Religion and Bioethics Spring 2020

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.

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.

“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. Israel is a pronatalist country and has a large focus on the idea of reproducing its culture due to the history of Jewish persecution. As a result, in order to understand these contrasting viewpoints, it is important to also consider the experiences of different people within different cultures; simply examining how they interpret different texts will not provide the perspective necessary to understand.

“Modern Reproductive Technologies and Jewish Law” by Michael Broyde focuses specifically on the legal issues of cloning within Israel, and within Jewish law. He notes a point of contrast in Jewish belief that dictates this argument: the conflict between wanting to help people, and the belief that everything may not be proper, particularly when related to intercourse. In Israel, decisions about the use of reproductive technology are handled case by case. Therefore, it is logical to assume that if human cloning were to take place, it too would be handled in this way. 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. Because Judaism is matrilineal, this becomes increasingly complex because there are debates on who would be considered the mother: the gestational mother, or genetic mother. If the genetic material came from a man, this is simplified, because he would be the father, though there are debates if this would be the case since the child was produced without intercourse. This, of course, points to inequalities between men and women, as in the case of cloning it would be much easier to claim parental rights as a man than as a woman. Furthermore, due to the matrilineal aspect of Judaism, if one mother (gestational or genetic) was not Jewish, this would create many issues in determining the child’s identity. There is also the question of whether a clone would be considered human, and if they may be used in immoral ways; Broyde, by analyzing Jewish law, determines that this individual would be considered fully human. 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 rabbanic 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 great 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 is needed to understand this issue. What I found most interesting in these issues was the complicated area of kinship that was discussed. Particularly, the fact that Judaism is matrilineal is especially interesting because this does add complications in terms of reproductive technology because women give birth; in paternal societies, while these issues are still incredibly complex, you do not need to consider the passing down of identity when you assign the label of mother either to the genetic or gestational 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 create greater understanding of why the decisions around reproductive technology in Israel are unique, and also deepen the explanations of their origins, as you could see the differences that exist in other societies. 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.

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?
• Do you think that human cloning will ever become a viable option? Broyde mentions that the Republican debate around cloning revolves around questions of morality. Could cloning ever become a morally accepted practice?

The reading and viewing materials for this week delve into discourse surrounding prenatal testing but through a lens broadened to include much more than just religious influences. Exploring multiple identity characteristics, we learn how various elements of a person’s life experience affect their ethical and moral considerations related to pregnancy. Note: This blog post reviews the book Testing Women, Testing the Fetus and the film The Burden of Knowledge: Moral Dilemmas in Prenatal Testing; I could not locate “Outsourcing Moral Responsibility: The Division of Labor among Religious Experts.”

Rayna Rapp’s Testing Women, Testing the Fetus is a compelling ethnographic study which explores the social impact and cultural meaning of prenatal diagnosis, specifically focusing on the ways that different identity characteristics (race, class, citizenship, education level, family background, among others) affect decisions about amniocentesis. Published in 2000, the book presents a highly comprehensive review and analysis of perspectives on prenatal testing among women, male partners, genetic counselors, lab technicians, and other medical professionals who Rapp engaged with over the course of 15 years. Rapp began her research after a personal experience with prenatal testing which involved a difficult and transformative decision-making process.

Rapp presents her analysis as contributions to three different discussions. The first topic concerns technological transformation of pregnancy, or how the advancement of technology affects pregnancy and reproduction. Secondly, she discusses the intersection of disability rights and reproductive rights and questions the best way to approach prenatal testing so that the two can both be supported. Her final topic concerns scientific literacy in America and the impact of differential understanding of diseases, genetics, and diagnoses in affecting decision-making. In summary, Rapp argues that “the very objects of [biomedical] knowledge—chromosomes, health risks, fetuses—and its technologies of intervention—sonography, chromosome studies, maternal and fetal health—are culturally constituted” (Rapp 13).

The film The Burden of Knowledge: Moral Dilemmas in Prenatal Testing examines the way ethical considerations affect the degree to which individuals support advances in prenatal testing technology. The 54-minute documentary consists of interviews with seven couples who have experience with prenatal testing as well as doctors, counselors, and medical scholars. The film breaks down prenatal testing into the chronological stages of the pregnancy process and relies solely on interviews to communicate information.

