PMDs and the Moral Specialness of Medicine: An Analysis of the ‘Keepsake Ultrasound’

  • Anna Smajdor
  • Andrea Stöckl
Part of the Health, Technology and Society book series (HTE)


PMDs raise questions about the relationship between morality and medicine, threatening the conceptual discreteness of medicine itself. Everyday items such as phones or watches are increasingly used for quasi-medical purposes. Conversely, products designed for medical use are entering marketplaces and being used in ways that serve users’ values and interests without mapping neatly onto established paradigms of medical need and authority. One example of this is the so-called keepsake ultrasound. When sought outside routine medical care, our lack of ability to monitor and regulate these scans raises ethical challenges. Devices or procedures such as keepsake ultrasounds, which can have both medical and non-medical applications and which can be used by both medical professionals and members of the public, thus raise new questions for regulatory authorities.


  1. American Pregnancy Association. (2016). Ultrasound: Sonogram. Available at Accessed May 12, 2016.
  2. Antiel, R. (2012). Ethical challenges in the new world of maternal–fetal surgery. Seminars in Perinatology, 40(4), 227–233.CrossRefGoogle Scholar
  3. Beauchamp, T., & Childress, J. (2009). Principles of biomedical ethics. Oxford: Oxford University Press.Google Scholar
  4. Bessell, T., Andreson, J., Silagy, C., Sansom, L., & Hiller, J. (2003). Surfing, self-medicating and safety: Buying non-prescription and complementary medicines via the internet. Quality and Safety in Health Care, 12(2), 88–92.CrossRefGoogle Scholar
  5. Chervenak, F., & McCullough, L. (2011). Ethics in obstetric ultrasound: The past 25 years in perspective. Donald School Journal of Ultrasound in Obstetrics and Gynecology, 5(2), 79–84.CrossRefGoogle Scholar
  6. Childress, J., & Siegler, M. (1984). Metaphors and models of doctor-patient relationships: Their implications for autonomy. Theoretical Medicine, 5(1), 17.CrossRefGoogle Scholar
  7. Clouser, K., Danner, P., & Gert, B. (1990). A critique of principlism. Journal of Medicine and Philosophy, 15(2), 219–236.CrossRefGoogle Scholar
  8. Darby, R. (2013). The child’s right to an open future: Is the principle applicable to non-therapeutic circumcision? Journal of Medical Ethics, 39(7), 463–468.CrossRefGoogle Scholar
  9. Dieterich, M., Stubert, J., Stachs, A., Radke, A., Reimer, T., & Gerber, B. (2013). Ruptured poly-implant protheses breast implant after aesthetic breast augmentation: Diagnosis, case management, and histologic evaluation. Aesthetic Plastic Surgery, 37(1), 91–94.CrossRefGoogle Scholar
  10. Earp, B. (2015). Do the benefits of male circumcision outweigh the risks? A critique of the proposed CDC guidelines. Frontiers in Pediatrics, 3(18). doi:  10.3389/fped.2015.00018.
  11. Gillon, R. (2003). Ethics needs principles—Four can encompass the rest—And respect for autonomy should be “first among equals”. Journal of Medical Ethics, 29(5), 307–312.CrossRefGoogle Scholar
  12. Greaves, D. (1979). What is medicine?: Towards a philosophical approach. Journal of Medical Ethics, 5, 29–32.CrossRefGoogle Scholar
  13. Halperin, D., Kohno, T., Heydt-Benjamin, T., Fu, K., & Maisel, W. (2008). Security and privacy for implantable medical devices. Pervasive Computing, IEEE, 7(1), 30–39.CrossRefGoogle Scholar
  14. Harris, J. (2004). Before birth–after death. Journal of Medical Ethics, 30(5), 425.CrossRefGoogle Scholar
  15. Häyry, M. (2004). There is a difference between selecting a deaf embryo and deafening a hearing child. Journal of Medical Ethics, 30(5), 510–512.CrossRefGoogle Scholar
  16. Jonsen, A. (2000). A short history of medical ethics. New York, Oxford: Oxford University Press.Google Scholar
  17. Kirmayer, L. (2004). The cultural diversity of healing: Meaning, metaphor and mechanism. British Medical Bulletin, 69(1), 33–48.CrossRefGoogle Scholar
  18. Kohut, R., Dewey, D., & Love, E. (2002). Women’s knowledge of prenatal ultrasound and informed choice. Journal of Genetic Counseling, 11(4), 265–276.CrossRefGoogle Scholar
  19. Leung, J., & Pang, S. (2009). Ethical analysis of non-medical fetal ultrasound. Nursing Ethics, 16(5), 637–646.CrossRefGoogle Scholar
