Assisted Reproductive Technologies and Prenatal Testing Policy Proposal
Dear Ethics Committee of Sasquatch Medical Center,
My name is Petar Zotovic and I am a fertility physician here at Sasquatch Medical Center (SMC). Recently, the Catholic Church has allowed our hospital to become non-denominational, one of the reasons being due to the diverse and growing population of Sasquatch, Connecticut. As you all know, Sasquatch has deep Irish Catholic roots and this was an important factor to consider while constructing the policy proposal. To members of the committee who do not fully understand the beliefs of each group in Sasquatch, I will state them briefly to you.
Irish Catholics are vastly against the use of Assisted Reproductive Technologies (ARTs) and prenatal testing (in cases of abortion), such as amniocentesis (Cahill et al. 1988: 143). In recent years, the city has seen a rise in population of minority groups which hold differing beliefs regarding ARTs and prenatal testing. The Jewish community favors the idea of ARTs, noting God’s first commandment, “Be fruitful and multiply, and fill the Earth, and subdue it…” (Bible Hub, Genesis. 1.28). With regards to prenatal testing, the Jewish population supports and even encourages procedures which may benefit a mother and fetus (NISHMAT 2000: 2). The Caucasian and African American population also support the use of ARTs and prenatal screenings if prices are affordable. The majority of African Americans in Sasquatch who live in poverty has increased by four percent in the past decade, and most are under-insured (Armstrong, Plowden 2012: 652). I am mentioning this because these individuals will qualify as patients for which the hospital will subsidize their medical care. In addition, Lebanese Shiites are proponents of ARTs as long as they are able to preserve their faith in Allah during the procedures. Similarly, they support prenatal screenings (Inhorn 2006: 96-97). The increasing Japanese population advocate the use of ARTs, especially in vitro fertilization (IVF), but opt out on prenatal testing. They prefer to abide by an “environmentalist” approach, which states that the mother is directly responsible for her fetus and is to make sure she does not gain excessive weight or engage in any unhealthy activities (Ivry 2009: 11). After taking into consideration the various beliefs of the people in Sasquatch, I am proposing a policy which allows the use of all ARTs available to the hospital; in addition, prenatal screenings are only allowed if the intention is to not abort a fetus if an abnormality is found to exist. My policy proposal attempts to satisfy the diverse population in Sasquatch, while still attempting to adhere to its Catholic roots regarding prenatal testing.
In attempts to abide by the still prevalent and dominant Catholic faith in Sasquatch, all attempts at abortion will not be executed. In the past, Sasquatch was a safe haven for Irish Catholics and was once ruled by Catholic auspices, so retaining some of their beliefs is still important. In addition, I agree with Cahill et al. in Donum Vitae when they state that “The human being must be respected- as a person- from the very first instant of his existence” (1988: 147). As a result, subsidies will not be granted in abortion cases. In alliance with my stance on abortion, prenatal screenings may only be conducted to examine a fetus for abnormalities. No attempts at termination may be done once tests have been performed. If the results of a prenatal test, such as amniocentesis, return with negative results, then the patient will have the opportunity to discuss their feelings and find ways to cope with a hospital counselor. All ARTs, including IVF, will be subsidized by the hospital for under-insured patients. IVF protocol will have a provision which will respect Islamic law; the provision will state that Shiite Muslims are eligible to participate in IVF if it involves a husband and wife couple. I am stating this because of Morgan Clarke’s ethnographic study in Lebanon; she concluded that Islamic law plays a crucial role in determining rules by which females must abide by if they want to undergo IVF treatment (Clarke 2007: 72). In her study, she comments “The prime principle at stake here is whether such scenarios are analogous to, if not identical with, the heinous crime of zina, that is sexual relations between parties not bound by a contract of marriage…” (Clarke 2007: 74-75). The preceding quote demonstrates the necessity of a husband and wife couple when performing IVF on Muslims. Of course, IVF treatment not between a husband and wife couple will be allowed if the patient and donor both agree and/or if no religious beliefs are interfered with. The following protocol on IVF will show the emerging minority population their beliefs are heard of and will be respected at SMC.
With regards to unused embryos being used for life-saving research, SMC must abide by two provisions. The first provision states that SMC will not be allowed to abort any embryos, keeping in line with Catholic roots in Sasquatch. The second provision states that frozen embryos may be used for life-saving research if they have not been placed inside the mother’s uterus and if the patients’ give consent. With regards to the second provision, I align with the Islamic belief that an embryo is not considered human if it is not inside the mother’s uterus; the embryo outside the uterus will not survive if it is unfrozen and is therefore not considered human (Eich 2008: 63). In “Decision Making Processes Among Contemporary ‘Ulma’: Islamic Embryology and the Discussion of Frozen Embryos”, Thomas Eich describes ‘Abd al-Salam al-Ibadi’s view on the topic by mentioning “Concerning the question of frozen embryos, he argued that the majority of classical fuqaha would have opposed abortion. Therefore, the use of frozen embryos for research could not be allowed, and the embryos should be implanted in the mother’s uterus” (2008: 68). I disagree with Ibadi’s statement because a large number of Muslims have differing views from the classical fuqaha he describes. Instead, expected costs and benefits, such as the opportunity to save a life, should be analyzed when deciding to donate frozen embryos for research. Above all listed priorities, patient consent is paramount. Only once patients have been fully informed about the research process, they will be able to donate their frozen embryos for research. This will eliminate any confusion on behalf of the patient and enable them to have more confidence in their decision.
