Background Information
I am a general surgeon currently working at the private hospital in Sasquatch, Connecticut. I identify as a Lebanese Shi’ite Muslim male. My family and I moved to Sasquatch 10 years ago, at which point we were the only Lebanese family in the community. However, there has been an influx of Lebanese immigrants and I am proud to say that I was recently elected as the president of the new Lebanese Cultural Association. With the growing immigrant populations in our community and my medical expertise, I am humbled to serve on this ethics committee as we transition to becoming a non-denominational hospital.
Policy Proposal
Reproductive Technology Use
IVF Treatments and Prenatal Testing
I believe the Sasquatch Hospital should begin to provide in-vitro fertilization (IVF) treatment and prenatal testing including amniocentesis. Though, the risk of miscarriage during an amniocentesis procedure is 1 in 200 (Rapp 97), which is the same as babies born with Down syndrome, patients in our community deserve to have the right to know about possible birth abnormalities. With the growing diversity in population, the availability of this procedure is essential as genetic diversity is also increasing.
Abortion Services
The hospital should not provide abortion services, unless extenuating circumstances persist. These circumstances fall in line with the United States federal guidelines listed under the Hyde Amendment. Abortion services should only be provided when the pregnancy is a result of rape or incest or is a medical threat to the woman’s life.
Though the hospital has become non-denominational, we must still consider the prevalent religious practices present in our community. IVF and prenatal testing allow for the expansion of knowledge, but abortion by two out of the three dominant religions in this community (Catholicism and Shi’ite Islam) prohibit the murder of a living being and an unborn fetus can be considered living as it is in the mother’s womb. The holy Quran teaches that “God had given people their bodies as a trust (amana) and that (we are) therefore responsible to take care it (Hamdy 151).” As a devout Muslim, I do not think it is ethical to break the amana that God has bestowed upon mankind and my fellow Catholic staff feels the same.
However, I also know that I have taken the Hippocratic oath and will follow all means to help patients live healthily. Thus, I propose that this hospital only provide abortion services when it is a medical necessity as explained at the onset of this section.
Unused Embryo Donation
From a medical perspective, I propose that unused embryos should be donated for life-saving research. I believe this follows the same reasoning as providing abortion services to women under extenuating circumstances. Unused embryos will not become living things and if they can lead to the cure of diseases, then it is worth it for them to be used for research.
Funding under-insured Patients
Subsidized funding for under-insured patients should be provided only for testing purposes, not abortion services even when extenuating circumstances persist. It is a pretty common standard around the Western world for governments to provide these funds. For example, “The French government normally reimburses medical procedures up to 80%, but in the case of infertility diagnosis and treatment, the national health insurance system covers the cost of the entire process (Ball 547).” Thus, I do not believe our hospital which condones abortion overall should provide funding for abortion services of those under-insured since they can get the funding elsewhere. Indeed the United States can currently use federal funds to fund under-insured patients with extreme cases for abortion.
Counseling Staff Regulations
Spiritual counseling by clergy should be continued, but the clergy should be opened to other religions that have recently become more prevalent within the Sasquatch community. “Shi’ites practice a form of individual religious reasoning known as ijtihad (Inhorn 18).” Thus, I believe all patients to this hospital across all religions should be able to have access to religious counseling in order to determine their course of medical action. Given that the vast majority of the community served is religious in some way, the inter-religious clergy will aid in daily smooth function of our hospital.
I propose implementing a mandatory training program for all counseling staff including social workers, genetic counselors, and clergy. This training program will educate counseling staff on official hospital policy regarding assistive reproductive technology and prenatal testing. It will give guidelines as to how staff can counsel under their own religious doctrines, while still adhering to hospital policy and national law.
Medical Staff Regulations
Furthermore, I propose a similar training program for all medical staff at the hospital. All staff will not be required to be in agreement with hospital policies proposed, but rather should be aware of official hospital policy. The staff should be willing to uphold the official policies at the very least.
I know there is currently some tension among the Catholic nursing staff to perform these procedures. I do not think any of the staff should ever be required to perform procedures that are against their religious beliefs. Thus, a team of new hires and a few of the current staff who are willing will be chosen to make a team designated for all the procedures stated in this policy proposal. Nonetheless, as stated in the above training program, the staff unwilling to perform the procedures will still have to acknowledge that the procedures are being conducted at this hospital under structured circumstances.
Works Cited
Nan T Ball, “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” Duke Law Journal 50 (2000): 545-587.
Marcia Inhorn, He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly 20 (2006): 94-120.
Sherine F. Hamdy, “Does Submission to God’s Will Prevent Biotechnological Intervention?” In Jeremy Stolow editor, Deus In Machina: Religion, Technology and the Things In-between (Fordham University Press, 2013), 143-57.
Rayna Rapp, Testing Women, Testing the Fetus (Routledge, 2000).
Dear Male, Muslim version of Rasika,
Thank you for your interesting perspective on this matter. Being of the Muslim faith you understand the position of the Catholic Church on abortion and other potentially life-ending reproductive procedures perhaps better than most other religions. You also understand what it means to be devout, so you can understand the perspective of many of the Irish-Catholic staff at this hospital.
