Religion and Bioethics Spring 2019

Thomson takes the stance that “while I do argue that abortion is not impermissible, I do not argue that it is always permissible” (65).

 

First, Thomson counters the common arguments of anti-abortion discourse. Under the premise that human life is defined to begin at conception and all abortion is immoral, Thomson juxtaposes choosing between the right to life of a woman and her unborn child. As both have an equal right to life since both are human, opponents of an abortion in this scenario argue that it is “(3) as one’s duty to refrain from directly killing an innocent person is more stringent than one’s duty to keep a person from dying, an abortion may not be performed. Or, (4) if one’s only options are, directly killing an innocent person or letting a person die, one must prefer letting the person die, and thus an abortion may not be performed” (Thomson 51). Thomson deconstructs this argument with a parallel example of a body-hijacking violinist who abducts a person in order to use their kidneys for 9 months in order to filter the violinist’s own blood and save the violinist from imminent death, and at the end of the 9 months the violinist would live and the abductee would die from kidney failure. Thomson insists that our modern sensibilities think it just  that the abductee be allowed to unplug and thus allow the violinist to die because the violinist has no right to the abductees body: “If anything in the world is true, it is that you do not commit murder, you do not do what is impermissible, if you reach around to your back and unplug yourself from that violinist to save your life” (Thomson 52).

 

Thomson goes on to point out a sexist fallacy inherent in concerns about the moral implications of 3rd party actions in answer to a request from a woman for an abortion. The typical train of thought defines what a mother is allowed to do by what a third party is morally allowed to do, but “But it seems to me that to treat the matter in this way is to refuse to grant to the mother that very status of person which is so firmly insisted on for the fetus” (Thomson 52). Thomson redefines the issue as such, giving the mother equal weight as a person and decisive agent in the scenario: “Both are innocent: the one who is threatened is not threatened because of any fault, the one who threatens does not threaten because of any fault” Thomson 53). However, there is also a power dynamic at play between the mother and her child. While both are considered equal human beings in this scenario, one is the mother and owner of the “house” or body, and the other is a fetus and an outsider that has either trespassed or once been welcomed in the the house but has began to threaten the owner’s life. Thomson uses another metaphor, of the “house” and the body, to argue that a woman’s right to her body undeniably allows a third party action to justly act on her behalf to save her life and her house from the trespasser. In essence, the right to life of the child is superseded by the right of the mother to control her own body.

 

Central in this discourse is the idea that no other person has the right to another’s body, even if the use of your body will save their life, and thus, according to Thomson, abortion is not completely unjust. However, while abortion is not an unjust act in Thomson’s eyes, she delineates between moral neutrality and what is viewed as socially decent through a surprising reference (at least to me) to religion. Thomson argues that when Jesus commanded his followers to be good samaritans, it “was not morally required of any of the thirty-eight that he rush out to give direct assistance at the risk of his own life, and that it is not morally required of anyone that he give long stretches of his life”… “to sustaining the life of a person who has no special right” to the samaritan’s body (Thomson 63). Furthermore, she deduces that taking responsibility for someone else is an act of Good Samaritanism, a social human decency, and that in her opinion the benchmark for actions towards other human beings should not fall below that which is “minimally good samaritanism.” Here the grey area of Thomson’s argument presents itself for she uses this ambiguous standard of “minimally good samaritanism” towards the fetus as a line in the sand to separate what is a just and unjust abortion in non-problematic pregnancies (Thomson 65).

 

In line with the discipline of philosophy, Thomson’s argument is almost sterile, devoid of reference to American cultural concerns. Contrasting, Faye Ginsburg demonstrates that the pro-life assertion that human life begins at conception is a rationale situated within a complex cultural critique of the evolution of American gender constructions and the subsuming of nurturance as a core value to that of materialism and egoism. The assertion that life begins at conception is symbolic of larger concerns about the degeneracy of American culture, and Ginsburg makes clear how hopelessly intertwined the two are … which raises the question, what came first, the chicken or the egg?

 

Ginsburg opens her ethnography of a abortion clinic in Fargo, North Dakota with the history of abortion in America. Abortion was an accessible and widespread practice, performed up to until 5 month gestation, with little stigma in 19th century America, and surprisingly the agents of change surrounding abortion litigation prior to the 1960s were doctors. Around the 1860s-1880s physician’s pushed to make abortion wholly dependent on professional medical judgement in a play to grab control of their profession and lower competition of outside abortion providers. Due to the influence of physicians, abortion became illegal unless it directly endangered the life of the mother. Allied with anti abortion physician’s but for different reasons were 19th century feminists who largely saw abortion as a promiscuous, upper-class male’s backup plan and thus societal safeguard for the consequences of unrestrained male sexuality, greed, and materialism on defenseless women. As time went on, women still did not mobilize against abortion due to societal preoccupation with eugenic and sexist arguments of “race suicide” and “maternal instinct.” In fact, medical procurement of abortion did not reach national significance as an issue until the 1950s case of Finkbine’s denied abortion of her fetus with thalidomide-induced deformations. While doctors yet again sought legal reform of abortion, this time to evade litigation suits, feminists were not aligned with the doctors unlike in the 1860s. Thus, the modern conflict we know today of pro-life vs. pro-choice began to take form.

 

Ginsburg goes on to detail the events of the 1950s-1970s, interweaving the rise of the New Right, Hyde Amendment, group strategies for litigation vs court appeal, and the Roe v. Wade decision. By including the national picture and discourse, Ginsburg is astutely able to narrow into the local moral world of Fargo, North Dakota, and contrast/explain the national with the local “social drama—moments of revelation of social divisions when ‘people have to take sides, in terms of deeply entrenched moral imperatives and constraints”(62). Most inducing of social drama was the Roe v. Wade decision. Roe v. Wade demonstrated to the pro-life constituency that the courts and legislature had taken the side of pro-choice, and therefore the pro-life strategy “shifted the grounds of the conflict to the “gray areas” left unclear in the Court’s decision—questions regarding a woman’s rights to have access to abortion—and aimed at restricting the delivery of abortion services through whatever means possible” (75). Thus, the polarization of sides in Fargo and the onslaught of picketers outside the Fargo clinic, the opening of Fargo dummy clinics, and other subversive strategies of pro life activists began.

