Author: Monica Vemulapalli

Invasive Genetic Screening: How Funding Allows Reproductive Advancement of Society and Innovation

The growing industry of medical technology has been promising for individuals in almost every part of the medical field, especially in the reproduction sector. I will be discussing specifically one type of reproductive technology, invasive screening procedures. As someone with a medical degree and a master’s in public health, I would like to share my increasing knowledge and experience with you all in order to give you important insight on the need for progression of this technology. Funding for screening along with prenatal diagnostic testing provides the parents with the best knowledge for them and the child, in addition to giving them options for further prenatal care. Not only will I persuade you all with concrete evidence provided from proven models, but I will also introduce the reasoning behind each model and the effects brought to benefit the people affected. The main arguments for funding of invasive genetic screening include the chance to prevent, the ability to prepare if something abnormal results, and the power of couples to be reassured with the option to know if their baby is healthy. These three arguments solidify why funding should be continued for prenatal and invasive testing.

Prevention constitutes a term that not many people know the true value of. To prevent is to take care of the problem before it exists, which is the problem itself for people. It’s easy to take prevention for granted because you carry on without knowing that what you’re doing might exacerbate the onset of the problem. When it comes to genetic testing, prevention is the central element of play. The probability for a certain disorder can occur in said pregnancy, so if there’s a chance to prevent it or ameliorate the situation, why not? If the mother and father have moral or religious grounds to keep the pregnancy going with negative results, it’s due to their way of thinking, so we can respect that, but raising awareness is key. Even if we can raise awareness in the end and prevent a small number of pregnancies in order to help not only the parents, but from fetal suffering, then the technology does justice. Technology allows us to do this.

As technology in medicine progresses at a rapid pace, it gives us the amazing capability to test for fetal diseases and abnormalities.  Rayna Rapp, author of Testing Women, Testing the Fetus : The Social Impact of Amniocentesis in America, describes the invasive process of amniocentesis, which screens for genetic abnormalities of the fetus, and delves deep into the world of prenatal diagnostic testing. She describes the political support or condemnation of prenatal diagnoses as dependent on state legislators’ opinions on certain topics, while if we contrast America with European countries, they usually have established healthcare programs covering prenatal diagnostic services. (Rapp 43) Informed consent and continuing routinization of prenatal diagnostic testing is crucial because it can result in the outcome that parents didn’t ask for. For example, Rapp describes a wrongful birth case in which a 37-year-old woman received her child’s medical costs for life after “suing over not being given information about amniocentesis. Her case influenced the American College of Obstetricians and gynecologists and the American Academy of Pediatrics to advise their member doctors that the offer of prenatal diagnosis to medically appropriate candidates was now constituted as the standard of care, at risk of a lawsuit.” (Rapp 40) Rapp’s discussion of this historic outcome set the precedent for routinization of diagnostic testing because it proved that if the test were offered, it could have resulted in a different, beneficial outcome for the mother, whether that be preparation for or prevention of the pregnancy.

Along with a right to know, there’s also a right not to know. However, when the knowledge can benefit the parents and the child, it can be used to create a better future through preparation. Looking at models of other countries’ policies on prenatal diagnostic testing and screening, Tsipy Ivry, of Embodying Culture: Pregnancy in Japan and Israel, compares and contrasts Japanese and Israeli models on prenatal testing and screening. These two culturally different models on prenatal attitudes will portray the importance for the need of prenatal care.

