Another Art Review for TAKE CARE!!!

Art Review by Ellen Wright Clayton, MD, JD

Rosaline E. Franklin Professor of Genetics and Health Policy, Professor of Pediatrics, Professor of Law, Director of The Center for Biomedical Ethics and Society at the Vanderbilt University Medical Center

 

Motherhood is about caring and connection. Recent developments present new challenges to this fundamental institution. Some of the developments are social. Women have always cared for other women’s children, especially since women until recently frequently died in childbirth.  Women historically confronted pregnancy, labor, and delivery with no small amount of fear.  Literature is full is stories about stepmothers, some of whom were wonderful, and a hopefully exaggerated proportion who were not. In today’s society, with divorce and remarriage, children often have two or more mothers at the same time, which can stress notions of the unitary family that characterize our society’s dominant discourse. Other developments are scientific. New technologies can enable pregnancies that otherwise would not occur.  Conception can be separated from carrying and birthing. The fetus can be visualized during pregnancy. Baby’s first picture is often a sonogram. And while blood ties have always had particular social salience, increased understanding of genetics has t ended to make them even more important. Not so long ago, efforts to establish paternity depended on whether the child looked like the father. Now the relationship can be established with certainty, using a blood sample or a simple swab of the inside of the cheek.

The artists in TAKE CARE explore the ways that social and scientific developments influence our understanding of motherhood, of connection and caring.  Sometimes, new knowledge of connection is beneficial. Take the case of mitochondrial DNA, the focus of Annette Gates’ work.  Unlike most of our DNA which comes from both parents, the DNA in mitochondria, the energy sources of our cells, comes entirely from our mothers. As a result, we are connected directly with our mothers, and their mothers, through generations. Maternal inheritance became important after hundreds of young professionals and dissidents were “disappeared” by the military regime in Argentina in the late 70’s and early 80’s. Their children were confiscated and placed in new homes, seemingly without a trace. But the grandmothers, the abuelas, enlisted the aid of Mary-Claire King who used the mitochondrial DNA to identify and return their grandchildren.

But the supremacy of genetic connection is not always so benign. New reproductive technologies allow many to overcome infertility, but often at a steep price. Some women experience the process of hyper ovulation, egg retrieval, and pharmacologic support of gestation as alienating, as transforming them into the objects of the medical gaze.  Jeanette May’s at times almost comical images of eggs serve as a counterpoint to quotidian pictures of women and sonograms. And yet women pursue these procedures specifically to create a family with children to whom they are biologically connected. Notably, while some women use donated eggs so that they can have the experience of gestation, it is far more common for women to implant and carry to term embryos created with their own eggs, evidencing the importance of genetic connectedness.

 

Our laws often enact the primacy of genetic connections. A number of courts have ruled that gestational surrogates, women who carry embryos created using the egg of another woman, usually the woman in the couple who commissioned the surrogacy, are not “mothers” of the resulting children and so have no basis on which to seek custody or contact. In these cases, the experience of pregnancy, with its risks,

discomforts, and obviousness, simply disappears as a matter of law.  Monica Bock’s inclusion of bits of umbilical cord, amniotic fluid, and the amniotic sac into dustpans perhaps symbolizes gestation as waste, of women as fetal containers. In our legal system, children are permitted to have only two parents no matter how many adults play a role in their lives, and those two parents have supremacy over all the others. In blended families, where the genetic parents separate from each other and then form new relationships, the new adults – the stepparents – can struggle to define their roles as parents, particularly as against the genetic parents whose claims once cemented by a modicum of nurture persist unless severed by abandonment or abuse. It is rage against the iconification of the genetic link that Kristina Arnold explores in her work. In her Drip installation, red glass pieces encased in hastily stitched plastic covers, protrude from the wall.

 

While behavior is almost surely the product of complex gene environment interactions, much effort has been devoted recently to dissecting the genetic contributions. Several years ago, for example, Caspi and his collaborators demonstrated that children with a particular genetic variant who were seriously abused during childhood were more likely to have serious behavior problems as adults. Such findings can be used in a variety of ways – to identify children who need special protection (although all children deserve a safe home), to identify druggable targets for treatment, to undermine the inadequate mothering explanation for children’s problems. Each of these uses raises its own ethical and policy challenges. As light dancing on Obermeyer’s beadwork shifts one’s perception of the work, so might new findings shift our understanding of behavior.

