The Virtuous Patientwoman

It is often said, and rightly so, that pregnancy is not an illness. Women who are pregnant, however, have reason to visit what Susan Sontag calls the 'Kingdom of the Sick'(La-bacqz in Shelp 1985 p.275) so that their health and the health of the foetus, can be monitored. With monitoring comes a range of onerous offers which women must consider: the offer of testing; the offer of results in the form of odds and ratios; the offer of certainty (that is, a definite genetic diagnosis by opting for amniocentesis or chorionic villus sampling) with the risk of losing the foetus or baby; and the offer of termination if the tests detect serious genetic disorders.

It might be argued that the virtues of a virtuous patient are inappropriate for a pregnant woman. Some discussion of the virtues offered by Karen Labacq, however, suggest that they have relevance to the issue of prenatal testing. The virtues of the virtuous patient, presented by Labacqz (Shelp 1985) are fortitude, prudence and hope.

Both Peter Geach and Rosalind Hursthouse present pregnancy as necessitating courage. Geach (1977 p.xxix) states that courage is what we all need in the end, and it is constantly needed in the ordinary course of life: by (for example) women who are with child'. Hursthouse (1987) states that 'most pregnancies and labours call for courage, fortitude and endurance, though most women make light of them—so why are women not praised and admired for going through with them?'.

Courage, in relation to prenatal testing for genetic disorders means facing the fears which emerge. Two aspects of courage or fortitude are identified as endurance and attack (Labacqz). Endurance in relation to testing could be related to the decision made, for example, to continue or discontinue the pregnancy as endurance has to do with 'keeping one's spirit from being broken by fear, grief or sadness'(ibid). Attack could represent a woman's efforts to demand support for the child born with a genetic disorder.

The second virtue of prudence necessitates, according to Labacqz (in Shelp 1985 p.282), our ability to perceive accurately, to learn 'the truth of things' and to be able to act in a fitting manner. Contemplation, docility (in the 'sense of teachableness, or openness) and trust are, Labacqz states, necessary for 'receptive silence before the truth of real things'(p.283). There are many issues to be prudent about in relation to prenatal testing—how, for example, to interpret the odds presented and what to do in the light of the odds. One woman may, for example, consider odds of one in seven positively (there are six chances out of seven of having a baby without a genetic disorder) and another may interpret a 1 in 120 chance negatively (her baby could be the one with the genetic disorder). Other questions relate to further tests and the risk factors relating to these tests and also relate to how to respond to positive results in the light of the possibility of false positives and negatives. What prudence seems to require is that information, and perhaps other women's experience of continuing or discontinuing pregnancies where genetic disorders have been diagnosed, are taken into account when contemplating actions. Prudence is unlikely to protect against all negative or painful emotions but prudent decisions should be easier to live with than imprudent decisions. The point should be made also that, as there are time constraints with many of these decisions, the knowledge, support and skills of a professional could be most helpful as a great deal will have to be considered in a relatively short space of time. The third, and final, virtue of the patient on this account is hope which includes 'hope for improvement, hope for the courage to withstand it all, hope for meaning to emerge out of the chaos, pain and sense of injustice'(Labacqz in Shelp 1985 p. 284). Whilst hope can be interpreted in different ways in relation to prenatal testing this would seem to be a virtue which will benefit the woman, making the difficult decisions more bearable.

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