The Japanese treat the mother and fetus as one unit and place emphasis on the maternal environment more than genetic factors, however their system for prenatal care is well-established into low-risk and high-risk factors. For example, “The guidelines of many institutions state that amniocentesis—known in Japan for its 1:300 rate of endangering the pregnancy—should be offered to patients above the age of thirty-five; in practice ob-gyns use a variety of age thresholds that do not always accord with the guidelines.” (Ivry 111) However, there is a nondirective conservation that most doctors have with their patients, and probability is not used enough in society as Dr. Tanaka argues “In Japan the concept of probability is underdeveloped. I think it is normal that people cannot associate these figures with themselves. For example, if you say that there is a probability of 1:300that the child will have Down syndrome, most people do not think that that has anything to do with them.” (Ivry 111) This statement helps us understand the need to raise awareness and prepare parents for the health of their future baby. Dr. Tanaka’s words showcase the international need to implement genetic testing. The need for understanding probability and pregnancy outcomes are crucial as age and medical pedigree can influence the baby’s health. As the average rate of women having children is increasing, so is the risk factor. Invasive genetic screening uses advanced technology to measure this probability and prepare the parents to make an educated decision. Ivry also examines prenatal care in Israel.

The Japanese prenatal care system contrasts with Israeli regulations, because in Israel, classes are held that explain the detailed procedure and concerns for those interested in amniocentesis. In addition, amniocentesis is state-subsidized for women who apply and meet the qualifications. An example of a woman Ivry interviewed, in all her three pregnancies she also made sure “to take a three-hour ride from her house to undergo intensive ultrasound screening at the clinic of a leading specialist and did not skip amniocentesis either. She told me about a friend of hers whose son had died ten months after being born with a metabolic disease that had not been diagnosed prior to birth. whose son had died ten months after being born with a metabolic disease that had not been diagnosed prior to birth.” (Ivry 224) From this example, we see that the outcome could have been different if the mother had gotten the genetic screening test. It could have diagnosed the metabolic disease which could have informed her of the effects and his lifespan. We can infer that Israelis emphasize the genetic environment rather than the maternal, and support, usually, the prenatal testing and screening as in the fertile culture of Jews lies a fear of medically worst-case scenarios and anxieties (Ivry 228), which leads them to prepare by using medically proven examinations.

The increasing standardization of pregnancy screening tests can be attributed to not only advancing technology, but also changing circumstances. In the beginning, “the technology of prenatal diagnosis was developed explicitly to allow the selective abortion of fetuses facing serious disabilities because of atypical chromosomes and genes” (Rapp 70). When one thinks of genetic screening, abortion might be the first option to come to mind. However, time and better understanding of these tests has made them evolve not for the sole purpose of abortion but as a tool of reassurance. A factor for women that increases the chances of chromosomal problems is age. Prenatal diagnostic tests such as amniocentesis makes screening for these problems possible. An important statistic to consider is the average age women are becoming mothers. In 1994, the average age was 23, now it is 26. This is due to a large number of older age women giving birth. A dramatic shift occurs in the age group of never married women aged 40-44, who in 1994, gave birth 31% on average, and now, the statistic has climbed to 55%. (Pew Research Center 2018) With the growing age of women giving birth, the need for prenatal diagnostic testing is also growing.  In addition, hereditary diseases in a medical pedigree allow those concerned to have the knowledge that is available from getting genetic screening. As a medical doctor who sees pregnant women over a certain age, it is important to give the necessary precaution and advice to get tested for the health of the fetus. Increasing funding will aid the process of reassuring most women that their baby is healthy from knowing certain characteristics of the pregnancy.

One of these characteristics is probability of the child carrying a hereditary disease that the parents might have in their family. Rapp states “Consciousness is also shaped by a more capacious sense of family history, and the memories of kinship through which that his- tory is constructed. Some women and men have had extensive experiences with disabled children, and they told richly detailed stories of growing up with affected siblings or cousins. Others recounted skeletons hidden in the family closet.” (Rapp 150) An important consideration when emphasizing the need for invasive genetic screening to take into account that hereditary diseases are still being transmitted from generation to generation. Rapp precisely states how more and more people are being aware of this fact and getting tested for their probability of a certain familial disorder in the baby. Genes shape who we are and form a sense of kinship, but the capability, recently discovered, to confirm or deny a baby’s chance of acquiring a disorder exists now and should be used.

