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Jarmel M 1989 Possible role of spinal joint dysfunction Osteopathic Annals 4(12):496–503 in the genesis of sudden cardiac death best meclizine 25 mg symptoms at 4 weeks pregnant. Journal of Hoag J 1977 The musculoskeletal system: a major factor Manipulative and Physiological Therapeutics in maintaining homeostasis buy meclizine 25 mg online symptoms in early pregnancy. In: Cleveland C purchase cheapest meclizine medicine 751, adjustments to muscle relaxants for subacute low back Haldeman S (eds) Conference Proceedings of the pain. Journal of Manipulative and Physiological Chiropractic Centennial Foundation, Davenport, Iowa, Therapeutics 27:388–398 p 359 Holdcraft L, Asseﬁ N, Buchwald D 2003 Jarski R, Loniewski E, Williams J et al 2000 The Complementary and alternative medicine in effectiveness of osteopathic manipulative treatment ﬁbromyalgia and related syndromes. Best Practice and as complementary therapy following surgery: a Research Clinical Rheumatology 17(4):667–683 prospective, match-controlled outcome study. Alternative Therapies in Health and Medicine Holzberg A, Kellog-Spadt S, Lukban J et al 2001 6(5):77–81 Evaluation of transvaginal Theile massage as a therapeutic intervention for women with interstitial Jennett S 1994 Control of breathing and its disorders. Urology 57(6 Suppl 1):120 In: Timmons B, Ley R (eds) Behavioral and psychological approaches to breathing disorders. Report: Journal of the American 81(1–2):105–114 Osteopathic Association 93(8):870 504 Naturopathic Physical Medicine Johnson J 2001 How the principles of exercise Khalsa P 2004 Biomechanics of musculoskeletal pain: physiology inﬂuence pelvic ﬂoor muscle training. Evaluation and the Health Professions 95:243–255 27(3):237–251 Joos S, Rosemann T, Szecsenyi J et al 2006 Use of Kim Y-J, Ban D 2005 Prevalence of irritable bowel next complementary and alternative medicine in Germany – term syndrome, inﬂuence of lifestyle factors and bowel a survey of patients with inﬂammatory bowel disease. In: Ward R (ed) Fundamentals of of the American Osteopathic Association osteopathic medicine. Williams & Wilkins, Baltimore 103(12):577–582 Karason A, Drysdale D 2003 Somatovisceral response Kirchﬁeld F, Boyle W 1994 Nature doctors. Journal of Manipulative and 1984 Lumbar spondylosis and stenosis correlation of Physiological Therapeutics 26(4):220–225 pathological anatomy with high resolution computed tomographic scanning. Pain 20):15–21 Research and Management 6(4):181–189 Kegel A 1948 Progressive resistance exercise in Klein D 1993 False suffocation alarms, spontaneous the functional restoration of the perineal muscles. Archives of General American Journal of Obstetrics and Gynecology Psychiatry 50:306–317 56:238–248 Klougart N, Nilsson N 1989 Infantile colic treated by Kegel A, Powell T 1950 The physiologic treatment of chiropractors: a prospective study of 316 cases. Journal of Urology of Manipulative and Physiological Therapeutics 63:808–814 12:281–291 Kelmanson I, Adulas E 2006 Massage therapy and sleep Kneipp S 1979 My water cure (facsimile edition). First published Complementary Therapies in Clinical Practice 1893 12(3):200–205 Knutson G 2001 Signiﬁcant changes in systolic blood Kendall F, Kendall E, Kendall-McCreary P 1993 pressure post vectored upper cervical adjustment vs Muscles, testing, and function, 4th edn. Williams & resting control groups: a possible effect of the Wilkins, Baltimore cervicosympathetic and/or pressor reﬂex. Journal of Manipulative and Physiological Therapeutics Kessinger R, Boneva D 1998 Changes in visual acuity in 24:101–109 patients receiving upper cervical speciﬁc chiropractic care. Post-Graduate Academy of Sciences 1069:155–167 Institute of Osteopathic Medicine and Surgery, Levitsky L 1995 Pulmonary physiology, 4th edn. New York McGraw-Hill, New York Kosek E, Hansson P 1997 Modulatory inﬂuence on Lewit K 1985 The muscular and articular factor in somatosensory perception from vibration and movement restriction. Pain Lewit K 1999 Manipulative therapy in rehabilitation 70:41–51 of the locomotor system. Butterworth-Heinemann, Oxford Krahl P 1973 [Physiotherapy and otolaryngology] [article in German]. Sbornik Kuchera M, Kuchera W 1991 Osteopathic Lekarsky 77(1):30–32 considerations in systemic dysfunction. Gastroenterology coverage and subsequent utilization of complementary 119:1766–1778 and alternative medicine providers. American Journal Loeppky J, Scotto P, Charlton G et al 2001 Ventilation