Book reviews 61 spiritual from the material, creating a dualism, because it ignores nursing tradition? The origins and development of nursing and the ethic of whole person care, both historically and culturally, derive from a view of the person as irreducibly and inseparably a material and spiritual creation. Although growing ever weaker, this ethic is still implicit in nursing. As the interviewed nurses assume, and as the authors are eventually forced to recognise, spiritual care is not a selfconscious addition to nursing care but the very way of love. Despite the price this book will undoubtedly become a nursing textbook on spirituality but I hope that it will also form part of a wider academic debate in nursing. For those outside nursing this book is a window into modem nursing theory. ANN BRADSHAW National Institute for Nursing, Oxford At women's expense: state power and the politics of fetal rights Cynthia R Daniels, Cambridge, Massachusetts, Harvard University Press, 1993, 183 pages, £15.92 hc The language of maternal-fetal conflict, this book's concern, is now part of English law. In the recent S case a Caesarean section was ordered on a pregnant woman against her will, despite her previous successful vaginal delivery when doctors had also predicted that only a section could save the baby. Now there is great uncertainty about the longstanding common-law tradition that the fetus has no legal personhood. The S judgment which has been denounced by the Royal College of Obstetricians and Gynaecologists cited the 1987 US case of Angela Carder, a young woman with cancer who became pregnant while in remission. She agreed that a Caesarean section could be performed if necessary after the twenty-eighth week of pregnancy, the point at which her attending physicians thought the fetus stood an acceptable chance of survival. In the twenty-fifth week ofher pregnancy she took a radical turn for the worse. The trial judge ruled that she had no interests because she was dying, and that the survival of the fetus was the priority despite its poor prognosis. The baby died within two hours of the operation; Angela Carder died two days later, having regained consciousness long enough to learn that her child was dead. After Carder's death the trial court decision was reversed, and women's right to bodily integrity re-stated firmly by the US Court of Appeals. Yet as Daniels ably and convincingly argues, there are many countervailing straws in the wind. Carder had not viewed herself as in conflict with her baby; she gave permission for the Caesarean at the age of likely fetal viability, knowing the risk to herself. The conflict was in the eye of the beholder, the trial judge; but the assumption of conflict between mother and fetus has now become general, Daniels argues. Although no one, not even a parent, can be forced to donate an organ to a relative, pregnant women can be and have been forced to have blood transfusions against their will, made to deliver in leg and arm restraints, and physically detained in hospital, particularly if they were suspected of drug use. How can such mediaeval barbarities occur in what some call the 'post-feminist' age? The new politics of fetal rights is in part a backlash reaction to the comparative success of feminism. The very 'permission' given to women by abortion statutes (in this country) and case law (in the US) has now been turned against them. Once a woman decides to continue with her pregnancy, fetal rights activists argue, she loses the right to bodily integrity. If fetal monitoring, Caesarean section, or restriction of her drug and alcohol intake will benefit the baby, in this consequentalist argument, the state should intervene to protect 'the tiniest citizen'. Daniels reports from three main battle zones in which the rhetoric of maternal-fetal conflict has affected policy in the United States: medical interventions in pregnancy; 'health and safety' policies which bar all women of childbearing age from certain forms of work unless they can prove they have been sterilised; and prosecutions of pregnant female addicts for 'supplying drugs' through the placenta. Although Daniels concerns herself solely with US case law, in the first two areas the opposing forces have also made inroads into British terrain: through the S case and a 1981 decision in which ICI was allowed to bar women from working with a chemical linked to cancer, rather than try to make the chemical less dangerous. It is developments in medical technology, as much as the backlash against feminism, which Daniels identifies as the origin of the new fetal rights policies. In the most interesting and original chapter of the book, chapter one, she points out that ultrasound scanning and micro-surgery on the fetus make the mother 'transparent', and thus invisible. Advances in the age of fetal viability and popular misunderstanding of in vitro techniques also contribute to the rhetoric of the independence of the fetus, ie, its ability to survive outside the mother's body. 'The women became the "maternal environment", the "operating womb", and even the fetus's "intensive care unit".' This incisive and insightful book uses the three core areas as a springboard to a broader discussion of the right to self-sovereignty and the inadequacy of its formulation. Although Daniels's discussion is primarily in terms of political theory, there are obvious repercussions for the principle of autonomy in medical ethics. 'Such concepts seem both essential to women's empowerment and yet incapable of capturing the potential, developmental and relational nature of pregnancy or the deeply social nature of reproduction. The politics of fetal rights thus suggests the need to rethink the concept of self-sovereignty from the point of view of the female body.' DONNA DICKENSON School of Health and Social Welfare, The Open University Ethical responsibilities in European drug research Edited by Peter N Bennett, Bath, Bath University Press, 1990, 84 pages, £15.00 hc This book contains a series of very short, readable essays on different perspectives on ethical and legal issues in drug research in the EEC. The essays are updated versions of papers given at a symposium held at the Maison de l'Europe of the European Parliament, Strasbourg on 14-15 September, 1989. The symposium was held in the light of recent legislative trends in several European countries which sought to protect the rights of group.bmj.com on May 27, 2016 Published by http://jme.bmj.com/Downloaded from fetal rights power and the politics of At women's expense: state Donna Dickenson doi: 10.1136/jme.21.1.61 1995 21: 61 J Med Ethics n http://jme.bmj.com/content/21/1/61.1.citatio found at: Updated information and services can be These include: service Email alerting right corner of the online article. cite this article. Sign up in the box at the top Receive free email alerts when new articles Notes http://group.bmj.com/group/rights-licensing/permissions To request permissions go to: http://journals.bmj.com/cgi/reprintform To order reprints go to: http://group.bmj.com/subscribe/ To subscribe to BMJ go to: group.bmj.com on May 27, 2016 Published by http://jme.bmj.com/Downloaded from