In a society that is improving daily with the fostering of medical care technologically and scientifically, genetic screening gives pregnancy a security. A security in knowing what the future holds, a reassurance in the health of the baby, and a chance for the parents to be prepared. Rapp says “The technologies of prenatal diagnosis, like all technologies, are produced at multiple intersections where the work of particular scientists, research clinicians, and health service providers engages social relations far beyond the purview of their laboratories, clinics, and consulting rooms. What come to count as the technologies of prenatal diagnosis, now and in the past, are shaped by large-scale transformations of biomedical knowledge, our legal structure, widely shared and sometimes contested cultural values, and the social identities within which service providers and patients encounter one another.” (Rapp 24) As society and its technologies advance, people are advancing with new knowledge and are better equipped for the future. Nevertheless, with all issues, moral, religious, and ethical concerns can arise, but while looking at models done in different countries, an evolution of opinion occurs based on many different factors. At the end, the decision is up to the parents to proceed with the screening, to terminate if the baby faces a serious disability, or to keep the baby as it is. However, in providing funding to this procedure, we are increasing the opportunities for pregnant mothers to get tested in the first place, to let them have a decision based on scientifically proven results, and to guide them with their pregnancy with assistance from medical and health-related professionals.

References

Ivry, Tsipy. Embodying Culture: Pregnancy in Japan and Israel. Rutgers Univ. Press, 2010.

Livingston, Gretchen. “They’re Waiting Longer, but U.S. Women Today More Likely to Have Children Than a Decade Ago.” Pew Research Center’s Social & Demographic Trends Project, 18 Jan. 2018, www.pewsocialtrends.org/2018/01/18/theyre-waiting-longer-but-u-s-women-today-more-likely-to-have-children-than-a-decade-ago/.

Rapp, Rayna. Testing Women, Testing the Fetus: the Social Impact of Amniocentesis in America. Routledge, 2000.

The Burden of Knowledge: Moral Dilemmas in Prenatal Testing. Dir. By Wendy Conquest, Bob Drake and Deni Elliott. Distributor: The Fanlight Collection, 1994. Docuseek2. Web. 24 Jun 2018.

Swasti Bhattacharya dedicates the book Magical Progeny, Modern Technologyto bioethics using a Hindu perspective, while Broyde writes about cloning in his work Modern Reproductive Technologies and Jewish Law using a Jewish perspective.

Within Bhattacharya’s work, she mainly relies on interpretations of theMahabharata, an epic narrativethat is widespread across the realm of Hinduism, to discuss the bioethical nature of assistive reproductive technology. However, the Mahabharataisn’t a centralized sacred text that is studied by every Hindu, as opposed to the Torah or the Bible, an important difference to note between her work and Broyde’s work. In this blog, I will thoroughly examine the main principles that Bhattacharya discusses, as it is imperative in order to understand her Hindu perspective that she presents. It is important to note, however, that Bhattacharya’s perspective should not be misunderstood as “the” Hindu perspective, but one of many Hindi perspectives. She constructs her own views using the context of several sacred texts, which involve six themes stemming from Hinduism. Along with discussing the principles outlined, Broyde’s work on cloning can be used compare and contrast in terms of already established religious and traditional Jewish law. Broyde provides a thorough analysis on cloning, whether it is permissible, and the conclusion that he comes to on the basis of familial status of clone and Jewish standards. These distinct works give insight into very diverse, yet some surprisingly comparable views of utilizing assistive reproductive technologies.

Bhattacharya highlights six main elements, in Chapter 4 of her book, that showcase the main aspects of Hinduism used to understand views on assistive reproductive technologies. We will examine these elements individually, while utilizing Broyde’s book as a resource to provide us with religious comparison and outside perspective into Bhattacharya’s list. The first element discusses how one needs to put the society’s needs above personal goals. The example Bhattacharya uses from the Mahabharatais using a “divine sperm donor” as opposed to a “human sperm donor,” and Kunti and Pandu choose Dharma, a god of merit and “the cosmic judge” in order to act acceptably within society as Dharma would not do anything unlawful. Therefore, we can see that even in using reproductive technology, the consideration of what society will think and what is right is maintained. There is a similarity within Judaism as Broyde states “the general Jewish obligation to help those who are in need, and particularly compounded by the specific obligation to reproduce, thus inclining one to permit advances in reproductive technologies that allow those unable to reproduce, to, in fact reproduce. On the other side is the general inherent moral conservatism associated with the Jewish tradition’s insistence that there is an objective, God-given morality, and that not everything that humanity wants or can do is proper” (296). What Broyde says is consistent with the dilemma that Kunti and Pandu had when choosing sperm donors, but also wanting to fulfill their duty to bear children. We can see a similarity where Hindu and Jewish views show that there is a central need to help society, but also to believe in tradition.

