What You May Not Have Known About Abortion & Some Medical Ethical Issues in Lebanon

You’d think class discussing ethics in medical school are the most boring. The truth, however, is that those classes are the only ones capable of engaging the entire class. The sloths wake up because of a rising tone with their classmates. The conservatives rise because the liberals in class are infringing on their beliefs. The liberals get infuriated at everyone else because they just don’t get it. And the physicians giving the lecture sit back and watch.

Pop corn material? You bet.

Because I am receiving my medical training in Lebanon, we have to also deal with certain aspects of Lebanese law pertaining to these issues and to say our laws are bipolar, nonsensical and surprising is an understatement.

• Abortion:

We all know abortion is illegal in Lebanon. There’s no pro-life, pro-choice debate. Women have no choice when it comes to this. However, did you also know abortion is illegal even when it comes to congenital abnormalities? In other words, it is illegal for a physician to abort a baby in Lebanon if the baby has, for example, Down’s Syndrome or any other defect which would render his life extremely difficult. The only situation in which abortion can be performed in Lebanon legally is when the pregnancy is endangering the mother’s life – and even that comes with its own baggage of morality clauses.

In fact, any physician who performs abortions that are not indicated – even if they are for what many perceive as common sense causes – can be targeted by the law especially if he rubs a prosecutor the wrong way. Some physicians refuse to do abortions fearing legal issues while others refuse to do so for religious issues. In fact, a physician who is training me said to my face: “I wouldn’t even abort my own sister if the baby was a product of rape.” I was outraged but this is how it goes.

Certain major hospitals in the country do not even do amniocentesis, which is a component in prenatal care and diagnosis to detect certain abnormalities. Their argument? We’re not aborting anyway so what’s the point of the mother knowing if the child has Down’s Syndrome or not? Besides, amniocentesis carries a theoretical 1/250 chance of causing a miscarriage – who needs that risk?

A relevant abortion real life story we were told is when a radiologist missed the absent right arm of her fetus, a condition called phocomelia. She later found out of the condition at a gynecologist’s visit and decided to abort. She then wanted to sue the radiologist for missing the condition but was eventually talked out of it because having the case reach a court of law would get both the mother and physician in jail.

• Gamete donation:

I daresay Lebanon doesn’t need more fertility. If anything, we need to have population control. But some people just need those little bundles of joy in their lives. Some want to because they feel a need to be parents. Others want to because society looks down upon the women who don’t give their husbands children. Many couples resort to In Vitro Fertilization or other methods of Assisted Reproductive Technology. Insurance companies pay for such practices without knowing so because hospitals cover it up in their charts.

For some couples, however, gamete donation is required for them to have children. Yes, the child wouldn’t be theirs biologically but that’s not all that matters now, right?

Here comes the interesting part, Lebanon-style: There’s absolutely nothing – no religious decree, law – allows sperm donation. It doesn’t matter what the man’s fertility status is. It doesn’t matter if the woman is as fertile as they come. Oocyte donation, however, is an entirely different story that is governed by each person’s sect. Meaning: whether or not a person is allowed to donate or receive donated oocyte is correlated with that person’s sectarian personal status. Move over civil marriage, I guess.

Don’t worry though, the sects agree on this. The Christian, Druze and Sunni sects prohibit this. Shiites are the ones who have gone off the rails – but not all of them. Lebanese Shiites fall under two main branches. There are those who follow Mohammad Hussein Fadalallah in their practices while others follow Iran’s Khamenei. Those who follow the latter are not allowed to donate or receive oocytes while those who follow the former can do so as per a fatwa which he issued shortly before his death. The condition? The oocytes have to donated by someone by the man’s other wives.

• Embryo Research:

Not a lot of research is being done in Lebanon. This is especially lower when it comes to embryo research – the number is zero. However, who would have thought that the law can actually be interpreted in a way that permits such research?

In fact, the Lebanese law pertaining to this issue stipulates that the embryo is a product of conception and can be manipulated as long as both parents agree. Other products of conception include the placenta. This effectively renders the embryo prone for research. So in a way, we are ahead Western countries in this regard.

Why hasn’t this law gained traction? Mainly because no institutions actually allow such forms of research to happen in their premises. Most of the country’s main hospitals are religious institutes at their base. The law has also passed unnoticed by the radar of sects because they’re all busy elsewhere and we still don’t know if it’s been put into effect. Interestingly though, at least some MP members (Kassem Hachem, I believe) tackled the issue at hand. Meanwhile, women are still waiting on their own domestic violence law.

• Conclusion:

We were asked the following question about frozen embryos: if you freeze an embryo for 5 years and then implant it, is the fetus one day or 5 years old?

All hell would have broken loose if we hadn’t been a small group in the discussion. I guess it doesn’t really matter where we legally stand from such issues. What is clear, at least to me, is that we are lightyears away from having a decent discussion about them. But I still find them fascinating.