Month: April 2017

My name is Hannah Gold: anthropologist, scientist, and mother. I have sent my original proposal around to the committee for review, and have carefully considered the commentary it received. Of course I did not agree with all of the feedback, nor was I willing to alter my stance on these issues if I didn’t think the counter argument was compelling enough. I have made changes where I saw fit. If I did not make a suggested alteration in my argument, I explain myself in detail. I will now present my updated opinion.

I am still speaking in opposition to this policy proposal. I am from a nearby city outside of Sasquatch therefore I can provide an unbiased, reason-based outsider perspective on this ethical dilemma. I want to begin by outlining the Catholic Church’s position on the topic of Assisted Reproductive Technologies (ART). We must first understand where this hospital stood on this issue prior to its separation from the church in order to judge just how big of a value shift this hospital would have to make if we were to begin to subsidize abortion services, IVF treatments, and prenatal testing. Donum Vitae, the statement by the Congregation of the Doctrine of the Faith on bioethical issues, takes a clear stance against ART if it in any way endangers a fetus. The church states, “Since the embryo must be treated as a person, it must also be defended in its integrity, tended and cared for, to the extent possible, in the same way as any other human being as far as medical assistance is concerned.” (CDF, 1987: 149) This translates to a complete opposition to abortion and IVF (due to the fact that it is not morally permissible to destroy an embryo at any stage), and acceptance of but strict limitations to prenatal testing. Hypothetically, this hospital could offer non-invasive prenatal testing and have it align with its previous values. However, what happens if the tests uncover something horribly wrong with the fetus? There are no options here, as abortion is absolutely not permitted. This begs the question, what is the use of offering amniocentesis procedures if nothing can be done about positive results?

Beyond the official documentation of the Catholic Church’s position, these values permeate into the everyday lives of practicing Catholics. A look into the history of this town and its inhabitants is proof of this; it took until 2017 for this hospital to even consider offering assisted reproductive services. In her ethnography Testing Women, Testing the Fetus, anthropologist Rayna Rapp interviewed American women of many denominations to understand the role that spirituality plays in decision-making during pregnancy. One woman said, “Basically, I grew up Catholic, I think it’s tragic to end a pregnancy, to end a life.” (Rapp, 2004: 155) Rapp writes, “several catholic women…told me they were afraid to go to confession in their neighborhood parish churches after having amniocenteses.” (Rapp, 2004: 159) It should be clear by now that, based on the value system outlined above and the fact that this town has operated under Catholic auspices for over one hundred years now, this hospital has a long way to go on the road to accepting and offering reproductive technologies, if this is even the correct trajectory.

Now, a divorce from the Irish-Catholic denomination is a fantastic opportunity to update the ethical ground upon which this hospital operates. As committee member Keenan Davis suggested upon review of this proposal, I must explain what exactly I mean by “updating” a system of ethics:

We live in a global world, in a country where innovation is the norm. These new conditions bring with it new situations that require new moral deliberation. As Leon Kass wrote in his article Reflections on a Public Bioethics, “we are summoned to search into deep human matters in order to articulate fully just what is humanly at stake at the intersection of biology and biography, where life lived experientially encounters the results of life studied scientifically.” (Kass, 2005: 224) Living amidst constant technical novelty requires continual discussion about what the new technologies mean for our society; living in a homogenous society requires that we include belief paradigms and ethics systems of an entire community rather than just appealing to one specific (Catholic) ideology. One way we can employ an update to our hospital is by offering spiritual counseling for non-Catholics as well as Catholics. Keenan pointed out that most hospitals do offer spiritual counseling, so to discontinue that for Catholics would be more exclusive than inclusive. I propose that rather than altogether discontinuing counseling by Catholic chaplains, we widen these services to include other religions represented in this community. Again our objective is to become more inclusive; to offer services that all community members will be accepting of and have access to. As I mentioned above, globalization has resulted in increasingly homogenous communities in this country. This requires peaceful coexistence among a variety of ethnic and cultural groups. For our town, this means we now must consider the broader community of Jews, non-Irish Catholics, Japanese immigrants and Shiite Muslims when writing policy, rather than simply appealing to the majority. Let’s examine these communities now.

In her ethnography Reproducing Jews, Susan Kahn evaluates the Jewish-Israeli position on assisted conception, which is arguably the most liberal out of our four representative populations. She writes, “at the time of my research in the mid-1990s, there were more fertility clinics per capita in Israel than any other country in the world.” (Kahn, 2000: 2) Kahn ultimately argues that these technologies are supported by, not counter to, Jewish religious law. She writes, “from the perspective of Jewish law, infertile couples seeking to solve their childlessness with the aid of new reproductive technologies does not evolve out of a consumerist impulse but out of a compulsion to fulfill a divine commandment.” (Kahn, 2000: 170) However, despite a general acceptance of ART in the Jewish community, that is not to say that all Jews are equally tolerant. In his chapter in the book Kin, Gene, Community, Dr. Don Seeman mentions Rabbi Eliezer Waldenman, an “important posek (decisor) identified with the Haredi or ultra-Orthodox community of Jerusalem, which opposed IVF as ‘unnatural.’” (Seeman, 2009: 349) A similar dichotomy of opinions is observed in the Shi’ite Muslim population. In her article titled Kinship, Propriety, and Assisted Reproduction in the Middle East, Morgan Clarke writes, “Almost all authorities, Sunni and Shi’a, are in agreement that artificial interventions in human reproduction are welcome, as a scientific advance and medical boon, insofar as they involve only a husband and wife couple.” (Clarke, 2007: 74) While this guideline seems simple, it is actually rife (thank you, Donna, I did not mean ripe like bananas) with complexity in practice. IVF, donor insemination, and surrogacy arrangements are considered forms of adultery, therefore are forbidden by Islamic law. (Clarke, 2007: 75) Even when the procedures are performed, there is extreme judgment surrounding them in some situations. Through interviews with medical contacts in Lebanon, Clarke found that “infertility is stigmatized, and any suspicion of abnormality, especially in the field of sexuality and reproduction, is to be avoided.” (Clarke, 2007: 74) However, clearly there are devout Muslims who are willing to withstand the stigma to have the treatments done. In her interviews with Lebanese Muslims, Marcia Inhorn found that many men with infertile wives were actively seeking IVF treatments for them. She writes, “In the Middle East, men in childless marriages who love their wives and ardently desire children and fatherhood must generally consider multiple options for marital preservation and family formation in light of prevailing religious moralities.” (Inhorn, 2006: 97) The same divergence in opinion we saw in Jewish and Catholic populations also exists in Muslim ones.

Lastly, we shall examine Japanese populations. In her studies on reproductive technologies in Japanese medical practice, anthropologist Tsipy Ivry found that technologies such as prenatal diagnosis “currently [are] located backstage of prenatal care.” (Ivry, 2010: 77) She cites the reason for this opposition to be the fact that Japanese people regard a mother and fetus as one single entity. She writes, “The gravity of the conceptual tension that PND tests—a set of technologies in which ‘the embryo and fetus come to be visualized as patient-like entities entirely or largely independent of the woman’s body’ (Locke 1998, 206)—introduce into a medical system that tends to emphasize the embodied mode of maternal responsibilities for fetal health.” (Ivry, 2010: 105) Here there isn’t so much a conflict of beliefs and values like we have seen in Catholic, Jewish, and Muslim populations, there is simply a lack of interest in these services.

We are now informed enough to consider a scenario in which this hospital provides abortion services and subsidizes them for under-insured patients, and how this would affect our patients, staff, and finances. As detailed above, the values held by the ethnic and religious groups in this community have extremely mixed opinions about ART. Even in the Jewish population, seemingly the most liberal when it comes to reproductive technologies, there exists fierce opposition to many of the practices. Of course the positions I outlined above are not by any means wholly representative, rather they likely inform the individual experience of decision-making during pregnancy. I am also not assuming that these communities will strictly adhere to stereotypes, as Keenan denounced. I simply want to highlight the discrepancies that exist within these populations to demonstrate that a decision to allow abortion, IVF or prenatal testing services may not necessarily be the most inclusive one.

