Hanging on to Sensitivity

by Eleanor Rodgerson, M.D.

What is modern maternity doing to its doctors? Think of the technology they face - the manipulation of reproduction! Frightening, isn't it?

Can physicians perform these experiments and still keep the common touch? Can they be sure that what they are doing for man- and womankind is the best? When I first heard of the new techniques, I thought, "How marvelous!" But, now, I'm afraid of the consequences. Regardless of patient results, can physician sensitivities be retained? How easy will it be to deal with patients' unanswerable questions?

Artificial insemination has long been a part of the infertility specialist's armamentarium and it was inevitable that experimentation would extend to the ova when methods to harvest and grow them were worked out. In vitro fertilization brought happiness to previously infertile women, but that was only a beginning.

Along comes the surrogate, a woman who provides the use of her uterus for incubation purposes, a business proposition. Using a surrogate carries the procedure beyond normal. The careerist, who has no time to take off for pregnancy, may hire a substitute. Single women and men can arrange for offspring. It is hard to imagine the physician at the side of the surrogate. Will she be called "Mother?" Will there be commiseration over the nausea, the swollen ankles, the stringy hair? Won't it all be impersonal? Perhaps surrogates will have to be institutionalized to be
monitored carefully.

And to go a step further - the development of clonings. Will there be the same feeling about the disabilities of a cloned individual? Will more radical steps be taken for treatment because, if it fails, another clone is readily available? The world is changing, as has been noted many times.

Should whatever comes along be accepted regardless of the loss of the character attributes that lead to attentiveness, kindness, sympathy?

There is pull in several directions: saving the marginal and destroying the unwanted, stressing the importance of family and tinkering with the maternity that is so much a part of it. Will physicians callously manipulate life and living?

Technology that was only dreamed of is here. Still, in the back of the mind remain pictures of friendly, generous, understanding men and women at the ready to treat, advise, and comfort. Is it the end of this kind of doctor? The old-fashioned family physician has almost disappeared and
the physician, "with a heart", may be on the way out. There have been warning signs - disputes over managed care, patents on genes, artificial body parts, cloning ideas. Is the doctor necessary for anything but pressing the buttons and pointing the way? Aren't those qualities we think of as
part of humanity fading?

I recently came across a saved excerpt from Alexander Solzhenitsyn's CANCER WARD. A young woman oncologist who realizes she has cancer is consulting with a senior doctor. "Generally speaking," he remarked, "the family doctor is the most comforting figure in our lives, and now he's being pulled up by the roots. The family doctor is a figure without whom the
family cannot exist in a developed society. He knows the needs of each member of the family, just as the mother knows their tastes. There's no shame in taking to him some trivial complaint you'd never take to the outpatients' clinic, which entails getting an appointment card and
waiting your turn, and where there's a quota of nine patients an hour. And yet all neglected illnesses arise out of these trifling complaints.

"How many adult human beings are there, now, at this minute, rushing about in mute panic wishing they could find a doctor, the kind of person to whom they can pour out the fears they have deeply concealed or even found shameful? Looking for the right doctor is the sort of thing you can't always ask your friends for advice about. You can't advertise for one in a newspaper either. In fact, it's a matter as essentially intimate as a search for a husband or wife. But nowadays it's easier to find a good wife than a doctor ready to look after you personally for as long as you want, and who understands you fully and truly."