Ultrasound, Gender, and Consent: An Apparent Feminist Analysis of Medical Imaging Rhetorics

ABSTRACT

This article uses an apparent feminist approach to engage a two-part research question: First, does gender affect the frequency with which people become subjects of medical digital imaging? Second, how do the subjects of medical digital imaging become persuaded to accept this role? Engaging with medical imaging and the technical communication surrounding it as an assemblage of technical rhetorics (Frost & Eble) and thus a technology, this project shows that women are more commonly scanned as a result of social biases. Further, this article argues that the ubiquity of scanning of women’s bodies has implications for political agency and privacy and for technical communicators’ understandings of efficiency. This study is preliminary but presents compelling evidence that further research on the technical communication surrounding gender and medical imaging is necessary.

KEYWORDS:

• Apparent feminism
• efficiency
• medical imaging
• technical rhetorics
• medical rhetorics
• gender

Acknowledgments

Thank you to Angela Haas, Gerald Savage, Julie Jung, Kellie Sharp-Hoskins, Katrina Dunbar, and Gretchen Frank for reading and providing feedback on this article in its incarnation as a dissertation chapter. Thanks also to Michelle Eble, Marie Moeller, Veronica Mitchell, Lori Beth De Hertogh, and Julianne White for their helpful suggestions, and to the organizers of the HASTAC Feminist Digital Scholars Workshop for making those suggestions possible. The East Carolina University Department of English and Thomas Harriot College of Arts and Sciences provided research funding.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Throughout this article, I use the term “medical imaging” rather than “radiology” because my focus is on the processes involved in deciding to create images and perceptions of images rather than on the professional administration of or training in radiology.

2. While I focus on modern digital imaging technologies in this article, the X-ray is hardly the beginning of this practice. Researchers have attempted to image the insides of female reproductive systems through autopsy and other methods for centuries (if not longer).

3. I purposely use the term “subjects” here – rather than “participants” or “patients” – to highlight the (common perception of) passivity on the part of the person being scanned.

4. For a variety of perspectives on feminist approaches to (and resistances of) traditional notions of empiricism, refer to Andrews (2015), Baker (2017), Mustafa, Ahmed, Saroch, and Bell (2011), Harding (1992), Hill Collins (1990). As for my positionality, I recognize knowledge as situated, and I believe research should be centered on those who are the “subjects” of whatever construction is being examined (a la feminist standpoint theory). I also am persuaded by Coole and Frost’s (2010) contention that it is possible “to accept social constructionist arguments while also insisting that the material realm is irreducible to culture or discourse and that cultural artifacts are not arbitrary vis-à-vis nature” (p. 27) – a distinction that seems important in an article about visualizing matter.

5. I will make references to women, men, pregnant women, and pregnant people throughout this article. These rhetorical choices are specific and purposeful, and they reflect the specific contexts they refer to. Non-binary people also are the subjects of biomedicine and many transmen have had successful pregnancies. However, trans and non-binary experiences with medical and legal communication must be theorized differently than the approach I take here because of the uniquely problematic ways those realms have interacted with trans and non-binary communities. For example, refer to Spade (2011), Serano (2013), Spencer and Patterson (2017).

6. For example, the prevalence of pregnant people sharing sonogram images as proof of their pregnancy propagates a culture of seeing the baby. This ubiquity, in turn, makes it easier for proponents of ultrasound-for-abortion legislation to support the idea that fetal ultrasound is a benign way to engage in inclusive social practices.

7. To further explain, Healy (1947) argues that Le Play pioneered the case study method in the late 1820s. Technical communicators have since taken up case study in force (Bernhardt, 1992; Bowdon, 2004; Doheny-Farina, 1992; Haas, 2012; Johnson, 2007; MacNealy, 1992). I also recognize case studies as an important method of inquiry for feminists. Feminists have long critiqued the tendency of hegemonic discourses to make unapparent the value of embodied epistemologies, and many varied feminist works have argued that experiential knowledge is both important and overlooked (Belenky, Clinchy, Goldberger, & Tarule, 1986; Hesse-Biber & Leavy, 2007; Ramazanoğlu & Holland, 2009). By utilizing case studies as a method into which I explicitly incorporate the experiential knowledge of particular users/people, I arrive at a method that draws on the values of both feminist work and technical communication research.

8. However, “CTs were performed more frequently for whites than other racial groups” (Kocher et al., 2011, p. 456).

9. For more on how pretensions to objectivity prevent us from making knowledge, refer to Derkatch’s (2016) discussion of practices like acupuncture and moxibustion and the ways that the inflexible standardized methods of clinical trials negate the possibility of these practices ever being found officially “effective.”

10. Weigner et al. (2014) found 79% of women indicated that “patients should give their informed consent” before a CT scan compared to 76% of men. This survey also showed that younger adults (aged 18–40) tended to be more likely to believe informed consent should be given before a CT scan than either minors or adults aged 41 and up. Weigner et al. concluded that 40% of emergency patients feel a general informed consent before a CT is appropriate while 34% and 15% respectively believed verbal or written consent was appropriate. “Most patients feel comfortable letting the doctor make the decision regarding the need for a CT. Most ED patients feel informed consent should occur before receiving a CT but only a minority feel the consent should be written and specific to the test.”

11. Recommendations range from age 40 to 50 as a starting point for annual mammograms (Pruthi, 2006).

12. Many accounts exist of medical professionals struggling to find ways to satisfy both these legal requirements and the requirements of their consciences and medical oaths – which are often in conflict. For example, some physicians have provided headphones to women for the duration of the procedure.

13. This law was also widely criticized as constituting “state rape,” since most pregnant people falling subject to this legislation would have had to undergo an invasive transvaginal ultrasound in order to satisfy the requirements of the law at early stages of pregnancy. Lithwick (2012), for example, wrote that “the law provides that women seeking an abortion in Virginia will be forcibly penetrated for no medical reason. I am not the first person to note that under any other set of facts, that would constitute rape under the federal definition” (para. 1).

14. In some instances when working through this case study, I use the term “woman” or “women” to reflect the terminology used in the laws themselves. However, while the laws may refer to and specifically target women, it is entirely likely that the violence of these mandated procedures would also be inflicted on nonbinary people – perhaps especially transmen – should the occasion arise.

Additional information

Funding

This article was also supported by a summer residency at the National Humanities Center.

Notes on contributors

Erin A. Frost

Erin A. Frost is an associate professor with the Department of English at East Carolina University. Dr. Frost’s scholarly interests center on issues of gender and feminism in technical communication, most often as they manifest in health and medical rhetorics, environmental policy, risk communication, and teaching with technology. Her work has appeared in Communication Design Quarterly, Computers and Composition, Journal of Business and Technical Communication, Journal of Technical Writing and Communication, Rhetoric Review, Technical Communication Quarterly, Programmatic Perspectives, Peitho, and Present Tense: A Journal of Rhetoric in Society. Her dissertation, Theorizing an Apparent Feminism in Technical Communication, won the 2015 Conference on College Composition and Communication’s Outstanding Dissertation Award in Technical Communication.