a View from the Trenches

Leon Kass’s, Reflections on Public Bioethics: a View from the Trenches, discusses the Council’s goals and mission, its influence on the public and political debates, and an evaluation of the processes and conclusions the Council faced when producing the five major works in its first term. Kass describes his three main objectives in his reflection: a discussion of public bioethics, an overview of accomplishments the Council produced, as well as general observations of the Council’s tasks and challenges. Throughout his remarks, Kass strongly emphasizes the significance of exploring, reflecting, and utilizing philosophical and anthropological questions to guide bioethical dilemmas and implement policies for the limits on biotechnology. In other words, the importance of approaching bioethical discourses through a truly holistic lens. Furthermore, throughout his reflection, Kass eloquently weaves in the Council’s focus and goal of increasing public understanding and increasing information transparency on how new biotechnologies can affect humanity. 

Kass begins by describing the mission of the council, which was to advise the President on bioethical issues that may occur with the advancement of biotechnology. In addition to its advisory role, the committee presents 5 other main objectives and functions, which all involve exploring how biotechnology and biomedicine address issues of larger humanistic and moral significance. When Kass mentioned how the Council is  “summoned to search into deep human matters in order to articulate fully just what is humanely at stake” (224), it highlighted to me that the council was not created to only fulfill political or policy-driven duties, rather, to complete tasks that are immensely educational and goals that are profoundly approached through a philosophical, anthropological, and cultural lens. 

In addition, Kass continues to illustrate how the Council does not consist of “experts” in science and biomedicine. Instead, the council includes members who recognize how biology and science are deeply intertwined with concepts of human experience and nature. Kass also mentions that the Council has a duty to promote the public discourse on bioethical issues to encourage the wider national public to understand the larger complex issues surrounding policies and judgments, in hopes of promoting a common ground in debates. Reading Kass’s remarks on the Council’s functions enriched my appreciation for anthropology, as applying anthropological tools assists us in answering complex ethical issues – which is a discipline that is typically dismissed. Furthermore, it suggested to me that you don’t have to be a scientist to explore these discussions. What is more essential is having an open mind on the relationship between culture and biology. As an anthropology and human biology major at Emory, I have had the fortunate opportunity to explore these separate subjects while also exploring how they connect with one another. Oftentimes, many of my peers would ask me what anthropology even is as it is quite an underrated discipline. I have had countless interactions where my classmates would even assume that anthropology is the study of archaeology. I strongly appreciate Kass’s message that answering these tough ethical questions surrounding science and biomedicine requires a deep understanding of culture and concepts in Anthropology. What do you think would be an effective strategy to bridge the gap between culture and biology?  I think that anthropology courses should be required for current and future students because crucial concepts such as ethnocentrism, and practicing cultural relativity and humility, will allow current and future leaders to embrace all beliefs that may oppose their own beliefs. Another question that I have in mind is: what do you think is more important when having these bioethical discussions: to have greater knowledge in science and medicine, or to have greater knowledge of anthropological and philosophical tools? 

Despite Kass indicating that the members of the Council employed anthropologic approaches with a holistic perspective, I also found his reflection quite ironic. Throughout his reflection, he proudly shares the Council’s success by welcoming everybody who is engaged and thoughtful of various ideas. However, I actually interpreted his remarks as quite ethnocentric, because defining human nature and experience, as well as defining the threshold of what is considered moral or immoral, is very diverse and subjective. My interpretations of elements of ethnocentrism embedded in Kass’s remarks were further supported when he argues that the Council was an extremely diverse and heterogeneous group. As Kass describes, the Council’s main goal was to provide a forum for the national public. Thus, I found this passage quite humorous as the makeup of the Council was predominately white and privileged males — which do not represent the entirety of the U.S population.  Furthermore, Kass’s pride in having such a diverse group of members demonstrates his ethnocentrism and ignorance. He defends that the Council included “liberals and conservatives, Republicans and Democrats, and independent; and by religion [the Council] are Protestants, Catholics, Jews” (226), making the Council the “most intellectual diverse national bioethics commission” (227)  as evidence against the notion that the Council is a “hyper-politicized group of right-wing fundamentalist.” He then mentions how these charges are sadly continued despite the Council’s “copious” findings. As the U.S is considered a melting pot of cultures, religions, traditions, and beliefs, I found it questionable and ironic how members of the Council felt it was appropriate to address issues for the greater public – given the fact that they are not considering any non-western dominated constructs and beliefs. I was shocked to read how Kass was so stern on how the Council serves as an epitome of diversity while disregarding the importance of representing other religions and beliefs, making his defense insufficient and somewhat making the backlash the Council faced justifiable. As a result, I felt that his arguments and defensiveness on the Council’s heterogenous makeup were ignorant, thereby, decreasing his and the Council’s credibility. Do you think that the Council’s “diversity” or lack thereof is a primary factor in the rumors and negative connotations of the Council by the public?  I wonder how the Council’s makeup has changed since its official formation of the Council in 2001.

Throughout our course, we studied various interpretations and definitions of kinship or kin relations in different religious systems, which was a key component in bioethics as kinship narratives prominently shape cultural attitudes, behaviors, and decisions, in accepting or prohibiting the use of biotechnologies —  especially for reproductive technologies. As a result, defining kinship must be contextualized and studied through a non-ethnocentric and Western-dominated perspective.  Applying my takeaways from this course and Kass’s reflection, I found Kass’s confident claims of the panel’s diversity and cultural competency very amusing, because the Council lacked representation from any non-western dominated religions and societies, such as Hinduism and Islam, which view opposing ideas of reproduction and kin. Another observation I had in mind was how Kass’s reflection lacked explicit ideas of kinship and the diverse interpretations of kin systems, which is fundamental in discussing bioethical issues, especially regarding reproduction. Did you think that Kass’s reflections were sufficient without any mention of kinship?

