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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

This week’s readings center on the abortion debate in the United States that began in the mid 1900s and is still of large concern today. Contested Lives: An Abortion Debate in the American Community by Faye Ginsburg is an ethnography that analyzes the conflict of abortion by utilizing Fargo, North Dakota as a microcosm of a larger American society. The second reading is a chapter excerpt from Hadley Arkes’s First Things: An Inquiry Into the First Principles of Morals and Justice and it explores the ethics behind the Roe vs. Wade decision in 1973 and its implications on society. Finally, the last reading, which was published earliest, is Judith Thomson’s “A Defense of Abortion” which explores the philosophy behind the right to life movement and argues against it. The readings this week encompass the moral reasoning and consequences of the pro-choice vs. pro-life debate in American society throughout the 1970s-80s.

From the onset, Ginsburg states her identity and any biases that might affect her work. She states, “I was concerned, initially, that being a young, unmarried, Jewish, and urban visitor from New York City might pose serious barriers to communication with Fargo residents (5).” She was extremely aware that she was about to enter a conservative and homogenous small city in the Midwest that prides itself for having the “highest rate of church attendance of any standard metropolitan area (4).” It was interesting that Ginsburg found her New Yorker identity the hardest identity to overcome when talking to Fargo residents. I believe this to be a testament to the divide in ideologies across the country and how reactions toward abortion differed even after the 1973 Roe vs. Wade decision. Thus, I appreciated that Ginsburg started off her ethnography with a couple chapters devoted to the history of abortion debate in the U.S., before delving into her findings in Fargo starting in Chapter 4. Unlike most ethnographic studies, she spends time acknowledging that there is a larger context of conflict that is occurring at a different pace outside of this small city.

Hence, I would like to discuss Thomson’s and Arkes’s works before analyzing Ginsburg’s conclusions because both works were published before Contested Lives and set the larger framework in which Ginsburg conducted her ethnography. Judith Thomson’s “A Defense of Abortion” defends the right of choice for a pregnant woman to control her own body. This moral philosophy paper was published in 1971 and spurred a lot of discussion and critiques from both sides of the abortion debate pre-Roe vs. Wade. Thomson operates under the assumption that “most opposition to abortion relies on the premise that the fetus is a human being, a person, from the moment of conception (47).” She calls attention to the issue that opponents of abortion do not “draw the line” from which a fetus is person to where abortion starts being impermissible.

Thomson uses the thought experiment of the unconscious violinist to explain her viewpoint. She sets a scenario of a famous violinist with a fatal kidney ailment who can only be cured by you and so the Society if Music Lovers kidnaps you. The next day, the director of the hospital informs you that “we’re sorry the Society of Music Lovers did this to you (48),” but to unplug yourself from the violinist now will kill him. Thomson questions “is it morally incumbent on you to accede to this situation (48)?” She then mentions the time frame and pushes the reader to determine if the decision would change depending on if you had to be plugged in for one hour (“be a good Samaritan”), nine months (equivalent to pregnancy), or nine years (a much longer time span)?

Thomson uses this thought experiment to walk through several scenarios from the extremist view of never aborting a child even to save a mother’s life to whether or not a mother has a special responsibility for the fetus from conception. At first glance, I found Thomson’s work to be very persuasive. The analogies used throughout the paper and moral reasoning resonated with me and I even found myself nodding my head as I read. I found myself proclaiming, “of course a woman should be able to save her own life” or “it is not her fault she was raped!” Nonetheless, after contemplation, I realized I felt prey to Thomson’s rhetoric strategy of simple analogies to explain the complex issue at hand. She successfully empathized with my identity as a female who hopes to have a child one day to get her point across.

Thus, it is important to put emotions aside and note several criticisms that should be addressed from either side of the abortion debate. First off, Thomson’s argument is solely based on the fetal right to life assumption. This assumption in itself only represents a portion of the larger controversy. Additionally, the violinist analogy obviously isn’t perfect and Thomson tries to remedy this throughout her reasoning. However, nothing can be changed about the fact that the violinist is a stranger to you, unlike a fetus inside of you, or that you were kidnapped in the scenario, restricting the abortion argument to extreme cases such as rape or imminent death for the mother.

• Did you find Thomson’s argument compelling?
• Do you believe that Thomson’s use of analogies was an effective method of communication? If yes, do you think the violinist analogy is representative of getting am abortion? Can any analogy be representative of that decision?
• What do you think should be the role of a third-party in the mother’s decision to abort her child?

