Islam, fatalism, and medical intervention: lessons from Egypt on the cultivation of forbearance (Sabr) and reliance on God (Tawakkul).

Islam, fatalism, and medical intervention: lessons from Egypt on the cultivation of forbearance (Sabr) and reliance on God (Tawakkul). This article draws upon fieldwork among poor dialysis patients inEgypt (2002-04) to revisit questions about fatalism fa��tal��ism?n.1. The doctrine that all events are predetermined by fate and are therefore unalterable.2. Acceptance of the belief that all events are predetermined and inevitable. and medicaltreatment. I analyze when and under what conditions devout Muslims incontemporary Egypt appeal to utter submission to divine will and whenthey seek particular medical interventions. The cultivation ofsteadfastness is highly valued in many religious traditions. Yet manyhistorical accounts by European travelers and Orientalist scholarsdescribe pious Muslims as "fatalists" for cultivating thisdisposition, (1) a descriptor (1) A word or phrase that identifies a document in an indexed information retrieval system.(2) A category name used to identify data. (operating system) descriptor that has persisted in the contemporaryWestern media. (2) It is critical to unpack See pack. the various implications ofthe charge of fatalism as well as the social realities that it masks fora better understanding of the practices of both Islam and biomedicine biomedicine/bio��med��i��cine/ (bi?o-med��i-sin) clinical medicine based on the principles of the natural sciences (biology, biochemistry, etc.).biomed��ical bi��o��med��i��cinen.1. . I argue in this article that the common formulation of passiveMuslim fatalism grossly misunderstands the ways in which religiousdispositions are embodied. Dispositions of acceptance of divine will arefar from passive and must be actively cultivated. Further, such adisposition is not necessarily contrary to acting in the world. Whetherand when to ultimately cultivate such a disposition is necessarilycontingent upon Adj. 1. contingent upon - determined by conditions or circumstances that follow; "arms sales contingent on the approval of congress"contingent on, dependant on, dependant upon, dependent on, dependent upon, depending on, contingent how much control patients feel they have in the face ofillness and other trials, and on whether they have any options thatwould really provide an appropriate "solution" that could belived with medically, socially, and spiritually. Among many Western observers, the Islamic theological premise thatbelievers should utterly submit themselves to the will of theiromnipotent Creator is taken to be a causal determinant of the way thatMuslim adherents live their lives--the assumption, among polemicists,being that they are condemned to irrationality, with little incentive towork for social progress in this world. Not only is Muslims'supposed proclivity pro��cliv��i��ty?n. pl. pro��cliv��i��tiesA natural propensity or inclination; predisposition. See Synonyms at predilection.[Latin pr to fatalism said to be politically dangerous, but itis also imagined to be a major impediment to the development ofscientific knowledge and to the reception of new technologies. (3) Ifbad conditions are accepted as a sign of God's will, then whyshould the faithful develop the technological means to improve them? Ifillness is a test of faith, then should devotees not seek medicaltreatment? Social scientists have generally had poor critical tools foranalyzing how believers face and experiences these questions,particularly given the prevailing secularist presumptions in academiaabout human agency and the normative subject who transcends culturalnorms and religious bounds (Asad 1993, Asad 2003, Mahmood 2005,Hirschkind 2006). Faith in divine will has often been interpreted aspassivity, inaction, or false consciousness--a functionalist func��tion��al��ism?n.1. The doctrine that the function of an object should determine its design and materials.2. A doctrine stressing purpose, practicality, and utility.3. mechanismto alleviate poverty and suffering. Or, too often, religion is assumedto be a tool of manipulation by the powerful to keep the disadvantageddowntrodden down��trod��den?adj.Oppressed; tyrannized.downtroddenAdjectiveoppressed and lacking the will to resistAdj. 1. . Another common assumption is that religion acts as a"constraint" against the presumed benefits of science andtechnology, or that it constitutes "resistance" against the"Western" origins of technoscience. My argument is not thatreligious devotion never takes such forms, but that when and howsubmission to God's will is articulated, experienced, andcultivated in particular places and times must be explained rather thanassumed. Clearly there are particular scientific methods, theories, andtechnologies that are embraced and others that are shunned by religiousscholars and self-described devout practitioners. Even the sametechnology could be shunned under a certain set of circumstances andappear to be beneficial under another. Throughout the course of myfieldwork on organ transplantation The transfer of organs such as the kidneys, heart, or liver from one body to another.The transplantation of human organs has become a common medical procedure. Typical organs transplanted are the kidneys, heart, liver, pancreas, cornea, skin, bones, and lungs. in Egypt, I came across severaltransplant surgeons who admitted to me that they themselves would neverundergo a transplant operation, because they believed that only God ownsthe body. In grappling with a way to render this in my analysis, I foundthat our analytical toolbox in the social sciences lends us to viewthese discrepancies as "ironic" at best, or"hypocritical" at worst. This has largely to do with ourtendency to think of religious ethics as a set of codified cod��i��fy?tr.v. cod��i��fied, cod��i��fy��ing, cod��i��fies1. To reduce to a code: codify laws.2. To arrange or systematize. rules thatmaps onto or constrains practice, rather than viewing religious ethicsas an embodied aspect of the self that is contingent upon dynamic socialprocesses (Hamdy 2006). The view of fatalism as irrational, passive, and anti-science isheld not only by outside Western observers, but is also part of aninternal debate among Muslims, including one that preceded thepresumptions of Western modernity. Muslim religious scholars have longdebated the terms under which one should cultivate steadfastness, underwhat circumstances one should seek technological intervention--and hereI focus on medical intervention in disease and suffering--whichinterventions are virtuous, and which interventions turn believers awayfrom dispositions of God-consciousness. (4) In the modern period, under the influence of colonial discourse,19th century Muslim reformers This page is a list of prominent Muslim reformers. Abdullahi Ahmed An-Na'im Leila Ahmed Reza Aslan Mehdi Bazargan Samira Bellil Assia Djebar Hamid Dalwai Shirin Ebadi Mawlana Faizani Ahmad Ghabel Asma Jahangir Ghada Jamshir defended Islam against the charge thatMuslims were doomed to colonial domination because of their"anti-scientific" and "fatalistic fa��tal��ism?n.1. The doctrine that all events are predetermined by fate and are therefore unalterable.2. Acceptance of the belief that all events are predetermined and inevitable. " worldviews, mostfamously put forth by the French Orientalist Ernest Renan Ernest Renan (February 28, 1823–October 12, 1892) was a French philosopher and writer, deeply attached to his native province of Brittany. He is best known for his influential historical works on early Christianity and his political theories. (Keddie 1972,Rahnema 1994). Yet rather than argue that Muslims were in fact relianton God, a disposition that was not necessarily backward, the Reformers,like the Orientalists, identified fatalism among the "masses"and argued that it was incorrect Islamic practice (Hourani 1962, Iqbal2002). (5) In modern Egyptian nationalist discourse, passive fatalism,an allegedly faulty religious belief, and anti-scence were conflated asone and the same problem. (6) Particularly in institutions ofbiomedicine and public health, state officials singled out passivefatalism as a dangerous disposition among the populace, particularly therural peasantry. (7) Fatalism continues to be posited by the Egyptianstate as a significant obstacle to progress, unless corrected via stateauthorized religious and scientific pedagogy, such as those instate-approved mosque sermons, popular films, schools, and public