Bioethics Via a Religious, Social Constructivist, and Ethnographic Lens

To start things off I will be discussing Shirin Garamoudi Naef’s “Gestational Surrogacy in Iran.” Gestational surrogacy is a form of surrogacy in which the surrogate is not the provider of the female gamete and only gestates another couples’ embryo. In other words, this reproductive science requires the involvement of another woman (that is not the mother) who is able to carry a specific couples’ baby and ultimately give birth to it. It is a very viable solution to infertility for couples that want to have children, and has been on the rise in countries like Iran. As this form of surrogacy has become increasingly popular, public debate surrounding it has also risen particularly between Shia and Sunni branches of Islam.

The majority of Shia Muslims consider this method of assisted reproduction as viable and legitimate through the lens of Islamic law, as long as it is only accessible for infertile couples that are married. Although Shia Muslims approve this method of reproduction, in Sunni Islam, the use of donor gametes and surrogacy is unacceptable and is regarded as analogous to Zina, which basically means it is considered adultery. The basis of Shirin Garamoudi Naef’s reading is focused on an analysis of Shia legal positions regarding the appropriateness and legitimacy of gamete donation and surrogacy.

A primary reason Shia authorities disagree with the mindset that surrogacy and the use of donor gametes is adultery, is because this form of reproduction does not involve or require the physical act of sexual intercourse. The Shia notion of unlawful sexual intercourse (zina) is not dependent on the biological result that stems from the contact and transfer of bodily fluids, but rather it is dependent on the illegitimate physical act that occurs via illicit sexual intercourse between a man and a woman primarily for pleasure and not for conception. It is in the lens of this logic that a large number of Shia scholars have put their stamp of approval on the use of third-party donations and surrogacy as means of assisted reproduction under specific conditions. Shia culture essentially “leaves room for the legal permissibility of a third-party donation and surrogacy” (page 158).

Additionally, Shia support of these reproductive methods are centered on the question of Nasab, which is a term derived from a series of patronymics, that ultimately indicates a person’s heritage in Arab culture. Sunni notions of Nasab take an agnatic stance, having means of heritage pass through the male figure. Meanwhile, Shia notions of heritage take a gender-balanced approach and recognize that maternal and paternal filiations are distinguished in many regards to be equal or proportional in determining one’s ancestral roots. Thus, leaving more room in regards to accepting artificial insemination and gamete donation.

However, an issue in the debate between Shia and Sunni Muslims in regards to these reproductive methods is that the definition of bodily substances is clouded, and still remains extremely tied to defining kinship and incest. A key example the author uses is breast milk and questions the notion of if it should be discussed when considering something to be incest or adultery.  Ultimately, rhetoric of incest does not follow a universal grammar. “For the definition of incest in Shia thought and practice is not dependent on the transfer or contact of bodily substances, rather it depends on the illegitimate physical act of illicit sexual intercourse and not on the act of conception itself” (Page 163). The author is using this to show how one can do something that is considered adultery in Sunni culture, yet not in Shia culture.

Overall, the act of insemination and conception resulting from the physical and social act of sex without a marriage is considered adultery, thus getting assisted conception involving third party donation to not be considered adultery is essentially the only way to legitimize the practice and is how Shia culture defends their stance that is severely opposed by Sunni culture. As I transition into the 2nd reading of this week, I must note that this first reading was extremely focused on religious’ viewpoints and stances, while our 2nd reading by Elly Teman was quite the opposite, taking the refreshing approach of a social constructionist.

Elly Teman’s article focuses in on surrogate mothers, and their motivations for agreeing to agree to   such a thing. Teman essentially analyzes the cultural assumptions that “normal” women would never volunteer to do such a ridiculous thing as become pregnant with the predetermined decision to give away the child for money. She starts of her analysis by discussing how basically the entire majority (over 99%) of surrogate mothers do not bond with their newborn babies after they are given away to the infertile couples that have hired them. Most surrogates have even reported that giving away the baby has been a satisfying event or celebration and that they would consider engaging in surrogacy again. The narrative of the surrogate mother who begins to regret her decision and attempts to reclaim the child she gave birth to has very little foundation in reality, despite its stereotypes that exist in television, film and popular journalism (one such example that comes to my mind is the movie Baby Mama with Tina Fey and Amy Poehler).

