This week, we read the book Magical Progeny, Modern Technology by Swasti Bhattacharyya and the article Impossible Gifts: Bodies, Buddhism, and Bioethics in Contemporary Sri Lanka by Bob Simpson. Both readings utilized religious texts to explain the relevancy of ARTs as they were first written and how they can be interpreted in the modern culture.
Bhattacharyya’s book was written for the purpose of “enriching the ongoing bioethical dialogue concerning artificial reproductive technology” and to “increase the religious awareness of the sensitivity of the healthcare delivery team” (Page 2). In order to achieve this goal, Bhattacharyya used an “interdisciplinary and organic” methodology – Interdisciplinary by incorporating South Asian studies, literature, religion, bioethics and nursing and organic by constructing these disciplines around the ethics preserved in the Hindu epic, the Mahabharata (Page 2-3).
Bhattacharyya begins her book by discussing the function of religion in medicine and bioethics. She explains that, across many cultures, there is (or used to be) an overlap between religious leaders and healers (Page 8). She uses the example of a mother, pregnant via gamete intra-fallopian transfer (GIFT) to explain that individuals can use reproductive technologies, but still attribute the resulting pregnancy to God’s graces (Page 15). Using additional patient examples, Bhattacharyya discusses the importance of “cultural competency” and its significance in bettering patient-provider communication and increasing the compliance amongst patients (Page 23). Cultural competency, from the perspective of a healthcare provider, is “the ability to provide care that is compatible with the values, traditions, and faiths of the patient” (Page 21). Similar to Bhattacharyya’s stance on the topic, I believe that cultural competency is an integral component of a successful healthcare provider.
Although the rest of this book focuses primarily on the Hindu faith, it is clear that cultural competency is not limited to a specific cultural or religious identity.
The next portion of Magical Progeny, Modern Technology focuses on the Hindu epic, the Mahabharata, and three examples of infertility presented within. To begin, Bhattacharyya gives her readers a background of Hinduism and the fluidity that this religion has compared to other world religions, emphasizing that there is no “universal Hindu view” (Page 26). Being an active follower of Hinduism myself, I appreciated her stressing the concept of pluralism in the Hindu faith. Bhattacharyya begins to explain the complicated family of King Samtanu and the dilemma he faces when the succession of his kingdom must run through his second wife, Satyavati. Throughout the stories of Gandhari, Kunti, and Madri, many methods of artificial reproductive technologies arise, including paternal surrogacy, abortion, sperm donation, adoption, and gene selection (Pages 39-47). One theme that is relevant throughout many generations of the Mahabharata is the idea of Niyoga, or levirate marriage, where a woman can have sexual relations with men other than her husband, in order to produce a child or an heir (Page 34). This idea of Niyoga was very interesting to me, as compared to Marcia Inhorn’s “He Won’t Be My Son,” there is a completely different view of the legitimacy of children. As we discussed earlier this semester, Sunni Muslims rely on the paternity of the child in order to denote kinship, while in Hinduism, there are multiple acceptable ways to produce an heir without the involvement of paternal genetics (Page 39).
Throughout the rest of the book, Bhattacharyya continues to use the stories of Gandhari, Kunti, and Madri to analyze the key elements of Hinduism, primarily focusing on karma, dharma, and ahimsa. She concludes by discussing the case of Jaycee Buzzanca, a child born via surrogacy to parents who had separated after her conception and before her birth (Page 78). Using the Hindu ideologies discussed throughout the book, she analyzes the Buzzanca case.
Discussion Questions
- Do you think cultural competency is as essential to the positive outcome of a patient as Bhattacharyya implies with her examples in Chapter 1?
- There is confusion whether Gandhari’s actions were indicative of an abortion or actions of a concerned mother during pregnancy. After reading her story, what do you believe is more supported by Bhattacharyya?
- Bhattacharyya analyzes the Buzzanca case in extreme detail – which of her examples do you feel best supports the actions of John and Luanne Buzzanca?