healthcampaigns (Hourani 1962, Armbrust 1996, Starrett 1998, Hamdy 2005,Hirschkind 2006). In these state discourses, utter reliance on God isoften regarded as a static quality, while feelings of activeresponsibility (toward citizenship, scientific inquiry, orself-improvement) are said to move people and society forward. I seek to re-orient the discussion of fatalism to two ends. First,I argue that the disposition of submission to God's utter will(al-tawakkul) is not a "passive" form of fatalism that negateshuman agency, but is in fact a disposition whose achievement requiresactive and persistent work on the self. Throughout academic debatesabout the connections between Islam and fatalism, there has been littlediscussion about how, precisely--through what practices andorientations--Muslims come to embody dispositions of belief,particularly that of utter reliance on God. (8) Secondly, I argue that we should remain attentive to when, andunder what conditions, acceptance of God's will should becultivated. Toward this end, we should not think of people'sperceptions of the amount of control they can exert over their lives interms that would oppose structural constraints and religious belief. Ourtendency to view structural, material conditions as entirely separatefrom religiosity re��li��gi��os��i��ty?n.1. The quality of being religious.2. Excessive or affected piety.Noun 1. religiosity - exaggerated or affected piety and religious zealreligiousism, pietism, religionism leads us to interpret believers' invocations ofdivine will as instances of "false consciousness," in whichpeople are "really" oppressed by limited structural andmaterial conditions, but appeal to religious reasoning as a"comfort mechanism." I substantiate these arguments through an ethnographic analysis ofhow Muslim patients in Egypt articulate their use or disuse dis��use?n.The state of not being used or of being no longer in use.disuseNounthe state of being neglected or no longer used; neglectNoun 1. ofparticular biomedical bi��o��med��i��caladj.1. Of or relating to biomedicine.2. Of, relating to, or involving biological, medical, and physical sciences. technologies. My work among terminally-ill kidneyfailure kidney failureor renal failurePartial or complete loss of kidney function. Acute failure causes reduced urine output and blood chemical imbalance, including uremia. Most patients recover within six weeks. patients in Egypt and the complex ethical reasoning that theyemploy reveals how their religious logics intersect with theirassessment of social and medical risks and benefits as they facelife-and-death decisions about their medical care. As they face limitedoptions for recovery, they actively work upon their selves to cultivatedispositions of acceptance of God's will. Sticking with What Works In the Tanta Tanta(tän`tä), city (1986 pop. 336,517), capital of Gharbiyah governorate, N Egypt, in the Nile River delta. It is a cotton-ginning center and the main railroad hub of the delta. University Hospital dialysis center where I conductedfieldwork on kidney failure in Egypt (2002-04), I sat with a group ofyoung men in their twenties who were following a soccer match on thesmall grainy grain��y?adj. grain��i��er, grain��i��est1. Made of or resembling grain; granular.2. Resembling the grain of wood.3. Having a granular appearance due to the clumping of particles in the emulsion. television while they received their dialysis treatment.(9) Many were poor, either agricultural laborers from the countryside orlow-income workers in Tanta's factories and service industries.They all received compensation for their dialysis treatment directlyfrom the Ministry of Health's program, which covers the full costof dialysis for the poor. (10) One of these men, Muhammad, told me thathe was born with only one kidney and suffered from hypertension. Oneday, he took the wrong pill for his high blood pressure which resultedin acute renal failure acute renal failureAcute kidney failure Nephrology An abrupt decline in renal function, triggered by various processes–eg, sepsis, shock, trauma, kidney stones, drug toxicity-aspirin, lithium, substances of abuse, toxins, iodinated radiocontrast. . The physicians had later told him that if he hadtaken two pills (the regular dosage) he would have died immediately. Butfor some reason he only took one and ended up in a coma. Muhammad was not particularly religious before his diagnosis butsince that time, seeing his young life suddenly and drastically changed,he said that he would never miss any of the five obligatory dailyprayers (alsalat), nor would he forget to continuously thank God forstill being alive. Before his illness, he had worked in a small clothing store with ayoung woman and had recently asked her family's permission to marryher. He said that she accepted the proposal, and that her mother alsohad accepted him into their home: This was last Ramadan. But it was her maternal uncle who opposed. He said to me, "Look son, this isn't because of the way you look, or the fact that you are sick. It's just that I don't want my niece to be a widow in a few months." He said it just like that, to my face. Just like that, he's telling me I'm going to die. I told him: "But people live for years on dialysis." I was so upset. I kept thinking, if only God let me get married and blessed me with a son or daughter. But I've gotten used to my situation now. It's all over. Alhamdulillah [All praise is due to God], I come to [the hospital for dialysis], I pray, I know God, I have to bring myself above this kind of hurtful talk [akabbar damaghl] so that these things won't bother me and so that I can go on. The doctors, too, told my family that it wouldn't work for someone like me to get married. I don't understand this. My family felt bad, saying that I was only 28 and that I shouldn't hear things like that, so they didn't tell me. But I am not convinced by any of this. Look, there are people here who have been doing dialysis for years and they are married. So why are they telling me that I cannot get married? Only God knows. Muhammad had his whole life in front of him and suddenly saw it cutshort. His difficulty in managing his disease was not only his physicalpain and newly acquired disabilities. He told me that the most difficultchange to endure had been the ways that his illness had altered hissocial relationships: his inability to get married, to continue working,and to spend time with friends who fear his condition could becontagious. His physicians had stated that he could not get married,essentially issuing him a poor prognosis, which to him felt like a deathsentence. Upon my questioning, the doctors later explained to me thatyes, they do indeed discourage patients such as Muhammad from gettingmarried, because the physical and sexual side effects Side effectsEffects of a proposed project on other parts of the firm. of kidney failureand dialysis would render such a marriage "not viable." (11)Shaking his head gravely, Dr. Yusuf had told me that dialysis was notreally treatment, and that transplantation was the only way out of thissituation. At the same time, Dr. Yusuf had also told me about his ownpersonal misgivings about transplantation, and had questioned whether itwas ethically responsible to put a living donor at such an unacceptablerisk. (12) He also, like Muhammad, questioned its efficacy for therecipient. Muhammad described his dialysis sessions, in contrast, as safe: theoutcome knowable and his life made bearable bear��a��ble?adj.That can be endured: bearable pain; a bearable schedule.bear . He told me: Getting a transplant isn't guaranteed. I know my kidney is ruined, so I come to [do dialysis] three days a week. Only God knows if I tried to get a transplant if I would die doing it. There are people who get sick with the transplant, the body rejects it, or they end up with other diseases. So I need to just be content with what I have. If I tried to transplant, I could die the next morning. So what would I have gotten out of it, just having had myself opened up and stitched back together? Sometimes the operation can last five to six hours- only God knows what could happen during that time. So I need to stick with what is guaranteed. I come here [to dialysis] and can go home after four hours. And that's it. This is a trial from God, most exalted and high. He created me as His servant/slave ('abd) and out of all the people that He created, God is thinking of me, in giving me this disease. And in my suffering, I am getting rid of my sins. I will still