I wonder, however, about the consistency of your arguments. Let it be known that I argued wholly against prenatal testing, abortion and IVS services in our hospital for the same reasons you cited as why we should not offer abortion services. We must consider both our history under Catholic auspices as well as the current ideologies represented in our community. I agree that the majority of the community would likely be very opposed to such practices.
However, you argue that we should offer prenatal testing procedures like amniocentesis. I would like to challenge you by posing a scenario: say a local family comes to our hospital for prenatal testing. The test reveals that the child will be born with microcephaly, a horrible neurological disorder where a baby is born with an underdeveloped head and brain. Children born with this, if they live long, tend to suffer from extreme behavioral, learning, and even locomotive issues. What happens if the parents then expect our hospital to offer abortion services? Does this count as an “extenuating circumstance”? What qualifies an extenuating circumstance, anyway? If this family feels strongly about aborting, they will likely seek out services elsewhere. They will have to travel long distances to the nearest city to get the procedure done. So my question is, what is the use of offering prenatal testing if we cannot follow through if the results are positive? I press you to define what you believe to be “extenuating” in order to answer that question.
Additionally, I wonder about your willingness to donate unused embryos to science. Even if we are donating these unused embroys leftover from IVF, we have no idea how they are going to be used. Can we ensure that none of them will be destroyed? It is entirely possible that procedures performed on the embryos are postmortem or death-causing. It could also be that we are just handing the embryos to researchers who will deem them unfit for research and will then throw them out. Is it indirectly our fault if the embryos are murdered?
All in all, I am mostly in agreement with your arguments. You stand by the fact that a belief system should be respected. After years of operating under certain values, it would be extremely difficult to rock the boat. Hopefully we can work together to ensure the protection and inclusion of all our community members.
Hannah
Dear Dr. Rasika Tangutoori,
Upon reviewing your policy proposal, I find that both of us have many disagreements on the course of action this hospital should take. In the beginning of your proposal, you mention that in vitro fertilization (IVF) treatment and prenatal screenings should be allowed. Your reasoning for the positions include that everyone must be given a chance at life and parents have the right to know the health status of their fetus. In the broadest sense I agree with you, but I am having trouble understanding why you chose these as your positions. For example, do you feel that parents knowing if their fetus has/does not have a genetic disorder will help alleviate their distress? Numerous studies, as seen in the film “The Burden of Knowledge: Moral Dilemmas in Prenatal Testing”, have shown that prenatal screenings cause more anxiety (short-term and long-term) for parents regardless of the outcome of such tests (Conquest et al.). In addition, what available options do parents have if their fetus is found to have an abnormality? You mention various counseling services, but they all have to do with time-frames preceding prenatal tests. As stated in my policy proposal, I feel a way to solve this issue would be for physicians and nurses to enroll in cultural competency courses, allowing them to comfort patients following distressing news. Overall, my disagreement with you in this matter is why you took the specific stance you did, not in your ultimate decision. I feel that you should have explained yourself more, allowing me and others on this committee to fully understand the roots of your beliefs.
My second disagreement with you is in the section titled “Funding Under-Insured Patients”. You mention that abortion services should not be subsidized in Sasquatch because patients “can get the funding elsewhere”. While that may be true, I feel that you missed the notion that other areas in the United States might not be as diverse and culturally evolving as Sasquatch. If required to travel to a new city, patients might have trouble finding hospitals which would agree to perform abortions. At this moment in history, Sasquatch is a town which is slowly altering its identity; changing a few regulations, such as allowed abortion services specified by the Hyde Amendment, in the hospital should be something to consider. I do want to make clear that my personal view is that abortion services should not be performed under any circumstances. I was just outlining that it is not effective for a hospital to perform abortions in extreme cases, but not subsidize them for patients that cannot afford the procedure.
Dr. Tangutoori, my occupation as a fertility physician may be a reason why I disagree with you on many topics. But at the same time I have viewed your policy proposal with open eyes and have attempted to offer appropriate and constructive feedback on a few occasions. I hope you carefully consider my response and I look forward to discussing the topic with you more in the future.
Thank you,
Petar Zotovic, M.D.
Dear Dr. Tangutoori,
Thanks for this. You have received some excellent comments, below, which I hope you will consider seriously. For my part, as an administrator of no particular faith, I cannot understand why you think hospital policy should be determined by the religious sentiment of some community members. How indeed will you define extenuating circumstances and more crucially, who will be tasked with making those determinations? Will this ethics committee meet to decide each case on an individual basis and, if not, then who? There are significant manpower and other issues involved here that we need to flesh out more fully. I guess part of what I am asking is, doesn’t the decision to remove ourselves from Catholic affiliation really entail a decision to start with a clean slate and function like any other hospital? How can we justify half measures? As a physician I had hoped that you would take a more objective view and ignore all this rhetoric about culture and religion. How does it help us to fulfill our mission as a hospital?
best wishes,
D Seeman, vice president for policy