A review of Beyond Clerics and Clinics: Islamic Bioethics and Assisted Reproductive Technology in Iran, by Robert M. Tappan.
Too often scholars’ conceptions of what constitutes the properly “Islamic” are reduced to the opinions of Muslim jurists. While disagreements in Islamic rulings are often highlighted as a way of complicating views of Islam as a monolith, the exclusive reliance on legal rulings can lead scholars to ignore important philosophical, theological, and ethical formulations on the one hand, and everyday practical and moral considerations on the other. This is particularly the case in studies of Islamic bioethics as they rely too heavily on religious rulings on the permissibility of utilizing certain biotechnologies or biomedical procedures such as organ transplantation, in vitro fertilization, sex reassignment, stem cell research and cloning – without examining the fundamental theological underpinnings of Islamic opinions, or equally important, the complex social contexts through which contemporary biomedical predicaments arise in Muslim societies. Robert Tappan’s dissertation is a welcome addition to a promising current in Islamic studies that tackles this problem.
Throughout his dissertation Tappan urges a comprehensive approach to Islamic bioethics that, as his title suggests, ventures beyond the discordant rulings of clerics, as well as what happens inside clinics in Islamic countries, without dismissing their respective significance. Tappan’s approach is at once a critique of a Western approach to studying Islamic bioethics and an internal critique of those practitioners and religious scholars partaking in its formulation. Tappan focuses his investigation on Assisted Reproductive Technologies (ART) in Iran, where fatwas guide civil laws pertaining to infertility treatment, as well as decisions made by doctors in clinics, without those fatwas necessarily being determinative of clinical practice. Tappan identifies the shortcomings in the clinicians’ efforts to construct a comprehensive and consistent ethics of practice and calls for renewed attention to the long term social consequences of certain infertility treatments along with a more in-depth approach in the construction of Islamic bioethics through engagement with Islamic theology.
In the first chapter, Tappan describes the social milieu within which problems of infertility treatment arise in Iran, relying largely on findings made by social scientists such as Marcia Inhorn and Haleh Afshar. Tappan clearly outlines that his research method is not ethnographic and is rather primarily textual, engaging with the Persian text of fatwas issued by various Shia jurists as well as articles published by Iranian clinicians staking claims to Islamic bioethics. However, he does occasionally rely on insight he gathered through conversations with individuals involved with infertility issues. Furthermore, Tappan spent nine months in Qom, the heart of Shia jurisprudence, where he studied Islamic law in an effort to better comprehend the jurists’ rulings, in addition to observing laboratory procedures and interviewing clinicians at the Avicenna and Royan research institutes, both located in Tehran. In this first chapter Tappan presents his primary concern that both Western scholars and those in the Iranian system rely exclusively on either fatwas or the Western ‘four principles’ approach as the only expressions of bioethics, an argument he embellishes throughout subsequent chapters by pointing out their relative shortcomings.
In chapter two, Tappan discusses the concept of bioethics generally and Islamic bioethics specifically. He presents an overview of efforts made by Muslim clinicians and bioethicists to make Islamic bioethics fit the Western mold by transposing Childress and Beauchamp’s famous four principles approach (of autonomy, beneficence, non-maleficence, and justice) onto Islamic teachings. After all, the four principles have travelled to the curricula of many universities in the Middle East, including Iran, where coupled with fatwas these two sources have become the mainstay of bioethical discussions. Tappan identifies the pitfalls of relying on the four principles approach as well as Islamic rulings, and suggests that scholars construct a set of principles derived from Islamic theology instead. Tappan presents the work of Abdulaziz Sachedina as an important approach to Islamic bioethics, which, he argues, aims to overcome the deficiencies of its contemporary formulations through in-depth engagement with the ethical underpinnings of Islamic injunctions, as opposed to the literal content of legal rulings. For example, Sachedina argues that preventing harm should precede efforts to do good in addressing bioethical problems, which in the case of ART means that preventing harm to the offspring of some infertility treatments should outweigh efforts to benefit infertile couples. According to Tappan, Sachedina also presents shura – consultation – as a key element of Islamic bioethics in place of the Western-philosophy rooted notion of “autonomy” and, further, encourages ethical towsiyah – advice – to replace legally binding fatwas, which would ostensibly allow for disagreement and debate.
