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Baier, Annette. 1985. Postures ofthe Mind: Essays on Mind and Morals. Miof Minnesota Press. ,\

Callahan, Sidney. 1987. "A Pro-life Feminist Makes Her Case." Utne R,i104-14.

CARALIHalifax. 1990. Telling Our Stories: Abortion Stories from Nova Sco·Halifax (Canadian Abortion Rights Action League).

Diamond, Irene, and Lee Quinby. 1988. "American Feminism and the LangFeminism & Foucault: Reflections on Resistance. Edited by Irene DiamonBoston: Northeastern University Press. .

Eisenstein, Zillah R. 1988. The Female Body and the Law. Berkeley: Univ,Press.

Hoagland, Sara Lucia. 1988. Lesbian Ethics: Toward New Value. Palo Alto, Cbian Studies.

Lange, Lynda. 1983. "Woman is Not a Rational Animal: On Aristotle's Biol~,tion." In Discovering Reality: Feminist Perspectives on Epistemology, Metapogy, and Philosophy of Science. Edited by Sandra Harding and Merill B.drecht, Holland: D. Reidel.

Lerner, Gerda. 1986. The Creation of Patriarchy. New York: Oxford.Luker, Kristin. 1984. Abortion and the Politics ofMotherhood. Berkeley: Univer:

Press.MacKinnon, Catherine. 1989. Toward a Feminist Theory ofthe State. Cambrid

University Press.McDonnell, Kathleen. 1984. Not an Easy Choice: A Feminist Re-examines

The Women's Press.Morgan, Kathryn Pauly. 1987. "Women and Moral Madness." In Science, Mo

Theory. Edited by Marsha Hanen and Kai Nielsen. Canadian Journal ofPmentary Volume 13: 201-26.

Murphy, Julien S. 1989. "Should Pregnancies Be Sustained in Brain-deadsophical Discussion of Postmortem Pregnancy." In Healing Technology.tives. Edited by Kathryn Srother Ratcliff et al. Ann Arbor: The University

Overall, Christine. 1987. Ethics and Human Reproduction: A Feminist AnMA: Allen & Unwin.

Petchesky, Rosalind Pollack. 1980. "Reproductive Freedom: BeyondChoose.''' In Women: Sex and Sexuality. Edited by Catharine R. StimpsoJ}Person. Chicago: University of Chicago Press. '0

Sumner, L. W. 1981. Abortion and Moral Theory. Princeton: Princeton Univ,Thomson, Judith Jarvis. 1971. "A Defense of Abortion." Philosophy and Publ;Tooley, Michael. 1972. "Abortion and Infanticide." Philosophy and Public Affi

65·Van Wagner, Vicki, and Bob Lee. 1989. "Principles into Practice: An Activist'

Reproductive Health Care." In The Future of Human Reproduction. EOverall. Toronto: The Women's Press. [

Warren, Mary Anne. 1973. "On the Moral and Legal Status of Abortion." The___.1989· "The Moral Significance of Birth." Hypatia, 4, 2 (Summer): 4\'\Thitbeck, Carolyn. 1973. "Theories of Sex Difference." The Philosophi

(Fall/Winter 1973-74): 54-80.

Section B:Procreative Technology and Procreative Freedom

The Meanings ofChoicein Reproductive Technology

Barbara Katz Rothman

ice and information have served as the cornerstones of the women's health androductive rights movements. We are, above all, pro-choice. We support theof the individual woman to choose, to choose pregnancy or abortion, toalternative medical treatments or none at all. And choice, we claim, rests

on information: to choose treatment for breast cancer, for example, requiresation on the full range of medical treatments, their side effects, and theirility of success. .emphasis on choice and information all sounded very logical at the time,

ed like women were going to get more and more control as first their access toation and then their choices expanded.beginning to have second thoughts.

ology is also about information, and about choice. More information on·ngs work seems to give us more choices, new and better ways ofdoing things.true of the technology of transportation, which brings us cars and jets, and of

chnology of reproduction, which brings us the Pill, amniocentesis and fetalors.while technology opens up some choices, it closes down others. The newis often greeted with such fanfare that the silent closing of the door on the oldgoes unheeded. For example, is there any meaningful way one could now

e horses over cars as a means of transportation? The new choice of a 'horselessge' eventually left us 'no choice' but to live with the pollution and dangers (ass the conveniences and speed, of course) of a car-bas'ed fransportation system.roductive technology is heralded for its choice-giving capaCity. For those whoord it, the enormous growth of information about reproduction does makenewly possible: the pregnant can choose whether or not to continue the preg-

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327'eative Technology and Procreative Freedom