Kass then addresses the Council’s five different projects produced during their first two-year term (26 months) to “embody [the Council’s] search for a richer bioethics” (229).  The five published works include Human Cloning and Human Dignity, Monitoring Stem Cell Research, Beyond Therapy: Biotechnology and the Pursuit of Happiness, Reproduction and Responsibility: The Regulation of New Biotechnologies”, and Being Human: Readings from the President’s Council on Bioethics.  Kass insist that he is “very proud” of the Councils work, commenting that the Council’s accomplishment employed in-depth, moral seriousness, accuracy, fairness, and judiciousness presentations and judgments.  Kass spends a significant portion of his remarks commenting and evaluating each volume’s subject and purposes. 

Kass begins with Human Cloning and Human Dignity, explaining how the cloning report is intended to address issues of larger humanistic contexts, which include human nature and procreation, healing, biomedical research, and the worth of human life. The report also emphasizes how cloning begins with producing a cloned human embryo, regardless of cloning to reproduce or for biomedical research. Kass then shares how the Council unanimously opposes cloning for reproduction as it poses a myriad of dangerous risks. For instance, cloning to produce children endangers the cloned child,  parents, and society’s dignity and freedom. He argues that cloning for procreation purposes would shift procreation to a form of manufacture, which would confuse relationship dynamics and personal identity. Personally, my Christian values and beliefs align with the Council’s prohibition of human cloning because it opposes God’s instructions to be fruitful and multiply (Book of Genesis) and it serves as a violation of the “natural laws” narrated in the bible.  However, when considering different societies’ cultures, I can understand the support for cloning to reproduce children. For instance, I predict members of Hinduism would potentially be more flexible on cloning because, as we have learned, Hinduism has many sacred stories and myths that highlight how procreation can occur without sexual intercourse. Furthermore, Hindu people value societal good and unity, leading them to believe that family is not defined by blood or genetic relatedness. Therefore, the Council’s agreement that cloning for procreation would confound relations and identity would contradict Hindu beliefs. This comparison strengthens the idea that ethical issues are incredibly challenging and complex, which is why having representatives of all communities should be considered, to find and form a common ground. 

Kass then moves on to cloning for biomedical research, expressing how the Council’s opinions were split. He comments how some Council members viewed cloning to be valuable for increasing knowledge and creating treatments for diseases, while on the other hand, some Council members were concerned with the notion that cloning is “ the deliberate creation, exploitation, and destruction of nascent human life.” (231). As a result of different stances, the Council recommended there should be a permanent ban on cloning to reproduce while cloning for biomedical research had varying consensus. Considering both viewpoints, I struggled to form my own opinions and was very conflicted. I interpreted that cloning for research could create preventative and curative medicine for current and future illness prevalence, which would save tremendous lives. However, I also understand how the cost of gain knowledge is the exploitation of human life. Do those benefits outweigh the cost? Overall, I think the cons of cloning for reproduction are valid,  however, I also feel it poses many other ethical issues and can be contradicting. For instance, it poses questions about the role of humans, while also exposing the tendency for humans to be egocentric. If killing human life is wrong and prohibited, what about exploiting or killing animals and biomes for consumer and research purposes? What makes human life more valuable than animals or the environment? 

To briefly include, Monitoring Stem Cell Research does not contain any policy or guidelines, but rather sheds light on how to present information to improve public debate on stem cell research. Moreover, the report offers information regarding developments and processes of stem cell research. Kass describes this report in four basic goals (232) and later conveys that the Council’s conclusion was that there is a “possibility of progress toward greater understandings of the issues, and toward more informed public decision making” (233) which would allow the society as a whole to be more appreciative for what is at stake. Beyond Therapy: Biotechnology and the Pursuit of Happiness”, in six parts, explores questions about how biotechnology alters and satisfies human desires and aspirations, and how those consequences will affect current and future generations. This report is valuable as it stresses how ethical issues require us to reflect on crucial questions on human nature and experience. As defining human nature and experience is very subjective, what would be the best approach to finding a common ground amongst differences in the characterization of those terms? Next, Kass comments on Being Human: Readings from the President’s Council on Bioethics, which implies how we need to consider what makes “human life rich, deep, and fulfilling” (238) since bioethical issues directly correlate to “the core of humanity” (238). He stresses these anthropological questions are matters that are often neglected in bioethical discussions. Kass then mentions how the Council’s discussions on insights into the human experience, were based on 95 different readings. I wonder who the authors were of the texts that the Council examined. I wonder if the selected books were written by predominately white males as well. Following, in Reproduction and Responsibility, Kass indicates that the goal of the project was to examine the regulatory measures enforced on biotechnology and ART practices. Kass portrays that the Council believed “regulatory institutions have not kept pace with the rapid technological advance… there are also great gaps… there is currently no public authority responsible” (242).  I wonder if any present regulatory institutions that monitor biotechnologies have improved since the report was written. To conclude, Kass explains the Council’s major accomplishment of offering legislative proposals targeting principles of human reproduction (243) and the Council forming a practical common ground. 

