I am on the hospital ethics committee as the head of the nursing staff and as a nurse practitioner. I am from an Irish catholic background as are the majority of the other nurses. I have worked at this hospital for 30 years and was reluctant to see it go through the transition of becoming non-denominational. I speak for the majority of the nurses at the hospital who have expressed to me similar complaints as myself.
1.
Our private hospital should continue in its longstanding tradition of not providing abortion services to our patients. Not only do our donors come from Catholic backgrounds and we would risk our funding in order to provide these services, but abortion services are immoral and do not respect the dignity of the individual. Medicine works to protect the good of human life, and healthcare staff works to assist a patient struck with illness, regardless of their insurance status (Donum Vitae 1987:145). It is important that we continue to exercise the Christian will of charity to address the needs of our poorest and most vulnerable patients by continuing to subsidize other forms of medical care. However, the most vulnerable in our society include the defenseless and those with no voice. It is therefore that as members of this community we must protect the unborn who only have us to speak up for them. It is important to note that these Catholic teachings are not only based in scriptures shared with our fellow Abrahamic religions but are also based in secular reasoning. For instance, while it is written in the book of Genesis that man was made in the image of God, rational arguments based in nature are also used by the Church to defend its positions, and those arguments can be used in any secular setting. Donum Vitae, the church’s doctrine on the respect for human life with regard to new technologies, states, “No biologist or doctor can reasonably claim, by virtue of his scientific competence, to be able to decide on people’s origin and destiny” (Donum Vitae 1987:145). It is outside of the moral bounds of any healthcare professional to be able to defend or justify their own ability to possess this deterministic value with regards to who will survive. It is our job and the job of this hospital to alleviate suffering of its patients and not to provide abortion services. While our hospital is somewhat remote from others, abortion services are not needed in emergency settings (unless of course the mother’s life is at immediate risk and there is no other option but to proceed with the abortion as an indirect consequence of saving the mother’s life, under which this action would be permissible as they life of the mother is equally as important as that of the fetus) and therefore individuals who choose not to follow this mandate are able to find these services in clinics in the state of Connecticut. The state of Connecticut follows the national precedent of Roe v. Wade and recognizes a human person after the beginning of the third trimester (although scientific advances are proving that premature babies are beginning to survive at even earlier gestation weeks than set out by the law). We argue that while the beginning of physical life at conception does not by any means “contain the whole of a person’s value nor does it represent the supreme good of man”, it does “constitute in a certain way the ‘fundamental’ value of life precisely because upon this physical life all the other values of the person are based and developed” (Donum Vitae 1987:146).
Similarly to the reasoning behind refusing abortion services, I believe that the hospital should not allow for IVF treatments when such treatments result in the discarding of “extra” embryos. It is important to reflect on this position from a rational lens, examining the fundamental values of life and whether or not it is permissible for technological interventions to replace human procreation and to affect a human in the first stages of development (Donum Vitae 1987: 146). In fact this teaching has been backed by science in the sense that “modern genetic science brings valuable confirmation. It has demonstrated that, from the first instant, the program is fixed as to what this living being will be: a man, this individual man with his characteristic aspects already well determined. Right from fertilization is begun the adventure of a human life” (Donum Vitae 1987:148). Therefore IVF treatment disrupts the development of a new life, and therefore changes the natural course of events in human’s biology. Technology is so advanced that now individuals can choose embryos based on lack of disability, or even gender. This type of selectivity puts the physician and the parents as usurpers of the place of God, as they will be “the master of the destiny of others inasmuch as [they] arbitrarily chooses whom [they] will allow to live and whom [they] will send to death and kills defenseless human beings” (Donum Vitae 1987:154). To prevent IVF is to safeguard against what could approach becoming a new type of eugenics, pitting parents against children of disability or children of a certain sex. We as a hospital ethics board must continue to prevent these future immoral acts.
