Hospital Regulations of ARTs in Sasquatch, Connecticut
Background information:
I am a cardiothoracic surgeon that has worked in the Sasquatch Hospital for 20 years. I was born and raised in a religious Catholic home and married a Catholic girl, but throughout our marriage, we have become a little more secular. I believe in Catholicism, but I am not sure how I feel about the rigidity of Catholic doctrine. Since the hospital administration knows that I am Catholic and are looking to retain their Catholic-based medical practice, they have decided to place me on the ethics committee that considers issues involving assisted reproductive technologies and prenatal testing. I am conflicted whether to provide my true opinion or my expected, devoutly Catholic opinion in these ethical talks.
- The first question our ethical committee is tasked to answer is whether or not the hospital should begin providing and subsidizing abortion services for patients. This question also extends to the use of IVF treatments and prenatal testing, including amniocentesis. My initial thought reflects the Catholic perspective, which is firm and precise. According to The Congregation for the Doctrine of Faith, it is explicitly clear that abortion is forbidden in all “No one can in any circumstance claim for himself the right to destroy directly an innocent human being” (Donum Vitae 147). This statement suggests that abortion is forbidden for everyone, Catholics and non-Catholics alike. Although I have been an active member with the local Catholic church for my entire life, after serving as a healthcare provider for 20 years, I have seen numerous cases in which I question this law. I do not, by any means, believe that abortion is acceptable in all cases. I believe abortion to be an atrocity in many situations, but in some cases, it may be an acceptable course of action. For example, many years ago when I was in residency, I saw a patient who had been impregnated after being the victim of rape. Should this woman now be forced to have the child? I believe she should have the right to an abortion.
In terms of using IVF treatments in this hospital, I am firmly against the idea. Conventionally, when using in-vitro fertilization, many embryos are created and only a few are actually selected to be implanted into the mother’s uterus. The leftover embryos are “disposed of”. From a Catholic perspective, this treatment is extremely problematic. “According to the Church, “each and every marriage act must remain open to the transmission of life.” It is inappropriate, even a sin, to separate intercourse and conception” (Bhattacharyya, 2006: 61). The Church objects to the use of IVF for multiple reasons. One reason is because IVF separates the act of intercourse from conception, which violates the overarching purpose of marriage. “Each and every marriage act must remain open to the transmission of life” (Humanae Vitae, 11). Additionally, IVF is forbidden by the Catholic church because the leftover embryos after treatment have the potential to develop into children. “The human being is to be respected and treated as a person from the moment of conception and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life” (Donum Vitae, 149). Moreover, the means used to acquire the materials necessary for IVF are scrutinized by the Catholic church. “Sperm donation is prohibited because sperm is usually obtained through masturbation and thus apart from the sexual intercourse of the married couple. IVF also separates the act of sexual intercourse from fertilization; consequently, it too is prohibited” (Bhattacharyya, 2006: 61). Furthermore, if IVF were to be offered at the hospital, using the leftover embryos for research is strictly forbidden. “To use human embryos or fetuses as the object or instrument of experimentation constitutes a crime against their dignity as human beings having a right to the same respect that is due to the child already born and to every human person” (Donum Vitae, 153). My opinion on IVF is in accordance with the Catholic church’s assertions. While I sympathize with those of other faiths, for this multitude of reasons, I believe that the hospital in Sasquatch should not provide IVF treatments for any patients.
When considering whether to offer prenatal testing that includes amniocentesis, there are various factors to consider. The places in which PNDs and amniocentesis become unethical are in their underlying purpose of the tests, in the additional risk of miscarriage, and in the risk of negative symptoms affecting the mother following the procedure/testing. A patient would only undergo PNDs and amniocentesis for three reasons: prevention, preparation, and reassurance. The first reason is to acquire information about the fetus’s health, and if there is something wrong with the fetus, have the opportunity to abort the pregnancy. The second reason is to be able to prepare in advance if you know there is something wrong with your fetus. The third reason is to ease the parent’s anxiety by knowing that there is nothing wrong with your fetus (Movie: The Burden of Knowledge). There is question whether the outcome of the test could influence mothers to abort their pregnancy. Test results allow us to make judgements based on probabilities, not certainties, and may encourage mothers to abort. “Man is wrestling for control with G-d…morally and spiritually…That is G-d’s territory” (Movie: The Burden of Knowledge). Ethically, as a Catholic, I cannot endorse PNDs or amniocentesis because of the risk that mothers may end up aborting their pregnancy upon hearing of bad test results. “[Prenatal Diagnosis] is gravely opposed to the moral law when it is done with the thought of possibly inducing an abortion depending upon the results…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 and as an abuse of the prior rights and duties of the spouses” (Donum Vitae, 150-151). Additionally, amniocentesis unacceptably increases the chances of a miscarriage. In Tsipy Ivry’s book entitled Embodying Culture, Ivry discusses the risks associated with amniocentesis: “Should suspicion arise about fetal health [in Israel], women will…undergo amniocentesis, with its 1/200 risk of miscarriage” (Ivry, 2010: 39). After considering the purpose of prenatal testing, given that abortion is not an option, there is nothing tested for that we can do anything about; in this case, abortion is certainly out of the question. The only potential benefit of prenatal testing/amniocentesis is preparation.
