Science versus Ideology: Discourses of Ethics and Medicine in the Abortion Debate

In debates surrounding, abortion, embryonic-stem cell research, and euthanasia, science and religion can at times seem violently at odds. Many, however, are reaching across ideological divides in an attempt to find common ground. In an article entitled “Seriously Seeking Common Ground,” Christina Page, a pro-choice advocate, critiques the Pregnant Woman Support Act proposed by Senator Bob Casey. In the beginning of her article, she praises the bill for its intent to help “neutraliz[e] income as a determining factor for what a woman does in her reproductive life.” This, however, is where her praise ends. For the rest of the article, she criticizes the bill for underhandedly slipping tenants of the pro-life agenda into law and conflating ideology with science. She is particularly critical of proposed funding that would be given to crisis pregnancy centers, usually run by pro-life groups, that help and encourage pregnant women not to have abortions. She argues that if such centers were to receive money, they ought to “stick to medical facts rather than ideology.” She ends by suggesting ways to strip the Act of its hidden pro-life agenda and make it more amenable to pro-choice proponents like herself.

In this post, I’d like to use Ms. Page’s article as a springboard for discussing the place of ideology in medical environments. Ideology, a term with a certain negative stigma, is thrown around frequently in debates surrounding these issues.

In this article, Ms. Page criticizes anti-abortion proponents for “hav[ing], in several states, succeeded in passing legislation mandating that ideological, medically inaccurate scripts be read to patients who seek abortions services. Mandating that ideology and inaccuracy be inserted into a medical environment, as the anti-abortion movement has done, is ethically troublesome.” I imagine Ms. Page is referring to something like South Dakota’s “abortion script.” Physicians in South Dakota are now required to read this “abortion script” to every woman before they have an abortion. This script includes the statements that abortion ends the life of a human being, that the woman has an existing relationship with the unborn child, and that there are a number of medical risks associated with abortion.

Is this ideological, as Ms. Page claims? Yes! It clearly reflects a set of tenants and beliefs regarding the status of the fetus/unborn child and the health of the mother. However, while I agree with Ms. Page that medically inaccurate information is problematic, the insertion of ideology into a medical environment is not necessarily ethically troublesome. In fact, it is ethically necessary.

Science is the pursuit and creation of knowledge about the natural, material world by observable and testable means. Politics, meaning, art, the supernatural, history, poetry, abstract math, life after death, etc., do not fall under the domain of science. And neither does ethics.

Ms. Page asserts that ideology has no place in a medical environment. To test this assertion, I will attempt to describe a few of the discourses types (Fairclough 1992) found in medical environments. In other words, I will attempt to briefly describe the language practices within a medical space. In a real sense, language shapes place (Tuan 1991). I’ll choose a hospital as my example.

As Ms. Page implies, in a hospital we would expect to find charts, diagrams, doctors giving diagnoses, medical students talking about the latest research, nurses discussing medication, etc. These would all be examples of medical discourse. But we would also find other kinds of discourses. What about when a patient is greeted by the receptionist when they check in? We no longer have medical discourse, since we could imagine the same thing said at a department store or a used car dealership. We might call this service discourse. We might also imagine patients and their families talking about what is going on at home, doctors talking about last night’s episode of Scrubs, and nurses joking with one another. We might call this conversational discourse.

Now, you would be right if you think that these examples don’t necessarily refute Ms. Page’s underlying point that ideological and medical discourses shouldn’t mix. But there’s one more kind of discourse I haven’t talked about yet: ethical discourse.

The specific piece of ethical discourse I’m thinking about is the Hippocratic Oath. (Imaginably, every hospital has its own code of ethics as well.) The Hippocratic Oath is not a piece of scientific or medical discourse. Its tenants are not derived from observable and testable knowledge about the natural world. It is an ethical document and it is ideological: those who swear to the oath adhere to a set of beliefs to which there are other alternatives. That the Hippocratic Oath is ideological is clearly seen in the history of the Oath itself. Over time the Oath has changed, with alternative oaths put forward, because many have felt that the ideology of the original no longer fits with modern cultural values. (The Oath referenced at the beginning of the paragraph is the modern version.)

The role the Hippocratic Oath plays may best be understood as a text that institutionalizes the ethical norms of the medical profession (Freed and Broadhead 1987). An excerpt from the modern Hippocratic Oath reads: “I will apply, for the benefit of the sick, all measures [that] are required…” While this excerpt is not scientific, such an ethical statement is an integral part of the treatment of patients. The physician, in swearing to this oath, takes an ideological stance to work to help the patient. We could imagine an Oath that might read, “I will apply, for the benefit of science and further research, all measure that are required…” But the ideology in the Oath is that the patient is of the utmost importance and the doctor works for the patient’s benefit. This is necessary to set a standard against terrible abuses such as human experimentation.

Science, then, gives us “all measures [that] are required.” In other words, science provides the doctor with the options, the means, the tools to heal the patient. Science does not, however, provide a motivation for using them. It can help. But it cannot tell us that we should care about the patient at all.

In this way, a medical environment requires both scientific and ethical discourse. Therefore ideology is an integral part of the medical environment.

Pro-choice and pro-lifer advocates, then, must continue to debate what ethical ideology ought to be in place when it comes to these issues. And they will have to continue to persuade the U.S. public to their respective positions. The danger lies in believing we can do science or medicine without ideology.