Author: Sindoos Areb Awel

 

In Vitro Fertilization (IVF) is an assisted reproductive technology (ART) that works by combining the egg and sperm outside the body. The process works by initially prescribing the potential mother fertility medication to stimulate egg production. It is essential to have multiple eggs since some eggs may not fertilize or develop after being retrieved. The eggs are retrieved through a surgical procedure where a ultrasound is used to guide a needle through the pelvic cavity to remove the eggs. Medication is given during this step to reduce any potential discomfort. Then, the male is to produce a sample of sperm to be combined with egg. The combination step is called insemination, the sperm and eggs are mixed together and stored in a Petri dish for the process of fertilization to occur. Eggs are then monitored to ensure that fertilization and cell division occurred. Once fertilization has happened, the eggs are now embryos and are ready to be transferred to the woman’s uterus. This transfer usually occurs three to five days after fertilization. After the transfer, implantation usually happens about six to ten days after the egg retrieval. This has been promoted as a fairly seamless process, but that might not be the case with low-efficiency rates. Although it addresses infertility issues among men and women, I believe that this is not a seamless solution that it is made out to be.

I would like to advocate for preventing the use of in vitro fertilization since it compromises the religious framework of reproduction. It is important to acknowledge that since there is a diverse population in the United States that practice many religions. In order to demonstrate the importance of natural reproduction, I will be discussing views on IVF from the Muslim medical community, and the Catholic community. Additionally, I will highlight why this technology should not be funded beyond religious justifications by using recent research that shows the inefficiency and lack of success of IVF.

To provide a Catholic perspective, I used the doctrinal material, Donum Vitae, which answers questions on reproduction, marriage, and biomedical procedures. Although the importance of fulfilling the desire to have a child is acknowledged, homologous IVF is considered morally illicit for a number of reasons (163). It states that IVF and embryo transfer itself must be judged and “cannot borrow its definite moral quality from the totality of conjugal life” (164). IVF and embryo transfer does involve the destruction of human beings since eggs and embryos may be destroyed during the process. Additionally, the trust of the process is placed in the hands of doctors and biologists, which is problematic since these healthcare professionals now have rule over the destiny of a human person. It is difficult to entrust other humans with control in such a natural process and places them in a superior position within society. Additionally, homologous artificial insemination is seen as morally illicit since it can not serve as a substitute for the conjugal act during the IVF process. Therefore the church opposes IVF from a moral standpoint since it is “in opposition to the dignity of procreation and of the conjugal union” (165). It is important to realize how these doctrines and perspectives will impact the mentality of many Americans that are Catholic. Nearly 31% of Americans are raised, according to the Catholic Church (National Geographic, 2015), which is a large amount of the population, and not to say all of them are in accordance with the Donum Vitae, but a good amount of practicing Catholics are. It is important to remember the demographics of the US population and what their sentiments will be towards policy change such as implementing IVF and having the government regulating it.

Upon looking at Muslim medical ethics and the study of Islamic Embryology, there is a mixed consensus as a whole on IVF, but there are cases in which any form of IVF is forbidden (68). Also since a majority of classical fuqaha would have opposed abortion, it only makes sense that IVF is seen as forbidden in those cases. When looking at the different stages of the embryo through an Islamic perspective, after the 120th day or when ensoulment occurs, which is after the stages nutfa, alaqa, and mudgha stages have passed is when abortion of the embryo would not be permissible. Additionally, abortion prior to ensoulment is also not allowed in some cases (68) so this would put Muslim couples with eggs that need to be disposed of or destroyed in a difficult situation. Additionally, if the embryos are not disposed of, they can be used for research, but the Islamic Organization for Medical Sciences (IOMS) decided at a conference in 1990, that using frozen embryos for research is “among the worst of three possible ways to deal with frozen embryos” (69). This could lead to possible issues later on with people undergoing IVF that may not to submit their embryos to research.  

Moreover, I believe it is important to examine the efficiency of IVF if it was to be funded by the government or other public institutions. For instance, there was a study published by PubMed that sampled over eight thousand women, ranging from 20 to 44 on their usage of IVF. Between 1993 and 2002, there was a 47% success rate, which means less than half of women that used IVF during this trial were unable to become pregnant. Additionally, it is important to note that each couple underwent an average of three cycles. I believe this success rate is too low to ensure funding. Perhaps if the success rate was over 50, that would allow for some certainty and trust. It is also essential to consider that natural human reproduction is also an inefficient process with every fourth or fifth egg-sperm interaction actually results in a live birth, so in vitro fertilization is considered to be even more inefficient. Additionally, the cost of IVF is important to consider since this is what the funding will go to. On average, IVF cycles cost about $12,000 prior to medications that cost an additional $3,000 to $5,000. For a procedure that is only successful less than half the time, the cost cannot be justified as efficient.

