An American radiologist surprised that Iranians have access to the same type of medical technologies. An American undergraduate student who sheepishly admits he never knew that Iran had cities until he saw Tehran during a film in class. Such stereotypes about Iran are all too common. The reality, however, is quite different, with Iran scoring advanced developments in science and technology ranging from the hotly debated issue of nuclear power to the lesser-known development of assisted reproductive technology (ART).
Iran, though not alone among Muslim-majority countries with active fertility clinics, is unusual in its acceptance of third-party reproductive techniques, including the use of donor eggs and embryos, as well as surrogacy. This may be all the more surprising since the Islamic Republic’s laws have been brought in line with Islamic law, and the legal use of such new technologies must be approved by the nation’s Supreme Leader, Ayatollah Khamenei — a religious scholar. So while other, predominantly Sunni, countries permit ART between a husband and wife but forbid the use of a third-party, permissive fatwas for the use of egg and embryo donors, and surrogacy, have been granted by some of the Iranian Shi`i scholars, and these practices have been given civil-legal approval (or tacit approval through silence).
Infertility affects Iranians at the same, or perhaps higher, rates than it does the rest of the world. Whether a case of infertility stems from complications arising from other medical conditions, environmental factors, the increasingly delayed average age for marriage, or other factors, Iranians struggle with the psychological pressures, and familial and social expectations that are inherent in this issue. The religious jurists aim to alleviate the suffering of their followers by granting such fatwas. The clinicians, also eager to ease the troubles of their patients, provide the procedures. However, the larger ethical debate about the costs and benefits of third-party involvement in ARTs has been mostly ignored. The jurists’ fatwas typically lack discussion or presentation of any moral foundation, and instead illustrate the scholar’s concerns for typical juristic matters such as from whom the child will inherit or around whom they must maintain more stringent modesty in dress and comportment. The clinicians, using the fatwas, then engage in ethical deliberations, though they are largely limited to the procedural concerns of the clinic — such as determining limits on the number of eggs a single woman may donate, or whether to allow anonymous or known donation.
Other aspects of third-party ARTs that might normally be considered in Western bioethical discourses have so far fallen outside the purview of either the jurists or the clinicians. Although effort has been made to help prospective parents overcome their infertility while simultaneously granting the child a sound lineage (an important religious and social matter in Islam), other considerations for the child are largely overlooked. Even as some jurists argue that such lineages in the case of third-party donation are religiously permissible, we have to wonder if this will be sufficient to protect the child’s rights from scrutiny and infringement throughout her life, or will she be subject to bias? Can children receive genetic health information about their donor parents? Will gametes and embryos become mere commodities? What is the fate of surplus embryos generated as part of a couple’s treatment? What about issues of coercion? Many jurists permit the individual to sell eggs and embryos, and to charge for serving as a surrogate. Research shows most donors and surrogates receive financial compensation, but there is no organized bioethical discussion of the potential coercion of women into what can be difficult, painful, and dangerous processes.
Discussion of ART in Iran calls for a deeper exploration of bioethical considerations and perspectives than has been provided thus far in the jurists’ discrete rulings on the mere permissibility of an act, or in the clinicians’ engagement with specific cases. However, it would be wrong for Western bioethical principles, cases, or concerns to be adopted outright without regard to the religious and social concerns and traditions of Iranian Muslims. Instead there is a need for a more profound engagement with Islamic theology. How can the tradition be plumbed for guidance on broad notions of love, marriage, family, and reproduction? Articulating these motivations can inform a more nuanced process of ethical reflection for all of those involved in the decision-making process.
A project like Contending Modernities provides additional resources and incentives to consider from a comparative perspective. The Catholic tradition has taken quite a different tack in responding to ART, with a much more restrictive stance on the use of these technologies. How might Catholic moral reflection on ART inform Muslim thinking on the matter—not just in Iran in the case of third-party involvement, but among Muslims worldwide, since all contemporary scholars of both major schools of thought (Sunni and Shi`i) accept the use of ARTs between husband and wife?