 

For millennia, women have worried that their children would be born with something visibly wrong. The ability to visualize the fetus using techniques such as ultrasonography and MRI has transformed pregnancy, providing the potential to make these fears concrete. These technologies can and often do provide reassurance, which is one reason ultrasound has become routine. At times, however, they reveal variations, some of which resolve but many of which are serious problems, leaving women with decisions about whether to continue the pregnancy, whether to undergo fetal therapy where possible, or whether simply to prepare for what may lie ahead. These concerns are represented in very different ways by Sadie Ruben and Libby Rowe.  Ruben represents the fetus as alien, strange, frightening, floating in liquid evoking amniotic fluid within the womb, taking over the woman’s body. Rowe’s malformed sock monkeys, by contrast, suggest that we are meant to accept and love children no matter what their challenges.

 

Finally, some of the artists comment on the technology itself. Sher Fick celebrates pharmaceuticals, which allow her to live. Her pill bottles are covered with fabrics, many of which show story book characters from our childhood.

 

Adrienne Outlaw intersperses colorful scientific videos of the embryonic heart and blood flow using such techniques as confocal microscopy with pictures of the dailyness of mothering and taking care – breastfeeding, snuggling, nurturing. The science is spectacular, but which is the more wonderful?

 

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First Review of TAKE CARE: The Art, Science, & Bioethics of Motherhood

 

Written by Tonya Vernooy, Art Critic/Writer, 2009 for TAKE CARE: The Art, Science, & Bioethics of Motherhood Exhibition.

  

Scientific progress makes moral progress a necessity; for if man's power is increased, the checks that restrain him from abusing it must be strengthened.                                                                                                     -- Madame de Stael, 1835[1]

 

 

As molecular medicine, genetic manipulation, cloning, and stem cell research their rapid progress so too must the morality and ethics that assist in governing their boundaries. Through an examination of the gray area between enhancement and therapy, necessity and desire, parent and child, the nine artists participating in Take Care: The Art, Science, and Bioethics of Motherhoodreveal that there is no definitive right answer to the question of biotechnological advancement. It is the informed dialogue that is paramount. The political philosopher Michael J. Sandel writes, "Breakthroughs in genetics present us with a promise and a predicament. The promise is that we may soon be able to treat and prevent a host of debilitating diseases. The predicament is that our new-found genetic knowledge may also enable us to manipulate our own nature...to make ourselves 'better than well.'"[2] Caught in the middle of this is the mother whose fundamental need to create, protect, and support her offspring to the best of her ability has to contend with biotechnology's possible repercussions While scientists are driven by the aspirations of discovery and improvement, the artists serve as the cultural conscience, helping to explicate the complex and question the ramifications of a science that will pervade social, political, cultural, and self beliefs.

  

 

Both Sher Fickand Lindsay Obermeyer examine normality and the question of enhancement versus therapy. But what is normal? In May 2008 USA Today reported that 51% of Americans were taking at least one prescription drug for a chronic condition, a 50% increase since 2001. In 7 years time, maintaining a certain standard of health by taking daily medication had become the norm.  In Coping SkillsSher Fick constructed a table to hold all of the medication she has consumed in her "pursuit of physical and mental health;"[3]prescriptions that enable Fick to become, and remain, an attentive, present mother. The structure exists as both an altar and a vanity. The mirrored shelf implies a dressing table that might hold cosmetic goods. Yet, the artist challenges this notion by carefully encasing each medication in a finely made quilt with suture seams. The preciousness or fragility implied by these colorful coverings can be attributed to either the medication itself or, more likely, the medicine taker. The coverings themselves contain varied images of skulls, religious imagery, monetary symbols, band-aids, plant life, 1950s children playing, and Frida Kahlo, who suffered a tragic miscarriage.  The vibrancy and symbolism along with the altar itself suggest Dia de Los Muertos, a celebration that honors lost loved ones. Could it be that the artist is commemorating her past self and simultaneously rejoicing in the person these pharmaceuticals have allowed her to become?