Both of these pieces approach understanding the social and cultural impact of prenatal genetic testing holistically and through story-telling. I found this to be a compelling strategy since pregnancy is widely considered to be a private topic in America. Unless an individual has close relatives or friends who are willing to share their experience, little personal information about the experience is readily available. Further, this style encourages readers and viewers to understand that the combination of identity characteristics and the degree to which certain elements of a person’s identity contribute to their morals is so incredibly specific and personal. While trends arise among women of the same race, education level, class, religion, etc., understanding a woman’s viewpoint is highly personal to her specific life experience. I appreciated the holistic approach supported by narratives since it communicates the nuances of prenatal testing and the overwhelming complexity of its reception.

At the end of Rapp’s book, she points out a key limitation which I also considered while reading: the subjects of her research all come from the New York City area. On one hand, this melting-pot city has a vast degree of diversity among its inhabitants, and Rapp successfully incorporates anecdotes from a very diverse group of individuals. On the other hand, the ethnography lacks the perspective of rural America. This may seem scrupulous, but considering the political power that rural America has in controlling reproductive rights, I think their perspective is a vital piece of the full picture. That all said, I find that the discussion of morals and ethics in relation to prenatal testing (as well as pregnancy issues as a whole) are often too simply boiled down to the impact of religion on values. I imagine that if this ethnography explored rural America, the effects of other social and cultural identity elements that this book powerfully explores would have once again been clouded by the effects of religion. I appreciate that this book highlights all of the many other social and cultural factors which affect women’s ethics and morals, so while I think the experience of rural America is important, I think it is meaningful that Rapp excluded it.

As for the film, I found the interview style palatable but doubted the reliability of the participants’ answers. The directors of the film ask couples to discuss a very personal aspect of their lives, and I think it would be very rare for a person to truthfully open up to a camera about such a raw and private experience. Further, the interviewees’ descriptions of their opinions regarding prenatal testing were all told in retrospect, and as Rapp brings up in her book, a person’s ethical and moral considerations at the time of a positive diagnosis versus when they have a child to love and hold are incredibly different. While the film was mind-opening and discussion-provoking, I think observation of couples currently going through testing and diagnosis would provide a more genuine understanding of a woman and her partner’s experience.  

One concept from the film that I found particularly thought-provoking was the idea that pregnancy is a terrible time to begin to learn about disability because women are forced to try to understand their values and ethics during a time when they are physically and emotionally drained. While it would be nice to walk through life with a completely solid understanding of one’s morals, I think this is rare, and for most women trying to conceive a baby (let alone women who conceive accidentally), I doubt this is a consideration on their mind. This left me wondering what non-religious, non-familial outlets are available to women seeking to gain ethical coaching during this difficult time? Since genetic counselors are taught to counsel through a non-directive approach, where can women turn for guidance? Is this why so many people rely on religious teachings since it’s such a concrete and obvious direction to turn to for advice?

Finally, I would like to know how the rest of the class digested Rapp’s assertion that “contemporary pregnant women have become our moral philosophers of the private” (Rapp 306). While on one hand, I think the claim empowers women and underscores the heavy weight that they are under to make moral choices, I also think this evaluation unfairly disregards the impact that male partners and other family members have on pregnant women’s decisions.

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 religion is used to guide people about what is morally acceptable.

Donum Vitae is a clear example of using religion to dictate what is morally acceptable. Shannon and Cahill have extreme views about what is moral and immoral. For example, children must be “the fruit of marriage,” so heterologous artificial fertilization and surrogate motherhood are not allowed because it goes against the unity of marriage (Shannon and Cahill 157). Homologous in vitro fertilization (IVF) is wrong because it separates procreation and the conjugal act. Homologous artificial insemination does not replace the conjugal act and can only be used to facilitate “the act [to attain] its natural purpose” (Shannon and Cahill 166). For those who are sterile and cannot use artificial fertilization, they recommend adoption or assisting other families and children.

Shannon and Cahill did present their arguments in a logical manner, and I understand their logic given their beliefs. However, I honestly disagree with most of this article because I do not agree with their beliefs. First, I do not agree that children must be a result of marriage or that procreation and the conjugal act must be connected. Additionally, I do not like some of their wording. For example, they discussed that researchers should work to find causes of sterility so that we can prevent it. I agree with this; however, I do not like that they then said that it will help sterile couples so that they can procreate “for their own personal dignity” (Shannon and Cahill 169). I do not think that one’s dignity should be equated to whether or not someone can or wants to have kids. However, if we need to have children for our own personal dignity, why would we not support using artificial fertilization to help people? If we are supposed to reproduce and we were given the knowledge and ability to create artificial reproductive technologies (ART) to help people reproduce, why should we not use it?

