1. Fatwas and "Official" Islam
1.1. Islam is considered to be Encompassing or comprehensive meaning that this religion teaches fields of all human activity including spiritual, social, cultural, educational, economic and political or medical. These activities are all read under the Sharia C- considered to be the Quaran, the primary source of the word of God.
1.2. When medically assisted conception is not in holy scriptures then Fatwas come about.
1.2.1. "Fatwa"-nonbinding religious opinions, interpreting whether a behavior or action falls into five categories according to the ShariaC. 1. obligatory 2. recommended 3.permited. 4. undesirable but not forbidden 5. forbidden.
1.2.1.1. Fatwas can be written by people of highest religious rankings two of which are also apart of the Egyptian government. Because the government of Egypt does not put much interest into IVF the government has neither promulgated or prevented the issuance of an official fatwa on appropriate use of new technologies.
1.3. First Official Fatwa by Al-Azhar (first authoritative statement of muslim view toward medically assisted conception.
1.3.1. His fatwa mentions what is considered to be permitted or forbidden. Some of these included forbidding a third party donation of reproductive materials, Artificial insemination is allowed, excess number of fertilized eggs can be preserved ect.
1.3.2. There has been concern as two how many people follow these rules and regulations of the Fatwa and how they affect practices.
1.3.2.1. Regarding the forbidding of a third party donation showed that in many countries artificial insemination and IVF is strictly prohibited. This is also considered adultery.
2. "Unofficial" Discourses of Islam and IVF
2.1. Views between classes
2.1.1. No matter what the class is of the couple (elite or masses) religion plays just as an important part to both of them. Poorer people who are illiterate still memorize important scripture messages. Elites are well educated and have studied their religion to the fullest extent.
2.2. Religious Theodicies
2.2.1. Unlike the West, the majority of Elite couples fill their explanations with talk of Gold and theodicies that provided meanings to why someone is in need of IVF. In the West these religious theodicies are rarely invoked.
2.2.2. Elite Egyptian couples are willing to try the new reproductive technologies only with understanding that God has made them infertile for a reason and it is God's plan for what is ahead in the future.
3. Discourses of Donation
3.1. Third party donation for test-tube baby making among Egyptians is considered "against religion" a "closed matter" and it "does not happen."
3.2. Two issues regarding third-party donation.
3.2.1. 1. Moral implications of third party donation for marriage: Even though there is no body contact with third party donations, it is still considered adultery.
3.2.1.1. There is another concern of incest. Couples are scared that with third party donations that a single donors offspring will meet and marry each other. This is considered the "main thing" wrong with donation for many couples.
3.2.2. 2. Moral implications of donation for kinship and family life. An ideal for Islam is to preserve the lineage/ origin of a child (this child's relationship with the biological mother and father) to be very important.
3.2.2.1. The confusion of line of decent is considered to be against nature and against God.
4. Contemplating Immoralities
4.1. There is a major difference in concerns of new reproductive technologies amongst the Western people and Egyptian people.
4.2. Egyptian views on Western reproductive morals.
4.2.1. Egyptians find what Western people do to be completely insane. They completely disagree by the fact that you can basically create your child; choosing hair color, skin type, eye color ect. One women said "It's like a supermarket!"
4.3. Egyptians fear both the intentional and accidental outcomes of Western practices.
4.4. Egyptian physicians have made it clear that because of the Western morals on donation practices they will not consider moving their because of fear that they will have to practice those treatments against their will.
4.5. A major fear of poorer infertile women seeking IVF treatment was the accidental "mix up" of sperm. They believed this because with a poorer facility came less regulation of what was going on behind doors.
5. Private Providers and the NRT "Epidemic"
5.1. NRT "Epidemic"
5.1.1. The true new reproductive technology boom period in Egypt ocured from the years of 1995 to 2000.
5.1.2. A problem to this was basically quantity over quality. With so many practices popping up, a common characteristic with these IVF centers was "low quality service" leading to both physical and financial "damage"
5.2. Rise of Private Practices
5.2.1. International organizations have placed a high demand/ priority for more private practices in health care.
5.2.2. In Egypt these have become apart both the low income to the high income neighborhoods.
5.2.3. "Pattern Two Country"
5.2.3.1. Country with a large and concentrated population where the formal private for profit sector now dominates all types of health provisions.
5.3. Private IVF Providers of Egypt
5.3.1. Dr. Zaki
5.3.1.1. Dr. Zaki is not considered a "famous professor" but besides that people still think and speak highly of his work.