  

 

Lindsay Obermeyer also deals with the pain and stigma of someone who requires medical and pharmaceutical intervention. Her fastidious beadwork enables the viewer to visualize the complexities of emotional and mental health care. All three portraits show her daughter in profile. In Shadow – Blues the internal silhouette is made up of clear crystals while contrasting shades of blue fly and swirl around her. She is completely still, unable to move, amidst a sea of activity; she feels empty, cold and alone. In the other portrait, Shadow – Red Hot, the pattern and complex beadwork take place within her profile; as if her mind and body are on fire. The world around her seems to melt away, again she is alone. In Voidthere is only her faint profile leaving the viewer asking: will her daughter ever emerge? Obermeyer's work calls out to the audience for help. The artist desperately wants to know if mood and mind altering medications will help or hurt. Are the trials and side-effects worth the possible outcome? Currently, geneticists are working on  prescriptions tailored to a patient's genetics, eliminating most trials and tribulations while opening up the door to enhancement possibilities. Nicolas Agar suggests this may become a slippery slope. "Some think that we should pass different moral judgments on enhancement from those we pass on therapy. They say that while therapy is justifiable, enhancement is not. The problem is that it is difficult to make the therapy–enhancement distinction principled. It is hard to find definitions of disease suitable to serve as a moral guideline for genetic technologies."[4]

 

 

The idea that our genetics will one day define our medical treatment is at once promising and scary. Everyone wants to be seen as an individual yet that individuality should not be an uncontrollable deciding factor in receiving health care and insurance or in becoming someone's companion, lover, parent, or child. In Kristina Arnold's Drip installation, the artist seems to be questioning how blood defines a person. The "drips" are dark red projections in clear plastic pouches with sutured edges, each unique in size and form, like individuals in a family.  The plastic pouches resemble microscope slides while each blood drip casts a long shadow on the white wall. These silhouettes of bloodlines are altered by light changes in the room, implying the coming changes in how a person is perceived as genetics becomes interchangeable with the definition of self. The self then becomes a commodity as Jeremy Rifkin, president of the Foundation on Economic Trends, predicted in 1998, "It’s likely that within less than ten years, all one hundred thousand or so genes that comprise the genetic legacy of our species will be patented, making them the exclusive intellectual property of global  pharmaceutical, chemical, agribusiness, and biotech companies."[5]While Rifkin's forecast proved over-eager, it certainly seems to be progressing. Stefan Lovgren of National Geographic wrote in October 2005, "A new study shows that 20 percent of human genes have been patented in the United States, primarily by private firms and universities." If one-fifth of our genetic material is owned by companies and colleges what does that leave for the individual? 

 

 

 

Focusing on the definition of self, Annette Gates creates porcelain organisms that are casts of originals; they are the structures left behind once the fabric shells have been destroyed in a firing process. The end result is an archetype, similar yet distinct from its mother. Within current cloning practices, where one de-nucleated donor egg is injected with another donor's genetic material, the end result is a clone with replicated DNA but this does not mean an exact duplicate. First, the genetic material from the donor egg does become a part of the clone, and second, as the clone matures the environment that created the original can never be the exact same thus its gene expression will vary. Gates' organisms tell tales of a fragile future where they cannot meet the expectations of the original; they are new conglomerations of old material. As the British philosopher, Jonathan Glover, points out, "There is the objection that a child created as a replica is treated, not as an end in himself or herself, but merely as a means."[6]Those means, he goes on to explain, can be the wish of a parent to live on after death or the desire to recreate a passed loved one. In the end the clones, like Gates' organisms, will always be fragile reproductions.   

 