The second element that Bhattacharya highlights, “the underlying unity of all life,” is difficult to use to interpret the view on reproductive technologies. This principle unity emphasizes an interconnectedness and “how the world, humans, gods, animals, plants, and everything else comes forth from a cosmic primeval being, Purusa.” This is similar, yet still different from Jewish scriptures, as God created the heavens and the Earth, according to the Book of Genesis.In Judaism and Catholicism, the cosmic power is God himself, not a primeval being, an entity from the earliest of time, predating “God” in Hinduism, who created Gods . To understand views on reproductive technology, the cosmology and religious component forms a basis for how the world is viewed in terms of creation.

The third element, dharma, is a central element to Hinduism, translating roughly to duty. Yet, the power and significance that dharma has in Hinduism cannot be emphasized enough. Childbearing and reproduction are thought of as a form of dharma, or to fulfill societal expectations.  In the Mahabharata, Pandu realizes that if he’s childless, he cannot fulfill his dharma. Therefore, Pandu and Kunti proceed to have children through other means, but only after assuring themselves their actions are seen legitimate by the society as that they are acting according to dharma, by God and in their duties within society. (69) On one hand, they need to fulfill dharma, but to do that, they need to deviate from the normal societal expectations to have children as Kunti needs to find another man to father her child. In the end, they fulfill their dharma within society, even if through a different form of reproduction. There is no true equivalent of “dharma” in Jewish scripture, but there lies a central importance placed on reproduction. The Book of Genesis explicitly states “to be fruitful and multiply,” and as Broyde states in his conclusion, “the fulfillment of the biblical mandate to conquer the earth (ve-khivshuha) is understood in the Jewish tradition as permitting people to modify—conquer—nature to make it more amenable to its inhabitants, people. Cloning is but one example of that conquest, which when used to advance humanity, is without theological problem in the Jewish tradition.” (317) Broyde justifies cloning as a means of fulfilling the expectation to reproduce, a statement written in the sacred text that Jews follow, even if it’s not the typical way. Hence, we can see that in both religions, reproduction is sacred, and using assisted reproductive technology to foster humankind is seen as permissible within reasonable terms.

The fourth element, the multivalent nature of Hindu traditions, can be explained as the flexibility and malleability of life and society. There is not one tradition, one law that is stated in Hinduism due to circumstances and individual adaptiveness. Broyde also states something similar, in my opinion, – When looking at Jewish views based on Broyde’s work, he says that “Jewish law insists that new technologies—and new reproductive technologies in particular—are neither definitionally prohibited nor definitionally permissible in the eyes of Jewish law, but rather are subject to a case-by-case analysis. (295). Broyde expresses the view that there is not an authoritative answer to using reproductive technology, but it depends. Bhattacharya might not be saying the exact viewpoint in terms of reproductive technologies, as Broyde is talking directly about this, but she also acknowledges the fact that there is not a specific judgement, that every circumstance is different in the realm of Hinduism and its traditions. The reason for no one judgement stems from there not being a central authority in Hinduism, as compared to Catholicism, where the Holy Bible and the Pope hold paramount importance, and Judaism, where the Torah does the same. There is no central sacred text that Hindus follow apart from several religious scriptures, which still does not equate to the Bible or Torah, hence the numerous sources and multivalent nature.

