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Feminist perspectives in medical ethics
1106
Book Reviews
among women toward self-help discussion groups rather than seeking of medical advice. Nichter’s comprehensive analysis of an outbreak of Kyanasur Forest Disease in South India explores the patterning of response to a new disease produced by ecological disruption within a specific regional and historical context. In the turning of local community activists to address other local development-related issues once the threat of KFD had subsided. Nichter too finds evidence for positive indirect effects in the shape of enduring community engagement and awareness.
The interweaving of topics and theoretical approaches summarised briefly here is an example of the great value to specialists of one or other region (in any social or medical discipline) of reading this important and consistently scholarly volume in its entirely.
Open Season: A Survival Guide for Natural Childbirth and VBAC in the 90s. by NANCY WAINEK COHEN. Bergin & Garvey, London, 1992. 407 pp., $16.95 (paperback).
cadre of data which examines all the paraphernalia that medicine has associated with a ‘natural’ birth and hundreds of stories gathered from her counseling experience. Anesthesia, drugs, electronic fetal monitors. episiotomy, forceps, IVs, and ultrasound are just a few of the procedures presented from many angles, but certainly the sarcastic humor interwoven into the text provokes a great many insights. The section on vacuum extractors is a prime example, when Cohen quotes one parent as stating, “The next thing on ACOG’s list of things to do to get a baby out (if vacuum extractions don’t seem to do the trick) is: Blast the thing out with a keg of dynamite.” This is well articulated, because when a doctor is ready to deliver (not necessarily the woman) often he will go to great lengths to find the one thing (forceps, vacuum extraction. pitocin drip or even C-section) to get the baby out. Many examples are based upon the experience of women, as it should be; a truly beautiful and important aspect of the entire book. The ultimate outcome of this book is to help the reader realize the importance of women reclaiming their birth experience. Should birth be enjoyed or controlled? When women discover their own personal power perhaps the codependent relationship between women and obstetricians may make hospital deliveries obsolete. Now wouldn’t that make a difference in the National Health Agenda?
I received this book to review while I wasin my 9th month of pregnancy. I was unable to write the review because I was so moved (as perhaps in disbelief) at America’s reliance on cesarean sections and the patriarchal myths that have existed since the beginning of time. Now. that my birth experience has occurred, I have rcvicwed the book for a second time. And again, 1 experienced so many emotions. But what better complement could I give this book than to say that it will provide the reader with the opportunity to be moved emotionally. ChildbearIng couples. educators. health professionals. scholars. grandparents. friends of women experiencmg VBAC (Vaginal Birth after Cesarean) should read this book as an excellent resource for the information needed to be supportive and caring of a woman‘s declslon for the natural path of childbirth. Many of you will remember Silenr Kn@: Cc~.wrrm Preclenrion and Vaginal Birth After Cesarcwn (Bergin & Garvcy. 1983) as the book of the 80s. Open Season is the book of the 90s which builds upon the content of the first book. If you haven’t had the opportunity to read Silerzr Knife. don’t miss reading Oprrt Seuson. This book will lead you through the American birth experience as a model to be housed in the Smithsonian Institute. I am in agreement with Cohen, when she states that the majority of births in America are so controlled by the medical establishment that one questions whether natural childbirth can ever be possible? Cohen’s most provocative chapter. “Birth Crap! Interferences and Interventions.” brings to the forefront a new paradigm to be embraced by society. She has synthesized a
Feminist Perspectives in Medical Ethics, edited by HELEN BEQUAERT HOLMES and LAURA M. PUKDY. Indiana University Press, Bloomington, 1992. 320 pp.. $14.95 (paperback). This collection was reproduced
of papers from two
on feminist medical ethics special issues of Hypariu: A Journal qfFeminisr Philosop/zy. The editors have selected an eclectic group of essays that represent five sections: The Medical Ethics Community: Feminist Views; The Role of Caring in Health Care; Women and Clinical Experiments; Women and New Reproductive Choices; and Contract Pregnancy. Each group of essays will provoke debate among scholars and students interested in medical ethics, especially those concerned with feminist thought. With limited space it is impossible to highlight each section. Hence, an intriguing
London School of Hygiuw Tropicul Medicine L;niwr.sify q f London Keppel St, London WClE
College o/’ Nursing
and
7HT,
HELEN LAMBEK~
U.K.