Unlike Donum Vitae, the role of religion is not as clear in regards to the laws and bioethical views towards ART in France, which Ball discusses in “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” 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 were to increase births after decreasing birthrates during the 1970s. However, in the 1980s public attention went to controversial cases, such as if a woman was allowed to use her deceased husband’s sperm to have a child. Finally, the French National Assembly passed 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 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 natural is static instead of dynamic. Rosseau argues that these static, “natural laws” may actually be subjective laws “developed from observations of their own society” (Ball 579). Therefore, we should not be keeping ART from most people who may benefit from it. This idea of what is natural being dynamic also may cause problems in Shannon and Cahill’s arguments of when ART should be used.

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? 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 of these readings 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 the role of religion. In Genesis 2, 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 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 it 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.

Furthermore, I think these discussions about bioethical issues are important to have, especially in today’s society which is so polarized. However, I find it difficult when there are things that I simply do not agree with, such as the fact that a child needs to be born via “natural” measures to married man and woman. Is there a way for Shannon, Cahill and me to come to an agreement on what circumstances reproductive technology is moral even though we disagree that a child is the fruit of marriage?

1. Clifford Geertz, “Thick Description” from The Interpretation of Cultures (Basic Books, 1973).

Geertz’s “Thick Description” opens by introducing the concept of the “new idea” as though the reader should have a firm grip on what concept he is referencing (Geertz 310). While a bit mysterious, this somewhat surprising introduction hooks the reader by appealing to a sense of curiosity. I wonder if this sense of mystery would have been absent had I read an associated prior work or chapter.

The first page declares that the “new idea” mentioned inevitably transitions from a thing of infinite potential to an importance that lacks the potential it once held (Geertz 310). Gertz argues that the anthropological works he will reference work to transition anthropological findings in this way to ensure long-held importance.

          The text reads as a critique of a good portion of anthropological thought. Some blatant examples of this critical tone include a critique of a work by describing the author’s similes as a result of «desperation” and framing “little stories” by Oxford scholars as things they “like to make up for themselves” (Geertz 311-312).

          He defines various terms through his own perspective, such as anthropology as the study of culture as “semiotic” or the study of symbols. He also labels ethnography as “an elaborate venture into”, or “thick description” (Geertz 312). In this instance, “thick” refers to the detailed why and what of an action, while “thin” refers to the more obvious facts of an action. This definition leads into extensive commentary on the purpose and means of cultural study. The commentary functions by citing schools of anthropological practice- for instance, the way that ethnoscience, cognitive anthropology, or componential analysis argues that culture is a symptom of psychological structure.

The text concludes with the author’s opinion of what anthropology should be used for. Geertz writes that anthropology, at least interpretive anthropology, does not exist to answer questions correctly per se but to find the way that others have answered.

2. Sherine F. Hamdy, “Does Submission to God’s Will Prevent Biotechnological Intervention?” In Jeremy Stolow editor, Deus In Machina: Religion, Technology and the Things In-between (Fordham University Press, 2013), 143-57.

Hamdy’s text asks the reader to consider the ties between religion and technology. She pushes against the notion that the two domains are separate and by addressing examples of their intertwining. The text opens with an anecdote, the story of an instance within a hospital in Egypt.  The anecdote describes a man refusing a kidney transplant for religious reasons. Within the second paragraph, the moralizing of individuals’ decisions based upon religious influence is brought into the conversation.

The author blatantly states her argument “against the dominant narrative: that religious fatalism obstructs people from pursuing biotechnological intervention. … people’s understandings of religion and biomedical efficacy are often inextricably enmeshed and together factor into their cost-benefit calculations about medical intervention,” (Hamdy 144). This clear thesis statement aided immensely in my understanding of the text as a whole. It is a powerful writing tactic.

The remainder of the text supports this argument through the employment of first-hand examples and other means of substantiated factual claims. Hamdy works to display the way in which an individual’s decision to receive a transplant is deeply complex. The text’s structure operates by following one narrative throughout. I found this somewhat narrative approach to be both extremely convincing and interesting.

3. Carol Delaney, “Father, State, Motherhood and the Birth of Modern Turkey.” In Sylvia Yanigasako and Carol Delaney editors, Naturalizing Power: Essays in Feminist Cultural Analysis (New York: Routledge, 1995), 177-200.

