Monthly Archives: March 2020

This week’s texts examine the role of religion in shaping the medical ethics of reproductive technology from perspectives other than that of an Abrahamic faith tradition, namely Hinduism and Buddhism. Whereas Bhattacharyya’s Magical Progeny and Technology applies an interfaith discussion of ethics and integrates such principles to real life cases, Simpson’s Impossible Gifts: Bodies, Buddhism, Bioethics in Contemporary Sri Lanka has an intrafaith comparison of the methodology of mobilizing the Sri Lankan public through Buddhist principles to participate in tissue and gamete donation, or the act of symbolic “gift giving”. Both texts grapple with how to interpret and apply medical ethics derived from a religious order in a religiously pluralistic world. 

Bhattacharyya’s Magical Progeny and Technology effectively strives to determine the way religion informs ethics in a clinical setting by using a comparative approach between Hinduism and Christianity. She first examines the relationship between religion, medicine, and medical ethics using a historical lens to educate the reader as to how Chrisitianity informed much of the ethical principles and laws in the US until the rise of secularism and religious plurality. Simultaneously, the author compares this to the history of medicine in Hinduism by describing principles in the Ayurvedas, a religious script entailing ancient Indian medical practices and ethics. This is followed by the author providing a thorough recall of some of the key takeaways from one of the most referenced works in shaping Hindu philosophy: the Mahabharata. Doing so introduces the reader to the context in which Hindu ethics originates from and highlights parts of the stories that are relevant to discussions on reproductive rights. Once again the author compares topics like the desire to have offspring, women’s autonomy in procreation, and the creative means taken to  bring forth a child to the explicit rules of the Catholic church. Bhattacharyya boils down the story to uncover six characteristics of Hindu thought. I was especially impressed with the way the author used the next chapter to explain and apply Hindu thought and principles in assessing the case of Jaycee Buzzanca. This methodology is effective in showing Hindu principles in action. 

I was particularly interested by the birth narratives in the Mahabharata. Often times when Hindus in my personal experience have discussed this epic, the focus is on the conversation between Krishna and Arjuna, in which they discuss the path of righteousness and inform Hindu ethics and philosophy seen today. The author does an outstanding job summarizing the key takeaways from this conversation which outline the aims of a Hindu’s life. The birth narratives focus on the women in the Mahabharata as they face and overcome issues with infertility using innovative measures. Bhattacharyya then connects the attitudes reflected in their attempts as using divine intervention is brought about through modern medicine today. For example, Gandhari’s usage of clay pots to “grow” her children mimics the process of IVF. Another topic discussed is the usage of sperm donation, niyoga, in which Pandu permits his wife Kunti to become inseminated by another man if he himself is infertile. However, she opts to not go through this route even though this act is clearly delineated from “adultery” and chooses a divine intervention where she can have a say in which deity will father her child. I am intrigued by the duality that exists in which a woman is powerful enough to choose her method of reproductive technology while another text “utilizes a metaphor likening the woman’s womb to a field” (Bhattacharyya 40) and a man’s sperm is seen as “seed” that is on the field and can be shared for the purpose of having a child. 

As a practicing Hindu, I was particularly interested as to why the author chose to compare Hinduism, a multifaceted religion with no founder or hierarchy, but a multitude or interpretations, sacred texts, and deities to a mostly uniform, monotheistic, hierarchical, and structured sect of Christianity like Catholicism. I was curious to see how the author would draw comparisons given the multitude of texts and mythological stories available in Hinduism and the main sacred text of Christianity. While the author acknowledges the diversity and complexity of Hinduism especially as it is practiced today, she makes clear that this comparison was necessary due to the prevalence of Christian principles in not just national law-making in the United States, but also internationally given the political influence of the Vatican on limiting the access to reproductive technology research.

Simpson’s text takes place in Sri Lanka where the prevailing religion is Buddhism. A key concept of “ethical publicity” is the impact that the surrounding culture has in determining one’s motivations for gift giving. What separates Buddhist notions of giving and doing good deeds is that the apparent “benefit” of a kind action could be negated from having the wrong intention. After Simpson highlights the 10 imperfections in Buddhism and the three “donations,” a much more focused story is told. The first one is the donation of food, the second is the donation of body parts, and the third is sacrificing one’s life. Like the Hindu text, the giving of body parts is highlighted in textual mythology in Buddhism when a king is persuaded to give up his own eyesight as he gave the gift of sight to others (Bhattacharyya 844). However, the issue is slightly different with blood donation. Many people of other faiths felt excluded as such donations were “unmistakably Buddhist idioms which are often alienating to those of other faiths” (Simpson 849). Comparatively, as Hinduism is more of a pluralistic religion, Bhattacharya mentions that Hindus could generally worship and see the divine in other faiths as well. I feel that this is too much of a simplification to make, as just because a religion is polytheistic does not mean that all forms of God are worshipped.

One striking similarity I found across the texts was how the woman enacted more agency in reproduction than the man, despite the prestige, power, and value of sperm. As Spencer notes, sperm is considered the “highest of substances.” in which “one drop of [semen] is believed to be equal to sixty drops of blood” (Simpson 853). However, egg donation is more acceptable as a reproductive technology given that it is more closely aligned to the requirements of the religious principle of dana upa paramita, in that egg extraction involves pain and discomfort while semen extraction is a result of a pleasurable, therefore, self-serving extraction. In the Mahabharata, powerful female figures such as Kunti, Madri, and Gandhari make the final decisions and come up with creative methods to overcome barriers to procreation.

Questions: 

How does the concept of “ethical publicity” from the Buddhist readings compare to the importance of “centrality of societal good” in the six elements of Hindu thought.

Could Simpson have used a comparative methodology for Buddhism?

Simpson’s goal in “Impossible Gifts: Bodies, Buddhism and Bioethics in Contemporary Sri Lanka” is to examine the Theravada Buddhist narrative of gamete and embryo donation in Sri Lankan society. He does this by contextualizing Theravada Buddhism in Sri Lanka. Then, Simpson discusses the history of eye and blood donation and what has made each type of donation effective/ineffective in Sri Lankan society. At the very end of his article, he discusses the future of gamete and embryo donation and potential obstacles to their acceptance. 