In chapter three, Tappan presents juristic views on ART between married couples. He provides a critical discussion of fatwas by Ayatollah Khui and Ayatollah Khomeini who ruled at the advent of ART technology, as well as more recent fatwas by Ayatollah Montazeri, Ayatollah Jannati, Ayatollah Makarim Shirazi, and the long-standing Supreme Leader of Iran, Ayatollah Khamenei, who, as Tappan shows, offers some of the most permissive fatwas on biomedical issues. The fatwas together touch on various issues such as the status of a gamete used from a deceased father and the resulting child’s right to inheritance, permissibility of methods of gamete procurement, and the usability of surplus embryos for stem-cell research.
Tappan dedicates the fourth chapter of his dissertation to juristic views on the universally controversial infertility treatments involving third party donations. He begins by presenting pre-Islamic and Islamic historical precedents for the contemporary rulings on third party donation, following with a comparative discussion of legal rulings by Ayatollah Sanei and Ayatollah Bahjat, among others, on the permissibility of egg, embryo, and semen donation, in addition to surrogacy. The chapter ends with Tappan raising Sachedina’s disagreement with permissive fatwas, primarily out of a concern with the stigma faced by children born of third party donors.
In the fifth chapter we see the result of Tappan’s research within the clinical setting at the Avicenna and Royan research institutes. Tappan observes that though fatwas guide clinical practice, the plurality of juridical viewpoints allows for a variety of practices that also depend on the personal commitment of medical doctors to following a particular jurist’s rulings. He finds that in the absence of a proper communication of moral reasons underlying the often terse legal rulings, clinicians are impelled to make independent bioethical decisions when the circumstances do not map onto those assumed by the jurists. Furthermore, Tappan observes that long-term consequences of clinical practices too often fall outside the purview of clinicians, permitting decisions that accomplish the immediate satisfaction of their infertile patients but may have grave consequences for the patients’ children. This chapter likewise concludes with a discussion of Sachedina’s critique of the opinion of Shi‘i jurists on ART issues, namely the time of ensoulment of the fetus, the sale of gametes, and the commodification of surrogacy.
In the concluding chapter, Tappan makes a call for Muslim clinicians, bioethicists and religious scholars to collaboratively identify bioethical problems and to construct comprehensive responses that conform to the fundamental ethical principles of Islam but are also communicable to a global audience. Tappan’s final contribution is to offer a prescription of his own on coping with problems of infertility, which involves focusing attention on preventive measures for infertility on the one hand, and promoting cultural acceptance of infertility as well as adoption on the other.
Overall, this dissertation is necessary reading for scholars interested in a clear presentation of viewpoints of some of the most important Shi‘i jurists on a variety of issues pertaining to ART, as well as those who are faced with the question: “What, really, is Islamic bioethics?” It is hoped that studies such as Tappan’s will increase interest in the nascent field of Islamic bioethics and further encourage an approach that takes stock of both the legal expertise of jurists and the everyday experiences of clinicians without sacrificing attention to either the long-term social impact of biomedical and technological procedures or the foundational ethical precepts of Islam.
Department of Anthropology
University of California, Irvine
Abdulaziz Sachedina’s work on bioethics
Fatwas by Shi‘i jurists
Bioethical articles by Muslim medical doctors
Ethnographies of Iran and other Muslim nations
University of Virginia. 2011. 289 pp. Primary Advisor: Abdulaziz Sachedina.
Image: Ayatollah Khamenei visiting Royan Institute for Reproductive Biomedicine. Original Image in Public Domain. Shown here reposted at Pacific Standard.