Self-Trust and Reproductive Autonomy (review)

The issue of how well women navigate through a complex trail of medical technology and gendered hierarchy in relation to their reproductive status is directly related to their level of self-trust. Carolyn McLeod, an assistant professor of philosophy at the University of Tennessee, analyzes the concept of self-trust and the level needed for women to respond successfully to a variety of reproductive situations in her book, Self-Trust and Reproductive Autonomy. As she notes in her introduction, her theory is that "the power of new medical technologies, the cultural epistemic authority of physicians, and the gendered power dynamics in many patient-physician relationships can inhibit women's reproductive freedom" (1).

McLeod sets out to document the various elements of how individual women can come to distrust themselves, at various stages in the reproductive cycle, as they operate within the male-dominated, hierarchical medical system. The author notes the increasing possibility of women's reproductive freedoms being restricted by the growing reliance of society on medical technologies as opposed to more intuitive methods. McLeod then defines the actual parameters of the concept of self-trust, and describes how this is a variant on the philosophical concept of trusting others.

McLeod describes this philosophical prototype of trust as an attitude of optimism about someone's competence and moral integrity, not necessarily her/his goodwill. Trust is also defined as a form of reliance on another. She extends this prototype concept of trust to what she terms the nonprototypical concept of self-trust, where individuals are optimistic about their own competence, and thus trust themselves. Distrusting themselves is directly related to an attitude of pessimism.

McLeod also uses models of interrelational dynamics to illustrate "conceptual categories of trust" (12). She notes that the physical and social environment of individuals will also determine the functioning level of self-trust. Basically, a medical practitioner's perceived social dominance or status can lead to vulnerability for her/his patients, if they happen to be part of a less dominant group. This impact of privilege, when combined with stereotypes as well as sexism and racism, can result in women questioning themselves and their decisions.

McLeod continues to expand on her definitions of trust and self-trust and how they both relate to the variety of reproductive situations that women face, such as miscarriage, infertility treatment, and prenatal diagnosis. She uses specific instances that demonstrate the societal norms separating women's feelings about their bodies and hard science. Examples include the effect of team medical treatment resulting in a female patient feeling more like a conglomeration of parts than a human being or the tendency of the medical profession to emphasize the role and responsibility of only the woman in terms of pregnancy.

This work, part of an overall Basic Bioethics Series, should prove valuable for healthcare or women's studies courses focusing on the impact of 20th and 21st century reproductive technology. McCleod's book also raises intriguing questions for future areas of study, such as medical studies/human subjects, survey instruments, and the relationships between medical practitioners and the practice of medicine and their consequences for women. While the author does rely on several anonymous case studies, there is an obvious need for additional concentrated and detailed survey studies of female patients and their experiences.

It is also interesting to examine McLeod's work in the context of the feminist critique of science. The work being done by scholars such as Ruth Bleier, Ruth Hubbard, Londa Schiebinger, and Nancy Tuana provide effective feminist critiques of the biological sciences and the results of the "politics of biology." The research done by McLeod and the issues she raises further demonstrate the wider problems within medicine and its need to better treat its women patients.

All in all, Self-Trust and Reproductive Autonomy is a solid introduction to the complex issues involved with women managing their many reproductive options and dealing with medical practitioners and technology within feminist philosophy. While the...