In the chapter titled, “The Question of Abortion and the Discipline of Moral Reasoning,” Arkes explores the interaction between morals and the law post-Roe vs. Wade decision made by Justice Blackmun. Arkes states, “Within the space of five lines, Justice Blackmun managed to incorporate three or four fallacies, not the least of which was the assumption that the presence of disagreement (or the absence of “consensus”) indicates the absence of truth (360).” The assumption referenced is that the judge’s decision was the answer to the dispute over when life begins. Arkes spends much of the chapter explaining that the judicial decision did not solve the dispute but rather added to the fuel because it brought to light even more ethical debates.

Arkes stresses the need for justification when making any moral decision. Arkes analyzes Blackmun’s suggestion that the “fetus becomes ‘viable’ somewhere between the 24^th and 28^th weeks, and he indicated that the state would have a stronger “’logical and biological justification’ to act at this point (376).” The next line is Blackmun’s clarification that “this justification would never be sufficiently compelling in any case to override the interest of the mother having her baby (376).” This judicial stance highlighted the importance of justification and also that the abortion debate by no means would end with Roe vs. Wade.

• Is it possible to create laws without taking morality into account? Is it justified to separate morals and laws?
• How does the need for justification change your viewpoint on the abortion debate from a mother’s, the fetal, and the physician’s perspectives?
• Do you agree with the Ann Landers argument presented by Arkes for a mother to have an abortion?

Finally, I’d like to return to Ginsburg’s work now that the other two readings for the week have set the national background under which Ginsburg was conducting her anthropological study. The abortion controversy that began once the abortion clinic open in Fargo in 1981 is a social drama. Ginsburg states it is a “sequence of phased conflicts typical of “social dramas”: breach, crisis, redress, regression to crisis, and eventually stabilization either through schism or reintegration (121).” There were many waves of strongholds on the pro-choice and pro-life sides throughout the 1980s.

In what she refers to as “procreation stories”, Ginsburg sought out life narratives from both sides of the argument. She found that pro-choice women found inequalities to be rooted in gender discrimination and choose economic and political remedies to solve the issue at hand. For pro-life women, “opposition to abortion, like other moral reform campaigns, is a gesture against what they see as the final triumph of self interest, a principle that represents both men and the market (216).” Thus, I found these overall findings to be interesting as they both point to abortion as an inherent feminism argument. All women interviewed thought that the underlying issue was with the definition of female gender identity and the placement of this identity in society.

It is important note that Ginsburg relays that there isn’t any large gap of socioeconomic class or other prominent identity that separates women on either side of the argument in Fargo. I think this is a remarkable statement because it actually highlights the intrinsic similarities between women on either side of the argument who are all trying to advance feminist values. It seems that it is the ideologies that are in opposition, not necessarily the women themselves.

Ginsburg’s goal in conducting her study was to “understand how this grass roots conflict shaped and was shaped by activists’ experiences of self, gender, family, community, and culture in a specific setting (6).” She was able to portray this inter-sectionality well, but concluded that the issue boiled down to a women’s place in society. She places a lot of significance on the role of nurturance in determining philosophical questions of either side of the abortion argument.

• After reading Ginsburg’s ethnography do you think that pro-life supporters are entirely different from their opponents, the pro-choice supporters?
• Ginsburg sheds a negative light on national media with ABC’s portrayal of the conflict in Fargo. An account is presented from a leader of the LIFE Coalition who is “disgusted and disappointed” because ABC “paid women money to interview anonymously and tell how their needs had not been met when working with the pro life groups.” Do you think the role of media has been positive or negative in the abortion debate today?
• What are your thoughts on Ginsburg’s final conclusion that any type of activist controversy “suggests a dynamic relationship between the construction of self and social action in (American) society (220)?”

