Book Reviews Bioethics & Organ Transplantation in a Muslim Society: A Study in Culture, Ethnography, and Religion Farhat Moazam Bloomington: Indiana University Press, 2006. 264 pages. Farhat Moazam was born in Pakistan and attended medical school there. For many years, she pursued her surgical and pediatric training in the United States, witnessing not only scientific progress in organ transplantation but also the rise of modern secular bioethics, the advocacy of individual rights and patient autonomy, and feminism (p. 175). Equipped with such privileged knowledge, she obtained high-ranking positions back in Pakistan, reflecting her competence as both a medical doctor and a medical ethics specialist. While working on this dissertation (she received her doctorate in religious studies from the University of Virginia in 2004), however, she employed a third and quite unexpected quality: that of an ethnographer. But Moazam has no ambition to contribute to the broader theoretical discussion of Marcel Mauss’ The Gift (W. W. Norton & Co., 2000). Rather, she brushes aside the applicability of reasoning in the tradition of the reception of Mauss (cf. pp. 126, 138, 143, and 218). Similarly, she is not concerned with theoretical eth- nological or sociological debates on globalization and its local appropria- tions, although, ultimately, this is what the story is about. To conduct her fieldwork, she chose to spend three months at a dialysis and renal transplantation unit in her hometown of Karachi. This vanguard institution for end-stage-renal-disease (ESRD) patients, part of her old med- ical college, is now both the largest and the first institution of its type in Pakistan. In addition, the country’s first renal transplant was performed there in 1985. Financed to a lesser degree by the state, about 60 percent of the institute’s budget has to be raised by sponsors (p. 46). Such services as dial- ysis, transplantation, medication, and follow-up are free of charge (p. 37), so there is a tremendous overflow of people in need. The institute, having started its pioneering work in a traditional society that is still strongly averse to posthumous donation, has to rely on live kid- PDF created with pdfFactory trial version www.software-partners.co.uk http://www.software-partners.co.uk http://www.software-partners.co.uk ney donations from blood relatives. By participant observation, especially in the pre-transplant clinic and in over 100 face-to-face interviews carried out mostly in Urdu, the author explores the institute’s moral microcosm. The medical staff received western medical training and adheres to the principles of modern biomedical ethics as formulated by American philosophers in the 1960s and 1970s (pp. 2-3 and 222). She traces possible conflicts with certain concepts of Islamic ethics and local perceptions of right and wrong. However, readers interested in normative Islam, as enshrined in Urdu- language publications by Pakistani religio-legal scholars, will be frustrated and should turn to other sources (cf. pp. 4-7 and 31-36). Instead, the “thick descriptions” offered in the book deal with subjective moral dilemmas that are either generated or reinforced by the application of modern medical advancements. In fact, Moazam does not adhere to a specific anthropologi- cal school, but feels free to anarchically combine selected reading from dif- ferent disciplines in order to shape her train of thought. In the clinic she was not a neutral observer, but rather a cherished (medical) colleague with unre- stricted access. After a diligent introduction, the author uses four chapters to unfold the basic perspectives of her field research and reflects her findings in a conclu- sion. Having practiced in the United States and private clinics in Pakistan, she suddenly finds herself “submerged in a sea of misery composed of ter- ribly ill patients and their destitute distressed families, with an overstretched, idealistic staff struggling to make a difference” (p. 19). Kidney donation practices are fraught with potential conflict, because Pakistani families are very collectivistic instead of individualistic (pp. 76 and 217). Western con- ceptions of autonomous decisions made by self-responsible individuals who make their personal choices do not apply to current Pakistani society at large (pp. 45, 74, and 220). Against their one-sided idealistic perception as caring, strong solidarity units, she also reveals “the ugly aspect of the Janus face of extended families” (p. 147). Chapter 1 presents the key players in this drama (e.g., surgeons, admin- istrators, nurses, and social workers) and their sense of responsibility toward their patients. Relating their background and individual characteristics, Moa- zam detects among them a common agenda of gender justice (p. 59). Chapter 2 traces the institute’s devoted self-understanding within an extended family paradigm (pp. 82 and 86-91). As such, the staff shows a fierce advocacy for patients in need. Chapter 3 analyzes the interests and more or less hidden motives of the larger family units involved. The people in charge have to negotiate with them, not simply with the individual patients, in order to obtain a suitable kidney. The approached family members often avoid direct con- Book Reviews 109 PDF created with pdfFactory trial version www.software-partners.co.uk http://www.software-partners.co.uk http://www.software-partners.co.uk frontation and, in some cases, employ various escapist strategies (p. 153). The explosive power lies in the fact that the best medicinal-biological match as a potential donor often does not feel obliged to donate, given his social status within the family hierarchy. Instead, weaker members and, for that matter, often women are presented as “volunteers.” Quite frequent cousin-cousin or intra-familial marriages mean that the spouse is also likely to become a poten- tial donor. However, it has to be taken into consideration that kidney dona- tions dash hopes for marriage proposals (pp. 66 and 163-64). In an original and highly convincing move, chapter 4 extends the partic- ipant observation to the last dimension and a hitherto lurking protagonist: Farhat Moazam herself. This part, a real eye-opener, makes up for the book’s slightly repetitive style and raises the whole study to the literary sphere of autobiographical writing as a sort of very different Bildungsroman (a novel of development and education). An over-achiever and, in the beginning, a powerful agent of globalization in the form of western medical standards and secular ethics, the author gradually readjusts and differentiates herself upon re-entering Pakistan and being exposed to on-the-ground realities. In a way, it becomes obvious that her fieldwork did not comprise three months, but rather a whole lifetime. One need not even be interested in organ transplantation, bioethics, or Islam to read this intriguing monograph with pleasure and profit. Stories of globalization or, rather, creative cultural reappropriations of allegedly world- wide patterns of modernity should concern everybody. In addition to the “standard” bioethical paradigm of the informed individual cum advanced medical progress, there are many more grand narratives that ought to be con- sidered against the background of diverse cultural settings. Birgit Krawietz Centre for Modern Oriental Studies (ZMO), Berlin, and University of Tuebingen Berlin, Germany 110 The American Journal of Islamic Social Sciences 25:2 PDF created with pdfFactory trial version www.software-partners.co.uk http://www.software-partners.co.uk http://www.software-partners.co.uk