Inventing Bioethics
This week, we read two pieces of literature: Magical Progeny, Modern Technology by Swasti Bhattacharyya and Impossible Gifts: Bodies, Buddhism, and Bioethics In Contemporary Sri Lanka by Bob Simpson. Both of these works focus on relating the use of artificial reproductive technologies to ancient texts. Swasti Bhattacharyya focuses on Hinduism and the ancient writing of Mahabharata narratives, and Bob Simpson focuses on Buddhism and how ancient Buddhist thought relates to modern technological advances in the reproductive field.
The goal of Bhattacharyya’s book is to “increase the cultural/religious awareness and sensitivity of the healthcare delivery system” (Page 2). By utilizing the interdisciplinary nature of bioethics, Bhattacharyya analyzes the role of “Hindu philosophy, religion, culture, history, and experience” presented in ancient Hindu stories in order to derive what is referred to as Hindu ethic (Page 3). The first chapter of Magical Progeny, Modern Technology is dedicated to discussing the principle of cultural competency, which is defined as “the need [for healthcare providers] to be understanding as well as sensitive to the different cultures, socioeconomic backgrounds, and belief systems of their patients” (Page 5). I believe that cultural competency is integral for healthcare providers in order to adequately treat patients. Bhattacharyya provides multiple examples of doctors misdiagnosing patients on account of cultural or translational misunderstandings (Page 22, 24). Aside from having a complete understanding of medicine, doctors must also possess an understanding of their patient’s cultural backgrounds.
Another argument presented here is that Bhattacharyya claims that religion has played a crucial role in the development of medicine, especially in regards to Judaism and Christianity. I think Bhattacharyya possesses a unique cosmology on this topic as a result of her upbringing. “Born and raised in the United States of America, my family combined South Asian and Japanese ancestry with Hindu, Buddhist, and Christian religious traditions…[this background] allowed me the freedom to question and probe the presuppositions that underlie our philosophical paradigms” (Page 4). This diverse perspective is utilized to argue against the secular bioethics movement. Bhattacharyya asserts that secularism set up a dichotomy between reason and faith, and by doing so, attempted to separate bioethics from religion. Personally, I believe this to be impossible on all levels. Bhattacharyya argues that separation of bioethics and religion is possible on an academic level, but not in a clinical setting (Page 14).
In reality—in a clinical setting—patients are commonly experiencing extreme emotions of joy or sadness, fear or relief. “Religion is the space in which these individuals can both express their joys and struggle with realities of suffering and death” (Page 16). Religion can provide hope in dire circumstances. Bhattacharyya continues to state that “eliminating religion often leads to an unwarranted dependence upon law as a source of morality” (Page 17). My opinion is that law does not always reflect morality. For these reasons, current bioethical books are mainly written with a focus on religion.
Do you think that bioethics and religion can be treated as independent entities in both academic and clinical settings?
The intention of law is to provide justice (hopefully), but does justice imply morality?
Do you think it is ethical for a doctor a doctor to alter patient care based on the religion that patient practices? What if the change in care puts the patients at greater risk?
Another interesting part of Magical Progeny, Modern Technology is the discussion of Hindu beliefs and practices. “A defining characteristic of traditions within Hinduism is their multivalent natures” (Page 26). Hindus practice in many different ways depending on their beliefs and traditions. This reminded me of our study on Judaism. We learned that in Judaism, depending on which Rabbinical opinion is followed, observance can vary tremendously.
In Judaism and Christianity, both religions use scripture in order to deduce reasoning for observances and traditions. These books are considered sacred. Both Judaism and Christianity interpret stories presented in sacred texts to answer ethical questions. Contrarily, the Mahabharata is considered “of secondary authority” (P.30), but it can help us answer questions because it “preserves the moral philosophical thinking of the Indian traditions” (Page 50). There are numerous references to sperm donors and other forms of alternative reproductive options in the Mahabharata, which can guide us in our ethical decision on contemporary issues. For example, there is a story in the Mahabharata that deals with the use of postmortem sperm. This story directly relates to a previous discussion of ours regarding Israeli soldiers donating to sperm banks, so if they perish in action, their legacy and genetic line can live on. The Mahabharata can help us answer these questions from a Hindu perspective. After analyzing the stories presented, we can conclude that “the Mahabharata would not only permit the use of surrogacy, sperm donation, participation in gene selection, and embryonic manipulation, it would condone such practices” (Page 52). Also, Bhattacharyya makes a big distinction between Judaism and Christianity and Hinduism. In the Old and New Testaments, there is an overarching belief of divine control over pregnancy. This belief is not present in the Mahabharata.
