## Facts

- Regina D. McKnight delivered a stillborn baby at an estimated 34–37 weeks’ gestation, weighing about five pounds.
- Autopsy testing detected benzoylecgonine (a cocaine metabolite) in the fetus.
- The pathologist testified the metabolite could only have come through maternal cocaine use and opined the fetus died one to three days before delivery.
- The pathologist listed the cause of death as intrauterine fetal demise with infection findings and cocaine consumption and classified the death as a homicide.
- A delivery nurse testified McKnight consented to a urine drug screen that was positive for cocaine.
- The State charged McKnight with homicide by child abuse, alleging her knowing and continued crack cocaine use during late pregnancy caused the death under circumstances showing extreme indifference to human life.

## Issues

1. Whether the trial court erred in denying a directed verdict based on alleged insufficiency of evidence of causation, intent (extreme indifference), and fetal viability at the time of cocaine ingestion.
2. Whether the homicide-by-child-abuse statute applied to the death of a viable fetus and, if so, whether it was displaced by the criminal abortion statute.
3. Whether applying the homicide-by-child-abuse statute to prenatal cocaine use violated due process notice requirements.
4. Whether prosecution under the statute violated the constitutional right to privacy.
5. Whether the charge and potential punishment violated the Eighth Amendment prohibition on cruel and unusual punishment.
6. Whether application of the statute violated equal protection.
7. Whether admission of McKnight’s urine drug test violated the Fourth Amendment.

## Decision

- The Supreme Court of South Carolina affirmed the conviction and sentence.
- The court held the evidence permitted a jury finding on causation, extreme indifference, and viability, so the directed verdict motion was properly denied.
- The court held the homicide-by-child-abuse statute could apply to a viable fetus and was not precluded by the criminal abortion statute where the State alleged reckless conduct causing death rather than an intent to terminate pregnancy.
- The court rejected constitutional challenges based on due process, privacy, equal protection, and the Eighth Amendment.
- The court held the urine test was admissible because the sample was obtained by consent, defeating the Fourth Amendment claim.

## Legal Principles

- A directed verdict is improper where evidence, including expert testimony and supporting circumstantial proof, permits a reasonable jury to find each element of the charged offense.
- “Extreme indifference to human life” may be established by knowing conduct that shows reckless disregard of a substantial risk of death to a child.
- Under South Carolina law as applied here, the homicide-by-child-abuse statute may reach prenatal conduct causing the death of a viable fetus.
- A general homicide statute is not necessarily displaced by a more specific abortion statute when the prosecution theory is not intentional pregnancy termination but fatal abuse or neglect.
- Due process notice is satisfied where statutory language and commonly understood dangers provide fair warning that conduct resulting in death can trigger serious criminal liability.
- The State’s interest in protecting a viable fetus can justify criminal sanctions for conduct alleged to cause fetal death without violating privacy protections.
- A statutorily authorized homicide penalty within legislative limits is not cruel and unusual absent gross disproportionality.
- A facially neutral statute does not violate equal protection merely because it impacts a subgroup more frequently, where the law serves legitimate governmental interests.
- A urine drug test does not violate the Fourth Amendment when obtained through voluntary consent.

## Conclusion

The court affirmed McKnight’s homicide-by-child-abuse conviction, holding that prenatal cocaine use could support liability for the death of a viable fetus when evidence supports causation and extreme indifference, constitutional challenges fail, and drug-test evidence is admitted based on consent.


State v. McKnight, 352 S.C. 635, 576 S.E.2d 168 (S.C. 2003)