Lastly, Kass addresses general observations, challenges, failures, and success of the Council’s work. He reemphasizes how the Council’s goal was to educate the public to increase understanding of ethical issues and highlights how the public must be involved in decision-making. However, he also recognized how people don’t really care enough or want to put in the effort to be informed: “it is very hard to educate anyone about an issue unless you are prepared to tell them what to do” (245), indicating that the Councils publishments have not successfully impacted the public understandings dramatically. However, Kass acknowledges that the Council’s projects have sparked an enormous amount of attention, thereby, contributing to a larger national debate and providing an effective start. 

Evidently, human experience and human nature are intimately connected to biotechnology, requiring us to deeply reflect on what the crucial components of human life truly are. In reality, people typically tend to avoid action or form an opinion on issues unless it directly affects them. Thus, I think bridging the gap between culture and biology is of paramount significance to exploring bioethics; whether that’s by increasing awareness regarding the direct consequences of biotechnology on human life, or by requiring educational systems to ask students humanistic questions to promote more holistic and effective debates. 

      In Human Cloning and Human Dignity, Leon Kass discusses the two main purposes of human cloning: cloning to produce children, and cloning for biomedical research. Cloning to produce children (reproductive cloning) is defined as “production of a cloned human embryo, formed for the purpose of initiating a pregnancy, with the (ultimate) goal of producing a child (Kass, 90)”, while cloning for biomedical research (therapeutic cloning) is defined as the “production of a cloned human embryo, formed for the purpose of using it in research or for extraction its stem cells, with the (ultimate) goals of gaining scientific knowledge of abnormal development and… human disease (Kass, 91).” The concept of cloning in general is entangled in complex ethical questions, as it presents both positive and negative consequences that threaten to infringe upon human rights and societal structure. 

The proponents for reproductive cloning present a variety of benefits cloning can bring. This includes the opportunity to produce biologically related children for infertile individuals or couples, cloning also allows for selective gene selection that can prevent significant genetic diseases for children at risk. Human cloning can also produce rejection proof transplant donors for sick individuals, and it is provides an opportunity to recreate people who possessed great intelligence, talent, or beauty. Furthermore, proponents argue that cloning is merely the next step to artificial reproductive technology (ART), thus banning it would be a violation of reproductive freedom. This presents an interesting argument, as cloning certainly can be seen as an extension, or even an evolution of ART. If cloning is framed as a new form of ART, do you think people’s perception of reproductive cloning may change? Furthermore, Scholar Laurence Tribe adds, “a society that bans acts of human creation that reflect unconventional sex roles or parenting models (surrogate motherhood, IVF, artificial insemination) for no better reason than that such acts dare to defy ‘nature’ and tradition is a society that risks cutting itself off from vital experimentation (Kass, 122).” Additionally, under the goodness of existence argument, proponents claim that “existence itself, is the first ‘interest’ that makes all other interests possible. Even taking into account the possibility of serious genetic or developmental disorders, this position holds that a cloned individual, once born, would prefer existence as a clone to no existence at all (Kass, 123).” This argument was particularly insightful to me because it argues that existence trumps one’s quality of life. I disagree with this sentiment, and it is also in conflict with one of the key benefits to cloning, which is the use of eugenics to enhance genetic features of humans. 

Although there are some benefits to reproductive cloning as highlighted, there are serious flaws to the arguments that must be addressed, as it raises the questions, do these benefits outweigh the cost of the consequence? 

The ethics of research on human subjects committee categorizes the consequences of reproductive cloning into biological and societal problems. There have been a few successful instances of mammalian reproductive cloning, however, studies reveal that 89% of cloned pregnancies are unsuccessful, and the majority of the few live clones suffer major abnormalities. Dolly the Sheep is infamous for being the first successful live clone, yet it is less known that she suffered from early onset arthritis and other health consequences that led to her death at six years of age, making her the oldest cloned mammal to date. Cloned pregnancies present significant risk to the surrogate as well, leading to conditions like toxemia and fluid build-up in the uterus which can be fatal. Thus, human cloning at this stage would fall under unethical experimentation on human subjects, and the steps that need to be taken to make cloning an ethical experiment would also be unethical. Reproductive cloning also presents a serious identity crisis among individuals, as the act of cloning is to produce multiple copies of an existing individual. This leads to complications behind the perception of the clone in society, the clone’s complicated genetic relationship to its family, and the ethics of eugenics that will certainly dictate the future of human reproduction. Furthermore, “the Council is unanimous in opposing cloning to produce children. [They] hold that harms and injustices to prospective cloned offspring and the women involved… are sufficiently great (Kass, 300).” 

Biomedical research for cloning, on the other hand, presents a new set of pros and cons. The major benefit to therapeutic research is that “such research could lead to important knowledge about human embryological development and gene action, both normal and abnormal, ultimately resulting in treatments and cures for many dreaded illnesses and disabilities (Kass, 30).” Yet, this form of cloning is controversial because its execution involves deliberately creating, manipulating, then ultimately destroying human embryos, and those same embryos, if implanted, carry the possibility of producing a human. I found this argument interesting because my current biomedical research project involves creating, manipulating, then ultimately destroying zebrafish embryos, however, the ethical implications are much less complex. It is true that human life is considered more valuable in our society, but it also brings up the question of who gets to determine what form of life is more valuable than others? Additionally, there is certainly an extent to which animal models can be used to study human conditions. Under these circumstances, how great do you think the ethical disparity is between using animal embryos vs human embryos for biomedical research? 

