Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-18T05:00:21.884Z Has data issue: false hasContentIssue false

How to Escape the Doctor's Dilemma?: De-Medicalize Reproductive Technologies

Published online by Cambridge University Press:  01 January 2021

Extract

Kara Swanson has painted a textured portrait of Alan Guttmacher, showing the tension between his embrace of medical paternalism and simultaneous rejection of the legal paternalism that regulated women’s access to abortion before Roe v. Wade. Swanson explains Guttmacher’s route, navigating the troubled waters between “what was medically indicated and what was legally permissible” in the realm of reproductive medicine, the path that Guttmacher identified as the “doctor’s dilemma.” She takes us from his 1930s practice, creatively assisting in his patient’s use of reproductive technologies such as artificial insemination, to the era post Roe v. Wade, after which he seems to have come to terms with a fuller commitment to autonomous reproductive choices. We learn that Guttmacher’s early career provided opportunities to exercise some of his prerogatives as a doctor in the absence of clear legal constraints. By the end of his life, the Supreme Court came close to having endorsed his preference, as Swanson notes, “privileging the doctor/patient relationship and medical expertise.”

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Swanson, K. W., “The Doctor's Dilemma: Paternalisms in the Medicolegal History of Assisted Reproduction and Abortion,” Journal of Law, Medicine & Ethics 43, no. 2 (2015): 312325.CrossRefGoogle Scholar
Comstock Act 17 Stat. 598 (1873).Google Scholar
86 F.2d 737. A pessary is a type of diaphragm.Google Scholar
Anon., “Recent Cases,” Harvard Law Review 50, no. 8 (1936–1937): 13121324, at 1312.Google Scholar
“But it is difficult to escape the conclusion that the Comstock Act, although perhaps not undesirably, has been almost emasculated by judicial nullification.” Anon., “Recent Decisions,” Columbia Law Review 37, no. 5 (1937): 852880, at 856. More recent evaluations of One Package reached similar conclusions, e.g., Posner, R., “The Learned Hand Biography and the Question of Judicial Greatness,” Yale Law Journal 104, no. 2 (1994–1995): 511–540, at 529, n. 63, describing the One Package case “which gutted the Comstock Act's prohibition against the importation of contraceptives.”Google Scholar
Dennett successfully appealed her prosecution in U.S. v. Dennett, 39 F.2d 564 (2nd Cir., 1930). The opinion that reversed her conviction and declared her pamphlet not obscene was written by Augustus Hand, N., cousin to Learned Hand, and author of a concurring opinion in the One Package case on appeal. Dennett's pamphlet appeared years earlier following an editorial endorsement by Victor Robinson, M.D., see “A Rational Sex Primer” Medical Review of Reviews 24, no. 2 (February 1918): 6575, and Dennett, M. W., “The Sex Side of Life: An Explanation for Young People,” id., at 68.Google Scholar
Swanson, K. W., Banking on the Body: The Market in Blood, Milk and Sperm in Modern America (Cambridge, MA/London: Harvard Uuniversity Press, 2014): At 228.Google Scholar
Boston Women's Health Book Collective, The New Our Bodies, Ourselves (New York: Simon & Schuster, 1984): At 318.Google Scholar
The legal regime for donor insemination made physician involvement a necessity in order to insure legitimacy of resulting children, see Swanson, supra note 8, at 226. Media reports suggest that liability for those who donate sperm remains an ongoing concern when do-it-yourself parenthood plans do not involve physicians, see Narayan, C., “Kansas Court Says Sperm Donor Must Pay Child Support,” CNN, available at <http://www.cnn.com/2014/01/23/justice/kansas-sperm-donation/> (last visited April 23, 2015).+(last+visited+April+23,+2015).>Google Scholar
Griswold v. Connecticut, 381 U.S. 479 (1965) (affirming a right to privacy in access to birth control).Google Scholar
Roe v. Wade, 410 U.S. 113 (1973) (striking down restrictive state abortion laws).Google Scholar
Planned Parenthood v. Casey, 505 U.S. 833 (1992) (setting the “undue burden” test for access to abortion).Google Scholar
Gonzales v. Carhart, 550 U.S. 124 (2007) (upholding the Partial-Birth Abortion Ban Act of 2003).Google Scholar
Weiss, B., “RU 486: The Progesterone Antagonist,” Archives of Family Medicine 2, no. 1 (January 1993): 6369.Google Scholar
Glasier, A. et al., “Mifepristone (RU 486) Compared with High-Dose Estrogen and Progestogen for Emergency Postcoital Contraception,” New England Journal of Medicine 327, no. 15 (October 8, 1992): 10411044.CrossRefGoogle Scholar
Peyron, R. et al., “Early Termination of Pregnancy with Mifepristone (RU 486) and the Orally Active Prostaglandin Misoprostol,” New England Journal of Medicine 328, no. 21 (May 27, 1995) 1509–1513; see also El-Rafaey, H., “Induction of Abortion with Mifepristone and Oral or Vaginal Misoprostol,” New England Journal of Medicine 332, no. 15 (April 13, 1995): 983–987, at 986.Google Scholar
I originally made this proposal at the American Association of Bioethics Meeting in San Francisco, November 21, 1996. See Lombardo, P. A., “Legal Limits on Reproductive Rights: Unlocking the Pharmacy.”Google Scholar
Prescott, H. M., The Morning After: A History of Emergency Contraception in the United States (New Brunswick, NJ: Rutgers University Press, 2011).CrossRefGoogle Scholar
Tummino v. Hamburg, 936 F.Supp.2d 198 (E.D. New York, May 10, 2013).Google Scholar
Weitz, T.A. et al., “Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants under a California Legal Waiver,” American Journal of Public Health 103, no. 3 (March, 2013): 454461.CrossRefGoogle Scholar
Weitz, T.A. et al. note that the term “aspiration abortion” is a more accurate term than “surgical abortion” for common first trimester abortions, which do not meet the standard definition of surgery, see also Weitz, T. A. et al., “‘Medical’ and ‘Surgical’ Abortion: Rethinking the Modifiers,” Contraception 69, no. 1 (2004): 7778.CrossRefGoogle Scholar
Cal. Bus. & Prof. § 2253 & 2725.4.Google Scholar
Ombelet, W., “Affordable IVF for Developing Countries,” Reproductive BioMedicine Online 15, no. 3 (2007): 257265, available at http://www.sciencedirect.com/science/article/pii/S1472648310603379; see also, Edwards, C., “Shoebox IVF: Hope for Infertile Couples,” BBC Health Check, June 21, 2014, available at <http://www.bbc.com/news/health-27814124> (last visited April 23, 2015).Google Scholar