Next, we must consider the staff of this hospital and the administrators who run it. A useful analogy here is that of traffic waves. When a traffic incident occurs such as an accident or construction, traffic on a highway will continue in a specific location long after the cause of the back-up has cleared. This physical phenomenon is analogous in many ways to the introduction of new technologies into a hospital. Say we make a decision to offer ARTs in our hospital. We have resolved our ethical traffic jam; however there would be persistent consequences of the implementation of these technologies for the staff who must use them. We are, essentially, forcing a value system upon a population of healthcare professionals and requiring that they perform procedures they do not agree with. Even if the doctors are willing to do the procedures, consider the stigma they hold. In her interviews with medical professionals in Lebanon, Morgan Clarke found that clinicians had to be extremely careful to tiptoe around the stigma. She wrote, “medical contact in Lebanon initially insisted on my signing a confidentiality clause, warning me, with perhaps exaggerated concern, that a breach of privacy could result in ‘honour killings’.”(Clarke, 2007: 77) In Rayna Rapp’s work, she found that many Catholic women feared going to their neighborhood churches after having amniocentesis. (Rapp, 2004: 159). I will now outline potential consequences of requiring hospital personnel to do these procedures.

As I mentioned above, the values held by our predominantly Irish-Catholic staff would interfere with them performing procedures such as abortions, IVF, and amniocentesis. This is a large reason why our hospital should not offer them. Though we are working with trained healthcare professionals, it is not a good idea to allow a community of healthcare workers to perform procedures they fundamentally do not agree with. This would be irresponsible for a hospital to do, as the quality of care would go down.

Finally, we all know how important a donor base is to a hospital, especially one in rural Connecticut. Who is to say that we could even afford the technology, never mind pay new specialists to perform the procedures and counsel our patients? Without a donor base, how conceivable is it that we could acquire the technology, hire people to train our staff, and hire more staff to perform the procedures? As committee member Dr. Elmasri pointed out in his critique of my proposal, I am making an assumption here that our Irish-Catholic donors would rescind their funding if procedures such as abortion are put in place in our hospital. While I cannot be certain that a decision to refuse these services will appease all of our benefactors, I am certain of the Catholic Church’s position on them. Presumably some of our Catholic donors operate within the confines of Catholic bioethics; therefore I can predict that the opposite decision (one where we do offer these services) could result in these donors pulling their funding for our hospital.

It has come to my attention that doctors have complained about Catholic clergy interfere with their work. Susan Kahn describes a similar scenario in Reproducing Jews, where rabbinic concerns for ART provide a major obstacle to Orthodox Jews seeking these medical procedures. In fact there is an entire organization (titled PUAH) dedicated to mediating the relationship between religious and medical authorities in Orthodox Jewish communities in Israel (Kahn, 2000: 89). My answer to this dilemma is, what about the business we lose when patients defect to other hospitals? What about the money we lose on equipment and professionals to perform procedures, with no one willing to have them? Perhaps most significant, what about the money we lose when we lose our donor base? This would be a tremendous loss to this hospital, and I believe it is very important to appeal to the values of those who give us money. As Adam Smith said, “all money is a matter of belief.”

I must now be transparent with all of you. Many of you who spoke in opposition to my proposal did so because I didn’t explicitly state that women in this community should not have access to these services, even if they need or demand them. Keenan was correct in saying that I only implied this position, but here I am stating it. We shall, with no exceptions, refuse services (abortion, IVF, and prenatal testing) to all women. Those who need or demand them shall be referred to the fertility clinic we will open in lieu of offering these services at this hospital. I explain this in more detail below.

After making that clear, I can speak to the critique I received by Committee member Donna, National Organization of Women Chapter President. Listen up, Donna. I am a woman. I don’t identify as a feminist but that does not mean I don’t value and strive for equality. I am fighting against offering ART in this hospital not to promote the patriarchy, but because it is what I think will allow this hospital to smoothly transition out of its previous allegiances to Catholicism. What matters most to me about a hospital is that it can operate effectively, treat patients comfortably, and take care of its staff. This decision is in no way meant to tell you what you should or shouldn’t do with your body. This is evidenced by my proposition to open a fertility clinic in Sasquatch. I’d also like to call attention to the fact that there are feminists who stand in strict opposition to reproductive technologies. In an article in the Creighton Law Review titled Feminist Perspective, feminist Barbara Katz Rothman cites the patriarchy as the reason why women should not use reproductive technologies. She writes that under the terms of a patriarchy, “women are described as the daughters of men who bear children” (Rothman, 1991: 1600) and as such have a moral obligation to do so. One of her arguments is that women should not be expected to go to great lengths to have children simply because that is their purpose according to the male agenda. All of this is to say that being opposed to reproductive technologies cannot be equated with being anti-woman.

On the one hand, a hospital has a duty to reflect the beliefs of its population, or else a foundation of trust and mutual understanding cannot exist. Anthropologist Sherine Hamdy writes,“the perceived efficacy of a treatment plays an important role in shaping one’s ethical stance toward it. To understand how patients arrive at complex ethical decisions, we must be attentive and vigilant to their own experiences and understandings of their disease processes and etiology and their own cost-benefit analyses, which may be articulated in religious terms.” (Hamdy, 2012: 156) If we begin to offer and subsidize abortion services, individual with strict catholic beliefs on abortion will feel less comfortable seeking treatment at this hospital. Being the main resource for healthcare in this community, that cannot and should not be the case. In Testing Women, Testing the Fetus, Rayna Rapp discusses the importance of environment to women and families seeking care at hospitals. The more successful patient care settings Rapp observed are those in which patients feel the most comfortable. She writes, “entering into the ecology of prenatal clinics are the stability of residential neighbourhoods: city, state, and federal health care funding and politics, hospital labor contract negotiations and issues of community control.” (Rapp, 2004: 169) Additionally, in her book Magical Progeny, Modern Technology, Swasti Bhattacharyya highlights the importance of what she calls “cultural competency.” This 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.” (Bhattacharyya, 2006: 5) By offering treatments that fundamentally clash with the beliefs of most of our patient demographic, we are putting our cultural competency in jeopardy. This hospital thus should not offer or subsidize abortion services, IVF treatments or prenatal testing.

On the other hand, as a modern-day hospital it would be irresponsible to not offer the most advanced and up to date treatments to our community. Additionally, not offering these services does not mean members of our community will not seek them out, it just means they have more hoops to jump through to receive adequate care. I propose we open a separate fertility clinic in our community, not affiliated with the hospital. This will provide an opportunity to offer abortion, IVF services, and prenatal testing, as well as hire a new staff with no conflicts of interest. Through a detailed analysis of many religious/cultural standpoints on issues of bioethics, it becomes extremely clear that patients seeking reproductive therapies should be considered in a case-by-case basis so as to respect the complex nature of decision-making in pregnancy. In their ethnographic work titled Blessing Unintended Pregnancy, Don Seeman et al write, “as many studies show, women make decisions about mothering and reproduction amid a complex layering of structures, beliefs, and values…” (Seeman et al, 2016: 44) Rayna Rapp argues that women are “at once held accountable at the individual level for a cascade of broadly social factors which shape the health outcome of each pregnancy, and individually empowered to decide whether and when there are limits on voluntary parenthood.” (Rapp, 2004: 319) A hospital previously rooted to such a specific set of values is not equipped to honor this complexity. However, a separate clinic in our community would. Let’s stop trying to squeeze the practice of ART into our institution, a place that comes with heavy baggage that would be tough to divorce from. Rather, let’s focus our efforts on building a safe space–unaffiliated with any one belief system–and hiring trained and willing staff so families can make their own decisions about fertility therapies.

Keenan introduced an interesting point about different segments of the community requiring different things in order to be comfortable. In other words, how do we decide what policies will make the majority of people feel accommodated? What if those who want access to reproductive services we refuse to offer no longer feel comfortable in this space? My argument has placed more value in the opinions stated by religious bioethics than by those held by secular ethicists. More broadly, I am siding with a religious worldview over a scientific one. I can justify this in two ways, both of which speak to the main discipline I used to generate my argument: anthropology. The first justification is that we are not only considering the current perspectives of our community members, but also the history. Irish Catholics define this community more than anyone else by virtue of sheer staying power. We cannot ignore the past when shaping the future. My second justification is that in this instance, I think religious beliefs are more powerful than scientific ones. By this I mean that an Irish Catholic patient of this hospital would have a bigger problem accepting treatment here—unrelated to pregnancy—if we were to offer abortion services than a secular woman would if the situation were reversed. The only evidence I have to support this statement is my personal sentiment as a secular “techno-optimist” (Braun, 2005: 42), though I do think this holds some clout.

