Haunting Images: A Cultural Account of Selective Reproduction in Vietnam

4. “Like a Loving Mother”: Moral Engagements in Medical Worlds

101 dr. tuẤn: “we must have a strong sense of responsibility” Dr. Tuấn usually talked about ultrasonography in enthusiastic terms. Yet in a conversation that my colleague Hằng and I had with him on May 19, 2004, he drew our attention to what he saw as the darker side of this technology: the human pain that resulted when a fetal problem was found. What Dr. Tuấn cherished about his job was to be able to reassure expectant mothers of the beauty and normality of their children -to-be, to share with them the happy future that this child body promised. The opposite situation was, I knew, one that he found difficult to bear. When I asked him about his role vis-à-vis the woman and her family in such cases, he responded promptly: I play a very important role for the patient and her family. People’s happiness is their children. In the face of that responsibility, which is great and heavy, we must have comprehensive skills. We must have a strong sense of responsibility (tinh thần trách nhiê .m) when making a diagnosis, and we must be very precise when assessing the condition of a child that is about to be born. When something abnormal is found in a child, we must feel deeply with people, encourage them, and support them spiritually. . . . The sonographer is the person who has the first contact with these people, so it is our responsibility to encourage (động viên) them by every means, to make them feel at peace, so that they can continue firmly along the road that they have to travel. chapter 4 “Like a Loving Mother” Moral Engagements in Medical Worlds 102 | Chapter 4 In this chapter, I examine the moral questions that practices of selective reproduction raised among the physicians I met in Hanoi; questions about how to care optimally for patients and about how best to fulfill their role as medical experts.1 In official public health discourse in Vietnam , technologies for prenatal screening were, as the previous chapters show, defined as unquestionably benevolent and useful. In day-to-day clinical practice, however, moral matters became more complex. The physicians I met struggled with a variety of ethical and emotional challenges as they sought to determine where to draw the line, how to distinguish between fetuses that were to be selected for life and those that were not. Close ethnographic attention to the dilemmas faced by these physicians, I contend, allows us to open the state and its public health projects to anthropological scrutiny. As state-employed cadres (cán bộ), doctors at this obstetrics hospital embodied the state; in dayto -day practice, the task of carrying out national health care initiatives was assigned to them. My conversations and interactions with these health care professionals have led me to suggest that the state must be seen not as a closed system of administration and governance, but rather as an open and affective structure of mutual belonging. The state is, this material from Vietnam suggests, suffused with sentiment; rather than simply a locus of rational and bureaucratic practices, it is a site of vivid imaginings, fantasies, and desires (cf. Aretxaga 2003). Conventional approaches to the state, however, render it difficult to bring this intertwining of power and passion into analysis. Despite recent deconstructions of the state as an integrated political entity, and despite reconceptualizations of states as powerful collective illusions, essentializing oppositions between state and society continue to prevail in anthropological analyses (cf. Ferguson and Gupta 2002). State-citizen divides tend to be sharply demarcated in research on the politics of reproduction; in many studies, the state is represented as an external agent of power and authority that encroaches on people’s reproductive lives in fairly brutal ways.2 The accounts of state-employed physicians such as Dr. Tuấn, however, invite us to reconsider these assumptions. The moral-emotional dilemmas that physicians described indicate that the medical world they inhabited was animated by intense interpersonal engagements that transcended conventional state-citizen dualities, revolving around what doctors described as a sense of responsibility (tinh thần trách nhiê .m). In the above statement, Dr. Tuấn set forth this sense of responsibility in very explicit terms; yet I often found it to be articulated more indirectly, manifesting itself in the touch of a hand “Like a Loving Mother” | 103 during...