SONYA R. HARDIN
Adult Health Departmenr L’nkersiiy of North Carolinn ut Charlotte Churlorre. NC 28223 C,‘.S..4.
article by Susan Wendall. on a feminist theory of disability, found in the section on “Feminist Views of Medical Ethic” will be discussed. Susan Wendall illuminated the social and political realities of women and disabled women in American society. The interface of sexism, racism, and classism with social oppression of disabled women enlightens one to the primary causes of a person’s limited activity as being related to a denial of opportunities, lack of accessibility, lack of services, poverty, and discrimination. One of the most profound statements made by the author, who is also disabled, referred to answering the question of “How are you?’ For someone who is disabled this question becomes one of conflict. Society is conditioned to hear the answer of “fine”, yet when one is disabled things are not “fine”. Suffering caused by the body is not an acceptable topic. Able-bodied people fear the inability to be in control.
Book Reviews This chapter as well as others promotes theory development from a feminist perspective and values women’s knowledge. A frequent theme throughout the book, is the need to allow women to describe their experience. The editors’ choices of chapters reflects that a feminine voice in ethics can transform the American culture. The writings in this book are a marvelous display of the critical thinking needed to revolutionize health care. Hence, the reader will be challenged to
Understanding and Preventing Suicide: New Perspectives, by DAVID LESTER. Charles C. Thomas, Springfield, IL, 1990. 121 pp. Some interesting ideas are put forth in this slim volume; indeed its main fault is that there are perhaps too many ideas and each is dealt with in too cursory a fashion. As the author’s stated purpose is simply to stimulate new research into the etiology of suicidal behaviour and to suggest new strategies for prevention, he may be forgiven for the approach. However, it is difficult to embrace the preventative strategies before examining the etiological theories in much greater detail. Lester contends that theories of suicide are not sufficiently developed and that it is therefore not surprising that efforts to prevent suicide have not succeeded. He suggests that theory development has been impeded by a dearth of ideas about how suicidal behaviours develop. Lester then goes on to describe theories which have been used to explain crime and delinquency and makes extrapolations from these theories to explain suicidal behaviour and to provide approaches to prevention. He makes it clear that he does not see suicide as a crime; rather, he is simply suggesting that by viewing suicide from a criminological perspective, the existing repertoire of approaches to prevention of suicide may be usefully expanded. The rationale for using criminological theories as a source of new perspectives on suicide is discussed very briefly in the introductory chapter and appears to relate more to the failure of other approaches than to any positive value of taking a criminological perspective. Indeed, the introductory chapter serves as a means of dealing with several large issues in a rather perfunctory manner: the failure of psychiatry, psychology, and sociology to provide an adequate paradigm for suicide is discussed in under two pages, and the contentious methodological issue of whether completed suicide can be studied by examining attempted suicide is dealt with in less than 3 pages.
In the Name of the Child: Health and Welfare 1880-1940. edited by ROGER CCIOTER.Routledge, London, 1992.292 pp. (hardback). The introduction and the 10 chapters that comprise this book are a collection of tightly researched topics on the history of the concern for children in public health policy and legislation. The setting is principally England, but there is some comparison with Germany, France, Australia and the United States. A very interesting chapter by Beinart (Chap. 9) uses the analysis of photographs to comment on the perceived place of children (or lack thereof) in the mind of colonial administrators in Africa.
reflect upon patriarchy.