As Teman is enabling her audience to view surrogacy via a social constructionist lens she had one sentence that really captured my attention. Teman writes, “Surrogacy constructs families through the marketplace, making them a matter of choice rather than fate and revealing that families are social constructs” (page 2). A key phrase that struck me in this sentence is “marketplace” due to its connotations that surrogacy is in fact part of the financial markets. I find it fascinating how such a complex concept of forming families relates directly back to such an artificial socially constructed concept such as money.

I also want to note that Teman mentions that giving birth to a child for the sole purpose of giving it away way is extremely threatening to dominant ideologies in many cultures that rely on an “indissoluble mother-child bond,” as we just read about in this week’s first reading and have been constantly discussing throughout the semester. For surrogacy truly does present itself as a direct challenge to the ideology of motherhood, despite its blatantly positive impacts on infertile couples. Yet although surrogacy shatters conventional religious beliefs surrounding motherhood, it also reveals that our entire belief in motherhood is entirely socially constructed, and does not have to be the natural, desired and concrete goal of all women should they want to be considered normal.

From here, Teman focuses on how many psychologists have tried to run tests that would distinguish surrogate mothers from “normal” women. Some of these studies focused on finding differences in terms of morality, while others focused on surrogate mothers’ attitude toward attachment and bonding. Teman writes, “To my knowledge, none of the studies have successfully located any ‘‘abnormal’’ personality traits among surrogates, yet continuous attempts have been made to prove otherwise over more than 20 years” (page 3). It is almost laughable how modern psychologists think there must be something wrong with a woman who agrees to be a surrogate. I’m not implying that I do not find the concept a little strange, because I definitely do, due to the fact that it violates such a concrete norm in our society. I’m just amused by the fact that for over 20 years they have kept trying to find some kind of abnormality when one clearly doesn’t exist based on the evidence. Nonetheless I found this reading very refreshing in the sense that it discussed the topic of surrogacy through a non-religious lens and was very easy to follow and comprehend.

Furthermore, our last reading of the week by Arthur Kleinman discussed how despite the advancements in bioethics over the years and the clear benefits the science poses to society, it is still clouded by extreme controversy that is only getting stronger. There has been a vast amount of efforts to repair and reform bioethics in recent years, yet none of these have come close to solving the unprecedented morale issues such a wide ranging of cultural and religious groups have with the science. For bioethics is extremely tied to morality and certainly requires a loose view of certain “traditional” aspects of society and life should it be worthy of any one man or woman’s support. In essence, Kleinman discusses how the only way to change the light in which bioethics is considered in, someone would have to work extremely hard to mediate the “immense differences in the social and personal realities of morale life with the need to apply a universal standard to those fragments that can ultimately foster not only comparison and evaluation but also action” (page 2). In reading this quote it becomes clear that bioethics will not be able to continue functioning unless someone finds a way of relating ethical deliberation and validity to the many religious and cultural groups that oppose it so venomously.

Kleinman takes on a really challenging task towards the beginning of his article, and that is that he attempts to define morality. He talks about how one forms their own morale experience or sense of ethical deliberation due to their own multidimensional experience with life. Kleinman implies that moral experience is about the local processes one has that realize values in ordinary living. I’m not entirely sure what this means, but to my best guess, Kleinman is basically saying that everyone develops their sense of the term morality differently, and this variation in morality across the entire world is dependent on one’s upbringing, the values they are taught by their parents, the way they learn to interact with people and how they experience interpersonal connections throughout their life, as well as the subjective values they observe in the society in which they exist in. Furthermore, in my attempt to address what this all means and why Kleinman wants his audience to know this, my best guess is that this is a key reason as to why bioethics is so widely controversial. So many different cultures and societies across the world have their own definition of morality, thus it is essentially impossible to appeal to everyone’s sense of ethical deliberation and justify such a controversial science. And this state of unknowing what to do, this state of perplexity surrounding bioethics is what Kleinman deems the quandary.