be tried [for my deeds after death] but the punishment will be lesser. I have kidney failure now and could die in five years. Why me specifically--God has ultimate wisdom (hikma) in this, it didn't just come to anyone. It came to me, God is saving me [from my sins and heedlessness] because now I remember God all the time. A person has to have his beliefs. Pain and suffering are not merely objective realities external toand constraining of the self (Asad 2003). Pain can be constitutive constitutive/con��sti��tu��tive/ (kon-stich��u-tiv) produced constantly or in fixed amounts, regardless of environmental conditions or demand. ofthe type of self a person strives to be; it can be transformative,acting on social relationships as well as on the self (Asad 2003).Muhammad worked upon himself through his pain to cultivate dispositionsthat he saw were righteous and that would prepare him for his final dayof meeting God. For Muhammad and his fellow dialysis patients, pain wasnot an abhorrence to be eliminated at all costs. Indeed, some pain wasregarded as a blessing, as a reminder of God, and as something for whichto be thankful. The belief in God's ultimate mercy and the purpose of hissuffering, on Muhammad's part, was not an automatic result ofhaving been born Muslim. His convictions were not a fixed aspect of hisperson--in fact, he admits that he was not particularly religious beforehis illness, and that he did not previously think of himself primarilyas a servant/slave of God. It was through his illness that he came toappreciate, and to an extent, to embody authoritative Islamic discoursesthat give meaning to his suffering. But this disposition was not onethat he had achieved once and for all, that would henceforth make hisillness tolerable. Every day posed challenges, and it continued to bedifficult to get from one day to the next. He talked about how he mustconstantly and continually work upon himself, through constant prayer,reflection, and invocation (dhikr Dhikr , ذکر (Zikr in Urdu and Zekr in Persian) (Arabic "pronouncement", "invocation" or "remembrance") is an Islamic practice that focuses on the remembrance of God. ), to come to this sentiment when facedwith suffering, treatment complications, and social stigma Social stigma is severe social disapproval of personal characteristics or beliefs that are against cultural norms. Social stigma often leads to marginalization.Examples of existing or historic social stigmas can be physical or mental disabilities and disorders, as well as . Patientswould sometimes take turns: when one person lapsed and called out to Godto end their misery, another would reassure him and remind him that hewas gaining great spiritual rewards for his steadfastness (sabr) in atime of trial. The spiritual struggle was never-ending and despair wasnever far away. Quest for Verb 1. quest for - go in search of or hunt for; "pursue a hobby"quest after, go after, pursuelook for, search, seek - try to locate or discover, or try to establish the existence of; "The police are searching for clues"; "They are searching for the the Good Across town, in another hospital dialysis unit, stories of deathand disease after transplantation circulated among patients. Thesestories served as reminders that only God could will life and death.Many patients often repeated that a person could not "save"someone or "lengthen a life" by donating an organ to someoneelse. Ali, a young patient in the unit, often said that you might thinkdoctors can help--but if they can heal, they are only instruments ofGod's unique healing abilities. According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. Ali, you might borrowlarge sums of money to pay a donor to part with his kidney, but you areself-deceived if you think that this will guarantee your recovery. Godis the sole guarantor who heals whomever whom��ev��er?pron.The objective case of whoever. See Usage Note at who.whomeverpronthe objective form of whoever: He wills and the One whodecides who will die when. Ali once said to me, "What is that particle that Zewaildiscovered? A femto-sone? We are less than a femto-sone in God'screation!" Ali, like many literate Egyptians, knew well theaccomplishments of Egyptian-American Nobel Prize Nobel Prize,award given for outstanding achievement in physics, chemistry, physiology or medicine, peace, or literature. The awards were established by the will of Alfred Nobel, who left a fund to provide annual prizes in the five areas listed above. Laureate and chemistAhmed Zewail Ahmed Hassan Zewail (Arabic: أحمد حسن زويل) (born February 26 1946 in Damanhur, Egypt) is an Egyptian American scientist, and the winner of the 1999 Nobel Prize in Chemistry for his work on femtochemistry. and his "discovery" (13) of the sub-atomicfemto-second (which Ali pronounced as "femto-sone" in EgyptianArabic) has entered into the Egyptian lexicon. Ali said this to me afterI showed him the back of my American driver's license where I wasasked to be an organ donor organ donorTransplantation A person/cadaver that donates his/her organ(s) to a recipient after death. Ali did not approve of organtransplantation even from dead donors. Echoing the justification of manyIslamic scholars, most notably the popular Egyptian television figureShaykh Sha'rawi, Ali argued that God alone owns everythingincluding human bodies and their parts. Who are we then to givesomething away that we do not own? Ali further stated that whoeverthinks they are "saving" someone by doing this ispresumptuous pre��sump��tu��ous?adj.Going beyond what is right or proper; excessively forward.[Middle English, from Old French presumptueux, from Late Latin praes , as they are less than a sub-atomic particle when comparedto divine powers, and God is the only one who saves. In the hospital dialysis center, Ali remained the most outspokenopponent of the idea of organ transplantation--for himself, that is. Henever discouraged others. But Ali genuinely struggled against this ideaas something that would improve his own situation. Ali and his young wife had two small children--the youngest born,he told me, after he fell ill. Unlike the other patients who many timesseemed completely exhausted by the dialysis, Ali could successfullyfight off the exhaustion, keeping up his energy, and making everyone inhis session laugh. Ali and his family lived in the countryside inMinufiyya. (14) Ali had worked in the army, which is why he had theinsurance to cover his treatment. Aside from his good humor, Ali stoodout in his politicized form of Muslim identity. The other patients pokedfun at his full beard, joking that he would be mistaken for a"terrorist," especially in my "American research."Ali tended to talk animatedly about the current attack on the umma(Muslim community) and about the ways in which we must come closer toGod to regain political and moral strength. Knowing that my topic was focused on transplants, Ali spent manyhours with me debating the Islamic stance on donating and receiving bodyparts. Ali was one of the few patients in the ward who could inpractical terms undergo a transplant without too much financialhardship: his wife and his many siblings had repeatedly offered todonate their kidneys to him, and his army insurance would cover allcosts of the operation in Cairo. Yet Ali was convinced that this washaram For the municipality of Haram, see .For the technical Islamic legal meaning, see .The Arabic term ḥaram has a meaning of "sanctuary" or "holy site" in Islam. (forbidden/sinful). Ali and I continued for months discussing his situation. One day hetold me, "Religion is the only issue that is stopping me. (15) Mostpeople in my situation would say it is halal ha��lal? Islamn.Meat that has been slaughtered in the manner prescribed by the shari'a.adj.1. Of or being meat slaughtered in the prescribed way: a halal butcher; a halal label. [permissible], because theyneed it. It is very rare to find someone like me who needs it and stillsays it is haram." I asked him, "Why are you not convinced by the shuyukh(Islamic scholars) who say it is halal?" He answered: "I have nothing to do with them" (malishda'wa bihum). Ali asked me to read him what I had written so far.After I did, he nodded and continued, "Write this down: If I got atransplant, I would have to pay no money. My wife wants to give me herkidney, and the army will pay for it, and they say that I will getexperts from abroad [to perform the operation]. But I am convinced:No." The army and other employer insurances calculated that the costs oftransplantation would be