By Sherine Hamdy
In Our Bodies Belong to God, Sherine Hamdy tackles the complex issues surrounding the debate on organ transplantation in Egypt; demonstrating the play of legislative, religious, biomedical and cultural frameworks particularly with regards to the expression “the body belongs to God.” Focusing on Islam, Hamdy illustrates throughout her ethnography, that while all the of her patients agreed that their bodies were not their own property, the way this concept is understood varies from context to context and is under constant negotiation. Her point is not to suggest that the expression can have infinite meanings, but rather to demonstrate the shifting and evolving nature of often-seeming fixed bodies of knowledge like religious or scientific “truths.” This point is key in her call for a “bioethics rebound,” in which bioethics should be unbound and “rebound” as a discipline fully integrated in the social analyses of political, economic, and cultural terrains in order to meet its original goals of improving health, justice, and medical benefit to most people (p.9).
From the outset, Hamdy explores the contention between the biomedical establishment and religious authority concerning ethics and the human body, illustrating there is no consensus with regards to efficacy, safety, religious permissibility, or legality of organ transplantation even amongst religious scholars and medical practitioners. This gray area is further exacerbated by the uncertainty and clinical inconsistency in defining and treating brain dead patients as a means for organ procurement. Following the discussion of brain death, Hamdy traces an even older unresolved religious/cultural debate regarding the proper treatment of dead bodies. This debate is analyzed in the context of the 1996 cornea grafting scandal, in which public eye banks in Cairo were closed following the discovery that “eye theft” was the source of cornea transplants. This analysis is particularly important because it reveals medical and religious debates about the proper interpretations of dead bodies, highlighting several unresolved medical practice issues including; 1) the exploitation of the poor, including the dead, 2) whether and how to obtain informed consent from patients in the context of a strongly paternalistic medical system, 3) the privatization of medicine and the related marketing of body parts, the eroding quality of medical care, and struggles in class inequalities between professionals and poor patients, and 4) longstanding cultural associations of eye disease and blindness with Egyptian “ignorance” (p.84).
Following differing lines of arguments on what constitutes the preservation and dignity of the physical body, Hamdy reveals an interesting dichotomy in the conceptualization of organ transplantation as a moral act. The sentiment that the intention of an act morally outweighs the form or consequences of an act, not only divorces intention from action but spirit from matter, by which the spiritual reward (the intention) for donating organs is attributed far more significance than the dead body (the form) (p.101). It is through this material/spiritual dichotomy that the utterance of Shaykh Sha’rawi, a popular religious figure and the first to argue against organ transplantation with the statement “the body belongs to God,” is analyzed. Under the umbrella of Islamic jurisprudence, theological questions touching on the permissibility of organ transplants are undeniably colored by the individual’s conceptualization of risk/benefit outcomes (factoring medical, spiritual, and social risks), which are shaped by their socio-political understanding of the treatment’s efficacy, their economic circumstances, and kinship ties. In effect, decisions about transplantation (whether an individual needs one or is deciding on donating or it is the doctor who is facilitating the transplant) are not individualized but rather inextricably bound in the lives and bodies of others.
As a Muslim, I find this book particularly interesting because it addresses the popular sentiment that Islam is in opposition to scientific advancement. Hamdy clearly demonstrates that religious rulings on sensitive topics are not as “religious” and transparent as we think them to be but rather bound in a multiplicity of social contexts and meanings. Furthermore, working on a CDC-funded hepatitis study at the Henry Ford Hospital’s Center for Health Services & Research in Detroit (an area with one of the largest Muslim populations in America), I often come across doctor’s notes discussing liver transplants as an almost routine transaction. Reading this account gave me an entirely new perspective on the “lived experience” of transplantation – both the personal and social processes that go into juggling concepts like self-preservation, health, dignity, and accepting “God’s Will.”
Summar Saad is a first year Ph.D. student in medical anthropology at Wayne State University. Her research interests include death and dying, religious and cultural dimensions of end-of-life issues, personhood, and bereavement.