In his critique, Dr. Elmasri argued that too much of the support for my arguments came from opinions presented by ethnographers, not facts. He is correct that I did pull quotations from some analysis sections within the ethnographies we read, where the author is pointing out trends they noticed while conducting their research. I believe this addresses one of the limitations to my use of anthropological findings to substantiate my argument. A participant observer in a society isn’t there to collect facts, they are there to collect stories. Stories innately have bias, and the way the observer decides to tell these stories also generates bias. Perhaps had I relied more heavily on theology, I would have had a deeper understanding of where the bioethics of different religions comes from, and therefore would have more accurate things to say about the religions represented in our community.

Finally, Keenan and others pointed out that based upon my previous arguments, there may not be support for a fertility clinic in our town. In response, I say that he is misinterpreting my warning about offering these services in the framework of a historically Catholic hospital. He thinks that this means there would not be a need for nor a donor base to support a brand new clinic. I did not, however, argue that there is not a need in our community for these services. When I spoke about homogeny earlier, I did not mean our population consists exclusively of religious people. There are nonreligious, religious but not observant, and completely secular people as well—though that is not to say that everyone who identifies with these categories will be pro-biotechnology. Additionally, there are observant religious people who will go seeking these treatments despite whether their bioethics deems it permissive. Evidence for this statement can be found in Sherine Hamdy’s research on Muslims in Cairo and their interactions with new biotechnologies. She writes, “In various ways patients grappled with how to achieve the greatest benefit for themselves and their families, while at the same time trying to conform to what would please God.” (Hamdy, 2012: 156)

I am arguing that the implementation of these services in our hospital is like trying to fit a square peg into a round hole. We should allow the women in our community who demand these services to be treated, but this hospital is not a conducive environment for this to occur. We must begin with a blank slate. Rather than expecting our same hospital donor base to continue providing support after implementing a change that would go against their values, we can start anew with different donors. Rather than training an unwilling staff to perform the procedures, we hire a willing staff to do so. This is the best solution.

This week’s readings included two pieces about the public debate and interpretations surrounding bioethics, while the other looked at a “new” movement in bioethics. The first reading, Reflections on Public Bioethics: A View from the Trenches by Leon Kass, is a review of the major work done by the President’s Council on Bioethics. The President’s council on Bioethics is “a public body, devoted to public questions, whose activities are fully open to public scrutiny” (222). Kass asserts the point that this council has “a duty to promote a greater understanding of these issues for a wider national public,” repeatedly mentioning the importance of discussing bioethics in terms of “ordinary public discourse” (223, 228). I think this is an important point because, before having read any of the articles presented in class, I personally didn’t know very much about human cloning and found it hard to interpret all the issues surrounding it due to the use of bioethics jargon.

The majority of Kass’s essays reviews the five major works of the council, which attempt to address the previously mentioned goals of the council. The first of these works, Human Cloning and Human Dignity: An Ethical Inquiry, was one of our readings from last week and discusses the case for and against cloning-for-biomedical-research and cloning-to-produce-children. As mentioned by Paula in her blog post last week, the majority of the council recommended no human cloning to be allowed.

Monitoring Stem Cell Research is an update that summarizes the significant developments in stem cell research, with the overarching goal “to convey the moral and social importance,” surrounding stem cell research (232). Because stem cell research was a relatively young and constantly developing field at the time, the council intended for this section to improve understanding in order to achieve better public discussion and decision making with regards to stem cell research.

Beyond Therapy: Biotechnology and the Pursuit of Happiness examines the use of biotechnology to serve “human goals beyond healing disease and relieving suffering,” (234). This section deals with questions of human character and humanity, looking into human desires for ageless bodies, happy souls, and “better children.” I found this section to be very interesting. On the one hand, I think the use of technology to potentially treat or prevent mental illness could be beneficial. However, I don’t think we should use these technologies to attempt to create “better children” by selecting for specific genetic traits. In the future, I think this can lead to a blurred line between what is humanity and what is not, while also making regulation of bioethics very difficult to put in place or enforce. As mentioned by Kass, the issues presented in this section force one to look beyond issues of fairness, autonomy, and equality and to consider issues of identity, hubris, and humility to name a few (237).

Being Human: Readings from the President’s Council on Bioethics focuses on aspects of “being human” and how bioethics issues touch on matters “close to the core of humanity,” (238). To address these questions in greater depth, the council published an anthology of readings surrounding the questions of what it means to be human. The final section of the council’s works, “Reproduction and Responsibility: The Regulation of New Biotechnologies,” discusses regulation of biotechnologies, finding that present regulatory institutions are unable to remain up to date with the fast pace of technological advance (242). Instead of recommending a proposal for new regulatory institutions, the council provided a proposal that targets what they believe to be unethical practices in human reproduction, one of which being the prohibited “use of human embryos in research beyond a designated stage in development,” (244).

While this report had the goal of improving public understanding surrounding the debate on bioethics, Kass notes that it is hard to educate people without telling them a direct answer on what they should do. Kass cites “the life question” as one of the “most frustrating aspects of public bioethics,” because it leads most to forget about other important aspects of public bioethics, such as human dignity and human freedom. The life question is “the principle that calls for protecting, preserving, and saving human life,” which as Kass states, although an important consideration, “cannot continue to be the sole consideration in public bioethical discourse,” (249).

Questions:

• In his essay Kass asks, “When and to what extent should we strive to change and alter nature and especially our own given nature, in an effort to improve or save it?” When do you think the altering of human nature should be stopped or regulated?

Our next reading, Not Just for Experts: The Public Debate about Reprogenetics in Germany by Kathrin Braun examines how policy debates in Germany regarding reproductive and genetic technologies stemmed debates on the definition of ethics and the role ethicists play in public policy. As Braun states, ethics in this context is about “how a nation-state should handle developments in science and technology, specifically in biology and medicine,” (42).

The two sides of the bioethics debate in Germany consist of techno-skeptics and techno-optimists, but the two sides are not strictly split based on ideologies. Techno-optimists “emphasize technologies potential benefits, welcome enhancement of choice, and believe that society is able. . .to calculate and to control potential risks,” (43). For them, ethics is a matter of choice with the task of rationalizing different conflicting values. Understood as a “specific type of professional academic expertise,” techno-optimists think the task of ethics is best performed by professionals.

Techno-skeptics on the other hand, “underscore the limits of technological solutions and the price that individuals and society might have to pay for them,” (43). An important ethos for techno-skeptics incorporates the will to not distinguish between a life worth living and a life not worth living. They conceive ethics as “a matter of paying respect to a set of common legal and moral principles,” fundamentally meant to convey the nature of a good society (43-44). For them, ethics should not be left to the experts, rather ethics requires participation of citizens in a public debate.

Braun conveys the different ways to link politics to ethics through two different discourses: managerial and republican. Managerial discourse is characterized by the belief that problems surrounding genetic and reproductive technologies can be handled through a risk-benefit analysis. Ethics, in this case, is “a set of tools and techniques to solve problems and make decisions,” and emphasizes the competence of experts to handle questions of ethics (44). Republican discourse assumes that problems of technology are a social problem, with genetic and reproductive technologies seen as “affecting fundamental moral principles, questions of identity, and the meaning of life,” (44). Emphasizing citizen engagement and the notion of a good society, problems of ethics cannot be solved, according to republican discourse, without the engagement between citizens and policymakers in a public debate setting (44).

In the rest of Braun’s paper, she applies these differing sides and discourses to portray the development of the bioethics debates in Germany. While the German Embryo Protection Act was highly restrictive, the German abortion law considers abortion to be “illegal but not subject to prosecution,” meaning that abortion is only necessarily considered morally and legally wrong in principle. Something I found interesting about the German abortion laws is that it is based on the idea of “support instead of punishment,” assuming social support is more effective in encouraging women to continue their pregnancy instead of banning abortion entirely, which I tend to agree with. Surrounding the debate on the status of embryos, in 2002 it was decided that the importation and use of embryonic stem cells be prohibited in principle, with the passing of the Stem Cell Act that same year.