The community of Sasquatch, Connecticut, is an increasingly diverse population, and as such, has a diverse set of needs. Though the town has predominant Irish population, Sasquatch has notable Jewish communities, mixed white and black communities, as well as influxes of Lebanese Shia and Japanese immigrants. Due to large distance between the town and a major hospital, major decisions must be made on a number of controversial topics. My ethical judgements will largely be made on the legal and normative lines, with an attempt to respect and please people from various backgrounds.
Before we begin, one must ask the question: what is the nature of the Catholic-affiliated hospital’s shift to become non-denominational? The background information of whether this move was motivated by diversity or as a nominal tactic is imperative to understand what effects this report’s suggestions may have. I will, however, proceed under the assumption that the shift was more than a titular change.
The American hospital system exists largely in the private sector with various government regulatory agencies and legislature who oversee rules and protocols. It is under that umbrella that many of the implicit suggestions made in the prompt of this paper raise legal eyebrows—is it within the law for hospitals to refuse to provide particular treatments or procedures? A second presumption that must be made is that both scenarios of each question are legal. I believe that once the argument becomes about the law, a new (and entirely different) conversation has begun.
The nearby hospital subsidizes care for under-insured patients, an assistance that can be seen in many hospitals across the United States. There is a growing issue of growing medical costs that result from the assistance of the under-insured—a burden that falls to a great extent on the deductibles of the lower middle class. The assistance given by the hospital close to Sasquatch has also been implicitly called into question.
A third presumption is that these fragmented populations will behave or believe similarly to those we have read about in class. It is entirely conjectural and reductionist to pigeonhole a group of people as similar to their macrocosmic religion, an identity which they may or may not hold as very salient.
With these initial conditions, the principal debate is that of assisted reproductive technologies (ARTs) and prenatal testing, a controversial topic that varies by culture, which must be taken into account given the heterogeneous population of Sasquatch. First, let’s take into account the faith and tradition of the Irish Catholic population. According to the Congregation for the Doctrine of Faith’s Donum Vitae and Dignitas Personae, we know that in vitro fertilization (IVF) and prenatal testing which would lead to termination of the fetus are not permissible. We must also recognize that this is the religious view of the Catholic Church, the majority religion of the Sasquatchian community and the religion of the hospital’s donors. Therefore, the power of this situation likely falls into the hands of the Catholics, akin to the axiom “money talks.” It would be important to know how evangelical this Irish population is—the advocation and maintenance of their religion may be an importantly held value to them, which would highly influence their interactions with the rest of the town.
In the United States, the availability of choice is very important. Few things are mandatory and few things are banned, many fall in between and are available if one would like, which can be seen in the American controversy of autism-causing immunizations whereby parents sometimes forego vaccines only later to be hit by a crippling (and preventable) disease. What keeps this process continuing is the American adherence to ‘choice’ and ‘rights.’

I would like to define a tenet of American culture that I have observed, ‘refusable availability.’ One often retains the right of choice and is infrequently obligated to anything. For example, a parent can choose not to vaccinate their child. Conversely, the current political obligating a woman to carry a child to term is being met with liberal animosity. In-line with this thinking, medical services ought to be available but refusable.
A fourth and final presumption is that people who shy away from a particular technology will not be bothered by another group taking advantageous of that technological service, unless the group in question is paying for it. This is a large condition, and assumes that there is no in-fighting between minority groups because of what is available, but leaves room for donors of a particular religion (in this case, Irish Catholics) to be choosy when providing certain services that do not adhere to their own religious beliefs.
I would now like to address the likely wants and needs of the minority populations. In some Jewish cultures, ART’s and prenatal testing are largely accepted, with little issue in early fetus termination. In terms of the Shia populations, there are religious ways to circumvent the religious red tape associated with reproductive technologies (whose legality in the United States I am not sure of), so the presence of further testing or assistance probably bother a Shia in the next room.
Because the hospital has chosen to become non-denominational, it should no longer refuse services on the basis of religion or to appease religious donors. Based on the tenet that I have alluded to of ‘refusable availability’, hospital ought to provide uniform assistance to the under-insured. It could incorporate religious restriction if it were explicitly a religious isntitition, but by becoming non-denominational, it has foregone that privilege. If pre-natal exams, IVF, and ART, are being provided at the hospital, it should follow the guidelines for the under-insured that other medical services observe. It is the hospitals choice to provide particular services, which then affect different classes or ratings of the hospital (such as being a Level 1, 2, or 3 trauma center depending on trauma-related resources). It is not the place of the ethics committee to tell the hospital which services to provide, but it is my belief that the assistance that the under-insured enjoy should be matched in religiously controversial medical policies.
As for hospital employees encouraging families to allow unused embryos to be donated for research, I do not believe there is as much ground to defend such a request. Additionally, the same reasoning can be applied to limiting counseling by the Catholic clergy. There is little precedent to claim clergies from any particular religion should be throttled, as I would not support the same of any other religion. This interpretation upholds the federal First Amendment, which has recently been used to overturn Trump’s travel ban. This recent judicial precedent suggests that the First Amendment not only protects expression of religion, but denies legal judgement or restriction on the basis of religion.
Concerning the finances of the hospital and the potential unwillingness of historically Catholic nursing staff to perform abortions, there is no way I can support forcing nurses into performing abortions, but this can perhaps be ameliorated with a combination of switching nurses around departments to maximize abortion-capable nurses in the obstetric department, as well as financially incentivizing abortion.