Throughout patients’ time at SMC, they will have access to genetic and social counselors. Spiritual counseling by Catholic clergy and access to spiritual counseling of other religions will not be utilized. Genetic counselors will be tasked with informing patients of risks they might face through ARTs and prenatal screenings and social counselors will help patients cope with any negative news that result from such screenings (as mentioned earlier in proposal). Spiritual counseling of any religion will not employed because physicians and nurses (mostly Catholic) at SMC will be required to enroll in a “cultural competency” course which will enable them to better understand the beliefs of all patients. Because the hospital budget for hiring new personnel is limited, this provision will not only save the hospital money, but will also improve physician/nurse-patient communication. Swasti Bhattacharyya mentions in Magical Progeny, Modern Technology: A Hindu Bioethics of Reproductive Technology that cultural competency is “the ability to provide care that is compatible with the values, traditions, and faiths of the patient” (2006: 21). This will be a new task physicians and nurses encounter, but will ultimately prove beneficial for the functioning of the hospital.
My job in this hospital is to be a fertility physician, which means doing anything in my power to ensure the healthy status of a fetus or baby. At the same time, I realize that the population of Sasquatch is changing rapidly, and new hospital accommodations are necessary. The policy proposal I am presenting to this committee attempts to reflect the hospital’s Catholic origins, while at the same time portraying a sense of humility to the increasing minority group in Sasquatch. I urge the entire ethics committee to consider this policy proposal with open minds and to vote for the passing of the proposal only if they believe it serves a humbling and beneficial purpose to the hospital staff and patients.
Thank You,
Petar Zotovic, M.D.
Works Cited
Armstrong, Plowden. “Ethnicity and Assisted Reproductive Technologies.” NCBI,
vol. 9, no. 6, 2012, 651-658.
The Bible. Bible Hub, Columbia International University, 1993.
“Prenatal Testing.” NISHMAT, 2000, 2.
All other sources are from class readings.
Dear Dr. Petar Zotovic,
Thank you for voicing your opinion on ARTS and prenatal testing to the ethics committee. I, a fellow fertility ethics committee member, along with the rest of the ethics board have thoroughly reviewed your argument and have prepared a response:
As a long-time colleague of yours, we have known each other for numerous years. We both remember back when the community of Sasquatch, Connecticut was made up of nearly all Irish Catholics, and we have watched this community become more and more diverse in recent years. Change in hospital policy must occur to account for the community’s needs, but I disagree with you regarding how to alter currently medical practices.
In your proposal, you state the general positions on the use of ARTs, prenatal testing, and abortion of all of the major groups that make up our diverse community here in Sasquatch. I believe this to be too simplistic of an approach. Some religions do not have clear and cogent rules outlined that everyone of that faith agrees with. For instance, in Judaism, there are numerous opinions on nearly every topic regarding Jewish observance. Catholicism is unique in that strictly defined rules have been established and are (presumably) universally followed by Catholics.
Personally, I am a Catholic who is practicing a little more moderately than most observant Catholics. I disagree with your argument that abortions should never be permitted in the Sasquatch Medical Center. I believe that under extenuating circumstances—such as rape for instance—a woman should be provided the option of having an abortion. Yes, by Catholic law, this is violating the natural rights of the unborn child, but I believe we must look at the quality of life this child will have once born. His mother never wanted him, but was forced to have him; his father will never be a part of his life; he will be a burden to his family.
Additionally, I believe that both IVF and prenatal testing procedures should not be executed in this hospital. Both of these procedures have the potential to violate the natural rights of unborn children to develop and get to know their parents. With IVF, this right is directly violated by destroying non-implanted embryos. Also, the only way to perform IVF is via the acquisition of sperm not involved in a marital act, and Catholicism deems this as ethically unacceptable. When considering prenatal testing, I believe that upon hearing negative results, this may lead the mother to having an abortion, which is unacceptable, except in extenuating circumstances (explained earlier in comment). The only advantage of prenatal testing is to be prepared for fetal abnormalities, but I do not believe that this benefit outweighs potential abortion.
I completely agree with you that all hospital staff should undergo cultural competency training. I think this is crucial because it will help us as healthcare providers maximize the effectiveness of care for all patients.
I am hopeful that the both us, along with the rest of the fertility ethics committee, can come to a consensus on how to most effectively alter current fertility-related medical practices as the hospital undergoes this major transition from being under Catholic auspices to becoming non-denominational. I look forward to hearing your thoughts on my response to your initial proposal.