Kleinman’s first proposal as means of approaching the quandary of bioethics is centered on human nature. He suggests that ethical standards can be applied to different issues across the world because a shared human nature is present in all humans that provide them with some common sense of morality. Kleinman then uses ethnography as means of validating the morale complication surrounding bioethics. In other words, he uses ethnography to allow people to find common morale ground in their discussion of bioethics because he feels that ethnography represents a very viable way to get people to solve the bioethicist’s dilemma.

Notably Kleinman mentioned the Rayna Rapp ethnography that we discussed earlier this semester. Kleinman writes, “It is hard to imagine a more illuminating approach to such controversial issues as abortion across distinct ethic and social class networks” (page 17). I completely agree with him and think this is such a good example for him to use in his argument. Rayna Rapp focuses on the ethics and morality that accompany different people’s experience with reproductive technology and the dramatic life choices the science creates. In doing so, she is exposing the different morale landscapes of each of her subjects, and Kleinman is using her findings to show how people of different morale backgrounds and senses of ethical deliberation have acted extremely similar in the sense that they have all judged the quality of a fetus and made the decision of whether it will or will not enter the moral community of which they exist in.

Conclusively, a key theme I have found across all three readings is that of policy and how to best form it on reproductive technologies and methods. From this course I have learned that there are so many contrasting viewpoints based on such different religious and cultural stances, causing the whole idea of forming policies to become quite overwhelming. Thus, I will leave you all with this question. What do you think is the best way to form policies? I personally don’t think there is one and am not sure if there ever will be… I think our best shot is in Kleinman’s approach.



12 Replies to “Bioethics Via a Religious, Social Constructivist, and Ethnographic Lens”

  1. Thanks for your blog Daniel. The summaries of the three readings were very informational and touch on the main topics discussed in them. I also liked how you delved a little deeper into the Kleinman reading.

    Naef has done a fine job discussing surrogacy in the context of many different interpretations of Islam. I think it’s an interesting debate, as the question of “Who is the mother-the one who supplied the genetic material to the child or the one who physically gave birth to them?” comes up. I think many would consider that a major part of motherhood is physically giving birth, as it is considered a stepping stone, if you will, to becoming a mother (experiencing the entire process). The question of what is considered to be adultery also comes into play. I personally don’t think it is adultery if someone gave birth to a child other’s conceived as I think adultery is not only the physical act of conception (intercourse) but to some extent the emotional act of deciding and engaging in intercourse. However, like Elisabeth mentioned in your blog post, I would expect the authors of Donum Vitae to have a different opinion regarding adultery and allowing the child to grow up in a “good” environment.

    Like you, I found the Teman article “amusing”. However, I think this reading is kind of interesting in terms of how my own life is currently like. Many of these surrogates don’t have a voice when critiqued the way that they were by Western scholars, and Teman does a great job dispelling their beliefs and the basis of which they hold them. In short, it seems to me that Teman is advocating very strongly for them, or at the very least destroying the poor reasoning held by these clearly biased people. In these past couple of months, I’ve had a similar experience (not in terms of surrogacy, thank goodness) where I have been accused of being at fault for things outside of my control, or blamed for things that I wasn’t responsible for in addition to being accused of being unsuccessful when I was put in a position of failure. I found it somewhat uplifting (even if it doesn’t pertain to me…at all really) that Teman is advocating for these people who don’t really have a voice in these matters, much like how I’ve had to learn to advocate for myself.

  2. Hi Daniel! Thank you for the comprehensive summary and commentary on this week’s readings. I thought the reading by Naef was interesting because it placed value on the structure of the marriage while still allowing flexibility for surrogacy. The couple, as pointed out, must be married and unable to carry their own child. However, as long as no physical contact outside of the marriage is performed, surrogacy is legitimate. However, the defining factors of kinship are less clear, which is interesting because in past readings, the way kinship is determined is typically a justifications for acceptability of reproductive techniques. Here, we see that the reproductive techniques are determined as acceptable before the kinship relations are clearly established.
    I appreciated the reading by Teman because it brought a new perspective on surrogacy that we haven’t really seen before, as it focused on the point of view of the surrogate mother themselves. We have heard again and again about how surrogate mothers want to keep the child after becoming attached to it. However, I have always found this claim to be rather absurd because agreeing to carry another person’s child is completely voluntary. I think a more valid claim that gets touched on less, is how a surrogate mother may be taken advantage of because of her financial situation, but again, the choice to carry another couple’s baby is voluntary. I agree with your point about surrogacy disproving “indissoluble mother-child bond” and would like to further point out how adoption too goes against this claim.
    Finally I appreciate your attempt to unpack Kleinman’s definition of morality and its importance in bioethics. I liked the definition she provided because, although obvious, I thought it made a good point of explaining how people across different cultures, are able to form their own opinions on bioethical issues.

