The ethics of birthing babies
[Editor's Note: This is our third installment of guest posts from Lamaze International's 2009 Annual Conference speakers. You can read all of our conference previews by clicking on the Lamaze 2009 Annual Conference tag. We hope to see you October 1-4 in Orlando at the Lamaze International 2009 Annual Conference. - AMR]
It is late summer and nearly all media outlets in the US are abuzz with news of town hall shouting matches over health reform. Americans – whose health system has the distinction of being the most expensive in the world (measured in dollars spent per capita) while leaving over 45 million people with no or limited access to care – are rightly fearful of change. It is a case of choosing “the devil you know” over the uncertainty of reform. Senators and members of congress are hearing stories of “death panels” that will deny care to the elderly and infirm, of benefits being taken away from medicare recipients and given to (illegal) immigrants.
Where are the ethicists? Clearly questions about who should have access to what kind of health care is an ethical question, but if you look closely at the debates over health reform, ethicists show up only when the issues are related to the beginning and end of life.
It is a sad fact that the rise of bioethics as a profession has served to limit the range of issues that are considered “ethical.” Ethical questions are restricted to those debated by “experts” — on television, radio, and on the pages of our newspapers — questions about stem cell research, cloning, and the end of life.
Those of us who work in and around childbirth know that questions of ethics and morality are not limited to the special issues taken up by bioethicists (the “experts”). Think, for example, about the debates between hospital birthers and home birthers. You are unlikely to see a bioethicist wade into this controversial topic, in spite of the fact that the conversation is rife with moral terms. “Good mothers” give birth at home (or in the hospital), only a “bad mother” would consider subjecting her baby to all that technology (or the care of a midwife). Good and bad. The debate over where to give birth is framed in moral terms. This is where the ethical rubber meets the road, in the moral aspects of mundane life. The ethics of everyday life – more common and more important than cloning, stem cells, and pre-implantation genetic diagnosis to most of us – gets ignored by professional bioethicists.
So why do bioethicists ignore the ethics of everyday life? It has a lot to do with their academic approach to the subject. When asked to consider the ethical problems associated with prenatal testing, most ethics pros will focus on the process of informed consent. Have the parents been told the risks and benefits of the procedure? Have they given their free and informed consent? The academic ethicist wants to be sure that the autonomy of the parents has been respected – if it has, there is nothing more to be done.
What’s missing here? The ethicist has not asked how our culture (and economy) shapes our attitude about disability (and the possibility of parenting a disabled child) or how the way we pay (or don’t pay) for health care influences parents’ choices. These everyday aspects of life play an important role in parents’ decisions about prenatal testing, yet the informed consent process does not address them. As long as parents make a “free” decision there are no ethical issues.
Come to the Research Papers session at the 2009 Lamaze International Annual Conference to hear more about the importance of everyday ethics. Raymond DeVries and I will consider issues much on the mind of childbirth educators, from elective cesareans to epidurals to male infant circumcision to the use of educational materials paid for by manufacturers of baby products. We’ll talk about the standard bioethical approach to these issues and, more importantly, what this approach leaves out. You will go away with an entirely new perspective on the ethics of childbirth.
Jennifer Torres is a doctoral student in the department of Sociology at the University of Michigan. Her dissertation is an historical examination of breastfeeding discourse and how this changing discourse affects women’s decisions about and experiences of breastfeeding.
Her co-presenter, Raymond G. De Vries, Ph. D., is Professor in the Bioethics Program, the Department of Obstetrics and Gynecology, and the Department of Medical Education at the Medical School, University of Michigan. He is the author of A Pleasing Birth: Midwifery and Maternity Care in the Netherlands (Temple University Press, 2005), and co-editor of The View from Here: Bioethics and the Social Sciences (Blackwell, 2007). He is at work on a critical social history of bioethics, and is studying: the regulation of science; international research ethics; the difficulties of informed consent; bioethics and the problem of suffering; and the social, ethical, and policy issues associated with non-medically indicated surgical birth.