is of Managed Care 12(7):397–404 greater in women than men, but the increase during Lane R 2000 Chronic fatigue syndrome: is it physical? Respiration Journal of Neurology, Neurosurgery and Psychiatry Physiology 125(3):225–237 69:289 Long A, Donelson R, Fung T 2004 Does it matter which Lane T, Matthews D, Manu P 1990 The low yield of exercise? Spine 29:2593–2602 physical examinations and laboratory investigations Lovas J, Craig A, Raison E et al 2002 The effects of of patients with chronic fatigue. American Journal of massage on human immune response in healthy adults Medical Science 299:313–318 (pilot study). Journal of Bodywork and Movement Lapp C 1997 Exercise limits in chronic fatigue Therapies 6(3):143–150 syndrome. American Journal of Medicine 103:83–84 Lukban J, Whitmore K, Kellog-Spadt S et al 2001 The Latha D, Kaliappan K 1992 Efﬁcacy of yoga therapy in effect of manual physical therapy in patients diagnosed the management of headaches. Journal of Indian with interstitial cystitis, high-tone pelvic ﬂoor Psychology 10:41–47 dysfunction, and sacroiliac dysfunction. Urology 57(6 Lawler S, Cameron L 2006 A randomized, controlled Suppl 1):121–122 trial of massage therapy as a treatment for migraine. Lum C 1996 Hyperventilation and asthma: the grey Annals of Behavioral Medicine 32(1):50–59 area. An approach to the Lum L 1984 Hyperventilation and anxiety state examination and treatment of the lumbopelvic–hip [editorial]. Churchill Livingstone, Edinburgh January, p 1–4 506 Naturopathic Physical Medicine Lum L 1987 Hyperventilation syndromes in medicine Martikainen K, Partinen M, Hasan J et al 2003 The and psychiatry. Journal of the Royal Society of impact of somatic health problems on insomnia in Medicine 80:229–231 middle age. Plenum Press, New York, of Rheumatology 23(6):1050–1053 p 113–123 Martínez-Segura R, Fernández-de-las-Peñas C, Ruiz- Lund I, Ge Y, Yu L et al 2002 Repeated massage-like Sáez M et al 2006 Immediate effects on neck pain and stimulation induces long-term effects on nociception: active range of motion after a single cervical high- contribution of oxytocinergic mechanisms. European velocity low-amplitude manipulation in subjects Journal of Neuroscience 16:330–338 presenting with mechanical neck pain: a randomized controlled trial. Journal of Manipulative and Lundeberg T, Uvnas-Moberg K, Agren G et al 1994 Physiological Therapeutics 29:511–517 Anti-nociceptive effects of oxytocin in rats and mice. Neuroscience Letters 170:153–157 Masuo K 2001 Which is more effective on weight loss- induced blood pressure reduction: a low caloric diet or Lustyk M, Jarrett M, Bennett J et al 2001 Does a an aerobic exercise? American Journal of Hypertension physically active lifestyle improve symptoms in women 14(4 Suppl 1):A214 with irritable bowel syndrome? Gastroenterology Nursing 24(3):129–137 Matthiesen A, Ransjo-Arvidson A, Nissen E et al 2001 Postpartum maternal oxytocin release by newborns: Madias N, Adrogue H 2003 Cross-talk between two effects of infant hand massage and sucking. Birth organs: how the kidney responds to disruption of acid– 28:13–19 base balance by the lung. Nephron Physiology 93(3):61–66 McCain G, Bell D, Mai F et al 1988 A controlled study of the effects of a supervised cardiovascular ﬁtness Maguire P, Pitceathly C 2002 Key communication skills training program on the manifestations of primary and how to acquire them. Arthritis and Rheumatism 31:1135–1141 325:697–700 McCully K 1969 Vascular pathology of Maguire P, Faulkner A, Booth K et al 1996 Helping homocysteinemia: implications for the pathogenesis of cancer patients disclose their fears. American Journal of Pathology Cancer 32A:78–81 56:111–128 Maher Committee 1995 Management of adverse effects McEwen B, Wingﬁeld J 2003 The concept of allostasis in following breast radiotherapy. Manual Therapy 2:216–220 Pharmacology 46(3):313–320 McLean L 2005 The effect of postural correction on Manjunath N, Telles S 2005 Inﬂuence of Yoga muscle activation amplitudes recorded from the and Ayurveda on self-rated sleep in a geriatric cervicobrachial region. Indian Journal of Medical Research and Kinesiology 15:527–535 121(5):683–690 Mehling W, Hamel K 2005 Randomized, controlled trial Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C 2000 of breath therapy for patients with chronic low-back Pool exercise combined with an education program for pain. Manocha R, Marks G, Kenchington P et al 2002 Churchill Livingstone, London Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. Thorax Messinger-Rapport B, Pothier Snader C, Blackstone E 57(2):110–115 et al 2003 Value of exercise capacity and heart rate recovery in older people. Journal of the American Marshall W, Murphy B 2006 Evaluation of functional Geriatric Society 51:63–68 and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study.
