Women and New Reproductive Technologies: Medical, Psychosocial, Legal, and Ethical Dilemmas

173 Pages·1991·3.771 MB·English

by  Judith Rodin (editor), Aila Collins (editor)

WOMEN AND NEW REPRODUCTIVE
TECHNOLOGIES:·
Medical, Psychosocial,. Legal,
and Ethical Dilemmas
WOMEN AND NEW REPRODUCTIVE
TECHNOLOGIES:
Medical, Psychosocial, Legal,
and Ethical Dilemmas
Edited by
Judith Rodin
Yale University
Aila Collins
Karolinska Institute
~
LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS
1991 Hillsdale, New Jersey Hove and London
Copyright@ 1991, by Lawrence Erlbaum Associates, Inc.
All rights reserved. No part of the book may be reproduced in any form, by photostat,
microform, retrieval system, or any other means, without the prior written permission of the
publisher.
Lawrence Erlbaum Associates, Inc., Publishers
365 Broadway
Hillsdale, New Jersey 07642
Library of Congress Cataloging-in-Publication Data
Women and new reproductive technologies : medical, psychosocial,
legal, and ethical dilemmas I edited by Judith Rodin, Aila Collins.
p. em.
Based on a conference sponsored by the John D. and Catherine T.
MacArthur Foundation Network on the Determinants and Consequences of
Health Promoting and Health Damaging Behavior, held June 16-18, 1987
in Key Biscayne, Flordia.
Includes bibliographical references and index.
ISBN 0-8058-0919-8
1. Human reproductive technology-Congresses. 2. Human
reproductive technology-Social aspects-Congresses.
3. Reproductive technology-Law and legislation-Congresses.
4. Women-Congresses. I. Rodin, Judith. II. Collins, Aila.
III. John D. and Catherine T. MacArthur Foundation Network on the
Determinants and Consequences of Health Promoting and Health
Damaging Behaviors.
[DNLM: 1. Ethics, Medical-congresses. 2. Reproduction Technics
congresses. 3. Reproduction Technics-legislation-congresses.
4. Reproduction Technics-psychology. 5. Social Environment
congresses. 6. Women-congresses. WQ 205 W872 1987]
RG133.5.W65 1991
DNLM/DLC
for Library of Congress
90-14148
CIP
Printed in the United States of America
10 9 8 7 6 5 4 3 2
Contents
Preface vii
1 The New Reproductive Technologies:
Overview of the Challenges and
Issues
Judith Rodin and Aila Collins 1
2 The History of the Relationship
Between Women's Health and Technology
Nancy Schrom Dye 11
3
Pregnancy-Inducing Technologies:
Biological and Medical Implications
Sam Thatcher and Alan DeCherney 27
4
Autonomy, Choice, and the New
Reproductive Technologies:
The Role of Informed Consent in
Prenatal Genetic Diagnosis
Ruth Faden 37
v
vi CONTENTS
5 Ethical Issues Raised by the New
Medical Technologies
Caroline Whitbeck 49
6 Women's Reproductive Rights:
The Impact of Technology
Sheryl Ruzek 65
7 Women and Advances in Medical
Technologies: The Legal Issues
Ellen Wright Clayton 89
8 Psychological Issues in New
Reproductive Technologies:
Pregnancy-Inducing Technology
and Diagnostic Screening
Nancy E. Adler, Susan Keyes, and Patricia Robertson 111
9 Communicating About the New
Reproductive Technologies: Cultural,
Interpersonal, and Linguistic
Determinants of Understanding
Rayna Rapp 135
10 The New Reproductive
Technologies: What Have We
Learned?
Aila Collins and Judith Rodin 153
Author Index 163
Subject Index 169
Preface
The theme of this book is reproduction and how it is viewed on the
threshold of the 21st century. The perspectives of many disciplines are
brought to bear on the staggering new opportunities, challenges, and
problems that now face those who wish to have a child. The book is based
on a conference sponsored by the John D. and Catherine T. MacArthur
Foundation Network on the Determinants and Consequences of Health
Promoting and Health-Damaging Behaviors, whose mission is to bring
together investigators from multiple disciplines for collaborative discus
sions and research that promote our understanding of successful adaptation
and good health, as well as of illness and disease.
At the conference we explored numerous domains where women's health
and women's lives have been changed profoundly by the explosion of new
technologies emerging in the last decades of the 20th century. In addition to
reproduction, we reviewed new technologies and their impact in the areas of
contraception, menopause, and breast cancer treatment. We want to thank
all the participants at the conference whose ideas and comments enriched
the meeting and are reflected especially in our two chapters of the present
book. Those participating included: Nancy Adler, PhD; Nancy Cantor,
PhD; Ellen Wright Clayton, MD; Aila Collins, PhD; Donald Coustan,
MD; Alan De Cherney, MD; Lorraine Dennerstein, PhD; David Dodd;
Nancy Dye, PhD; Ruth Faden, PhD; Marianne Frankenhaeuser, PhD;
M. R. C. Greenwood, PhD; Florence Haseltine, MD, PhD; Britt-Marie
Landgren, MD; Sandra Levy, PhD; Richard Love, MD; Virginia Olesen,
PhD; Anne Peterson, PhD; Rayna Rapp, PhD; Anthony Reading, PhD;
. vii
viii PREFACE
Judith Rodin, PhD; Sheryl Ruzek, PhD; Philip Sarrel, MD; John Steege,
MD; Caroline Whitbeck, PhD; Deborah Wingard, PhD.
We chose to highlight reproduction in this volume because in bringing
medical technology to bear on creating life, the profound ethical, legal,
social, and psychological issues surrounding the use of technology come
perhaps most sharply into focus. Many disciplines and many perspectives
speak to this question and we have tried to represent a broad spectrum of
them in the present volume.
In addition to the conference participants, many other people were
crucial to the completion of this book. We thank Debbie Whitney-Saltiel
for her key role in organizing the meeting, Grace Castellazzo for orches