Among the Council, there were two categories of proponents for biomedical research for cloning: those who favored cloning but with serious moral concerns of using live human embryos, and those who saw “no special moral problems [with therapeutic cloning], and therefore should be endorsed with enthusiasm as a potential new means of gaining knowledge to serve humankind (Kass, 34).” Council members who were against this form of cloning viewed it as morally wrong, as they expressed “we find it disquieting, even somewhat ignoble, to treat what are in fact seeds of the next generation as mere raw material for satisfying the needs of our own (Kass, 35).” Given that therapeutic cloning presents the unique opportunity to learn more about the causes of diseases and genetic disabilities that can alleviate human suffering of people who already ‘exist’, do you think the good outweighs the bad? Do you think it would be an ethical alternative if the embryos used for research were donations of leftover embryos from IVF couples (these embryos would otherwise be frozen or discarded)? 

In Cloning People: A Jewish Law Analysis of the Issues, the author describes how the ethics of cloning is accepted in Jewish law. First, it is important to note that the “Jewish law insists that new technologies- and particularly new reproductive technologies- are neither categorically prohibited nor categorically permissible in the eyes of Jewish law (Boyd, 504).”  Thus, if cloning is accepted as a form of ART, it is neither morally good nor bad under the Jewish law. The complication arises when determining who the cloned child belongs to, given that cloning is an asexual process of reproduction. Under Jewish legal tradition, “the gestational mother is the legal mother of the child (Boyd, 511)”, and the sperm donor is the father. However, there are also authorities who rule that in the “absence [of a] sexual relationship, even if paternity is established,  there is no fulfillment of the biblical obligation to ‘be fruitful and increase’ or a fulfillment of the rabbinic obligation to inhabit the Earth (Boyd, 513).” Thus, because cloning involves no sexual relationship in reproduction, this would not “fulfill the mitzvah to procreate according to Jewish law (Boyd, 513).” It must also be recognized that under Jewish law, the term ‘be fruitful and multiply’ mainly applies to men. Thus, when a woman donates her egg for reproductive cloning, and another woman carries the baby to term, no man is involved in the production of this child, therefore there is ‘no mitzvah’ and it brings in the question of who is the father, which is a unique problem that is unique to reproductive cloning. In cases as such, if a father must be claimed under Jewish law, who would be the father? Jewish law also states that regardless of genetic similarity, the gestational mother is the legal mother. Would you agree that the gestational mother in the scenario above is the rightful mother of the child, despite the child being a genetic clone of the donor mother? 

A major difference seen between the Council and Jewish law, is that while the Council questioned much of the ethics behind the alternative motives behind reproductive cloning, Jewish law “sees nothing wrong with having children for a multiplicity of motives other than one’s desire to ‘be fruitful and multiply’ (Kass, 532).” For example, if an individual suffering from leukemia decided to create a clone for a bone marrow transplant, the Jewish law sees this act as serving two goods, which is the creation of a new life while simultaneously helping another life. To conclude, although cloning is not seen as the ideal way to reproduce, given the ambiguity it presents to lineage and determination of mitzvah, reproductive cloning is still acceptable under Jewish law if it is the only way an individual can have children.

“Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? A Quandary for ‘The New Bioethics,’” written by American psychiatrist and medical anthropologist Arthur Kleinman in 1999 argues that with increasing globalization, a widening income gap, and modernization of our world, the “universal” principles of bioethics no longer represent local moral experience. In bioethics discourse, Kleinman claims that there is dissonance between moral experience and ethical reflection. This means there is a gap in connecting what matters to people locally, and articulating what matters “in a self-aware language that aspires to universal reflection, comparison, and criticism” (Kleinman 79). I agree with Kleinman’s analysis of the lack of universality in bioethics and the need to reframe the principles of this multidisciplinary study. 

One quote that resonated with me from Kleinman’s article that gets at the main point of his argument is, “Modeling ethics as a person’s individual choice, which in turn are supposed to be based in deep, philosophically and psychologically informed reflection shaped by religion and secular standard that seek universal application, simply does not account for the social processes of moral life” (Kleinman 72). The manner in which ethics is framed is based on the moral reasoning of one local community (the middle to upper-class, majority-white male scholars, lawyers, and medical professionals and agencies), thus excluding other communities’ moral and human experiences. Ethics, as it is framed right now, is very ethnocentric. Therefore, Kleinman concludes that ethics is irrelevant, as it does not take into account other ways of living. 

A good example Kleinman gave to prove the disconnect between moral experience and ethical reflection is the idea of human nature. Kleinman states, “a shared human nature assures that, regardless of context, humans will universally bear the same moral sensibilities” (73). Yet, “there is no agreement on what human nature is” (74). How can we define human nature and claim that all humans “bear the same moral sensibilities” when it is impossible to know the morals and values of all living humans? I personally believe the claim of human nature is illegitimate, as I do not see a way to define the term. If one individual does attempt to define human nature, that definition only applies to that individual’s specific human experience and context. While Kleinman displays the disconnect between local moral realities and ethical discourse, the article “Blessing unintended pregnancy” (Seeman et al., 2020) discusses the disconnect between moral experience and public health discourse. 