Even though the Mahabharata is not considered primary authority, do you think that looking at the stories presented here is a reasonable/logical place to find answers to our ethical questions on ARTs from a Hindu perspective?
Do you think that a certain level of “holiness” associated with a text is required in order to use it to guide our ethical principles?
Today, and even in the ancient writing of the Mahabharata, character traits of sperm donors were chosen. Do you think this type of eugenics is ethical?
In order to evaluate ethical dilemmas, Bhattacharyya analyzes the six key elements of Hindu thought. Three core concepts here are dharma, karma, and ahimsa. Dharma is described as an “ethical category” (page 68). Karma literally means “action”, and is the concept that all action has consequence, positive and negative. Ahimsa “suggests the principles of nonmaleficence and beneficence” (Page 73). With an understanding of these principles, we can analyze an ethical dilemma from a Hindu perspective. In the final chapter of Magical Progeny, Modern Technology, the ethical case of the Buzzanca family is presented.
What do you think is the ideal course of action in the Buzzanca case?
Our second reading this week, Impossible Gifts: Bodies, Buddhism, and Bioethics in Contemporary Sri Lanka, takes a similar approach to Bhattacharyya’s work in that it uses ancient texts to try and justify the use of ARTs in contemporary times. Bob Simpson delves into Buddhist text and tradition about charity that has led to the widespread donation of human tissue, specifically eye donation and blood donation. Simpson analyzes the permissibility of these two types of donations according to Buddhist tradition and discusses the viability of sperm and egg donation at the end of his article.
In order to gather information about Sri Lankan Buddhist culture, Simpson conducted research about “the reception of new reproductive and genetic technologies among doctors, clinicians, and others involved in regulation and policy-making in Sri Lanka” (Page 840). In Theravada Buddhism, the ultimate goal of nibbana is achieved through numerous actions, including the act of donation, called dana. In “Buddhist practice, the intention-action nexus is crucial when it comes to evaluating the consequences and worth of an action” (Page 843). To me, this sounds very similar to the Hindu principle of karma.
In this article, Simpson references the term “ethical publicity” multiple times. Ethical publicity is defined as “draw[jng] on the core values of society, culture, and religion to shape the motivation to give in each particular context” (Page 840). This principle is used to try and describe the transition to normalcy that both eye and blood donation have undergone to become common in Sri Lankan society. Ethical publicity does not include sperm donation because sperm is considered the “highest of substances” in Ayurvedic Medicine (Page 853).
In this article, there is a proposed system of blood donation where if you need a blood transfusion, it is expected that a family member donate an equal amount to replenish the used blood. Do you think this is ethical with blood? With eyes? What about other body tissues/substances?
In Sri Lankan society, it has become relatively normalized to donate eyes and blood. Do you think that with ethical publicity it is possible for kidney donation to become common in this society?
Dear Jonah,
I was also drawn to Bhattacharyya’s opinions on the inability of religion to dissociate from ethics. My interpretation of her argument is that morals don’t exist outside of religion. In other words, religion is a person’s source of moral teachings and ethical behavior guidelines. She basically says (comment if you disagree) that if we aren’t using religion, we are using law, and law doesn’t have inherent understanding of what is good or bad. You mentioned in your post that you agree with this part of her argument.
I spent this past summer learning about His Holiness the Dalai Lama, who has dedicated much of his work life to creating a program of “secular ethics,” basically a code of ethics that draws on inner human values rather than religion. Some stuff he says about secular ethics:
“Today any religion-based answer to the problem of our neglect of inner values can never be universal, and so will be inadequate. What we need today is an approach to ethics which makes no recourse to religion and can be equally acceptable to those with faith and those without: a secular ethics.” (Beyond Religion, HHDL)
“I am confident that it is both possible and worthwhile to attempt a new secular approach to universal ethics. My confidence comes from my conviction that all of us, all human beings, are basically inclined or disposed toward what we perceive to be good.” (Beyond Religion, HHDL)
So to challenge your opinion, do you think that humans are not moral beings? Do you think that we as people could “figure out” a code of ethics without the use of religious scriptures on the topic? Do you think this is part of Bhattacharyya’s argument?