Clinically buy discount meclizine on-line symptoms 2 dpo, massage group had higher dopamine and encouraging depressed patients to engage in serotonin levels and lower levels of cortisol physical activity is likely to have potential and norepinephrine buy meclizine 25mg line medicine effexor. Twenty depressed 25 mg meclizine with mastercard symptoms xeroderma pigmentosum, community- suggest that depressed pregnant women and dwelling older adults (average age = 69) their offspring can beneﬁt from massage completed a pilot study of ballroom dance therapy. Field lessons from a selection of six dances (foxtrot, et al (2005) report that in studies in which waltz, rumba, swing, cha-cha and tango) from cortisol was assayed either in saliva or in urine, the National Dance Council of America’s signiﬁcant decreases were noted in cortisol syllabus. In studies efﬁcacy and hopelessness as outcome in which the activating neurotransmitters predictors. Participant feedback indicated the (serotonin and dopamine) were assayed in dance lessons were enjoyable and urine, an average increase of 28% was noted well-received. These studies between exercise and mental well-being have combined demonstrate the stress-alleviating been well documented. A meta-analysis of 11 effects (decreased cortisol) and the activating treatment outcome studies of individuals with effects (increased serotonin and dopamine) of depression yielded a very large combined massage therapy on a variety of medical effect size for the advantage of exercise over conditions and stressful experiences. Based on these ﬁndings naturopaths are strongly Naturopathic care of individuals with depression encouraged to consider the role of exercise interven- should clearly consider incorporating massage as part tions in care of depressed patients. Hydrotherapy and depression Exercise and depression There is a modest degree of support for the value of • Physical activity and depression: A 10-year study spa therapy (thermal, ﬂotation, chemical) in treatment by Harris et al (2006) examined associations of moderate depression; however, since the majority between physical activity, exercise coping and of spas do not accept individuals with serious behav- depression in a sample of initially depressed ioral problems or those who are at risk of suicide, this patients. These patients (n = 424) completed form of therapeutic intervention offers only limited measures of physical activity, exercise coping, evidence of value in such conditions (Dubois 1973, depression, and other demographic and Dubois & Arnaud 1983, Guillard 1990). Physical activity counteracted the reduce anxiety and depression in patients with chronic effects of medical conditions and negative life pain (Kjellgren et al 2001). It appears that physical cedure in which the individual was immersed in a activity may be especially helpful in the tank ﬁlled with water of an extremely high salt con- context of depression associated with medical centration. The results indicated that the most severe perceived pain intensity was signiﬁcantly reduced, Patients with diagnosed ﬁbromyalgia received whereas low perceived pain intensity was not inﬂu- 30 chiropractic treatments that combined ischemic enced. After 30 days there was an average dence offered suggests that additional beneﬁt is avail- lessening of 77. The improvement in the three outcome measures was maintained after 1 month without Physical medicine therapeutic treatment. The treatment approach involves extensive • Spa treatment appears to offer beneﬁt for some education related to nutrition, diet, and people with depression. The syndrome (see also instinctive sleep nutritional education consisted of encouraging postures in Chapter 9) patients to increase vegetable consumption and reduce Apart from pain, fatigue is one of the most wide- dietary animal protein. Supplementation consisted of spread of symptoms (Lane et al 1990), ranging from ground barley plant tablets, a digestive enzyme, and mild to extreme, intermittent and ﬂuctuating to con- trace minerals. Clearly, with These tests commonly involve strength assessment of etiologies that range from endocrine to nutritional, the arm or leg. During