Swasti Bhattacharyya structures her book by talking about the role of religion in bioethics from the point of view of academics, clinical situations, and public policy. Then she discusses the Mahabharata, a Hindu epic, and the passages within it that are relevant to discussions on reproduction and fertility. Next, she contrasts a variety of Hindu perspectives to those of Roman Catholicism. She pulls out six main themes in the Mahabharata that run throughout Hindu thought. Lastly, she ends the book by applying these six principles to a United States court case on the parenthood of Jaycee Buzzanca. 

Even though he details multiple points of view of organ and tissue donors, Simpson does not mention much about those on the receiving end of the donation or their attitudes about donation. While the discussion on eye and blood donation is useful for applying similar principles to gamete and embryo donation, his argument would have been more effective if he spent more time elaborating on his reasoning behind the conclusions he makes and perhaps going beyond just sperm donation being difficult and egg donation being more likely to be accepted. 

I thought it was interesting when Bhattacharyya was describing bioethicists in the United States as “operating more like philosophers, attempting to rely more on moral principles that they felt could plausibly claim to be universal, rational, and ‘secular’” (Bhattacharyya p 13). This is very reminiscent of the type of argument put forth by the Donum Vitae, as it attempted to ground itself in common human reasoning. By the end of the book, she calls for the inclusion of Hindu perspectives in bioethics in order to make the field more representative of the world it is trying to describe, instead of moving towards secular universal bioethics. She argues that the pluralistic nature of Hinduism could be applied to the field of bioethics to account for the complexities in life that academics sometimes try to minimize. It is unclear whether she means just the idea of pluralism in general that Hinduism is an example of or the specific beliefs and traditions of which Hinduism is a diverse group of. 

Both authors construct their arguments by drawing together the work of previous scholars and researchers. This is unlike some of the other readings in this class that have been more ethnographically oriented. In both authors’ arguments, they draw the reader’s attention to significant texts and narratives in each religion and use those as models with which followers of each religion weigh their bioethical decisions regarding reproductive technology. While this does make their argument much clearer, it does leave some room for wondering about the accuracy of great texts such as the Mahabharata for daily life. Sometimes one’s actual values are not reflected in those works, so Bhattacharyya may be lacking some additional insight by only relying on the Mahabharata and other scholars.

To compare the two readings’ arguments specific for reproductive technology for this week, I will focus on gamete and embryo donation as that is specifically what Simpson focused on, and Bhattacharyya mentions it as well. Simpson claims that Buddhist attitudes are mostly against sperm donation because male infertility is stigmatized against, sperm is very valuable to Ayurvedic medicine, using donor sperm can be seen as adultery, and donating would be “not of pride but of shame (laejjakama)” due to masturbation (Simpson p 854). Egg donation would be more readily accepted because it fits with the King of Sina narrative of giving despite pain. Furthermore, there is less stigma against female infertility and could be seen as adoption. Hindu attitudes are relatively more positive towards sperm donation, perhaps because the Mahabharata resolves some of these issues that Simpson brings up. The practice of niyoga is allowed and addresses the threat of adultery, but women are opposed to it (as Satyavati’s daughter in laws were). Questions of who the child’s father can remain, but moral and social fatherhood is ultimately more important than biological fatherhood. The divine sperm bank presented to Kunti in the Mahabharata also circumvents the need to masturbate in order to donate sperm. Bhattacharyya does not explicitly focus on egg donation, as that might not have been present in the Mahabharata, but she does speak of adoption positively, in the context of Kunti adopting Madri’s two sons to raise as her own. 

Questions:

Last week during class, Dr. Seeman brought up the idea of each religion having a cost to the benefits of their beliefs. Based on the texts, what might be the cost vs. benefit discussion with regards to Hindu and Buddhist bioethics?

In Simpson’s article, he mentions how Ayurvedic medicine treats sperm as a high value substance that can have devastating effects on a person if they lose too much of it. How would you reconcile this with the divine sperm donation example in the Mahabharata?

Why did Bhattacharyya choose Jaycee Buzzanca as the singular case study she looked at and applied Hindu bioethics to?

This unit’s works place an emphasis on the role of religion in reproductive technology and furthermore discusses implications of religion’s role in streamlining many bioethical decisions and ways of thinking in society when intertwined with culture, philosophy, law and literature. Through these works, we can gain insight into how religious perspectives and values guide contemporary bioethical issues, namely reproductive technology and donation. A common theme acknowledged repeatedly throughout both Swasti Bhattacharyya’s Magical Progeny, Modern Technology : A Hindu Bioethics of Assisted Reproductive Technology and Bob Simpson’s “Impossible Gifts: Bodies, Buddhism and Bioethics in Contemporary Sri Lanka” is the plurality of beliefs in modern society. We are called upon to listen to others while we speak ourselves and acknowledge different worldviews because this gives us a larger pool of information to utilize when we make important bioethical decisions in our lives. Additionally, we can even understand the plurality within our own culture and religion which isn’t always so obvious.

Bhattacharyya’s Magical Progeny, Modern Technology uses birth stories from the Mahabharata, an ancient Hindu epic, to shed light on the Hindu perspective on reproductive technology. She sets up the framework of the book in her introduction by first making some crucial points. Bhattacharyya acknowledges she is striving to find a middle ground which allows multiple perspectives to exist at once to stimulate dialogue across cultures and thus create dynamic solutions to complex bioethical issues (Bhattacharyya, 3). I really appreciated her methodology as it not only is rather unique but very applicable to many societies around the world. Too often, we try to construct some concrete principal that is very rigid in nature and cannot be flexed to incorporate any nuances. Instead of making a Hindu ethic, she “weaves” an ethic from Hindu religion, culture, and philosophy from the Mahabharata to respond to the assistive reproductive technology debate. Specifically, the stories of the Pandava children and their enemy cousins, the Kauravas are used to bring to light Hindu principles as a model for how people can navigate difficult bioethical issues. Hindu perspectives are applied to a particular case in the United States that dealt with ownership of a child, Jaycee. Bhattacharyya also draws comparisons of the Hindu approach to reproductive technology with the Roman Catholic and Hebrew perspectives towards this technology. It is here, in my opinion, where the reader really is able to comprehend the imaginative and pluralistic ways in which Hinduism approaches this bioethical debate. Overall, I thought Bhattacharyya did a fantastic job of voicing the main message of her book which is bringing attention to modern society to find ways to incorporate a variety of religious perspectives. She utilizes the Mahabharata in a way that convinces the reader Hinduism has relevant contributions to make in the ongoing global conversation surrounding reproductive technology.