Libby Rowe's Womb Worries series addresses the anxieties all mothers-to-be have when they prepare for a new life. Currently, genetic testing is still in its early stages, generally for upwards of only 14 genetic abnormalities. However, a laboratory at Baylor College of Medicine has begun trials for genetic testing that looks for 200 different genetic diseases. Its chair of molecular and human genetics, Arthur Beaudet, believes that this screening process will become routine in five years time. The Houston Chronicle reported, in December 2008, the issues surrounding such a test include potential false positives, which could lead parents to abort a healthy fetus, the implication that a life with a disability is not worth living and disparity between those who can and cannot afford such a test (it is currently $1600).[7]  It is interesting then that Rowe has chosen to use the sock monkey to convey her worries. The sock monkey was historically a working class child’s toy, made from red-heeled knit socks used by factory and farm workers. The artist has taken this toy and remade it for adults as either a cautionary tale or to highlight the possible horrors that await us if we don’t get tested. Although each monkey is still smiling, unaware of their abnormalities, ready for love, how is a parent supposed to care for a child that has two heads, one genital, and no legs? Like Paul McCarthy's Tomato Heads of 1994, whose "novelty item appearance hints at the manic consumerism of our theme-park utopias," Rowe makes us aware of the capitalistic culture behind these natural maternal anxieties.[8]There is no right answer, it is an individual choice, but one that is made for a price. As Richard Hayes, Executive Director of the Center for Genetics and Society, states, "We support the use of that [genetic screening] to allow couples at risk to have healthy children. But for non-medical, cosmetic purposes, we believe this would undermine humanity and create a techno-eugenic rat race."[9]

 

Whether through cloning or genetic manipulation, Sadie Ruben's Alien Fetuses ask if the aberrations that originate from gene expression errors are worth potential desired results. Her creatures' destinies are unknown as they sit, brewing – growing – within glass jars that seem to resemble pasta containers used in the kitchen rather than scientific vessels of experimentation. Ruben's fetuses are commenting on the commoditization of lab created embryos. The gold flecks adhering to their opaque, amorphous bodies indicate their precious worth. But we are left to wonder what happens to them if Ruben is unable to care for them? They are helpless and completely dependent upon human ministering. These beings can be seen as a critique of trendy hobbyists trying to genetically engineer life in their garage. With visions of becoming the Steve Jobs of biotechnology, laypersons are beginning to experiment with new life forms at home. A group known as DIYbio has begun a community laboratory where amateurs can explore their scientific ideas. Co-founder Mackenzie Cowell suggests that this type of unrestrained environment could lead to some very important discoveries. He added, "We should try to make science more sexy and more fun and more like a game."[10]But Ruben's fetuses tell a different story, one of a nebulous future where their lives are not entertaining rather they exist in a lonely laboratory.

 

This laboratory lifestyle could become a reality if Dr. Davor Solter, developmental biologist at the Institute of Medical Biology, is correct in his prediction of the future use of artificial wombs. He says, "In essence, it would eliminate all the limitations we have now: you could have as many or as few progeny as you want...I can visualize a fetus floating freely in fluid and the umbilical cord attached to a machine."[11]The work of Monica Bock questions the current and evolving value of the mother in our society as biotechnology advances. Bock's Afterbirth (Sac, Fluid, Cord) focuses on the importance of a mother's body in keeping her fetus alive and growing. Yet it is the placenta – whose sole function is to provide nutrients and oxygen from mother to child – that is so quickly discarded after the child is born. The three dustpans reference this quick disposal and hint at the possibility of life as a commodity. That they are three in number indicates birth, life, and death or mother, father, and child; all are easily swept away in the world of biotechnological progress if they do not meet decided standards.

 

 Embryo selection and enhancement is key to Jeanette May's investigation of a mother's role within these new biotechnological advancements. The artist's initial question seems to be: Is it not the mother's responsibility, nay, purpose, to want the absolute best for her children? The use of slick photography and poster-size imagery draw the viewer into a bright environment surrounded by happy, beautiful people, colorful plant life, and a consumer-happy lifestyle. Upon closer inspection, we realize that all is not right with this world. Eggs are forced into square molds, growing fetuses are compared to plants bred for certain characteristics and mommies-to-be are perusing magazines imagining their lives as Michael Kors advertisements. May's posters seem to ask: once society has screened for all possible defects, how long until we manipulate those genes to acquire certain traits under the auspices of having a "happier" life and the duress of "keeping up with Joneses"? The Wall Street Journal recently reported that Fertility Institutes of Los Angeles will soon offer its clients the ability to pre-select their "choice of gender, eye color, hair color and complexion, along with screening for potentially lethal diseases."[12]Is it the duty of the future mother to provide the best that technology has to offer for her children? Or is she turning her children into accoutrements?