the test, while in the supine psychological to physiological and/or pathological, position, the patient is asked to think about the chief there are no magic bullets for remedying fatigue, any complaint, or the major stress in their life. The treating doctor then places coping systems and/or excessive demands of a physi- the patient prone and uses leg-length assessment in an cal or psychological nature, or just plain breakdown attempt to evaluate ‘balance’. Causes, as with most health length variations other than anatomical variations that problems, usually lie in a combination of the three would suggest autonomic imbalance, then a treatment major inﬂuences: biochemical, psychosocial or biome- is administered. Self-regulating processes that are over- hand on the back of the skull of the prone patient, and whelmed or underfunctioning need to be identiﬁed the other on the sacrum. Light pressure is then applied and offered assistance towards recovery, by means of to these 2 regions. They were, however, allowed to biomechanical tools; the second involved asking the receive any other treatment available for this condition. Objective measurements of knee extensor muscle fatigability also revealed signiﬁcant • High- and low-velocity manipulation of the thoracic improvement in the treatment group. This was achieved and upper lumbar spinal segments solely through the protocol described above, without • Gentle articulation of thoracic and upper lumbar spine direct treatment of the quadriceps or lower limbs. Clinical approaches should clearly take account ing 24 chronic failed chiropractic patients, signiﬁcant of such variables. The score for vomiting with therapeutic exercise and yoga, although the was unchanged (from 0. Patients were divided into two cancer and chemotherapy groups, with the experimental group receiving The results of a study by Andersen et al (2006) acupressure with massage, while having hemodialy- indicate that 6 weeks of a multidimensional exercise sis treatment. Findings were that those individu- are undergoing chemotherapy, can lead to a reduction als in the treatment group had signiﬁcantly decreased in symptoms and side-effects. The researchers divided fatigue into different Physical medicine therapeutic categories: measures for fatigue • Physical fatigue: The sense of fatigue that • Light forms of manipulation (e. The women Fibromyalgia syndrome (see instinctive received 30 treatments, two or three times weekly. Note: A number of studies relating to the pain expe- • manipulation of the upper thoracic and cervical rienced in ﬁbromyalgia are discussed later in this region using rotational and high velocity thrust chapter under the subheading ‘Pain’. To what reported after both 15 and 30 treatments and were extent, in any given case, the soft tissue approaches sustained for at least 1 month following the end of the alone might be responsible for the resulting beneﬁts treatment. Among those who did not report beneﬁt after 30 Various mechanisms could be involved. Pain inhibi- treatments it was observed that there had been a less tion may be achieved as a result of: than 35% improvement by the end of 15 treatments, and that this: ‘suggests that a minimum 35% improve- • increased spinal mobility following ment in pain intensity must be observed after 15 treat- manipulation that tends to decrease central ments or it may no longer be appropriate to pursue transmission of pain from adjacent structures this form of treatment’. However, this does not clarify following manipulation whether the ischemic pressure, which calmed the • paraspinal muscles relaxing due to stretching trigger points, would have, on its own, achieved of apophyseal joint capsules during similar results. Ten patients received treatment between teaching (learning about the condition and self- three and ﬁve times per week for 4 weeks. During this help measures) and a third group received only time the remainder (the controls) received no treat- moist-heat treatment. Treatment consisted of: noted in the self-teaching group (Jiminez et al • soft tissue massage using a counterirritant 1993). Studies which showed the greatest improvement in their compare joint manipulation with soft tissue approaches quality of life (Rubin et al 1990). There is no evidence that the underlying condition is assisted As with chiropractic evidence it appears that osteo- by these methods, although they clearly have an pathic manipulation offers relative beneﬁts to patients important role to