Sasquatch Community Hospital
May 2, 2017
Dear Ethics Committee,
My name is Greeshma Magam and I am a female Indian-American physician who is an active follower of the Hindu faith. Due to my diverse background, I was asked by the hospital administrators to provide a complementary perspective to the pressing questions addressing alternate reproductive technologies that your committee has been discussing throughout the past few months.
I understand that your hospital currently subsidizes medical care for under-insured patients, a practice that must be very beneficial to the low-income members of your community. However, with the rise of artificial reproductive technologies and the expensive cost of these amenities, I understand where your dilemma comes from.
After the submission of my initial policy proposal, I received multiple questions and comments regarding the stance that I took on some of the ART’s in question. While I appreciated all of the feedback I received, there were some comments that I agreed with and some that I did not agree with. With the advice that I received, I have altered my initial policy proposal with a clarification of my stance, which overall stayed the same.
Although abortion services are still a highly debated topic in the healthcare industry, there are certain circumstances in which I believe that offering these services are necessary. I say this from both a medical professional and a follower of the Hindu faith. As Swasti Bhattacharrya details in her book, Magical Progeny, Modern Technology, there is a story within the Mahabharata, one of the Hindu epics, that can be interpreted to question whether abortion is a viable option. Gandhari’s actions during her prolonged pregnancy was to remove “the iron ball of clotted blood” (Page 46). While Bhattacharyya is explicit in stating that Gandhari’s actions were to result in the birth of her child, this story can be interpreted that there are certain circumstances where abortion may be an option, for example when the mother’s life is in danger. Father Donnigan questioned how I, as a Hindu, could accept the possibility of offering abortion services when Mahatma Gandhi fought with a nonviolent perspective. While Gandhi was, and still is, a figure of strength in India and Hinduism, I don’t believe that my policy should change due to the nonviolence that he preached. Additionally, I wholeheartedly believe that offering these services is nonviolent, in that it will result in a greater good for the patient. This is similar to how I do not think that my stance goes against the Hippocratic Oath that I took when I completed my education to become a doctor. The procedures that are in question are not illegal in the United States of America, and thus allows physicians and medical professionals to perform these procedures while still keeping to the Hippocratic Oath.
Due to the expensive nature of these services and the size of your hospital, I understand that it would be impossible to subsidize abortion services for every under-insured patient wanting the procedure. However, I do believe that the subsidization of abortions at your hospital should be offered to under-insured women on a case-by-case basis. In order to form a guideline for what circumstances permit the subsidization of abortion services, I referenced the stance that the US government currently takes with federal funding. The Hyde Amendment prohibits the use of taxpayer funding to cover the costs of abortion services in Medicaid patients (ACLJ). However, a provision during the Obama Administration made it flexible, so that abortion services be provided to Medicaid patients in the case of rape, incest, or threat of life to the woman (ACLJ). While this amendment is also under debate, I believe this is a good guideline to follow for the subsidization of abortion services at your rural, privately-owned hospital. Dr. Tangutoori questioned that since the Hyde Amendment would allow these patients to receive the procedure elsewhere, why should SCH need to provide the services? To respond, I would like to remind the hospital board that your hospital is the only one within a 45-minute drive in all directions. In extreme, life-threatening situations, this is too much time to take a patient to another hospital that provides the procedure. Because the provision is allowing the federal government to subsidize abortion services under the same conditions that I am proposing to you, I believe that little funding from your hospital will be necessary to provide the procedure. More important than funding the procedure, in my opinion, is the need for there to be a medical staff within your hospital able to perform the procedure when necessary. I will discuss the staffing dilemma you face after clarifying my stance on the other ART’s in question.
