title: Moral implications of obstetric technologies for pregnancy and motherhood.
abstract: Drawing on sociological and anthropological studies, the aim of this article is to reconstruct how obstetric technologies contribute to a moral conception of pregnancy and motherhood, and to evaluate that conception from a normative point of view. Obstetrics and midwifery, so the assumption, are value-laden, value-producing and value-reproducing practices, values that shape the social perception of what it means to be a "good" pregnant woman and to be a "good" (future) mother. Activities in the medical field of reproduction contribute to "kinning", that is the making of particular social relationships marked by closeness and special moral obligations. Three technologies, which belong to standard procedures in prenatal care in postmodern societies, are presently investigated: (1) informed consent in prenatal care, (2) obstetric sonogram, and (3) birth plan. Their widespread application is supposed to serve the moral (and legal) goal of effecting patient autonomy (and patient right). A reconstruction of the actual moral implications of these technologies, however, reveals that this goal is missed in multiple ways. Informed consent situations are marked by involuntariness and blindness to social dimensions of decision-making; obstetric sonograms construct moral subjectivity and agency in a way that attribute inconsistent and unreasonable moral responsibilities to the pregnant woman; and birth plans obscure the need for a healthcare environment that reflects a shared-decision-making model, rather than a rational-choice-framework.
authors.affiliation: Institute for Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland. brauer@brauerstrub.ch.
authors.forename: Susanne
authors.initials: S
authors.lastname: Brauer
mesh_terms: D003657:Decision Making / Q000941:ethics; D036861:Delivery, Obstetric / Q000941:ethics*; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D028681:Moral Obligations; D009014:Morals; D010358:Patient Participation; D028701:Patient Rights / Q000941:ethics; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics; D011247:Pregnancy; D037841:Pregnant People; D011295:Prenatal Care / Q000941:ethics*; D016216:Ultrasonography, Prenatal / Q000941:ethics*
keywords: Autonomy; Birth; Motherhood; Pregnancy; Prenatal care; Sonogram
references.citation: J Med Ethics. 2009 Jul;35(7):410-4
references.pmid: 19567688
references.citation: Bioethics. 2009 Jan;23(1):9-19
references.pmid: 19076938
references.citation: Obstet Gynecol. 2008 Oct;112(4):913-8
references.pmid: 18827136
references.citation: Gene Ther. 2008 Mar;15(5):338-9
references.pmid: 18283288
references.citation: BJOG. 2009 Jun;116(7):886-95
references.pmid: 19385961
references.citation: Bioethics. 2008 Jun;22(5):258-68
references.pmid: 18447861
references.citation: BMC Med Ethics. 2008 Jun 17;9:11
references.pmid: 18559083
references.citation: Curr Anthropol. 2001 Apr;42(2):235-63
references.pmid: 14992215
references.citation: Sci Technol Human Values. 1998 Winter;23(1):45-70
references.pmid: 11660551
references.citation: Bioethics. 2007 Nov;21(9):478-87
references.pmid: 17927624
references.citation: Health Care Women Int. 2008 May;29(5):448-67
references.pmid: 18437594
references.citation: Nurs Ethics. 2003 Nov;10(6):588-601
references.pmid: 14650478
references.citation: J Perinat Neonatal Nurs. 2005 Apr-Jun;19(2):145-54
references.pmid: 15923964
references.citation: Semin Perinatol. 2010 Oct;34(5):337-44
references.pmid: 20869550
references.citation: J Med Philos. 1982 May;7(2):179-95
references.pmid: 7119608
references.citation: J Med Philos. 1984 Feb;9(1):45-62
references.pmid: 6726101
references.citation: Bioethics. 2007 May;21(4):181-90
references.pmid: 17845476
references.citation: Can J Nurs Res. 2007 Dec;39(4):117-29
references.pmid: 18277791
references.citation: Med Health Care Philos. 2003;6(2):153-65
references.pmid: 12870636
references.citation: Hastings Cent Rep. 2009 Nov-Dec;39(6):34-42
references.pmid: 20050369
references.citation: Hastings Cent Rep. 1981 Oct;11(5):26-31
references.pmid: 7309497
references.citation: J Med Ethics. 2011 Aug;37(8):461-5
references.pmid: 21429958
references.citation: Obstet Gynecol. 2007 Apr;109(4):979-84
references.pmid: 17400862
references.citation: Kennedy Inst Ethics J. 1996 Dec;6(4):392-6
references.pmid: 11645338
references.citation: Bioethics. 2009 Jan;23(1):1-8
references.pmid: 19076937
references.citation: Hypatia. 2006 Winter;21(1):54-73
references.pmid: 17111556