Upon inspecting the process of in vitro fertilization and look at the efficiency of this technology, I was able to conclude that funding for this procedure is not justifiable. Looking at the procedure from a moral perspective, it is also not sound since the destruction of other embryos is involved in almost every procedure. By using the works of Donum Vitae and Muslim medical ethics, I was able to use religious texts and doctrines as a grounds for demonstrating why individuals in the United States that align with those ideologies also might not support funding for in vitro fertilization through the government.

 

Stewart, Holman, Hart, Finn, Mai, and Preen. “How Effective Is in Vitro Fertilization, and How Can It Be Improved?” Fertility and Sterility 95.5 (2011): 1677-683. Web.

 

Jones, H.W. et al. “Reproductive Efficiency of Human Oocytes Fertilized in Vitro.” Facts, Views & Vision in ObGyn 2.3 (2010): 169–171. Print.

 

Brockopp, Jonathan E., and Thomas. Eich. Muslim Medical Ethics: from Theory to Practice. University of South Carolina Press, 2008.

 

Catholic Church. Congregatio Pro Doctrina Fidei. Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day. Washington, D.C.: Office of and Promotion Services, United States Catholic Conference, 1987. Print.

 

Sgarro, Victoria. “Who Are U.S. Catholics? Numbers Show a Surprising Shift” National Geographic, 17 Sep. 2015, https://news.nationalgeographic.com/2015/09/150917-data-points-how-catholic-population-has-shifted-in-the-united-states/. Accessed 30 June 2018.

 

“In vitro fertilization (IVF)” Medline Plus, 4 June. 2018 https://medlineplus.gov/ency/article/007279.htm

*Disclaimer*: This post does not reflect the views of the student.

Thank you for a great class & summer semester!

Upon reading the works of Michael Broyde and Swasti Bhattacharyya on paradigms of thought and rationalization on reproductive technologies, I was able to gain an understanding of how religious texts make for foundational bioethics. These texts help us navigate a religious perspective on these technologies. There were some key differences that I noticed between the works of Bhattacharyya and Broyde; for instance, there was fundamental differences in methods and texts used as referential material.

Bhattacharya uses the Mahabharata, which is one of the two major Sanskrit epics of ancient India and Broyde uses Jewish law, which is built upon the Torah. The Torah has narratives and so does the Mahabharata, but the Torah also contains commandments, statements of laws, statements of ethics, and other scripture that is essentially a universal doctrine for Jews. The Mahabharata does not hold that type of weight among the Hindu community and is not as universal. Additionally, Christianity and Judaism has had a role in foundational bioethics that Hinduism did not have simply because Christianity and Judaism also function as powerful institutions in Western society (Bhattacharya 28) . This is a fundamental difference between Hinduism and Judaism that influences the Western understanding of bioethics. Bhattacharya argues that until recently, North American ideologies on issues involving reproductive technologies such as infertility have been “primarily shaped by concepts and beliefs grounded in traditional Jewish and Christian perspectives” (Bhattacharya 12).

Beyond differences in power and influence, there are also differences in religious structure such as the idea of scholars and officials that have a certain amount of power and say within the Jewish community, while this sort of position does not exist in Hinduism. Broyde highlights this structure as a fundamental aspect of Jewish law. He notes that Jewish law recognizes the rabbinical authorities of every generation to have final declarations on what is permissible and what is not (Broyde 508), which is how decisions on reproductive technologies were/are made.