 

After an ethnography of the local positions of Fargo pro-life and pro-choice activists and their “procreation stores,” Ginsburg concludes with an analysis of the why behind each position. As Ginsburg succinctly puts it, “ Each position represents conflicting interpretations of the shifting social consequences of and connections between sexual activity, reproduction, and motherhood for women in American culture” (213); Ginsburg asserts that both positions are feminist in their own interpretation of the word.

 

Through ethnography, Ginsburg frames the pro-life opposition as arising due to the widening possibilities of female narratives in society that exist outside the domestic sphere. For pro-life proponents, the unique ability of women to bear children and the associated nurturance and motherhood qualities attributed to the “woman” identity that a man cannot possess are jeopardized by abortion’s ability to destabilize the natural progression surrounding the creation of a family unit (marriage, sex, birth, not necessarily in that order) and thus threaten the cultural value of motherhood. Furthermore, abortion conceals the result of illicit sexual relations in the view of pro-life advocates, and, as pro-life activist Roberta from Fargo echoes, “easy access to abortion as decreasing women’s power by weakening social pressure on men to take emotional and financial responsibility for the reproductive consequences of intercourse” (190,214).  Pro-life proponents view pro-choice opposition and logic as “culturally male—sexual pleasure and individual ambition separated from procreation and social bonds of caretaking—is set against their own identification of ‘true femininity’ with the traits of nurturance that are, in American culture, conflated with motherhood”(205). In contrast, pro-choice proponents do not celebrate the culturally constructed differences between men and women but rather seek to equalize men and women in society through allowing motherhood to be a choice at all times that does not then define a woman’s identity.  

 

While modern discourse often pits them against each other, Ginsburg paints the coexistence of pro-choice and pro-life activists in Fargo, North Dakota as undeniably rocky but not without a local respect and acknowledgement of mutual motivation: protection of what each defines as the right of women.

The reading by Ginsburg discusses the debate of abortion in Fargo, a rural community in North Dakota, during the early 80’s. This particular instance is a good example of the many discourses on abortion that occured in the United States throughout this time. The debate was sparked when the Fargo Women’s Health Organization opened, which allowed abortions, birth control, and information on sexual health to become accessible for the first time. The clinic catered to many people in surrounding areas despite the numerous amount of protests that occurred outside of the clinic. Many of the patients receiving abortions were typically young, unmarried women, who did not plan to be sexually active and became pregnant from the lack of preventative measures taken. Although abortions have become increasingly common since they became legalized in 1973, the introduction of the clinics where majority of abortions occur, was/is quite difficult to establish due to the social acceptance of abortions. When inspecting an area’s acceptability of abortion, religion must be considered as a major influence. In Fargo, Christianity is extremely prevalent and therefore may be the root cause to many of the pro-life opinions shared throughout the area. Majority of activists on both sides of the debate are white, middle class females. “Pro­-choice activists consider inequalities between the sexes to be rooted in social, legal, and cultural forms of gender discrimination” (Ginsburg 7) and therefore abortions are viewed as a way to create equality between man and women that pregnancy often disrupts. “Pro-­life activists, on the other hand, accept difference, but not necessarily hierarchy, in the social and biological roles of men and women” (Ginsburg 7) and therefore feel the need to maintain and protect pregnancy/motherhood as a defining quality of womanhood. Furthermore, pro-life activists view abortion as a disregard to the the link between reproduction and male support of family.

Ginsburg outlines three major themes in the connection between abortion and american culture. The first theme concerns irresponsible sexual activity as being a natural occurrence for men and an unnatural occurrence for women. The second theme emphasizes the unjust disregard for those that are dependent such as the fetus, disabled, and elderly. The third theme critiques the power behind and authenticity in human relations, and how abortion questions these elements.

In her analysis, Ginsburg also comments on how the increase in the amount of women joining labor force, and the availability/safety of new reproductive technologies might sway people’s opinion of abortions. Women now have more options as to the path they chose in life in terms of career and family. Historically, abortions were commonly practiced and only made illegal by those wanting to protect the lives of the dependent, and physicians attempting to gain control of their practice. Furthermore, some scholars claim abortion was made illegal to combat the decline of birth rates in the United States, and some feminist even claimed that abortion promoted actions stemming from male lust. It’s interesting to note that those who created the stigma around abortion including physicians and feminists, were those trying to legalize it a century later. Similarly, religion was much more passive in the abortion discourse in comparison to modern times. From the late nineteenth century with the campaign to criminalize abortion, to the 1960s pro-choice movement, and finally to the legalization of abortion in the twentieth century, attitudes and acceptability of abortion have fluctuated. However, although abortions were legal, they were not available to many people. Of the clinics and hospitals in Fargo, none of them offered abortions for fear of the stigma and backlash they would received from pro-life activists in the community, therefore opening a free standing clinic was not an easy task. After much debate and political/legal difficulty surrounding the opening of the clinic, those seeking services of the freestanding clinic were faced with pro-life activists that encouraged women to consider other options. Pro-life activists used tactics such as prayer vigilants, sidewalk counselors, movies, and other forms of media/advertising. A major theme throughout the pro-life activists goals was to educate those seeking abortions because they were deemed uninformed about the life of the fetus. But many of the tactics used, including the advertising, use of “counselors”, similar names of the activists groups, and indistinguishability between the people made it easy for those seeking abortions to come to pro-life establishments. This resulted in many legal cases that eventually favored thr Fargo Women’s Health Organization, and ultimately made the two sides of the abortion debate distinguishable.

However Both the pro-life activists and pro-choice activists, as demonstrated through ethnographic accounts, recognize each others interest and concern for the well being of women. There have been instances where the clinic has referred women to the pro-life community for financial support and moral support in her desire to the children. Since the establishment of the Women’s Health Organization clinic, there have been debates and conversations between the activists on both sides that has resulted in an understanding of each other’s viewpoints. Both sides have come to recognize that good intentions placed for women in the community, despite the disagreement on the practice of abortion.