play in management. A gradual had six visits/treatments and it was found decline in the increased myoglobin over a 1-year period that 12 of the patients concentration was observed over repeated responded well in that their tender points massage treatments as self-reported muscle became less sensitive (14% reduction in tension decreased over time. The 15 massages resulted in a self- 458 Naturopathic Physical Medicine reported reduction in pain in 85% of the on treatment with connective tissue massage (30% patients and a reduction in analgesic use by and 10%). Depression and self-rated One of the main ﬁndings in this pilot study of women quality of life improved but no improvements with initially severe pain due to long-standing and inca- were observed in sleep, ability for activities pacitating ﬁbromyalgia was that they experienced a sub- and anxiety. Previously, it has been reported in a consisting of medical care from the clinic nurse double-blind study of 48 women with ﬁbromyalgia or physician (Alnigenis et al 2001). However, that connective tissue massage gives pain relief in no impact on pain, depression, well-being and one-third of the treated women (Brattberg 1999). The greatest beneﬁts were Exercise and ﬁbromyalgia noted in areas of mood and depression, as well as in reduced pain levels (Field et al 2003). All symptoms showed favorable progress during a Supervised and graduated exercise 4-week period with manual lymph drainage therapy. Fibro- Relaxation and ﬂexibility comprised upper and myalgia patients who attempt to begin an exercise lower limb stretches and relaxation techniques.
Over time cheap meclizine 25 mg otc medicine venlafaxine, the initial way a problem is deWned then crystallizes policy debates order meclizine without prescription treatment leukemia, producing what can then become a very rigid framework order meclizine paypal medications 2355, all but impossible to expand or modify (Rochefort and Cobb, 1994: vii, pp. Constitutionally, in the course of nearly 30 years of Supreme Court reasoning, abortion rights have become rigidly deWned as a problem of decisional autonomy, that is, as a problem of privacy and choice. Politically, during that same time period, the problem of abortion has been deWned by pro-life activists (as we would expect), but also by pro-choice advocates (as we might not expect) on the basis of a very traditional model of motherhood, one invoking cultural and ethical depictions of women as maternal, self-sacriWcing nurturers. The combination of deWning the problem of abortion rights constitu- tionally in terms of the privacy of choice and politically in terms of a traditional view of motherhood has produced a rigid, serious policy conse- quence – namely, failure to obtain access to abortion services for women in the form of public funding of abortions. Correction of this policy conse- quence requires a redeWnition of the problem of abortion rights from both constitutional and political perspectives, which entails, as part of that re- deWnition, a transformation of the traditional model of motherhood to include nontraditional elements. To understand more clearly what is in- volved in this transformative process, let us review the current status of how a traditional model of motherhood underlies the current way the problem of abortion is deWned. McDonagh Problem definition: constitutionalism and politics In the United States, the Due Process Clause of the Fourteenth Amendment of the Constitution prohibits the state from depriving ‘any person of life, liberty, or property without due process of law’. This Due Process right of privacy has been interpreted by the Supreme Court to mean that a state may not interfere with a person’s choice about whom to marry, how to educate and raise one’s children, or the choice to use contraceptives. When the Supreme Court established the constitutional right to an abortion in Roe v Wade in 1973, it did so by ruling that the Due Process right to privacy was ‘broad enough to encompass a woman’s decision whether or not to terminate her pregnancy’ without interference from the state. This decision was a breakthrough for women’s rights because it immediately struck down nu- merous state laws that had severely limited procurement of an abortion (Ginsburg, 1985; Klarman, 1996). The Court reasoned that because a pregnant woman ‘carries [potential life] within her’, she ‘cannot be isolated in her privacy’ and her ‘privacy is no longer sole’. Thus, in Roe, the Court established