Another notable difference is how Broyde and Bhattacharya use the religious texts they focus on. Bhattacharya made it very clear that she is not claiming authority as a religious institution of Hinduism with her writing on reproductive technologies. She was simply aligning narratives from the Mahabharata with common themes of kinship and reproduction that is discussed in Jewish and Christian bioethics. Therefore she uses subjects such as infertility, paternal surrogacy, sperm donation from Jewish and Christian bioethics, but uses cosmology and stories of kinship to illustrate portrayals of those subjects in Hinduism. For instance, the story about the royal families, the Pandavas and Kauravas, demonstrated the difficulties of having sons when the women could not reproduce (Bhattacharya 46). By using examples such as those, I agree with Dr. Seeman that her role with this text is to be an “authoritative interpreter.” Additionally, when looking at the language Bhattacharya uses compared to the language Broyde uses, Broyde uses more authoritative language. Although Broyde acknowledges that Jewish law inspects new reproductive technologies on a case by case analysis, (Broyde 504) he states exact conclusions on specific technologies such as cloning. He presents both perspectives clearly on cloning: the moral conservatism perspective and one of Jewish obligation (Broyde 504). Broyde is able to do this since he can fall back on Jewish law and Jewish institutions that abide by these proclamations, which means a majority of Jews probably do as well.

Another distinct difference Bhattacharyya highlighted was views of religious and societal figures in themes of kinship and reproduction. For instance, in Judaism (and Christianity) God is viewed as a figure with ultimate control and power when it comes to procreation (Bhattacharya 70). The traditional uses of prayer are directed to God in religious narratives such as the story of Sarah and Abraham, when Sarah gave birth at age 90, which also reflects God’s ability grant Sarah the ability to give birth when she shouldn’t have been able to due to menopause. There is also a special relationship between God and women as God enables women and they usually take more initiative when it comes to praying for children. While in Hinduism, Bhattacharyya highlights that there is a coequal existence with God (Bhattacharyya 62).

I believe that most of differences when discussing religious perspectives on reproductive technologies is due to the specific methodology that I highlighted earlier, but I definitely believe that differences between Hinduism and Judaism contribute to these differences as well. Bhattacharyya acknowledges that there is no governing body within Hinduism that can make proclamations about bioethics and that defining Hindu ethic would be impossible (Bhattacharyya 16) and also problematic. However, she does believe that the characteristics of Hindu thought should be essential aspect of Hindu bioethics, which makes sense since these characteristics describe how all aspects of life including reproduction should be approached by most Hindus. While Jewish law distinguishes these ethics very specifically within reproductive technologies even to the point of labeling who would be the legal mother of a child in the case of cloning (the gestational mother) (Broyde 511).

When looking at contemporary bioethics and considering technologies that are controversial today like prenatal testing, I believe that Broyde would approach this by the law that when no other method is available, Jewish law allows for a certain reproductive technology (Broyde 533). By using this approach, I thought that prenatal testing might be viewed as supplementary and therefore prohibited, however, I realized I was mistaken upon doing some research. An article published by the National Institutes of Health (NIH) stated that genetic screening is permissible if used for treatment, cure, or prevention of disease (Rosner). As for Bhattacharyya, I believe that since she too would consider prenatal testing permissible, because, as discussed in class, she has rationalized secular bioethics well by using the Mahabharata.

By investigating these two works, I was able to begin to understand Hindu thought and Jewish law more in its applications with reproductive technologies. This was my initial exposure with both religious texts, but through reading these works I better understood how Jewish law was built upon Judaism as an institution which has more influence and power within Western society compared to Hinduism. Although there were some obvious differences between the two works and their approaches to reproductive technologies, being able to understand how influential Judaism (and Christianity) was in establishing Bhattacharyya’s understanding of HIndu bioethics demonstrated how deeply rooted religion is in fundamental aspects of bioethics.

 

Bhattacharyya, Swasti. Magical Progeny, Modern Technology a Hindu Bioethics of Assisted Reproductive Technology. Albany: State U of New York, 2006. Print.

 

Broyde, M. “Cloning People: A Jewish Law Analysis of the Issues.” Connecticut Law Review 30.2 (1998): 503-35. Web.

Rosner, F. “Judaism, Genetic Screening and Genetic Therapy.” The Mount Sinai Journal of Medicine, New York 65.5-6 (1998): 406-13. Print.

According to the verse 1:27, humankind is introduced as an image of God and in the next verse reproduction is addressed. It is stated in verse 1:28, “God blessed them, and God said to them, “Be fruitful and multiply, and fill the earth and subdue it; and have dominion over the fish of the sea and over the birds of the air and over every living thing that moves upon the earth,” this demonstrates that God in a way has instructed humankind to reproduce since they are unique in relation to other living things. The usage of the word “blessed” showcases that reproduction and perhaps having kin is a blessing from God and a gift. This gift of life may also be more of a blessing since the two verses (1:27 and 1:28) highlight that humankind differs from other living things since having sovereignty and control over other living things is stated. Continuing in the second chapter, the notion of reproduction becomes more detailed as the story of Adam and his rib being used to create Eve is stated here. “And the rib that the Lord God had taken from the man he made into a woman and brought her to the man,” through this linear notion of creation, human reproduction is acknowledged again. Verses 2:23 and 2:24 showcase the strength of kinship by using words lie “This at last is bone of my bones and flesh of my flesh” and introducing familial lineage by using father, mother, wife and saying that they all become one flesh. This shows that kinship is valued and there is a sense of importance placed on lineage and family relations.

