As the CEO of Sasquatch Hospital, I have been asked to craft a new policy proposal regarding assisted reproductive technologies and prenatal testing. I accepted this job just as the hospital was shifting away from its official association with the Catholic religion a few years ago. Over the past few years, I have gotten to know the many different populations that make up Sasquatch, Connecticut. I have also been in communication with anthropologists who, over the past year, have been talking in depth with our patients about their feelings on these assisted reproductive technologies. Although these conversations are limited in their confinement to the hospital setting, interview format, and absence of long-term relationships, they offer the best perspective we have on the population we are trying to serve. With such a diverse array of individuals in our lively community, we must take every voice into consideration. Nonetheless, it is impossible to please everyone in our quest to set regulations on healthcare. This new policy proposal certainly does not set a unified front for all the voices in our community; But I have worked diligently to address everyone’s concerns in a way that fosters cooperation between different religions and cultures.
The inevitable solution to a situation in which different groups of people have different objectives is to provide most services but restrict their usage. We should provide In Vitro Fertilization (IVF) treatments for our patients. Studies have shown that a small but significant portion of the Jewish and Lebanese Shi’ite communities use IVF as a way to overcome infertility. Though these studies were not conducted in the United States, the anthropologists at Sasquatch hospital have made similar conclusions among the Jewish American and American Lebanese Shi’ite communities. The statement made in Genesis that we should “be fruitful and multiply” has been interpreted by the Jewish community to be a commandment. The Jewish community places an emphasis on reproduction. Additionally, most religious leaders agree that life does not begin at conception. These reasons among others lead to the general acceptance of IVF among Jews (Kahn 2000:3). Shi’ite Islam promotes decision-making through the use of individual thought processes, also known as ijtihad, but practicing Shi’ites also hold the guidance of local religious leaders in high esteem. Most of these leaders have approved of IVF technology provided that certain precautions are taken. Shaikh Fadlallah, one of such religious leaders, and a Sunni religious leader both agreed that IVF is permissible when the gametes are provided by the couple that wishes to conceive through this process (Inhorn, 2006: 111). IVF is valued by important segments of our population, so we need to provide these services to them.
It is important to appeal to our largely Irish Catholic donor base as well because without them, we cannot run this hospital. We should take their perspective into account when making policy influencing pregnancy. We should not subsidize abortion services because doing so would contribute money from donors towards initiatives they do not approve of. Additionally, the Department of Social Services (DSS) in Connecticut funds all abortions that are medically necessary as per Doe v. Maher in 1986. Medical necessity is decided by the physician of a patient. It includes “health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring. (Cohen, 2010: 1). We should fully cooperate with the DSS of Connecticut to allow under-insured patients to receive abortions under conditions where they are medically required. To reduce instances of abortion and unnecessary killing of what many Catholics deem as life, we should only allow it to be performed in situations when the mother’s or fetus’ life is at risk during the pregnancy (Cardinal Joseph Ratzinger and Archbishop Alberto Bovone, 1987: 149). In addition to abortions, prenatal testing and amniocentesis are necessary provisions to allow people to exercise precautions in their pregnancy. In particular, members of the Jewish community utilize these resources (Ivry, 2010: 11). Individuals using this service at our hospital would not be able to terminate a pregnancy based on any genetic conditions they discover, however, because under my policy proposal the hospital wouldn’t allow voluntary abortions. Instead, they could use this information to prepare for the consequences of the genetic disease once the child is born. These services would also allow healthcare providers to ensure the health of the fetus and mother during the progression of the pregnancy. The restrictions placed on abortions, prenatal testing, and amniocentesis would appeal to our Irish Catholic donor base, so our hospital can continue to run under their generous financial contributions.
The procedures ascribed to dealing with unused embryos from IVF create another challenge for Sasquatch hospital. Despite the fact that we would be allowing IVF, we need to be respectful of the official Catholic position that life begins at conception. In addition to not subsidizing abortion funds, we should strongly reject any research initiative where embryos are harmed no matter what future result the research could bring. However, we should financially support any study where the embryos are completely unharmed and the research has a clear positive outlook for future patient health. We should also encourage the donation of gametes to couples. Some Jewish and Islamic individuals have been accepting of this process, so we have people that will benefit from this provision (Ivry, 2010: 209-211; Inhorn, 2006: 111). Although I propose to not act in accordance with the official Catholic belief that every child has the right to be raised by his or her parents, donation of gametes should reduce the wasting of unused embryos (Cardinal Joseph Ratzinger and Archbishop Alberto Bovone, 1987: 158).