I was very excited to read this book because although I come from a fairly strong Indian and Hindu background, I wasn’t very familiar with any conversation about reproductive technology use in my culture or what ways Hinduism could approach this debate. Interestingly enough, this may be so because Bhattacharyya acknowledges that there is no specific decree or set of regulations outlined by the religion regarding this technology. She instead analyzes the birth stories to produce the perspectives Hinduism takes. That being said, Bhattacharyya’s discussion and analysis of how Hinduism and the Mahabharata approach this debate is what stuck out to me the most from the book, partly due to the fact that we have discussed other perspectives (namely Catholicism) approaches to the debate in class. Although I wasn’t familiar with Hindu perspectives on procreation before reading the book, I wasn’t too surprised about the analyses Bhattacharyya provided. Being raised Hindu, I have learned the religion permeates through all aspects of life (culture, relationships, family etc.) and thus I have found it is very important to know there is a difference in being “culturally Hindu” as opposed to “religiously Hindu.” By being religiously Hindu, I mean adhering to the strict practices of the religion where as being culturally Hindu means one could not really be aware of every minute detail of the religion, but their way of life and behavior certainly reflects the ideals. I believe it is certainly possible to be both, but I recognize myself as more well versed in the culture of Hinduism even though I do practice the religion as well. The book confirmed a lot of what I have experienced in my lifetime in regards to the plurality of the culture; there is more than one way to live and call yourself a Hindu, as “…religion, philosophy, and the conduct of daily life are all tightly interwoven” (Bhattacharyya, 27). Accordingly, we see there are multiple avenues utilized to reproduce.

Bob Simpson’s “Impossible Gifts: Bodies, Buddhism and Bioethics in Contemporary Sri Lanka” aims to find ways the donation of gametes and women’s embryos can be made sense of in Sri Lanka, a society where organ and tissue donation is already recognized as a sort of duty through the concept of “dana” in Theravada Buddhism. Simpson draws on previous work done by Parry and Laidlaw to frame the transactions, as they are called, of organ and tissue donation in Sri Lankan society. Simpson uses the observations made by Parry and Laidlaw to extend insights into the beliefs of Sri Lankan society. Before delving into the Buddhist framing of donation, Simpson discusses the concept of ethical publicity. I interpreted ethical publicity as a means to weave society’s values and principles into a vehicle that drives one to donate. Simpson discusses the many dangers that can arise from framing donation in this way, many of them unforeseen such as indebtedness or even framing donation as a ‘gift of life.’ I was especially intrigued by the notion of a ‘gift of life’ being problematic, because in Western society we often focus on just how brave or impactful life-saving donations can be and forget there could be many secondary societal consequences created by these acts. Theravada Buddhism preaches to give parts of the body to help others and to show the donor he or she is not attached and self-indulged. Several stories from Theravada Buddhism roots discuss the giving of body parts which Simpson says holds significance for modern Buddhists. Overall, it is very clear that Buddhist ideals streamline the majority of the beliefs behind the donation process and the very act of donation itself. Donation of blood and tissue (eyes) can be traced back to significant historical events/times and each have significant justification and foundation in Buddhism. One problem with this however, is that many non-Buddhist groups such as Tamils, Muslims and Christians often are alienated and cannot find their own freedom in thought to act as they would like. This made me question the fine line behind religion’s role in these practices within Sri Lankan society, and at what cost this promotes a troubling sense of homogeneity.

Whereas organ and blood donation easily finds its grounds in Sri Lankan Buddhist society through “dana upa paramita” and has grown so much there are hints of commercialization of these transactions, gamete donation results in several issues that poses problems for the Sri Lankan Buddhist people. One of the problems regarding sperm banks is the means to obtain sperm, as there is no other way to obtain it other than physical pleasure which has no grounds in Buddhism. Sperm is also seen as a powerful substance having as much value as sixty drops of blood and the loss of sperm by a man can cause much worry. Ova on the other hand align much more with dana upa paramita as its donation involves much more pain and no pleasure like sperm donation does. When reading this section of the article, it really became clear that the ‘gift of life’ is not a stand-alone concept in Buddhism. The gift of life is only valid when it is positively viewed in regards to moral terms. This is the same issue that plagues societies all around the world, and one example that we have talked about is Donum Vitae and the Catholic perspective on reproductive technology. It is crucial when thinking of the concept of ‘gift of life’ that we always understand the principles and beliefs through which ideas governing the use of the body and ways of procreation for each society. This not only allows use to gain a broader understanding of other perspectives but more importantly is a prerequisite in order for us to even beginning to think about incorporating other pieces of thought in our bioethical decisions. Both works strive to emphasize this idea in order to shape the contemporary bioethical discussions regarding reproductive assistive technology.

While reading both of these works, I could not help but constantly think of the intertwinement of religion and culture in regards to bioethical debates. As mentioned earlier, in my personal life, I understand that there is a distinction between the two; however, religion consistently seems to guide the bioethical discussions surrounding reproductive technology across societies from all over the world. After reading and thinking about these two works, I found a difference that has made me perhaps even more puzzled on how we as humans can use religion in our decisions in life. For example, Hinduism is crowned a model in Bhattacharyya’s novel for which Western Society can use to inform their decisions regarding procreation. In my opinion, Bhattacharyya does an exemplary job demonstrating how the creative ways of procreation in the Mahabharata can be framed within modern culture. Where infertility is countered with divine power in the Mahabharata, modern medicine accomplishes this through technology (Bhattacharyya, 53). Additionally, humans and gods are seen as working together to reproduce in the Mahabharata whereas in the Hebrew perspective, God seems to have the ultimate divine control (Bhattacharyya, 68). As we have discussed with Catholicism, it is a sin to separate intercourse and conception whereas Hinduism clearly separates the two. In summary, the evident “leeway” in in the Hindu approach stems from the religion’s ability to be able to stray away from a universal philosophical principle, and examine each particular situation on its own terms. For Bhattacharyya’s work, Hinduism seems to have very few pitfalls in approaching to answer to the reproductive technology debate. Yet, the difference I noted in Simpson’s work, is that Buddhism did indeed limit approaches to reproductive technology discussed in the previous paragraph. We saw earlier that living in and committing to a Hindu style of life and behavior is portrayed as having seemingly limitless options to procreate. This is great for those who are in this society. However, what happens to those committed to Sri Lankan Buddhist way of life? Will they permanently be in a limbo when it comes to taking a side on this debate? The moral and physical restrictions placed on them by their religion seems to be impossible to overcome in order to create the ‘gift of life.’

