 To introduce the moderator for the next panel, the moderator is Dr. Asim Pidella, who is the director both of the program of medicine and religion and also the Divinity Schools Initiative on Islam and Medicine here at the university. Dr. Pidella is an associate professor of medicine in the section of emergency medicine and a faculty member at the McLean Center. Dr. Pidella's work as a clinical researcher and a bioethicist has focused on improving healthcare outcomes and experiences in the American Muslim community. He's developed methods for designing community-based healthcare interventions and hospital policy accommodations. Additionally, Dr. Pidella has collaborated with Islamic study scholars and with institutes worldwide to analyze how moral reasoning and scientific data concerning modern biomedicine interact with traditional Islamic frameworks. Today, Dr. Pidella will be the panel's moderator and he will be, we're changing the order a little bit. He will be the first speaker on the panel and the topic that he will talk about is Muslim conception of motherhood, gestational surrogacy and uterine transplantation at issue. Please join me in giving a warm welcome. Dr. Asim Pidella. Thank you so much, Mark, for that kind of reduction. It's really an honor every year to be here amongst the faculty, amongst what I think is a community of scholars who you have to respond. So again, thank you, Mark, for giving us this opportunity. So as you heard of my title, I'm going to talk about this, but to set that up, I wanna talk a little bit about what I've been doing for many years, right? And in this conversation of how religion is part or not part of bioethics discourse. And so this has been a perennial conversation. You all know about this. I've presented it many times around this. This is just one special issue. I have a journal that myself and others in the audience actually are on the editorial board for. And so we talk about these issues of how religion belongs or doesn't belong. And most recently, there was an editorial about whether or not we should publish religiously derived opinion pieces on ethical issues. This is from the Developing World of Bioethics Journal because the question was whether this is part or parcel of public reason-based dialogue or not. Obviously, as any scholar, my mentee and postdoc was also part of this presentation. Rosie and I wrote this article and rebuttal to that thinking about, well, why not? I set that up because I'm gonna share with you a model of thinking about why I'm gonna talk about from the lens of Muslim patient ideas as well as from Islamist scholars thinking about motherhood. When me as ethicist think about morally assessing biotechnology, we do these things more or less. We think about the implications and ramifications of the technology, largely the harms and benefits to individuals and societies in many different ways. We think about the biomedical science involved. Often we think about the origin of that, the implications of that are outside, but what's the origin? So for example, a classic example would be about data on hypothermia from Nazi Germany. So we think about the origin in some ways of the biomedical science or the technology, where does it come from? And we also sometimes, less often, think about the nature and essence of the object acted upon by biotechnology, right? And this, I mean, the ontologies of what that thing is, the values attributed to that thing, or that person, or that being, or that intervention by society, by individuals, and the meanings it has, right? This is how we think about, or analyze biotechnology from an ethical perspective. Now there's no reason, I think, and I'll argue, that religious frameworks can't be part of that conversation. So here, religious frameworks help us think about ontologies to provide values and meanings to things, right? And particularly in this case, and what I'm gonna present, how Islamic scholars and texts from that tradition think about the value, meaning, and the ontology of motherhood. On the other end, there's no reason why Muslim or religious communities should not offer a sense of how harms and risks are weighed for their community, right? How religious values are under attack or not under attack, or their identity is at issue or not. So in the work that I do, I think about, okay, the ontologies and the religious values from religious lens, just so for a way of us thinking about bioethical issues. So for me, it's not a question whether religion is part of bioethical discourse, I think they're together. They have to be. If we're going to do justice to the society and the people that we live around. So in any case today, I'm going to present some empirical data on attitudes towards assistive reproductive technologies and motherhood, largely drawn from mass space samples in Chicago and DC. This is work that I've been doing for several years. Then I'm going to detail Islamic bioethical judgments on specifically urine transplantation and sargassi. And yes, I'll give you a closure. There's a selected Fatwa hunting where I only present views from the swimming world in these journalical academies that bring together physicians and scholars for certain reasons. In Q and A, you can ask me why I selected those only. And then I want to share with you