Ethics and Reproductive Technology

A Book Review of Ethics of Assisted Reproductive Medicine: A Comparative Study of Western Secular and Islamic Bioethics by Dr. Sharmin Islam

In the summer of 2019, I had the privilege to spend a few weeks attending the International Institute of Islamic Thought (IIIT) summer program. There, I chose gene-editing as my topic of interest and in an effort to find relevant English-language works was directed to the institute’s publications on bioethics. 

Boston University Professor George J. Annas concisely noted in 1984 that

dependable birth control made sex without reproduction possible…now medicine is closing the circle…by offering methods of reproduction without sex.[1]

Sexual ethics deals with the former, but Ethics of Assisted Reproductive Medicine by Eastern University (Bangladesh) Associate Professor Dr. Sharmin Islam addresses the latter: to what extent are these technologies permissible to use, who can use them, and how do different philosophers, bioethicists, medical experts, public health officials, lawmakers, and ulema’ (Muslim jurists) approach related ethical issues that arise from such usage? 

Dr. Islam’s book tackles these questions in a comparative manner: first by defining western secular bioethics and Islamic bioethics, and then comparing the conclusions on the morality and permissibility of four methods of assisted reproductive technology (ART).

Bioethics

Many, if not most, of these technologies are being developed in the West. It follows that the proposed policies and regulations arise from evolving traditions of thought dominant in the West. As bioethics as a discipline began to flourish in the 1970s, Dr. Islam argues that theology played a prominent role, which she attributes both to the leading roles Christian and Jewish theologians played and the “dominance of theological language and methods.”[2] But now, she says, that’s no longer the case.

The question of what has played the greatest role in formulating a secular bioethics is a controversial one. What is nevertheless undeniable is that Western bioethics has now become secular. What then precisely is secular bioethics?…Bioethics in this fragmented order became a branch of practical ethics, which holds the view that man is capable of self-fulfillment without recourse to any source of knowledge, other than empirical finds, in other words, without recourse to the guidance of the transcendental or supernatural Supreme Being.[3]

In this paragraph, Dr. Islam points to the question of why there is need for an inquiry informed by Islam: belief in Allah and submission to Allah sets forth a moral imperative to actualize His guidance in all aspects of life. This is not to position western secular ethics and Islamic bioethics at fundamental odds. Ulema’ reason and exercise their intellectual faculties to handle complex contextual issues in line with the principles of the Qur’an and Sunnah.

Islamic ethics views standards of value as absolute, objective and eternal, and in fact emanating from the Divine.[4] 

But to claim full incommensurability, she briefly argues, is too “one-sided”[5] and that

there are commonalities and differences, but the two perspectives should not be separated on flimsy grounds. They should come close to each other to explore the possibilities of both and to understand them better.[6]

For example, the spirit of principles like autonomy, justice, beneficence, and nonmaleficence provides ample common ground. 

She references a few bioethicists and contemporary ulema’, and in some instances ikhtilaf (differences of opinion) among them. She also assumes a readership that is unfamiliar with philosophy. Two chapters outline the historical development of the field, traditional theories like deontological and teleological ethics, and more contemporary approaches such as communitarian ethics. The third chapter addresses general moral principles and summarizes components of Islamic jurisprudence, and the fourth is on the relevance of these discussions. Each topic demands volumes and in-depth inquiry of its own, but she introduces enough for the reader to grasp the arguments referenced in later chapters. Specialist readers will also benefit from the viewpoints offered. Because of the breadth and depth of knowledge that a proper understanding of Islamic jurisprudence requires, I will limit the reflection on these chapters.

Most of the latter half of the book addresses ART’s application infertility treatment, as for couples to seek out medical intervention in such cases falls under hifz al-nasb (preservation of posterity), one of the maqasid al-shariah (higher objectives of Islamic law). “As Islam encourages reproduction, it advocates the treatment of infertility”[7], and generally this is not exclusive to Islamic law. But while acting on those objectives, she warns Muslim physicians to be wary of judging the morality of an issue based on others’ ethical premises, redirecting them to a set of ethics informed by Islam around ART.

The ARTs she addresses range from the not-yet possible to controversial: artificial insemination, in vitro fertilization (IVF), surrogacy, and human cloning. 

Artificial Insemination

There is a pivotal distinction between Artificial Insemination Donor (AID) and Artificial Insemination Homologous (AIH). AID, or heterologous insemination, makes use of donor sperm from a third party, whereas AIH refers to artificial insemination by use of the woman’s partner. The distinction is crucial as bioethicists of all backgrounds have to consider the questions unique to using sperm from a third-party, such as anonymous donors, disclosure laws, lineage, etc. Dr. Islam notes that within an Islamic context, it is permissible only within an Islamically valid marriage.[8] So this excludes third-parties (AID) and posthumous sperm retrieval, which remain an area of concern for bioethicists.

In Vitro Fertilization

Artificial insemination extracts sperm to directly deposit into the uterus, but in vitro fertilization (IVF) extracts both male and female gametes for manual fertilization in vitro. The embryo is then transferred to the uterus.