  3. Daniel,

    Thank you for your wonderful blog post! I appreciated your summation of the texts and agree with you that Teman’s article was certainly a refreshing read ofter the dense text written by Shirin. As you discuss later in your article, Kleinman dives into the construct of morality. I definitely struggled a bit to grasp his ideas, however fully agree that a person’s sense of morals and “ethical compass” derive heavily from their lived experience and local moral world. Kleinman suggests that ethnography is a very useful way to collect and compare varying individual moralities. I feel that Kleinman attempted to create some definition of morality through the amalgamation of individual morals and, by doing so, creates his own contentions within his text. He does, however, point out some very interesting facets of ethics that I hadn’t quite thought about before. He suggest that there is no evidence to support that ethics evolves. This left me wondering what his opinion would be on the evolution of morality. Has individual’s senses of morality evolved?

  4. Daniel,
    Thanks so much for your in depth discussion of each readings, and for tying them together at the end. I did not come to the same conclusion as you did regarding the central theme of the readings, but that may be simply because of my own bias. Without disputing your argument for policy being core (I agree that it is pertinent to this week’s readings), I’d like to make a case that what connects these readings is perhaps something a bit less technical. Perhaps, in addition to your understanding of policy as a core idea, I’d like to argue that perspective is a relevant theme this week and just about every week. In the Naef reading, each sect of Islam has their own conception of what constitutes adultery, leading to their differing approaches to surrogacy. Teman tries to dispel many misconceptions among the broader society and academics as well regarding surrogacy, stressing the importance of the lived experience of surrogates and arguing for a realistic assessment of the situation. Kleinman, of course, argues that our lack of consensus on morality as a collective human race poses a challenge to developing a coherent bioethics, and contends that the solution lies in developing a deeper understanding of one another vis a vis ethnography. Naef reflects on differences in views (perspectives!) to explain an observed phenomenon. Teman fights for a fair recognition of lived experience (understand the perspective of women, in my own words) in informing societal views and research parameters. Kleinman purports that the solution to the problems bioethics face lies in considering people’s perspectives. I hope you accept my claim that perspective is core in this week’s readings. I look forward to elaborating further as well as hearing your take on the significance of policy during tomorrow’s class.

  5. Hi Daniel,
    Wonderful job with the blog this week. Your blog was very comprehensive in regard to this week’s readings. I liked how you pointed out key phrases that you enjoyed and added your own thoughts to certain topics. I think that you raise a good question on how policies to be formed and I agree that Kleinman’s approach could be our best shot. As Dr. Seeman taught us in class, a good ethnography should consider the culture, society and lived experiences which are all important aspects that are affected by policy. In the United States where the government is supposed to act for the benefit of its people, I feel like this method would be great in deciding policy. However, my biggest issue would be whether this kind of approach can be useful in a national policy. I feel that this would be a great approach to statewide or community policy, but countries are usually very diverse in belief and culture that I am hesitant to say that this approach would be useful in creating large-scale policies.

  6. Hello Daniel, thank you for your post. I appreciated how you tied the readings together and your analysis of each. I thought that you made great points about Kleinman’s article on ethnography. It is important to point out that everyone’s moral experience is purely based on their cultural and societal views and can be changed and formed by the people in one’s life. This can also be said for perceptions on assisted reproductive technologies. Although many rules are set by religious officials, ideas about motherhood and fatherhood are socially constructed. What may be normal to one person could be abnormal to another. Because of these discrepancies, I think it is necessary to include ethnography into policy-making decisions because of its ability to provide a variety of views and experiences.

