the diagnosis and management of conditions resulting from adverse maternal behaviours in pregnancy. The case was brought by a local authority on behalf of a 6-year-old affected by fetal alcohol spectrum disorder (FASD), (rather than the more severe fetal alcohol syndrome (FAS)).6 It was accepted by all parties that the child's condition had resulted from continuing maternal alcohol consumption in pregnancy, despite warnings of the consequences for the fetus/future child (which the mother had understood) and provision …