Questions:

• Do you relate more to a managerial or republican discourse surround the meaning of ethics and its place in policy?
• Do you think it’s entirely possible to distinguish between a life worth living and a life not worth living? How would the distinction translate into ethical policy?

Our last reading, The New Conservatives in Bioethics: Who are they and what do they seek? by Ruth Macklin, analyzes the new label of a “conservative” movement in bioethics which they believe challenges ideas and topics in liberal, mainstream bioethics. Throughout the reading, Macklin asserts how these new labels have led to misunderstandings and misinterpretations within bioethics. For example, what used to be deemed conservative bioethics is generally considered to be liberal bioethics now. Macklin cites conservative bioethicists as opponents of biotechnology and its use in “interventions they term ‘artificial’”, new reproductive technologies, stem cell research involving the destruction of embryos, and biomedical efforts to enhance physical or mental capabilities (35).

The mission of conservative bioethics is “to prevent our transformation into a culture without awe filled with people without souls” (37). Conservatives find that mainstream bioethics often disregards the “deeper questions of human dignity and human nature,” (37). Macklin takes issue with the mission of conservative bioethics and find that it leads to confusion about the bioethics field. Through the use of poetic and metaphoric language, appeals to emotion, sentiment, and intuition, mean spirited rhetoric, and discussion of “projects,” Macklin conveys how conservative bioethics has come to misconstrue many concepts and ideals within bioethics. This made me think about our two previous readings for this week, and how both conveyed how important it is to discuss the debate in bioethics in terms the public can understand. Personally, I found many of the examples cited by Macklin to be troubling, especially the opposition to all things “artificial.” The label of being artificial can come with a negative connotation and I think the way the conservatives use this term is inaccurate. As mentioned by Macklin, there is no “artificial sex” that brings “artificial babies.” The babies conceived in this way are quite real, with nothing artificial about them, and they are not conceived through sex because, usually, the female is unable to conceive a child the “natural” way.

Questions

• Do you think labels like liberal and conservative can be applied to bioethics? Or do you agree with Macklin that such labels render confusion within the field?
• In her discussion of making children “more biologically equal,” by researching stem cells that could help address child diseases, Macklin asks the question, “Why is it acceptable (or is it?) to alter the physical environment to benefit individuals with disabilities (i.e. accommodations for wheelchairs) but not their biological attributes?” What do you think about this question? Do you think physical environment and biological attributes are comparable in this instance?

This week we read three very different texts. Two of these works, “Gestational Surrogacy in Iran” and “The Social Construction of surrogacy research: An anthropological critique of the psychosocial scholarship on surrogate motherhood” addressed the issue of surrogacy from different perspectives, both using various ethnographic methods. The third text by Arthur Kleinman discussed how ethnographic research ties into the field of bioethics.

Shirin Garmaroudi Naef’s work “Gestational Surrogacy in Iran” lays out an interesting perspective on Shia Islam and the acceptance of gestational surrogacy as a morally licit practice. This text reminded me of the reading for Unit one, specifically the works by Marcia Inhorn and Morgan Clarke. Naef takes a similar ethnographic approach and conducts the study with both participant observation in infertility and IVF clinics in Tehran as well as talking to scholars at the center for Shia scholarship in Iran. The work is consequently grounded in two sections: one focusing on the religious and scholarly viewpoints with regard to surrogacy and the other focusing on gestational surrogacy in practice.

-Do you find it helpful that Naef’s work includes the opinions of both religious scholars and of individuals going through the surrogacy process?

Naef’s thesis is grounded in opposition to the work done by French anthropologist Heritier. Heritier bases much of his argument on the practice of milk kinship, in which the woman who breastfeeds a child becomes linked to the child in the sense that incest taboos prevent any type of relationship between these two individuals and their future kin. In this sense, incest is linked by the transmission of bodily fluids. In contrast, Naef’s thesis shifts the definition of incest to illicit sexual acts:

“I argue that the definition of incest in Shia thought and practice does not depend on the transfer or contact of bodily substances. Rather, it depends on the illegitimate physical act of illicit sexual intercourse, and not on the act of conception itself” (163).

It is through this thesis that Naef explains the permissibility of several practices of artificial reproductive technology in the Sunni religion. Through interviewing several religious leaders, the conclusion drawn is that:

“the distinction made here between physical contact and the transfer and contact of bodily substance in definition of adultery makes the fertilization of the woman’s egg with the sperm of another man other than her husband and then the implantation of the embryo in the woman’s womb religiously permissible” (165).

Naef continues to draw distinctions between Sunni and Shia scholarly thoughts with regard to maternal relatedness. While several Shia scholars of the past and most Sunni scholars believe that the mother is the person who gave birth to the child (citing a verse in the Quran), most Shia scholars today believe that the producer of the egg is the mother of the child (166).

Naef also finds support for the thesis of illicit sexual activity, not bodily fluid contact to be the reasoning behind the acceptance of surrogacy in Shia Islam when conducting interviews.

“The distinction that Farideh makes here between the act of gestation and the physical proximity through the (illicit) sexual act is a further reinforcement of this Shia thought. In other words, there is also a fundamental difference between reproduction and sexual intercourse in her thinking. Almost all the informants I interviewed referred to this distinction” (177).

-Did this reading change your perception with regard to how surrogacy is viewed within two sects of the same religion?

-Did you think Naef did enough to describe why Sunni and Shia Islam diverge with regard to the incest taboo and what is considered adultery?

The second article for today was “The social construction of surrogacy research: An anthropological critique of the psychosocial scholarship on surrogate motherhood” by Elly Teman. I liked that this article really challenged a lot of assumptions I had about surrogacy in the US, especially due to the portrayal of surrogacy in the media. Teman began by simply stating that over 99% of surrogate mothers willingly relinquish the child after birth (1104). When faced with individuals surprised with this statistic, Teman states “I suggest that this public uneasiness with the idea of surrogacy and the meta-narrative it engenders—of the surrogate who regrets her actions or refuses to relinquish—is more illustrative of the cultural anxieties that surrogacy encapsulates than that of the actual majority of cases” (1105).

-Were you surprised that 99% of surrogates willingly relinquish the child? Why or why not?

Teman bases her arguments on two assumptions set out by psychosocial literature on surrogacy. Teman states that these arguments have led to bias in the way that data on surrogacy is collected.

The first assumption is that surrogates are not “normal” women. Teman illustrates that the view of a woman who is willing to carry another woman’s child implies something about sexual deviance and adultery (1106).

-Does the link between surrogates and adultery described in Teman’s article seem similar to the issues raised in Sunni and Shia Islam?

The second assumption made in surrogacy research is that women who are surrogates can be “normal”, but only if then must they have a good reason to go through this process. I think that this is really captured well in the following passage:

“Whatever reason is proffered for her choice, the surrogate is constructed as deviant: Her altruism ranges beyond normative boundaries; her desire for money is constituted as greed or as a function of extreme poverty; or her reparative motive is indicative of past sins for which she must punish herself. By finding ways of constructing the surrogate as deviant, the scholarship “proves” that a “normal” and “natural” woman would not make such a choice unless compelled by a circumstance” (1108).

-Do you find this argument problematic? Do you see this issue reflected in the film we watched in class last week?

The last article of the week was “Moral Experience and ethical reflection: Can ethnography reconcile them? A Quandary for ‘The New Bioethics’” by Arthur Kleinman. In this article Kleinman discussed how important it is on a clinical and policy level for bioethics to relate “ethical deliberation to local contexts” through the use of ethnography (70).

Kleinman goes on to discuss how bioethics acts with principles that are out of touch with the status of many people it acts to help. “The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not being with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer health-care resources because of their positioning at the bottom of local social structures of power” (72). I found this really compelling because I feel like a lot of the new bioethics issues (think IVF, cloning, abortion procedures) are resources that are unequally available to only the wealthiest of people that perhaps discussing these exclusively ignores the ethical issues that are still affecting people living in countries with issues we think we’ve “solved” (disease rates, hygiene service, etc.).