trating the work needed to move a set of conference papers to an integrated
book, and Barbara Faulkner for her excellent administrative and secretarial
assistance. We are especially appreciative of the support provided by the
John D. and Catherine T. MacArthur Foundation for the exciting meeting
that led to this project.
ACKNOWLEDGMENTS
Many people contributed time and effort to this volume, and their
contributions are gratefully acknowledged. Debbie Whitney-Saltiel helped
to organize the meeting on which this book is based. Grace Castellazzo
organized and reorganized the chapters, and dealt with all matters of
conceptual framing with both the authors and the publishers. Gloria
Fontana orchestrated all the indexing and cheerfully took on some last
minute editing as well. Barbara Faulkner retyped much of the material.
The John D. and Catherine T. MacArthur Foundation supports the
Health and Behavior Research Network, which sponsored the conference
and preparation of chapters. Their commitment to this particular activity,
and to fostering multidisciplinary discussions, has been quite important in
helping new ideas to develop and see the light of day.
We are also grateful to Robin Weisberg and the staff at LEA for working
so quickly and efficiently.
Finally, we thank our coauthors and contributors for their distinguished
efforts and ideas.
Judith Rodin
Aila Collins
1 The New Reproductive
Technologies: Overview of
the Challenges and Issues
Judith Rodin
Yale University
Aila Collins
Karolinslea Institute
Major breakthroughs in medical technology affect everyone. The life span
has been dramatically extended. The role of medical science is to compress
morbidity-to push illness further and further to the end of the life span so
that people will enjoy many more years in good health than ever before
(Fries, 1980). Although the impact of technology is widely felt across the
life span, those technologies that have changed the nature and process of
reproduction may be of greatest consequence to women. To take only a few
examples, infertile couples now have many more ways to have natural
children, genetic testing provides opportunities for families to make deci
sions about what type of child they will have, and new ways of monitoring
fetal development bring more precision to childbearing than ever before.
Despite these dramatic opportunities, however, the new reproductive
technologies are not without problems. The authors of the following
chapters explore the complex array of benefits and problems presented by
the new reproductive technologies. The issues are complex, and the debate
often acrimonious. More significant than the question of whether the
technologies are good or bad, however, are the questions related to for
whom they are good, in what instances, and for whom they should be made
accessible. These thorny issues can be debated at multiple levels, from the
ethical implications, to the social and psychological consequences for
society and for the individual, to the legal and the medical outcomes. All
viewpoints are represented in this book and each chapter highlights a
different array of problems and opportunities.
1
2 RODIN AND COWNS
UNIFYING THEMES AND ISSUES
Fundamental to all the chapters are four major themes. They are empha
sized differentially in each chapter, but they represent the major threads
that integrate and distinguish the various perspectives held by the authors of
this book.
The Impact of Technology on Women's Lives
All the chapters suggest that the new technological interventions have had
a significant impact-both positive and negative-on the quality of wo
men's lives. As Dye points out, "Technology development cannot always be
viewed as a straightforward narrative of progress." Although technology is
not all good or all bad, often its effects are dramatic. Pervasive in the use
of the new technologies is the view that it can solve all our problems, and
many of the current authors believe this view is dangerous-that we are a
society looking for a high technology "fix." Several question whether "doing
everything possible" is always the right answer.
The new technologies create tensions within individuals, between mem
bers of families, and among members of society. This has a profound
impact on the quality of women's lives. Health and safety risks are not the
only considerations one must make with regard to the applications of these
new technologies. We must take account of the effects of these technologies
on human relationships, including those between patient and health-care
provider, between members of families, and among members of commu
nities.
Many of the authors believe that women are struggling to strike a
balance-wishing to take advantage of the new advances in medical
technologies and pharmacology, but not wanting a natural process like
reproduction to become entirely medicalized. They argue that many women
are resisting the emerging view that pregnancy and procreation are medical
problems comparable to other states of disease. This tension is enmeshed in
the use of technology and the increased intervention of medical practice into
reproduction.
Many of the authors emphasize that whether or not women and their
families value high technology depends on class and culture. Women of
lower socioeconomic status and in some traditional cultures may be less
likely to use or to value the high technologies. Social factors must be
recognized as important determinants of acceptance and resistance to
technological innovations, of how these innovations emerge and are
disseminated, and of whom they affect.
The new technologies may alter the quality of women's lives because, with