'he choice of contraception simultaneously closed down some of the choices forfamilies. North American society is geared to small families, if indeed to any

dren at all. Everything from car and apartment sizes the picture book ideal of"'es encourages limiting fertility. Without the provision of good medical care,care, decent housing, children are a luxury item, fine ifyou can afford them. So itchoice all right that contraception gave us, and a choice we may very well experi­

as being under our control, but it may be a somewhat forced choice. In its ex­e, legislation has been repeatedly introduced to punish 'welfare mothers' by cut­off payments if they have more children. Sterilization abuse is the flip side of the

rtion battle: the same sorry record....

a there may be choice brought to us by information and technology, the choicesget when we learn how to use contraception and back-up abortion for fertilitytrol, but the choices may very well be heavily weighted for, or against, us.oth the medical monitoring and management aflabor, and the use ofcontracep­and abortion, are very well-established aspects of reproductive technologies; itt the specifics which keep changing, as newer techniques, machinery and chem­get introduced. The next level of reproductive technology I want to address

lbines fetal monitoring with fertility control to produce something new: 'quality01: control not just of the number of children we bear, but of the 'quality' or·tion of those children.

niocentesis and sonography are the technologies which provide the informa­to make this new set of reproductive choices possible. Sonography, the use ofd waves, allows the visualization of the fetus in utero, and the detection ofgrossornical deformities. Amniocentesis is the withdrawal of a small amount of the'otic fluid which surrounds the fetus. When done between the sixteenth andieth weeks of pregnancy, the fetal cells in the fluid can be cultured and exam-Other tests can also be performed on the fluid. These techniques allow the di­:is ofmany (under a hundred at this writing, but increasing all the time) genetices and syndromes. Test results are available by the twenty-fourth week, the le­it on abortion in the United States. If the fetus is found to have a terminal ill­ike Tay Sachs disease which invariably kills in eary childhood), a severely inca-ting condition (a syndrome which leads to such profound retardation that the,ould be unable to learn to walk or to talk), a moderately disabling condition'heekhair-bound or unable to walk without assistance), or a socially undesir­ndition (if, for example, the fetus is found to be of the 'wrong' sex, such as a

If fourth daughter), a woman can use this infof};nation to choose an abortion.opening up Of choices and control with this te¢hnology is astounding. ThereUfse, still no guarantee of a perfect baby-and even a perfect baby can be

:erribly imperfect in accident or illness after birth-but one no longer need'Wn syndrome, spina bifida or a host of other diseases and unwanted condi­

is of course begs the basic question of what makes any particular conditiondisabling or undesirable. Why Down syndrome, why daughters, whyair-bound? But information is available, and information makes choice pos-

Procreative Technology and Procreative

nancy, can even learn more about the fetus and then choose whether or nottinue; the infertile can choose new ways of attempting pregnancy; birthingcan choose alternative ways of managing their labors and births. Choices abwant to look a bit at the negative side, though, look to see what, if any, chobeing lost to us, going the way of the horse.

Fetal monitoring is a good place to start. Fetal monitors, belts to go aropregnant belly and electrodes to screw into the fetal head during labor, are areproductive technology whose sole stated purpose is to bring more informaenable more and better choices. By knowing more about the condition of thduring labor, more informed choice was to be possible for the management ofbor. But some strange things happened. We didn't really get all that much rnaformation than we had before-good nursing care always provided considerabformation about the fetus. It certainly did look like more information thoughthose long strips of print-out. But more importantly, the information came incontext. Instead of having to approach the woman, to rest your head near heto smell her skin, to feel her breathing, you could now read the informationfetus from across the room, from down the hall. While still one being onmedical personnel came to see the woman and fetus as separate, as two diffetients. And indeed more choices could be made: the fetal heart rate indidistress-should the mother be sectioned?

When a woman chooses to have a cesarean section because she is informe,fetal monitor indicates some distress, is she gaining or losing control? Inanswer is going to depend on the accuracy of the information. If medicalners are overly quick to read fetal distress, as they have been, then the loss Q

is clear. The woman is having major surgery, with all of its attendant rishealth and life, making herself sick, weak and dependent as she enters motBut if the information is correct, and the fetus, her baby, is at risk and thcould ensure its greater health, then she is gaining control over her motheshe makes this short-term sacrifice for the long-term health of her child.

What happens when the woman and her medical practitioners disagreeeither about the accuracy of the information, or about the choice whichmade based on the information? What if a pregnant woman does not wanthis sacrifice? Has all this new information expanded her choices? It seems.icine is once again turning to the state, as it has so many times in the p'medical choice ahead of women's choices. In several bedside Juvenile Courtwith a lawyer appointed to represent the unborn fetus, another represepregnant woman, and yet others representing the hospital, women have losto choose, and have been ordered to submit to cesarean sections, the fethem claimed by the state as a 'dependent and neglected child'. (Hubbard,

Thus information may expand the opportunity for choices, but it certnot guarantee whose choices will be honored.