that it is constitutional for the state to protect the fetus from the moment of conception and that a pregnant woman’s right of privacy to make a choice to terminate pregnancy can be limited by, or balanced against, the state’s interest in protecting the fetus as a separate entity from the consequences of that choice. Prior to viability, although the state may not prohibit an abortion per se, the state may protect the fetus by requiring restrictive regulations, such as 24-hour waiting periods and informed consent decrees, and by prohibiting the distribution of any information about abortion in publicly funded family planning clinics. What is more, law scholars concur that the Due Process foundation for abortion rights, as interpreted by the Court, means that it would be constitutional for a state to prohibit the use of public resources to assist a woman in obtaining an abortion, even if her pregnancy is subsequent to rape or incest, and even if her pregnancy threatens her with death. After the stage subsequent to viability, the state in promoting its interest in the potentiality of human life may not only prohibit state assistance in obtaining an abortion, but may also prohibit a woman from choosing an Models of motherhood in the abortion debate 215 abortion, ‘except where it is necessary. Thus, although Roe has proved resilient in the ensuing decades for retaining the constitutional right to choose an abortion, deWning the problem of abortion rights in terms of privacy has proved completely inadequate for establishing a constitutional right to state assistance for obtaining one. This is consistent – the Due Process right of privacy to be free of government interference when making choices about one’s own life or reproductive options does not usually include a constitutional right to government assistance in exercising one’s choice. Hence, the constitutional right to choose to use contraceptives, as established in 1965 in Griswold, does not include the constitutional right to government funding to purchase contraceptives. Thus, the constitutional problem with using privacy and the Due Process Clause for deWning abortion rights is that a Due Process depiction of the abortion issue reinforces the Court’s disconnection between the constitu- tional right to an abortion and abortion funding. Since the right to make a choice without government interference – such as the right to choose an abortion or whom to marry – does not include the right to government assistance in exercising that choice, there is little, if any, constitutional leverage to apply to the abortion access issue. When we turn to the political arena, we run into a similar dead-end to procuring access to an abortion, as a result of the problem deWnition of abortion. Based on his experience, he draws attention to the conservative political message developed not only by pro-life activists, but also by the pro-choice community over the last decade. Starting at least in the mid-80s, around the time of the Thornburgh decision, pro-choice activists became so fearful that the right to an abortion would be overturned in court that they began to develop powerful conservative strategies with which to reach out to the American public. The conservative message, as Saleten analyses it, was premised on convey- ing a persuasive view of abortion rights that would be suitable for the mass media and for electoral campaigns. As a result, the right to an abortion came to be politically framed as the right to get the govern- ment out of your life; that is, the government should have nothing to do with your right to have an abortion. Thus, rather than getting the state out of a woman’s uterus, access to public funds, public facilities, and public personnel for abortion services involves getting the state into a woman’s uterus, so to speak. The pro-choice strategy of politically deWning the abortion message to be getting the government out of women’s lives, therefore, is counterproductive as a claim for public funding of abortion services. The traditional model of motherhood and abortion rights Underlying the problem deWnition of abortion rights is a traditional view of motherhood – one that rests upon a relational view of women, deWned in terms of an ethic of care, inclusive of a nurturing, if not a sacriWcial, relationship between mother and fetus. Relying on the traditional model of motherhood to deWne the problem of abortion, however, does not give us the necessary arguments to justify public funding of