1107 new paradigms
College of Nursing Aduli Health Department University of North Carolina at Charlotte Charlotte. NC 28223 U.S.A.
and to shed the old skin of
SONYA
R. HARDIN
Seven theories of crime and delinquency are described: classical theory, positivist individualist, social structure, learning theory, social control. social reaction and social conflict. The latter two theories, according to Lester, have been given no consideration by suicidologists. He might have been wiser to have concentrated his efforts on these theories and provided us with greater depth. Instead, there is a very brief summary of each major criminological theory, the theory is then used to explain suicide, and the implications for prevention which flow from that theory are discussed. It is difficult to argue the statistics presented by Lester regarding the suicide rate and the fact that a variety of efforts have failed to result in any significant decreases. The idea of turning to a different discipline for ideas of where to go next is appealing and some of the ideas he extracts are provocative. The result is perhaps what Lester intended; some new thinking is undoubtedly stimulated. However there are many avenues of inquiry which might prove useful. For example the differences in rates between the U.S. (12.4/ 100,000) and Canada (13.5/ IOO,OOO),the difference in most at-risk groups (the elderly in the U.S. and the elderly plus young adults in Canada) or the rate of increase in suicide among young men and in Native peoples, are each areas worthy of exploration. As for new insights that will help us to “understand and prevent suicide” at a more micro level, one might prefer to recommend William Styron’s even slimmer volume Darkness Visible. Styron’s poignant description of his own depression not only increases our understanding of the progression through which one may move toward suicide, but also explains very clearly and very persuasively how, in certain cases, we can act to halt that progression. Unioersity of Toronto Toronto, Ontario Canada M5T IWS
JUDITH FRIEDLAND
What becomes clear as one reads this history is that the transition of the view of children as adults in miniature to that of children as persons who are evolving into adults developed rather recently during the period between the two World Wars. It was the social and economic upheavals of the late nineteenth century that brought change to the Dickensian world of children and led political figures such as Margaret McMillan to enact child labor laws (Chap. 1). These were later followed by pronatalist policies that promoted child allowances for families (Chap. 10). Anti-vivisectionists opposed experimentation on orphan children and demanded a more responsible process for the development of serums and vaccination procedures (Chaps 3, 4 and 5).
Book Reviews
among women toward self-help discussion groups rather than seeking of medical advice. Nichter’s comprehensive analysis of an outbreak of Kyanasur Forest Disease in South India explores the patterning of response to a new disease produced by ecological disruption within a specific regional and historical context. In the turning of local community activists to address other local development-related issues once the threat of KFD had subsided. Nichter too finds evidence for positive indirect effects in the shape of enduring community engagement and awareness.
The interweaving of topics and theoretical approaches summarised briefly here is an example of the great value to specialists of one or other region (in any social or medical discipline) of reading this important and consistently scholarly volume in its entirely.
Open Season: A Survival Guide for Natural Childbirth and VBAC in the 90s. by NANCY WAINEK COHEN. Bergin & Garvey, London, 1992. 407 pp., $16.95 (paperback).
cadre of data which examines all the paraphernalia that medicine has associated with a ‘natural’ birth and hundreds of stories gathered from her counseling experience. Anesthesia, drugs, electronic fetal monitors. episiotomy, forceps, IVs, and ultrasound are just a few of the procedures presented from many angles, but certainly the sarcastic humor interwoven into the text provokes a great many insights. The section on vacuum extractors is a prime example, when Cohen quotes one parent as stating, “The next thing on ACOG’s list of things to do to get a baby out (if vacuum extractions don’t seem to do the trick) is: Blast the thing out with a keg of dynamite.” This is well articulated, because when a doctor is ready to deliver (not necessarily the woman) often he will go to great lengths to find the one thing (forceps, vacuum extraction. pitocin drip or even C-section) to get the baby out. Many examples are based upon the experience of women, as it should be; a truly beautiful and important aspect of the entire book. The ultimate outcome of this book is to help the reader realize the importance of women reclaiming their birth experience. Should birth be enjoyed or controlled? When women discover their own personal power perhaps the codependent relationship between women and obstetricians may make hospital deliveries obsolete. Now wouldn’t that make a difference in the National Health Agenda?