some of the dominant scriptural understandings of why or why not certain things are permissible or not permissible. In the end, I hope that sort of case example will help us think about and critically analyze the constructions of motherhood. What bonds are privileged when we think about producing parenthood and how do scientific and social imaginaries interact in that production of motherhood or parenthood by biomedicine? So what's the challenge? And I think you all know this that fertility rates are dropping everywhere in the world. It's not just a phenomenon in the developed world or the developing world everywhere. And there are many causes for that. Some are lifestyle choices, smoking is a big contributor to infertility in both men and women. We know that there are issues of spermatility challenges that affect men. There are issues with uterine abnormalities that affect women. So there are other causes as well. But this is a multifactorial issue which has led to fertility decline across the world. Now for the Muslim community, this is also led to some interventions. That's kind of the way I got into this work. This is a mentee of mine at Drexel. She's doing a psychosocial spiritual intervention around depression in women who have not been able to have a child as a way of improving fertility rates. That's the work that she's doing. And the other way, this is across the pond. There's ideas, for example, Lebanon, this is Marsha Inhorn's work around what fatherhood means. So if you're not able to have a child, is fatherhood under attack? Or when you're thinking about getting married, given the way that fertility rates are declining, should you also have some funds to allow for IVF in that society as part of your marriage sort of contract? So the masculinity is under challenged in certain ways as well and across the pond. In any case, to solve all of these problems, buy them as it comes in, right? And there are many ways that we can solve or clinical infertility at least, perhaps, by producing what I call parenthood links, right? And these can be from genetic parenthood links through the artificial insemination, IVF, right? Through all the way through social bonds, right? We can kind of think about how gestational surrogate works or doesn't work. And there are some ideas around whether or not adoption or fostering is part of parcel of intervening upon the social determinants of health for the issue of clinical infertility, right? So in any case, this is how we produce parenthood or some ways. Now, coming down the pike, you've heard about this in biotech terms as well. The ideas about human reproduction through cloning, right? We only do that for dogs and movie stars in Hollywood. There's no reason why we can't necessarily do that, right? In the coming years for humans at the University of Chicago, perhaps. And the other ideas about creating synthetic gametes, right? For couples who are not able to reproduce quote-unquote naturally, perhaps we can de-iniculate sperm and put it in a donor ova, and therefore you can now have a same-sex couple having a child through synthetic gamete production. Again, the science is not too far off. So these are things that are coming down the pike, but I'm not going to talk about them. I just want to spend time talking about uterus transplantation and gestational surrogacy here in this presentation. All right, so now let's kind of take a journey through how Muslim communities think about these sorts of things. I mentioned to you that I do empirical work in mosque communities. This is data from four mosques within Chicago and D.C., where we were doing emergency tailored RNRCT actually on organ donation and end-of-life care. And before being, or right at the first session, we had a survey, and that survey, there were attitudes around RERT that we included these questions on. Sure, some with you, but for the purposes of you analyzing the implications of the data, you should know this is adult, males and females, right, who have had no experience with organ donation or transplantation, and they're fluent in English. So I'll only use an English-based survey. So here is one sort of a panel of that survey asking about reproductive health. We asked, according to your perspective, rank, you know, which of these four things define motherhood for you on a rank order scale, sharing genetic material, the act of bearing someone, right, pregnancy and delivery, breastfeeding, or raising a child, which is the most important, and you wouldn't rate that. And then we said, imagine yourself as part of a healthy, happy marriage, right, and you were afflicted with something, now you have to pursue an option of treatment, and all of these are efficacious. How do you think about IVF? Are you comfortable without egg donation, and so on and so forth? So this is what we got out of that survey. We got 158 people, there were about equivalent number of male and women participants, largely a South Asian sample, based on the must that we went to, largely individuals who were not born here, however they'd been here in the States a long time, see greater than 15 years, 82% of the sample. And there was this largest Sunni mosque, and there's a reason why, in the discussion I'll talk about why Sunni mosques and their views are different than Sunni mosques. So