Prenatal diagnosis is acceptable under the moral lens of the church, and I believe that we should continue to assist expecting mothers in all ways possible including prenatal testing. Prenatal testing can assume mothers that they are expecting a healthy baby, or it can make it possible for mothers to plan for accommodating disability or future medical procedures to be carried out on the child (Donum Vitae 1987:150). However, amniocentesis may only be performed if it is believed to “safeguard the life and integrity of the embryo and the mother, without subjecting them to disproportionate risks” (Donum Vitae 1987:150). Amniocentesis is becoming an increasingly safe practice with a trained professional so we believe the evaluation of the risks should be performed and explained to the mother on a case-by-case basic. While I believe that on a hospital-level prenatal diagnosis must continue to be performed, it is important to note that we as medical professionals should not “induce expectant mothers to submit to prenatal diagnosis planned for the purpose of eliminating fetuses which are affected by malformations or which are carriers of hereditary illness, is to be condemned as a violation of the unborn child’s right to life” (Donum Vitae 1987:150). The purpose behind prenatal diagnosis should not be to result in abortion but rather to provide reassurance or assistance to expecting mothers. It is important that as medical professionals we inform mothers of the nature of the testing or at the minimum remain value neutral in order not act in favor of terminating life based on whatever characteristics are considered “better”.
2.
The community based around this hospital is increasingly diverse, and I believe that we as a hospital system should grow in our spiritual counseling to reflect that diversity. The Church holds the utmost respect for other religions and I believe that we should diversify our counseling group to reflect this. In less centralized religions such as Islam or Judaism, the advice of different counselors is especially important to families as there is less of a centralized mandate compared to that of the Church. The values placed on new families may also be different, for instance instead of focusing on natural law and the human person, Islam bases much of its reproductive ethics on the legitimacy of kinship relation (Clarke 2007: 82). These different methods of guidance should be available to our patients.
While many of these religions are more permissible and flexible with regards to ARTs, abortion and prenatal testing, it does not require us as a hospital to provide these different services. On one hand, belief systems of patients may play a large role in why patients choose to undertake procedures that are considered morally impermissible and against natural law (Rapp 2000: 53). At the same time, healthcare delivery in the United States is centered on choice and free will and these patients may go elsewhere to take part in these services. It would be more morally impermissible for us as a hospital to create exceptions, allowing for certain religious groups to obtain these procedures and going against our traditional hospital mandate, than for us to make a blanket statement that provides equivalent and morally justified services to all of our patients.
With regard to the claim that Catholic clergy are interfering with the doctors’ work, it is important to understand that families absolutely always have the right to refuse testing or ARTs, or any treatment in general. The doctors in this hospital should not be recommending that women undergo treatment that puts the fetus at unnecessary risk and should not allow for IVF treatment due to the destruction of fertilized embryos. If doctors are unable to recommend against these procedures for the reasons stated earlier they should at the minimum remain value neutral and refer the patient elsewhere if it is their expressed desire to undertake these morally illicit procedures.
3.
Clearly as the head of the nursing staff and a nurse practitioner I believe that new nurses should absolutely not be hired based just on their willingness to assist in abortion and IVF procedures. It is in the right of a nurse or doctor to refuse partaking in these services as they do not want to be a part of a morally illicit activity that results in the death of human persons. It is morally impermissible for a hospital institution to force an individual to act against their religious beliefs with the threat of being fired. This would violate hospital policy as well as state and federal law. If these services are not provided to our patients, this would no longer be an issue for the nurses at this hospital. Refusing to allow for abortion services is also important to our donor base that allows for us to run a hospital that saves the lives of individuals in this relatively remote area, an objective we as a board should prioritize above all else.
I value your informative comments and your representation of the nursing staff at the hospital. I am the CEO of this hospital who was hired just as the hospital was becoming non-denominational. I have been here for a few years now, and I can see how Catholic beliefs are deeply rooted in the foundation of the hospital and in activities of the community. I may not be a longstanding member of this community but it is easy to see the powerful influence of the Catholic Church here. But as a relative newcomer, I also see the burgeoning communities of Lebanese Shi’ites, Jews, and Japanese. This town has a strong Irish Catholic community and while we certainly need to consider their concerns to a high degree, we also need to keep in mind that the hospital is no longer affiliated with the Catholic Church. Regardless of how this may trouble people, we need to move forward with changes that represent this change. The voices of all communities must be taken into account. With this change comes a re-evaluation of our assisted reproductive technology policies.