 

The reading by Thompson begins by critiquing the common claim opposing abortion that states how humans cannot pinpoint an exact moment in which the fetus becomes a person. The development of the fetus is continuous, and is therefore a person from the moment of conception. Thompson agrees that the fetus has likely become a person before birth and to draw a specific line to where personhood begins is somewhat arbitrary. However, a newly fertilized ovum, according to Thompson, is no more than a clump of cells. The argument is that the fetus is a person, regardless if one disagrees or agrees, is not sufficient because it does not link the status of the fetus as a person to the impermissibility of abortion. Thompson goes in to understand this missing link by proposing that the fetus’s right to life is more important than the mothers right to decide what happens with her body. But in considering situations of rape is this claim still justified? Many people would argue that pregnancy resulting from rape would permit an abortion, but in making that claim, a fetus as the product of rape has less right to life than a fetus resulting from an unintended or abnormal pregnancy. For this reason, some do not see abortion as permissible in the case of rape, or even in cases where the mother’s life is threatened, though not many people have this extreme view.

Thompson goes deeper into the argument of how a fetus might threaten a mother’s life, and the permissibility of abortion in that instance. Are the rights to life between the mother and child equal? Many believe that abortion is killing the child, but not doing anything with the mother is not necessarily killing her. Thompson claims that “it cannot seriously be thought to be murder if the mother performs the abortion herself to save her life” (Thompson 52). To let the mother just wait for her death to come is rather ridiculous. However, many mothers cannot safely or accurately perform an abortion themselves and need a third party in order to do so. Thompson claims that not all acts of self defense are justified, but in this case “both are innocent” and “there are only two people involved, one whose life is threatened, and one who threatens it” (Thompson 53”). Therefore it seems that decision rightly belongs to the mother. The argument continues saying that we cannot intentionally kill individuals, but when a person is dependent on an individual for survival, that doesn’t mean that individual must assist the dependent person. The individual does not owe the dependent individual assistance. So Thompson concludes that “the right to life consists not in the right to not be killed, but rather in the right not to be killed unjustly” (57).

The mother’s responsibility for inviting the fetus into the world questions her right to abortion, because the invitation was voluntary. However, this question of responsibility cannot be extended to instances of rape, and even in instances of unplanned pregnancies. Just because a window of opportunity is opened, does not necessarily imply intentions of becoming pregnant. Therefore just because it would be more favorable and decent to help another individual, not doing so would not necessarily be unjust. Of course saving the life or helping another individual in need would be a good thing to do, especially when trying to be a “Good Samaritan” as instructed in the bible, but no law says one must be a Good Samaritan.

The reading concludes with her claims that an individual is not responsible for carrying a child she does not wish to have, but does not have the right to guarantee the child’s death. In other words, the fetus does not have the right to the mother’s body, but the mother does not have the right to ensure the death of the child should it become birthed or survive in some way. However, throughout this entire argument it is assumed that the fetus becomes a person from the moment of conception, which is of course a different but related debate.  

 

The reading by Arkes begins with discussion on the Supreme Court Case Roe v. Wade, as a significant landmark in the abortion debates. In the case, Justice Blackmun states that pregnancy will always be with us as long as man is present and that many women will become pregnant more than once in their lifetimes. We cannot use religious or theological accounts to make these decisions because claims cannot be judged as completely true or false. The question of what makes a human arises, and it is concluded that the determining factor cannot be left to appearances or anything tangible, but rather “consciousness” (Arkes 374). However, we have a difficult time in defining what consciousness is and how to measure it. Many people do not have moral understandings of their own acts and motivations, and therefore would not be considered as persons. These attempts in defining consciousness are really just attempts to define when a fetus becomes a person, and allow us to disregard other tangible measures from the brain or heart.

Arkes goes into explain that a fetus is not a potential human, because it’s not possible for the fetus to become anything else. Rather, the fetus’s development is continuous and became more developed as time passes. Therefore there is no point in development where a nonhuman becomes a human. Arkes makes the claim that if the the offspring can only be human, it’s not always wrong to kill if one has justification for doing so. Rape may be a good justification, but we also must consider poor mothers, or those who cannot emotionally handle a child as possible justifications. Furthermore, the wellbeing and welcoming of an unwanted child should be considered as a justification.

 

To truly understand a perspective we must have some framework or background in which to explore the perspective as it relates to a community and individuals within that community. Bhattachary specifically advises against creating a “Hindu ethic” less it be exclusionary to large confounding factors such as location- this to say the American Hindu ethic might have noticeable differences than the Sri Lankan Hindu ethic; and the New York American Hindu ethic might be much different than the Sea Coral Drive in San Diego California Hindu Ethic (Bhattachary 3). As such I feel the framework provided by Simpson in Impossible Gifts which is based both in policy/regulatory history and fieldwork experiences with clinicians provides a viable framework as it considers the bi-directional relationship of culture (individualized beliefs, religious myths, and behaviors) and institutional policy (Simpson 840).

With Theravada Buddhism being the state religion of Sri Lanka, it is reasonable to say that the two are fairly intertwined; and thus, views historically held by Sri Lanka which were dependent on Buddhist philosophy might aide in extrapolation of their view on up and coming phenomenon such as IVF. Theravada Buddhism stresses charity and donation as a means of ethical development in aide of removing the ego and becoming above oneself. This idea of giving is broken down into levels consisting of worldly goods, body parts, and life (Simpson 841). Practically, this translates to donating blood being a very common occurrence in Sri Lanka- going so far as to having blood donation centers at religious events not being an uncommon sight.  Simpson tells of a man relaying to him the notion that he hopes he ties from a brain hemorrhage so that little damage is done to his body and as much of it as possible can be donated.

These beliefs extend to the world of policy in many ways but is chiefly illustrated by eye donations. Sri Lanka leads the world in eye donation and so much so that the supply of donated eyes outstrips the need for new eyes in the country leading to groups being put in place to manage the export of eyes to over sixty other countries, irrespective of their cultural identity (Simpson 846). Furthering this notion that giving is a cornerstone of the Theravada and subsequently the Sri Lanka culture.

It is with that said and before I transition into IVF and such that I want to recognize this idea that the Sri Lanka culture and the Theravada Buddhist beliefs are i) not monoliths and ii) not inherently identical. Simply because a religion says to live one way and because a country is a majority of that religion does not mean every individual in that country will treat every situation the same and draw the same conclusions from a given situation. As such policies must be passed. such as outlawing the sell or purchase of body parts, tissues, and fluids in Sri Lanka, providing tangible consequence to actions deemed immoral (Simpson 850). This also explains why certain dissenting opinions exist such as those individuals who worry about the export of eyes to countries of different cultural make up- no individual exists in a vacuum.

