Manslaughter Conviction For “Negligent Breastfeeding”

[ By on December 17, 2014 ]

Stephanie Greene, a 39 year old nurse was convicted of killing her six-week-old daughter by administering a morphine overdose through her breast-milk. Greene survived a severe traffic accident in 1998, and suffered from seizures, chronic pain, and post-traumatic stress disorder. Following the accident, Greene was taking multiple pain medications prescribed by a neurologist, in order to treat her pain disorder. The pain persisted over a course of 16 years, and didn’t go away. Therefore, in 2014, Greene was still taking pain medications. In early 2014, Greene had been breastfeeding, although she had been taking morphine. Usually, it is suggested that you don’t breastfeed if you take pain-killers. However, not breast feeding at all isn’t suggested because it can increase the health risks of the baby. Thus, Greene decided to breastfeed her baby. Her baby died. The jury that assessed Greene’s case decided it was her fault the baby died, because she was taking morphine and poisoned the baby. However, no evidence of injection was found at autopsy, which left two possible solutions: “Either a massive dose, 50-100 tablets of the type of morphine prescribed for the mother, was administered orally to the baby, or a genetic defect prevented the baby from metabolizing the tiny amounts of morphine transmitted by breast milk.” In 2005 there was a similar case: a woman who was breastfeeding her newborn, had also been taking pain medication (codeine). An enzyme in the body converts codeine to morphine, and if multiple copies of this enzyme exist too much morphine is produced and intoxication can occur. Instead of initiating a homicide investigation, such as Greene’s case, a medical examiner analyzed the mother’s genome. The examiner found that the mother carried multiple copies of the codeine-converting enzyme. Therefore, the baby had a genetic defect. A different enzyme slowly clears morphine from the infants blood, and children lacking this enzyme have been identified. This would be another genetic defect. Is it possible that Greene’s baby could have had a genetic defect? One fifth of Sids (Sudden Infant Death Syndrome) cases are due to genetic defects. Is it right to charge a mother with a manslaughter due to “negligent breastfeeding,” when the death of her infant could be due to a genetic defect? Or is it right to create restrictions involving who can breastfeed, and who can’t?

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7 Comments on “Manslaughter Conviction For “Negligent Breastfeeding””

  1. elenagolub

    So there’s kind of a two part problem here – one is the ethical quandary and the other is the criminal investigation. I think you can’t deal with the latter, so perhaps your role (if I’m understanding the project correctly) is to investigate whether the former absolves Greene assuming the morphine came through breast milk rather than orally. I’m also curious just how pointed a doctor’s explanations of risks to the baby were, and whether the doctor can ever say, Don’t do this. Wow, this is complex.

  2. elenagolub

    If you really wanted to dig deep, I imagine there is case law regarding Christian Scientists and withholding medication – but perhaps there is some on a normally healthy practice such as breast feeding being “mistakenly” utilized?

  3. elenagolub

    Very interesting case- seems like a no brainer for the mom and the defense to pursue testing for this phenotype. How common is/ are the known defects? This kind of case is so strange- you could not imagine it being brought fifty years ago. What about our times seeks to criminalize parenting?

  4. elenagolub

    Thanks, Elena, for posting. It is always devastating when parents believe they are following “best practice” suggestions and inadvertently harm a child.

    Your two questions are interesting and would open some interesting bioethical doors…

    Is it right to charge a mother with a manslaughter due to “negligent breastfeeding,” when the death of her infant could be due to a genetic defect? — You are thinking about that perhaps because of the codeine case, of course. Perhaps there are also other, simpler explanations? If the mom had been advised not to breastfeed while taking a heavy painkiller…was it OK for her to go forward anyway? Advice to moms that “breast is best” assume that those nursing are not passing along either dangerous medications or, in the case of HIV, harmful viruses. Are doctors clear with moms about this?

    You also ask, is it right to create restrictions involving who can breastfeed, and who can’t? In the case of HIV, we do advise moms not to breastfeed as the virus travels through body fluids. Is that unethical? Perhaps not, though I imagine that if a mother did not have much money, she’d be in a bind. Formula is expensive, and in some places – India, parts of Africa – the water folks mix formula with is dangerous. Hmm… Not all restrictions on breastfeeding are because of an offended sensibility…

    Good luck with your project!

    DK

  5. elenagolub

    Given that most people don’t know what genetic mutations each of us have, it is safe to assume a small proportion of us will have a reaction to any type of exposure (think allergies to bee stings, for example). Therefore, this case is implying that we are each responsible for knowing the pharmacokinetics of our own drug metabolism. I don’t think so. What about the physician who prescribed her morphine? Was the physician informed that she was breastfeeding? Did the physician who prescribed her the drug or the pharmacist who filled it inform the mother what the signs of overdose would be in her infant, or how long the drug is expected to stay in her system so she could time her dose to minimize her child’s exposure? All of this information is available to medical professionals, and they should be required to use it.

  6. elenagolub

    It is important to understand the details in a complex case. I found the following additional info:
    “A review of her medical records showed Greene carefully hid her pregnancy from her primary doctor. After a home pregnancy test showed she was pregnant, she told her primary doctor she needed to go to a gynecologist for a birth control. She then got prenatal care from that doctor while not telling her all the painkillers she was taking. She also skipped appointments with her primary physician when it was obvious she was pregnant and sent her husband to pick up her painkiller prescriptions, Barnette said.” http://www.theguardian.com/world/2014/apr/04/woman-20-years-killing-daughter-morphine-breast-milk

    So in this case the context was evaluated by a jury that found a pattern of behavior that is indicative of child abuse. And it appears the conviction was for homicide by child abuse, not for ‘negligent breast feeding’ which is not a valid legal charge. The issue of how the baby was fed is only one factor.

  7. elenagolub

    Eva, thank you for commenting. When reading an article about this case, I had a completely different perspective. In fact I assumed the perspective of the author of the article I read, because it was in fact the only article I read. However, I find your comment intriguing. I did not know that Greene had a suspicious past, and that it may have been her intention to kill the baby. Now that I see the evidence, it absolutely changes my opinion. The evidence supports why the the jury convicted Greene. Articles such as the one I read, leave out those details. Hence, why I misunderstood the case. It is important to know such things when evaluating a case such as this.

Hi Stranger, reply with your thoughts:

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