This is where I struggle. Religion is a great means of justification when it allows for increased flexibility in one’s actions, but when religion is more stringent the picture quickly becomes more bleak. For the societies such as Sri Lanka, do we just accept that since culture is so tied to religion, religion will always reign supreme and promote one way of thinking? Obviously, we know religion is one of the most influential, if not the most, influential vehicles in almost every society’s beliefs, values, and culture (way of life). Religion streamlines our daily lives. And from these two works, we see that religions offer differing amounts of autonomy and discretion when tackling certain bioethical practices such as reproductive technology. This is not to say that any religion is superior to the other, for this defeats the purpose of both works in regards to incorporating a multitude of religious perspectives in our modern society. In a hypothetical world where there is no religion, I would be curious to see the reasons and justifications people would utilize on both sides of the reproductive technology debate. Would there necessarily be more autonomy in making these decisions without religion? Or perhaps would the same societal pressures that are present today be just as influential, such as the emphasis on individual rights in Western society as opposed to the emphasis on duty as we see in Hindu societies? I do not think there is a clear cut solution to my question by any means, but I believe it is worthwhile to ponder over for societies that are very religious. It is impossible to overturn any major religion and its guiding principles, but if we are to somehow separate culture from religion, is there any promise for groups of people such as Catholics or Sri Lankan Buddhists to find ways to be free from the moral repercussions of utilizing reproductive assistive technology? And as these two works suggest, how can we actually go about incorporating different religious ideals in our lives, when it seems that religion is almost impossible to bend? Perhaps if we are indeed able to separate culture from religion, then we could fit these new perspectives into our cultures and then make more informed bioethical decisions.

Ally Brennan

The texts for week four all discuss the issue of reproductive technology for Jews, and more specifically Israeli Jews. “Ethnography Exegesis and Jewish Ethical Reflection: The New Reproductive Technologies in Israel ” by Don Seeman describes and analyzes the differing ways of interpretation that cause different perspectives on reproductive technology between Jews and Catholics, with France used as a secular comparison. “Modern Reproductive Technologies and Jewish Law” by Michael Broyde gives an outline of legal issues that may exist regarding cloning in Judaism, while Reproducing Jews: A Cultural Account of Assisted Conception in Israel by Susan Kahn is an ethnographic study done in Israel on women who use reproductive technology. These three sources offer different analyses on the general topic of reproductive technology in Israel, and, when read together, offer a holistic view of the issue. This blog post will first examine each text individually. To conclude, it will synthesize the pertinent information from each source to provide a greater understanding of the use of reproductive technology in Israel.

“Ethnography Exegesis and Jewish Ethical Reflection: The New Reproductive Technologies in Israel” aims to reveal the importance of how different cultures interpret things within the reproductive technology debate. France, which is used as a secular comparison in this text, makes decisions that align with what is considered “natural;” as a result, they limit IVF to heterosexual, steril married couples, as historically, and traditonally, this would be representative of a natural family. In contrast, Israel relies heavily on religious texts, which is similar to Catholics. There is a difference between where Jews and Catholics find their answers in religious texts; Catholics tend to find answers in the beginning of Genesis and use narrative to find answers, while Jews often look for legal prohibitions. Furthermore, in the debate around reproductive technology, Jews rely more on Leviticus than Genesis. This difference, in part, can explain how these two religions have very different answers for the question of when and how to use reproductive technology, despite using the same source. Donum Vitae, the accepted doctrine on reproductive technology for Catholics, states that IVF should really only be used if doing IVF with the husband’s sperm. In Israel reproductive technology is used for many different reasons and in multiple different forms; Israel, in fact, is the leading country for IVF. There is a cultural history in Israel that also helps account for this difference in perspective in addition to the legal readings of religious texts. For instance, it is a pronatalist country, and thus encourages high birth rates. Consequently, in order to understand the contrasting viewpoints that different cultures have towards reproductive technology, it is important to examine aspects beyond interpretations of texts, and consider other elements such as the experiences of individuals who live within these societies. The consideration of multiple societal components (interpretations of texts, culture, lived experience) allows for a more complete understanding of the complex arguments regarding reproductive technology.

 Broyde focuses specifically on the legal issues of cloning within Israel, and within Jewish law. He notes that “the Jewish tradition is betwixt and between two obligations:” the belief surrounding the importance of helping others, and the belief that everything may not be proper, particularly when related to intercourse (Broyde 296). These two beliefs come into direct conflict in the debate around reproductive technology. In Israel, decisions about the use of reproductive technology are handled case by case. Every couple or individual must go through a screening process, and many consult a rabbi, who may make a specific recommendation based on the circumstances of the person/people seeking out reproductive technology (Kahn). Therefore, it is logical to assume that if human cloning were to take place, it would also be handled case by case. The specifics of cloning lead to many questions, particularly in relation to kinship. Because a clone would be the exact genetic copy of another person, there is much debate over who the parents of such a child would be. Judaism is matrilineal, which complicates cloning if the genetic donor is female. In this case, there are debates on who would be considered the mother: the gestational mother, or genetic mother. If one woman was not Jewish, the status of the child would be in jeopardy, creating a situation in which the child “should be converted” (Broyde 306). On the other hand, if the donated genetic material came from a man, assigning a status to the child becomes less complex as the donor would be the father, and the woman who gestates the child the mother. If the gestational mother were Jewish, the child would be Jewish as well. One could assume that there would still be rules about what male could donate the genetic material to avoid creating a mamzer child, as explained by Kahn. 

There is also the question of whether a clone would be considered human, and if they may be used in immoral ways. Broyde references that some fear “society will mislabel cloned individuals as something other than human and use them as organ sources” (313). Broyde, by analyzing Jewish law, determines that this individual would be considered fully human and “treated with the full dignity of any human being,” nullifying the argument that clones would not be considered people (315). Finally, the issue of cloning opens up a new ethical debate over who has access to someone’s DNA, and the issues of stealing someone’s DNA. Because an individual’s DNA could be easily accessed and used for cloning, there would have to be strong legislation in place to protect people and their genetic material, though the extent of this would likely be heavily debated.