less than years of dialysis treatment, and manyencouraged the (ex-)employees whose treatment they paid for to seektransplantation. I asked Ali why he was so convinced not to pursue atransplant, and Ali told me that God did not make it easy for him toaccept the idea. I told him, "But you wouldn't have to pay anymoney, and your wife has offered to give you a kidney. Why isn'tthis [evidence that] God has made it easy for you?" Ali shook hishead and said, "No, but I prayed salat Noun 1. salat - the second pillar of Islam is prayer; a prescribed liturgy performed five times a day (preferably in a mosque) and oriented toward Meccasalaah, salaat, salahworship - the activity of worshipping al-istikhara." He pulled out a wrinkled piece of paper that he carried in hiswallet. He told me: "Look at the date." The date on the piece of paper was over a year old: April 26, 2002.It was a referral from the army for a fully paid appointment forAli's wife to be tissue-typed with him. Ali's wife had beenpleading with him to go to the appointment, but Ali had been refusing,feeling that it was not right. The Arabic word istikhara means "seeking the good." ManyMuslims, when faced with a choice that they feel they cannot make,perform a special salat (ritual prayer) of two raka' (prayercycles) in length, and then ask God directly for proper guidance so thatthey can make the choice that will be good for them in life and infaith. In Egypt, Muslims often pray salat al-istikhara before a marriagechoice. They believe that your heart must be neutral, that you cannot beleaning toward one decision or another, and that you must truly becommitted to doing what is right. God will then answer by makingapparent the right choice. Ali told me that after praying salat al-istikhara, he never felt"happy" about a decision to go and get tested for tissuetyping Tissue typingA procedure involving a test or a series of tests to determine the compatibility of tissues from a prospective donor and a recipient prior to transplantation. . He told me that he did not feel like the right thing for him todo was to get up and get dressed and say to his wife, "Let'sbring the kids and go get tested now." I asked him, perhaps toocynically, if he felt this way about going to the dialysis unit threetimes a week. Defiant, he said yes. Ali explained that he interpretedhis reluctance to tissue-typing to be God's answer to his prayer,and refused the idea of transplantation for the past five years, out offear that it was haram. Having articulated a deep mistrust of state-appointed Islamicscholars, those who described the practice as "permissible" onstate television and in the newspapers, Ali felt that he had only hisown heart and conscience to trust. That it why he was deeply committedto seeking God's counsel through prayer. When he looked in hisheart, he did not find transplant as an option that would bring"the good" (al-khayr). A Change of Heart Ali spent hours debating with himself, and with me, about whykidney transplantation Kidney TransplantationDefinitionKidney transplantation is a surgical procedure to remove a healthy, functioning kidney from a living or brain-dead donor and implant it into a patient with non-functioning kidneys. could not possibly be pleasing to God. He wouldtell me, "God is trying me with this disease. When we are tried byGod, we remember Him and praise Him for everything. God says: 'Hewho is not pleased with My will can find another universe [besides theone God created] to live in.'" That is why it surprised me when one day I came to the unit and Alihappily announced to me that he was going to get a transplant. I askedhim what had changed his mind. He had gone to Cairo to the militaryhospital for a check-up and the doctor who treated him there himself hada transplant operation in the United States. He encouraged Ali, tellinghim that God had given us our bodies as a trust (amana) and that he wastherefore responsible to take care of it. Dialysis was slowly ruininghis body, the doctor told him, and was not a treatment that would evermake him better. But, the doctor reasoned, God blessed him with thechance to have a transplant and the military insurance that could coverit. When I had previously spoken to Ali, he would tell me that his wifehad pleaded with him daily for her to give him her kidney, but that herefused completely, not wanting to hurt her in any way. But his recentdoctor's appointment had clearly made an impression on him.Furthermore, he said, one of the patient's sons in his dialysisunit, a military Captain, had heard a television program where arespected Islamic scholar said that it was not haram to have thisprocedure done, and that God urges us to seek cures. The scholars ontelevision had said that it was haram to leave your body to deteriorate,Ali explained, (ma ta'adish nafsak lil tahluka), paraphrasing theOur'anic verse in colloquial col��lo��qui��al?adj.1. Characteristic of or appropriate to the spoken language or to writing that seeks the effect of speech; informal.2. Relating to conversation; conversational. Egyptian Arabic. Ali was happy and laughing that day, saying "May God stand byus." He said that when he was in the Ma'adi hospital, he spoketo a lot of doctors and that they said that they performed transplantoperations there every day, and that the outcomes were successful.People did fine after transplants, they told Ali. Ali told his wife, Wafiyya, to come to the unit that day so that Icould speak with her as well. As we passed by him to go to the waitingroom, he winked and gave her a high-five. Wafiyya and Ali, both 28 yearsold, had been married for seven years and had two young children.Wafiyya's situation illustrates the ways in which kinship patternsshape the ethics of organ transplantation in Egypt. Wafiyya told me: Before, Ali kept saying that it was haram, and also he was worried about me, because of the children. From the beginning of his sickness, I've been begging him to transplant. Dr. Charles, also for the past two to three years has been telling him that he's young and that the disease will hurt him. (16) But he kept saying that transplanting was haram. Back when we got the qirar [authorization for state medical coverage] to be able to do the tests, we were on the path to getting this transplant done, and all of a sudden he said: "No." But now he's starting to accept the idea again ... I heard [the popular television religious figure] Shaykh Sha'rawi say that God gave [your body] to you, and you can't give away what God gave you. But I said [to Ali]: Why can't I give it to you? I'm going to save you. Am I supposed to leave him and let him die? But he kept saying no, because of the children. Back then, our daughter was 3 and a half years old and the boy was just three or four months old. Now the girl is six and the boy is 4. But I'm still worried about them (She starts to cry). Right now they are in a nursery--where will I leave them? Who will look after them? His brothers and sisters say, "[We'll donate], leave your wife. She's so young." I went and talked to my parents. I told them: "This is my life and he's my husband, and if God forbid, something happens to him, what am I going to do?" (She starts to cry again.) Wafiyya's parents felt that they had to protect her at allcosts. What went unstated was that Ali could soon die, and her parentsworried about her being in a vulnerable physical and social situationthat could be exacerbated by the loss of her own kidney. But her mainconcern was for her husband to get better so that their family lifecould continue. Ali's siblings felt bad letting Wafiyya be the oneto donate, but if they were to donate, Ali would have to worry about hissiblings' spouses' feelings. (17) Wafiyya continued: Yesterday, the army doctor in Cairo said to him: "It's been five years on dialysis. That's enough." The doctor's wife had given him her kidney, but [they performed the operation] in the United States. So Ali said to himself, "When you keep washing your galabiyya [long dress-shirt] it starts to tear, and it wears out. Dialysis is like that, washing the kidney and wearing it out. After five or six years it will be completely worn out." The body is the same way. He is making jihad [struggling to get better] on his whole heart, on his whole body. Wafiyya was obviously torn over the position she was in. At leastwhen All had refused to even consider a transplant, on the grounds thatit was haram, she had given up feeling responsible. Now, she said: I just want him to transplant so that he gets better, and so