Monday, July 23, 2012
Ultrasound Technology Can Impede Informed Consent
by Evan Selinger
Earlier this year, controversy surrounded ultrasound legislation in Texas, Virginia, North Carolina, Texas, and Idaho. Lost in the critical commentaries on abuses of patients’ and physicians’ rights was concern over a fundamental violation of liberty. This issue hasn’t gone away, even though sonogram coverage isn’t currently grabbing headlines.
Medical experts routinely use ultrasound technology in ways that favor the Right to the Life agenda, even in states that don't have mandatory ultrasound laws. This problem goes unnoticed because the potential harm caused by the medical community is not the result of political ideology. Rather, it arises from inadvertent exploitation of patients’ natural human weaknesses and cognitive tendencies. To understand why, we need to grasp how typical conversations about ultrasound images can impede rather than foster informed consent.
In cases where advocates pushed for mandatory ultrasound, proponents insisted that women considering abortion should be subject to robust informed consent policy. From this perspective, ultrasound technology looks like a perfect tool for ensuring women understand the profound ramifications of using surgery to terminate a pregnancy. Unfortunately, discussions of what ultrasound images reveal isn’t limited to objective medical facts.
When my wife was pregnant six years ago in upstate New York, every visit to the sonographer followed the same pattern: the fetus she carried was called a “baby”. This way of speaking had a profound effect upon how we thought about the pregnancy. Whenever we discussed a sonogram, we wanted to know what it revealed about our “baby”.
We weren’t just given a frameable copy of an ultrasound image to proudly display. We also received a videotape of moving ultrasound imagery. It was edited to include a superimposed caption on top of the “baby” who cartoonishly states, “Hi mom and dad. See you soon!” Conditioned by this experience, when we returned home and momentarily lost sight of the still image, my wife panicked and exclaimed, “Oh no. We’ve lost our daughter!”
Referring to the sonogram’s subject in this way is a departure from clinical terminology. Clinically speaking, a baby differs from a fetus; it has been birthed and is biologically separated from the mother’s life support systems, i.e., it must breathe and eat on its own. Far from being merely a matter of semantics, this point is significant because much of the abortion debate centers on contested opinions about the extent to which babies should be understood as similar to or different from fetuses.
At issue is the status of personhood and its associated rights. Pro-choice advocates contend that despite their biological potential, fetuses—unlike babies—are not human persons because they lack various features. Pro-life advocates see matters in the opposite way.
When physicians and technicians refer to sonograms as revealing information about “babies,” they probably aren’t deliberately trying to use a framing technique to interject their personal views on the abortion debate. Communicating effectively with patients requires using language that’s easy to grasp, and fetus is not a word used in everyday conversation. Unfortunately, using baby language in this context risks inappropriately biasing the patient’s (and partner’s) judgment.
Given the human mind’s basic tendencies, thinking about options for a “baby” will, for many of us, immediately brings to mind considerations about independent persons who can feel, suffer, and be deprived of their potential. These considerations, which impact both intellect and emotion, are aligned with the Pro-life agenda.
Critical scholarship on sonogram interpretations, notably Lisa Mitchell’s Baby's First Picture: Ultrasound and the Politics of Fetal Subjects and her essay, co-authored with Eugenia Georges, “Baby’s First Picture: The Cyborg Fetus of Ultrasound Imaging,” suggests my wife and I had a common experience. The scholarship presented there details the powerful effects ultrasound descriptions can have, including reducing anxiety, improving compliance with medical advice, and fostering bonding.
These effects are often tied to statements about the “baby’s” appearance, activity, subjectivity, potential, and social connections. Common descriptions refer to the “baby” as playing, dancing, partying, waiving, being good, being cooperative, and even being athletic, smart, or quick like dad or mom. Likewise, when fetal movement impedes an ultrasound, patients are told the “baby” is shy, modest, or doesn’t like to have a picture taken. Mitchell concludes that these statements translate technical data into non-medical terms that are burdened by cultural assumptions about responsible parenting.
This problem—which, for the sake of shorthand reference, can be called problem of personification—is exacerbated by current genetic counseling protocols. During genetic counseling, both actual and potential medical complications are discussed. The personification problem, however, goes unaddressed. While issues related to risk are emphasized, problems concerning how to perceive the main being for whom risk is an issue are ignored.
In calling attention to the problem of personification, I am trying to avoid making any pronouncements on the matters that lead abortion discussions to be mired in endless controversy. My commentary solely concerns the ethics of medical communication. To be sure, effective communication with patients can require medical professionals to depart from clinical terminology—to simplify complex technical information with comparisons, stories, and metaphors. In many cases, this is both appropriate and helpful. However, instances can arise where popularization backfires. Because judgment about the fetus-baby dispute is a political and religious matter, medical experts should do everything in their power to avoid biasing those in their care about the issue. A crucial step in this direction is to avoid equating the use of ultrasound technology detailed here with informed consent advocacy.
Posted by Evan Selinger at 12:25 AM | Permalink