Safe Havens Legislation - From a Doctor's View

November 20, 2002

I am a pediatrician. It is the most rewarding of professions. I am privileged to experience daily human physiology at its most dynamic; an evolving anatomy, an exacting pathophysiology, a gentle psychology, highly scientific while acutely social. It is a gift to be able to welcome the newest and smallest beginnings, to witness the awesome change that is infancy to adulthood, that is illness to well-being, and to walk, with families, from grief toward acceptance after a child's passing.

I have dedicated my life to serving and celebrating the lives of this Commonwealth's youngest. And I see it as not only integral, but paramount, to include in my responsibilities a commitment to work with those who serve children by developing and enacting public policy intended to improve their well-being. I am here today because my patients, the children of Massachusetts, expect to be loved, expect to be respected, expect to be safe. I am here today because, as their doctor, they expect me to be.

For all of us who work with, work for, or care about children, we, as a community, are especially touched by stories of infant abuse and neglect. In the extreme, we are shocked and saddened when confronted with the unnerving details of infant abandonment, with all attending horrors. My response, like yours, is visceral - an overwhelming sense of sadness. It is accompanied by an immediate impatience to recover a comprehensive legislative response.

Modeled after legislation enacted in Texas in 1999, the Commonwealth of Massachusetts has developed legislation designed to prevent unsafe infant abandonment. Specifically, the legislation (known as "Safe Haven" legislation) would provide legal protection against prosecution for abandonment if a parent surrendered custody of a newborn in a designated "safe haven" (such as an Emergency Room, Police Station or Fire Station). The intent was to remove the threat of criminal charges, giving parents the "option" to leave their children in the arm of police officers or fire fighters instead of abandoning them in dumpsters or alleyways. It is a swift solution - one that satisfies our collective need for an immediate solution. It is a 45 second answer.

But infant abandonment, the problem of infant abuse and neglect, is not a 45 second problem. It requires a curious mind, a compassionate heart and committed resources.

Working on a daily basis with the highest of high-risk families here in Massachusetts, I know that those most at risk for abandoning their newborns - frightened adolescents, victims of domestic violence, and individuals suffering from acute psychiatric disease - are those least likely to see a police station or a fire house as a safe haven for either themselves or their child.

To those frightened adolescents, the proposed legislation would offer no counseling. Having already failed them with under-funded state teen pregnancy prevention programs, we would fail them again. This so-called "Safe Haven" would offer to these teens no post-partum medical care, potentially lifesaving post-partum care. It would offer no support for teen parenting programs or for school based child care.

To those victims of domestic violence, the proposed legislation would offer no services. Health care professionals have long known that the period in a woman's life when she is at greatest risk of being abused by her partner is during her third trimester of pregnancy. If a woman feels forced to surrender her newborn, either for her own safety or for the safety of the child, we would turn a blind eye to her need. This so-called "Safe Haven" would offer to women no protection from further physical, sexual or emotional harm.

To those suffering with acute mental illness, the proposed legislation would offer no treatment. Under the supervision of physicians, women with mental illness are often directed to stop taking their most potent mood stabilizing or anti-psychotic medications. They are directed to do so because these medications are often teratogens - meaning, they are medicines that can cause harm to an unborn child. It is not at all uncommon for a pediatrician to attend a delivery of child to a new mother that is then acutely manic, acutely depressed, or acutely psychotic. These mothers are in that condition because they have selflessly given up their own life-saving medication for the sake of their child. This so-called "Safe Haven" would offer no professional screening for untreated or poorly controlled mental illness, would ensure no treatment, no therapy, would guarantee no effective grace period for those mothers who, when receiving proper medical care for themselves, later wished to reclaim their infant.

This legislation may make us all feel good. "At least we have tried", we could say. Perhaps we could even allow ourselves to sleep more soundly thinking, perhaps, just perhaps, we could save the life of at least one little baby.

I, however, am held to a higher standard. On becoming a physician, I swore to the Hippocratic Oath. The most fundamental precept of which is: Primum non nocere - First, Do No Harm.

We must acknowledge that the legislation may well be completely ineffective. But, we must also acknowledge that our "Safe Haven" legislation offers no safe haven to those mothers at highest risk for needing its provisions. And what I fear most of all is that the legislation will, in fact, make Massachusetts less safe for the infants the "Safe Haven" bill is specifically designed to protect.

In legalizing infant abandonment, the potential for abuse is enormous. Let me tell you a story: There are times, when working as the discharging physician at my hospital's newborn nursery, that I can do no better than to whisper a quiet "I am sorry, my dear" in the ear of my beautiful, high-risk newborn patients. In this season of deep and painful budget cuts and a growing desperation among our society's "have nots", as a physician, I can do little other than kiss them on the forehead and apologize as I sent them out into the inhospitable world. I send them out without an identified primary care pediatrician, without newborn nursing home visits, without appropriate resources, financial or otherwise, to ensure adequate food, clothing or shelter, and without effective parental supports, financial or otherwise, to ensure they are ready, willing and able to provide the adequate affection.

But, as hard as it is to kiss these sweet children on the forehead and sent them out into the world, it is even harder to see those children come back; to see them come back to the clinic with spiral fractures, fractures caused by the deliberate and forceful twisting of an infant's growing arm or leg, a fracture pathogneuomnitc (meaning characteristic only) of child abuse; It is harder to see them come back to the ER, lethargic, unresponsive after having been shaken so fiercely, their fragile little brain bruised (often permanently) as a result; It is harder to see them back in the hospital, malnourished, neglected, having been so deprived of the love and attention required in infancy, so dispossessed that the child might only drink from a bottle propped up against a pillow instead of from the arm of a caregiver. You see, when children are deprived of human touch, of human contact, simply being held is stimulating. And it is too much for these children to feed and be held at the same time. It is almost impossible to imagine, but a child so neglected that he or she has missed that precious window where most come naturally to learn how to love, and be loved.

These smallest victims of abuse deserve better. They deserve better than to be abandoned, and they deserve better than to be abandoned in the arms of someone not trained to recognize those signs of abuse. And those perpetrators do not deserve an easy, anonymous, legal out.

With the full weight of the Commonwealth's state government behind you, you should not be able to abandon your child, no questions asked, no consequences rendered. Our state government should not accept broken families, broken lives, with no counseling offered, no interventions considered. We cannot right something so inherently wrong simply by making it legal.

Massachusetts should become a true "Safe Haven", for all children and families. Infant protection starts before birth, with well-funded, effective adolescent pregnancy prevention programs and accessible, high quality prenatal and postnatal care. The children of Massachusetts expect more from me, their caregiver, and they expect more from you, their community. They expect and deserve a public policy standard set higher than "being safe is better than being dead".

Thank you.
Charlotte Moore, M.D.
Pediatric Resident, Boston