  20. Lloyd, P., Lupton, D., & Donaldson, C. (1991). Consumerism in the health care setting: An exploratory study of factors underlying the selection and evaluation of primary medical services. Australian Journal of Public Health, 15(3), 194–201.CrossRefGoogle Scholar
  21. National Health Service. (2015). Ultrasound scan. Available online at: Accessed January 13, 2016.
  22. O’Dowd, A. (2012). Women have had “harrowing” experiences over PIP implants scandal. British Medical Journal, 345, e4560.CrossRefGoogle Scholar
  23. Overall, C. (2013). Ethics and human reproduction: A feminist analysis. London: Routledge.Google Scholar
  24. Palmer, J. (2009). The placental body in 4D: Everyday practices of non-diagnostic sonography. Feminist Review, 93(1), 64–80.CrossRefGoogle Scholar
  25. Parker, M., & Gray, M. (2001). What is the role of clinical ethics support in the era of e-medicine? Journal of Medical Ethics, 27(suppl1), i33–i35.CrossRefGoogle Scholar
  26. Pellegrino, E. (1999). The commodification of medical and health care: The moral consequences of a paradigm shift from a professional to a market ethic. Journal of Medical Philosophy, 24(3), 243–266.CrossRefGoogle Scholar
  27. Pickstone, J. (2000). Production, community and consumption: The political economy of twentieth-century medicine. In R. Cooter & J. Pickstone (Eds.), Medicine in the 20th century (pp. 1–21). Australia: Harwood Academic Publishers.Google Scholar
  28. Porter, R. (1989). Health for sale: Quackery in England, 1660–1850. Manchester: Manchester University Press.Google Scholar
  29. Porter, R. (2003). Quacks: Fakers & charlatans in medicine. Stroud: Tempus.Google Scholar
  30. Practice Committee of the American Society for Reproductive Medicine. (2013). Definitions of sterility and recurrent pregnancy loss: A committee opinion. Fertility and Sterility, 99(1), 63.CrossRefGoogle Scholar
  31. Roberts, J., Griffiths, F., Verran, A., & Ayre, C. (2015). Why do women seek ultrasound scans from commercial providers during pregnancy? Sociology of Health & Illness, 37(4), 594–609.CrossRefGoogle Scholar
  32. Salter, B., Zhou, Y., & Datta, S. (2015). Hegemony in the marketplace of biomedical innovation: Consumer demand and stem cell science. Social Science and Medicine, 131, 156–163.CrossRefGoogle Scholar
  33. Shildrick, M. (2015). Leaky bodies and boundaries: Feminism, postmodernism and (Bio) ethics. London: Routledge.Google Scholar
  34. Smajdor, A., Sydes, M. R., Gelling, L., & Wilkinson, M. (2009). Applying for ethical approval for research in the United Kingdom. British Medical Journal. 16. 339.Google Scholar
  35. Smajdor, A., Stöckl, A., & Salter, C. (2011). The limits of empathy: Problems in medical education and practice. Journal of Medical Ethics, 37, 380–383.CrossRefGoogle Scholar
  36. Spiro, H., McCrea Curnen, M., Peschel, E., & St James, D. (Eds.). (1993). Empathy and the Practice of Medicine. Beyond pills and the scalpel. New Haven and London: Yale University.Google Scholar
  37. Stephenson, N., McLeod, K., & Mills, C. (2016). Ambiguous encounters, uncertain foetuses: Women’s experiences of obstetric ultrasound. Feminist Review, 113(1), 17–33.CrossRefGoogle Scholar
  38. Stöckl, A. (2013). The expert patient and usage of the Internet. In P. Cavanagh, S. Leinster, & S. Miles (Eds.), The changing roles of doctors (pp. 69–79). New York: Radcliffe Publishing.Google Scholar
  39. Tomasini, F. (2006). Exploring ethical justification for self-demand amputation. Ethics & Medicine, 22(2), 99–115.Google Scholar
  40. Turner, B. (2010). Vulnerability and human rights. University Park, Pennsylvania: The Pennsylvania State University Press.Google Scholar
  41. U.S. Food and Drug Administration. (2015). Avoid fetal “Keepsake” images, heartbeat monitors. Washington: FDA.Google Scholar
  42. Weindling, P. (2004). Nazi medicine and the Nuremberg trials: From medical war trials to informed consent. Basingstoke, Hampshire/New York: Palgrave Macmillan.CrossRefGoogle Scholar
  43. Window to the Womb. (2016). Available online at Accessed May 13, 2016.

Copyright information

© The Author(s) 2018

Authors and Affiliations

  1. 1.Department of Philosophy, Classics, History of Art and IdeasUniversity of OsloOsloNorway
  2. 2.Norwich Medical SchoolUniversity of East AngliaNorwichUK

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