- As previously stated in part 1, the Catholic Doctrine of Faith applies to everyone, not just Catholics. Since I am a Catholic, I believe that the hospital should retain its counseling by Catholic clergy even though the hospital is now technically non-denominational. I have become slightly more moderate in terms of my religious observances throughout my years of practice, and I entertain the idea of having clergy of other religions in the hospital to guide patients of alternate faiths. Just a few decades ago in Sasquatch, Connecticut, this would not have been considered because such a large majority of the population were Irish Catholics. Today, since a diverse array of religious communities have moved into the area, including communities of Jews, a mix of white and African-American non-Irish Catholics, Lebanese Shiite Muslims, and a Japanese community, we must consider their perspectives and be tolerant of their beliefs as well. I believe that the hospital should only provide medical services that are acceptable according to Catholic law, while also allowing clergy of other faiths to advise patients who desire counsel. This gives clergy the opportunity to provide counsel to patients of all faiths, but treatment options should consist strictly of Catholic-approved treatments. This allows patients to receive optimal care because clergy of various faiths will have the opportunity to consult with doctors about “various cultural and religious influences, [so that] a healthcare provider can be sensitive to the particular needs of a patient” (Bhattacharyya, 2006: 22). This is crucial because the purpose of a hospital is to take the best possible care of their patients, and this would increase the quality of care.
- As discussed in part 1, abortion and reproductive services are not acceptable according to Catholicism. The hospital is a private institution and can provide whatever services they wish. Because I have been born and raised in a Catholic home and lived a Catholic life, I believe that these procedures are ethically questionable, but that does not mean that hospitals should not provide these procedures as treatment options.
I have become slightly more secular as my career has progressed, and although I do not think that I would condone abortion and reproductive services in my family or my community, I believe they should be provided at the hospital. As previously discussed in section 1, there are extenuating circumstances in which I believe abortion to be acceptable (rape cases, etc.). Additionally, just because something goes against a religion does not mean that people do not want it. A very small percentage of individuals that practice religion are devout in their observance.
Now to answer the question of how to deal with nursing staff who refuse to perform abortions and reproductive services. Nurses have certain responsibilities that come along with their job, and regardless of how they personally feel about tasks they are asked to perform, they are expected to complete the assignment. If a nurse is not willing to conduct abortions and reproductive services required by their job description, I believe the hospital should initially provide notice that if the required services are not provided to patients, the nurse will be fired. There are no other hospitals within a 45-minute drive, leaving nurses with few alternative job options nearby. The hospital may not have a large budget to hire additional staff, but I suspect that most of the nursing staff will not risk their jobs over this issue. In the event that a few nurses leave, the hospital can utilize the small budget for replacements.
Good Evening Jonah,
I, like you, grew up Catholic, but since have slightly strayed from the staid position of the Church. Also like you, I agree that we should maintain the Church’s position on some issues; however, I believe there needs to be more of an accepting attitude towards some opposing viewpoints.
Concerning abortions, you cited the Catholic Church’s official doctrine saying, “No one can in any circumstance claim for himself the right to destroy directly an innocent human being” (Donum Vitae 147). You then say that abortions should be allowed in certain cases such as rape. This concerns me for a number of reasons, 1) This goes against the Catholic Church’s teachings, where under no circumstances should abortions be allowed. If we are to concede on this matter, why not allow abortions, with some restriction, for all women? If a woman is pregnant, she is certainly willing to drive more than forty-five minutes for an abortion, so by not providing abortions, this hospital is doing nothing to change the political status of abortion. 2) Could this practice of allowing abortions for rape victims lead to women, who were not raped, claim that they were? Would there be any procedures in place to ensure that the woman was actually raped, so that nobody is falsely accused?
Another area where we disagree is with IVF treatments. You seem to mention that the Catholic Church is completely opposed to IVF, citing, “Each and every marriage act must remain open to the transmission of life” (Humanae Vitae, 11). This is not completely true, however. It is my understanding that IVF is licit if and only if the treatments do not take away from the conjugal act and no embryos are harmed. This can be achieved by using a perforated condom, so that the act of marriage is still open to life, while still being able to collect sperm. Singular embryos can be made as to not harm any embryos, therefore creating a licit way to IVF treatments. While this may be an expensive way to perform IVF, judging by the women I have talked to from Israel and Lebanon, the reward of being a mother is priceless.
