Focusing on the foetus: medicine, technology and professional identity

1. Focusing on the foetus: medicine, technology and professional identity HI296 Week 8

2. Structures of surveillance: the panopticon Jeremy Bentham (1748-1832), Panopticon (1791)

3. Discipline in the Panopticon • ‘Penitentiary’: why were panoptic prisons given this name? • Benefit of panoptic surveillance: you never knew when you were being watched, so you had to behave all the time… • Which was intended to instil self-discipline, and internalization of society’s rules and codes of behaviour.

4. Stateville Penitentiary Centre, IL. In use 1925 to present

5. Presidio Modelo Prison, Cuba. In use 1926-1959

6. Building the medical panopticon: therapeutic surveillance Concepts: ‘Moral Management’ Instilling self-discipline Therapeutic optimism Middlesex County Lunatic Asylum c. 1850 (originally built 1829) 

7. Building the medical panopticon: therapeutic surveillance Octagon Ward Johns Hopkins University Hospital, 1890

8. Building the medical panopticon: therapeutic surveillance Rochester Methodist Hospital Radial Nursing Unit 1957 (Built in collaboration with Mayo Clinic) ‘Special Observation Unit’, know as ‘the silo’…

9. Text from consumer ad: http://www.allheart.com/om13fetal.html(accessed 18/11/08) “Fetal Stethoscope (Fetoscope) Designed for superior auscultation of the fetal heart. Stethoscope is equipped with chrome-plated brass binaural and stem. The 22 inch black tubing can be easily shortened to facilitate use of the headrest. Listening to the Fetal Heart Starting at around 20 weeks, the fetal heartbeat can usually be heard without Doppler amplification (ultrasound). At this point a special stethoscope called a fetoscope can be used. The heartbeat is best heard over the baby's back, which often seems firm when you feel around the uterus. It may be difficult to hear the fetal heart by stethoscope if the mother is overweight or if the placenta is on the front wall of the uterus. PLEASE NOTE: It gets easier to hear later on in the pregnancy, so don't get discouraged! Always remember that every pregnancy is unique, and mothers should always consult their obstetrician with any questions. These fetal stethoscopes are intended for use by professionals. Our Everyday Low Price: $19.98, 2 for $38.98”

10. So who wins in the medical panopticon? “I am very unhappy now. The trial of my womanhood which to me is so very bitter has come upon me again. When my little Ellie is 2 years old, she will have a little sister or brother. And this is the end of all my hopes, my returning joyful youthfulness… Hannah Whitall Smith, 1852 “Has the unborn infant no rights? Is it a matter of no importance whether we destroy that life locked up in its mother’s womb? … Is there any moral difference in murder within the womb from that without?” Dr. T Ridgeway Barker, 1892 “The obstetrician alone must be the judge of what is to be done…” Dr. George McKelway, 1892 “To my mind, the answer [about whether to perform a craniotomy or a cesarean section] depends on the social status of the woman, her desire for a living child, and particularly upon whether she is the mother of several children or is pregnant for the first time. In the former event… the patient has already done her duty to the State … In the latter event … such interference is highly reprehensible … decapitation is preferable to forever abolishing the reproductive function of a young woman.” Dr. JW Williams, 1917 “So long as the child is within the womb or indeed within the maternal passages, it is regarded by the law as part of the woman’s body.” Dr. Draper, 1890

11. Panopticon Instrumental reality/clinical reality Technological imperative Tacit knowledge ‘authoritative knowledge’ ‘nursing gaze’/‘medical gaze’ ‘doctor’s time’ Fetocentrism ‘Electronic Age’ of medicine Machine-body tending ‘pre-conditioning’/’prepared birth’ Surveillance medicine ‘epidemic of risk’ Cephalopelvic disproportion Symphisiotomy Pubiotomy Reading Self-Assessment:Crucial terms and concepts

12. Seminar topic: Authority, images and infants • To what extent does the power of medical imaging – from x-rays to ultrasound -- emerge from their self-evidence, and to what extent does come from from the authority granted to them by medical professionals? • Who does, and who should control the images created by these medical technologies?