In a rapidly developing world centered around technology, I think it is time we, as a hospital, introduce the use of reproductive technology and prenatal testing to our hospital. These technologies not only reflect the incredible strides made in the medical world, but also provide pregnant women and their families with the ability to prepare for their future. As a physician at the Sasquatch Hospital, I believe these technologies are necessary to our hospital, for they will greatly improve the treatment we are able to provide to our patients.
With a growing and varied local population, the ultimate goal of our hospital should be to provide the best medical care our diverse population needs. While I understand the importance of our Catholic origins and what they mean to our donor base, I think it is more important to acknowledge the changing culture in our area. I recognize that some of the policies I am going to propose will not be conducive to the Catholic religion. However, I feel as though we should not limit the medical care and services our hospital can offer due to differing religious beliefs among our population.
One of the major policy changes I wish to make would be to provide reproductive technologies, such as in-vitro fertilization, and prenatal testing, such as amniocentesis. Over the past decade, these technologies have grown in popularity and acceptance, but still face some resistance regarding the ethics surrounding the decisions and outcomes of such technologies. Personally, I do not believe in-vitro fertilization nor prenatal testing are unethical. They are both harmless procedures and exist to facilitate and better comprehend pregnancy and its outcomes. While some may argue that IVF violates the natural laws regarding the appropriate way to conceive a child, I believe “natural laws” are more so a social construct and differ based on the individual and their beliefs. For example, the French bioethics laws initially, “restricted access to artificial reproductive technologies (ART) to sterile, heterosexual couples of childbearing age,” (Ball 2000: 545-546). The French put these restrictions in place out of fear the technological advances would alter cultural norms and defy what they considered “natural.” Although nature served as the source of truth for many Enlightenment philosophers, Rousseau stated, “philosophers of natural law who hold too strictly to the dictates of nature are ‘in habit of abstracting the content of natural law from the behavior of men in civil society. . .’” (Ball 2000: 579). I agree with Rousseau’s statement and believe that what most consider to be natural is subjective and developed from observations of society.
Along with providing IVF treatments, I would suggest implementing a provision to encourage families to allow unused embryos to be donated for life saving research. From a medical standpoint, research done on embryos is somewhat rare and the findings from such research could turn out to be crucial in the future. I understand some families will be unwilling to donate their unused embryos due to personal beliefs, but I think the provision should be included regardless. The demographic in our community has changed dramatically over the years and I think more individuals would be willing to donate unused embryos for research purposes. In order for a patient to make what they believe to be the right decision, it is important for doctors and medical professionals to explain in detail what donating an unused embryo to research entails, conveying both the benefits and consequences of donations. I want to stress that it is unacceptable to make families feel as though they are forced to donate. Pressuring a patient into making a decision that goes against what they believe in is unethical and violates our role as doctors to provide the best possible care and treatment. If the patient chooses not to donate their unused embryo, then we must honor their decision.
Prenatal testing is another service I suggest we provide at our hospital. Prenatal testing, such as amniocentesis, allows pregnant women to test for abnormalities, disorders, and defects of the fetus that previously could have only been realized once the child was born. From a medical standpoint, this technology is revolutionary, providing women with a wealth of knowledge while also giving them time to consider their situation and prepare for the outcome. As stated by someone who has undergone prenatal testing, “what harm can a test do if its going to provide you with important information?” (The Burden of Knowledge: Moral Dilemmas in Prenatal Testing, 1994). Some claim that by offering the tests we would be creating anxiety; however, I find that to be completely false. Just because the tests exist, it does not mean one must undergo them. If anything the existence of the tests can serve to shorten the period of anxiety and relieve women of the unknown.
In regards to the efficacy of prenatal testing, I believe offering and deciding to receive prenatal testing are both ethical decisions. In a study about women and the option to undergo prenatal testing, Reyna Rapp, a feminist anthropologist, described women who received prenatal testing as “moral pioneers.” She viewed these women as individuals who, “submitted to the discipline of a new reproductive technology in order to reap its biomedical benefits,” (Rapp 2004: 307). The decision to use prenatal testing has been given a negative stigma due to the fact that the test results may cause one to be more likely to get an abortion. However, that is not always the case and it should be noted that prenatal tests have the ability to provide women immense medical benefits, without a resulting in a negative outcome. The tests allow women to become aware of the situation they are going to face and provide them with more knowledge and time to prepare for the arrival of their child. Although prenatal tests are considered unethical by certain religions, I believe, as a non-denominational hospital, it is important to look at access to prenatal testing on a more individual, secular basis.
