Culture and Religion   2 comments

Testing Women, Testing the Fetus presents many opportunities to explore the LCT Cultural Medicine curriculum, but Rapp spends a significant amount of time examining a topic that is not on the list of learning objectives: her subject’s religious affiliations, and the effects those affiliations have on their choices and responses. Maybe religion is implied under “cultural beliefs and values,” but I wonder if a more direct heading of faith and religious beliefs in the context of medical care would be appropriate?

Rapp identifies her subjects by denomination and adherence, and presents belief systems as a significant variable in many cases. In her discussion of positive-diagnosis abortion, she offers her “strong impression” that Catholic women, for instance, “suffer more guilt and frame their suffering more explicitly in terms of sin and the need for absolution” (252). Of course Catholics were not alone in expressing feelings of moral conflict and turning to personal faith in the situation of selective abortion: Rapp also speaks with Protestant and Jewish women, and a “returned” Buddhist (251). The situation of elective abortion is already a cause for self-doubt and grief, and I found it interesting that some women had the support of their faith and families to get through the situation while other women felt they had to hide their aborted pregnancies within the very same context of faith (258).

Abortion is gendered, medicalized, and thoroughly immersed in cultural and political sites of contention and judgment; it is an extreme example most doctors will never have to deal with. Nevertheless, this discussion illustrates the need for physician awareness of their personal belief systems and an understanding of how those belief systems might interfere with objective patient care.

The account of the woman who was counseled by obstetricians and genetic counselors to go to a Down’s syndrome convention when she was trying to terminate her pregnancy shows the damage that can be done when doctors impose moral judgment in place of clinical judgment (Rapp 254). The impetus to “guide” the pregnant woman’s decision is fraught with moral overtones and subjective values, and magnifies a difficult personal decision into a judgmental social discourse. I think that Rapp’s subsequent chapter illuminates clearly the repercussions on both sides of the decision to abort a disabled fetus, and also unfolds the fact that the person(s) who must live with the outcome of the decision is the woman and her family, and not the counselor, doctor, or health care provider.

Another potential topic within the cultural discussion is the response to disability. I found the idea of “imagined communities of extended kinship” in terms of the Down’s syndrome children intriguing, and I felt it places them in a cultural category of their own (Rapp 291). This viewpoint contrasted sharply with the “incurably damaged” babies who seem to be an affront to some of the physicians who deliver them (267). It appears that explaining a child’s disabilities to new parents must be on a par with telling someone they have a fatal disease; it signals not only very bad news for the patient, but also a failure of the physician’s skill on some level. As Rapp notes, “Doctors may have strong personal and professional responses to delivering and treating babies who cannot be seen as normal, and whose ills cannot be cured, investing them with symbolic meaning which sometimes supersedes their individual characteristics” (266).

My question: would educating medical students to the potential capabilities (instead of the probable disabilities) of these children be an appropriate topic to include in a cultural medicine forum?

Rapp, Rayna. Testing Women, Testing the Fetus. New York: Routledge, 1999. Print.

Posted September 28, 2010 by MGalbreath in Uncategorized

2 responses to “Culture and Religion

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  1. Your response touched on many nerves, one of which we brushed against in class last week but did not elaborate on. Recommending that a woman who is considering abortion go to a Down’s syndrome convention is appalling, but connecting parents who are considering all options to parents who are raising children with varied syndromes may shed light on the possibilities if one chooses not to abort. I don’t think anyone should be required (or even recommended) to meet with parents of a Down’s syndrome baby, but for some–especially those whose religion does not allow for abortion as an option–it may be helpful. Requiring such contact is like requiring women who choose to abort to undergo sonograms and view their fetuses (as promoted by the pro-life movement).

    Issues of pregnancy, abortion, and behavior that leads to pregnancy are deeply tied to religion for many individuals. I was surprised that the doctors featured in Rapp’s narratives were so ill-equipped to deal with religious issues. One would think religious and cultural sensitivity training would be a substantial part of medical training but apparently not. Seeing the list of curriculum topics we have to work with and realizing how little time is spent on topics of such gravity makes Rapp’s examples no less shocking, but less surprising. I agree that religion deserves its own curriculum moment, since “cultural beliefs and values” is so broad.

  2. “I found it interesting that some women had the support of their faith and families to get through the situation while other women felt they had to hide their aborted pregnancies within the very same context of faith.”

    I didn’t at all. Being raised in a strict Protestant household, I was *clearly* aware of just how evil abortion (and pre-marital sex, and…and…) is, and I always felt more compassion for the women who had abortions (for whatever reason) than the fetuses that were lost, mostly because I could only begin to imagine what kind of living hell those women would go through afterward.

    You’re absolutely right that doctors should be more aware of the implications of religion in situations like these. But I can’t think of a better way to handle it. Bring in a clergy member from the patient’s religion? Hardly appropriate, as that would provide undue pressure and scrutiny, particularly where critical faiths are concerned. Have a generic priest available for whatever counseling the patient might request? Impossible, as this issue is such a contentious one that is viewed so differently from so many standpoints.

    That leaves me to think that it’s a decision that only the woman can make on her own (which I think, fundamentally, is absolutely the case), but that sounds like I’m not convinced any counseling or decision-making support is needed when I absolutely believe it’s essential.

    How can women, when dealing with such a fundamentally troublesome and complex issue, possibly get care, concern, and support that can be deemed “appropriate”? How on earth can a doctor be trained to come anywhere close to providing that kind of care? Is it possible?

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