As with every country some individuals have reproductive barriers and the idea of donor insemination isn’t a new one, but in the 1900s Sri Lanka decided that for the public good they would form and subsequently regulate sperm banks (Simpson 852). Simple enough but one major problem got in the way- lack of donors. Well that happens to the best of business and the solution is simple- advertise! For some strange reason advertisements asking for sperm donations were not deemed acceptable by the public conscious so the question had to be asked- what underlying cause is stopping the Sri Lankan people from donating sperm? If blood and eye donations are such a hit why does that not extend to sperm donations?

One major problem Simpson found was stress- for every individual on every side of the donor insemination, IVF with donated sperm, etc. debate there was stress (Simpson 852). Stress about questions of infidelity. Stress about questions of personal identity for the child. And, stress about the collection method of samples to be donated. When physical pleasure is minimized to become less associated with your physical self it is hard to justify the methods associated with giving a sperm sample. So the conclusion is simple, the Sri Lankan Theravada Buddhists are not in favor of IVF, right?

Let’s look at the other half of IVF- ova donation. The collection of ova involves surgery and thus physical pain solving the last problem (Simpson 854). Socially, Simpsons found, women were more likely to help others in the ingroup dissolving questions of infidelity. Reproduction isn’t associated with some physical act as explained by Bhattacharyya so there is no immediate objection to the IVF itself (Bhattacharyya 52). In short, there are no religious qualms with ova donation.

Thus, it seems there are no major problems with IVF as a technology and utilizing IVF as a means to create progeny, but the question of will or won’t a society adopt a technology is filled with nuance which can’t be answered solely by historical contingency or by analyzing religious values without context. Culture is a fluid thing which can answer many questions if applied correctly, but no country is a monolith and no people are all the same. I have to wonder though, to what extent to these religious considerations survive outside of the majority? Are Hindu bioethics surviving on Sea Coral Drive in San Diego California?

In Swasti Bhattacharyya’s book Magical Progeny, Modern Technology, she discusses the Hindu perspectives on reproductive technologies, including IVF, adoption, and surrogacy. To do so, she cites many traditional Hindu stories, relying primarily on the Mahabharata and the messages it carries. In addition to this primary goal, Bhattacharyya also speaks extensively about the importance of cultural competency in a clinical setting, as well as the presence (or lack thereof) of religion in both academia and clinical environments. Bhattacharyya sets the scene by stressing the relevance of incorporating Hindu perspectives into bioethics debates. In the United States and globally, those ascribing to a Hindu tradition are numerous and growing, yet bioethics tend to be centered around Christian and Judaic perspectives. The importance of learning from and about different perspectives is increasingly important as America continues to become more diverse, and second/third/fourth generations immigrants formulate their own unique worldview that incorporates a great many set of identities. These religious beliefs underscore the perceptions and actions of many people, but religion tends to be marginalized in academic settings and poorly understood in clinical settings. This problem has seeped into bioethics discussions as well. But to cast aside religious perspectives is to leave out the most important factor for individuals when dealing with dilemmas involving life, birth, and death. It is therefore important and relevant to expand current religious influences on bioethics to include perspectives that accurately represent what individuals deal with when considering procedures such as IVF or abortion.

Hindu perspectives on reproductive technologies present themselves quite differently from other religious traditions. Whereas it was simple for us to read Donnum Vitae and understand wholly the position of Catholicism on reproductive technologies, there is no one central Hindu authority, or even a clear consensus about what a “Hindu perspective” would entail. It is multivalent, subjective, and malleable, and focuses more on acting ethically in a given situation rather than establishing absolutes. Bhattacharyya reconciles this by presenting a foundation of Hindu values and stories from which they’re drawn, and then discusses the perspectives that could be formulated from them. The mythologies presented in the Mahabharata serve as Bharracharyya’s key evidence for how Hindu perspectives about ART are structured. These stories discuss extensively the ideas of childbirth, procreation, kinship, and lineage, and include many fictive parallels to modern day reproductive technologies. Mythical stories about gods as sperm donors, surrogacy, adoption, exogenous birth, and more, establish an already fairly liberal precedent for the modern day equivalents of these stories. The characters in the Mahabharata “reflect a creativity and moral openness” (99) in finding ways to circumvent “normal” procreative processes. The author then identified six Hindu characteristics that embrace “a diversity of thought and experience”: emphasis on societal good, unity of life, dharma, the multivalent nature of Hindu thought, karma, and commitment to ahimsa. Each of these parts can be easily applied to bioethical debates about ART—for example, the idea of dharma and a woman’s responsibility to fulfill her childbearing responsibilities. All of these six characteristics intersect to provide a diverse, complementary worldview where alternate views are not only tolerated but are welcomed and internalized. The case study of Jacyee Buzzanca exemplifies this commitment to “viewing and honoring the views of life from many perspectives” (97) and is compared/contrasted to a Roman Catholic perspective, a tradition much more concerned with establishing absolutes and universal rules.

A Hindu perspective on bioethics and ART is one that contains ideals commonly represented in religious traditions—ideas of doing no harm, responsibility for actions, and one’s prescribed role in this world. However, the way that these concepts come together is quite unique, and is a perspective that is important to incorporate into bioethical debates. In many cases, involving religion tends to place limits on what one can and cannot do. Hinduism opens it back up and provides grounds upon which case-by-case moral dilemmas can be creatively managed.

The article by Bob Simpson, Impossible Gifts, takes yet another approach to viewing reproductive technologies, as well as organ and tissue donation. Interestingly, he talks about Ayurvedic medicine and how sperm donation is not a well-received practice due to issues of paternity. This contrasts quite heavily with the previous reading about Hindu bioethics, which also have links to Ayurvedic medicine. Beyond this, the article gives another very distinct view of tissue donation as “gift giving,” a practice deeply rooted in Buddhism that carries a lot of weight. Both of these readings truly show the process of “inventing bioethics” and how groups come to form their own ideas of what is moral and right.

After reading and reflecting on both of these very nuanced schools of thought, I wonder if we will ever reach a point in America where all of these diverse opinions will be incorporated in bioethics conversations? America, although nominally secular, definitely takes Christian viewpoints more seriously than others. Will Hindu or Buddhist perspectives ever carry much weight when it comes down to making legislative decisions about what is right or wrong?