 

Adrienne Outlaw continues this examination of maternal responsibility within the realm of advancing technology. The artist posits: How far should a mother go to protect her young? Does technology offer the best outcome for a child born today or tomorrow? In Outlaw's Fecund video series, electrified, metal breasts protrude militaristically from a white wall, each containing a unique video. The recorded imagery shows either the latest in biophysics research, such as green florescent proteins tracking tumor growth, or the natural tenderness that exists between a mother and her child, like a newborn baby breastfeeding.[13]As the viewer's get up close to the metal nipples to peer inside, similar to a breastfeeding infant, they become aware that the hard material of the bosom creates a distance between mother and offspring; technology seems to be getting in the way.    At the same time, however, the viewer is given a chance to see the amount of knowledge possible at the cellular level, thus parents may be given the opportunity to make sure their progeny's cell division is developmentally on target. The question then becomes one of what happens when a cell goes awry.  Is it a mother's duty to make sure that her embryos, her fetuses, have everything they will need to survive and succeed in the 21st century, even if that means genetic interference? Professor Ronald M. Green of Dartmouth College suggests that with gene manipulation we could live in a disease-free world, he asks, "Why not improve our genome?"[14]

 

While Sher Fick and Lindsey Obermeyer investigate the growing pharmaceutical role with advancing medicine, Annette Gates concentrates on the idea of the self within the world of cloning, Libby Rowe   and Sadie Ruben   examine the rights of the fetuses within genetic progress, and finally Monica Bock, Adrienne Outlaw, and Jeanette May explore the function of the mother within the biotechnological age. Through their artwork these artists explore the crucial social, economic, and ethical implications of biotechnological advancements and create a space for important dialogue. As Dr. Sirine Shebaya, Greenwall, Fellow in Bioethics and Health Policy at the John Hopkins Berman Institute of Bioethics, writes, "The best way to avoid slippery slopes to bad outcomes is to have an informed, democratic discussion that takes into account both expert opinions and social values. We need regulations because scientists and the general public need clarity about what they can and cannot do, a convincing rationale for permissions and restrictions, and a voice in arriving at decisions with such important ramifications."[15]These artists are that voice.

[1]

De Stael-Holstein, Madame Influence of Literature Upon Society (
New York : William Pearson & Co., 1835)  

[2]   Sandel, Michael J. The Case Against Perfection: Ethics in the Age of Genetic Engineering. (

Cambridge , Mass: Harvard
University Press, 2007) p 5-6.
University Press, 2007) p 5-6.

[3]See Sher Fick's artist statement

[4] Agar, Nicolas, "Designer Babies: Ethical Considerations," ActionBioscience.org, American Institute of Biological Sciences, 2006.

[5]Rifkin, Jeremy. The Biotech Century (London: Phoenix, 1998), p.63.

[6]

Glover, Jonathan. Choosing Children: Genes, Disability, and Design (
Oxford : Clarendon Press, 2006) p. 65.  

[7] "

Houston
Chronicle Examines Prenatal Genetic Test That Can Detect More Than 200 Conditions," The
Houston Chronicle, December 24, 2008.  

[8]Rugoff,  Ralph, "Deviations on a Theme – works by Paul McCarthy," Artforum, October 1994.

[9]Steere, Mike, "Designer babies: Creating the perfect child," Cnn.com/technology, October 30, 2008.

[10]Wohlsen, Marcus, ""Hobbyists try genetic engineering at home: Critics worry amateurs could unleash an environmental or medical disaster," MSNBC.com. December 26, 2008.

[11]Pearson, Helen, "Making Babies: The Next 30 Years," Nature, Vol. 454, July 17, 2008, p. 260.

[12] Gautam Naik, "A Baby, Please. Blond, Freckles -- Hold the Colic:  Laboratory Techniques That Screen for Diseases in Embryos Are Now Being Offered to Create Designer Children," The Wall Street Journal, February 12, 2009, page A10

[13] Created in

collaboration with biophysicist Dr. David W. Piston of
Vanderbilt
University .
 

[14]Britt, Robert Roy, "Designer Babies: Ethical? Inevitable?" www.livescience.com, January 11, 2009.

[15]Shebaya, Sirine, PhD, "Are 'Designer Babies, on the Horizon?" www.scienceprogress.org, May 15, 2008.

 

 

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