I received this book to review while I wasin my 9th month of pregnancy. I was unable to write the review because I was so moved (as perhaps in disbelief) at America’s reliance on cesarean sections and the patriarchal myths that have existed since the beginning of time. Now. that my birth experience has occurred, I have rcvicwed the book for a second time. And again, 1 experienced so many emotions. But what better complement could I give this book than to say that it will provide the reader with the opportunity to be moved emotionally. ChildbearIng couples. educators. health professionals. scholars. grandparents. friends of women experiencmg VBAC (Vaginal Birth after Cesarean) should read this book as an excellent resource for the information needed to be supportive and caring of a woman‘s declslon for the natural path of childbirth. Many of you will remember Silenr Kn@: Cc~.wrrm Preclenrion and Vaginal Birth After Cesarcwn (Bergin & Garvcy. 1983) as the book of the 80s. Open Season is the book of the 90s which builds upon the content of the first book. If you haven’t had the opportunity to read Silerzr Knife. don’t miss reading Oprrt Seuson. This book will lead you through the American birth experience as a model to be housed in the Smithsonian Institute. I am in agreement with Cohen, when she states that the majority of births in America are so controlled by the medical establishment that one questions whether natural childbirth can ever be possible? Cohen’s most provocative chapter. “Birth Crap! Interferences and Interventions.” brings to the forefront a new paradigm to be embraced by society. She has synthesized a
Feminist Perspectives in Medical Ethics, edited by HELEN BEQUAERT HOLMES and LAURA M. PUKDY. Indiana University Press, Bloomington, 1992. 320 pp.. $14.95 (paperback). This collection was reproduced
of papers from two
on feminist medical ethics special issues of Hypariu: A Journal qfFeminisr Philosop/zy. The editors have selected an eclectic group of essays that represent five sections: The Medical Ethics Community: Feminist Views; The Role of Caring in Health Care; Women and Clinical Experiments; Women and New Reproductive Choices; and Contract Pregnancy. Each group of essays will provoke debate among scholars and students interested in medical ethics, especially those concerned with feminist thought. With limited space it is impossible to highlight each section. Hence, an intriguing
London School of Hygiuw Tropicul Medicine L;niwr.sify q f London Keppel St, London WClE
College o/’ Nursing
and
7HT,
HELEN LAMBEK~
U.K.
SONYA R. HARDIN
Adult Health Departmenr L’nkersiiy of North Carolinn ut Charlotte Churlorre. NC 28223 C,‘.S..4.
article by Susan Wendall. on a feminist theory of disability, found in the section on “Feminist Views of Medical Ethic” will be discussed. Susan Wendall illuminated the social and political realities of women and disabled women in American society. The interface of sexism, racism, and classism with social oppression of disabled women enlightens one to the primary causes of a person’s limited activity as being related to a denial of opportunities, lack of accessibility, lack of services, poverty, and discrimination. One of the most profound statements made by the author, who is also disabled, referred to answering the question of “How are you?’ For someone who is disabled this question becomes one of conflict. Society is conditioned to hear the answer of “fine”, yet when one is disabled things are not “fine”. Suffering caused by the body is not an acceptable topic. Able-bodied people fear the inability to be in control.