To resolve this discrepancy, Kleinman suggests ethnography. He explains how “ethical standards can be applied in each case because a shared human nature assumes that, regardless of context, humans will universally bear the same moral sensibilities” (73). However, Kleinman also says that there “is no agreement on what human nature is” (74).

-Do you think humans have a shared human nature? If so, do you think that human nature is something that can be defined? (Think of how it is defined by the Catholic Church for instance)

Kleinman praises the ethnographic works of Paul Farmer, the famous physician-anthropologist for his work in Haiti as well as Rayna Rapp’s ethnography that we read in class. In the final section of his paper, Kleinman discusses what he considers to be a layout of the best methods anthropologists can use to present a compelling argument in the same way that Farmer and Rapp do. Some of these points are similar to what we discussed in class, such as the ethnographer discussing their position in the research, as a way of being self-reflective (91).

Overall I felt that Kleinman’s argument was well presented and interesting when it comes to focusing on what he considers a significant gap in bioethical works. What did you think of it?

This week we read ‘Knowing’ the Surrogate Body in Israel by Elly Teman and Gestational Surrogacy in Iran: Uterine Kinship in Shia Thought and Practice by Shirin Garmaroudi Naef. Through interviews and participant observation field work, both ethnographic works take a look at surrogacy and its place in Israeli and Shia cultures, respectively.

The goal of Elly Teman’s work is to analyze surrogacy as a “cultural anomaly” in Israel and how it has made its own place in Israel’s pronatalist society.  She uses the concept of ‘authoritative knowledge’ to convey how “surrogates, intended mothers, and health professionals attempt to solve the anomaly of surrogacy in practice” (263). Through intuitive, medical, and technological knowledge, Teman provides insight on the surrogacy process women experience in Israel. Intuitive knowledge refers to the situation in which the intended mother ‘knows’ the pregnant body of the surrogate, providing a way for the intended mother to claim maternity. Statements from both surrogates and intended mothers mention how each woman knew she had chosen the ‘right woman’ to go through this process with her as soon as the women had met. This intuitive knowledge also served to minimize the connection between the surrogate and baby while emphasizing the intended mother’s ‘meant to be’ relationship with the unborn child through an equal partnership in the pregnancy.

Teman uses ultrasound experiences to convey another way in which surrogates extract themselves from the pregnancy and allow the intended mothers to go through the pregnancy experience as if they were pregnant. During ultrasound screenings, the surrogate “symbolically becomes a silent participant, a transparent medium,” allowing intended mothers to view the fetus as an “individual entity, alone on the screen, as if removed from the surrogate’s body” (268). Doctors and ultrasound technicians would address the intended mother and father during the screenings, reemphasizing the removal of the surrogate from the situation, both emotionally and physically, while simultaneously allowing the intended parents to feel more connected to the pregnancy process.

Doctors and other medical practioners play an important role in the surrogacy process through their “effort to designate the intended mother’s status” by addressing her as “the mother” and directing all medical knowledge to her instead of the surrogate patient (271). Along with the equal partnership between the two women, medical practioners work to create a unitary patient construction, treating the intended mother the same way they would the surrogate, providing her with all the same care. The concept of a ‘hybrid patient’ address the abnormalities that surrogacy presents (i.e. having two separate patients) and allows for normal practices to ensue after birth.

The 3 different forms of knowledge confirm the intended mother’s maternal identity and serve to “confirm, rather than challenge, the Jewish-Israeli cultural belief system” (276). I found the emphasis of an equal partnership between the surrogate and intended mother to be a very interesting experience. Also, the emphasis from the doctors and medical staff of the intended mother’s maternal identity played a very important role throughout the process, a role that I  was previously unaware of.

Questions:

• Do you think Teman’s analysis effectively addresses the “anomaly” of surrogacy in a pronatalist society such as Israel?
• Do you think all societies should promote an equal partnership approach between the intended mother and surrogate? Does this help surrogacy fit a more culturally norm framework of pregnancy?
• What type of relationship should exist between a surrogate woman and the child that is born? Should such a relationship exist at all?

In our second reading, Shirin Garmaroudi Naef explored surrogacy in Shia thought and practice and the relationships established through surrogacy and uterine kinship. Through analysis of Islamic legal texts, consultations with Shia scholars, and ethnographic field research, Naef attempts to “show how juridical meaning ascribed to physiological facts and bodily substances. . . leaves room for the legal permissibility of gestational surrogacy” (160).

In the first part of her chapter, Naef mentions that the “notions of contact and transfer of bodily substances has become an approach for studying kinship and assisted reproduction in Muslim societies” (161). Naef argues that the definition of incest in Shia thought does not depend on the transfer or contact of bodily substances, but rather on, “the illegitimate physical act of illicit sexual intercourse, and not on the act of conception itself” (163). With this notion of kinship relation, she conveys why and how Shia thought and practice define surrogacy and assisted reproduction as acceptable.

Naef emphasizes the distinction between directly inserting sperm into a female surrogate’s uterus and implanting an embryo into the surrogate’s uterus, citing it as a reason as to why sperm donation is not entirely forbidden. While it is forbidden in Sunni Islam, Shia scholars argue that, although it is not allowed, fertilization of a women’s egg with donor sperm from a man other than her husband is not analogous to zina (Islamic law concerning unlawful sexual intercourse). Shia authorities authorize such insemination in a lab dish which may then be implanted into the wife’s uterus because, since the sperm is not inserted directly into the wife’s uterus, no forbidden act has taken place. From this, traditional surrogacy is not religiously permissible according to most scholars, but gestational surrogacy is viewed as an acceptable form of assisted reproduction because fertilization takes place outside of the woman’s uterus. Also, this translates into the donation of gametes and embryos. Since the fertilization takes place outside of the woman’s uterus, it is not considered zina and the resulting child is considered legitimate. Thus, embryo transfer and gestational surrogacy are not forbidden according to Shia Islam.

Another distinction made between Sunni and Shia thought is maternal relatedness. Shia jurisprudence “recognizes a bilateral filiation in which maternal filiation acquires the same importance as paternal” (166). Because of this, females play an important role in producing and contributing to the line of descent of a child through ties of uterine kinship. Shia scholars argue maternity is established at conception and, in the case of egg donation or gestational surrogacy, regard the mother as the producer of the ovum. Because of this, a child conceived through gestational surrogacy is not considered to be related to the gestational mother or her family in any way. Likewise, the father is considered to be the man who produces and provides the sperm.

Naef also looks at the issue of breastfeeding and the important position it holds in Islamic legal tradition. According to Islamic customs, the milk bond, “establishes [a] permanent legal realtion[ship] between the child and the milk mother” as well as all members of the milk mother’s kin (173-174). The Shia position on milk kinship states that “kinship relations created by the ‘act’ (and not ‘milk’ as substance, my emphasis) of suckling is equivalent to kinship relations created by nasab” (174). However, according to the viewpoint of Ayatollah Mo’men, a prominent Shia scholar, gestational surrogacy should not be analogous to milk kinship because gestational surrogacy, “does not establish any filiation (nasab) and marriage prohibition (mahramiyat) between the children conceived in this way and the surrogate” (174-175).

The final parts of Naef’s chapter look at the experience of Iranian gestational surrogates and what they think of their experience. While many of the women she interviewed had financial incentives to partake in surrogacy, many of the women also expressed emotional reasons for surrogacy, in order to help friends or family. In both instances, “both groups emphasized the altruistic aspect of the process, helping a woman to become a mother as well as preventing a marriage from falling apart because of infertility” (176). In the end, all women believe that the resulting child does not belong to them, the gestational surrogate, but the contributors of the embryo, the “true parents.” As previously mentioned, no women considered this to be adultery because, according to the Shia notion of adultery, it is only established by the social and physical act of illicit sexual intercourse,” not the biological act, which was an important distinction to be made for many of the women. Also, many women acted as surrogates for siblings who were unable to conceive on their own because they believed it to be better than involving a complete stranger. This wasn’t considered incest because it violated no social or physical illicit act.