The fifth element, karma, contrary to stereotypical understanding, means action. Bhattacharya states that “According to the Mahabharata, everyone, regardless of gender, social status, or philosophical commitment, is subject to the constraints of karma; all will reap the fruits of the seeds planted by their actions.” (71) In the context of assisted reproductive technologies, Bhattacharya points out that “acting in the present can transform he current and future course of karma. Kunti, Madri, and Gandhari all took decisive actions that altered the course of their situations regarding having children.” She uses the examples of the three queens and their reproductive difficulties to say that they took action to fulfill their childbearing duties. Similarly, Broyde states that there is a qualification of the action that a Jew does in society, however the familial status also plays a pivotal role in the conduct. He says that “whether the cloning process is permissible (mutar), prohibited (asur), or a good deed (mitzvah). However, the determination of whether any particular conduct is good, back, or neutral is not dispositive in addressing the second issue: the familial status of an individual (re)produced through cloning in relationship to other humans generally…” (296). Even though karma and the Jewish qualifications of action are not identical, we can see them as each religion promoting certain actions to usually reward reproduction.

Broyde addresses not only the classification of cloning, but also the main dilemma after deciding to clone to be the status of the family. He comes to conclusion that “the vast majority of Jewish law authorities rule that children produced through other than sexual means are the legal children of the inseminator, and indeed such activity is considered a positive religious activity (a mitzvah)—a good deed” (301). Broyde argues throughout the section of the permissibility of cloning in the context of Jewish law as it “views cloning as far less the ideal way to reproduce people, however, when no other method is available, it would appear that Jewish law accepts that having children through cloning is a mitzvah in a number of circumstances and is morally neutral in a number of other circumstances.” (315) In addition, examining cloning through a Hindu lens, Bhattacharya states that “in regard to fetal stem cell research and cloning, the Hindu belief in the underlying unity of all life acknowledges the sanctity of fetal life, of all life..” (107) The principle of unity is used to discuss the possibility of cloning as Broyde discusses.

The final aspect of Hindu bioethics that Bhattacharya uses as guidelines for usage of assistive reproductive technology is the commitment to ahimsa, or no-harm. Bhattacharya says that this concept relates to the other five elements as “by acting in the spirit of ahimsa, one is acting in a manner that would most likely support the good of society and positively affect one’s dharma and karma.” (74) Bhattacharya also highlights the dynamic state of life as ahmisa and the other values are malleable in each situation. When compiling all of these concepts together, she states that “while biology and social status are not insignificant, of greater importance are those who intend to take on the parental dharmic responsibilities.” (96) She expresses that dharma and the duty to have a child is an important factor in general when discussing form of reproduction that results in a fetus. This principle, again, lies deep in Catholicism and Judaism, as written in sacred text and just simply been a natural and expected way of societal existence.

Bhattacharya gathers these six principles into the topic of assistive reproductive technologies and applies them in her conclusion. She concludes that one can clearly argue that the Mahabharatawould not only permit surrogacy, sperm donation, participation in gene selection, and embryonic manipulation, but also condone such practices. (52) When comparing with the Hebrew Bible, she says that “in the Hebrew Bible, God is unquestionably in ultimate control of the process of producing offspring.” (56) However, there are stances where assisted reproductive technologies are permitted, which Broyde’s work outlines. Broyde implies that Jewish law allows these forms of reproductive technologies if it fit the family’s needs. Bhattacharya uses the Hebrew Bible and Roman Catholicism viewpoints as comparative analyses to contrast, but also share how the theme that religion is the basis for belief surrounding reproduction is seen across both Hinduism and Judaism.

In looking at and analyzing the works of two different authors, writing about two different perspectives and religious outlooks, we are presented with dissimilar viewpoints on reproductive technology. However, looking more closely and examining the basis for why each of the authors comes to their conclusion, both Jewish and Hindu perspectives seem less different than at first thought. Both offer viewpoints that accept the use of assisted reproductive technologies for the most part, but also state that the usage is circumstantial and can be attributed to a diverse set of beliefs. However, when examining the reasoning for reaching their respective conclusions, the causes are different as they stem from their own religious texts that comes from Judaism and Hinduism, which influence Broyde and Bhattacharya, respectively, which contain a unique set of culture and traditions.