    Furthermore, I appreciated that you highlighted Teman’s quote on surrogacy and describing it as “marketplace.” Many people who have strong opinions against surrogacy think that the process is just a monetary transaction and it should not be allowed because humans should not just be succumbed to just a dollar value. As seen in the movie we saw in class last week, many people were against the family’s decision to find a surrogate in India because they viewed it as a “marketplace.” While the surrogate did do it primarily for the monetary gain, she expressed her feelings of happiness for the family and how glad she was to provide a child to them. While this process was long and stressful for the parents, they were able to have children and did not think of any of the financial transactions that occurred.

  7. Hi Daniel,

    Thank you for a very comprehensive and well-written blog post!
    When reading, I found it interesting when Teman mentions that giving birth to a child for the sole purpose of giving it away way threatens the dominant ideologies in many cultures that rely on an “indissoluble mother-child bond”. Looking back on Naef’s point that explains because of kinship understandings in Shia communities, the role of the mother comes from conception and gestation. Because of this, it is possible for the child to have two mothers. The demonstrates Temnan’s point that while surrogacy becomes more accepted, separating from the idea of an “indissoluble mother-child bond” is not.

    I also really appreciated how you took the overall messages and themes that each of these authors presented in their works, and then tied it to the influence and relevancy that they have on policy making. However, I would have to agree with Noah that this was not the core idea of the readings. Despite this, I still agree that understanding the individuals perspective and the importance of ethnography, is necessary in shaping future policies regarding ARTs.

  8. Hey Daniel! Thanks for this great summary of this week’s readings. I thought Elly Teman’s article was particularly interesting and illuminating, especially after having read so many ethnographies and articles about surrogacy and other reproductive technologies. She brought up some really great points that had not been addressed yet in this class, such as the idea that even science can be an unintended cultural product. Her discussion of how surrogacy is often depicted in mainstream Western society reminded me of Dr. Seeman’s article from last week in that often the discourse surrounding a practice (surrogacy, pregnancy, abortion) is not representative of the local moral worlds of the people actually dealing with these things. Circling back around, I think this is the key to why ethnography is so valuable. I was excited that Kleinman brought up Paul Farmer, who I think has done a great job of transforming ethnography into clinical, scientific use. I also think that oftentimes the utility of ethnography is poorly understood, and Kleinman’s article gives a good defense of it and provides examples of its utility.

  9. Great post Daniel! When explaining the Shia viewpoint on gamete donation and surrogacy, you pointed out that “this form of reproduction does not involve or require the physical act of sexual intercourse” and is therefore a legitimate means of reproduction that is not considered adultery or zina. I find this interesting when juxtaposed with the position of Donum Vitae, in which the separation from the act of sexual intercourse is the very thing that makes artificial reproduction illegitimate and therefore immoral. It is interesting how in one system of beliefs the separation from the act of intercourse is the thing that legitimizes assisted reproductive technology, while in another it is the thing that condemns it.

    I too was really struck by Teman’s assertion that surrogacy reveals that families are a social construct, and I have a problem with it. Just because an alternative method of something has been discovered and legitimized does not mean that the original method is automatically a social construct. For instance, if hiring the services of a hitman suddenly became legal and legitimate, that would not automatically make not murdering people a social construct. Admittedly, my opinion is biased by the lens of natural law and my own beliefs, specifically in that objective reality and truth exists and should be upheld. For someone who does not believe in an objective truth or a correct way that reality should be ordered, there is no reason to not think that everything is a social construct. I suppose it would be reasonable to say that in a world where hitmen are a natural and legitimate part of society, not murdering people would indeed be revealed as a social construct. Not that I’m equating surrogacy to hiring a hitman; I’m just attempting to point out that unless there is no understanding of objective truth and a way that the world should operate, alternative methods to something does not automatically reveal that something as a social construct.