“Blessing unintended pregnancy” discusses findings from an ethnographic study on homeless African American mothers living in a shelter in the southeastern United States. Several life-history interviews were conducted and when asked about their unintended pregnancy, the majority of the women expressed that pregnancy and their child’s birth was a blessing. In public health discourse, getting pregnant when you are unable to support a child financially is highly stigmatized and is viewed as burdening society. That is why our public health system is built to prevent these types of situations from happening. However, this perspective is coming, again, from middle to upper-class, majority-white male scholars, lawyers, and medical practitioners and administrators. While this community has diversified, this is still the demographic majority. If the public health system were to take into account how unintended pregnancy has impacted the African American women at the Naomi House shelter, they would see a whole different story. A lot of these women saw getting pregnant as “a story of redemption” (Seeman et al. 37). For example, Diana saw her unintended pregnancy as a way to escape an abusive partner and start fresh at the shelter where she could obtain childcare help and other supportive resources. The conclusion of the article includes a powerful quote that sums up this argument: “The question, to put it simply, is not whether ‘religion’ complicates efforts to promote family planning, but whether family planning efforts have adequately considered the diverse and multiply contested terrain of moral experience through which individuals and communities navigate” (46). So, how do we bridge the gap between global public health and ethical deliberations and the local moral experience? I believe there are two possible ways to go about resolving this. 

Kleinman argues that ethnography can aid in bridging this gap. Ethnography teaches others about moral processes different from their own and the meaning behind these processes. A good example is Nancy Scheper-Hughes’s ethnography focused on a Brazilian Shantytown. This study focuses on the practice of selective child neglect by mothers in the poor shantytown neighborhood, neglecting weaker infants to let the stronger infants live. While the Western world may view this practice as extremely unethical, the women in the town consider this practice necessary for their survival and their stronger children’s survival. This ethnography opens people’s eyes to a different way of thinking and Scheper-Hughes demonstrates the collision between local morality and ethical reflection. Ethnographers should also be self-reflexively critical of their position in the cultures they study. In my cultural anthropology class, we read “A Thrice-Told Tale” by Margery Wolf. This ethnography takes place in a small Taiwanese village. Wolf takes the time at the end of the book to self-reflect on her presence in this village and the limitations that come along with writing an ethnography from a white American perspective. This portion of the book was so valuable, and is a practice of what Kleinman calls “ethnographic sensibility.” Ethnographic sensibility brings the ethnographer, and later readers of the ethnography, “within and without the flow of experience” (Kleinman 88). Thus, ethnography helps people understand other local perspectives, working toward building a more inclusive non-local discourse. 

The other way to go about resolving this, in my opinion, is making it a requirement to take one or two anthropology courses in undergraduate school, as most of the people included in debates around public health and ethics pursue secondary education. I think this would help people gain an anthropological perspective on these issues and would assist in creating cross-cultural understanding. This would allow more voices to be represented in global discourses and could contribute to reaching a place of global solidarity. 

The question I would like to pose is, are there other ways to bridge the gap between moral experience and ethical reflection? If so, what are they? Additionally, how can we bring this argument back to the ethical debates on abortion?

This week’s content in both, Rayna Rapp’s Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America and The Burden of Knowledge: Moral Dilemmas in Prenatal Testing, was abundant in the discussion of the ethical, cultural, economic, and religious influences surrounding prenatal technologies (e.g. amniocentesis). In Rapp’s book, she dives into a plethora of topics such as the history, methodology, and development of amniocentesis in America, the lived experience of pregnant women as they undergo testing, await results, and decide whether to accept or reject their pregnancy, their partners and families, risks, medical communications, misconceptions, factors influencing women’s refusal to receive amniocentesis or abortion, genetic counselors and the challenges and responsibilities of their professions, and much more. At the start of every chapter, Rapp intentionally begins with a snippet of an interview with a woman describing her experience pertaining to the specific focus of that particular chapter. In doing so, she illustrates the importance of incorporating lived experience and personal stories into her research.

In Chapters 1-2, Rapp outlines her methodologies and goals for the book. She states the need for research within this specific field of prenatal testing and amniocentesis, and the broader field of biomedical sciences as a cultural object. She walks through the history and development of topics including abortion, eugenetics, geneticization and how prenatal diagnostic services have slowly emerged in American medical systems. In Chapter 3, this discussion is continued in the  emergence of genetic counseling as a profession. A point she made that I found interesting was how many counselors “feel that they can keep up with the science, but were never given the tools to keep up with the cultural differences they now encounter” (Rapp 58). This reveals a glaring blind spot in the field of counseling, that if paid attention to, can significantly improve the caliber of prenatal care that is provided for women from diverse cultural backgrounds. Rapp then walks through the various range of conceptions and misconceptions surrounding prenatal testing between women from diverse backgrounds in Chapter 4. These misconceptions include, but are not limited to, mother-child fusion especially within Puerto Rican and Dominican culture, higher probability of sickle-cell anemia within African American culture, the belief that chromosomal anomalies lead to homosexuality, and more. One additional factor that influences the extent of these notions is the genetic counselor’s ability to convey meaning across linguistic boundaries. This kind of “ language barrier” that is encountered often “may eclipse a complex imbrication through which transnational migration, racial prejudice, religious beliefs, gender practices and assumptions, and scientific worldviews may all be uneasily stitched together” (Rapp 82). Rapp illustrates that devoting attention to these cultural aspects is not only a complex matter, but it is also crucial to improving the field of genetic counseling. 

