Event Title
Ultrasound’s Risk: Reproductive autonomy and epistemic moral injury
Start Date
27-6-2010 9:00 AM
End Date
27-6-2010 10:30 AM
Description
This presentation is part of the Technology and Intervention in Pregnancy and Childbirth track.
Three main questions are the focus of this paper: First, how does ultrasound shape the relationship between woman and fetus? Second, which major cultural models of pregnancy does ultrasound mobilize? Third, what potential risks, harms and wrongs for women does ultrasound entail? In answering these questions, I consider multiple varieties of this medical biotechnology, including 2D, 3D and 4D ultrasound.
I argue that ultrasound intervenes in the woman-fetus relationship to alter both woman-fetus bonding and the social visibility of the pregnant woman. Ultrasound distances a woman from her fetus such that she must engage in a process of forming intimacy with the fetus through her interactions with the image provided. Negating the woman’s embodied intimacy with the fetus, pregnancy becomes a process of acquainting oneself with an interior entity which has been separated through a cultural understanding rooted in the prevalence of pregnancy monitoring techniques. With rapt attention being given to the technological quickening on screen, the woman whose uterus is featured recedes from visibility and recognition. I then turn to broader cultural considerations by analyzing the public meanings and models of pregnancy that ultrasound mobilizes. I comment on two prevalent representations of the woman-fetus relationship, as well as the cultural reconstruction of maternal and fetal subjectivity the models engender. The increased use of ultrasound in the clinical setting is intimately tied to the production of both models. The two models are (1) the container model and (2) the oppositional model.
Next, I explore feminist responses to the effects of ultrasound on the woman-fetus relationship and to the cultural prevalence of models of pregnancy that ultrasound motivates, highlighting the limitations and pernicious effects of visual knowledge as the underlying, guiding epistemic approach at play. Such an approach harms women by objectifying and disembodying them. Moreover, ultrasound as an imaging technique falsely separates woman and fetus, ignoring the extent to which their modes of existence and corporeality are deeply intertwined. In short, the current predominant use of ultrasound prioritizes visual knowledge over embodied knowledge and in so doing, relegates women’s embodied knowledge to private impressions, thus undercutting or outright denying the privileged epistemic access women have to the fetus.
While acknowledging the importance of feminist philosophical interventions into ultrasound that privilege embodied knowledge, I argue that such an approach misses several key risks, harms and wrongs of ultrasound. To address this problem, I develop an analysis of ultrasound as an epistemic moral injury. This concept brings together insights from Jean Hampton and Miranda Fricker.
According to Hampton, morally injurious practices deny the equal moral worth of persons. They represent their recipients as having lesser moral standing or unequal moral value. Morally injurious practices bring about “diminishment,” or damage to the acknowledgement or realization of a victim’s value. Whether an action diminishes another depends not on whether a person feels denigrated or on a person’s perception of a practice, but rather on the interpersonal and cultural determination of the meaning of that practice in the context of a particular society. Viewing ultrasound through this lens, I maintain that in current obstetric practice in North America, women risk moral injury when undergoing ultrasound procedures. Such practices can diminish the moral standing of women, while inappropriately elevating the moral standing of fetuses to the status of persons with intentions, interests, mature consciousness, etc. In fact, ultrasound practices elevate the moral value of the fetus at the expense of the equal moral value of the woman. In short, ultrasound damages women’s equal moral worth. This represents one crucial, yet underexplored aspect of the risks, harms and moral wrongs of ultrasound.
I then fuse Hampton’s analysis with insights Miranda Fricker offers in Epistemic Injustice (2007). I argue that we can recognize that women undergoing ultrasound risk not only diminishment as ethical beings, but also as epistemic agents, which is to say, they can be diminished, harmed and wronged in their capacity as knowers, and more specifically, as embodied knowers. This happens when they are not recognized as valuable, viable participants in epistemic exchanges. Pregnant women undergoing ultrasounds risk experiencing both testimonial injustice, which Fricker explains happens when “prejudice causes a hearer to give a deflated level of credibility to a speaker’s word” (Fricker 2007, 1) and hermeneutical injustice, which occurs “when a gap in collective interpretive resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences” (Ibid.). Pregnant women risk undergoing testimonial injustice when they, as embodied knowers, are not recognized by doctors as knowledgeable about their own pregnancies. They risk experiencing hermeneutical injustice, when their embodied “knowledge claims fall into lacunae in the available conceptual resources, thus blocking their capacity to interpret, and thence to understand or claim a hearing for their experiences” to quote Lorraine Code’s insightful summary of Fricker’s concept (Code 2008). Thus pregnant women’s ability to understand their own pregnancies is impaired, as they are unable to render the embodied experience of their pregnancy fully intelligible to themselves or others.
Ultimately, what the elevation of forms of visual knowledge over embodied knowledge sustains is a conferral of credibility excess on doctors and a corresponding credibility deficit on pregnant women. In the context of the ultrasound procedure, doctors and sonographers do not view women as equal or even reasonable partners in the epistemic interaction. The lack of uptake has very harmful consequences, as it results in an undermining of women’s reproductive autonomy and their self-trust, both as moral agents and epistemic agents, to extend Carolyn McLeod’s helpful concept (McLeod 2002). The erosion of their trust in themselves as embodied knowers can result in alienation and an unwillingness to draw on the epistemically privileged relationships they have with the fetus, which can be a source of crucial knowledge.