5.3.1.2. He is described as "tall light and handsome." His patients like the way they are treated by him, he treats with a gentle manner and is soft spoek and self-effacing.
5.3.1.3. He also makes it clear he is a religious man which is important to the majority of Egyptian couples.
5.3.2. Dr. Yehia at Nozha Hospital
5.3.2.1. Dr. Yehia is considered to be a "professional doctor" amongst his patients.
5.3.2.2. His main characteristics that show he is a great doctor is his ability to communicate with others. He is considered to be comforting, reassuring and friendly.
5.3.2.3. He also is a doctor who knows how to give bad news properly with a caring attitude. This is extremely important especially when dealing with the males who are infertile.
5.3.3. Quality of Care: Patients' Perspective
5.3.3.1. "Patient-centered medicine" is highly looked for when choosing an IVF doctor.
5.3.3.1.1. 1. They adopt a biphsychosocial perspective. 2. They regard their patient as a person; and are concerned with understanding the individuals illness by listening. 3. They divest themselves of paternalistic power by sharing power with patient. 4.They afford far greater priority to the personal relationship between themselves and patient. 5.They invoke the notion of "doctor as person" where doctor and patient are influencing each other at all times.
5.3.3.2. Lack of Time
5.3.3.2.1. A negative aspect to the majority of Egyptian doctors is their lack of time for the patient. The doctors are said to be very very busy. They see patients give them orders and send them on their way.
5.3.3.3. Interpersonal competence
5.3.3.3.1. Interpersonal competence is central to trust from the IVF patients. The patients believe that they need their doctors to be genuine and sincere in order to trust them.
5.3.3.4. Negative Trust Calculations based on three things:
5.3.3.4.1. 1.Perceived greed of physician. 2. Perceived dishonesty (regarding sucess rates) 3. Perceived lack of religiosity
6. Quality of Care: Physicians' Perspectives
6.1. The 6 major industry problems physicians see.
6.1.1. Clinical Maldistribution
6.1.1.1. Within Egypt the IVF centers are poorly distributed throughout the area. The 36 centers are within two major cities.
6.1.1.2. People must travel to the major cities in order to receive IVF treatment. This is a very expensive process considering the travel time and pay to get to these locations.
6.1.2. Dependency upon Western experts and materials
6.1.2.1. Refered to as "neocolonialism"
6.1.2.2. The major technologies and medicines are exported from the Westn manufatories.
6.1.2.3. IVF centers who lack trained employees must import consultants from the West to carry out their work
6.1.2.3.1. This is both a blessing and a curse.
6.1.3. Costs and shortages of equipment and supplies.
6.1.3.1. Physicians who are not properly trained will purchase expensive technologies that are not usefull to their practice. There is no need for it.
6.1.3.1.1. With this comes shortages of supplies. An IVF center will have one technology but will lack the other such as Cryopreservation.
6.1.4. Local infrastructure problem
6.1.4.1. Within Egypt there are also frequent power outages which causes a problem for freshly filtered water. With this comes the demand of back up generators.
6.1.5. Local shortages of qualified staff.
6.1.5.1. The majority of Egyptian couples are very nervous about what happens "behind doors" with IVF. Employees are needed for laboratory work in IVF and Egyptian medical schools do not offer this type of education.
6.1.6. No formal state legislation has been enacted to regulate IVF centers.
6.1.6.1. It has been mentioned before that the government is not fully supported of this move towards more IVF technology. With that comes less regulation of what is going on within these IVF centers. But there are changes being made to improve this like a law banning foreign laboratory personal.
7. Reproductive Medicine and Religious Morality
7.1. Religion has served to be a major constraint and restricts of how test tube babies are to be made in Egyptian IVF centers.
7.2. Religion has both reduces the number of new technological options and the number of infertile couples willing use these new technologies.
7.3. "Secularization Thesis: industrial and industrializing societies, the influence of religion diminishes as the scientific basis of the new technology undermines faith.
7.3.1. This thesis is said to not apply to Islam community and sometimes these beliefs among religion have increased.
7.4. Local Moral Worlds
7.4.1. These moral worlds are derived from local religious traditions.
7.4.2. In Western worlds this is under-appreciated. Religions such as Christians, Jewish and Muslim communities have found at least 6 major concerns to new reproductive technologies.
7.4.2.1. An exception with these concerns though compared to Islam religion is that these are not moral* concerns and are more of a theological concern.