One of Naef’s main findings was how surrogates used the language of kinship to “disconnect themselves from the experience of surrogate pregnancy,” while also maintaining “the social order in dealing with infertility” (181-182). She also found throughout her fieldwork that, even in the presence of assisted reproductive technologies, God was still considered to be the divine creator of human life. An important conclusion made by Naef was the importance of women in the establishment of nasab as well as the important place they held in the establishment of kinship ties. Naef showed how Shia scholars applied ancient religious and legal texts to challenge the bioethical dilemmas presented by surrogacy in Iran (183).

Questions:

• As mentioned in the chapter, is motherhood a biological or legal determination? Does giving birth to a child entitle the person to motherhood?
• Do you think having your sibling as a surrogate is considered incest? Or do you agree with the Shia definition of incest, in which having your sibling as a surrogate does not violate the realm of incest?
• Can surrogacy be a truly altruistic act?

This week’s readings are both from Volume 25 of the Creighton Law Review and analyze different perspectives on reproductive technologies. “New Reproductive Technologies: Protestant Modes of Thought” by Gilbert Meilander is a review of the perspectives presented by various contemporary Protestant theological ethicists. On the other hand, “Reproductive Technologies and Surrogacy: A Feminist Perspective” is an opinion article by Barbara Rothman, who identifies as a feminist. Both readings specifically place an emphasis on the notion of surrogacy, religion as a guiding factor, and reflect many of the other readings/discussions we have had in class this semester.

“New Reproductive Technologies: Protestant Modes of Thought” by Gilbert Meilander

From the onset, Meilander admits that his article will not be all encompassing of the Protestant attitude towards reproductive technologies, especially because “there is no one ‘Protestantism’ (1637).” Hence, he presents the perspectives of six theological ethicists who analyze biblical themes and the duality of human nature. The search for guidance in the Bible reminded me a lot of our class discussion on Hinduism and the Mahabharata. Like Hinduism, since Protestantism has no single authority, people look to biblical stories to find answers to modern issues.

The first ethicist discussed, McDowell tries to “appeal to biblical passages and themes, attempting to cull from them some general direction and guidance (1638).” She concludes that the Bible emphasizes that priority in one’s life is first to God, and then to family and hence does not approve of surrogacy. She admits that though surrogate motherhood is compassionate, it is compassion gone too far and is not appropriate behavior particularly because God always comes first. O’Donnovan builds on this loyalty to God by stating “faith affirms that God has made us through human begetting (1644).” He argues that new reproductive technologies turn begetting into making and hence should not be allowed. Simmons also echoes this thought by saying that sexual intercourse is intimate and does not have to lead to childbearing. Hence, he supports planning for children and believes a child is a gift from God, so one should not mess with this divine process. I found it interesting though all the ethicists who looked to the Bible were against reproductive technologies, they all used different biblical themes as support. Meilander shows that this is a classic example within theological anthropology.

• Do you agree with these biblical themes and the conclusions made by the ethicists?
• Based off our class discussions, are these biblical stories or themes that support new reproductive technologies?

Meanwhile, the theological ethicists that focused on the duality of human nature disagreed on their conclusions. Smith and Ramsey both agree that humans are “finite and free,” but that new reproductive technologies are a destruction of humanity in a larger sense. Unlike Simmons, Smith claims that you cannot separate sex and reproduction and so technologies intervene in this process. His opinion is that “such techniques are within our power and are an expression of the marvelous freedom that characterizes human nature, they will, Smith judges, be destructive of the other, equally important, aspects of self (1640).” Ramsey goes further and believes that the duality of nature approach is also against IVF. He makes a powerful claim that “in turning against the basic form of humanity that is parenthood and that holds together the love-giving and life-giving dimensions of our nature, we are losing a sense of what is truly human (1641).” Ramsey believes that the technologies are dehumanizing from a Protestant perspective.

On the other hand, Fletcher believes that the most important aspect of being human is the right to being free and rational. He believes this is the main “victory of mankind” and thus cannot be violated. He thinks that kinship is a social construct and having children aren’t the greatest thing in the world. This comment on kinship got me thinking back to our very first class and how Fletcher is a clear example of the cultural constructionist approach. He does not believe kinship is rooted in blood relationships. Meilander opposes Fletcher’s opinions with the other ethicists and finally shares his own thoughts. He thinks that the evidence presented by Smith/Ramsey is much stronger than Fletcher’s and I agree. Meilander concludes that overall “it may still be that faith is most likely to give rise to understanding of what is truly human (1646).” I feel like this is the case in many cultures around the world and something I relate to personally. Though I don’t consider myself to be super religious, whenever I’m in a bad situation or I’m anxious about something, I turn to prayer. I believe in a higher power because life just doesn’t make sense sometimes. Never will everyone agree on what is truly human, and hence I agree that is when faith steps in.

• Do you agree with Smith/Ramsey or Fletcher on the duality of nature?
• Do you believe it is an inherent right for humans to be completely free? Is this right lost when humans do not act rationally?
• Has your definition of kinship changed over the course of the semester?

“Reproductive Technologies and Surrogacy: A Feminist Perspective” by Barbara Rothman

Rothman presents a narrative of how her perspective, a feminist stance, has developed over the ages. She begins by stating that feminists and religious leaders are both opposed to surrogacy, but makes it clear that feminists “are coming from a very different place, and we are going to a very different place (1599).” Rothman’s main strategy in her argument is to define words we commonly use and give hypothetical/example situations to prove her point. She believes that the feminist opposition to surrogacy stems from issues in the language we use and defining a woman’s place in society. She asserts, “when one analyzes the language used by members of society, the assumption of that society are often revealed (1604).”

Throughout her article, Rothman defines words like patriarchy, kinship, incest, genetics, inheritance, motherhood, pregnancy, and the sanctity of family. By define, I mean explains how these words are used in society and what effects they have. I found her explanations to be very compelling. Rothman clarifies that patriarchy used as a synonym for sexism or men’s rule is actually wrong and rather defines it as “system in which men rule as father (1600).” It is an old system within many societies that affects views of childbearing. Rothman uses the analogy of a child as a seed to explain how patriarchal values make it seem like the fathers have rights to the children and mothers are just vehicles for growth. Hence, surrogacy is considered fine under this system because the surrogate mother is just another vehicle. I found it interesting that Rothman made it all boil down to a power struggle as she said that men “maintain control of the seed” by maintaining control of women during pregnancy. She also references the Bible, and points out the terminology of “man described as having begotten his first-born son (1600).” Unlike O’Donnovan from Meilander’s article, Rothman focus not on the idea of begetting but who is said to have begotten. Both perspectives show the importance of begetting children and how it affects views on surrogacy.

Rothman’s use of analogies was also successful because they got me thinking outside of the box about the issues she presented. In describing the outcome of the famous Baby M case, she paints a hypothetical scenario of the same case with a man who has sex with an underage girl, sends her gifts, and claims custody. This is an interesting case because on either end how does one decide who has rights over a child when they are not half and half? It opens an entire new can of worms and Rothman argues that our society struggles with this issue mainly because of “the position women find themselves within out society (1603).” This parallels back to Ginsburg’s book last week that displayed that most women focus on advancing feminist ideals and their place in society as a reason for activism within the abortion debates.

Furthermore, Rothman also connects it back to kinship when discussing the issues of through surrogacy. Incest is a social construct as explained by Rothman, but it does also have a biological significance when considering genetic defects of the children. However, what exactly is considered incest is culture dependent and certain things are just considered distasteful, even when there is no direct genetic relatedness. She places this root of this issue on what constitutes relation as she points out “just because two children have the same father, the children are not really related (1601).” Hence, this reading depicts how our discussions from early on the semester about kinship and relatedness make up how reproductive technologies are viewed.

Rothman finally presents her perspective at the end of the reading by stating “we need to find a perspective as a society that does not discard the intimacy, nurturing, and growth that grows between generations, but a perspective that supports, develops, and encourages intimacy. We need to reject the very concept of surrogacy (1607).” She shows that from a woman’s standpoint every child is precious, genuinely her own, and limited. Hence, the loss of an actual baby in any sense is devastating and women should not be treated as a societal resource. It is impossible to find a uniform solution for every case, but regardless women should have choice in these endeavors despite societal undertones. However, Rothman does acknowledge how difficult of a task this is to accomplish given how deep-rooted these societal values, positions, and terms are.