We thought that information would give us power. \"lhat we perhaps ovethat it is power which gives one control over both information and choice:

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e next step in the politics of reproductive control is the politics of social control.

References

ard, Ruth. 1982. 'Some Legal and Policy Implications of Recent Advances in Prenatal Di­nasis and Fetal Therapy.' Women's Rights Law Reporter, Spring,? (3): 201-18.

'ea tive Technology and Procreative Freedom

od, and so their choices have expanded and they have gained control over theirIndeed they have, just as contraception and abortion provide us with the very

and very true experience of controlling our fertility. Choices open and choicesFor those whose choices meet the social expectations, for those who want what

'bciety wants them to want, the experience of choice is very real.rhaps what we should realize is that human beings living in society have pre­little choice ever. There may really be no such thing as individual choice in astructure, not in any absolute way. The social structure creates needs-thefor women to be mothers, the needs for small families, the needs for 'perfect'

<iren-and creates the technology which enables people to make the neededices. The question is not whether choices are constructed but how they are con­cted. Society, in its ultimate mean1ng, may be nothing more and nothing lessthe structuring of choices.

The question then for feminism is not only to address the individual level of 'aman's right to choose' but also to examine the social level, where her choices arectured. Yes, we will have to continue to fight the good fight for information andchoice, the rights of the individual womap to choose contraception, abortion,iocentesis, pregnancy by in vitro fertilization, pregnancy by donor insemina­, labors with and labors without electronic fetal monitoring, to have no childreno have one child or to have many children. We must not get caught into discus­s of which reproductive technologies are 'politically correct,' which empowerwhich enslave women. They ALL empower and they ALL enslave, they all can beby, for, or against us. We will have to lift our eyes from the choices of the indi­

al woman, and focus on the control of the social system which structures herices, which rewards some choices and punishes others, which distributes the re­ds and punishments for reproductive choices along class and race lines.'here will never be 'free' choice, unstructured reproductive choice. But the struc­in which choices are made should, and I believe ultimately can, be made fair,

'cal, moral. Individual rights to information and to choice are an absolute neces­for such a system, but are not alone sufficient to ensure an ethics of reproduc-

Procreative Technology and Procrl

There are ... genetic conditions ... about which we might be better 0

ing. XYY, the genetic condition which some studies suggested may be Iiinal behavior, is an example. The studies have been largely discredited,search shows there are women currently aborting XYY fetuses becapotential father said, 'It's hard enough to raise a normal kid. Ifhe throw:across the room will I think he's doing it because he's two, or because he

What will happen as we get even more information, if we can begin tojust retardation, but which fetuses are likely to become children ofbordenot just Tay Sachs, but which fetuses are likely to develop juvenile diabeinformation may be giving us choice, but is it coming any closer to giving

And finally, briefly, what of the great expansion in the treatment of intiits choices? .. , All of the technology still leaves many couples, about aof those treated for infertility, without a pregnancy. At what point is ittheir fault, out of their control, inevitable, inexorable fate? At what pointon with their lives? If there is always one more doctor to try, one mor,around, then the social role of infertility will always be seen in some sensthey chose to give up. Did taking away the sense of inevitabilityof the'and substituting the 'choice' of giving up truly increase their choice antrol?

There are those who are successful with the new technology, those fordrugs and surgery are a success. Surely they have now experienced the cho

sible. And it is the woman's choice. There may be pressure, subtle or pgenetic counselors, doctors, family members, but it is still the womanto abort or not to abort. Or is it?

When we have this information, when we make these choices for ourwe not then accepting responsibility for their condition, responsibilitygenuine control? Ifwe choose not to abort a 'defenctive' fetus, and thelescent it becomes hurls at us, as adolescents so often have, 'I didn't askwhatever are we going to say now? Will our children be able to sue us filife, as they have successfully sued their doctors? The doctors failed to proformation which would have given the mothers the choice of abortion.mother who, given the information, chooses not to abort? Can she be he.ble for her child's condition, denied state services, insurance payments,with child abuse?

And if we do choose to abort, is that truly a choice? What of the wornthe fourth floor, walk-up apartment in a city designed without accessabled-is her 'choice' to abort a fetus with spina bifida an exercise in freeof the woman with few economic or family resources who chooses to a'with Down syndrome because she is fully and truly informed about the stwhich will be available to her child after her own death?

It seems that, in gaining the choice to control the quality of our childbe losing the choice notto control the quality, the choice of simply accepthey are.

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