thathe can get back to his normal self. But he says that he doesn'tbelieve that transplanting will get him back to normal. (18) I tell him:"Our Lord is with us" (Rabbina mawgud). Ali and Wafiyya did eventually decide to return to the Cairomilitary hospital laboratory for tissue analysis. (19) A few weekslater, I was back at the dialysis center when Ali got a phone call inthe unit. I could see Ali's face clearly while he was on the phone. It was from Wafiyya and she had just gotten the results of the labback. Ali tried to act calm and unaffected: "Wafiyya heard from the[military] hospital. Let's see what will happen now," heannounced to a fellow patient, Madame Sabah, before returning to Wafiyyaon the phone. There was no tissue match. Ali still sounded unimpressed saying, "Okay, okay, MadameSabah sends her salamat [greetings] to you," and hung up,announcing to whoever was interested that there was no match. (20) Madame Sabah immediately saw through Ali's attempts to becavalier about the news. She said: "Don't be upset, Ali,we're better off this way. We won't make other people [i.e.the donor] sick with us, we won't get all swollen [from thepost-operative treatment], we won't be in the hospital days afterdays, worrying about some kind of infection. The way we are withdialysis is just better." Madame Sabah was a widow in her fifties who never had any children.She was so pleasant and well-loved that she had many family members whooffered to donate their organs to her, most pressingly her niece. Butthere was no way Madame Sabah could think of taking this from her.Mothers generally refuse to take kidneys from their daughters; theunstated presumption was that life should flow from older to youngergenerations. In this logic, who is a mere aunt to accept a kidney fromher niece? Later, Ali told me, "Madame Sabah was just saying those thingsto make us both feel better, so that we would be able to stay patientand steadfast in the face of this hardship (tasabbar nafsaha watasabbarni). But of course she wants a transplant and to get better,just like the rest of us. But what can we do?" In the months that followed, Ali came to accept this news as a giftfrom God. God had prevented him, he explained, from doing somethingpotentially haram. He continued to thank God for the blessings that hewas receiving on dialysis. A year later, the patients in the dialysisunit were cheered up by the news that Ali's wife Wafiyya gave birthto another baby girl, whom Ali described as "sweet as honey." The hours that I spent talking with Ali made me appreciate morefully the complex ways in which people embody and live questions aboutdivine will and how much of their lives they feel they can control, andhow much they feel they should control. In contrast to the US situation,where kidney-failure patients could be put on a waiting-list to receivekidneys from anonymous brain-dead donors, in Egypt, patients had to"find kidneys" themselves, from living donors. (21) It wasclear that in the Egyptian case, patients themselves having to findtheir own kidney for transplant brought to the surface a host of ethicalquestions and dilemmas. (22) Once, in trying to compare Ali's situation with that ofpatients in the US, I asked Ali what he would do if he couldhypothetically put his name on a list and be told that the hospitalwould make all the arrangements for him to receive a kidney from ananonymous dead donor. He thought for a while and said that he wouldprobably accept it, even if deep down inside he still had reservations. A remarkably insightful man, Ali realized that his refusal wasshaped and instantiated in a particular social situation in which he hadto overcome several obstacles to proceed with a transplant (to find adonor, to be responsible for the donor's tests, to bear theresponsibility for the donor's sacrifice, pain, and side effects).Already predisposed to mistrust this particular medical practice, Alilacked the drive to surmount sur��mount?tr.v. sur��mount��ed, sur��mount��ing, sur��mounts1. To overcome (an obstacle, for example); conquer.2. To ascend to the top of; climb.3. a. To place something above; top. each hurdle, as each of these stepscontinuously raised for him the ethical uncertainties surrounding organtransplantation. He thus recognized that were he in an alternatesocio-medical setting in which a kidney was somehow made available tohim without such constant reminders, he would likely accept it. Giventhe reality he lived in, though, he turned to God to seek the strengththat he needed to remain on dialysis for the rest of his life. In explaining Ali's reluctance to pursue transplantation fromhis wife in his first five years on dialysis, his physicians describedhim as "religiously extreme" or "fatalistic." ButAli himself did not think of his religion as preventing him from seekinga beneficial treatment. Nor was his reluctance the default position dueto scarce material resources inhibiting medical access. Ali did havemilitary insurance that could cover all the costs of a transplant, andfamily members willing to donate to him. Yet he insisted that he wouldrather die and "meet God" than be responsible for causing harmto his family members, or for putting his family in debt to buy a(tissue-compatible) kidney, which he saw as clearly haram. (23) Aliharbored deep reservations about "using" his wile as hiskidney donor--being responsible for his wife's potential illness,suffering, or potential inability to look after their children. (24) But what are we to make of Ali's sudden change of heart? Hehad temporarily allowed himself to be convinced by a competing moraldiscourse about the meaning of the "body belonging to God," inwhich he should pursue transplantation as a means to respect and carefor the body that God had given him. And what are we then to understandof Ali's ultimate acceptance of the news of incomplete tissue matchas a divine sign to not pursue the transplant? The doctor at the military hospital, and hearsay hearsay:see evidence. from a fellowpatient's son about the proclamations of a television shaykh (ofthe type Ali had earlier claimed not to trust) were in one instance ableto convince Ali that it was part of his religious duty to pursuetransplantation to protect the body as a divine trust. This occurred ina new context in which Ali was shown the fruits of successful transplantsurgeries and the routinization of transplantation in a large militaryhospital in Cairo. While his thrice-weekly routine of hemo-dialysis in aless-than-ideal hospital setting in Tanta had made him wary of medicalservices and practices, the state-of-the-art facilities in Cairo hadmade an altogether different impression on him, particularly thedoctor's exhortations that such potentially efficacious treatment(the doctor himself having been a post-transplant survivor returning todaily activities) were within his reach. Perhaps it was returning to the reality of poverty in his ruralvillage in Minufiyya that deflated his hopes. Or perhaps it was hisreturn to the drudgery of the commute to Tanta and the dialysis regimen.When a slim window of hope had opened and transplantation looked like itmight be a beneficial solution to his illness, Ali saw it as not onlyreligiously permissible, but agreed with the doctor that it would be areligious duty to pursue it, if it meant restoring his health. But thishope was fragile, and was soon crushed with the news of an incompatibletissue match with his wife. Patients like Ali who at times seemed the most resolute in theirpositions often change their minds depending on changing circumstancesin their lives. This does not make their religious convictions any lessstrong or meaningful. Finding it hard to believe the religious scholarswho permitted transplantation, and long unable to make this positionsalient in a situation in which he might harm his young wife, Ali hadinitially turned to supplication and prayer for guidance. Many analystsof religion, appealing to notions of false consciousness, would maintainthat such behaviors are examples of religion serving as a "comfortmechanism" in suffering. In Egypt, some physicians andinterlocutors I encountered would interpret the fact that Ali hadbelieved that transplantation was permissible when his wife was stillpotentially a donor for him, and later as forbidden/sinful when hiswife's tissues were not a match, to be a manipulation of thereligion to suit his circumstances. But such an interpretation would miss the point. Religion was notan object external to Ali's self that he manipulated to suit hisneeds. Devout