Chapter 5 delved into “the problem of scientific literacy in a highly stratified society” (Rapp 113) as well as the emotions and experience of the woman as she anticipates amniocentesis. Something I found very interesting was that “women without privileged educational backgrounds were likely to remember and to mention specific media sources when I asked about their first encounters with this technology” (Rapp 115). This relationship with media illustrates the importance and weight of media as a news source especially for people from lower economic classes. Given the impact it has in reaching the lay public, further exploring the intersection between media and scientific literacy would be very fruitful. Additionally, Rapp’s interview with Merced Rodriguez discussed how Rodriguez was distraught and crying when deciding to get the amniocentesis test; however, she decided to go to church for an hour and then felt better. This demonstrates the power of religion in providing emotional and mental relief amidst an emotionally turbulent time. It would be interesting to consider how spiritual or religious aspects may be incorporated into genetic counseling in order to provide a more holistic, effective approach. Chapter 6 explores the gender power dynamics between pregnant women and their partners, the complexity of the waiting period for results of prenatal testing (especially its associated anxiety), and different cultural, religious, and economic influences towards attitudes toward childhood disability and abortion,and family history. Chapter 7 delves into the balance between the profound influence of strong religious affiliations, kinship, or other social support structures and the influence of accessibility to prenatal testing information, education, and socioeconomic factors over women’s decision to accept or reject a pregnancy which transitions into the detail of the official procedures and methodologies of cytogenetic laboratories, including the technicians, technologists, and geneticists within them in Chapter 8. In Chapter 9, Rapp explores the web of factors involved in deciding whether to continue or end a pregnancy. 

As we have discussed in previous classes, the concept of kinship has many layers and dimensions. Chapter 10 challenged the concept of kinship through the introduction of the idea of kinship of affliction where this was “the notion that people with Down syndrome could be removed from the kinship nexus that was theirs ‘by birth’ and relocated inside either own separate tribe” (Rapp 277). I found this to be disturbing as this definition stemmed in part from the medical use of the term “simian” and its devolutionary implication that people with Down syndrome more closely resembled primates rather than humans. This lens “further segregates them from people without this characteristic, recategorizing them as closer to the nonhuman primates than to their immediate human kin” (Rapp 295). This led into discussion on how religious beliefs and practices condition acceptance as well as the importance of forming new communities. Lastly, Chapter 11 discussed areas she has yet to explore but would like to (e.g. basic research scientists whose experiments pioneer the field of gene hunting and mapping), deconstructs her own point of departure as a former abortion counselor, importance of media and caliber of scientific literacy, as well as her own personal, lived experience with abortion of XYLO. The movie, The Burden of Knowledge: Moral Dilemmas in Prenatal Testing, walks through the complex layers that surround the MSAFP screening test, amniocentesis, genetic counseling and several women’s personal experience with these (emotions associated with deciding to screen, receiving counseling, waiting for results, receiving the results, decision to have/not have abortion). Through interviews with multiple women, the movie explores their experience throughout the whole process of amniocentesis,  acceptance or rejection of the pregnancy, and the complex thought that feeds into each decision. Highlighted within the movie was a deep flaw in the medical system as seen through the behavior of the medical personnel. One woman recounted the aggressive push of her genetic counselor to abort her fetus upon discovering that her baby would have Down syndrome. This negativity toward Down syndrome is not only problematic, but the counselor’s persistent vocalization and assertion of this onto the mother is unacceptable. My question is, from rich sources like Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America and The Burden of Knowledge: Moral Dilemmas in Prenatal Testing, how can genetic counseling in America be elevated to incorporate the complex entanglement of religious, cultural, socioeconomic considerations in practice and approach? How can the American medical system be mindful of the delicacy surrounding each patient and their context?

Susan Kahn’s “Reproducing Jews: A Cultural Account of Assisted Conception in Israel”brings together multiple ethnographical accounts to paint the reality of reproductive technology in Israel. The overwhelming acceptance of assisted fertility technology in such a place requires a deeper analysis behind such motivations of acceptance. In the introduction Kahn lays out an important undertone felt by many within Israeli society. She says, “The barren woman is an archetype of suffering… from the childlessness of the Matriarchs in the book of Genesis… to the later biblical image of Hannah weeping over her inability to have children, Israelis learn that barrenness is a tragic fate for a woman” (3). This undertone is perpetuated by the Jewish commandment for men to procreate and the concept that Jewish women have Jewish babies regardless of the father’s religious identity. In Israeli society the fate of the Jewish people relies in the hands of Jewish women and in their abilities to procreate. “The overwhelming desire to create Jewish babies deeply informs the Israeli embrace of reproductive technology” (3). Remembering the deep tragedies of a woman’s inability to reproduce and her quintessential role in the continuum of Judaism constructs a positive narrative around assisted fertility technology in Israel.

The first chapter recounts the stories of many unmarried women living in Israel who have turned to artificial insemination to carry out their desires to have children. From the many different cultural accounts of these women, there seems to be a few underlying themes. The first is the support from the Israeli government for single unmarried women. Regardless of motive, the state “subsidizes single parents in three main areas: housing, childcare and tax exemptions… This support indicates that the state feels a responsibility toward the children being raised by single parents and exhibits an appreciation for the financial difficulties they face.” State support is not only limited to individuals who are already single parents in fact it encourages single women in the pursuit of parenthood. “These state policies… also subsidize the pursuit of single parenthood (and) contribute to the growing social acceptance of unmarried mothers” (16). By providing financial support before and during conception, the Israeli government provides easy access for unmarried women to reproduce. This also creates an interesting dynamic since financial support provides the state with more control over reproductive rights. An example is the extensive interviews and background checks women must pass for a doctor to approve of them becoming a mother. Another is the fact that a doctor can deny a woman of assisted fertility technology if she is a lesbian. Lastly, something I found quite frightening that, in my opinion, infringes upon a woman’s reproductive rights was the influence the Israeli government potentially has on choosing the sperm donor.