When looking at the language and differences of interpretation used with these verses, however, differences in the Jewish and Christian uses of Genesis arise. For instance, in verse 1:28, Judaism views “Be fruitful and multiply” as a commandment. We discussed in class how not reproducing would in sense be a sin since it essentially going against a commandment of God. This simple understanding of the interpretation has shifted and heavily influenced how human reproduction, kinship, and fertility are valued in Jewish communities as a whole. This approach to human reproduction has shaped how the Jewish community is more favorable towards alternative reproductive technologies such as artificial insemination and in vitro fertilization (Seeman 346). Additionally, just looking at the fact that Israel has the highest Jewish population and is also leading in IVF technologies by supplying the highest amount of IVF clinics just demonstrates how that biblical ideology has manifested into modern practice. However, the idea of kinship and marriage has deviated from traditional interpretation despite the concept of reproducing still remaining central. In Susan Kahn’s work Reproducing Jews: A Cultural Account of Assisted Conception in Israel, the stories of the women showcases that varying idea of kinship. These women are all single and would like to have kids enforcing the fact there is no need for marriage especially with the existing technologies in order to have a child. In fact, the idea of having a child seems to be embedded in what is expected in marriage as one woman tells the story of how she found out her husband was infertile and divorced him a few years later (Kahn 11). Although it doesn’t explicitly say that was her motivation for divorcing him, it is implied and this showcases that was a large factor in her decision.

As for the Christian usage of Genesis specifically within the first two chapters, the same verse (1:28) is interpreted as a sense of encouragement but not a mandate. Human reproduction and a child is seen as a gift and blessing, but not a mandatory practice. Since the language “gift” and “blessing” is used (157), that in a sense hints at selectivity since a gift is not meant for everyone and something is no longer a blessing if it is granted to everyone. In class, we discussed how purity and celibacy are valued more, especially in the Catholic church. Additionally, the Catholic church is not as supportive of alternative measures for reproduction as Judaism is, which is apparent in the Donum Vitae. There is a sense of apprehension over the use of science and technology when interfering with human reproduction as stated, “science and technology are valuable resources for man…but they cannot themselves show the meaning of existence and human progress.” When it comes to specific artificial reproduction technologies, the Catholic church prohibits all practices except for homologous in vitro fertilization since other practices such as heterologous IVF is seen as “contrary to the unity of marriage, the dignity of spouses & vocation proper to parents.” It appears that there is an emphasis placed on familial ties and ensuring that the child has a family, which I interpreted an emphasis placed on kinship in general. The Donum Vitae also adds that artificial reproduction cannot interfere with the natural process of reproduction and is not meant to be used by single women where they need sperm or egg from an external individual (159).

By looking at the Donum Vitae, the Book of Genesis and from class discussion, I was able to draw conclusions that within the Jewish community there is an emphasis placed on human reproduction and having a child over the unity of marriage and having a traditional family, while the Catholic Church placed an emphasis on maintaining the moral integrity of the child and ensuring that the child is not hurt and has filial relationships with parental origins. Although I understand there are a lot more complexities and nuances to artificial fertilization and how both the Church and Judaism have differing perspectives, I decided to focus on continuing interpretations of the first two chapters of Genesis to align with discussions we had in class on Tuesday.

 

Catholic Church. Congregatio Pro Doctrina Fidei. Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day. Washington, D.C.: Office of and Promotion Services, United States Catholic Conference, 1987. Print.

 

Kahn, Susan Martha. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Durham [N.C.]: Duke UP, 2000. Print. Body, Commodity, Text.

 

Seeman, Don. “Ethnography, Exegesis, and Jewish Ethical Reflection.” Ethnography, Exegesis, and Jewish Ethical Reflection: The New Reproductive Technologies in Israel. 2010. Kin, Gene, Community (2010) 340-362. Print.