Our second reading for this week, Impossible Gifts: Bodies, Buddhism, and Bioethics in Contemporary Sri Lanka by Bob Simpson, focused on the concept of donation in Buddhism. While eye donations and blood donations are common in Sri Lanka, Simpson focuses on how this can lead to the use of ovum/sperm donation in facilitating reproduction amongst this population (Page 840). Simpson first discusses the general idea of dana (donation) in Buddhism, as it is the first of the ten perfections (dasa paramita) needed to attain nibbana, the ultimate goal for a Buddhist (Page 842). There are three factors in which one’s dana is judged, including the motive of the donor, the purity of the recipient, and the item which is being donated (Page 842). There are also three ways in which dana can occur: donating one’s possessions, donating one’s body parts, and sacrificing one’s life for another (Page 843).
As Simpson states, this idea of sacrificing one’s life is also present in other world religions, such as Christianity and Islam. There are many overlapping ideas in both Bhattacharyya and Simpson’s works, indicating a close similarity between Hinduism and Buddhism. As Simpson explains the idea of nibbana as “the realization,” I am reminded of the concept of moksha in Hinduism, which is the ultimate goal involving the release of the soul (Page 843).
Through the story of the Sivi King, Simpson explains the significance of eye donation and organ donation in the Theravada Buddhist population. The increase in eye banks and donations came with problems as well, especially when pertaining to recruitment and exploitation of donors (Pages 846 – 847).
Organ and blood donations are common in Buddhism due to the justification of the practice (Page 852). However, new technology has raised questions involving the donation of ovum, sperm, or embryos in producing life, as opposed to prolonging life. Contrary to all of the justifications behind organ and blood donation, there seems to be an opposition to sperm donation. As Simpson explains, there is a presence of shame, not pride, when a man has given a sperm sample for donation (Page 854). Interestingly, however, this opposition isn’t generalized to all reproductive organs – egg donation is less opposed because there is a pain in the retrieval process, indicating it’s similarity to the dana of donating one’s body parts (Page 854).
Discussion Questions
- How do you feel about the early practice of the Eye Donation Society, in which members sought out potential donors from the family members of the deceased? Do you believe family members have the authority to provide consent on behalf of a deceased person?
- Do you believe that there is a cultural stigma to infertility in Buddhism since it is assumed that the woman is the source?
Your post outlines the major arguments of the readings well. I like how you discussed the methodology of Bhattacharyya’s research, and I actually felt that she should have elaborated more on her methods in the introduction of the book. You say that you agree that cultural competency is an important skill to have as a healthcare provider. Your opinion could be strengthened by examples maybe from your own life that led you to believe this. I agree that it is important. When I volunteer at a hospital, I see how vital communication is to proper care, and I think doctors are increasingly taking it into consideration. A language barrier is one factor that provides challenges to healthcare. I often encountered patients I could not communicate with because of this. When I accompanied a family member to a surgery he was undergoing, the nurse asked him if he had any cultural concerns. I guess this is a more direct way of asking about how culture might affect their perspective, but the book stresses that you should learn about a patient’s culture by being an avid listener. As in the example of the book, you cannot always know from that simple question that epilepsy means something different in a family’s language. I am glad you chose to write about this week’s reading because as a follower of Hinduism, you can really add to our insights about their views of ART’s. To answer your question about the stigma of infertility in buddhism, women are much more open to each other about their infertility than men are. I wouldn’t say it’s stigmatized for women, but it definitely is for men. This is what hindered the campaign for family replacement donation. Men did not want to admit to family members that they were infertile. But there was also the issue that sperm donation is seen as shameful because it derives from pleasure rather than the discomfort required from donation of kidneys, eyes, blood, etc.
Hi Rachel! Thank you for your feedback. To support my statements about cultural competency, I can describe the research I do at Emory. For the past three years, I have been part of a qualitative research project in Sickle Cell Disease (SCD) that aims to provide a database for patients and family members with the disease. Its purpose is to provide accurate information and detail potential treatment options so there is an informed decision-making process between the patient and healthcare provider. Because SCD disproportionately affects African Americans, this idea of cultural competency is essential. I have heard participants discuss this cultural barrier between patients and providers, which is why I agree with Bhattacharyya that cultural competency is necessary to the healthcare industry.
Greeshma, your blog was very well-written and did a good job reflecting the readings.
I appreciated that Bhattacharyya’s approach was more pluralistic in nature than the other authors we’ve studied, despite introducing the novel Hindu background to our course. Her discussion of cultural competency separates Bhattacharyya from other authors as she seems to be the only author who is also a medical practitioner. Other authors have offered descriptive passages as ethnographers, whereas Bhattacharyya offers a normative approach of how to improve patient compliance and generally improve healthcare from a communicative perspective.