In regards to spiritual counseling, it is necessary to make a change in policy. We cannot provide all these assisted reproductive technology services and continue to have a solely Catholic spiritual counseling service. This would send out a conflicted message to our community that we provide these resources, but our staff vehemently discourages patients from using them. Additionally, we need a more diverse group of counselors to allow patients to make informed decisions. Patients should be allowed spiritual and cultural support of their choosing before they make decisions about whether they should use assisted reproductive technology or not. I propose that we incorporate counselors from different disciplines. This should include support that ranges from African American Catholic priests to Japanese cultural advisors. The diversity of opinions should alleviate concerns by doctors that the Catholic spiritual counseling is directly conflicting with their work. While I don’t expect secular doctors to fully support any spiritual counseling, I believe it is important for patients to be able to reach out for religious support when they see fit.
Some staff members may oppose many of the new initiatives I propose to incorporate into our care of patients. If the hospital is going to move in this new direction, we need the full cooperation of all our healthcare staff. Therefore, we should not only provide training programs to teach our current staff how to perform these new procedures, but we should also hold educational sessions to remind the staff that what we are doing is ethical and is best for the community as a whole. If many staff members continue to resist performing these procedures, we should train a group of current staff dedicated solely to performing these procedures and ensuring that patients feel as comfortable as possible during the process.
As the CEO of Sasquatch Hospital, I have proposed a plan here that requires concessions from all members of the community but addresses everyone’s concerns. A situation as dynamic and complex as this one requires oversight and openness to change. It is necessary to assess the satisfaction of the variety of groups affected by our decisions. Therefore, we should reevaluate after a year to see how doctors feel about the change in protocol and if patients are using the services we provide. We should also see if patients are using the spiritual counseling resources in their decision making process. Though we always need to reevaluate, I am confident that the plan proposed here would allow the hospital to address the concerns of the diverse population of Sasquatch, Connecticut.
Analyst, Robin K. Cohen Principal. “STATE PAYMENT FOR ABORTIONS.” STATE PAYMENT FOR ABORTIONS. N.p., 17 Mar. 2010. Web. 21 Mar. 2017
Hi Ms. Spector,
As I was reading your proposal for the ethics committee of Sasquatch Hospital, I found many sources of overlap between our opinions as to what the hospital should do to address the dilemma surrounding whether or not it should provide various methods of artificial reproductive technology. I agree with your stance that IVF services should be provided to be inclusive of the values of our patient population; however, I would be interested to hear whether or not you believe IVF should be subsidized by the hospital for patients who cannot afford it.
While I understand that the donor base of the hospital is an essential source of revenue, I do not think that it should restrict the procedures and services offered at the hospital, especially since the hospital recently became non-denominational. However, I must admit that I did not know of the current policy put forth by the Department of Social Services (DSS) in Connecticut, which funds abortion services that are deemed “medically necessary” by the doctors. With that knowledge, I can understand why the hospital will not subsidize abortion services; however, I think you should consider other situations in which the pregnancy may be healthy, but result from rape or incest. Although these are extenuating circumstances, I believe the hospital should provide these services to our patients if they happen to be in this position, in accordance with the Hyde Amendment.
While our personal background and professional experiences lead us to differing viewpoints in the debate of providing access to artificial reproductive technologies at Sasquatch Hospital, I believe the continued teamwork of the ethics committee can provide an effective compromise to please the many cultural and religious backgrounds we serve.
Sincerely,
Greeshma Magam, M.D.
Dear CEO Spector,
Thanks for this. I very much appreciate your attempt to square the circle and arrive at a compromise that makes everyone happy. But in doing so, haven’t you just substituted financial stability for any coherent moral and medical vision? You seek to limit abortions yet allow IVF and other procedures that lead to… abortion. Is there any way to have this cake and eat it as well? Moreover, you propose projects that are costly and difficult, like providing counseling services from a wide variety of different religious and cultural backgrounds. Where will we find such people? As your director of community relations, I would ask respectfully that we both spell out a bit more carefully how we intend to sell this to the community and how we hope to pay for it.
best wishes,