Swasti Bhattacharyya wrote and published Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology in 2006. Dr. Bhattacharyya is a professor of philosophy and religion and has a background as a nurse. Her healthcare background provides her insight into pragmatic bioethics with consideration of Hindu and Indian ideologies.

Bhattacharyya acknowledges that Westerners have reified religion, and consequently, dominated discussions while non-Western voices have mostly been excluded from shaping American ideology, including bioethics, despite the ever-expanding pluralism and diversity brought in and cultivated by immigrants. Religion permeates through our ways of being and is inseparable from culture, philosophy, politics and the social, which is why cultural competency, or cultural humility, is necessary for medical competency. It is necessary to listen to perspectives that are different than our own in order to understand people and communicate effectively because no one knows everything, and we cannot expect to intuitively know everything. So, here we are, listening to what Dr. Bhattacharyya has to say about Hindu bioethics while keeping in mind that Hinduism has many facets and voices. If I had to choose an excerpt from the book to reflect what Bhattacharyya wants to highlight about Hindu thought, it would be this:

“Rather than focusing on prohibiting various actions, the Hindu ethic… emphasizes the presupposition that all are ultimately interconnected, that each of us has a particular dharma a commitment to ahimsa, and that karma ultimately holds each of us responsible for all of our actions” (108).

Dharma is difficult to define but essentially informs people how to behave. Individuals should live on “a path of ahisma, ‘no harm’ or nonviolence’” and act with nonmaleficence and benevolence (73) with consideration to the greater good of society because everything is interconnected and interdependent. Individuals should also live with respect to karma, which means “action,” that fundamentally “ is the cause of current situations and the determinant for the future… making humans directly responsible for both the positive and negative fruits of their actions” (73).

These elements are highlighted by the Mahabharata, a wide-read and influential text that includes narratives that inform Hindu and Indian way of life. For example, if we look at stories about Kunti, Madri, and Gandhari, we find that matriarchs participate in actions that can be related to reproductive technology. Kunti rejected niyoga, which is a “levirate marriage or traditional practice that allows a women to have sexual intercourse with a man other than her husband for this express purpose [of producing heirs]” (35) and instead, she used a mantra gifted by the God Durvasas to produce three sons engendered by the gods of her choice. This was a form of genetic selection and models modern sperm donation. Niyoga reminds me of Jewish law, which allows temporary marriage for the purposes of conceiving children. Similarly, Madri used Kunti’s mantra to produces sons engendered by the God of twins. Gandhari’s story involves an extended pregnancy that produced a ball of clotted blood. After asking a God to give her the 100 children she was promised instead of a clotted ball, Gandhari was given instructions that allowed her to create 100 embryos out of the clotted blood, and she used clay pots to incubate the embryos. A connection could be drawn from this story to “’artificial wombs’ that gestate the developing embryos until they are brought to term” (46) as well as modern day “Clomid (clomiphene citrate), IVF, GIFT, ZIFT, etc. which often result in development of multiple embryos” (47).

These narratives illustrate the importance of procreation and kinship for the purposes of continuing the family line. Bhattacharyya says that “there are few if any limitations on the utilization of creative means in one’s attempt to produce [a] son,” and the Mahabharata would condone surrogacy, sperm donation, gene selection, and embryonic manipulation based on the stories (51-52). Unlike the Catholic Church’s clear stance against conception without sexual intercourse, the Mahabharata does not consider the act of sexual intercourse necessary for procreation. Additionally, the matriarchs of the Mahabharata stories take control pretty much as equally as the Gods. This contrasts the stories in the Bible where God takes charge of procreation and humans to have little to no control. Biblical stories of Abraham and Sarah, Issac and Rebekah, Rachel and Jacob, Elizabeth and Zechariah as well as Mary illustrate God’s control over procreation. To that end, the stories of Tamar and Judah, Naomi and Ruth show us that humans can still take some control.

Bhattacharyya shifts from narrative to pragmatic bioethics and introduces us to the case of Jaycee Buzzanca. John and Luanne, a married couple, decided to use IVF to conceive Jaycee, and commissioned Ms. Snell to be the surrogate mother. After the fact, John claimed “dissolution of marriage” and did not wish to financially support Jaycee (78), but the California Court of Appeals ruled that “even in the absence of a genetic or biological relationship, parental relationships may be established when the intended parents initiate and consent to reproductive medical procedures” (79). The court considered individual rights and what would be best for individuals, which reflects American cosmology.

Hinduism, on the other hand, puts emphasis on individuals in the context of their communities and societies. Hinduism does not construct a rigid definition of family and does not require people to be blood-related in order to be considered family. “Family” could include immediate family members, extended family members, neighbors, or community members. A father would not necessarily need to be biologically related because Hinduism is more concerns with the father that “invests time and energy in the process of raising the child” (92). To that end, since John intended on creating Jaycee and was circumstantially able to provide a means of support for Jaycee, then John was obligated to do so according to the dharma of parenthood. Hinduism emphasizes that for the good of society, parents like John need to see their commitments through and take responsibility for their children. It is important to point out that, unlike the Catholic Church whose opinion on conception and responsibility to children is black and white, Hinduism dabbles in liminal space and considers circumstance, intent, dharma, karma, and ahimsa, which can modify the results and ethical implications of cases. All in all, if we take lessons and make bioethical interpretations and applications based on the Mahabharata, we should make decisions and carry out actions that maximize elements of dharma, karma, and ahimsa.

Reading Magical Progeny, Modern Technology, I wonder how the American healthcare system can include voices that have historically been left out and integrate these voices into its systems. Do medical schools have education on medical ethics involving culture and religion? Should healthcare workers be held responsible for understanding different cosmologies or should religious consideration and consult be left to pastors, rabbis, and chaplains?

 

In her ethnography, Embodying Culture: Pregnancy in Japan and Israel, Tsipy Ivry uses her own experiences with pregnancy and her research on the topic to compare and contrast two widely different medical systems. Both Japan and Israel are non-Western, highly industrialized societies that provide medical facilities and insurance subsidized by the government (Ivry 20). Their differing religious and historical backgrounds heightened Ivry’s interest in the matter and helped her understand that “there is much more to pregnancy than merely the transitory stage to birth and motherhood” (Ivry 1). She discusses the importance of understanding pregnancy as much more than just reproduction and uses Japanese and Israeli beliefs to do so.

