Midterm Assignment (Ayman Elmasri)

The community of Sasquatch, Connecticut, is an increasingly diverse population, and as such, has a diverse set of needs. Though the town has predominant Irish population, Sasquatch has notable Jewish communities, mixed white and black communities, as well as influxes of Lebanese Shia and Japanese immigrants. Due to large distance between the town and a major hospital, major decisions must be made on a number of controversial topics. My ethical judgements will largely be made on the legal and normative lines, with an attempt to respect and please people from various backgrounds.
Before we begin, one must ask the question: what is the nature of the Catholic-affiliated hospital’s shift to become non-denominational? The background information of whether this move was motivated by diversity or as a nominal tactic is imperative to understand what effects this report’s suggestions may have. I will, however, proceed under the assumption that the shift was more than a titular change.
The American hospital system exists largely in the private sector with various government regulatory agencies and legislature who oversee rules and protocols. It is under that umbrella that many of the implicit suggestions made in the prompt of this paper raise legal eyebrows—is it within the law for hospitals to refuse to provide particular treatments or procedures? A second presumption that must be made is that both scenarios of each question are legal. I believe that once the argument becomes about the law, a new (and entirely different) conversation has begun.
The nearby hospital subsidizes care for under-insured patients, an assistance that can be seen in many hospitals across the United States. There is a growing issue of growing medical costs that result from the assistance of the under-insured—a burden that falls to a great extent on the deductibles of the lower middle class. The assistance given by the hospital close to Sasquatch has also been implicitly called into question.
A third presumption is that these fragmented populations will behave or believe similarly to those we have read about in class. It is entirely conjectural and reductionist to pigeonhole a group of people as similar to their macrocosmic religion, an identity which they may or may not hold as very salient.
With these initial conditions, the principal debate is that of assisted reproductive technologies (ARTs) and prenatal testing, a controversial topic that varies by culture, which must be taken into account given the heterogeneous population of Sasquatch. First, let’s take into account the faith and tradition of the Irish Catholic population. According to the Congregation for the Doctrine of Faith’s Donum Vitae and Dignitas Personae, we know that in vitro fertilization (IVF) and prenatal testing which would lead to termination of the fetus are not permissible. We must also recognize that this is the religious view of the Catholic Church, the majority religion of the Sasquatchian community and the religion of the hospital’s donors. Therefore, the power of this situation likely falls into the hands of the Catholics, akin to the axiom “money talks.” It would be important to know how evangelical this Irish population is—the advocation and maintenance of their religion may be an importantly held value to them, which would highly influence their interactions with the rest of the town.
In the United States, the availability of choice is very important. Few things are mandatory and few things are banned, many fall in between and are available if one would like, which can be seen in the American controversy of autism-causing immunizations whereby parents sometimes forego vaccines only later to be hit by a crippling (and preventable) disease. What keeps this process continuing is the American adherence to ‘choice’ and ‘rights.’

I would like to define a tenet of American culture that I have observed, ‘refusable availability.’ One often retains the right of choice and is infrequently obligated to anything. For example, a parent can choose not to vaccinate their child. Conversely, the current political obligating a woman to carry a child to term is being met with liberal animosity. In-line with this thinking, medical services ought to be available but refusable.
A fourth and final presumption is that people who shy away from a particular technology will not be bothered by another group taking advantageous of that technological service, unless the group in question is paying for it. This is a large condition, and assumes that there is no in-fighting between minority groups because of what is available, but leaves room for donors of a particular religion (in this case, Irish Catholics) to be choosy when providing certain services that do not adhere to their own religious beliefs.
I would now like to address the likely wants and needs of the minority populations. In some Jewish cultures, ART’s and prenatal testing are largely accepted, with little issue in early fetus termination. In terms of the Shia populations, there are religious ways to circumvent the religious red tape associated with reproductive technologies (whose legality in the United States I am not sure of), so the presence of further testing or assistance probably bother a Shia in the next room.
Because the hospital has chosen to become non-denominational, it should no longer refuse services on the basis of religion or to appease religious donors. Based on the tenet that I have alluded to of ‘refusable availability’, hospital ought to provide uniform assistance to the under-insured. It could incorporate religious restriction if it were explicitly a religious isntitition, but by becoming non-denominational, it has foregone that privilege. If pre-natal exams, IVF, and ART, are being provided at the hospital, it should follow the guidelines for the under-insured that other medical services observe. It is the hospitals choice to provide particular services, which then affect different classes or ratings of the hospital (such as being a Level 1, 2, or 3 trauma center depending on trauma-related resources). It is not the place of the ethics committee to tell the hospital which services to provide, but it is my belief that the assistance that the under-insured enjoy should be matched in religiously controversial medical policies.
As for hospital employees encouraging families to allow unused embryos to be donated for research, I do not believe there is as much ground to defend such a request. Additionally, the same reasoning can be applied to limiting counseling by the Catholic clergy. There is little precedent to claim clergies from any particular religion should be throttled, as I would not support the same of any other religion. This interpretation upholds the federal First Amendment, which has recently been used to overturn Trump’s travel ban. This recent judicial precedent suggests that the First Amendment not only protects expression of religion, but denies legal judgement or restriction on the basis of religion.
Concerning the finances of the hospital and the potential unwillingness of historically Catholic nursing staff to perform abortions, there is no way I can support forcing nurses into performing abortions, but this can perhaps be ameliorated with a combination of switching nurses around departments to maximize abortion-capable nurses in the obstetric department, as well as financially incentivizing abortion.