Much bioethical analysis takes place when a medical practice is already in place. However, once a certain practice has been accepted, in the sense of having become integrated into health care practice, it becomes much more difficult to close it down. In this project we demonstrated that to engage, critically and analytically, with the entrenchment through which certain questions and understandings become positioned as central ethical questions or understandings is crucial in the striving for ethical analysis of the development and introduction of new technologies.
Through an analysis of media coverage in newspapers and in the medical magazines “Läkartidningen” and “Dagens Medicin” during the period of 1998-2016 we examined what ethical aspects of uterus transplantation were raised, presented and discussed in this material, and how this was done. The project also examined ethical questions that are not raised and discusses the implications of not addressing these questions. Doing so, we showed how specific assumptions, norms and values are expressed and used to underpin specific positions within the debate, and how certain subjects, desires and risks become shrouded or simply omitted from it. Our approach—which we labelled the Ethics of the Societal Entrenchment-approach—allowed us to discuss how the identification of something as the problem helps to shape what gets to be described as a solution, and how specific solutions provide frameworks within which problems can be stated and emphasised.
In our analysis we identified one dominant and two smaller, and more fragile, discourse coalitions – an ensemble of actors who draw on or embrace a certain discourse or certain sets of discourses. The first coalition consisted of the transplantation teams and their patients, who gave accounts to journalists. Within this discourse coalition, live UTx-IVF was described as the solution to the problem of UFI. The second discourse coalition was predominantly made up by medical professionals outside the transplantation team and medical ethicists, who wrote articles themselves, and women with UFI, who gave accounts to journalists. This coalition accepted the definition of the problem given by the first discourse coalition only partially: that women with UFI who wished to become genetic and gestational mothers had not previously been helped by the health care system, and this was problematic. Also, the third discourse coalition was populated by medical ethicists, and by some columnists and journalists. This coalition re-defined the problem in terms of the limits of medical innovation and ethical concerns, such as the issue of priority-setting.
Within the first step of our approach, we showed how certain discourse coalitions – ensembles of actors who draw on or embrace a certain discourse or certain sets of discourses – were formed, and how these coalitions positioned certain concerns as central ethical concerns. In the second step, we discussed aspects that we identified as ethically troubling in the media discussions of UTx-IVF in Sweden. In doing so, we showed how different problems and solutions come to gain acceptance or be questioned, and what were considered to be ethically relevant aspects to address within a particular debate. We also critically discussed whether some questions or some ways of addressing certain questions should be positioned as ethically troubling and if so, why.
Publications: Guntram L and Zeiler K (2019) The Ethics of the Societal Entrenchment-approach and the case of live uterus transplantation-IVF. Medicine, Health Care and Philosophy 22(4): 557–571. DOI: 10.1007/s11019-019-09891-w.
Time period: 2015-2016
Funder: Linköping Universitet och Riksbankens Jubileumsfond via Zeilers Pro Futura Scientia fellowship.