It's a Shame! Stigma Against Fetal Alcohol Spectrum Disorder: Examining the Ethical Implications for Public Health Practices and Policies

Stigma can influence the prevention and identification of fetal alcohol spectrum disorder (FASD), a leading cause of developmental delay in North America. Understanding the effects of public health practices and policies on stigma is imperative. We reviewed social science and biomedical literatures to understand the nature of stigma in FASD and its relevance from an ethics standpoint in matters of health practices and policies (e.g., diagnostic practices, awareness campaigns). We propose (i) a descriptive model of stigma in FASD and note current knowledge gaps; (ii) discuss the ethical implications of stigma based on two distinct criteria (dignity and consequences); and (iii) describe two cases and the concerns associated with inadvertent stigmatization by public health initiatives for FASD. We recommend further empirical and ethical analyses to examine whether public health policies and practices inadvertently stigmatize and impact the success of public health initiatives and programs for FASD.