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J. Boohekamp, R. Berghmans, W. Dondorp, G. de Wert, Zorg voor zwangere verslaafde vrouwen: rechtvaardiging van drang en dwang. Tijdschrift voor Psychiatrie, 54, 2012, 3.

ABSTRACT Zorg voor verslaafde zwangere vrouwen: rechtvaardiging van drang en dwang j. boonekamp, r. berghmans, w. dondorp, g. de wert achtergrond De praktijk van de zorg voor verslaafde zwangere vrouwen is gericht op de bescherming van het toekomstige kind. doel Bijdragen aan reflectie op en verantwoording van de praktijk; agendasetting voor nadere ethische discussie en onderzoek. methode Ethische analyse op basis van criteria voor drang en dwang, toegespitst op de Rotterdamse aanpak. resultaten Drang-en dwangmaatregelen impliceren een inbreuk op de handelingsvrijheid van de zwangere vrouw. Dat vraagt om een explicietere morele verantwoording dan tot nu toe in de praktijk wordt gegeven. conclusie Een morele verantwoording vraagt om nadere onderbouwing in termen van de proportionaliteit en subsidiariteit van specifieke vormen van drang en dwang. Het routinematig aanvragen van een prenatale voorlopige ondertoezichtstelling lijkt met die voorwaarden op gespannen voet te staan. Een belangrijk knelpunt is het ontbreken van juridische ruimte voor dwangmaatregelen in het belang van het kind vóór een zwangerschapsduur van 24 weken. [tijdschrift voor psychiatrie 54(2012)3, 000-000] trefwoorden drang, dwang, ethiek, verslaving, zwangerschap In de afgelopen jaren is er steeds meer aandacht gekomen voor de bescherming van het nog onge-boren kind tegen mogelijke bedreigingen van diens toekomstige gezondheid en welzijn (Gezondheidsraad 2009). Verschillende ontwikke-lingen hebben daartoe geleid. Er is meer bekend over de schadelijkheid van het gebruik van mid-delen zoals heroïne, nicotine en alcohol voor de ontwikkeling van de foetus. Zaken als die van Savannah en 'het meisje van Nulde' hebben de bezorgdheid van burgers en beleidsmakers gevoed over tekortschietend ouderschap en discussie over ingrijpen van professionals in opvoedingssituaties gestimuleerd (Onderzoeksraad voor Veiligheid 2011; rvz 2008). Er is minder tolerantie ten opzichte van gedrag van burgers dat henzelf of anderen schaadt en een groter dan gemiddeld beslag legt op overheidsgeld en -middelen (rvz 2010). En in de zorg zelf valt een verschuiving te constateren van een liberale benadering, waarin terughoudendheid bij ingrijpen in het leven van burgers centraal stond, naar een meer actieve, 'outreachende' benadering (Gezondheidsraad 2004). Een belangrijk element daarvan is dat men-sen met een beperkte autonomie en zelfredzaam-heid actief geholpen worden bij het versterken van hun autonomie, ook als zij daar zelf niet expliciet om vragen (Schermer 2003). De Rotterdamse aanpak van de zorg voor ver-slaafde zwangeren past in deze tendens naar min-der vrijblijvende hulpverlening. Men probeert de leefstijl van de vrouwen in kwestie actief te

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