 

One of the most polarizing characteristics between Japanese and Israeli doctors is their perceptions of the health of the patient and what constitutes as “good” or “bad” during pregnancy. Israel’s pro-natalist state provides national health insurance to their citizens, which cover most costs of gestation. As a result, Israel has the highest rate in the world of IVF clinics and has more lenient abortion laws (Ivry 38). Among the many services covered by health insurance are diagnostic tests that can detect abnormalities in the fetus. Having access to such tests has lead to a heightened awareness and resulting paranoia about knowing the health status of their baby. Ivry mentions that “the word ‘hysteria’ is often used, by doctors, male partners, and relatives, and sometimes even by women themselves, to signify an anxiety about possible abnormalities in the fetus” (Ivry 47). The women become dependent on the doctors to constantly reassure them that their baby is fine and are depicted as an external bystander of their own pregnancies. The doctors’ main concern is that the women fully understand all aspects of their own health, and the health of their fetus,  and are thus recommending procedures that are in the best interest of their patients, making them less tolerant of patient’s personal decisions (Ivry 76). Contrarily, Japanese prenatal care is focused much more on the natural changes during pregnancy and how they can affect the health of the baby. The health progression of the baby is connected with the woman’s “conduct of her daily life” (Ivry 92). Japanese doctors stress the importance of keeping the “maternal environment” as safe and healthy as possible and as a result, the fetus will grow with little complications. The patients are not as enthusiastic about prenatal diagnostic testing because they are not as threatened by statistics on fetal abnormalities. Women spend much of their pregnancy monitoring all aspects of their lives including diet, work and travel in order to ensure that no harm will be inflicted upon the fetus.

Furthermore, the way that women experience their pregnancies are significantly distinct. Japanese women and society stress the importance of bonding with the fetus while it is in the womb. The mother will often take time off of work beginning at about month five of gestation so that she can spend time with the fetus. She will talk to it, sing to it and touch her belly often in order to ensure that her baby knows that he/she is safe and wanted. The doctors also participate in this bonding by personifying the fetuses during check-ups and ultrasounds. As Ivry mentions in her work, such theories of prenatal bonding “designates women as the primary creators of the children: with every breath they take, every move they make, women make their children” (Ivry 165).  Unlike Japan where the pregnant women are virtually hidden, in Israel pregnant women are “highly visible” (Ivry 187). They do not take nearly as much time off of work and are not worried about their diet or weight gain during pregnancy. Israeli state is also more inclusive of men in gestation by providing pregnancy classes for both the mother and father and allowing the father to attend routine check-ups. Israeli society often separates the woman and the fetus, which allows them to continue on in their “normal lives” without disruption from the pregnancy.

Ivry effectively describes the pregnancy in Japan and Israel and highlights gestation as a cultural category in need of more social analysis. After reading her work, I was shocked by the wide variation of views on gestation were and how such a common natural event can be treated with such unique/varied procedures. I also wonder if Western societies, who are so stringent about prevention of diseases, would relate more with Israeli medicine or Japanese? We discussed in class last week that biotechnology is not culture-neutral and ideas about risk vary from setting to setting, which can be seen Ivry’s descriptions on Japan and Israel. Pregnancy is a universal event and is much more than just the physical changes that occur. All aspects of gestation can be understood in matters of cultural values and societal perceptions of humanity.

The attitudes towards pregnancy are highly different in separate regions of the world, as analyzed by Tsipy Ivry in her book Embodying Culture: Pregnancy in Japan and Israel. From how women are treated to abortion policies, each region has adapted their own unique cultural perspectives on pregnancy. For Japan and Israel, they can be effectively summed up by environmentalism and geneticism, respectively.

Japan’s environmentalism is entrenched in its history of eugenics. In the past, they had sterilized those with undesirable traits but later adopted a stance of “taking care of oneself/the body (odaijini)” to produce better babies (Ivry 127). This shift to taking care of the women has become a large aspect of how the Japanese treat gestation. From a careful diet to reducing anxiety and stresses on the pregnant woman, the health of the mother is core in predicting how healthy the child will be. The Japanese do not necessarily scorn birth defects such as Down Syndrome (Ivry 173); in fact, women, unless they were raped or do not have the financial means to support the child, cannot opt for an abortion. Japanese pregnant women are seen as “less threatening” (Ivry 26) because of this attitude towards children born with Down Syndrome and abortion. Wrongful birth suits are not so much seen as cases for delivery accidents.

Pregnancy in Japan has been cultivated to manage the mother and instill habits to create a bond between parent and child. Though pregnancy is “less medicalized, supervised, and socially manipulated” in Japan than in Israel (Ivry 4), there seems to be a fundamental different system of values in place. Pregnant Japanese women are heavily encouraged to monitor their diets and even talk to their children while they are still in the womb to encourage intelligence and a stable relationship once the child is born.

Israel, in contrast, has adopted an attitude of diagnosing the fetus (Ivry 4). Israel’s geneticism involves a rather fatalistic view that genes and chromosomes of their child are beyond their power. Notably, obgyns push mothers to take many more tests to monitor the health of the developing child. Though pro-natal, Israel has a rather lax policy on abortions. Despite constant legislative attempts to reign in leniency, a “defective fetus” is permitted to be aborted if the mother so desires (though may encounter some resistance past the third trimester) (Ivry 39). The conception of a child does not appear to be featured as prominently; some women cited that they “could hardly imagine…speaking of “babies” in the early stages of pregnancy” (Ivry 2). Doctors are highly stringent in their regiment of testing. Every pregnancy is at high risk of fetal catastrophe, especially given the concept of “Jewish Diseases.” The fetus is meant to be diagnosed rather than formed a bond with.

Both cultures have a wildly different outlook on how pregnancy should be treated—it is a time that should be treated with extreme caution, but Japan and Israel heavily differ on how they handle pregnant women. Though an objective truth might state that neither culture is “more correct” in how they treat pregnant women, would Western culture favor a Japanese viewpoint or an Israeli viewpoint?