I would also like to discuss the stance of our hospital on prenatal testing and diagnosis. I agree that it is morally wrong to test with the intention of aborting if the results come back positive. I believe that we should offer the tests, however, to allow for planning in case the baby will have some disorder, or to allow us to fix the problem if possible, and therefore perform the best possible care.
Finally, concerning the attitude towards uncooperative nursing staff, how can our healthcare professionals be expected to care for the beliefs of the patients if their own beliefs are not taken into account also. I suspect, since this is a small town, and since you propose that abortions only occur in extenuating circumstances, abortions will not be a major procedure of this hospital. Could we possibly only assign nurses that are willing to assist in the procedure to the few cases that we get? I do not believe that we should coerce the nurses to perform procedures that they are comfortable with.
Dear Mr. Adler,
Upon reading your proposal, I must say that I do appreciate how, as both a devout Catholic and a surgeon, you were able to distinguish between your faith and its beliefs and your medical understanding and opinion on the topics at hand. I believe it is important for us, as doctors, to remember that even though we might not ethically agree with certain decisions made by patients, our main responsibility as doctors is to provide patients with the best care possible. For the most part, I would agree with most of what you have stated in your proposal, but I do take issue with a few things and have some questions.
Regarding the maintenance of Catholic clergy, I also agree that providing these services would increase the quality of care provided by our hospital, as well as improving the patient/provider relationship. By allowing clergy of alternate religions to assist patients of other faiths, I think the hospital is taking a step in the right direction towards being more inclusive of our diversifying population. However, I disagree with your assertion that the hospital should only provide medical services that are deemed acceptable to the Catholic faith. I think this could result in confusion and a few issues. For one, by allowing other religious clergy to provide counseling to other patients, due to different faiths having differing opinions regarding ethical medical services, this could lead to clergy suggesting solutions that are not necessarily in accordance with the Catholic faith. For example, a Jewish woman could seek counseling from her rabbi on whether or not she should undergo amniocentesis, for she is very concerned about the future of her fetus. If the rabbi were to suggest she undergo such testing, what options would the woman have if we as a hospital refuse to provide such a service because the Catholic faith does not believe prenatal testing is ethical? What would you suggest we do as a hospital if this were to arise?
On the topic of extra embryos being used for research, I would be willing to meet you half way, so to speak. You mention that as a devout Catholic, it is forbidden to condone IVF due to the possibility that the leftover embryos have the ability to develop into a human life. While I suggested that families should be allowed to donate their leftover embryos to research, I understand why many individuals, not just Catholics, might take issue with this. Because of this, I would be willing to forbid the leftover embryos from IVF to be used for research. There are many other hospitals in the United States that condone this practice and I would be willing to forgo the provision of using embryos for research, as long as we implement IVF services in our hospital.
I agree with your proposal on how to deal with nurses who refuse to perform abortions and reproductive services. As you stated in your proposal, we are now a non-denominational institution and although it may go against what some personally believe in, we as medical personnel have certain responsibilities we can not overlook. Since we are the only hospital within a 45-minute drive, I find it hard to believe that many nurses would be willing to give up their job due to the hospital offering these new services. If they do, I think the hospital would easily be able to replace such nurses while also remaining under budget.
In all, I think we would be able to agree on a proposal in which our hospital provides new medical services such as reproductive technologies as well as prenatal testing. After reading your proposal, it is my understanding that you are able to look past your personal religious beliefs in order to provide our diverse population the exceptional medical services they deserve. I truly respect your dedication to your practice and would be willing to work with you on achieving an outcome in which all doctors and patients would be satisfied, from both a religious and medical standpoint.
Sincerely,
Molly Nestor, M.D.
Dr. Adler,
I admit that I was somewhat confused by your position. You seem to be advocating that our hospital eschew abortion and testing under most circumstances in accord with Catholic doctrine on the one hand, but make exceptions to that teaching (as in the case of rape) and coerce hospital staff to participate, on the other. I this correct? If so, I cannot understand what you hope to gain. You will outrage everyone, no?
Moreover, I do not understand why your own cherry-picked Catholic teachings should be imposed. Aside from asserting that YOU think a child conceived through rape is not deserving of life, do you have ANY coherent explanation for your position? Would you also assert that a child who escaped abortion should be subject to killing later under those circumstances? I understand that everyone has their own moral feelings or intuitions about things, but if you want to argue for a policy of one kind or another you need to convince people who do not naturally share your own point of view. Please articulate.
I am sorry but it seems to me that by making an essentially emotional argument about your (partial) attachment to the teaching of the Church you have neither explained why the hospital ought to follow those teachings nor why you think it should depart from them under particular circumstances of your choosing.
In my view, this is just too little, too late. We either have a Catholic hospital or we do not and I am left scratching my head over which side you are on?
Don Seeman, Professor of Christian Ethics Sasquatch College