• Can you think of other words we commonly use in society that could reveal assumptions about society?
• How do you define incest?
• How do you think surrogacy would be viewed in a matrilineal society?

I’d like to start by acknowledging that these two readings were published 30 pages away from each other in the Creighton Law Review, which struck me as noteworthy. The Creighton Law Review is published by the students of the Creighton University of Law, which is a Jesuit institution. Though from intensely different perspectives, both articles have moments of agreement.

I will first discuss the “Feminist Perspective” article by Barbara Katz Rothman. I felt that the piece had a moderately erratic flow from idea to idea, with particular parts appearing to be unsubstantiated. Contrary to most of our readings in this course, this one is not based on any sociological data or ethnographic interviews, and seems to be substantiated on only her own arguments and parallelisms, which places heavy weight her rhetoric to be compellingly persuasive. The most notable unsupported statement was that “Men repeatedly win custody battles at much higher rates than women do.” A study by Braver et. al in Arizona State University found women are more liekly to be awarded primary residential care 68-88% of the time, with fathers receiving custody 8-14% of the time, and equal custody 2-6% of the time (1). In addition to a number of inconsistencies, I am not quite sure who the audience of this piece was supposed to be. She has strongly promoted the perspective of the woman in pregnancies and highlights biblical and modern norms surrounding procreation as marginalizing women.

Rothman begins the passage with a legal anecdote of Baby M, a situation where an inseminated surrogate broke a contract with a couple in an attempt keep the baby, as she had changed her mind during pregnancy. Though she won the lawsuit concerning motherhood, she lost custody to the father (whose sperm had helped to create the child), thus returning matters as the contract originally bound.

Rothman remains fixated in an traditional surrogacy (insemination of the surrogate) as opposed to gestational surrogacy (in vitro fertilization) in order maintain an overarching patriarchal narrative, as the former involves only paternal relation to the child and the latter involves both maternal and paternal relation to the child. Rothman also derides women who are involved with traditionally surrogacy, likening them to underage Catholic girls who lose their child in court to adult fathers. Counter to what I would anticipate from most feminist perspectives, Rothman’s arguments in fact lead her to argue against ART’s more generally.

I found Rothman’s article to be largely reductionist of the role of the mother and surprisingly unclear on her stances on certain issues. In the end, her label on infertility as a disability did not seem to bring her closer to supporting ART’s, but rather to continue to double-down that the child inherently ought to belong more to the gestational mother than anyone else.

This passage did however get me thinking differently on certain topics. For example, what changes would satisfy Rothman’s worldview? Does the historic/religious and modern societal marginalization of women justify additional changes to the legal ownership of a baby by courts law (which are already decided in a ratio of 7:2::mother:father)?

Meilaender identifies himself as a Protestant, who, rather than a Catholic decree-follower, wanted to delve into the texts themselves. Contrary to Rothman’s citationless article, Meilaender’s article is littered with references and quotes. My favorite quotee was David Smith, who agree with Rothman’s distaste for traditional surrogacy, but arrived there using different reasoning. He argues in a tractional surrogacy, one parent (the father) remains truly related to the child compared to the infertile parent (the mother), and offered an alternative via adoption in which both parents would be unrelated. I saw this as a fair double loss where both parties still lost, with respect with the traditional model where both parents are fully related to the child.

Meilaender’s narrative uses these arguments to reject such technologies altogether in favor of a simpler two-person model, thus doing away with the question of parenthood completely. An issue that seems central to Meilaender is the importance of the biblically highlighted sexual embrace that precedes pregnancy. Towards the end, he uses Oliver O’Donovan to feign support for IVF to make a point that would eventually erode what it meant to be a parent and questions whether that power lies with people or with God.

Though the readings were from vastly different angles, they came to a common moment of agreement. Some additional questions that were raised for me were (as usual) the role in this intensely religious-driven ethical rhetorical for the non-Protestant masses. I could completely support this for the internal regulation of the Protestant people who choose to subscribe to it, but it feels inappropriate to have it be the sole foundation of any legal bases.

Should IVF be able to be limited or banned to those of faiths that allow it because the religions of the majority population deem it to be immoral? If no, does a decentralized sect like Protestantism ever allow for politically democratic establishments of majority opinion?

1. Sanford Braver and his colleagues at Arizona State University recently conducted a study to see how the public would judge custody decisions and their perceptions of the legal system regarding custody (Psychology, Public Policy and Law, 2011).

The two readings from this week discussed the issue of surrogacy from a feminist  and Protestant point of view. The first article, “Reproductive Technologies and Surrogacy: A Feminist Perspective”, outlines the disadvantage females face when dealing with surrogacy, emphasizing a branch of gender inequality (Rothman 1599). The second article, “New Reproductive Technologies: Protestant Modes of Thought”, focuses on a Protestant perspective, which consists of adhering to biblical tests rather than accepted religious notions of a church (Meilander 1637).

In “Reproductive Technologies and Surrogacy: A Feminist Perspective”, Rothman forms arguments against surrogacy which are quite different from accepted religious views. She begins by mentioning the misinterpreted definition of “patriarchy”; instead of meaning overall “sexism or men’s rule”, Rothman defines it as “…a system in which men rule all over the world” (1599-1600). In general, the word of a female is not taken into consideration while the bond between a father and son is the dominating familial relationship. Rothman continues to state that females are not even referred to by name, but rather as “daughters of men who bear them children” (1600). This disregard for female importance brings up the issue of control. Man always feels a need to have control over a situation, but once impregnating a female, this sense of control becomes lost for nine months. As a result, males attempt to control females, which is one of the many reasons why females’ voices are not taken seriously in Rothman’s eyes (Rothman 1600-1601).

In addition to the problem with “patriarchy”, Rothman describes the issue of incest. She begins by stating that incest is socially constructed and varies by culture. For example, some societies believe children are siblings if they were breast-fed from the same female. Other societies believe children are siblings if they came from the same uterus. Numerous other cultures have beliefs different from the preceding two, pointing to the fact that what might be incest at one place may be completely normal in another location. This leads to the following controversial topic: Should marriage be accepted between a male and female if they were both born to the same mother who underwent two separate surrogate pregnancies? Modern United States society  would see the marriage as acceptable because there is no genetic relationship, but other societies would see this as incest (Rothman 1600-1601). The question of what constitutes incest is still a sensitive topic and most likely will continue to be debated in the coming years.

A third topic Rothman sheds light on is the issue of unfair custody over a child. Due to the male dominance explained above, men in the 1980s won custody over children at much higher rates than women. At this time period, children were seen as a status item and because men had higher incomes and more assets, they were able to win the legal battle (Rothman 1603). Overall, Rothman described the situation as “When men want custody, they get custody” (1603).

In “New Reproductive Technologies: Protestant Modes of Thought”, Meilander focuses on biblical texts, as opposed to the views of the church, to form his arguments. Even though the Bible places mass importance on procreation, it stresses that our first priority should be towards God, not family. James McDowell refers to  Jesus’s statement in which he tells us not to love our mother and father more than him. This does not serve to undermine the familial relationship, but emphasizes the need to put God first (Meilander 1638).

In addition to prioritizing God over family, Meilander refers to David Smith’s view on surrogacy. Smith states that if a married couple is unable to have a child and turn to “a reproductive technology that involves the person or gametes of a third party, then the fertile partner is purchasing authentic parenthood for himself or herself…” (Meilander 1640). As a result, this may cause all three parties to be of unequal status, complicating the topic of who the real parents are. Due to the probable predicament, Smith urges for the discontinuation of artificial insemination by donor (Meilander 1640).

The two articles described above both outline the issues of surrogacy, but from two different perspectives. Rothman’s feminist approach outlines the gender inequality women face, stressing the need for women to have more voice and status in society (1599). In contrast, Meilander’s biblical approach focuses on scriptures of the Old and New Testament, allowing him to form his view in a different manner (1637). Overall, both readings related to the topic of kinship, which was discussed in week two of the course. It allowed questions to be raised about whether consanguineous or fictive kinship should be the dominating force in determining how related two individuals are. Personally, I align more strongly towards the view of consanguineous kinship because fictive kinship seems to imply that people would like to be related, even though society might not accept them as relatives. The issue of kinship discussed in week two and its references in this week’s readings continue to play a significant role in modern society and only more debate and questions will allow our understanding of the situation to evolve.

