Colliton, William F.

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The Linacre QuarterlyVolume 50 | Number 4 Article 1411-1-1983[Book Review of ] Power and the Profession ofObstetrics, by William Ray ArneyWilliam F. CollitonFollow this and additional works at: http://epublications.marquette.edu/lnqPart of the Ethics and Political Philosophy Commons, and the Medicine and Health SciencesCommonsRecommended CitationColliton, William F. (1983) "[Book Review of] Power and the Profession of Obstetrics, by William Ray Arney," The Linacre Quarterly:Vol. 50 : No. 4 , Article 14.Available at: http://epublications.marquette.edu/lnq/vol50/iss4/14Book Reviews Power and the Profession of Obstetrics William Ray Arney University of Chicago Press, Chicago, Ill. , 1982, 279 pp., $25. This reviewer , a practicing obstetrician, was not moved by this book , though it may well be of value to sociologists and historians. The text purports to be a third kind of h istory of obstetrics, reflecting the view neither of the profession nor of its critics. While studiously researched and beautifully documented in a long sec-tion of notes (pp. 243-279), very little of the text is devoted to detailing historical facts. The rascally Chamberlens, while getting a mention, really don 't receive the attention that such characters deserve or could easily support as in, let's say, a historical novel. Arney does use the archives of obstetrics to support his view of the deploy-ment of power before the profession's official organization early in the 20th century and its redeployment follow ing World War II. The largest portions of the text are devoted to monitoring and surveillance, a new order of obstetrical con-trol, and maternal-infant bonding and how it conflicts with the monitored delivery of obstetrical services. Arney seems to be presenting a female chauvinist's view of essentially male chauvinistic control of the obstetr ical experience. While, in his view, patient care concerns on the part of the physician may playa role in decision-making with regard to deployment of newer technologies, the suggestion clearly came across to me that th is was more a matter of the discipline of obstet-rics (i .e ., its practitioners) maintaining control over what is most frequently a normal (and, therefore, non-medical) experience. Needless to say, this is some-what offensive to one who has dedicated his lifetime to caring for expectant mothers and their unborn children. When speaking about maternal-infant bonding and the obstetrician's embrace of t his concept, the author certainly didn 't talk to any of my confreres. While some pediatricians in our community are strong supporters, most obstetricians feel that this matter closely resembles a ceramic container of large bowel excreta, or words to that effect . The section on medicine, ethics and the reformulation of the doctor-patient relationship was interesting but, in my judgment, a little too brief. There is also no suggestion as to what is the proper course of _action for the human family with regard to some of the newer technologies, i.e ., in vitro fe rtilization, sex selection, genetic engineering and the like. Arney noted that "there has been a breakdown in the profession 's capacity to contain the ethical dimensions of its work behind a professional boundary , and it is th is social aspect of contemporary ethical debates that merits examination." In my judgment, t he heart of this problem lies with the m oral theological community whose thinking and counsel for society has lagged well behind techological advances. The reviewer was comforted by t he observation that at best , only one·tenth of the m edically "eligible and appropriate" amniocen· tesis was performed in 1978. The figures given were an estimated 15,000 studies done fro m a potential reservoir of women numbering 1 50-200,000. To one who views this undertaking as a "search and destroy mission" with the ultimate prac-tice of ex terminative medicine, this was comforting. In today 's m edical-legal climate, there is no argument with regard to the need of informing all pregnant women at potential risk of the availability of this study, but the fact remains that November, 1983 367 the way the doctor makes the presentation ordinaril y tells the tale. Arney also noted, "The NIH 'consensus-developing' T ask Force on Predictors of Hereditary Disease or Congenital Defects recommended against requiring prior commitment to abortion , but there is no m echanism for enforcing their recommendation." He also noted, quite accurately, that "the incidence of severe depression follow ing elective abort ion for genetic reasons is so great" that "it may be more difficult to deal with than either an abortion of 'convenience' or a stillbirth at term," or perhaps "even more difficult than bearing and rearing a defective child." Arney does an excellen t job in summing up the implicit agreement m ade between modern obstetric ians and modern women. He writes, " The rule, simply stated, is that birth should occur withi n a flexible system of obstetrical alternatives in which a woman's experiences can take prominence against a background of obstetrical expertise and safety. Around this rule modern women and modern obstetricians have begun a univocal discourse over childbirth . They are ostensibly engaged in a dialogue , but in the exchanges o nl y a single voice is h eard." Unfor-tunately, in living o u t this agreement, the patient and this doctor occasionally end up in an adversary relationship. The au thor, by way of conclusion, gives a very positive and accurate presentation of the benefit to both m other and baby of a prepared childbirth (psychoprophylaxis) approach to delivery. The reviewer was , perhaps, prejudiced from the start against the book. It is written in the language of the intellectually elite. Like ecclesiastic langu age, it can be difficult to read. It is discomforting to be driven to the dictionary to under-stand the meaning of a passage, especially when the thought can be simply expressed. Who needs to say "concatenation " when " linking together" says it all . The reviewer would not pay the $25 price listed for this publication. - William F. Colliton, Jr ., M.D . Chairman, Department of OB/GYN Holy Cross Hospital Silver Spring, Maryland A Theory 0/ Medical Ethics Robert M. Veatch Basic Books, Inc., New York, 1981, xi + 387 pp., index. This is undoubtedly an important book in medical ethics , both for moralists working in bioethics and for those in the h ealth care professions. If only because of the stature of its author, it is bound to be influen t ial, and with good reaso n. For Veatch is a balanced and thorough writer whose reputation in the field of bioethics is largely deserved. Moreover, the book's topic is important and the project it represents is ambitious ; it is nothing less than an attempt to articulate an ethics for the medical professions fro m the ground up. Veatch seeks to articulate a public ethics which will really provide guidance for the difficult decisions health care professionals and others must make in the modern health care setting. Fur-thermore , the ra nge of topics discussed and Veatch 's device of focusing discus-sions by way of concrete bioethical dilemmas make the book valuable no matter what one thinks of the success of Veatch 's project. In the first of the four parts of the book, Veatch surveys various traditions of m edical and physician ethics. He discusses the Hippocratic and Judeo-Christian 368 Linacre Quarterly 

[Book Review of] \u3cem\u3ePower and the Profession of Obstetrics\u3c/em\u3e, by William Ray Arney

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[Book Review of] \u3cem\u3ePower and the Profession of Obstetrics\u3c/em\u3e, by William Ray Arney

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