 

Examining Religious and Ethnographic Interpretation of Assisted Reproductive Technologies in Jewish and Christian Societies.

Human reproduction centers Jewish and Christian ideologies in the religion sphere and helps construct the concept of kinship and societal relations, as seen by examining the Book of Genesis. In chapter 1 of the Book of Genesis, God creates male and female (1:27), to who he “blesses” with the goal of reproduction, or so it is interpreted. When God blessed them in 1:22 to be “fruitful and multiply…”, the process of reproduction comes to light as a way to not only sustain the human population, but to carry on the words of God. God blessed them to give them a productive free will, one that will be used to make the right decision toward furthering the human race. 1:27 looks at this concept, of “So God created humankind in his image, in the image of God he created them; male and female he created them.” The term image can be interpreted diversely, as it could mean that humans take a quite physical image or at least similarity to the entity of God. Or the image could encompass how humans and God share an immortal soul that is far different from any other of God’s creations. The interpretation that seems to fit is the ability to morally discriminate between two choices. God created humans to “take dominion…” (1:26) over all creatures because he gave humans the very capability that he possesses in order to sustain his own unique creations.

How does reproduction play a role in these comparisons? Reproduction takes one of the central roles in this chapter knowing what God’s intent of creating humankind was. The whole purpose of the chapter was to create humankind and give them the ultimate power: to reproduce in his sacred image. This can be interpreted as reproduction causes the lineage of God to be carried, or moral discrimination to be upheld in human society. The view of human reproduction being highlighted is 1:28 shows that God said “”Be fruitful and multiply, and fill the earth and subdue it,” which can be applied to the importance of reproduction as it is taken as God’s commandment which must be fulfilled through marriage. The end of chapter 2 signals how God made woman from, “[2:22] had taken from the man he made into a woman and brought her to the man. [2:23] Then the man said, ‘This at last is bone of my bones and flesh of my flesh; this one shall be called Woman, for out of Man this one was taken.’” How God created woman from man portrays the raw, intimate connection that the pair have been given.

Kinship, in the form of marriage, in religious context agrees with this context as marital union is sacred and one of the most important concepts in religion. A man was not complete by himself, he needed “a helper as his partner (2:18),” and after a woman from his flesh was created, he was complete. An interpretation of why God didn’t want man to be alone could be the birth of the concept of kinship. God creates a companion for man, a woman, for the rest of his life and to reproduce. A family is born. Kinship is created not only for the sole purpose of reproduction, but also for the diffusion of sorrow, happiness, and thoughts. A single human being has an infinite amount of feelings and thoughts, that kinship in any form, in my opinion, is crucial to the fostering of their growth. Similarly, reproduction is also not for the sole purpose of creating offspring but to create kin. The first two chapters of Genesis lead to how man and woman “become one flesh” (2:24) or join in a sacred act of matrimonial union to serve the needs of each other and to produce kin.

Interpretation of the religious text is critical to differences in understanding and forming opinions about human reproduction. Jewish and Christian interpretations revolve strictly around the commandment of being “fruitful and multiply”, mainly or usually through natural reproduction because marriage is a sacred precedent in both religions. The Christian uses of Genesis are clearly highlighted in Respect for Human Life, as the Congregation  for Doctrine of the Faith provides their opinions, to be taken from authority of the Church, to assistive reproductive technology outside of normal reproduction. Their main position emphasizes that assistive reproductive strategies can only be considered legitimate in the context of a legal marriage and no interference by a third party. For example, if they are unable to conceive naturally, the Church can allow implantation of sperm of husband in the wife, but any procedure that requires sperm or egg from third party or womb is illegitimate. The Congregation uses natural law, as opposed to Jewish Rabbis, to reason how there is agreement with religious scripture and justify religious teaching using rationale and authoritative answers, via the Magisterium. In Judaism, rabbis follow similar reasoning, but use more positivistic laws, as a result of not only religious scriptures, but also cultural ideologies and evolution.