Finally, Reproducing Jews: A Cultural Account of Assisted Conception in Israel by Susan Kahn offers an ethnographic account of the experience of using reproductive technology in Israel. Kahn’s research spanned two years, and she conducted interviews, attended support groups, conducted participant observation at fertility centers, and interviewed rabbis. She analyzed the decision making process that women go through before using reproductive technology, and found that there were many unmarried women who used reproductive technology in order to have a child. Because reproductive tech is subsidized by the government, Kahn found that all potential mothers have to go through a screening process, which did create some opportunity for discriminiation for lesbian couples. She also examined the relationship between rabbinic law and the secular democracy of Israel in relation to reproductive technology. The Aloni commission, which was a report created by rabbis, legislatures, and fertility experts, stated that unmarried women do have the right to have children, and that these children would exist without that stigma of being mamzer, or a bastard child. Furthermore, she expands on the idea that in Israel decisions made about reproductive tech are done on a case by case basis by examining how paternity works in these cases, as it is often up to a rabbi to decide these matters. She also examines how important purity is in fertility clinics in order to maintain Jewish identity. Surrogacy is also dealt with, which reveals the complexities involved in Jewish kinship; because it is matrilineal, deciding who the mother is in surrogacy affects the identity of the child. Overall, I thought Kahn was effective in outlying the process of seeking reproductive technology in Israel, and the complex social factors that cause each individual’s decision. Because Israel is a pronatalist, and one of the crux ideas is to “be fruitful and multiply,” many single women seek out this technology to reproduce without stigma.

I found that these three sources really complimented each other, and helped to fill in the gaps apparent in each source. For instance, I thought that while Kahn’s book gave a comprehensive description of current reproductive technologies in Israel, Broyde’s analysis on the potential of cloning added a perspective on what could develop in the future. Furthermore, I thought that the framing provided in Seeman’s piece provided context for the interpretations seen both in Broyde and Kahn’s work, while Kahn’s work in particular provided examples of the lived experiences that Seeman states are needed to understand this issue. What I found most interesting in these issues was the discussion of the complicated area of kinship. The matrilineal aspect of Judaism is particularly interesting because this increases the complex nature of kinship and reproductive technology. In paternal societies, issues of reproductive technology and kinship are still incredibly complex. However, the debate is different because the transmission of identity is not paramount when assigning the label of mother to either the gestational or genetic mother. One critique I have of Broyde and Kahn’s work is there is no cross cultural comparison; while Seeman’s article contributes this, on their own these pieces do not offer these nuanced views. I believe that a comparison would help to emphasize the different approaches to reproductive technology across cultures, ultimately generating a deeper understanding of why the decisions around reproductive technology in Israel are unique.

Finally, I found all three texts to be well organized and easy to read. In particular, I enjoyed how Kahn outlined her book as I thought it gave a logical, sequential description of the process of using reproductive technology in Israel. Furthermore, I enjoyed how each source outlined key questions that related to the issues discussed. This, I thought, was particularly important because it is essential to recognize that not all questions can be answered when dealing with such a complex issue. Because there are so many different debates that must be addressed when discussing reproductive technology, it is impossible for one source to answer every question. Therefore, I thought that both Broyde and Kahn did a good job of focusing on specific questions in order to not overwhelm the reader. Furthermore, each author recognized that there also were simply questions that are unanswerable. Kahn, for example, concludes her book by asking a series of questions revolving around changing kinship in Israel, the final being “and if the ends make means irrelevant, what will the texture of Jewish life be like?” (Kahn 171). This question reveals the depth of the questions possible to ask when dealing with reproductive technology. This question cannot be answered because, at least currently, there is no answer. This question reflects the reality that there will always be unknowns when dealing with the ethical questions surrounding biotechnology. I thought that the inclusion of unanswerable questions improved both Kahn and Broyde’s work, as it showed that both scholars acknowledged the limitations of their work. This acknowledgement, I think, made both works seem more reliable and also more engaging, as it encouraged the reader to think about how complex the topic of  reproductive technology really is.

Discussion Questions:

• There are clear issues regarding gender in the debate around reproductive technology. How might changing ideas of gender (i.e. increased gender fluidity) play out in this debate?
• Why are ideas of kinship so essential in the debate of reproductive technology in Israel? 
• How does Israel’s pronatalism influence the use of reproductive technology? How is its specific history related, and how (and why) does this contrast with views on reproductive tech seen in Catholicism? Do you think this will change over time?
• Clearly, there are issues around the general morality of cloning. Broyde mentions the idea of the “slippery slope,” which includes fears of organ harvesting, or the use of clones for experimentation (Broyde 312). Do you think that people will ever find cloning to be morally acceptable and ethical? Or will these greater fears outweigh the potential benefits human cloning could have?

Modern bioethics is assumed to be secular, but many societal norms and bioethical perspectives in our society are still intertwined with religion. It is difficult to separate the two, especially with Catholicism as it intends to use universal philosophical and natural law arguments so that even those who are not Catholic should be able to agree with their claims. However, in Donum Vitae, which is the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation” and addresses biomedical issues from the Roman Catholic Church’s perspective, some of the arguments presented seem subjective based on the evidence presented and could use further explanation, especially to appeal to those who are not Catholic.

For example, Donum Vitae uses a quote from Pope John Paul II (1980) to argue that reproductive technologies tempt man “to go beyond the limits of a reasonable dominion over nature.” However, they also cite shortly after that God created male and female and gave them “dominion over the earth” (Gn. 1:28). This idea of a reasonable dominion over nature is not unjustified, but it does require further explanation about why we are limited in on our dominion and what objective line constitutes a reasonable dominion.

This is not the only time the evidence is not clear. Another example is also in reference to Genesis 1:28, which states that “God said unto them, Be fruitful, and multiply, and replenish the earth, and subdue it.” This indicates that we should reproduce. Given that we should have children and that we have at least some dominion over the earth, reproductive technologies do not seem to be an unreasonable method to use our dominion to reproduce. However, Donum Vitae and the Catholic Church do not believe that we are obligated to have children, but there is no explanation why the Catholic Church believes this. It does not seem to align with what I have read of the Book of Genesis, but I have not read the entire Book of Genesis. This is another example of an idea that may not be unreasonable but requires further explanation of how the Church came to this conclusion so that the readers, especially those who are not Catholic, can follow their arguments.