-HG
Hi Hannah,
Thank you for your comment!
I agree that Bhattacharyya asserts that when we aren’t using religion, we fall back on law. Law is not always moral. The goal of law is to bring justice, but not everyone agrees on a universal definition of justice or an ideal course of action to reach justice.
While I was composing this blog entry, I strongly considered including a section on how the Dalai Lama’s opinions on Secular Ethics would apply here. Last semester, I took a class that focused on Secular Ethics, and we read the Dalai Lama’s book, Beyond Religion, which you reference in your comment.
My personal opinion on whether or not religion and bioethics can be separated goes back to my upbringing. I entertain the possibility that I could be incorrect, but I believe that I acquired my morals from my religious background. Growing up as a modern-Orthodox Jew, my parents and my community taught me how to live an ethical life, displaying values of philanthropy, honesty, care, and humility on a daily basis. I do not know who I would be if I had been brought up without the religious background (I guess I will never know…). I truly value the Dalai Lama’s optimistic opinion, but I question whether all humans are inherently good with so much evil in this world.
Jonah, I thought your analysis of Bhattacharyya’s book was excellent. You clearly explained her main points and ideas and I thought your mention of her background and how it affected her outlook was an important concept to address, since it was so unique.
Regarding the topic of a dichotomy between religion and bioethics, I agree with you in the sense that I think it is hard to completely separate religion and bioethics. Like you mentioned, some people find comfort in their religion while in a clinical setting, providing them with answers to medical outcomes they might not be able to understand. Because of this, I think it would prove to be very difficult to treat religion and bioethics as independent entities in both an academic and clinical setting. For some, the two topics are very intertwined and to separate the ideals and beliefs from the reality of a situation, to me, doesn’t seem entirely possible. For others, the two topics can be completely independent, which is why, I think, there is such a struggle regarding religion and bioethics because not everyone is able to take on the same perspectives and understandings of the two topics.
Also, I don’t agree with Bhattacharyya’s assumption that an elimination of religion leads to dependency on the law as a source of morality. I agree that the intention of law is to provide justice, but I don’t believe that justice implies morality. An example of achieving justice but not morality can be found in cases of more fortunate individuals getting lesser sentences because of status and their ability to afford the costs of the justice system. I think religion and law are two separate concepts that, in some instances, might reflect similar ideals but ultimately, they don’t hold the same place in society.
I think the concept of “cultural competency” plays a major role regarding your question on deciding whether or not a doctor should alter patient care based on a patient’s religion. The patient/provider relationship is an interesting one because, for the most part, patients in a clinical setting do not fully understand all the medical terminology and the outcomes or consequences they are facing. Because of this, I think many rely and put trust into providers of care to do the best for the patient. I think knowing a patients complete background is an important factor to know in order for providers to provide the best, most appropriate care for their patient. I think it would ethical for a doctor to alter care based on the religion of the patient if the patient fully comprehends and agrees to the alternate method of treatment. I also think this could help facilitate a more fluid comprehension of religion and bioethics. If the patient practices a particular religion that is against certain medical care, I think it’s important for the patient to have access to alternative treatment that is more conducive with their religion. I think it would allow people to choose a path of care that they feel more comfortable with. If the change in care were to produce a greater risk for the patient, I think the patient should be made aware of the consequences. The doctor can advise against the care and explain the risks involved, but ultimately I think it is the patients choice.
Hi Molly,
I agree with you that a judicial system has the capacity function independently of religion, but there have also been cases where penal systems are religion-based. For instance, in Judaism, there is a court solely based on Jewish law, called the Sanhedrin. At a time in history, this was considered the law of the land.
In terms of doctors altering care for patients based on a patient’s religious practice, do you think it is ethical for certain hospitals with religious affiliations to cater care towards their particular religious affiliation, even if some of the patients practice a different religion?
