Medical Ethics in Theory and Practice in Iran:
A Case Study of Gamete Donation and its Place in the Curriculum of the Tehran University of Medical Sciences

Abstract

ABSTRACT
Iran is the only Islamic country in the Middle East which undertakes gamete donation, an assisted reproductive technology which has developed in the past 30 years. This study addresses the current situation and future potential of gamete donation in Iran in the context of the various cultural, legal and religious dilemmas which accompany it. This project utilizes a mixed methods approach, including in-formal group discussion and participant observation. Additionally, semi-structured interviews were conducted with practitioners (N=12) in three fertility centres as well as with the members of the Planning Committee of the Medical Ethics Centre of Tehran University of Medical Sciences (TUMS) (N=7). General information about the centres was also collected using a questionnaire (N=3).
The results of the study suggest that the practice of gamete donation can result in bioethical issues in the legal, socio-cultural, political and religious contexts in Iran. The identity of a child resulting from gamete donation is an important legal issue that overrides other issues such as inheritance. In addition, gamete donation creates new categories of relatedness involving genetic and social factors that generate socio-cultural complexity and ambiguity. The socio-cultural context in Iran may create specific stigmas and social pressures for the child, donor and recipient. Other issues that might occur include the exploitation of the donor, harassment and blackmail of the recipient, commercialisation of the whole procedure, and incest.
In addition, the varieties of fatwas that have been raised in relation to gamete donation generate an unclear and ambiguous religious situation for patients, donors and physicians. Moreover, the results show a gap between permitting gamete donation by fatwas and its practice. The lack of specific laws, guidelines, unique codes of practice, and health policies related to gamete donation not only causes problems related to the practice of gamete donation, but also has considerable socio-cultural repercussions in Iran.
This thesis also considers how the medical ethics curriculum of Tehran University of Medical Sciences can be adapted and further developed to address the issues raised by the use of this new bio-technology in the Iranian context. Analysis of the current medical ethics curriculum at TUMS, demonstrates that it offers physicians an ethical framework and also provides training related to some of the bioethical issues which are involved in gamete donation practices, although gamete donation has not been specifically included in this curriculum. In the absence of this type of medical ethics curriculum, gamete donation practices continue to be considered in a haphazard and informal way during teaching rounds in the clinical years.