In “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates,” Ball discusses the history and current stance of artificial reproductive technologies (ART) in France as of 2000. Overall, the timeline of the legality and morality of ART in France is intriguing because they kept shifting their stance. In most of the 19^th and 20^th centuries, ART was seen as “repugnant to natural law” (Ball 548). It was banned in hospitals until the first government-sponsored sperm bank was established in 1973. Then in 1978, ART became completely covered by the national health insurance system with an infertility diagnosis, whereas other medical procedures are normally reimbursed up to 80%. However, the motive behind this was to increase births after decreasing birthrates during the 1970s. In the 1980s, public attention paid to controversial cases, which eventually led the French National Assembly to pass laws in 1994 that only sterile, heterosexual couples of procreative age can use artificial insemination and IVF procedures.

This decision had clear ethical motives: to protect the “traditional family structure.” They saw this imminent disruption of the typical family structure via the use of ART as bad for two reasons. However, similar to Donum Vitae, their justifications are not completely clear. First, they viewed a nation as a combination of several families and each individual family as the foundation of their society. As a result, they wanted to maintain the traditional family structure to keep a strong foundation of individual families to keep the nation stable. However, they do not give a clear reason why a non-traditional family structure would be destabilizing and from where this idea of the traditional family structure stems. Second, they thought that providing ART to those who were not heterosexual or who were not of reproductive age was unnatural because they cannot “naturally” have children. This is an attempt to use a secularized natural law argument. To counter this, Rosseau, as argued by Ball, questions what is natural; using ART for those who are not heterosexual or of reproductive age is only unnatural if the concept of nature is static. Rosseau argues that these static, “natural laws” may actually be reflexive laws “developed from observations of their own society” (Ball 579). As a result, these observations may not truly be universal as some in the Catholic Church believe. Therefore, these natural law arguments may be insufficient to prevent people from using ART.

A question I had when reading the Ball article was how much of an influence did Catholicism have in the formation of the concept of the “traditional family structure” in France? The importance of the family unit was also mentioned in Donum Vitae; it states on page 158 that “the vitality and stability of society require that children come into the world within a family and that the family be firmly based on marriage” and later adds that a family consists of a husband and wife. Since these two articles have similar views on the importance of this typical family structure, were these ideas shaped by the same ideas from the Catholic Church? Although the Church and State separated in France before 1994, religion could have still influenced societal norms, like it can today, which can then influence the laws put in place. Although France was secularized, was Catholicism still an important part of the culture? Did this idea of the “traditional family structure” persist from a time when France was not secularized? Or is the traditional family structure independent of religion altogether?

One question I had throughout both Donum Vitae and Ball’s article is why do we tend to view things as static and resist change, especially regarding bioethical issues? It seems reasonable that our understanding of what is natural and moral would evolve as our understanding of the world develops over time. Currently, we view nature as something that is dynamic, not static, and we use nature to talk about how things change. However, Donum Vitae and France’s view of ART ignore this and demonstrate an outdated static view of nature. They then rooted their values in this static view of nature, creating a dichotomy of licit and illicit based on the idea of dignity. However, dignity becomes more subjective when it is based in a dynamic system of nature, which allows us to leave the dichotomy of licit and illicit and realize that moral authority is not as obvious as Donum Vitae and France may make it seem.

Tsipy Ivry’s book titled, Embodying Culture: Pregnancy in Japan and Israel, is a well-designed double ethnography. Through cultural immersion and the creation of a thick description, Ivry sought out how cultural beliefs weigh into views on prenatal testing and diagnoses in these two non-western, medicalized countries. Ivry performed fieldwork in both Japan and Israel, where she collected her research through four different sources: interviews with ob-gyns, interviews with current and past pregnant women, attending pregnancy classes, and lastly, attending pregnancy events. Ivry learns early on that both pro-natal cultures focus on delivering babies healthily and to full term. Yet, she identifies the different systems and methodologies employed to achieve this shared goal: “Geneticism” versus “Environmentalism.” Ivry claims that while Israeli healthcare systems heavily emphasize genetics through the endorsement of prenatal testing, Japanese healthcare systems rather focus on environmentalism by maintaining perfect maternal environments.

Pre-natal testing is more common in Israel than it is in Japan. One reason for this is explained by the directors of the Program for the Prevention of Inborn Abnormalities that “… in Israel ‘we are simply tailored to deal with our own problems’” (41) to address and eliminate genetic anomalies unique to Jews.  The Jewish population appears to be susceptible to specific diseases and, in the hopes of “eliminating genetic ‘Jewish diseases’ in the Israeli population” (44), prenatal testing exists to analyze genetic markers in genomes of pregnant mothers. For example, Tay-Sachs disease is a specific genetic disorder associated with Jewish people, and pre-natal testing can detect this disorder during the pregnancy. Given the prevalence of these genetic concerns, I believe it makes complete sense for Israel to advocate for more prenatal testing than other countries, such as Japan, as a means for combating Jewish-specific diseases. Ivry interviewed doctors such as Dr. Ramon, a well-established Israeli ob-gyn who specializes in obstetrical ultrasound, to explain how important and common it is for Israeli ob-gyns to rely on testing, examinations, and all existing prenatal tests as a source of information and education. Doctors must be completely transparent about these options so that their patients are well-versed to make critical decisions about their pregnancies. I believe this level of commitment and investment in the doctor-patient relationship creates the solid foundation to combat genetic pre-dispositions and pregnancy hurdles. The emphasis on pre-natal testing and education is also critical to managing patients that experience high levels of anxiety or hysteria, as supported by Ivry’s discussions with Dr. Ramon.  Dr. Ramon explains that during bouts with hysteria, patients look to their doctors for comfort and assurances that the pregnancy is normal. As these patients utterly trust their doctors, it appears only right that the doctors want to make sure that all the bases are covered and that technology and testing is fully employed to inform the situation. In Israel, doctors strive to assertively recommend and deploy all the genetic tests available and designed to assess fetus anomalies before birth, while also providing the patient comfort, and striving for healthy births.