this is social demographics. Obviously I went to mosques, so you can imagine that the ratings of L'Adassi were very high amongst this group, so I won't go through that, but they're a very religious group. So what do they think about motherhood? This is what came out of that first question, right? So what do you think is the primary, the number one determinant of motherhood, and you see here that the responses were raising the child as perhaps the most common amongst the group, right? Number one, 30%. But sharing genetic material or the act of gestating a child was also not far behind, 20%. The idea of breastfeeding was a minority view or very few people felt this was the determinant, number one, but you should know that in Islamic tradition there's an idea of milk motherhood, right? Milk and ship. So this was something that we put into the survey. So anyway, you see that. Now thinking about the treatments that are proposed, let's talk about gestational surrogacy. So you all know, in gestational surrogacy, genetic links are maintained, right? The progenitor of the ovum and of the sperm are the married or not married, but the couple that wants to have a child, and then you involve a person to be a gestational carrier for that child. So genetics are fine, right? But it involves a third party, and so you see here the group of these participants were not very comfortable, right? Overwhelmingly not comfortable with the idea of gestational surrogacy. Now in uterus transplantation, genetics is not an issue, neither is gestation, right? You have a donor who's given a uterus, and so those are preserved, yet you see again, maybe a little less significant, but there's uncomfortability around this idea as well as a solution to not having a child. So then we said in that survey, we also asked what about this idea, right? I would choose not to have children. Not those four options, just not have a child. Then again here, people are uncomfortable with not having a child, yeah? All right, so what's the summary? So I showed you the uncomfortability data, right? Not comfortable with uterus transplantation, not comfortable with gestational surrogacy, not comfortable with not having children, by and large, and if you did predictive associations, right? I didn't share that table with you, but you would see that individuals who are not comfortable with not having children were also not comfortable with not doing, I'm sorry, with doing uterus transplantation and surrogacy. So these sort of trended together, and what was obviously interesting in the sample that's highly skewed, those are more religious, right? They were particularly not comfortable with the idea of uterus transplantation, all right, amongst all the other associations. So that's the data about meanings and values from the Muslim perspective sociologically. Let's think about how scholars, or let me present to you how scholars think about this issue as well. Okay, so first, just as a caveat, we should know that there are many things in Islam, but the importance of the family unit is really central. The idea that you are a community that is the idea of relatedness is drawn from this idea of a nuclear family, then you have rights and responsibilities there, you have extended family to then tribes, nations, peoples, communities, right? So it just goes out like that in concentric circles. And we have actually manuals that talk about the rights that your neighbor has that's seven doors away, right, upon you as a community. So it's a big important thing within Islamic tradition. Now, when you think about the higher objectives of Islamic law, the termi is maqas al-shari'ah, which takes human interests and affect them into moral ends for law, then there are also three central or essential objectives that are located, the locus of that is in the family. One is the preservation of lineage, the preservation of progeny, and even the preservation of wealth, which comes in heritage goes to family structures, and the Quran is a distributed shares for each person how closely they're related to you, these all are part of the family. Now you should know that scar say there are six total essential objectives, three of them are part and parcel of the notion of the family unit, right? So it's really, really important to think about. So let's think about options. I like the fact that John Lantus mentioned this idea of going to a spiritual healer and this idea of an ontology of healing within traditions. So I can't talk about those treatments until I talk about the idea of how healing occurs or how Muslims think or most of scholars think about healing. So you have examples about treating infertility in the Quran. One of the first verse now, I can't point all the way up there, can I? Yeah, maybe. So this first talks about the idea that for God is the dominion of the heavens and the earth, he creates whom he wills, he gives as a gift to some children, those children being men and women, and for some of them pairs, right? Men and women, male and female child. The important part of the verse is right here. And he makes some Aqeem, barren. He is all-knowing, all-capable. So this idea that there are people who are always going to be a part of the normal bell curve who are infertile and this is part of God's plan. And then you have