Recent reports of hospitals conducting drug tests on patients without their knowledge or consent highlight a concerning lack of respect for individual autonomy within the healthcare system. These practices urgently require reform, as they subject vulnerable populations, particularly pregnant women, to harmful and unwarranted scrutiny.
Virtua Health, one of New Jersey’s largest providers, is embroiled in a lawsuit after news stories revealed a systemic practice of secretly testing pregnant women for narcotics use. Despite Virtua Health having explicit policies requiring clinicians to obtain informed consent from their patients, those guidelines were disregarded, violating one of the core pillars of ethical medicine by stripping patients of their right to make informed decisions about their own care.
Informed consent isn’t just a bureaucratic checkbox but a cornerstone of medical ethics. Adopted in the aftermath of World War II when the world learned of the horrific medical experiments conducted on humans by Nazi doctors during World War II, the requirement to obtain informed consent protects patients from being forced to relinquish their rights to obtain medical care. It guarantees that patients, regardless of their background or position, are not coerced into care against their will and that they fully understand the risks, benefits, and alternatives before undergoing any medical procedure.
These incidents of forgoing informed consent are not isolated. Instead, they reflect a broader trend in health settings where control is prioritized over compassionate care. It is particularly troubling in maternal health, where false positives can result in stress, trauma, and family separation, often with discriminatory effects. According to the lawsuit filed by the New Jersey Attorney General’s Division on Civil Rights, Virtua Health has practiced a policy of drug testing all patients admitted to its labor and delivery or high-risk obstetrics units since 2018, with staff regularly failing to obtain informed consent from pregnant patients before administering such tests.
Such practices can lead to other harmful forms of discrimination that harm patients seeking reproductive healthcare. Research shows that women of color and those from low-income communities are far more likely to be subjected to drug tests despite the evidence that they are no more likely to use substances compared to other populations. This systemic bias not only perpetuates long-standing disparities in healthcare but also erodes trust in medical institutions.
The real-world consequences of these policies are devastating. False positives—sometimes triggered by something as innocent as eating a poppy seed bagel or taking a common medication such as Adderall—have led to invasive investigations and, in some cases, the separation of families.
At Virtua Health, staff failed to perform the proper confirmatory testing needed to rule out false positives before reporting positive test results to child protective services, forcing mothers and families to endure stressful investigations at a time when they should be healing and bonding with their newborns. Instead, their birthing experience is marked with fear, alienation, and potentially long-term psychological trauma. This isn’t just a policy failure; it’s a betrayal of trust, a theft of dignity, and a stark reminder of how systemic practices can strip humanity from healthcare. Reforms like New York’s proposed ban on drug-testing pregnant people without informed consent outside of emergency situations are urgently needed.
When hospitals act as enforcers for state agencies, they turn what should be a safe and supportive environment into a place of fear and control. This dynamic is not merely an ethical failure but a potential violation of constitutional protections. Supreme Court precedent, such as in Printz v. United States (521 U.S. 898, 1997), establishes that the government cannot compel private entities to perform actions they are constitutionally prohibited from performing directly. Furthermore, under the state action doctrine, private entities performing traditional public functions or working closely with the government may also be subject to constitutional limitations. By conducting drug tests and sharing the results with state agencies, hospitals may act as state agents even if their actions are voluntary, bypassing the Fourth Amendment’s protections against unreasonable searches and seizures.
As a result of these privacy violations, patients may hesitate to seek the care they need, fearing their personal information could be turned over to authorities. This fear doesn’t affect everyone equally—it’s especially pertinent to those who use drugs. When individuals avoid seeking medical care due to the fear of criminalization or judgment, the consequences include untreated health conditions, increased rates of preventable deaths, and the heightened spread of infectious diseases like HIV and hepatitis. This cycle of harm endangers individuals and undermines public health efforts on a broader scale.
These practices raise serious concerns about healthcare providers’ ethical and legal duties. When hospitals take on roles similar to law enforcement, they betray their core mission: delivering compassionate, patient-centered care. To address this issue, we need reforms that separate healthcare from state surveillance, safeguard patient rights, and ensure that medical settings remain spaces of trust and protection.
The healthcare system should not be about policing patients. Instead, it should assist people in improving their health and empower them to make their own choices, free from coercion or unnecessary interference. By championing policies that protect all patients’ autonomy, we can create a system that genuinely serves and supports everyone.