Book Reviews This chapter as well as others promotes theory development from a feminist perspective and values women’s knowledge. A frequent theme throughout the book, is the need to allow women to describe their experience. The editors’ choices of chapters reflects that a feminine voice in ethics can transform the American culture. The writings in this book are a marvelous display of the critical thinking needed to revolutionize health care. Hence, the reader will be challenged to
Understanding and Preventing Suicide: New Perspectives, by DAVID LESTER. Charles C. Thomas, Springfield, IL, 1990. 121 pp. Some interesting ideas are put forth in this slim volume; indeed its main fault is that there are perhaps too many ideas and each is dealt with in too cursory a fashion. As the author’s stated purpose is simply to stimulate new research into the etiology of suicidal behaviour and to suggest new strategies for prevention, he may be forgiven for the approach. However, it is difficult to embrace the preventative strategies before examining the etiological theories in much greater detail. Lester contends that theories of suicide are not sufficiently developed and that it is therefore not surprising that efforts to prevent suicide have not succeeded. He suggests that theory development has been impeded by a dearth of ideas about how suicidal behaviours develop. Lester then goes on to describe theories which have been used to explain crime and delinquency and makes extrapolations from these theories to explain suicidal behaviour and to provide approaches to prevention. He makes it clear that he does not see suicide as a crime; rather, he is simply suggesting that by viewing suicide from a criminological perspective, the existing repertoire of approaches to prevention of suicide may be usefully expanded. The rationale for using criminological theories as a source of new perspectives on suicide is discussed very briefly in the introductory chapter and appears to relate more to the failure of other approaches than to any positive value of taking a criminological perspective. Indeed, the introductory chapter serves as a means of dealing with several large issues in a rather perfunctory manner: the failure of psychiatry, psychology, and sociology to provide an adequate paradigm for suicide is discussed in under two pages, and the contentious methodological issue of whether completed suicide can be studied by examining attempted suicide is dealt with in less than 3 pages.
In the Name of the Child: Health and Welfare 1880-1940. edited by ROGER CCIOTER.Routledge, London, 1992.292 pp. (hardback). The introduction and the 10 chapters that comprise this book are a collection of tightly researched topics on the history of the concern for children in public health policy and legislation. The setting is principally England, but there is some comparison with Germany, France, Australia and the United States. A very interesting chapter by Beinart (Chap. 9) uses the analysis of photographs to comment on the perceived place of children (or lack thereof) in the mind of colonial administrators in Africa.
reflect upon patriarchy.
1107 new paradigms
College of Nursing Aduli Health Department University of North Carolina at Charlotte Charlotte. NC 28223 U.S.A.
and to shed the old skin of
SONYA
R. HARDIN
Seven theories of crime and delinquency are described: classical theory, positivist individualist, social structure, learning theory, social control. social reaction and social conflict. The latter two theories, according to Lester, have been given no consideration by suicidologists. He might have been wiser to have concentrated his efforts on these theories and provided us with greater depth. Instead, there is a very brief summary of each major criminological theory, the theory is then used to explain suicide, and the implications for prevention which flow from that theory are discussed. It is difficult to argue the statistics presented by Lester regarding the suicide rate and the fact that a variety of efforts have failed to result in any significant decreases. The idea of turning to a different discipline for ideas of where to go next is appealing and some of the ideas he extracts are provocative. The result is perhaps what Lester intended; some new thinking is undoubtedly stimulated. However there are many avenues of inquiry which might prove useful. For example the differences in rates between the U.S. (12.4/ 100,000) and Canada (13.5/ IOO,OOO),the difference in most at-risk groups (the elderly in the U.S. and the elderly plus young adults in Canada) or the rate of increase in suicide among young men and in Native peoples, are each areas worthy of exploration. As for new insights that will help us to “understand and prevent suicide” at a more micro level, one might prefer to recommend William Styron’s even slimmer volume Darkness Visible. Styron’s poignant description of his own depression not only increases our understanding of the progression through which one may move toward suicide, but also explains very clearly and very persuasively how, in certain cases, we can act to halt that progression. Unioersity of Toronto Toronto, Ontario Canada M5T IWS
JUDITH FRIEDLAND
What becomes clear as one reads this history is that the transition of the view of children as adults in miniature to that of children as persons who are evolving into adults developed rather recently during the period between the two World Wars. It was the social and economic upheavals of the late nineteenth century that brought change to the Dickensian world of children and led political figures such as Margaret McMillan to enact child labor laws (Chap. 1). These were later followed by pronatalist policies that promoted child allowances for families (Chap. 10). Anti-vivisectionists opposed experimentation on orphan children and demanded a more responsible process for the development of serums and vaccination procedures (Chaps 3, 4 and 5).