The Dream of the Perfect Child (review)

Joan Rothschild's The Dream of the Perfect Child opens and closes with an interesting double thesis: First, the eugenic agenda of the eighteenth through the mid-twentieth centuries has been relocated to the private, domesticated space of the clinic and the discourse of individualized medical decision making, and thereby strengthened.¹ Second, "The discourse of the perfect child is neither scientific-medical conspiracy nor male plot." Rather, "technology, medicine, and parental expectations intersect to distort the desire for normal, healthy babies into the dream of perfect ones"—a desire that she argues is both understandable and appropriate (227). Rothschild sets out to defend these two claims using a promising interdisciplinary mix of history, science and technology studies, and ethical analysis. The first three chapters are an informative and helpful history of the idea that humans can be perfected through science, medicine, and social policy. The fourth chapter is a useful primer on genetics and prenatal diagnostic technologies, which is accessible to a humanities audience but not overly simplistic.

Unfortunately, once these four chapters are complete and Rothschild begins her analysis of contemporary culture, she does not directly explore or defend her own theses. Instead, she sticks to reporting on prenatal genetic testing practices and summarizing existent critiques of these practices. Rothschild rehearses by-now familiar concerns surrounding prenatal testing, such as how it effects a shift to the fetus as the primary object of reproductive medical attention, political problems with the language of defects, and the expansion of the category of "risky" pregnancies.²

Rothschild displays little curiosity about the details and diversity of pregnant women's experiences. She does not show much concern or empathy for how women understand or experience the choices they make about prenatal testing, nor for the anxieties and conflicting emotions that may frame these choices. Although she has a chapter entitled "The Parents," this chapter does not actually explore parents' perspectives, but is rather a description of our usage of contemporary prenatal procedures. When she does try to enter into women's experiences, her descriptions are overgeneralized, and they sometimes come off as condescending or romanticized. For instance, she claims without support or citation, "Women candidates for prenatal testing find themselves distanced from the abstracted language of scientific probability. . . . A medically and statistically oriented discourse has little relevance for decisions they are making and the dilemmas they face" (213). And elsewhere, "The pregnancy experience directly contradicts antagonistic self-other dualisms" (217). Surely, some women resent and feel alienated from their fetuses, and thereby experience pregnancy as an antagonistic dualism.

I have several concerns about Rothschild's use and presentation of empirical data, which can be divided into four categories.

Insufficient or Inappropriate Citations of Sources

Although Rothschild offers readings of the ideas of historical figures such as the Marquis de Condorcet and Charles Darwin, she relies almost exclusively upon secondary sources rather than primary texts. Some of her specific empirical claims receive no citation at all. Late in the book she refers without citation to conclusions gathered from "my own interviews" (196), but she includes no information about whom she interviewed, her methodology, or anything else about these studies or how she drew her conclusions from them.

Distortions of Empirical Facts

Rothschild's hyperbolic language sometimes distorts or misrepresents the facts. For example, citing Barbara Katz Rothman's claim that women experience pressure to use prenatal diagnostic technologies once they are available, she states that this availability "narrows women's choices" (191, emphasis added). But if there were no prenatal diagnosis options, women would have no (relevant) choices at all, so it is hard to imagine how the introduction of a new option could narrow their choices. On the strongest reading, we could claim that the introduction of the technology replaces one choice-free situation with another, and even this seems overstated. The point that social pressures and medical routines conspire to make women's choices about prenatal testing less than fully autonomous or reflective could be more effectively expressed without the exaggeration.

Hasty Inferences...