          From the paper’s very opening, Delaney critiques the work of anthropologists. She argues that the way in which “kinship” is used in Turkey is overlooked by many anthropologists because of the nature by which “kinship” is widely used in anthropology (Delaney 177). Having been a student in many Women’s Studies courses, it is my strong opinion that works of feminist theory often use language that is very difficult to understand. Unfortunately, this piece further supports that opinion of mine.

          The piece rests on the argument that that nationalism should be viewed through the lens that, in defining nationalism, it is most logical to define the term through ideas of cultural concepts. She emphasizes the importance of acknowledging the intersections of concepts such as family, religion, and nation. Like the prior work, Delaney explicitly states the purpose of her work. She writes that her goal is not merely to “highlight the differential placement of man and women in and to the nation” but to “show the role that symbolism of mother and father play in the conceptualization of the nation,” (Delaney 178).

          Delaney discusses the differences between “Father State” and “Motherland” in Turkey (Delaney 179). These differences are discussed through historical evidence. This historically-evidence based work provides abundant context to the work’s argument. Linguistic examination is used as evidence as well. Within the text, Delaney intertwines the position of women and the structure of language. This addressing of symbolic function is integral to the argument.

          The piece goes on to discuss the ways in which procreation and birth are used to discuss the nation of Turkey. Delaney argues that this use of language contributes to the way in which procreation and birth are framed as natural.

She discusses the notion of paternal role in citizenship and general identity. As she writes, “citizenship is not gender neutral” (Delaney 188). Gender in legality is added to prior evidence of the nation’s enactment of gender. The text closes in a summary of these ideas. Its argument points are weaved together in the conclusion.

Prospective Discussion Questions

-In what ways do the works employ evidence to very effectively drive their points home?

-Was there an argument tactic that really stood out to you? Was there one that really convinced you?

-Did anything about these articles really stand out to you as surprising?

We hear the word all the time: culture. We ‘learn’ culture in the language classes we take. We are ‘taught’ our culture, whether that be by our parents, by our religious leaders, by our friends, by ourselves, but what is the definition of culture, and what constitutes culture? These are questions Clifford Geertz attempts to begin to examine in his first chapter, “Thick Description: Toward an Interpretive Theory of Culture” in his book, The Interpretation of Cultures.

Geertz begins by scrutinizing definitions offered for words such as ethnography and anthropology and moves on to claim that anthropology, ethnography, and understanding culture all require what he describes as ‘thick description.’ To Geertz, thick description equates to analyzing, examining, and describing situations and observations in immense detail. He goes on to offer some definitions of culture from other sources; however, he arguably does not offer his own clear definition of the word culture, besides comparing it to “webs of significance” that man is suspended in (Geertz 5). Instead, Geertz visits and revisits example after example in an attempt to prove his theory regarding thick description and validate the ideas of others in terms of how one can measure culture.

As I read his work, I found myself questioning many of his main points, especially when it came to his idea of ‘thick description.’ While one may observe the actions of people within a cultural or religious context, I believe that in order to truly understand a culture, and what culture is, one must first immerse oneself in the culture. It is not enough to simply ‘thickly describe’ a culture, or even to live in a village and observe. To me, truly and fully understanding a culture requires becoming a part of that culture, and only then can one begin to ‘thickly describe’ it. Therefore, I do not believe that anthropology should be solely an observable science; it should be an immersive science. ‘Thick description’ and observation cannot begin to compare to physical, mental, and social immersion, but the two combined can create a much better understanding of the culture one is attempting to describe.

This brings me to the following reading by Sherine Hamdy, “Does Submission to God’s Will Preclude Biotechnological Intervention? Lessons from Muslim Dialysis Patients in Contemporary Egypt.” In her work, Hamdy argues against the idea that “religious fatalism obstructs people from pursuing biotechnological interventions;” however, I do not believe that she could have come to this conclusion without first immersing herself in the culture (144). Throughout the first portion of the work, Hamdy examines the laws and regulations in Egypt surrounding organ donation and transplantation, with the most surprising aspect, in my opinion, being that “brain-death is not recognized as legal death, hence all organ donors are living” (144). She then goes on to describe her experiences working with dialysis patients who have refused to undergo kidney transplants and how their religious beliefs affected their decisions.