patients like Ali embodied a religious tradition in whichthey struggled to cultivate within themselves the disposition of rida,or contentment with God's will. Ali believed strongly that truesubmission to God maintains that God's will transcends everything,and the purpose of worship and remembrance is to bring oneself in uttercloseness to God, such that "God is with you wherever you are"(The Qur'an, aI-Hadid, 57:4), and "Wheresoever where��so��ev��er?conj.In, to, or from whatever place at all; wherever.Adv. 1. wheresoever - where in the worldwherever you turn, thereis the Face of God" (The Qur'an, aI-Baqara, 2:115). That is tosay, in Ali's devotion to God, when he felt that he had theopportunity for transplantation, he felt that God had willed for him toseize this opportunity. When there was no such potential, after news ofhis wife's incompatible tissue type, he read God's willfavorably as well: that God had prevented him from pursuing somethingpotentially harmful or sinful. In the words of an oft-cited Prophetic tradition, "Howremarkable is the case of the believer! There is good for him ineverything, but this is not the case for anyone except for the believer.When the believer receives any good, he is thankful to God, and gets areward. And when some misfortune befalls him, he endures it patiently,for which he is (also) rewarded." (25) As Ali and many patientsre-iterated, the Prophet Muhammad indeed told his believers to"seek counsel (fatwa fat��wa?n.A legal opinion or ruling issued by an Islamic scholar.[Arabic fatw ) from their own hearts." This had ledmany to the conviction that behind their specific illnesses lay divinewisdom. In these specific struggles toward God and conscientiousdevelopment of dispositions of fortitude, they embodied the sentimentthat their bodies belong to God and remained preparing for the day thatto God they would return. One day when sitting with a group of patients' wives andmothers in the dialysis waiting room, I heard them discuss the possiblecauses of kidney failure. They wondered whether their loved ones werepredisposed because of previous infections with schistosomiasis schistosomiasis(shĭs`təsōmī`əsĭs), bilharziasis,or snail fever,parasitic disease caused by blood flukes, trematode worms of the genus Schistosoma. , whetherit was the toxic water or air or whether it was the pesticides in thefood. (26) One woman then forcefully cut the conversation short:"No, this comes from God," she said. The patients nodded andthe conversation shifted. This reiteration was a reminder thatGod's infinite wisdom is behind all trials. It was also a call forthe proper disposition toward illness. To blame the environment for highlevels of toxicity when one feels ultimately helpless against it fostersfrustration and anger, rather than the proper sensibility ofsteadfastness, fortitude, and ultimate gratefulness toward God. (27)God's will, in this worldview world��view?n. In both senses also called Weltanschauung.1. The overall perspective from which one sees and interprets the world.2. A collection of beliefs about life and the universe held by an individual or a group. , is never deemed"senseless." (28) Dialysis patients who cried out in pain weregently told by fellow patients or family members to glorify God instead. Through ethical dispositions toward steadfastness and patience,many ill patients drew on Islamic theological notions of faith in theface of suffering as redemptive of past sins or heedlessness of God.Some patients lamented that they could not perform the pilgrimage toMecca due to their dialysis treatment, and some of them debated amongstthemselves whether they could try to make the trip anyway, given thatSaudi Arabia has dialysis centers available. One of the patients in thecenter had discovered that he had acute renal failure when he fell intoa coma while performing the hajj hajj(häj), the pilgrimage to Mecca, Saudi Arabia, one of the five basic requirements (arkan or "pillars") of Islam. Its annual observance corresponds to the major holy day id al-adha, in Mecca. He was taken to a hospitaland put on dialysis for months until he was well enough to come home. Hehad later remarked how grateful he was for the fact that the Saudigovernment had funded such treatment and made it available to those inthe country for pilgrimage. This story had made other patients considerembarking on the journey. It was not that they saw it as an obligationthat they must fulfill; it was clear to them that in their states ofillness they were exempt from this duty. They envisioned the hajj as asublime spiritual experience that would re-charge them with thefortitude and faith required to go on. Here again, steadfastness is nota "passive" disposition, but one that requires a training ofthe senses through acts of piety, such as ritual prayer, reflection,invocation of God, or pilgrimage. Conclusion In Western academia, there has been much discussion of Muslims as"passive fatalists" on the one hand, and attempts to show thatthis is not the case--that Muslims really do have "agency," onthe other. Yet this debate has missed the more important questions ofhow such a disposition (what I have called the reliance on andacceptance of God's will) is achieved, and under what contexts.Many patients with whom I worked in Egypt conscientiously and rigorouslytrained themselves to regard all acts as products of God's perfectwisdom and ultimate will (Asad 2003; Mahmood 2005). Many lamented thatthey fell short of the religious virtue that they sought to attain. Truefaith, as they saw it, is accompanied by tawakkul, a disposition thatmust be continuously cultivated through pious practice and reflection.It is only through constant prayer and strong belief, they often toldme, that they could endure their trials. Whereas the disposition of forbearance can clearly provide greatsocial and psychological relief to the patient, this does not mean thatpatients manipulate religious sentiments to maximize this benefit fromit. One tendency in Western scholarship is to view the cultivation ofsteadfastness as passive, and another is to view it as an activemanipulation of the religion to serve as a comfort mechanism, or toplacate the disadvantaged (Sholkamy 2004). We should not assume thatpatients foreclose fore��close?v. fore��closed, fore��clos��ing, fore��clos��esv.tr.1. a. To deprive (a mortgagor) of the right to redeem mortgaged property, as when payments have not been made.b. all treatment options out of "fatalism,"nor should we assume that they merely appeal to God to comfortthemselves, after the fact, in their lack of access to treatment. (29)People embody and experience religions to varying effects. In the caseof Ali, his efforts to cultivate steadfastness as he struggled to"find the good path" involved a continual alignment of himselfwith God's will. He continually invoked God to allow him tounderstand each turn of event as part of God's overall plan ofbenevolence BENEVOLENCE, duty. The doing a kind action to another, from mere good will, without any legal obligation. It is a moral duty only, and it cannot be enforced by law. A good wan is benevolent to the poor, but no law can compel him to be so.BENEVOLENCE, English law. and compassion (al-rahma). To assume that religious practitioners refuse particulartechnologies or medical interventions out of "fatalism"carries the danger of missing the contingencies that inform when andunder what conditions patients work to achieve this disposition. Such acharacterization potentially overlooks rampant problems in medical carewhich patients seek to avoid. Paul Farmer has memorably cautionedagainst the tendency to confuse structural violence, poverty andinequality with "cultural difference" (Farmer 1992, 1997,1999). I would add that there is also a tendency to conflate con��flate?tr.v. con��flat��ed, con��flat��ing, con��flates1. To bring together; meld or fuse: "The problems [with the biopic]include . . poverty andstructural violence with "fatalism"--a tendency which obscurespossible problems with treatment as well as the ways in whichforbearance is a virtue that can be actively cultivated in coping withsuffering, rather than a direct outcome or cause of suffering. The perceived efficacy of a treatment plays an important role inshaping an ethical stance toward it. To understand complex ethicaldecisions, we must be attentive and vigilant to patients' ownexperiences and understandings of their disease processes and etiology,and their own cost-benefit analyses which may be articulated inreligious terms. That