Ultrasound’s Risk: Reproductive autonomy and epistemic moral injury
This presentation is part of the Technology and Intervention in Pregnancy and Childbirth track.
Three main questions are the focus of this paper: First, how does ultrasound shape the relationship between woman and fetus? Second, which major cultural models of pregnancy does ultrasound mobilize? Third, what potential risks, harms and wrongs for women does ultrasound entail? In answering these questions, I consider multiple varieties of this medical biotechnology, including 2D, 3D and 4D ultrasound.
I argue that ultrasound intervenes in the woman-fetus relationship to alter both woman-fetus bonding and the social visibility of the pregnant woman. Ultrasound distances a woman from her fetus such that she must engage in a process of forming intimacy with the fetus through her interactions with the image provided. Negating the woman’s embodied intimacy with the fetus, pregnancy becomes a process of acquainting oneself with an interior entity which has been separated through a cultural understanding rooted in the prevalence of pregnancy monitoring techniques. With rapt attention being given to the technological quickening on screen, the woman whose uterus is featured recedes from visibility and recognition. I then turn to broader cultural considerations by analyzing the public meanings and models of pregnancy that ultrasound mobilizes. I comment on two prevalent representations of the woman-fetus relationship, as well as the cultural reconstruction of maternal and fetal subjectivity the models engender. The increased use of ultrasound in the clinical setting is intimately tied to the production of both models. The two models are (1) the container model and (2) the oppositional model.
Next, I explore feminist responses to the effects of ultrasound on the woman-fetus relationship and to the cultural prevalence of models of pregnancy that ultrasound motivates, highlighting the limitations and pernicious effects of visual knowledge as the underlying, guiding epistemic approach at play. Such an approach harms women by objectifying and disembodying them. Moreover, ultrasound as an imaging technique falsely separates woman and fetus, ignoring the extent to which their modes of existence and corporeality are deeply intertwined. In short, the current predominant use of ultrasound prioritizes visual knowledge over embodied knowledge and in so doing, relegates women’s embodied knowledge to private impressions, thus undercutting or outright denying the privileged epistemic access women have to the fetus.
While acknowledging the importance of feminist philosophical interventions into ultrasound that privilege embodied knowledge, I argue that such an approach misses several key risks, harms and wrongs of ultrasound. To address this problem, I develop an analysis of ultrasound as an epistemic moral injury. This concept brings together insights from Jean Hampton and Miranda Fricker.
According to Hampton, morally injurious practices deny the equal moral worth of persons. They represent their recipients as having lesser moral standing or unequal moral value. Morally injurious practices bring about “diminishment,” or damage to the acknowledgement or realization of a victim’s value. Whether an action diminishes another depends not on whether a person feels denigrated or on a person’s perception of a practice, but rather on the interpersonal and cultural determination of the meaning of that practice in the context of a particular society. Viewing ultrasound through this lens, I maintain that in current obstetric practice in North America, women risk moral injury when undergoing ultrasound procedures. Such practices can diminish the moral standing of women, while inappropriately elevating the moral standing of fetuses to the status of persons with intentions, interests, mature consciousness, etc. In fact, ultrasound practices elevate the moral value of the fetus at the expense of the equal moral value of the woman. In short, ultrasound damages women’s equal moral worth. This represents one crucial, yet underexplored aspect of the risks, harms and moral wrongs of ultrasound.
I then fuse Hampton’s analysis with insights Miranda Fricker offers in Epistemic Injustice (2007). I argue that we can recognize that women undergoing ultrasound risk not only diminishment as ethical beings, but also as epistemic agents, which is to say, they can be diminished, harmed and wronged in their capacity as knowers, and more specifically, as embodied knowers. This happens when they are not recognized as valuable, viable participants in epistemic exchanges. Pregnant women undergoing ultrasounds risk experiencing both testimonial injustice, which Fricker explains happens when “prejudice causes a hearer to give a deflated level of credibility to a speaker’s word” (Fricker 2007, 1) and hermeneutical injustice, which occurs “when a gap in collective interpretive resources puts someone at an unfair disadvantage when it comes to making sense of their social experiences” (Ibid.). Pregnant women risk undergoing testimonial injustice when they, as embodied knowers, are not recognized by doctors as knowledgeable about their own pregnancies. They risk experiencing hermeneutical injustice, when their embodied “knowledge claims fall into lacunae in the available conceptual resources, thus blocking their capacity to interpret, and thence to understand or claim a hearing for their experiences” to quote Lorraine Code’s insightful summary of Fricker’s concept (Code 2008). Thus pregnant women’s ability to understand their own pregnancies is impaired, as they are unable to render the embodied experience of their pregnancy fully intelligible to themselves or others.
Ultimately, what the elevation of forms of visual knowledge over embodied knowledge sustains is a conferral of credibility excess on doctors and a corresponding credibility deficit on pregnant women. In the context of the ultrasound procedure, doctors and sonographers do not view women as equal or even reasonable partners in the epistemic interaction. The lack of uptake has very harmful consequences, as it results in an undermining of women’s reproductive autonomy and their self-trust, both as moral agents and epistemic agents, to extend Carolyn McLeod’s helpful concept (McLeod 2002). The erosion of their trust in themselves as embodied knowers can result in alienation and an unwillingness to draw on the epistemically privileged relationships they have with the fetus, which can be a source of crucial knowledge.