17 - 23 May 2001
Issue No.534
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Al-Ahram Weekly On-line 17 - 23 May 2001 Issue No.534 |
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As fertility technology advances in leaps and bounds, society lags behind in grappling with issues of morality and ethics. Fatemah Farag delves into the world of assisted reproduction
Legislating morality
Who is a parent? Now wait, this was never an easy question, and it has been complicated even further by modern developments in the field of fertilisation. Today, if you cannot procreate naturally, science can help.At first, this sounded like a great thing, but that was before all the tangle of ethical and moral questions turned up. How does society feel about gay couples, or, say, women over 60 having children? The way science has advanced, in some cases becoming a parent is more a function of how much money you can spend and how persistent you are than what nature provided. In short, to attain the status of parenthood, you are no longer at the mercy of sexual preference or forces as unreliable as luck or fate.
Conventional biological and conceptual categories reel under the weight of options created by modern science. In the West, a woman who bears a child that is the product of an egg donated by someone else is encouraged to think that carrying the foetus is the crucial component of motherhood. Meanwhile, a woman who hires a surrogate to carry her fertilised egg is encouraged to believe the opposite.
The recent debate in Egypt over gestational surrogates is a case in point of the growing grey area surrounding fertilisation and questions of motherhood. The uproar began with Dr Ismail Barada, a renowned gynaecologist who was practising in the United States for some 30 years before returning to Egypt two years ago. Barada was confronted with a patient who did not have a uterus and wanted to have a child. "The only way such a woman can have a baby is by using a surrogate, which is what I suggested. However, she alerted me to the fact that this might be religiously complicated," recounts Barada. Abdel-Mo'ti Bayoumi, head of the Faculty of the Fundamentals of Religion at Cairo University, was approached for his opinion and approved the procedure -- but many people in society strongly disagreed.
Before we take this any further, let us define what "gestational surrogacy" is. According to the definition given in a paper delivered by Barada to the Doctors' Syndicate, a child of a surrogate pregnancy is identified as the product of "an egg from the genetic mother and a sperm from the genetic father, which was fertilised in vitro and transferred to the uterus of another (surrogate) woman when the cell began to divide." The surrogate is hormonally prepared to receive the fertilised egg ahead of the procedure and, if all goes well, carries the baby to term. The newborn is then handed over to its genetic "parents".
Al-Azhar's Islamic Academy issued a fatwa (religious ruling) prohibiting surrogate pregnancies on the grounds that they go against Islam. The issue has sparked furious debate and to get a taste of the kind of furore that has been raised, bear with me the following excerpt from an article in a prominent daily paper: "Even if a husband gave written consent that his wife could act as a surrogate, there is a religious problem that would prohibit this. Islam prohibits the semen of one man to touch a foetus that is a product of another man's semen. Will we issue a law prohibiting husbands from exercising their legal right [to sexual relations] with their wives when they are pregnant with another man's baby? And were such a law passed, will we put these husbands under 24-hour surveillance to make sure they do not have sexual contact with their wives -- which is their right, in accordance with their marriage contracts? Or shall we create a special prison for such men, who rent out the wombs of their wives?"
With the level of discourse being what it is, it comes as no surprise that many have found the debate offensive. "I think the debate is insulting," says Dr Ragaa Mansour, of the Egyptian IVF Centre. "Infertility, especially in this society, is a very sensitive and private subject, and the things being said and the terms used, like 'renting wombs', are really terrible." Mansour, however, doesn't approve of gestational surrogacy. "Personally, I would not want to become involved in this kind of procedure. When I help a couple, it is a very personal and emotional issue. I cannot see bringing in a third party."
Barada counters this argument by suggesting that it is not up to doctors to make such decisions for their patients. "Doctors should make judgements regarding medical procedures, not the moral implications of these procedures," he explained. Naturally, everyone has his own opinion, and Barada is not without his own value-judgements. "Of course, we live in a society governed by religious values, and in accordance with these values, I would not perform an egg donation, for example, because this is a clear case of khalt el-ansab [miscegenation]."
The donation of eggs for vitro fertilisation is a complex procedure. The eggs are not easily frozen, so the donor must take hormones to synchronise her reproductive cycle with that of the recipient. Once this is achieved, the donor's ovaries are "over-stimulated" and the extra eggs are "harvested" for implantation in another woman. The procedure is fraught with ideological complications. Egg donation makes it possible for a woman to procreate without ever giving birth or raising children, so the original question of "who is a parent" again becomes difficult. In Egypt, the concept is summarily unacceptable, because the egg of the donor will be fertilised by the sperm of a man who is not her husband. This means that because of the DNA makeup of the child, the donor will have had a child by another man and the recipient's child will not have its "mother's" genes.
The issue is clear in the case of egg donation, but does surrogacy affect the DNA make-up of the foetus? The question has been central to whether or not surrogacy is acceptable on religious grounds. According to Barada the answer is an emphatic "No." "I can't understand why there are so many people who think that genes can be changed so easily. Once an egg is fertilised, its DNA makeup cannot be changed," insists Barada. Once again his paper offers a concise explanation: "Each individual human has 46 single chromosomes in all of the cells of their body, and these are arranged in identical pairs, numbered one through 22. The 23rd pair are not identical, and are termed the 'sex chromosomes', because they determine whether an individual will be a boy or a girl." When fertilisation happens, 23 chromosomes from the egg and 23 from the sperm "fit together like a cogwheel" (the zygote) and are sealed with a chemical barrier. If anything happens to alter this makeup, it results in disease, explains Barada. "If the surrogate's blood 'alters' the DNA [of the child], what is going to happen? The nose will change? Will she give birth to another species altogether?" demands Barada, exasperated.
Mansour agrees that fertilisation seals the DNA make-up of the child, but she is still apprehensive. "When you test the blood of a mother during pregnancy, her blood carries the DNA traits of the child. It is a very intimate relationship -- imagine eight cells implanted in a mature human being. Who can say?"
For his part, Mohamed Abul-Ghar, professor of gynaecology and obstetrics at Cairo University and a fertility expert, dismisses the whole debate as much ado about nothing. "Cases requiring surrogacy account for a very small number of those who require assisted fertilisation. So I hardly think the issue is worth all the effort being put into this debate."
Barada counters, however, that "if someone is ill, they don't care if there are many people out there who have the same illness -- they just want to be cured. Surrogacy gives one per cent of infertile women the chance to have a child. It is devastating for these women not to have the opportunity to have their own children, and if you could not have a child except through surrogacy, it would take you five seconds to decide whether it was ethical."
All this heated debate about the quest for parenthood, no matter how tenuous the biological relationship, leaves open the questions about the children that might be born of these procedures. "There are many recorded cases of men who have children at the age of 80 and no one says anything," says Barada. "I know of the children of parents who are in their prime but become orphans because their parents are killed in an accident. My father had me late in life, and he died when I was 20. It pained me very much to lose him; he was the best father anyone could want. I do not think you can legislate morality."
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