said, we should not assume that patients appeal toGod's will only because a treatment has been deemed inefficacious in��ef��fi��ca��cious?adj.Not capable of producing a desired effect or result; ineffective.in��effi��ca or inaccessible. In many cases, the ethical disposition patients havetoward a particular treatment, an assessment of its benefit and harms,as well as understandings of disease etiology and specific experiencesof the illness are not separate from, nor do they formulaicallydetermine, various dispositions toward divine will and acceptance. (30) I have argued in this article that religious sentiments, includingthose that attribute a positive value to steadfastness in suffering,should not be seen as passive, as anti-science, or as constraints tomedical treatment. In various ways, patients grappled with how toachieve the most benefit for themselves and their families while tryingto conform to what would please God. Reliance on God should not beunderstood in opposition to seeking treatment--that is, we should notask whether patients appeal to God or seek treatment, for one does notnecessarily exclude the other. Rather, we should remain attentive to theinterrelations between the two. An appreciation for what it means toembody a religious tradition, in which religious reasoning and sentimentis not understood as external to the self, but as central to it, canhelp us broaden our understanding of medical life-and-death decisionsand of ethical formations in devout patients' lives. ACKNOWLEDGMENTS Thanks to Mazyar Lotfalian and Christopher Furlow for theirinvitation to submit to this special issue. I benefited from thediscussion of Michael Fischer al the AAA panel on "Islam andScience" in December 2006, and from feedback on previous drafts ofthis piece from lan Straughn, Jessaca Leinaweaver, Zareena Grewal, andtwo anonymous reviewers for AQ. Thanks also to Richard Grinker, AQeditor. NOTE ON TRANSLITERATION I have simplified standard IJMES IJMES International Journal of Middle East Studies transliteration from Arabic toEnglish. I have omitted the 'ayn in front of Ali because'Ali's in possessive form appears cumbersome. 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Berkeley: University ofCalifornia Press. Weber, Max Weber, Max, German sociologistWeber, Max(mäks vā`bər), 1864–1920, German sociologist, economist, and political scientist. At various times he taught at Berlin, Freiburg, Munich, and Heidelberg. . 2003 [1904]. The Protestant Ethic and the Spirit ofCapitalism. Mineola, NY: Dover Publications, Inc. Sherine F. Hamdy Brown University ENDNOTES (1) Fatalism, the notion that humans can exert little or no controlover their own destinies, has long held the fascination of Westernsocial theorists. For example, Durkheim (1979[1897]) argued thatfatalistic tendencies resulted from structural forces in society thatcoerced individuals into feelings of utter hopelessness. Weber'scomparative study of religion focused on the cosmological forces thatshaped fatalistic worldviews (2003[1904]). Weber specifically turned toIslam and Hinduism as cases to contrast with the purportedly morelogical and rational notions of predestination predestination,in theology, doctrine that asserts that God predestines from eternity the salvation of certain souls. So-called double predestination, as in Calvinism, is the added assertion that God also foreordains certain souls to damnation. that were central toProtestant theology and from which emerged modern capitalism. SeeNafissi 1998 and Acevedo 2008 for a discussion. According to the FrenchMarxist historian Maxime Rodinson, Weber did more than anyone toestablish the view that Islamic "fatalism" is responsible forthe stagnation StagnationA period of little or no growth in the economy. Economic growth of less than 2-3% is considered stagnation. Sometimes used to describe low trading volume or inactive trading in securities.Notes:A good example of stagnation was the U.S. economy in the 1970s. of Muslim societies and the "listlessness listlessnessshows lack of interest in its surroundings. " ofMuslims (cited in Nafissi 1998:107). (2) This assumption forms the premise of Samuel Huntington'sand others' "Clash of Civilizations" thesis that arguesthat the cultural division between the Judeo-Christian West (in which anethic of individual self-empowerment prevails) and Islam (in whichMuslims are condemned to fatalism, authoritarianism, and the inabilityto evolve) will dominate the global political scene of the 21st century(Huntington 1993, 1996; see Acevedo 2008 for a discussion). (3) Hence the particular European narrative of science andtechnology emerging in opposition to religion is assumed to beuniversal. Another false assumption is that science and technologynecessarily lead to social benefit for all. (4) Such debates surface in centuries-old debates of Islamicthought, whether under the rubric RUBRIC, civil law. The title or inscription of any law or statute, because the copyists formerly drew and painted the title of laws and statutes rubro colore, in red letters. Ayl. Pand. B. 1, t. 8; Diet. do Juris. h.t. of kalam (theological debates),'aqida (doctrine), or fiqh (jurisprudence). Varyingconceptualizations of human behavior, between the poles of tawakkul(utter reliance on God's will) on the one hand and sa'i(acting in this world) on the other have parallels to, but are not thesame as, longstanding philosophical and theological debates betweenirada (human agency) and qadar Allah (the predestination of God'sultimate will). (5) The legitimacy of viewing God's predestination of allevents as negating human agency and human responsibility (al-istislamal-qadari) has been refuted by Islamic scholars. However, I would arguethat contemporary Muslims, including nationalists and physicians, lookdown on tawakkul (which is highly valued in the Islamic scholarlytradition) as also being "anti-science" and anti-progress (asdo Western observers) and bolster their arguments with Islamic scholarlydiscourse against al-istislam al-qadari. In Western academia, I believethat the word "fatalistic" has been used to describedispositions that might be variously called sabr, tawakkul, oral-istislam al-qadari. (6) Muslim reformers such as Muhammad 'Abduh, Rashid Rida, andJamal al-Din al-Afghani Jamal al-Din al-Afghani(born 1838, Asadabad, Persia—died March 9, 1897, Istanbul) Muslim politician and journalist. He is thought to have adopted the name Afghani to conceal the fact that he was of Persian Shi'ite origin. re-oriented discussions of correct Muslimbehavior in terms of active responsibility and social progress,specifically arguing that the active pursuit of scientific knowledge wasa duty incumbent upon Muslims (Keddie 1972, Hourani 1962, Kerr 1966,Dallal 2000, Rahnema 1994). (7) The Egyptian fellah, or peasant, was said to be particularlyprone to submissiveness and fatalism, a disposition that observers usedto explain the continued oppression of Egyptians and their supposedaversion to revolt. Historian Gabriel Baer discusses how misleading thisgeneralization is and on what shaky grounds it stands; see Baer 1969,chapter 6. For a humorous and insightful discussion of Ayrout'sdepiction of the fatalistic Egyptian peasant, and its continuedappearance and persistent influence among "experts" on Egypt,see Mitchell 2002. (8) Important exceptions to this lacuna lacuna/la��cu��na/ (lah-ku��nah) pl. lacu��nae ? [L.]1. a small pit or hollow cavity.2. a defect or gap, as in the field of vision (scotoma). are discussions by Asad1993, Asad 2003, Mahmood 2005, Hirschkind 2006. (9) Tanta is the capital of the Nile Delta province Gharbiyya,located less than 100 km north of Cairo. I conducted fieldwork in fivedifferent private and public dialysis centers there. I omit the fullnames of patients and physicians to protect their privacy. Allinterviews were conducted in colloquial Egyptian Arabic. (10) Although the poor receive government compensation fordialysis, this does not mean that all poor patients in need of dialysisreceive it. Major obstacles include high rates of under-diagnosis ofkidney failure, the lack of access to dialysis clinics, and the lack ofknow-how to obtain the necessary paperwork from the government forcompensation. (11) This illustrates the ways in which physicians in Egypt act associal gatekeepers. In this instance, the physicians did not confinetheir role to intervening in the health of Muhammad, their patient, butalso intervened in the larger social consequences of his family,including of a potential wife. (12) As I lay out