Background Information

            I am a general surgeon currently working at the private hospital in Sasquatch, Connecticut. I identify as a Lebanese Shi’ite Muslim male. My family and I moved to Sasquatch 10 years ago, at which point we were the only Lebanese family in the community. However, there has been an influx of Lebanese immigrants and I am proud to say that I was recently elected as the president of the new Lebanese Cultural Association. With the growing immigrant populations in our community and my medical expertise, I am humbled to serve on this ethics committee as we transition to becoming a non-denominational hospital.

Policy Proposal

Reproductive Technology Use

IVF Treatments and Prenatal Testing

I believe the Sasquatch Hospital should begin to provide in-vitro fertilization (IVF) treatment and prenatal testing including amniocentesis. Though, the risk of miscarriage during an amniocentesis procedure is 1 in 200 (Rapp 97), which is the same as babies born with Down syndrome, patients in our community deserve to have the right to know about possible birth abnormalities. With the growing diversity in population, the availability of this procedure is essential as genetic diversity is also increasing.

Abortion Services

            The hospital should not provide abortion services, unless extenuating circumstances persist. These circumstances fall in line with the United States federal guidelines listed under the Hyde Amendment. Abortion services should only be provided when the pregnancy is a result of rape or incest or is a medical threat to the woman’s life.

Though the hospital has become non-denominational, we must still consider the prevalent religious practices present in our community. IVF and prenatal testing allow for the expansion of knowledge, but abortion by two out of the three dominant religions in this community (Catholicism and Shi’ite Islam) prohibit the murder of a living being and an unborn fetus can be considered living as it is in the mother’s womb. The holy Quran teaches that “God had given people their bodies as a trust (amana) and that (we are) therefore responsible to take care it (Hamdy 151).” As a devout Muslim, I do not think it is ethical to break the amana that God has bestowed upon mankind and my fellow Catholic staff feels the same.

However, I also know that I have taken the Hippocratic oath and will follow all means to help patients live healthily. Thus, I propose that this hospital only provide abortion services when it is a medical necessity as explained at the onset of this section.

Unused Embryo Donation

From a medical perspective, I propose that unused embryos should be donated for life-saving research. I believe this follows the same reasoning as providing abortion services to women under extenuating circumstances. Unused embryos will not become living things and if they can lead to the cure of diseases, then it is worth it for them to be used for research.

Funding under-insured Patients

Subsidized funding for under-insured patients should be provided only for testing purposes, not abortion services even when extenuating circumstances persist. It is a pretty common standard around the Western world for governments to provide these funds. For example, “The French government normally reimburses medical procedures up to 80%, but in the case of infertility diagnosis and treatment, the national health insurance system covers the cost of the entire process (Ball 547).” Thus, I do not believe our hospital which condones abortion overall should provide funding for abortion services of those under-insured since they can get the funding elsewhere. Indeed the United States can currently use federal funds to fund under-insured patients with extreme cases for abortion.

Counseling Staff Regulations

Spiritual counseling by clergy should be continued, but the clergy should be opened to other religions that have recently become more prevalent within the Sasquatch community. “Shi’ites practice a form of individual religious reasoning known as ijtihad (Inhorn 18).” Thus, I believe all patients to this hospital across all religions should be able to have access to religious counseling in order to determine their course of medical action. Given that the vast majority of the community served is religious in some way, the inter-religious clergy will aid in daily smooth function of our hospital.

I propose implementing a mandatory training program for all counseling staff including social workers, genetic counselors, and clergy. This training program will educate counseling staff on official hospital policy regarding assistive reproductive technology and prenatal testing. It will give guidelines as to how staff can counsel under their own religious doctrines, while still adhering to hospital policy and national law.

Medical Staff Regulations

            Furthermore, I propose a similar training program for all medical staff at the hospital. All staff will not be required to be in agreement with hospital policies proposed, but rather should be aware of official hospital policy. The staff should be willing to uphold the official policies at the very least.

I know there is currently some tension among the Catholic nursing staff to perform these procedures. I do not think any of the staff should ever be required to perform procedures that are against their religious beliefs. Thus, a team of new hires and a few of the current staff who are willing will be chosen to make a team designated for all the procedures stated in this policy proposal. Nonetheless, as stated in the above training program, the staff unwilling to perform the procedures will still have to acknowledge that the procedures are being conducted at this hospital under structured circumstances.

Works Cited

Nan T Ball, “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” Duke Law Journal 50 (2000): 545-587.

Marcia Inhorn, He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly 20 (2006): 94-120.

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

Rayna Rapp, Testing Women, Testing the Fetus (Routledge, 2000).