Jonah-
I think you did a good job discussing topics we had touched on in class and on previous readings and incorporating them into your post. This is really helpful so that the reader can focus on these topics and be able to compare and contrast these different ethical issues. I also liked that you made sure to touch on Bhattacharyya’s upbringing and how this ties into the issues that come up throughout the book.
I wanted to add on to your opinion and that of what Hannah wrote about the ability for humans to evaluate ethical morality with or without religion. I think that secular bioethics have an important value, both clinically and academically, and the quotes from the Dalai Lama are very strong arguments for the implementation of these sorts of bioethics. However, even secular bioethics aren’t by any means universal. Just looking at the philosophies of utilitarianism and deontology one can see that they are very different, and can be hard to pull apart and analyze in a non-academic setting. This is where i think religious bioethics has stepped in and really been useful in those time-crunched, stressful, clinical settings. In fact, in this post you used the quote: “Religion is the space in which these individuals can both express their joys and struggle with realities of suffering and death” (16). And i think that many people do turn to religion in these settings, and it is therefore extremely beneficial to gain understanding of religion within bioethics in order to assist the patients who are going through this suffering. If doctors and healthcare providers are unable to understand how religion affects ethical decision making, I believe there would be negative situations during doctor-patient interactions.
Hi Diana,
I completely agree with you regarding the necessity of a doctor understanding the religious outlook of patients they are caring for. I think that this point directly relates to the concept of cultural competency and is integral for a doctor to understand more than just medicine to adequately care for patients.
For my response to the questions on secular bioethics, please refer to my response to Hannah’s comment above. This also addresses some ideas present in your comment.
Hey Jonah,
I agree with your thought that the law does not always reflect morality. I do not think that bioethics and religion can be treated differently in academic and clinical settings. As we saw in the book, religion plays a major role in the clinical setting. As a result of this, I think it should play as important of a role in the academic setting as it does in the clinical setting so that culturally competent care is established. I think it is both ethical and necessary to alter his or her care based on the religion of the patient. I know there are some religions that do not accept blood donations. Normally, a doctor would administer blood transfusions, but in this case, he or she should modify the care as to avoid the violation of the religion. This change could put the patient in greater risk, but the doctor must respect the wishes of the patient. I find it difficult to look at the Mahabharata as a source for answers to today’s dilemmas because it never really gives a definitive “why” certain practices are permissible. Hindus claim that they can perform such procedures because that is what is done in the epic. That begs the question to which I have yet to find an answer, why was the person in the epic allowed to do such things. I do believe that mild selection of traits through sperm donation is ethical. It reminds me of sexual selection in a way, and if this is not able to be done naturally in this instance, I think it is ok to do it artificially.
I was a little surprised by the blood donation system where it is expected that a family member is expected to donate blood if you need it, except in emergencies where it is expected that you donate after the fact. I think that this is a fairly effective way to maintain a blood supply, but its ethical standpoint seems to be shady. I think as one moves to eyes or other tissues the ethics seem to be much less apparent, because generally eyes and tissues are things that you need to survive. I could understand it a little better if it were an intention to donate once dead, but not while living. It is easy to agree to donate eyes, because they take them when one dies, and blood, because it replenishes. A kidney would be more difficult. As much as Buddhism’s idea of lack of bodily attachments would seem to warrant many kidney donations, people are inherently more selfish than they wish to appear. Many people like the security of having a “backup” kidney just in case, so I do not foresee it becoming popular, while living at least.
Great job, really thought provoking questions!
Ben
Hi Ben,
I appreciate your thoughts related to culturally competent care and the possibility of treating religion and bioethics as mutually exclusive entities in both an academic and a clinical setting. I agree with you that in a clinical setting, it is extremely important because it can help establish culturally competent care. In terms of the academic setting, I disagree with you. I believe there could be a theoretical form of bioethics that does not inherently include (but certainly related to) religion. As we all know, the world does not present us with ideal circumstances, so this academic approach would not be applicable in a clinical setting.
In terms of your argument regarding a patient declining a blood transfusion because of their religion, I have a follow up question. How can you balance the doctor allowing the patient free will of treatment to receive with the Hippocratic Oath, which upholds doctors to certain ethical standards?
Thanks!
Jonah