PRIMUM NON NOCERE! (FIRST OF ALL, DO NO HARM!)

"All happy families are alike; each unhappy family is unhappy in its own way."  This is how Tolstoy begins Anna Karenina, one of the greatest novels of all time.  I am not sure whether that statement is universally true; I am sure, however, that it is universally true that nobody should make families unhappier by separating parents from their children unnecessarily. Keeping families together should be a commonplace; yet the opposite takes place far too commonly to be an exception to what should be a golden rule  I will give an example from our pediatric practice.

Not every parent interacts well with his or her child at our office.  (An example: one mother tried to text someone while I was about to give her frightened four-year-old vaccinations.)  Most, however, are caring; the parents I will now describe were very caring indeed.

They were obviously different.  The man wore the earrings; each had long hair of equal length; none of the socks or shoes matched, etc.  I remember asking them, "Whatever you smoke, do you ever smoke it in front of the kids?" You get the idea.

They were, however,  model parents.  They explained everything I was going to do, and comforted their two little sons admirably.  Their jeans might have been torn, their shoes might have been worn, but no matter--their children were very lucky to have such parents.

I was surprised that they didn't keep the next appointment, since they never missed appointments in the past. The following month, however, the children did come to the clinic--this time accompanied by foster parents.  Both boys looked miserable.  You could see that their world had fallen apart.  They were glum and taciturn, the direct opposite of their usual behavior.  The foster parents informed me that the boys now attended  daycare, since both adults worked.  They were decent people, but not very affectionate; each one sat silently while I examined two equally silent kids.

What had happened?  The foster parents told me that dad and mom had been caught smoking pot and that the children were removed from the home for that reason.  Soon after the visit,  I received a phone call from the mother; she was so very concerned about how the children were doing.  Both parents were in jail.

It is possible that there is more to this story.  Perhaps the parents had been caught selling drugs; the biological mother, however, denied that they had done so.

If their sole crime had been possession of a small amount of pot, it certainly wouldn't have been the first time that a family has been split up without good cause.  America's incarceration rate is the world's highest; 50% of state  inmates and 90% of federal inmates are serving time for non-violent drug-related crimes.  In addition, sentences for the same crime often result in years behind bars in America, in contrast with months behind bars in Europe. Punishment for possession of crack--even small amounts of which are equated with much larger amounts cocaine--is especially unfair and especially hard on the poor and minorities. (African Americans constitute 15% of the general population and 30% of those incarcerated.)

What about the children of those sentenced--sometimes for years--for such "crimes"? The statistics are disheartening. For instance, one in four children of poor African-American parents has had a parent serving time in jail during crucial years of child development.  Inmates are able to provide neither emotional nor economic support for their families; it is a real problem, especially for their children. Nor has mass incarceration made neighborhoods safer; there is, in fact, evidence to the contrary. In addition, too many families are the victims of what one reporter calls "poverty capitalism."  This occurs when local communities depend on fines to balance their budgets and thus tend to ticket people--especially poor people--more than necessary.  Inability to pay these fines and missed court appearances often result in jail time.

Many of those serving time lose precious time raising their children. You don't have to be a pediatrician to know that a child's perception and interpretation of separation can be very different from that of an adult--What seems like a small amount of time to a judge can seem like an eternity to a child; what might damage an adult for years might damage a child for life.

I later found out that the two boys had been placed permanently with their paternal grandmother in Wyoming.  I never heard from them or their parents again.

"Breakin' up is hard to do," is a rock 'n' roll classic that everyone was singing in the 60s.  "Breakin' up families must be exceedingly hard to do"--I doubt there will ever be a hit with that title, but I hope that that title will someday hit home.

Note: Details have been changed to protect the privacy of those involved.

This article appeared on page 7 of the Mid-Atlantic Ethics Committee newsletter, Fall 2014, published by The Law and Health Care Program of the University of Maryland.