 

Questions to Consider:

When the word “patriarchy” comes to mind, what is your first thought on its definition?

Do you feel Rothman’s argument was persuasive? If not, where do you feel she could have improved?

Two weeks ago, we discussed how translation through time could cause some information to be lost or misreported. Do you think Meilander could have fallen subject to this? Do you think he should have used more sources outside the Bible?

How do you connect the two above readings to the concept of kinship discussed in week two of class?

 

This week’s readings discuss theological and feminist approaches to surrogacy. Last week two of our readings provided firm arguments for or against abortion, but the surrogacy readings this week seem to focus more on the important questions that arise from a discussion of surrogacy. Though arguments are explored for and against surrogacy, the authors are more concerned with how this topic makes us rethink questions about women’s place in society, human nature, and family.

From the outset of her article, Barbara Katz Rothman establishes her opposition to surrogacy, but she mainly focuses on how the issue of surrogacy inherently provokes questions about our ideas of men and women in society. She illustrates the importance of patriarchy in the Judeo-Christian religious tradition; the value placed on father-child relationships still influences the political climate of America. She references linguistic discourse to support this claim: “It manifests itself in the language when Mrs. John Smith bears John Smith Jr- women bear the children of men (Rothman, 1991: 1600).” The child belongs to the father, and the mother is simply the means of creating that child- the dirt in which a man’s seed will grow. Rothman calls our society a modified patriarchy, a system categorized by rule of fathers that includes a primary emphasis on genetic material (Rothman, 1991: 1602). It is within this patriarchal and genetic context that people reflected on the emergence of reproductive technology. Women obtained the privilege of half-ownership of their children because their genetic contribution was likened to that of men. Rothman claims that women obtain patriarchal privileges when they display similar characteristics to men. With this logic, perhaps women had access to other women’s bodies to plant their seed and procure their children. But Rothman argues that this creates a dichotomy between those women that can afford this access to other women’s bodies, and those who were relegated to the dirt in which someone else’s seed will grow. The nature of this situation does not benefit all women equally. I can see how surrogacy might create problems if women are selling the use of their bodies to wealthier women. It reminds me of our discussion about selling organs on the black market. Body parts should not be sold as commodities because it creates problems like these. But I don’t think this economic problem is grounds to condemn surrogacy entirely. It is a beneficial resource for people who cannot have children any other way. Perhaps the only way to permit it ethically is to prohibit a monetary contract. This would likely limit surrogacy to relatives because pregnancy is an expensive, time consuming process, but at least it would prevent the problems associated with selling the use of one’s body.

• How would you resolve this problem Rothman poses about surrogacy?

• Do you agree that our society is a modified patriarchy that still relegates women’s opinion on matters regarding reproduction?

• Do you agree that women only obtain privilege when they display similar characteristics that men have?

Not only does Rothman claim that surrogacy doesn’t benefit women equally, but she also says it raises questions about custody when the surrogate mother intends to keep her baby. Rothman uses the famous case of “Baby M” to show how male opinions dominate even when women are awarded the privilege of half-ownership of their children. In 1985, Mary Beth Whitehead agreed to be inseminated by William Stern and carry a baby, called “Baby M,” to term as a surrogate mother for Elizabeth Stern. After giving birth, Mary Beth Whitehead wanted to keep the baby. In the court case that ensued, William and Elizabeth Stern were permitted to keep the baby on the grounds that it was in the child’s best interests; but Mary Beth Whitehead maintained her parental rights (In Re Baby M). This is the case that started much of the legal debate over surrogacy and its implications. Rothman points out that William Stern obtains custody even when Mary Beth Whitehead’s legal motherhood is not questioned.

Rothman introduces her article with a discussion of society’s male-driven perspective on reproduction, but she concludes with a female perspective. She projects this notion of the potential for life even before conception occurs. This is something we have not really seen before in our discussion of when life begins. She claims that women view reproduction as beginning at ovulation and continuing through until the adulthood of the child; men view it as a discontinuous process that starts only when the sperm fertilizes the egg. She emphasizes that viewing it in a discontinuous way devalues the role of women in reproduction and relegates them to the dirt in which the seed is planted. Rothman sees parenthood as belonging to the mother who provided “the blood and nutrients of her body.” (Rothman, 1991: 1607). She claims that the kind of logic created by the patriarchal perspective takes children out of the arms of their mothers and places them in the control of society. Her article frames society as a dichotomy between men and women, and while I recognize that men certainly hold more power than women in society I don’t think you can easily define a male and female perspective as she does. In fact, I don’t see ovulation as the beginning of reproduction as she says women do. I think that would illustrate an extreme matrilineal view of reproduction. Women certainly invest more resources than men in reproduction, but I see the beginning of reproduction as a joint process separate from that of ovulation.

• Do you agree with Rothman’s descriptions of male and female point of views towards reproduction? Does your view fit in with her description?
• What is your definition of parenthood?

Gilbert Meilander frames the question of surrogacy from a very different perspective. While Rothman views religion’s position on surrogacy as stemming from unified patriarchal ideas, he emphasizes the great variability of opinions and modes of reasoning employed by Protestant theological ethicists to determine whether surrogacy is ethical. Rather than asking questions about men and women’s role in society, these ethicists ask what it means to be human. They interpret general themes from religious texts and apply them to ideas about being human. They each choose to emphasize different texts and weight some themes greater than others. The arguments they make originate from a discussion about the duality of human nature or with a discussion about Jesus.

Discussions about the duality of nature reflect on the finitude and freedom of human beings. Janet Dickey McDowell focuses on the finitude of humans when she claims that surrogacy infringes on the “bounds of appropriate behavior (Meilander, 1991: 1638).” Although it may seem like a compassionate action, she argues that surrogacy lacks a connection between the gestational mother and the family with whom her child will be sent. Paul Simmons emphasizes the idea of parenthood as a calling-  it should be done intentionally rather than accidentally. He sees in surrogacy an opportunity for couples to show this commitment and appreciate their child as a gift. By invoking this idea of choice, he advocates the religious idea of freedom in his view of surrogacy.

• Is it problematic that in surrogacy there is “no sense that a child is not simply an entity created in order to be given to others” (Meilander, 1991: 1638)?

David H. Smith and Paul Ramsey focus on ideas of parenthood to illustrate their opposition to surrogacy. Smith sees two inherent features of humanity: 1. “The embodied nature of the self” 2. The bond of marriage as a deep and avowed commitment of the self (Meilander, 1991: 1639).” I would like to focus on his ideas about parenthood because they afford important comparisons with Rothman’s ideas of motherhood. Smith and Ramsey see parenthood as involving love-giving and life-giving. They argue that separating reproduction from sexual love may be within our bounds as free individuals, but this doesn’t make it advisable in terms of our finitude. Smith also notes the inequality afforded to spouses when they enter into an agreement with a surrogate mother. One spouse pays for his “authentic parenthood,” while the other isn’t afforded the same opportunity (Meilander, 1991: 1640). Smith argues that this goes against the notion of joint marriage. Smith’s logic goes against Rothman’s depiction of religious perspectives as focusing only on fatherhood. I agree that this unequal parenthood might pose some problems for a couple’s marriage, but I think the desire for a child may surpass the cost of these problems.

While some ethicists have centered their arguments on the duality of human nature, others have centered them on Jesus. In the Gospel of John, God created the world through his love. This love was expressed through Jesus. Ramsey strengthens his arguments against surrogacy through his discussion of this. He says we need to keep the love-giving and life-giving aspects of parenthood together because by doing so, we exhibit “a trace of the original mystery by which God created the world because of his love (Meilander, 1991: 1644).”

The articles we read this week illustrated the various methods by which we understand and form opinions about surrogacy. They highlight the idea that we approach surrogacy from a variety of different perspectives, and this leads to a wealth of different questions that we ask. Surrogacy brings up questions about what parenthood is and what it means to be human. It is easy to say “Yes, I think surrogacy should be an option,” or “No, surrogacy should be illegal,” but those responses hide the fundamentally different ideas about human nature and society that underlie apparent agreements of stance.

 

 

 

 

In Re Baby M