Testing Women, Testing the Fetus : The Social Impact of Amniocentesis in America by Rayna Rapp is a book rich in anthropological research, documented participant observation, personal accounts of pregnant women and fathers of fetuses, and analysis centered around amniocentesis. Rayna explores the social impact of amniocentesis through 11 chapters, beginning with the methodology and routinization of prenatal diagnosis and concluding, appropriately, with a hopeful concept of endings serving as new beginnings. Rapp does an incredible job of informing the reader of the history of prenatal diagnosis and background on amniocentesis, which I believe is paramount to understanding the racial, cultural, and socioeconomic underpinnings of prenatal diagnosis’ impact on expecting mothers. Through the educational foundation she sets with readers, Rapp connects amniocentesis with an array of questions and topics; ethics, ableism, religion, cultural and ethnic background, and maternal responsibility are part of the many constructs that Rapp investigates. 

Ethics plays a large role in Rayna Rapp’s critique of the development of prenatal diagnosis and, through her third chapter on the communication of risk, sheds light on the interconnectedness of eugenics and genetic counseling. The rise of eugenicists, scientists who study the discipline of improving the human population through selective breeding, largely brought to life the field of genetic counseling; the avenue through which amniocentesis results are communicated. Rapp discusses the concept of “positive” eugenics vs “negative” eugenics, meaning sexual reproduction among people with desired traits versus people with undesired traits. The potential ethical ramifications of this field of study seem to bleed over into the medical practice of amniocentesis and the field of genetic counseling. “Positive” and “Negative” eugenics come with an implicit assumption of the rules which determine certain humans superior to others. Though genetic counselors specialize in neutrality in working with peoples of differing backgrounds and with various ideas on the science of reproduction and pregnancy, amniocentesis and the communication of its results can come with implicit laws of what is “good” and “bad” that may not align with patient’s own beliefs, especially if communicated with any amount of bias or hidden agenda by a medical professional. The idea of theological or divine determinism, for example, is a reason for many women to not seek abortion when given the news of a fetus developing with disability.  

In the chapter titled “The Disabled Fetal Imaginary”, many direct quotes from women and men suggest the immensity of misinformation that exists around disability and fetus development. There are many interviewees who describe Down’s syndrome as something entirely unlike the realities of Down’s syndrome. This chapter highlights the importance of communication throughout the pregnancy process and after the discovery of genetic and developmental disorders. Rayna attributes race and socioeconomic class as two of the primary factors in determining a patient’s response to the results of amniocentesis. She posits the likelihood of similar upbringing, educational background and cultural disposition between white patients and genetic counselors compared to recently relocated Hispanics or peoples struggling with a language barrier. On observing an interaction of a male biostatistician with a female genetic counselor, Rapp describes, “Watching such interactions, it was hard not to make two judgments: first, that male professional expertise sits uncomfortably in a room with less-credentialed but more specialized female professionalism; and second, that male anxiety is commonly and acceptably expressed through rationalized hostility.” (109) Her feminist voice certainly surfaces through this comment, as does her opinion on the challenges of genetic counselors in offering the best guidance and information to their patients. Rapp does not dive into the topic of male domination in the medical industry. Even in the subject of pregnancy and reproduction, male scientists and thought-leaders have dominated the path for women’s reproductive health. I would be so curious to know Rayna’s thoughts on the male bias of women’s reproductive health care and how it has impacted the resources, information, and support available to women during the whole pregnancy process. Perhaps it is too large of a subject that might complicate Rapp’s writing and deflect from the center of her study.  

“No one enters the decision to undergo amniocentesis trivially; genetic counseling is too sobering an experience to permit a casual use of this technology by any of the women among whom I have worked.” (Rapp, 307) Rayna articulates a question that was brought up in class; how and when do we determine a fetus to be a human? And how do our morals bend when the reality our future life deviates so far from our expectation? Described in Tsipy Ivory’s article “Outsourcing Moral Responsibility: the Division of Labor among Religious Experts”, “FLOH’s rabbis position themselves as medical decisors” (Ivory, 10) which is in direct opposition to the work of a genetic counselor. According to Ivy, rabbis are in consensus about the conditions in which an abortion is permissible following the diagnosis of fetal anomaly. What lacks from the offices of genetic counselors that rabbis offer in bounty is ethical judgement. Though Rapp emphasizes the importance of remaining neutral as a health care professional, I wonder how often this leaves women of weak or no religious affiliation with a heightened sense of moral dilemma, perpetuating the issue of defaulted maternal responsibility in pregnancy.  

 

In Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America, anthropologist and feminist Rayna Rapp explores fetal testing and how it has become a routine part of pregnancy care for some portions of the population. Additionally, she discusses the populations likely to use it, and the role and communication of the healthcare provider. Rapp makes an effort for her feminism to be intersectional by capturing not only the well-educated, financially stable, secular white woman in America but by gathering stories from women whose stories are typically not explored – uneducated, economically disadvantaged, middle class, working class, and a racially and ethnically diverse group of women. Rapp’s expertise in the subject started with going through an amniocentesis herself and subsequent termination of the pregnancy upon a diagnosis of Trisomy 21, then diving into the field to tell other women’s stories. Specifically, Rapp argues that the use of prenatal testing and intervention technologies are culturally constituted.

According to Rapp, the topic is especially complicated due to the “intersection of personal pain and national political struggles” (Rapp 1999). This goes beyond what many of us might first think with the pro-choice vs pro-life debate. The discussion also includes healthcare in a country where all members do not have equal access, disability rights, and the right to informed consent.

Rapp goes over the history of the amniocentesis procedure, informing us that it dates back to 1882, predating ultrasound technology, though it was not popularized until 1950 for the purpose of treating Rh disease. The addition of ultrasound technology made the amniocentesis procedure safer and less likely to cause miscarriage. In the 1960s, a similar test known as chorionic villus sampling (CVS) test was developed which allows for women to be tested at the end of the first trimester, though it carries a higher risk of miscarriage as well as possible birth defects. Maternal serum alpha-fetoprotein screening is also now common which can predict neural tube problems and this is also measured in an amniocentesis. One issue, which Rapp addresses, with all of these tests is results are not a definitive diagnosis – but instead, a screening.

One important point which chapter 3 discusses is genetic counselors, which became a certified career in the 20th century. According to Rapp, genetic counselors are built to be neutral. However, their role is inherently not neutral when eliminating technology for fetuses exists. Either way, neutrality is not always good. Some women do not want to be given a choice. Another problem that exists is that genetic counselors usually have no ethnic or cultural diversity training. This buttresses Rapp’s argument that the “hegemony of the scientific model can never be absolute” (Rapp 1999).