In what Kahn refers to as ‘Stage 4: “Choosing” Sperm’ out of her 8-stage artificial conception process she recounts the experiences of multiple women who were told it was best to choose sperm donors who resembled the women or were of similar Ashkenazi descent. “We see in these accounts how women were encouraged to choose sperm that ‘looked like them,’ which in most cases meant ‘light’ or of Ashkenazi origin” (37). The reasoning behind this encouragement was assured to the women by doctors and nurses in that having a child that more closely resembled someone else was unfair to the child who would never know that person. To me this decision is creepy. Especially given the scientific understanding that choosing sperm from more diverse origins produces taller and more intelligent children as well as less genetic mutations which are abnormally present in the Ashkenazi gene pool. What I find uneasy about these ‘suggestions’ from doctors and nurses is the link to the government. The influence the state has on deciding who can and cannot donate sperm, as well as the possible influence on persuading women to choose sperm donors that ‘look like them’ is a conflict of interest. I cannot speculate on what these interests encompass, but I do find the encouragement of genetic inbreeding of ‘lighter’ Ashkenazi Jews to be disturbing and not far from the Darwinian ideology leading to the horrors of World War II. This is where the line of freedom becomes tricky. The fertility clinics restrict sperm donations to young medical and law students allowing the government to regulate who the father is. I personally believe that the government should have no say in a woman’s reproductive rights. However, this belief I hold is mainly concerned with abortion rights. Does the financial support for reproductive technology from the state of Israel, which I see as a good thing, outweigh the concerning influence the state may have on these children? Is it okay for Israel to genetically design their future populations through assisted fertility technology? Is this desire to create ‘lighter’ Ashkenazi Jews really that different than religious laws preventing sexual relations between different sects or religions? The influence the Israeli government has on reproductive technologies, especially through financial support, truly brings up the question: if the state acts as a paternal figure economically what other potential paternal rights does the Israeli government have over the inception, growth, and development of these children?

Another prominent theme in this book was the acceptance of these Jewish children into society after birth. I enjoyed the stories of how mothers went about explaining the lack of a father to their children. I laughed at the part where one woman, Nomi, recalled her detailed explanation to a friend of her daughter, Yuval, as to why her daughter did not have a father to which “Yuval cut in and said ’Ima (Mom), stop the shit, I don’t have a father’” (48). It reminded me of the adaptability of children and how irrelevant and unrealistic the concept of a perfect nuclear family really is. Balance does not come from two parents but from a community of loving individuals who have the child’s best interests at heart. It was touching to read the accounts of grandparents who were initially unaccepting of their daughters becoming pregnant in this way only to completely reverse ideologies once the baby arrived. Stories like these bring up the juxtaposition between artificial insemination and life. We use the term ‘artificial’ to describe an alternative pathway to the most natural process known to man, reproduction. What is ‘artificial’ about removing sexual intercourse from the creation of a human? There seems to be great stigmatism around assisted conception, yet when the baby arrives there is life which includes excitement, joy, and endless possibilities. The child now represents nothing artificial and everything natural, the child is alive. How can we view something so natural as the reproduction of our own kind as ‘artificial’ based on the means through which it was created?  On many of the cultural accounts these babies were enveloped into the dynamics of their extended families and were well incorporated into the Israeli society. This incorporation definitely has something to do with Halakha, or Hebrew law. “For children born to unmarried Jewish women are not Halakhically considered ‘illegitimate,’ contrary to traditional common law in Euro-American notions of bastardy in which children born out of wedlock are considered illegitimate… Thus, children born to unmarried Jewish women are considered to be full-fledged, marriageable Jews” (74-75). The Halakha acceptance of children born to unmarried Jewish women is an important aspect in the acceptance and access to assisted fertility technology for unmarried women in Israel.

            In Chapter 4 Kahn expands the dialogue of assisted fertility technology to include ovum-related technologies. After explaining the details of the procedure, she goes into the Halakhic concerns about this use of technology. This brings up a very interesting dialogue around “Who is the mother? The woman who donates the egg or the woman who carries the pregnancy and gives birth” (128)? Throughout the chapter this topic is debated through different points of view from different religious scholars. Although I understand the importance of determining whether the child is truly Jewish or not, I personally think it should be a decision each parent makes for their child. More than DNA or the uterus from which they came the most defining feature of a child is the process of development. If this child is raised in a Jewish community by Jewish parents and given a bar or bat mitzvah then they have accepted Judaism. However, I highly doubt that the Jewish community would accept this logic. In my experience Rabbis love intricate and illogical explanations for abstract concepts. An example of the need to come up with explanations is in the shammash candle in the menorah. It is prohibited to use the light from a menorah for any type of work, yet we cannot help but use the light to see as we look around the room. To solve this, it is said that the Shammash candle is what is giving us the light to do work while the other 8 candles are not used. I expect a similar conclusion to be made about the legitimacy of a Jewish child born with ovum-technology. Intricate laws and details will be made surrounding each case and each possible scenario. In the end, however, the perpetuation of Judaism relies in the hand of Jewish women. In how a child is raised and by whom not by the laws set forth by these rabbis on the technicality of Jewish DNA. We use light from all 9 candles, but we say we only use one; this arbitrary logic may work for candles on Hannukah, but it is much more difficult to incorporate into the religion of a child.  

