Unit 10: Surrogacy, Ethnography, and Bioethics – Jesse Rosen

This week’s readings focus on ethnographic approaches to surrogacy in several ways. They examine a variety of ethnographic methods in relation to surrogacy and other bioethical issues, while also analyzing how these ethnographies may or may not successfully represent a culture and impact public policy.

Arthur Kleinman’s “Moral Experience and Ethical Reflection: Can Ethnography reconcile them? A quandary for the new Bioethics” critiques current ethnographic approaches to bioethics for not focusing enough on the lived experiences of the individual and failing to generalize conclusions to inform policy change. Kleinman begins by explaining different approaches to bioethics. Basing bioethics on the idea of human nature and universal objective truths, he claims, cannot work because of widespread disagreement on what human nature entails. If there is no universal understanding of human nature, natural law cannot be universal. Using evolutionary arguments is even more hopeless, as we cannot know our ancestors’ evolution of ethics. Complete cultural relativism also has pitfalls, with local ethics only being able to be understood in the context of a translocal framework. Further, using only locally-based ethics may lead us to condone acts like genocide where it is locally accepted, even if outsiders know that it is universally wrong. Thus, a combination of local and translocal ethical principles must be used to assess individual moral reasoning. 

Kleinman’s solution is to use ethnography to inform bioethics. He complains though that clinicians generally do not understand the research approach of ethnography, while ethnographers perhaps lack training in the pragmatic side of ethics. Kleinman argues that ethnography should be used directly to impact ethical deliberation, and that ethnographies that fail to do so are unsuccessful. The work of Paul Farmer, and ethnographer and physician, is seen to be successful by Kleinman because it reformed the global strategies for dealing with MDR tuberculosis. 

While it’s great to hear a case of systemic change as a result of ethnography, Kleinman fails to note that Farmer’s job as a physician puts him in a unique position to make credible recommendations for changes to clinical care standards. Many ethnographers may recognize systemic issues in the course of producing an ethnography, yet not feel comfortable directly approaching policymakers with recommendations on bioethical issues as a non-clinician. So while it’s true that ethnography often ends at description and interpretation, it is perhaps not the burden of the ethnographer to move to further action unless they are so inclined and qualified. I would not call an ethnography ending in description unsuccessful, because it can be used for later prescriptivist interpretation by those with training in that field.

The second focus of Kleinman’s article is the gap between the lived experience of individuals and their culture’s official views. Kleinman provides the example of abortion in China. Decades of ethnographies focused on religious, governmental, and philosophical views regarding abortion. Jing Bao Nie then conducted an ethnographical study of individuals and found that men often did not even know when their wives had an abortion. The decision and moral deliberation usually fell squarely in the hands of women, and in a patriarchal society the voice of women had been disregarded in prior studies. Thus, in order to gain a true view of how bioethics are being applied in a society, it is necessary to examine the lived experiences and morals of individuals within that culture. He applauds Rayna Rapp’s ethnography, which we read earlier in this class, for doing this well.

I agree with Kleinman’s conclusion, but I would have preferred it expressed in fewer and simpler words. Of the readings for this week, Kleinman’s article was by far the most difficult to digest. There is little organization to the article and some concepts are presented in such an abstract manner as to be left ambiguous. For someone interested in pragmatism of research, Kleinmain makes surprisingly little effort to make his article approachable and to clearly communicate his views. 

Another paper Kleinman would surely applaud is Elly Teman’s “The Social Construction of surrogacy research: An anthropological critique of the psychosocial scholarship on surrogate motherhood.” This article explores ways in which past research involving the experience and psychology of surrogates has used Western assumptions surrounding motherhood to slant both their methods and conclusions. The article presents and rebuts three primary assumptions surrounding surrogacy: that surrogates have abnormal psychology, that surrogates are motivated by altruistic or reparative reasons rather than financial ones, and that surrogates are somehow avoiding or denying their grief over “losing” a child. Incredibly, Teman is able to use results and testimony from these problematic studies themselves to rebut each assumption. 