There are many reasons that women may or may not want an amniocentesis. Age, education, limitations of the test, the opinion of the father, and family history, as well as previous pregnancy history all, affect a woman’s decision. Experiences of their friends and coworkers can influence them as well. Their cultural and ethnic background may affect it as well, influenced by older women in their family who may not see a need for it or may believe that getting an amniocentesis could possibly influence a pregnant woman to abort.  Doubts about the usefulness of the test, considering the limitations of what the test shows and that it does not necessarily show how severe it can be (such as Down Syndrome ranging from mild to severe), may guide a woman away from getting an amniocentesis. Additional reasons against an amniocentesis also vary from fear of miscarriage, discomfort with the procedure, and religious reasons. The number of factors that go into their decision is not limited. However, religious reasons go in both directions. While some may argue that their god would not give them problems they could not handle, others argue that their god gives them solutions for problems. Many women also question whether a decision makes them selfish, worry about the suffering of a fetus – not from the abortion, but the life and quality of it that they have, and the burden that it could place on their family.

Regardless of a woman’s decision, communication between doctors, counselors, and women remains difficult. “Code-switching” between scientific lingo and colloquial language is an issue. Women with more scientific literacy are more likely to get more specific information from their doctor. Answering questions about background and medical history may not make sense to every patient and therefore, their answers may not be as informative. Some women made find the citing of statistics at them to be inconsiderate of their personal situation, and that counselors do not understand their specific concerns. Single mothers and lesbians often feel ostracized in their circumstances due to the stress put on by healthcare professionals to know about a paternal background. With varying reasons, there is a near consensus among women who do get an amniocentesis on a couple of things: anxiety is high during the waiting period between the procedure and nearly all of them are glad they got it after they get the results.

Another point that Rapp makes religious and science are intertwined, not to be considered individually on personal decisions such as an amniocentesis or how to go forward upon a positive diagnosis, and open to interpretation. Although pieces of work such as the Donum Vitae exist, there is no definitive Catholic viewpoint, or Jewish, or any other religion. Texts like these do exist but do not solely dictate and control the decision making of every single member of the religion.

In the latter portion of her book, Rapp begins to take a more personal approach to the subject. Chapter 8 offers an in-depth analysis of analyzing the sample gathered in amniocentesis and her experience working with the lab technicians. In Chapter 9, she discusses the myriad of emotions that women have to deal with upon receiving a positive diagnosis. Although estimates of over 90% exist for women who choose to terminate the fetus after a diagnosis, two groups tend to exist: some knew immediately they would do so, and others went through an extensive decision-making process. All of the women who received one experience severe grief from their loss of the child, likening it to a miscarriage or fetal death more than an abortion. The support these women received after vary, with some being cut off by friends or family, and others receiving their full support. On the other end of the spectrum, Rapp discusses mothers who receive diagnoses upon the birth of their child without having received a prior amniocentesis or other prenatal tests. Many discuss being scared and angry at the beginning, but ultimately loving and being grateful for their child.

Continuing on the note of prenatal testing, the article by Ivry starts off with the anecdote of a Rabbi taking on the moral responsibility of a couple’s decision to terminate in order to relieve them of the agony of the decision. Ivry’s main focus is outsourcing moral responsibility in terms of the prenatal test, diagnosis, and potential termination. Getting the approval of a rabbi gives a message that it is Halachically appropriate. This is often done on a case by case basis, as not all Rabbis feel the same. But rabbis offer something that the doctors cannot in their line of work, ethical judgment. Some are vehemently against it and others permit it in the case of fetal anomalies. This model of outsourcing responsibility offers some peace for pregnant women.

There is an interesting comparison to be drawn between the discussion that Ivry makes of rabbis taking on moral responsibility, and Catholicism, in which Rapp states that Catholic women often experience an extra layer of guilty due to their religion. Religion’s role in the decision-making process is varied and complex, not guaranteed to ease or worsen the woman’s decision.

In Testing women, testing the fetus, anthropologist Rayna Rapp draws on her personal experience with amniocentesis, when she learned that she was pregnant with a fetus which had Down’s syndrome. She then decided to study prenatal diagnosis and the patients’ feelings towards it. She finds failures within communication between healthcare providers and patients to be unavoidable. This is because she claims that though non-directive counseling aims to be unbiased, it fails to do so because practitioners cannot truly be completely objective. However, she does concede that it is also made difficult by the fact that patients’ beliefs are so diverse and complex that they can’t be fully understood. What I found impressive with her work was that she was careful to keep in mind the differences in race, religion, class, etc. throughout her investigation and was cognizant of the effects that this could have.

More intriguing to me was Outsourcing Moral Responsibility, in which I found it interesting how Tsipy Ivry and Elly Teman begin by telling a story about a Rabbinic expert on Jewish law, Rabbi Cohen, and how he handled Jewish laws and ethical considerations while offering a couple counsel on termination of an abnormal fetus. Rabbi Cohen decides that the termination is allowed and puts the couple at ease by taking the moral responsibility on himself. Ivry and Teman draw on this to inquire about the transfer of this moral responsibility. More specifically, the division of moral labor when counseling on reproductive issues. There is a lot of specialization which occurs, dividing the specific kinds of labor so that they are enacted by the proper specialists. They use outsourcing as a metaphor for the transmission of moral responsibility. They identify different strategies for dealing with moments of moral breakdown. When studying American women, who were less likely to share their decision-making process with others, one strategy was that of “non-directiveness”, which can entail genetic counseling, which allows individuals to understand the genetic information without offering any straightforward moral interpretations. In another study done on Vietnamese women, it was found that they desired to share their moral burdens with extended family, and the care they received included explicit directions for decision-making. In the case of Jewish women, they were found to request the advice of a rabbi, who in turn would begin a systematic procedure of dividing moral labors and burdens with other specialists in order to come to a conclusion. The message is that there is a Halachically-appropriate way out of an unbearable post-diagnostic decision because the diversity of rabbinic opinions can be activated…” (Ivry and Teman 11). This was surprising to me because more often than not, ethical decisions, especially about pregnancy, are often made more difficult when they try to go hand-in-hand with religion. However, we can consitently see that experts dividing the moral burden with their consultees seems to help mental health long-term. However, even Ivry and Teman acknowledge that “…even a successful division of moral labor cannot promise exemption from concomitant moral burdens…” (Ivry and Teman 24).