abortions. To gain for women state assistance in procuring abortion services, therefore, requires a redeWnition of the problem of abortion, one that draws upon a model of motherhood that incorporates non-traditional elements into the way women are envisioned when seeking an abortion. To reframe the abortion debate to make it possible to secure a constitu- tional right to abortion funding, we must reconsider the central ethical and legal issue that haunts abortion policies – what justiWes killing the fetus? When we look more closely at the way pro-choice advocates answer that question when explaining why they support abortion rights or why they themselves procured an abortion, we Wnd that their justiWcation for abortion rights, far from carrying a non-traditional message about women’s rights, relies upon and reinforces some of the most traditional components of motherhood by invoking the principles of ‘lifeboat’ ethics. In order to fulWll her role as nurturer, a woman is forced to choose how to provide the greatest good for the greatest Models of motherhood in the abortion debate 217 number; to do so, she must make a calculation of whom or what to sacriWce. Presumably, she would gladly sacriWce herself, if this would be most beneW- cial to all concerned, which, in the case of an abortion, could include the decision to continue a pregnancy. However, when using the traditional model of motherhood to justify the non-traditional goal of obtaining an abortion, it turns out that the pro-choice utility calculation can indicate that the best way to help the most people is to sacriWce the fetus by aborting it. From a political vantage point, this is a strategic way to ‘have your cake and eat it too’, since such a justiWcation leaves in place traditional cultural assumptions about women as care-givers, even while expanding the non- traditional options open to women in the form of the right to an abortion as an instrument of care-giving not to the fetus, of course, but to others. What is signiWcant about Kate Michelman, therefore, is that when she tells her story about why she obtained an abortion, that story reveals a premise that the best way to present the abortion issue is to embed it within a traditional model of motherhood. To put it another way, Michelman’s justiWcation for abortion exempliWes the political power of obtaining non- traditional goals for women by infusing those goals with the most traditional imagery associated with women. Michelman’s story employs a traditional view of a woman whose identity is deWned in terms of her childbearing goals, child care responsibilities and economic dependency on a husband. The killing of the fetus by means of an abortion, therefore, is justiWed as a sacriWce necessary for the survival, if not the good, of the greater whole. Lifeboat ethics and justification for killing Michelman’s story not only illustrates a traditional view of motherhood in the context of obtaining a non-traditional goal for women – abortion rights – it also corresponds to a speciWc ethical model that justiWes killing – lifeboat ethics. The Model Penal Code (Philadelphia: American Law Institute), pre- pared and published by the highly respected American Law Institute, analyses the lifeboat model in terms of a justiWed choice of evils. The context of the lifeboat model involves a situation in which the homicidal actions of an individual that ordinarily would be criminal are nevertheless defensible because these acts are the only way to save other lives. As stated in the Code, ‘conduct that results in taking life may promote the very value [life] sought to be protected by the law of homicide’ in the Wrst place. The example provided by the Model Penal Code is: [Suppose someone] makes a breach in a dike, knowing that this will inundate a farm, but taking the only course available to save a whole town. If he is charged with homicide of the inhabitants of the farm house, he can rightly point out that the object of the law of homicide is to save life, and that by his conduct he has eVected a net saving of innocent lives. The life of every individual must be taken in such a case to be of equal value and the numerical preponderance in the lives saved compared to those sacriWced surely should establish legal justiWcation. As Dame Mary Warnock asserts, when faced with a choice of two people dying, or one person dying at the expense of another, the decision is easy – though it is the lesser of two evils, the latter is preferable to the former.