By analyzing the history of medical advances in the realm of fetal surgery, sociologist Monica Casper attempts to link the cultural and social implications that arose from the debut of the unborn patient. Casper suggests that the work put into furthering this controversial procedure was not done in a vacuum, but rather is directly related to reproduction politics and public response to the procedure. Casper analyzed and interpreted stories from watchers of fetal surgeries, medical professionals, and a few mothers affected directly by fetal surgery. The data and viewpoints she gathered from these interviews and direct exposure to the procedure helped Casper to formulate strong questions regarding the ethical, medical, and political consequences fetal surgery could present. Casper aims to convince readers of the negative implications breaching the womb in this manner could present through her critical analysis of fetal surgery.
One strong argument that Casper presents is that fetal surgery ceases to be imbedded in women’s best interest, but rather adopts the fetus as the patient of focus. This autonomy granted to the fetus has a direct relationship to abortion politics, as well as what Casper refers to as “fetal politics”. In fact, she states that scientific research is shaped by social events, politics, professional concerns, and is not done in a linear fashion of discovery. Who, what, and how things are researched is directly related to what is going on outside of the medical realm. She explains how many view fetal surgery to be a benevolent alternative to aborting an otherwise unviable fetus, a so called “rescue mission”. This makes fetal surgery an option to pro-life individuals, even though the procedure is not lacking risk for the mother or the fetus involved. Many approach this procedure with a “life at any cost” mentality. Intrauterine surgery has a very low success rate, yet the interest and wonder surrounding this innovative technology will only fuel future advances and discoveries going forward with fetal surgery. While deconstructing the history of fetal surgery, Casper uncovered that despite risks of negative impacts on the mother’s health, intrauterine procedures did not cease to progress at a rapid pace. In reference to intrauterine transfusions and corticosteroid treatments, the public reception showed that invasiveness fascinated more people although both treatments were done with similar intentions. “Like other cutting edge medical procedures, such as cloning or genetic therapy, fetal surgery is the stuff of Nova, inspiring wonder and our concern about our capacity to alter human destiny” (Casper, 3). Casper warns us of proceeding without reflection on the larger implications this risky option has on women’s health care.
Casper suggests that adopting the fetus as the primary patient erases the woman’s role in pregnancy, as if the fetus has its own separate interests and needs that deserve to be addressed regardless of the impact this may have on the mother. It brings to question, where does the mother end and the fetus begin and vice versa? This question may be answered differently depending on who is asked, but it is relevant for understanding the complex spheres that have to merge together in order to make fetal surgery possible. Casper repeatedly uses the term hybridity, which refers to the multiple fields and specialities of medical professionals involved in fetal and maternal health. At times, the overlap of knowledge between those involved allows for cooperation that can lead to success. In other instances, the unclear boundaries and authority battles can lead to conflict and failure. Further, she uses the term “work object” to show how various professionals have different subjects of interest. For example, an OB GYN may focus more on maternal health than solely the health of the fetus. In contrast, fetal surgeons may be primarily concerned with the well being of the fetus while the mother is seen simply as an incubator for the more vulnerable patient inside of her. These terms help to strengthen her argument by showing the complex dynamics at work within the scientific community that is invested in furthering this technology. The range of political views that may have been brought to the table while this research was proposed can not be ignored, nor can they be excused from having an influence on the research done. The war on women’s health care can be directly related to the increased monitoring and viewing of the fetus as a person with equal rights to the mother it is inhabiting.
Another important question posed in the book is who really has access to this procedure and should it become a standard aspect of reproductive care? The data regarding the costs and accessibility of fetal surgery make it apparent of the procedure’s target audience. Before reaching the decision to have fetal surgery, one would have to have access to prenatal care which is not an option for all mothers. There are significant disparities between the races and class statuses of mothers who receive adequate or any prenatal care. Casper suggests that fetal surgery should take a backseat while one first addresses the health care crisis that is unfolding in the United States. Expensive and seemingly heroic medical advances can distract society from the fact that millions of people are uninsured and receive inadequate health care or are forced into bankruptcy after a major health issue. If only certain populations are being given access to this life-saving procedure, what does this say about how society views the disadvantaged and excluded populations?
While Casper presents a strong argument, I identified a few flaws with how she presented some of her claims. For one, her language at times makes her seem too casual while discussing such a controversial topic. She even makes a few puns that could make readers question her credibility and professionalism while presenting a topic she is supposed to be passionate about. She refers to doctors as “cowboys” on a few occasions, which distracted me from what she was actually trying to suggest and led me to question how she views medical professionals and their authority. Furthermore, she uses language that is quite dramatic and gruesome to describe some aspects of the surgeries. This shows some clear bias against the advancement of fetal surgery and how she views it to be destructive in literal and metaphorical ways. Phrases such as “peeled back” and “breaching the womb” bring up feelings of discomfort for readers and give a negative connotation to the invasiveness of the surgery. If she made some minor adjustments to her word choices then I believe it would eliminate the possibility of her credibility being questioned and would make some of her claims sit better with skeptical readers.
Overall, Casper successfully convinced me of the political and social implications that fetal surgery presents regarding the way society views mothers, fetuses and reproduction as a whole. Like many other human rights movements, as women were gaining more control over their reproductive rights, society managed to push back with a way to erase or suppress the role of the mother. Society simultaneously created more expectations for the extent of motherly sacrifice. Casper formulates an interesting food for thought that could relate to many other medical and political advancements being put forward in direct response to cultural and social shifts.