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How to Escape the Doctor's Dilemma?: De-Medicalize Reproductive Technologies

Kara Swanson has painted a textured portrait of Alan Guttmacher, showing the tension between his embrace of medical paternalism and simultaneous rejection of the legal paternalism that regulated women’s access to abortion before Roe v. Wade. Swanson explains Guttmacher’s route, navigating the troubled waters between “what was medically indicated and what was legally permissible” in the realm of reproductive medicine, the path that Guttmacher identified as the “doctor’s dilemma.” She takes us from his 1930s practice, creatively assisting in his patient’s use of reproductive technologies such as artificial insemination, to the era post Roe v. Wade, after which he seems to have come to terms with a fuller commitment to autonomous reproductive choices. We learn that Guttmacher’s early career provided opportunities to exercise some of his prerogatives as a doctor in the absence of clear legal constraints. By the end of his life, the Supreme Court came close to having endorsed his preference, as Swanson notes, “privileging the doctor/patient relationship and medical expertise.”