  10. Great post Daniel. I agree with your point regarding the link between reproductive technologies and kinship within the two Muslim communities. “In the theoretical case between conception and gestation, in the case of oocyte donation or surrogacy, jurists ascribe full maternity to the woman who bears and delivers the child,”(163). Jurists of Sunni Islam regard motherhood to be linked to the woman who bears and delivers the child, and thus the woman who provides a womb for a couple is granted motherhood within this ideology. Thus jurists regard gestation as the integral component of motherhood, rather than who provides the oocyte needed for conception.
    I think your assertion that research surrounding surrogacy is inherently biased is well documented in Terman’s article. Questionares tended too assume the emotional negativity surrounding surrogate motherhood. When describing Jadva et al, she criticizes three of the categories that the woman may choose, suggesting that “the researchers assumed that the women did necessarily have some degree of doubt” as well as “imply that surrogates will have some degree of difficulties” and “bonds do exist in different degrees between surrogates and the children they bear, that these bonds are ‘‘special,’’ and that no such relationship is conceivable outside of these terms,”(1108). This suggests that researchers’ assumption, that surrogacy is abnormal behavior for women, influenced the structure of the questionnaire and therefore the results.
    Kleinman also argues a lack of consensus in Nie’s study of Chinese views on abortion according to different backgrounds. Citing Nie’s research, Kleinman argues, “there is no master narrative, no uniform cultural position on abortion. Rather, there is great diversity among all the groups involved; some doctors, women, and families support the state’s policies, while others (many others) contest and resist them, and still others articulate narratives of experiences that are complex mixes of official ideology, unique conditions, and individual agendas”(86). The statements regarding China’s stance on abortion, provided by “China experts” is by no means as conclusive as these experts suggest. The consensus represented by the states official stance is dismantled by unofficial voices. Thus when studying the views belonging to Chinese people from various backgrounds, local accounts are necessary.

  11. Thank you for your post!

    I really enjoyed Naef’s take on the various aspects of surrogacy and Muslim ideals that impact the way that motherhood is perceived. This article, in combination with Marcia Inhorn’s article earlier in the semester, helped me understand how Sunni and Shia Muslims may differ in their opinions on the use of ARTs. As we have discussed all semester, motherhood is a complex topic with no easy answers, and we have seen these Muslim scholars debate and use their experiences to show how Muslims see motherhood. Shia scholars seem to be split on how they see motherhood: some emphasize the woman who gave birth to the child while others emphasize genetic relations. Even other opinions exist as the idea of “milk siblings” would show.

    We discussed Arthur Kleinman earlier in the year as well. In his current writing, he discussed how ethics come to be based on each individual’s personal circumstances and experiences. He says that to truly understand one’s personal situation and how he or she balances ethics with morality, high-quality ethnography is necessary. I think that your description of Kleinman was well-done. He noted that ethnographers try to use their work to understand peoples’ local moral worlds; then, they try to apply these individual circumstances to the larger society they are studying. While I see the value in such an approach, it has its shortcomings. A scientist might argue, for example, that there using specific situations to representatively describe a larger population would be failing to account for the external validity of such a study.

  12. Why hello there Daniel,

    Thanks for your post. One comment you made in the middle of the post, “Yet although surrogacy shatters conventional religious beliefs surrounding motherhood, it also reveals that our entire belief in motherhood is entirely socially constructed,” regarding the Teman reading stuck out to me.

    Before taking this course, I hadn’t thought too much about if and to what extent motherhood was culturally constructed – in some ways, I assumed there was a biological argument because the concept of motherhood was so widespread cross culturally. While I still hold that there is likely a biological element, this course really made me question the extent of that biological element.

    What initially started my line of inquiry was the Thomson article regarding abortion and her use of the violinist analogy. That analogy showed me that while the structural elements of the two situations were the same, I was significantly more bothered by the “unhooking of a dependent life” in the case of the child even though the two lives should be equal with pro-life logic, and with pro-choice logic the fetus isn’t even considered a human life yet. Thus, somehow along the way I have picked up a habit of valuing the lives of babies, even those unborn, over that of a grown adult; and is this response biological or conditioned? To me, this cannot be a purely biological response for we learn values this complex through community and surrounding culture.

    I’d be interested in exploring how kinship is expressed towards children in other cultures – are they as valued and revered as they are in Western America? And if not, does the society value or construct motherhood differently? Is there a relationship between the kinship of society at large to children and the place of mothers in society? If so, I would argue that motherhood is more culturally constructed than I expected at the beginning of the course and if not, that there is a definite biological component.

    Anywho, thanks for your time in writing this post!


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