Ob-gyns in Japan, in contrast to Israel, focus on the environments of childbearing women rather than genetic testing. Ivry explains that pre-natal routines in Japan consist of “measuring the patient’s weight gain, abdominal circumference, and funcal height.” (84) Additionally, Japanese ob-gyns take “taijukanri”, weight supervision, exceptionally strictly. The Mother-Child Health Handbook is a book given to all Japanese pregnant patients at the first pre-natal visit. In this handbook, mothers record their weight, meals, temperature, and many other things that is a departure from how pregnancies are followed and recorded by Israeli doctors. While both Japan and Israel are striving for the same goal, the Japanese approach to pregnancy is largely based on environmental factors and the Japanese healthcare system places significant importance and responsibility on ensuring that these environmental factors are properly measured and observed during the pregnancy. I found this chapter of the book extremely interesting because I was unfamiliar with these principles of Japanese healthcare. The early distribution and depth of the Mother-Child Health Handbook shows how vital the environment is on Japanese pregnancy. By contrast, as Ivry points out that, in Israel, there are no such written disclosures or guidelines during the pregnancy and any sort of disclosures about how to care for the baby are only handed out to patients after a successful birth, never before. Also, Ivry writes that the well-being of Japanese babies is entirely dependent on the environment, “kanya” of their mother. If the environment is not well-kept, or if the fetus is underweight, or overweight, the teachings tell the mother that the baby may not be born healthy or birthed to full term. Genetics do not appear to be a primary concern. You can even see this point through the language used in some of the interviews. A specific interview with Dr. Ootsuma intrigued me. Ootsuma said “Maternity checkups are not free of charge, so from one visit to another the mother should check herself, how much she has gained …” (92) It is evident that mothers play the central role in determining the outcome of their pregnancy, and doctors do not prioritize the discussion of or recommend pre-natal testing with their patients because they believe that keeping the mother in healthy shape is much more valuable and impactful on the fetus.

Ivry noted many other interesting differences between the Israeli and Japanese health systems. One that stood out to me involved the differences between the ob-gyn offices. In Dr. Ramon’s waiting room in Israel, there was a mural that read, “’Aloka (a popular ultrasound technological brand) gives birth to perfection’” (46). This contrasts to the waiting room of Dr. Oikawa in Japan where on his waiting room’s wall there “was a colorful placard of the food pyramid, with a digital scale just below it.” (84). She noted that women would routinely walk into the office and weigh themselves on this scale. These two contrasting environments illustrate the varying frameworks of the healthcare systems’ approach to pregnancy. Just viewing these two waiting rooms, the difference in priorities that each culture places on genetic testing and natural environmental factors is plainly obvious. 

The book raises the interesting question of whether either approach is better than the other to ensure a healthy pregnancy. I wonder whether the similarities of the Israeli and Japanese approach are more important that the differences. I question whether cultures that place an emphasis and importance on pre-natal care, whether driven by genetics, environment or simply education, is sufficient to trigger mothers to take pregnancies seriously and to be mindful of their health during the pregnancy. I would be curious to compare whether the percentage of healthy births dramatically differs in both countries and whether either approach is more effective. In her first chapter of the book, called, A Risky Business, Ivry reports on a pregnancy event speech given by Dr. Cohen in Israel in which he readily conceded that ultrasound technology is not perfectly designed to identify every anomaly.  In her third chapter, Japanese Prenatal Care, Ivry suggests that “[a] body that can give a good birth is the result of the continuous hard work of “bodybuilding””(92). But, a healthy mother does not guaranty a healthy birth, and I believe that it is the emphasis on healthy pregnancies is the common denominator that motivates both communities to manage their pregnancies with the goal of healthy births.

Questions for Class Discussion: 

-How do Japanese and Israeli Americans view pregnancy and new reproductive technologies?  

-Do they carry the cultural perspectives that are outlined through this book?

-Do you believe that pre-natal testing mutes diversity of disabled people?

Japan’s population continuously shrinks as the birth rate falls to the lowest level in history. The unique Japanese history and traditions form the society and culture of marriage and reproduction in the country. The book Embodying Culture: Pregnancy in Japan and Israel by Tsipy Ivry and Mac Marshall makes comparisons between being pregnant in Israel and Japan. Even though Israel tends to be known as a pro-natalist state, the book suggests that abortion of defective fetuses in Israel is a lot more common than in Japan (37-39). Moreover, the significant number of different pregnancy tests in the two countries suggest their differences in their emphasis and value. In other words, the comparisons made in the book explains the impacts of a country’s history, culture, and religious beliefs on their perspective of reproduction.

The book starts off the first chapter by explaining the Jewish religious imperative of “be fruitful and multiply” and that Israel is often being perceived as a pro-natal state as a consequence of surviving military conflicts (37). Reproduction is valued in the state of Israel. However, the frequency of abortion of defective fetuses is also explained in the text (39). In fact, pregnant women often sued their doctors for them failing to detect the abnormalities of the fetuses (26). Their strong emphasis on detecting abnormalities during pregnancy is backed up by the reason of “Jewish disease” that the recessive diseases were spread due to intermarriage in a small community (44 and 266). Compared to Japan only having three items in the “Japanese diseases” list, there are 47 items in the “Jewish diseases” list (266). It is inevitable that biological history and reproductive culture are not mutually exclusive and they are interconnected.

As a Japanese myself, I was quite surprised to learn how reproduction and women are valued differently in Israel. Unlike in Israel, Japan does not encourage tests for down syndrome due to moral issues; only patients with a high risk of carrying the disease are permitted for the test. Pregnant women in Japan are not concerned about fetus abnormalities as much as women in Israel. Moreover, pregnant women in Japan are also very valued during the process of pregnancy. Their weight is also controlled for the purpose of carrying children more easily for mothers (74). It is clear that both women and babies are valued during the process of birth-giving and the idea of “multiply and be fruitful” is not widely valued. However, in eras when militarism was emphasized in Japan, reproduction was encouraged in society (78). In fact, in 1907, the Meiji government outlawed practices of abortion and infanticide; “between 1920 to 1940 the population grew from nearly fifty-seven million to seventy-three million” (78). Embodying Culture: Pregnancy in Japan and Israel explains that the historical background can change the value of procreation and babies in society. The idea also relates to the current Japanese society that struggles to cope with the decreasing birthrate. As women become more accepted to enter the workplace, they decide to carry fewer children in order to main their job positions. Moreover, there are still not enough childcare and support for mothers to work and that creates the issue of a shrinking population. On the other hand, the Japanese government works to reduce the burden for working mothers to raise its fertility rate.