IVF is largely accepted by both contemporary ethicists and ulema’ [9], but as in the case with artificial insemination, Dr. Islam cites the Organization of the Islamic Conference (OIC)’s stipulation that it is limited to within an Islamically valid marriage. 

A consequence unique to IVF is leftover embryos, due to the multiple eggs retrieved from the ovary and fertilized to maximize success. Is it ethical to use them for human embryo stem cell research? Is it okay to “dispose” of them? In the United States, nearly one million embryos sit in frozen limbo, and many parents remain at a loss of what to do with them.[10] She takes the opinion that while the best case scenario is to limit the amount of leftover embryos, with some stipulations, it is a permissible source of research cells.[11]

Surrogacy

There are two forms of surrogacy: traditional surrogacy, where the surrogate is the biological mother and her egg is artificially inseminated with sperm and carries the baby to term for someone else. Gestational surrogacy, which uses eggs of the intended mother, so the surrogate is not the biological mother.

Where IVF and artificial insemination are controversial in certain circumstances, surrogacy evokes an even larger debate over the commodification of wombs, outsourcing pregnancy, and the potential for abuse and exploitation, but Dr. Islam argues that Islamic bioethics is straightforward in its approach and it is impermissible all together on the basis of it failing to protect lineage [12], among other reasons. 

Human Cloning

Of the technologies discussed in the book, the idea of human cloning was the most evocative of creative science fiction shows and seemingly improbable in our lifetimes. However, the famous case of Dolly the Sheep demonstrates human cloning to be a possible reality. Dolly was the product of genetic material from a mammary cell in a sheep inserted into an unfertilized egg cell of another sheep, and then implanted into a third sheep, its surrogate mother. Though human cloning is not yet possible (and banned in many countries), Dr. Islam mentions both Islamic bioethics and western secular bioethics as largely critical of the notion.[13] The idea brings to light questions around souls (is the cloned human the same person as the original? Or a sort of twin?) and genetic/kinship ties. 

Conclusion

Dr. Islam does not cover every permutation and situation possible, and as perspectives on family and marriage continue to change, bioethics can only run to address them. Works like hers, even if or when one disagrees with her conclusions, provide a useful methodology to examine where western secular bioethics and Islamic bioethics can agree and diverge on the use of ART. As these technologies become more accessible, Muslims must continue to seek decisions regarding them. 

Even this brief explanation of ART illustrates that it is not enough to maintain only personal rights at the center of the discussion: long-standing impact on health, families, and communities must be evaluated. Physical and mental health concerns, especially for the women and children directly impacted, cannot be ignored. From the individual to a policy level, the methods employed to arrive at ethical judgments require deliberation. Many of these issues may seem remote or too niche, but that is precisely why other perspectives should not be relegated to the periphery. Allah has given us freedom, but it is not unconditional nor an end in and of itself; our freedom is liberation from whims and a means to obey His will alone. Raising righteous children is praiseworthy, and it follows that so is undertaking the start of the task that is parenthood in a proper manner. 

Amazon link to the book here. This is not a sponsored post.

Works Cited:

  1. Annas, George J. “Law and the Life Sciences: Redefining Parenthood and Protecting Embryos: Why We Need New Laws.” The Hastings Center Report, vol. 14, no. 5, 1984, pp. 50–52. JSTOR, http://www.jstor.org/stable/3561100. Accessed 6 Mar. 2020.
  2. Islam, Sharmin. Ethics of Assisted Reproductive Medicine: a Comparative Study of Western Secular and Islamic Bioethics. The International Institute of Islamic Thought, 2013. pg 29
  3. Ibid., pg 31-32
  4. Ibid., pg 64
  5. Ibid., pg 199
  6. Ibid., pg 194
  7. Islam, Sharmin et al. “Ethics of surrogacy: a comparative study of Western secular and Islamic bioethics.” The Journal of IMA vol. 44,1 44-1-5920. 13 Apr. 2013, doi:10.5915/44-1-5920
  8. Meah, Jamir “In Vitro Fertilization” SeekersGuidance, 20 Dec. 2018, https://seekersguidance.org/answers/halal-and-haram/in-vitro-fertilization/
  9. Ibid., pg 102
  10. Fraga, Juli. “After IVF, Some Struggle With What To Do With Leftover Embryos.” NPR, 20 Aug. 2016, www.npr.org/sections/health-shots/2016/08/20/489232868/after-ivf-some-struggle-with-what-to-do-with-leftover-embryos
  11. Ibid., pg 125
  12. Ibid., pg 144
  13. Ibid., pg 177

Photo Credit: https://betenmoire.tumblr.com/post/178946304974/fesq-s3006-instagram-fesqproject


About the author: Heraa Hashmi is best known for her research project, Muslims Condemn. She is a graduate in Molecular, Cellular, and Developmental Biology and has also studied linguistics. Her interests include the Islamic sciences, cognitive linguistics, and bioethics. You can follow her on Twitter here.

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