in my larger study on organ transplantation inEgypt, the lack of agreement over the legality of extracting organs frombrain-dead patients means that transplantation (of the kidney and liverlobe) depend entirely on living donors. See Hamdy 2006. (13) For discussions on whether sub-atomic particles are"discovered" or "constructed," see Andrew Pickering(1984) and lan Hacking (1999). (14) Minufiyya is a rural province in the Nile Delta, from whichAli commutes to Tanta thrice-weekly for his dialysis treatment. (15) Armando Salvatore (1997) discusses what he calls thehyper-objectification of Islam among both Western observers andcontemporary Muslims who draw on Islamic rhetoric for political ends.Ali, in his politicized form of Muslim identity, stands out from theother patients (many from rural backgrounds) when he makes statementssuch as "Religion is the only thing stopping me." Most of hisfellow patients do not articulate "religion" as an autonomousagent in this way. I argue in the paper that Ali does not generally view"religion" as an object external to himself, but in the abovequote he is participating in an increasingly dominant discourse thatrepresents the role of religion in one's life in this objectifiedway. (16) Dr. Charles was a British nephrologist NephrologistA doctor who specializes in the diseases and disorders of the kidneys.Mentioned in: Kidney Biopsynephrologistwho oversaw thedialysis clinic in Tanta. (17) See Hamdy 2006 for a discussion of how kidney donation flowsalong specific kinship patterns, with respect to age, gender, and familyposition. (18) See Crowley-Matoka 2005 on Mexican post-transplantpatients' sense of liminality between illness and recovery, and howthey never quite achieve the promise of returning to "normal." (19) Crowley-Matoka notes that much unlike the situation in theU.S., in Mexico (and, I would add, in Egypt as well) it is the medicalprofessionals who create the desire and demand for kidneytransplantation among patients (2005). (20) The more powerful generation of immunosuppressant drugs Immunosuppressant DrugsDefinitionImmunosuppressant drugs, also called anti-rejection drugs, are used to prevent the body from rejecting a transplanted organ. thatare now available in Egypt (at higher cost) make complete tissue matchless necessary, and many in Ali's position might have proceededwith the transplant anyway. In this case, refusal to proceed was both acombination of reluctance on the part of Ali and on the part of thephysicians. Because the number of patients needing transplants farexceeds the facilities available, physicians in Egypt (in statehospitals) are disinclined to proceed with transplants without a fulltissue-match, to increase chances of graft survival. See Cohen 2001 onthe relationship between donating kin and immunosuppressant drugs. (21) The process is much more mystified mys��ti��fy?tr.v. mys��ti��fied, mys��ti��fy��ing, mys��ti��fies1. To confuse or puzzle mentally. See Synonyms at puzzle.2. To make obscure or mysterious. in the contemporary U.S.,where kidneys are procured through a complex medical industry, theminutia mi��nu��ti��a?n. pl. mi��nu��ti��aeA small or trivial detail: "the minutiae of experimental and mathematical procedure"Frederick Turner. of procurement rendered less visible to the waiting patients.This is especially the case with organs procured from brain-deadpatients. Yet living kidney donation is currently on the rise in theU.S., exceeding cadaver cadaver/ca��dav��er/ (kah-dav��er) a dead body; generally applied to a human body preserved for anatomical study.cadav��ericcadav��erous ca��dav��ern. donation for the first time in the U.S. in 2001.(Kaufman et. al. 2006:82). (22) Crowley-Matoka argues that with each step (finding a kidney,testing, paperwork, etc.) desire for the transplant is created andsubstantiated in the patient (2005). Ali's case also shows thatwith each step, a patient's hopes can be quickly dashed. NorthAmerican North Americannamed after North America.North American blastomycosissee North American blastomycosis.North American cattle ticksee boophilusannulatus. kidney-failure patients also face these dilemmas of findingtheir own kidneys, when they feel that the waiting-lists are too longand that they cannot sustain life on dialysis while waiting (see Kaufmanet al. 2006). (23) While the buying and selling of organs is officially illegalin Egypt, hospital regulations generally turn a blind eye to thepractice which has proliferated in Cairo, and hospital laboratoriesoften facilitate tissue-compatible donors willing to sell their kidneyswith potential recipients. (24) I argue elsewhere that wives' bodies are generally seenas more "expendable" than those of men, and that wivesgenerally donate kidneys to their husbands at much higher rates than theother way around (Hamdy 2006). (25) This hadith hadith(hädēth`), a tradition or the collection of the traditions of Muhammad, the Prophet of Islam, including his sayings and deeds, and his tacit approval of what was said or done in his presence. is well-known and oft-cited among Egyptians. It iscited in the modern Islamic scholar Sayyid Sabiq's compendia com��pen��di��a?n.A plural of compendium. ofhadith traditions, Fiqh al-Sunna (Sabiq 1994). (26) See Hamdy 2008 for the ways in which poor Egyptian dialysispatients posit what I call "political etiologies" for theirkidney failure which renders the logics of transplantation nonsensical.I argue that poor Egyptian kidney-failure patients understand andexperience their illness in terms of Egypt's larger social,economic, and political ills, implicating corrupt institutions, pollutedwater, the mismanagement mis��man��age?tr.v. mis��man��aged, mis��man��ag��ing, mis��man��ag��esTo manage badly or carelessly.mis��manage��ment n. of toxic waste toxic wasteis waste material, often in chemical form, that can cause death or injury to living creatures. It usually is the product of industry or commerce, but comes also from residential use, agriculture, the military, medical facilities, radioactive sources, and , and unsafe food.Transplantation is thus understood to be a medical treatment whosepotential benefits cannot possibly surmount the harm done to theirbodies, nor do the benefits seem to outweigh the costs. (27) In contrast, recognition of the cause of injustice andsuffering and doing something about it, if one was able, is viewedpositively in Islam, as part of "commanding the good and forbiddingthe wrong" (see Cook 2003 and Mahmood 2005). (28) This is an important point because scholars of organtransplantation in North America argue that a major incentive forsurviving family members to agree to the donation of their lovedones' organs is to construct meaning out of the"senseless" loss of life (Lock 2002, Sharp 2006). (29) Hence my slight difference from Hania Sholkamy'simportant discussion of forbearance in Egyptian medical experiences,where she writes: "God, as the ultimate source, is a formula thathelps ex post facto acceptance but is not one which precipitates an apriori a prioriIn epistemology, knowledge that is independent of all particular experiences, as opposed to a posteriori (or empirical) knowledge, which derives from experience. fatalism. It is a tenet that leaves plenty of room for people totake initiative in defining, managing, and protecting their health andwell-being" (Sholkamy 2004:122). For All, what was important was acontinual alignment of himself, and his own desires, with what heunderstood to be God's will. (30) For example, artificial insemination artificial insemination,technique involving the artificial injection of sperm-containing semen from a male into a female to cause pregnancy. Artificial insemination is often used in animals to multiply the possible offspring of a prized animal and for the breeding with donor sperm isrejected as a treatment for male infertility, but not because it is seenas inefficacious or inaccessible. Infertile in��fer��tileadj.Not capable of initiating, sustaining, or supporting reproduction.infertile,adj unable to produce offspring. couples in Egypt appeal toGod in cultivating steadfastness in their difficult situations ratherthan resort to practices that rely on third-party semen, ova, or wombs,for they consider these practices to be unethical for introducingforeign reproductive elements into a marriage and "confusing"the blood lineage of the offspring. These practices, notably, do notachieve the desired goal, which is defined as producing biologicaloffspring of both husband and wife (Hamdy 1998; Inhorn 1996, 2003).