The book explains the bidirectional relationship between historical background and reproduction. People make decisions about their babies based on their countries’ historical and cultural backgrounds and changes. Moreover, governments also implement new public policies to cope with the social problems caused by changing birthrate and arising reproductive issues. In other words, the comparative studies of the two countries’ medicalized pregnancy explain that pregnancy as a biosocial phenomenon.

Discussion Questions:
Japan is working on preventing a further decline in its population. Do you think there are other effective ways other than implementing public policies to raise Japan’s fertility rate?
What did you find most interesting in the book?

In many countries, there is supposed to be a separation of Church and State. However, many societal norms, bioethical views, and, as a result, laws today are still intertwined with religion. It is difficult to separate the two since many people use religion to guide their views about what is morally acceptable. It is not bad for one’s moral compass to be driven by religion; however, it does make it difficult in our society to come to agreements about the morality of reproductive technologies when there are people who are not religious at all, who are members of different religions, and who are members of the same religion but interpret religious texts in different ways.

Donum Vitae intended to use universal philosophical and natural law arguments so that even those who are not Catholic can agree with their claims. However, I still disagree with many of the arguments since some of the evidence used seems to be contradictory. For example, they cite Pope John Paul II (1980) who said that reproductive technologies tempt man “to go beyond the limits of a reasonable dominion over nature” in the introduction. However, they also cite shortly after that God created male and female and gave them “dominion over the earth” (Gn. 1:28). These two statements seem conflicting because neither the quote from Genesis 1 nor anywhere else in Genesis 1 or Genesis 2 presents any limitation on the dominion over the earth.

This is not the only place there appears to be discrepancies between Donum Vitae and the Book of Genesis. In addition, “God said unto them, Be fruitful, and multiply, and replenish the earth, and subdue it” (Gn. 1:28). This indicates that we should reproduce, and given that we should reproduce and that we have dominion over the earth, I do not understand the moral opposition to reproductive technologies as a whole, including heterologous artificial fertilization and surrogate motherhood which Donum Vitae states are illicit. However, Donum Vitae and the Catholic Church do not believe that we are obligated to have kids, as we discussed in our previous class in relation to celibacy in the Catholic Church. This does not seem to align with what I have read of the Book of Genesis, but I am not a religious person and have not read the entire Book of Genesis. As a result, I do not completely understand this stance, as well as a few other opinions that the Catholic Church mentioned in this article, which has led me to disagree with a number of their conclusions. I am curious, though, to read more of the Book of Genesis to try to understand their evidence. I am also curious to know how the views of the Catholic Church may have changed since Donum Vitae was published and why these views have or have not changed.

In “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates,” Ball discusses the history and current stance of artificial reproductive technologies (ART) in France as of 2000. Overall, I thought the timeline of the legality and morality of ART in France was intriguing because they kept shifting their stance. In most of the 19^th and 20^th centuries, ART was seen as “repugnant to natural law” (Ball 548). It was banned in hospitals until the first government-sponsored sperm bank was established in 1973. Then in 1978, ART became completely covered by the national health insurance system with an infertility diagnosis, whereas other medical procedures are normally reimbursed up to 80%. However, the motives behind this was to increase births after decreasing birthrates during the 1970s. In the 1980s, public attention went to controversial cases, which eventually led the French National Assembly to pass laws in 1994 that only sterile, heterosexual couples of procreative age can use artificial insemination and IVF procedures.

This decision had clear political motives: to protect the traditional family structure. They saw this imminent disruption of the typical family structure via the use of ART as bad for two reasons. First, they viewed a nation as a combination of several families, so each individual family was the foundation of their society. As a result, they wanted to maintain the traditional family structure to keep a strong foundation of individual families to keep the nation stable. Second, they thought providing ART to those who were not heterosexual or who were not of reproductive age was unnatural because they cannot “naturally” have children. Ball presents Rosseau’s argument to counter this idea of what is natural. Using ART for those who are not heterosexual or of reproductive age is only unnatural if the concept of nature is static. Rosseau argues that these static, “natural laws” may actually be subjective laws “developed from observations of their own society” (Ball 579). As a result, these observations may not truly be universal like some in the Catholic Church believe, as previously mentioned in reference to Donum Vitae. Therefore, in my opinion, we should not be keeping ART from most people who may benefit from it based on observations that are not universal.

A question I had when reading the Ball article was how much of an influence did religion have in the formation of the traditional family structure in France? The importance of the family unit was also mentioned in Donum Vitae; it states on page 158 that “the vitality and stability of society require that children come into the world within a family and that the family be firmly based on marriage” and later adds that a family consists of a husband and wife. Since these two articles have very similar views on the importance of this typical family structure, were these ideas shaped by the same religions ideas emphasized in Genesis 2:24 and Genesis 2:25? Although the Church and State separated in France before 1994, I would expect religion still influenced societal norms, like it does today, which can then influence the laws put in place. Was France still a relatively Catholic country during this time or did this idea of the traditional family structure persist even though France was no longer very religious? Or is the traditional family structure independent of religion altogether? Additionally, what were the stances in other countries about ART during this time?

One question I had throughout both Donum Vitae and Ball’s article is why do we tend to view things as static and resist change, especially regarding bioethical issues? It seems reasonable to me that our understanding of what is natural and moral would evolve as our understanding of the world develops over time. I think it may come back to our interpretation of the Book of Genesis. In Genesis 2:9, God made the tree of life that has knowledge of good and evil. But does this mean that things are either good or evil or is it a spectrum of good to evil? If we view good and evil as two distinct categories, that could contribute to viewing things in a more static mindset. However, I think it is more realistic that good and evil is a spectrum and that many of these bioethical issues, including those regarding reproductive technology, fall somewhere in between good and evil. If we consider it a spectrum, then it may be easier to adjust our view on an issue as we learn more about reproductive technology and learn more about the world in general. This view that good and evil is more of a spectrum instead of a dichotomy could help remind us that what is natural is dynamic, not static.