Bioethics & Organ Transplantation in a Muslim Society: A Study in Culture, Ethnography, and Religion

Farhat Moazam was born in Pakistan and attended medical school there. For many years, she pursued her surgical and pediatric training in the United States, witnessing not only scientific progress in organ transplantation but also the rise of modern secular bioethics, the advocacy of individual rights and patient autonomy, and feminism(p. 175). Equipped with such privileged knowledge, she obtained high-ranking positions back in Pakistan, reflecting her competence as both a medical doctor and a medical ethics specialist.

While working on this dissertation (she received her doctorate in religious studies from the University of Virginia in 2004), however, she employed a third and quite unexpected quality: that of an ethnographer. But Moazamhas no ambition to contribute to the broader theoretical discussion of Marcel Mauss’ The Gift (W.W. Norton & Co., 2000). Rather, she brushes aside the applicability of reasoning in the tradition of the reception of Mauss (cf. pp.126, 138, 143, and 218). Similarly, she is not concerned with theoretical ethnological or sociological debates on globalization and its local appropriations, although, ultimately, this is what the story is about.

To conduct her fieldwork, she chose to spend three months at a dialysis and renal transplantation unit in her hometown of Karachi. This vanguard institution for end-stage-renal-disease (ESRD) patients, part of her old medical college, is now both the largest and the first institution of its type in Pakistan. In addition, the country’s first renal transplant was performed there in 1985. Financed to a lesser degree by the state, about 60 percent of the institute’s budget has to be raised by sponsors (p. 46). Such services as dialysis, transplantation, medication, and follow-up are free of charge (p. 37), so there is a tremendous overflow of people in need.

The institute, having started its pioneering work in a traditional society that is still strongly averse to posthumous donation, has to rely on live kidney donations from blood relatives. By participant observation, especially in the pre-transplant clinic and in over 100 face-to-face interviews carried out mostly in Urdu, the author explores the institute’s moral microcosm. The medical staff received western medical training and adheres to the principles of modern biomedical ethics as formulated by American philosophers in the 1960s and 1970s (pp. 2-3 and 222). She traces possible conflicts with certain concepts of Islamic ethics and local perceptions of right and wrong.

However, readers interested in normative Islam, as enshrined in Urdu language publications by Pakistani religio-legal scholars, will be frustrated and should turn to other sources (cf. pp. 4-7 and 31-36). Instead, the “thick descriptions” offered in the book deal with subjective moral dilemmas that are either generated or reinforced by the application of modern medical advancements. In fact, Moazam does not adhere to a specific anthropological school, but feels free to anarchically combine selected reading from different disciplines in order to shape her train of thought. In the clinic she was not a neutral observer, but rather a cherished (medical) colleague with unrestricted access.

Farhat Moazam, Bloomington: Indiana University Press, 2006. 264 pages

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