Imagining a Fetus: Insights from Talking with Pregnant Women about their Decisions to Undergo Open-Uterine Fetal Surgery. In: Toombs SK, editor. Handbook of Phenomenology and Medicine. Dordrecht: Springer Netherlands; 2001. pp. 393-415. [DOI: 10.1007/978-94-010-0536-4_21]

Retrieving the Moral in the Ethics of Maternal-Fetal Surgery

Open-uterine surgery to repair spina bifida, or 'fetal surgery of open neural tube defects,' has generated questions throughout its history-and continues to do so in a variety of contexts. As clinical ethics consultants who worked (Mark J. Bliton) and trained (Virginia L. Bartlett) at Vanderbilt University-where the first successful cases of open-uterine repair of spina bifida were carried out-we lived with these questions for nearly two decades. We worked with clinicians as they were developing and offering the procedure, with researchers in refining and studying the procedure, and with pregnant women and their partners as they considered whether to undergo the procedure. From this experience in the early studies at Vanderbilt, we learned that pregnant women and their partners approach the clinical uncertainty of such a risky procedure with a curious and unique combination of practicality, self-reflection, fear, and overwhelming hope. These early experiences were a major contributing factor to the inclusion of an ethics-focused interview in the informed consent process for the Management of Myelomeningocele Study (MOMS) trial study design.

Confronting diminished epistemic privilege and epistemic injustice in pregnancy by challenging a "panoptics of the womb"

This paper demonstrates how the problematic kinds of epistemic power that physicians have can diminish the epistemic privilege that pregnant women have over their bodies and can put them in a state of epistemic powerlessness. This result, I argue, constitutes an epistemic injustice for many pregnant women. A reconsideration of how we understand and care for pregnant women and of the physician-patient relationship can provide us with a valuable context and starting point for helping to alleviate the knowledge/power problems that are symptomatic of the current system and structure of medicine. I suggest that we can begin to confront this kind of injustice if medicine adopts a more phenomenological understanding of bodies and if physicians and patients--in this case, pregnant women--become what I call "epistemic peers."