One such patient, Muhammad, would often speak of the uncertainty regarding the outcome of such a surgery. He often claimed his decision to continue dialysis instead of receiving a transplant was due to his trust in God. As a psychology major, as well as someone who has not immersed myself in Muslim Egyptian culture, I would argue that his reluctance to undergo surgery is not solely due to his trust in God, but also his innate, biological fear of death, and that if he trusted God to give him the option of surgery and ensure that he would live, he would accept the transplant. However, Hamdy views the situation differently and argues that the act of receiving dialysis treatment falsifies the claim that “religious fatalism obstructs people from pursuing biotechnological intervention” (144).

While she does describe how she initially spent a long period of time arguing with another patient, Ali, over his decision not to receive a transplant, despite the fact that he would not have to bear the cost, Hamdy ultimately displays her understanding of his culture and beliefs towards the end of the piece. Although she does not agree with his decision and urges him to consider every option, she eventually accepts that “patients like Ali embody a religious tradition in which they struggle to cultivate within themselves the disposition of… contentment with God’s will” (154). Such acceptance displays, in my opinion, a true understanding of the culture, followed by what I believe Geertz would describe as thick description.

In the last reading, however, “Father State, Motherland, and the Birth of Modern Turkey” by Carol Delaney, the author arguably does not achieve such understanding of culture. While Delaney captures the overall history of Turkey, she does not, in my opinion, capture the culture of Turkey. She effectively summarizes a large portion of Turkey’s history and some of the aspects of the patriarchal society that exist within Turkey, but she seems to under-analyze the actual culture that exists within Turkey because she focuses excessively on the rhetoric used in the culture and how it portrays women as being inferior to men. For example, Delaney highlights how “the system… construes nature as created by God, who is figured symbolically as masculine”  while “nature, which is created by God, is both inferior to and dependent upon God and is symbolically construed as female” (182). While I definitely see her point, this extensive analysis of rhetoric detracts from her main ideas within the piece, specifically the inequalities between men and women within Muslim Turkish culture.

However, despite this weakness, Delaney points out key aspects of Turkish-Muslim culture that support her overall argument. For example, she examines the focus on procreation and how it creates unfair expectations of women as opposed to men, as well as an imbalanced narrative regarding the roles of men and women in procreation. As described by Delaney, Muslim women in Turkey are expected to produce children for their husbands, but the “men, in their procreative function, are associated with divine creativity” and given credit as “the one who bestows life as well as essential identity via the soul” (184). This analysis provides clear evidence as to the inequalities and lack of credit given to the women, as even though the woman is the one who carries the child inside her body, feeding it, keeping it alive, and housing it for nine months, the man ultimately receives all of the credit for creating the child. (184). If Delaney had led with this point, it could have aided her in proving her point and capturing the reader’s attention.

I also believe that this key factor also displays Delaney’s failure to immerse herself in the culture prior to making judgements. I believe that her examination of Turkish-Muslim culture does not fully account for the culture itself, only the aspects that Delaney disagrees with. In ignoring much of the culture, Delaney’s argument, in my opinion, does not provide enough understanding of the true culture and the proposed reasoning behind such ideology and rhetoric. In this situation, her ‘thick description’ simply is not enough; it requires a more immersive understanding of the culture itself. It seems to me as though she entered into the culture with a hypothesis and solely gathered evidence to prove her theory, ultimately leaving out the rest of the culture in the process.

Essentially, in my opinion, understanding culture requires immersing yourself in it, which, to me, means living in the culture, putting oneself in others’ shoes, and examining the situations with an insider’s perspective. While anyone can judge a situation from afar, no one can truly understand the situation if one does not experience it. Therefore, while anyone can provide ‘thick description’ of a culture or circumstance, unless you do not first immerse yourself in it, I do not believe you can ever truly understand it. You cannot understand a person’s motives solely by observing them; you have to put yourself in their shoes to be able to comprehend why they do what they do.

Possible Questions to Examine:

1. What do you think of the idea of thick description? Do you believe you can describe a culture without immersion?
2. What does immersion look like to you?
3. Do you think Delaney proved her point well in her piece, or would you have written the piece differently if you were her?
4. What is your definition of culture? Do you think any of the readings offered a clear definition of culture?

Dear Religion and Bioethics Students, Welcome! I look forward to sharing your thoughts and ideas this semester. Remember you blogs are visible to your classmates.

Don Seeman