From my understanding and research, most rabbis permit other options to reproduce when natural reproduction does not work. However, some believe similarly as the Church because the usage donor sperm and eggs are usually rejected as they create “halachic problems.” Some rabbis permit the usage of donor eggs as long as the husband gives consent. The problem arises when the identity of mother is decided, because Jewish lineage is passed through the mother. The status, if the genetic mother differs in her identity from the gestational mother, is hard to decipher. In a specific example from “Jewish Medical Ethics: Assisted Reproduction and Judaism,” Dr. Wahrman says that “Rabbi Moshe Heinemann, Rabbinic administrator of Star-K Kosher Certification states unequivocally that if the egg is from a Non-Jewish woman, then the baby is not Jewish. In this very stringent ruling, when a donor egg is used, the birth mother is not considered the halachic mother.” Rabbi Heinemann also stated that “the use of donor sperm was a private matter for the couple to decide, and in certain situations it would be recommended in order to fulfill the first commandment as well as to keep the marriage together.” (Silber 2010) To add, the majority of Jews nowadays accept the use of third party donor gametes due to the pro-natal nature of the state of Israel, as Rabbi Heinemann cites as the reason. The key to truly understanding how unnatural reproduction plays a role in society involves not only religion, but the ethnographic framework of a country or population.

By examining the cultural context of gamete donation and other assisted technologies, we can understand diverse analyses outside of solely relying on religious texts. Susan Kahn, in Reproducing Jews: A Cultural Account of Assisted Conception in Israel, takes readers into her life researching and learning about new reproductive technology shaping Jews in Israel and her personal accounts of conducted work. She provides detailed insight of her anthropological work on IVF in Israel. The central importance of reproduction from Judaism is prominent in Jewish culture from how Kahn discusses specific examples and analyzes the Israeli acceptance of newer technologies to help in reproduction. She states how IVF is centralized through the government due to the high importance placed on fertility, in contrast to other countries where reproduction is decentralized, such as the U.S. Conducting research on “unmarried, secular, Jewish American woman without children,” observing fertility clinic activities, and interviewing rabbis on their opinion, Kahn explored the diverse atmosphere of opinions and beliefs about reproduction. Kahn states in her conclusion in chapter 2 that “Within a society where marriage is so deeply entrenched as a religious and divinely inspired institution and where it has been integrated as such into the secular legal foundation of the state, exposing it as a social construct may have particularly profound and subversive implications.” (Kahn 86)

Kahn’s statement constitutes how ethnography and religion are intertwined because extrapolation from religious texts makes up cultural expectations and policy. Moreover, Kahn emphasizes the positivistic outlook that remains in Jewish society, as she states, “From the rabbinic social practice of mining traditional texts for coherent kinship metaphors, to the ongoing efforts of contemporary Israeli Jews, both secular and religious, to make sense of this technology while using it to realize their reproductive futures, there is a range of coexisting kinship ideologies from which to choose in the ongoing cultural effort to reproduce Jews,” (Kahn 174). In conclusion, religious text interpretation establishes concrete context to reproductive importance set in place, but ethnographic context presents societal and adaptive insight to how evolving practices such as reproductive technologies can establish a malleable view on kinship and reproduction in a particular society.

 

Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day. Canadian Conference of Catholic Bishops, 1987.

Kahn, Susan Martha. Reproducing Jews: a Cultural Account of Assisted Conception in Israel. Duke Univ. Press, 2006.

Wahrman, Miryam Z. “Jewish Medical Ethics: Assisted Reproduction and Judaism.” Claus Von Stauffenberg, www.jewishvirtuallibrary.org/assisted-reproduction-and-judaism.

Silber, Sherman J. “Judaism and Reproductive Technology.” Advances in Pediatrics., U.S. National Library of Medicine, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3071555/.