With regards to your proposal on the reproductive technology, I agree on abortion, amniocentesis, and prenatal testing, but I disagree with your comments on IVF. I am glad you see the necessity of allowing abortions when the mother’s life is at risk. I certainly respect your opinion that life begins at conception, and in my proposal I do everything I can to uphold those values while appealing to different communities. This is why I included requirements that amniocentesis and prenatal testing only be performed in situations that will aid the health of the mother and fetus. Regarding the idea of natural conception however, I feel our policy must diverge from traditional Catholic opinion. People in our community would use and benefit from IVF, so we must provide these services. Many Jews and Muslims accept this technology as a way of overcoming sterility. Sterility is a serious problem that can be devastating. There is also social pressure in the Jewish community to have children. Should individuals that are having trouble conceiving be told they are simply unlucky and should accept that? IVF empowers couples to fulfill their desires to be parents. Also, rather than “disrupting the development of new life” and “chang[ing] the natural course of events in human’s biology,” conception through IVF aids that development. You can think of it similarly to how you rationalize amniocentesis and prenatal testing because IVF does not harm the embryo in any way. The mother still gestates for nine months as the fetus develops naturally.
You express concerns regarding eugenics and extra embryos. I agree that the extra embryos from IVF are a concern, but there is no way to avoid some wasting of embryos when IVF is performed. The benefits to our diverse community of IVF outweigh the dissatisfaction of the Catholic community. Nevertheless, there are policies we can enforce to limit the expiration of extra embryos. We can encourage couples to donate these embryos to other couples who cannot conceive on their own. I understand the traditional Catholic position that an individual has the right to be born from the womb of his biological mother and raised by his parents; but at the same time, this arrangement would save extra embryos from expiring. I feel you would agree that the death of embryos is worse than its birth by a non-biological mother. With regard to eugenics, we can also enforce policies that prevent couples from choosing which embryos are implanted.
I value your opinion immensely as a nurse practitioner and as a member of the dominant Catholic community. Your concerns must be addressed if our hospital is to continue running smoothly. However, it is important for our community to move away from our association with the Catholic church and place importance on the diversity of voices present in our community. This means accepting new technologies because their benefits for overcoming sterility are greater than their costs.
Great comments Rachel, and good attempt to find middle ground. I appreciate your taking this project so seriously!
Dear Diana,
Thanks for this very thoughtful and well-written response on behalf of the nursing staff. As the professional ethicist appointed to this committee, however, I need to raise some concerns.
For one thing, I appreciate your desire to create exceptions to your general policy on abortion and reproductive services for members of non-Catholic religious groups. However, I must remind you that there is no way that we can legally or ethically defend the provision of different services to hospital patients or clients based on religious profession. Even assuming we could neutralize the legal issues of discrimination raised by this suggestion, how would the hospital go about deciding who is Catholic, Shiite, etc? And if you could cross that hurdle, wouldn’t it require the hospital to make decisions about he adjudication of various legal and moral dilemmas in different religious systems? As you know, for example, Orthodox Jewish teachings on abortion vary to an extent among decisors, and are broadly different from the approach taken by Reform Jews. Would a person of Jewish origin who self-defines as secular be treated by you as Jewish under the category? What about a non-believing Catholic? I think therefore that you need to reconsider this proposal in such a way that the hospital does not make distinctions in care based on religious background or profession.
While I am personally sympathetic to the goal of maintaining the Catholic heritage of this hospital moreover, I think you will need to make some hard choices now that the hospital is no longer under Catholic auspices. I appreciate the care you put in to thinking about IVF, though it is hard to see why IVF should really be treated differently from elective abortion, as this is what it typically entails.
I fear that with this plan you will still alienate your Catholic base but prevent the hospital from serving broader populations.
I also strongly recommend you do a little bit of basic research about the controversy over whether Catholic hospitals can legally refuse to provide abortion services in general.
Certainly, I would feel more confident in advance of our next meeting if you and other committee members had familiarized yourself with these issues.
best,
Dr. Immanuel Kantowitz