            In conclusion this book showed a very interesting representation of social, cultural, and legal norms around reproductive technologies in Israel. In my opinion, as these technologies improve and are further incorporated into our world, those societies that embrace the wonders of the creation of life rather than focus on the ‘artificial’ aspect will reap the benefits. After all, despite the immense gender inequality within Christianity, Islam, and Judaism they all share a dependence upon women to continue their traditions. To lose track of the importance of women and impose strict regulations on reproductive rights will eventually lead to their own downfall. After all, without Jewish women reproducing there is no Judaism.

-Elie York

It is no surprise that different religions would have a say on reproductive technologies. Many religions have principles and values that stem from important scriptures or oral law, and these principles and values are typically used to determine the morality of scientific inventions. The readings for this week focus on what different religions, particularly Judaism and Christianity, have to say about reproductive technology such as surrogacy, IVF, gamete donation, and even abortion. The main purpose of the Donum Vitae is to show the Church’s views on various reproductive technologies. In Genesis 1:28, there is the commandment to be fruitful and multiply. Humans are given dominion over Earth and according to Christians, this dominion includes science and technology. However, the dominion needs to be according to God’s rules, meaning that human beings have the responsibility to keep science and technology in check. This includes assisted reproductive technology, which the Church views as going beyond the dominion granted to man (Donum Vitae 141). The principle/value Christian law uses as the means of measuring the morality of reproductive technology is whether this technology is “at the service of the human person, of his inalienable rights, and his true and integral good according to the design and will of God.” (143) There is an emphasis on whether the technology preserves the integrity of an individual’s identity. To determine whether reproductive technology violates this principle, the Donum Vitae first emphasizes what constitutes a human being that is worthy of these rights: “From the moment of conception, the life of every human being is to be respected in an absolute way because man is the only creature on earth that God has “wished for himself” and the spiritual soul of each man is “immediately created” by God.” (147) We see from this one statement that Christian views on reproductive technology largely stem from the idea that human life begins from the moment of conception when the fetus is first a zygote. This places a large barrier on reproductive technology which, in some cases, could lead to the murder of a human being. For example, the main Christian argument against abortion and IVF is the idea that it could cause harm to the embryo. In the case of IVF, spare embryos are often discarded. If they are preserved, the means of preservation are also unethical. The idea that man has the capability of destroying human life with science and technology is an example of how man’s dominion granted by God has gone astray, and how man is attempting to “play” God. Another issue with reproductive technology posed by the Church is the idea that human procreation is really meant to be an act that is between a husband, wife, and God; assisted reproductive technology adds another element to the equation which is inherently “unnatural”.

The Church also emphasizes how assisted reproductive technology violates certain human rights, such as the right of a man and woman who are joined through marriage to become a father and mother only through each other, i.e., through Conjugal relations (158). It also goes against the child’s right to be brought into the world in marriage and from marriage since IVF or gamete donation doesn’t necessarily require a couple to be married. In terms of the Church’s view on surrogacy, it represents a “failure to meet the obligations of maternal love, conjugal fidelity, and of responsible motherhood” (160) and goes against the child’s right to be carried in the womb and be biologically nourished by the woman who is raising him. It also seems that Christian law focuses on a very literal interpretation of Biblical text. For example, God’s commandment to man to cling to his wife and become one flesh in Genesis 2:24 has been interpreted as an emphasis on the importance of a conjugal relationship between husband and wife. When an embryo is brought about by IVF, it is “deprived of its proper perfection when it is not desired as the fruit of the conjugal act.” (162) The Church views the consummation of marriage as what gives the man and woman the ability to take on the role of mother and father. At this point in the reading, I was wondering if the use of assisted reproductive technology was morally allowed in any form by the Church if it was done by a married couple and was not a substitute for conjugal relations. My question was quickly answered. Artificial insemination is not prohibited if it isn’t used as a substitute for the conjugal act but as a means to facilitate and to help so the act attains its natural purpose of procreating. (166) It is important to note that the Church does acknowledge the suffering brought about by infertility, but it suggests other means of attaining a child such as adoption which is encouraged, unlike in Muslim communities according to the previous week’s readings. (169) The implications of this are that Christians don’t necessarily place the same importance on kinship as other religions might. The emphasis that limits certain reproductive technologies is on the rights of the child from the moment they are conceived, and not necessarily whether the child would have any biological closeness to the parent.

The reading by Dr. Seeman offers a deeper look into the differences in interpretations of Biblical texts between Jews and Christians. The primary claim of this reading is that these two religions interpret the texts differently when determining the legitimacy of different assisted reproductive technologies. For example, while Christian law typically uses Genesis as a means to show what traditional marriage and procreation should look like, Jewish law focuses on the quote “to be fruitful and multiply” (1:28) as a commandment that needs to be fulfilled through any means, this includes the allowance of certain reproductive technologies. Jewish law also focuses on Leviticus more than Genesis when determining the morality of assisted reproductive technologies. (Seeman 346) In addition, much of Jewish Halacha is derived from examples set by the Jewish forefathers and mothers. For example, Hagar served as a surrogate for Sarah but her son, Ishmael, was raised by Hagar and was viewed as her son. Jewish Halacha states that the birth mother remains the mother no matter who may raise the child. (342) One question this raised for me is how this can be reconciled with the idea that Leah and Rachel, wives of Jacob, had servant surrogates but these surrogates were not considered the actual mothers of the sons they bore. It is also interesting to point out that Protestants use these same examples in the Bible to show how surrogacy can cause strife in the household, and therefore should be banned. (343) All in all, many religious individuals would naturally consult with religious leaders before moving forward with attaining children through assisted reproductive technology. I think this says a lot about the relationship between science, religion, and ethics, and how often they intermingle in our society.

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