stories in the Quran. This is of Yahya, who in English she would say is John that says he was wanting a child, an inheritor, and we responded to him how we made correct or perfect or bettered or made whole his wife who was barren. So just in response to prayer, you have this idea of divine intervention. So this then leads the idea that theology relates with law that seeking treatment for infertility is not a bigotry. If you leave it off, it's okay, you're not sinful because some people are not going to be fertile or they're gonna be left barren. So that's the idea of infertility. So let's talk about gestational surrogacy for a second. So the ruling is, and I put the term you all know, I'm sure, Haram, impermissible by Islamic law. This is how Sunni scholars think about it and you know how gestational surrogacy works. And the reason they give is confusion of lineage, both of who the mother is and who the father is. So as for the mother, the reason they go back, this is another verse in the Quran. It says here, I'll give you the context if you want in the Q and A, but those of you who can claim the title of mother and umma hatum illa illa yuladnahum are those who bore you and birthed you. That is the definition. The Arabic is very strong there that that is who a mother is. That's the label that you get attached to. So now in gestational surrogacy, the woman who was born and gestated a child is the mother, right, based on this verse. And then what about the father? There's a saying from the Prophet Muhammad, peace and blessings of Allah, that says, that the child is for the bedspread, meaning what? That when you have illicit marriage, you don't inquire about who's the father and who's the mother. It is for that if there's a legal marriage, that child is attributed to those parents. That's it. You don't inquire, stability of society is more important. That's the deal. So if there's a known marriage, you stop there. So now who would be the father? The father is the husband of the gestational carrier because there's illicit marriage, perhaps, and that would be the father. So this is gestational surrogacy, right? Where we would think genetics are preserved, but you see how scholars now are having other ideas of parenthood. Let's take Eurus' transportation example here. So just to preface, right, the idea of Eurus, of organ transportation in Islamic tradition, scholars say that if it's life-saving, it becomes obligatory, otherwise it's permissible. In some cases, it is impermissible. So when you talk about sex organs, the scholars sort of say that it's haram, it's impermissible, and the way they go about this is that they talk about the idea that it contains genes, genes pass on heredity, and then therefore you'll have confusion of lineage. So you can't donate ova and sperm or testes and tubes. Now as far as the uterus, an interesting argument comes about in the scholarly paradigm. I'm not saying this is all scholars, but there's a group that talks about this, that there's a metaphysical reality attached to the uterus. And what is that? Again, you go back to the scripts, and they sort of say, and I'm gonna kind of go through this entire verse. O mankind, fear or be conscious of your Lord that created you from one soul and created for it its mate, and mate from them, many men, right, and many women. So all of mankind comes out from that. And be mindful, fearful, be conscious of God, right, the one who you ask your rights from, and, or that haram, and the womb. So there are other things in the Prophet, the idea that the womb is gonna ask, did you cut relations off with me? Meaning you didn't talk to your parents or brothers or sisters or children in the afterlife. That will demand rights, and that you'll be sinful for not completing the rights of the womb. So they say, okay, we have some question about whether our uterus transportation's okay. Now are you gonna tell me that in Saudi Arabia they allow uterus transportation? That's true, but I'm just telling you that there is another dominant view that this might not be permissible. Now to an interesting case, when I presented this in a Muslim context, people understood it, but I just want to say it's not just a Muslim context, there are many contexts where there are polygamous marriages, right, here's from the States, this is a Filipino soap opera. And so there's an interesting case presented to a fit council in 1984 and 1985 about this idea of gestational sargassi within two wives of the same husband. So I know my time's ending here. The idea here was that they first said this is permissible because there's no confusion who the father is, because it's legally embedded, right? And we will just assign the rank of a milk mother to the gestational carrier refine. Then the year after they said, no, we can't do this because the scientists came and presented data that perhaps you don't know which ova is it the, which ova is part of that embryo. It's possible that there's a miscarriage and then therefore there's actually of the mother who is gestating. So they said if there's any doubt there then we can't allow this procedure. Okay, so now close to ending and then we're gonna have a perhaps a conversation. So let's attach names to people. So you have Fatima and Mustafa as the people who want to have a child. You have