While I personally support the use of prenatal testing, I do understand the issues some individuals still have with such tests, one of them being abortion. A few years ago, the majority of our community was Catholic and many members of the community felt that it was unethical for our hospital to provide abortion services. In recent years, the demographic of our community has sufficiently changed, bringing new cultures and beliefs to our population. After surveying the population, I found close to half of the community identified as pro-choice, reflecting a shift in our cultural norm. Because of this, I advise that the hospital provide abortion services to both insured and uninsured patients. Subsidies for abortions should also be provided and should be determined on a case by case analysis of the patient and their financial situation. I realize that most of the donors still identify with the Catholic religion and the church’s viewpoint on abortion, but we must realize that we are now a non-denominational hospital, and we should respect and cater to the changing ideals reflected in our society. As doctors and providers of care, we made a decision to help the lives of others above all else, regardless of whether or not we personally agree with such services.
The notion of cultural competency has become extremely important in aiding the communication and understanding between patients and their medical team. Defined as, “the need [for healthcare providers] to be understanding as well as sensitive to the different cultures, socioeconomic backgrounds, and belief systems of their patients,” cultural competency allows doctors to adequately and effectively provide care based on their patient and the patient’s needs (Bhattacharya 2006: 5). Regarding the improvement of cultural competency, I think it would be beneficial to continue counseling from Catholic clergy and expand counseling services to clergy of all religions. Being as we are no longer a predominately Catholic community, I believe the expansion of religious counseling services is integral to providing the best care our diversified community. Throughout my experience, I have come to find that religion helps some patients better understand the rather secular nature of the medical language.
In implementing this provision, it has come to my understanding that some doctors have complained about how the opposition to reproductive technology by clergy interferes with their work as a medical professional. As a doctor, I understand the frustration that stems from patients choosing to listen to religious guidance over medical expertise, but the implementation of religious counseling could greatly improve the patient/provider relationship. An example of how religious beliefs come to effect medical decisions can be found in a study done by Sherine F. Hamdy in which she examines why Muslim men come to refuse life-saving treatments. One Muslim dialysis patient in Egypt refused to get a kidney transplant because he believed his body “belong[ed] to God,” and God had already decided when he would die before he was even born, so accepting a transplant would be altering God’s decided path for him (Hamdy 2013). As a doctor, it’s hard to see a patient refuse a treatment that would save their life, but it is important to respect their decision and understand the beliefs behind the decision.
With these new provisions in place, I believe this hospital will be better suited to serve the needs of our local population. By acknowledging both our individual differences and the ever-changing nature of society, we will be able to provide more advanced medical service and improve the lives of those in our community.
Hello Molly,
You cited IVF and prenatal testing as “harmless,” but I think this oversimplifies the medical procedures. IVF produces hundreds of excess embryos (an important factor to the Catholic Church) and secondary prenatal tests (i.e. amniocentesis) have a risk of damaging the fetus, so they are certainly not harmless. Though these risks can be overlooked for the sake of knowledge and health, it is important to be upfront and transparent, especially as a vassal for a hospital. Additionally, I think you have under-emphasized the psychological turmoil of going through medical testing, as discussed by Tsipy Ivry.
I found this to be naive of the financial operating of the hospital and the importance of happy benefactors. The report was geared for like-minded hospital folk, but did not seem to hold any rhetoric towards the often stubborn and strong-willed religious communities. I believe it is important to acknowledge that if I did not agree with your stances before reading this ethics report for religious reasons (which I don’t), my opinion would not have been swayed.
You yourself cited Hamdy in her example of a devoutly religious Muslim man who refused a kidney on religious grounds. If such a man is willing to sacrifice life in the name of his god, how can one assume that a Irish Catholic benefactor would be similarly devout and uncompromising?
Ayman, just a quick note that your use of the term vassal here is incorrect. Do you mean to say “representative”?
Dear Dr. Nestor,
Thank you for this. I appreciate your thoughtful and conciliatory tone, which has not been universal on the committee! However, I would like to point out that you err in making abortion simply a “Catholic” issue. Polls show increasing pluralities of all Americans uncomfortable with unlimited abortion and, I must note, the church’s own position is grounded not in some arcane revelation but on reasoned argument from first principles, i.e. widely accepted natural law arguments. Why do you think the abortion question must be treated as “religious” and hence outside the scope of our adjudication while murder, prohibited even more explicitly in Bible’s mandate not to kill, can be accepted without question on your part as fundamental to an unmarked and non-denomination secular morality? In short, I see a deep logical flaw in your argument which, if you do not address it, undermines the scope and effectiveness of your argument. I would urge you to reconsider. What you are pleased to call religious issues, like whether the hospital should serve meat to patients who request it during lent, or whether counseling outside of church guidelines should be permitted, ultimately concerns me here little. The Church has long proven its desire and ability to act as good citizen in a multicultural and multireligious world. Here however, we are speaking not of “religion” but of the taking of life. I feel you must respond to this in a more direct and active way than you have so far done if we are going to make any headway at all in formulating new, agreed upon hospital policies.
best wishes,
Father Delaney, Director of Chaplains