Another important point you brought up is Bhattacharyya’s emphasis that Hinduism does not hold universal views, which introduces a novel element when compared to the Abrahamic religious cultures we have seen so far. Whereas Abrahamic religions (Islam, Christianity, and Judaism) have sects and division, Hinduism is a much more decentralized, varied religious tradition. This means that the overarching power of some central institutions is completely absent in Hinduism.
In response to your question on the Sri Lankan organ charity organisation, I think it largely hinges on legal precedence. In countries like France, organ donation is the default action upon death without legally opting out. I personally believe that such a system allows religious exemption while capturing the neutral individuals who never make an explicit statement as an organ donor or non-organ donor. In the frequent cases of being a non-organ donor is a world where explicit consent to donate organs, there is not much legal room to posthumously donate a family member’s organs. I recently read that 1 in 5 organ donations come as a result of lethal vehicular accidents, a major source for organ transplants that may be threatened with the advancement of self-driving cars that err significantly less than humans. With an already hostile climate, perhaps family member donations should be allowed in our culture where explicit denial of organ donation is rare.
Unit 7:
Greeshma, your blog post was extremely informative and covered the main points thoroughly. Near the beginning of your blog you mentioned the following: Cultural competency is “the ability to provide care that is compatible with the values, traditions, and faiths of the patient”. Out of all the points you discussed, I feel this one is the most important. In modern day medicine, physicians usually focus on what treatments they can provide to patients which will increase their quality of life the most, ignoring the patients own values and beliefs. An example can be seen in a previous weeks’ reading when a patient refused to receive a kidney transplant (wanted continue dialysis) because he felt his body was not spiritually ready for the transition. This example serves a great purpose in outlining the incongruities doctors and patients have at times, emphasizing the need for enhanced cultural competency.
I would also like to attempt to answer your discussion question which mentioned if cultural competency is essential to the positive outcome of a patient. I personally think it is necessary for the following reason. In most cases, a patient’s faith is what prevents them from undergoing a specific procedure. If a physician is able to acknowledge the beliefs of a patient, then both the patient and doctor can narrow their focus on treatments which make the patient happy and satisfy the doctor. Even though the treatment may not be the best/most advanced one, the patient’s faith allows them to believe they made the right decision. If the doctor is able to understand this and he/she continues looking for appropriate treatments, I think a positive outcome will eventually emerge.
Overall, your blog post was well-written and I enjoyed reading it.
Hi Greeshma,
I really enjoyed reading your blog post. I especially liked when you connected the reading’s content with your own and showed a connection between your own interests and the readings. I think that quality made your blogpost exciting to read.
Reading Magical Progeny, Modern Technology by Swasti Bhattacharyya left me astonished by how flexible the hindu approach towards reproductive technologies and obtaining a child is. It was also one of the few times I read a text in which it is the woman’s desire to have a son and it is her task to have a son. I know of many narratives in which men, especially in power positions such as royal families or even Kings in the history of many countries and empires such as Persia were tasked with the goal of having a son and thus often had to have intimate relationships with multiple women. I thought the story of Gandhari, Madri and Kunti battling with infertility was incredibly interesting, pointing out the many ways by which pregnancy can be achieved. I also thought it was impressive how Swasti Bhattacharyya was able to connect the narratives of the Mahabharata to modern ethical issues and discussions about reproductive technologies in western countries.
On this note I think Swasti Bhattacharyya does a great job finding a balance between telling stories from the Mahabharata but also making inferences about modern medicine such as when she explains what it means to be a good physician by explaining how important it is for physicians to understand other people’s religious views. She can obviously enter both worlds of discourse in such a pluralistic way because she is not only a scholar in hindu literature but also a nurse, familiar with modern medicine.
Connecting this week’s reading with our past reading I think it is most noteworthy how much more flexible and pluralistically oriented the hindu approach is to reproductive means. The reproductive means she describes in hinduism can be considered completely illegitimate in the Lebanese communities. The stark contrast between these cultures/religions really surprised me this week.
These are great questions and I really appreciated the comparison with previous weeks’ readings,.