Amira who is the individual who is the donor of the uterus that now Fatima has. And then you have Jannah and Barak who are the married couple that Jannah's the one who's going to have to be the sargat. So the contestations are like this, right? That the issue here with gestational sargassi is that Jannah's involved, right? That she's potentially a mother and that she potentially has a husband. Therefore we can't allow this. For the idea of two wives the issue is that perhaps Jannah is the one who gave the Ova, right? So we can't allow this. And then if you think about uterus translation then there's no problem within gestational or genetic or rearing roles but there's some issue of afterlife ramifications. Perhaps. So what do we see here when you combine the data from the community as well as from the scholars? That all groups, scholars and LATC, agree that motherhood or seamotherhood as a composite of genetic relationships, gestational relationships and rearing relationships that these have to come together to assign the notion of parenthood. And in this case I'm talking about motherhood. Yet, as you can imagine scholars want to update their sort of metaphysics and think about their law so genetic science right into Islamic law I would argue perhaps is not the best thing. Maybe it was a positive element, maybe it wasn't. Why? Because we can't fully prove the genetic bonds as you see, right? And I mentioned I'll tell you what the Shi'a's do so the dominant tradition and the Shi'a tradition says genetics equals parents, right? So they're able to move away and so these things are permissible but then they have to work out how you deal with the ideas of who you can marry and not marry inheritance and everything else but they just take the genetic vote fully. Soon these scholars don't. Lastly, this issue, right? So now we want to use this data to counsel Wilson's. Well, Wilson's don't want to be a childless either. But there's no acceptable biomedical solution that maintains these three sort of linkages, right? And doesn't also implicate afterlife bonds. So I would say we don't yet have a solution that would meet all parties' needs. Perhaps adoption and fostering but then I said to you if we think this is a problem are we going to be interacting in those social determinants of say for example, depression? Are we or are we not as a health care system? All right, so I'll end with this slide. I mentioned to you this is the way that we think about or I think about how we assess moral assessment, how we assess biotechnology, harms and benefits. From the data presented there's an issue about the needs confusion versus having children. Benefit, harm. In terms of the origin of the biomedical science one of the things I presented to you is this issue of whether the donor of that uterus is now a parent. That uterus will ask about rights on the day of judgment. And lastly, when the scholars are talking what constitutes motherhood, what constitutes a child? So these are all things that we have to deal with as you think about interventions and policy with solutions in our society. I'll end there, thank you. Okay, one or two questions? Yes. The uterus and we're talking about the transplantation. But isn't it possible that the uterus would be transplanted and the native ovaries would be functioned? So, and it seems to be worth applying, we're applying it based on the assumption that the ovaries would also be transplanted. No, so because they dealt with that but you can't have egg donors, right? So the ovaries are an issue of well, they're eggs that are contained within ovaries and that laser genetic bonds. But when you specifically talked about the uterus itself, the thing that is just dating the child that is gonna give nourishment to the child, will it then demand rights in the afterlife that the child didn't recognize who I was? Any questions? Yeah, sorry, yeah. Nice talk, enjoyed it. So I'm curious about you surveyed people and you asked about their discomfort and the discomfort seemed to correlate with the level of religiosity. But I'm a little uncomfortable with using discomfort as a surrogate for being informed by religiosity. So, I mean, discomfort can come from a lot of different things as well, right? I mean, unfamiliarity, things like that. Yeah, so actually, part of the reason I'm leaving today is I'm presenting this larger data to UNESCO conference in Morocco tomorrow. And the question is, are the relationships between these based on scholars thinking meaning scholars have taught communities that's why they're uncomfortable or is the idea that they're uncomfortable so now we should think about how scholars think about it. What's the relationship? So only one point was related to religiosity, that was uterus transplantation. And I interpreted that because transplantation in general is plurality within scholars. Some say you can't do it. But all the other relationships had nothing to do with the religiosity, which is my point, is there something else going on? It's not that scholars say something and then people believe, that's not how it works. So that's what I'm gonna present there. Thank you. With that, we'll end. Thank you all and I'll introduce the next speaker. So our next speaker is all known. Well, I should give this, yeah, let me give this to you.