Sincerely,
Dr. Jonah Adler, M.D.
In response to my colleague’s stance on abortion and amniocentesis, I agree to his suggestion and to his determination to continue honoring this hospital’s roots to the Catholic tradition. However I strongly disagree with his stance towards IVF treatments. It is extremely hypocritical for him to allow for subsidized IVF treatments to all of our patients. IVF is in itself a procedure that calls for a type of abortion. As the human person is created at the moment of conception and it is at that moment at which all its rights are and should be protected, IVF in the form at which it is currently performed calls for the creation of a number of embryos, only a few of which will be implanted while the others will be destroyed. This is a form of abortion and we cannot allow it at our hospital. Furthermore, IVF is currently one of the most expensive fertility treatments in the United States. Even if it is a procedure that is licit in other religious traditions, it is still far too expensive to be subsidized by a rural hospital in Connecticut. I request that if anything is to be subsidized it be funding for fertility treatments with married couples, an important factor not only in the Catholic faith but also in the Islamic faith.
I find it interesting while reading the second half of this proposal that the doctor would prefer to remove any sort of spiritual counseling altogether. I think that it is important to note that many tricky ethical dilemmas arise for families at times while in hospitals, and it is important for individuals to have someone to speak to about these issues beyond simply the doctors. While doctors may explain out their preferences, it is important to note that most of the times these opinions come from a scientific background and are not specific to any sort of bioethical or religious knowledge. This is why I think it would be more helpful for the members of this community to have a wide array of spiritual counselors available to speak with rather than to have the nurses partake in cultural competency training. My fear is that cultural competency training would lead to the creation of stereotypes of people from different ethnic and religious backgrounds rather than providing patients with an equal level of understanding and care. If we were to use religious leaders in our hospitals, I think that they would be more adapted to give good advice to our patients and to be able to transmit this advice in a culturally appropriate way. I also believe that it would be especially important to provide religious and spiritual counselors for members of the Hindu, Islamic or Jewish faith as these religious are more decentralized when compared to Catholicism. Having specialized spiritual leaders would really assist our patients with making tough, moral choices.
Hello Dr. Zotovic,
I applaud you for upholding the Catholic Church’s position when it comes to abortion. I only ask of you now, will the hospital do anything to change the country’s current political stance on abortion? If not, then by not providing abortion procedures, the hospital really is doing very little to combat the atrocity that is abortion.
When it comes to IVF, I agree with you in that the Catholic doctrine is a little too restrictive. My question is, how do you expect to subsidize the fertility treatments, something that the Catholic Church does not agree with? Surely the donors, predominantly Irish Catholics, will not appreciate their money going toward something that they do not support. I believe that we need to either find a source of revenue to contribute to the expensive subsidized fertility treatments, or we should be less generous with our subsidies.
You say that you are sticking with the Catholic Church in terms of not aborting the embryos, but the Catholic Church does not agree with any sort of embryonic research. This position is included in the Donum Vitae, where Emeritus Pope Benedict XVI says embryonic research is morally illicit. Since undoubtedly some excess embryos will be produced, I believe that we should appeal to our Islamic patients in letting the embryos naturally expire (Clarke 2007, 75). I do also find flaw in the Islamic belief that the embryos are not human because they are not able to survive without intervention outside of the womb. At what point is something considered human? Using that same logic, a baby would not be human because it is unable to survive without any help for the first few years of its life.
I personally disagree with your decision to not allow clergy members from other faiths to offer counseling to patients upon their request. While as Catholics we believe that our moral laws apply to all, that does not mean that we need to disrespect other religions. Especially at this hospital, where we will only provide care that reflects Catholic teaching, it cannot hurt to allow patients to meet with people that better understand the laws of their own religion better than the doctors themselves. I believe that this will help the patients to feel more comfortable with the treatment that they are receiving, and therefore have a better outcome. With regards to the staff enrolling in a cultural competency course, I think we need to keep in mind that we are treating individuals, and we cannot come into any new doctor-patient relationships with predispositions. I believe a better way to ensure that the patient is getting the quality care he or she deserves would be to allot more time for interaction while asking a series of questions that will allow the patient and doctor to best feel comfortable with each other.
I hope we can rectify any of the minor issues and pass this policy.
Dr. Zotovak,
I
Why are you assuming that you can define people and their positions based on ethnic or religious background. You assume all Catholics think alike, all Jews, all Shia Muslims? What is the basis of this supposition and can you please avoid stereotyping everyone? As a proud Catholic and feminist I think decisions about termination and reproductive technology must be left to the conscience of individual women. How dare you claim to think and decide for me on the basis of some books you once read in a college anthropology course! The sooner you learn to speak to us rather than about us the faster we might accomplish something worthwhile. If you try to prevent women from exerciing their constitutional rights at your hospital there will be legal action against you and lots of negative publicity, of that I can assure you. Please reconsider your position!
Donna Leahy, Chapter President, National Organization of Women