I found it interesting how in a literature review, conducted as part of her ethnographic study, Teman began analyzing the assumptions made by researchers rather than the surrogates they studied. It becomes clear that the researchers are clinging to traditional views such as a mother’s instinctive attachment to a child to which she gives birth and the nurturing/emotional nature of a woman. They justified the surrogate’s choice to gestate someone else’s baby with her trying to right past wrongs such as abortions, and assumed surrogate mothers have an experience comparable to mothers who give up their children for adoption. Instead of going into interviews with an open mind, researchers imposed their own worldview upon surrogates and did not adjust their conclusions to reflect the evidence they found. Teman managed to turn these unsuccessful studies into an insightful and compelling article. 

Kleinman would also be happy to see that Teman takes her conclusions and makes prescriptive suggestions for policy surrounding surrogacy. These recommendations include allowing surrogates to continue contact with recipient couples, to whom they’ve been shown to have more difficulty with separation than to the child. Group counseling for the couple and the surrogate together is also advisable rather than the surrogate alone, since surrogates are shown to have more issues with communication with the recipient couple than with relinquishing the baby. 

The third reading for this week is “Gestational Surrogacy in Iran” by Shirin Garamoudi Naef. This chapter utilizes primarily close readings of Islamic texts, interviews with religious scholars, and discussions with/observation of those who are receiving or have received assisted reproductive technology (ART). Naef makes the interesting distinction between Sunni and Shia views on ART when it comes to gamete donation and surrogacy. 

In the Sunni view, mixing of bodily substances is the primary concern when it comes to incest and adultery. Mixing of identical bodily fluids is the basis of incest. All biological substance is said to come from the man, so even milk is considered a male agnastic substance originating from the pregnancy. So any baby who has suckled from the same milk as oneself is covered under marriage prohibition. Because the mixing of reproductive substance is forbidden outside marriage, donor gametes are forbidden. Further, because women have no reproductive substance, gestation is the only determinant of motherhood and surrogacy would result in a child unequivocally belonging to the surrogate. Surrogacy is therefore forbidden as well. 

The Shia view is that the forbidden act in adultery and incest is the act of sex rather than combining of fluids. Further, the biological contribution of men and women is considered roughly equal and symmetrical. This means that even donor sperm or ova is permissible in that it is not adulterous, though the child is usually considered to be that of the donor. In the case of surrogacy, the gestational surrogate is usually considered to simply be nurturing the embryo. According to scholars such as Ayatollah Sane’i, it does not even break religious law to have an unmarriageable individual or sibling act as surrogate. Surrogates interviewed showed joy at being able to help others achieve parenthood and didn’t express attachment to the children they bore.

Naef goes over many different interpretations of the Qur’an and Islamic law. One of the most intriguing parts of the chapter for me was the instances in which individuals believe a gestational surrogate is also a mother. It was explained that inheritance occurs between a gestational surrogate and child, and it occurred to me that in a scientific sense this does happen to some degree. Epigenetic factors are affected to a large degree during pregnancy, and uterine hormone levels are theorized to affect aspects of children from personality to physical characteristics. Gestational surrogates do impact the attributes of the babies they bear. Whether that grants them status of mother is another question.

While Naef does speak to individuals involved in the ART process, she uses her discussions with religious scholars as a framework for her analysis. Arthur Kleinman and Elly Teman might be critical of this ethnographic approach, noting that while it conveys the official views of the community, it may not reflect the true actions and beliefs of individuals. Both the Teman article and the chapter by Naef are clearly written and nicely organized, making them accessible to the layperson. 

As the result of gamete donation myself and someone likely to use a surrogate later in life, I have been curious as to how these technologies are viewed by others. While my gut feeling is that a surrogate has little stake in a child after birth and definitely no kinship relation, it has been eye-opening to see that this is not the default view for everyone. It is a relief though to learn that surrogates across cultures seem to feel that they are not a parent. 

One question I’d pose to the class is why so many religious leaders and governments continue to impose a kinship bond between gestational surrogate and child when that relationship is wanted by neither surrogate nor intentional parents? When all stakeholders want the same thing, I’d think the solution would be obvious and uncontroversial, but it is not. Further, do you suppose surrogates are proof that the “instinctive” mother-child bond is culturally/socially-based, or is the surrogate’s lack of a bond to the children they birth due to some other factor? The same goes for other issues/assumptions brought up in Teman’s article — do you have theories for why these phenomena really occur? And for anyone in the class seeing surrogacy as wrong or exploitative, I’d be very interested in hearing your perspective and arguments in your comment or during class if you’re willing to share.