In-vitro fertilization (IVF) is an expensive procedure for families who are unable to conceive naturally. While I believe that IVF is an important medical service that should be offered, I understand due to its’ expenses why your hospital would be unable to subsidize these services for under-insured patients. Unless your hospital can receive outside funding for these services, I do not believe that IVF should be subsidized, as it does not seem like an economically stable decision for the hospital to take. However, I do believe that these services should be in place in this hospital in the event that patients who can afford its’ services want to undergo this procedure. Concerns for my stance on IVF is the community that this hospital serves. I understand that the Catholic hospital background and the conservative population in Sasquatch, CT may not be as understanding to my views of accepting the ART’s that are now available. However, like I stress throughout my proposal, I am not stating that these procedures should be offered freely to everyone or should be forced onto someone due to their situation, but rather that they should be available in the event that someone within your community finds the need to use them.
As a member of the healthcare industry with a research background, I do believe that there should be a provision where the hospital should encourage families to allow unused embryos to be donated for potentially life-saving research for families undergoing the IVF treatments. While this decision is entirely up to the parents, I believe that educating them about the progress being done in this field, and the benefits of this research, is essential for parents to make an informed decision regarding their unused embryos. In my opinion, donating unused embryos to science is a great idea, especially since those embryos will die on their own given time. Recent research has shown that there is a potential in embryonic stem cells that isn’t available in adult stem cells and using this method to further research can help in “gene therapy for genetic disorders, and the generation of replacement tissues and organs for transplant” (APH). While encouragement from the hospital is acceptable, under no circumstance should the hospital try to pressure parents to change their decision regarding donating their unused embryos for research purposes. While my medical and research background would suggest that the donation of unused embryos is more beneficial than not, it is not my decision, or any other individual’s, to persuade someone to do what they do not personally believe in. To my peers who, once again, questioned the acceptance of the community for my stance, I would continue to say that my medical background is what guides me to make this policy recommendation. While any stance will have an opposition, I believe that the stance that I have chosen to take allows the community to choose whether or not to use the services that are available. In no way am I suggesting that the community should be forced to use an ART if they do not wish to use it. Similar to how my views are not above those of the community or other hospital members, their views are not above mine, and I believe that my stance allows the community the freedom to choose for themselves without imposing their beliefs on others.
Prenatal testing and amniocentesis are rights that I believe should be offered to all expecting parents, regardless of their ability to afford the costs. It should be a parent’s decision whether or not they would like to use prenatal testing or amniocentesis during their pregnancy, but I believe that they should be available to everyone across the board. Prenatal testing, or blood serum testing, is not a diagnostic tool; however, is necessary for the “prevention, protection, and reassurance” of family members and can detect for neural tube defects, such as spina bifida, down’s syndrome, and anencephaly (The Burden of Knowledge, 1994). Unlike the blood serum test that is common in prenatal testing, there is more concern with amniocentesis, as there is a 0.05% chance of miscarriage after undergoing the procedure (The Burden of Knowledge, 1994). Whether or not to use the amenities provided by the hospital is a decision left to the parents, but in the end, I still think that access to these types of tests is necessary, for those who choose to use them. Even if the subsequent procedures are not available, it is my belief that the knowledge is always beneficial in preparing the parents about what to expect in raising a child with disabilities. In addition, there is a significant Jewish population within the community your hospital serves. As Tsipy Ivry describes in her ethnography, Embodying Culture, there is a prevalent knowledge of pregnancy in Israel called “geneticism,” in which the mother is responsible for undergoing diagnostic testing in order to ensure the health of her child. In order to be inclusive of the views of your patient population, there should be access to testing within your hospital, and the decision to use these services should be left up to the parents and family members involved. Similar to my earlier statements, this should be a procedure offered by your hospital, but not one imposed on members of your community.
Your committee is also debating the inclusion of spiritual counseling by Catholic clergy. While historically Catholic, your hospital is currently non-denominational. Due to this, I believe that if the Catholic clergy are present for counseling, your patients should have access to clergy members of other faiths as well, especially since the population you treat includes people of many faiths and cultural backgrounds. Regardless of the testing and technology that the medical staff favors, the eventual decision for or against the use of assisted reproductive technologies should encompass the views of the patients. As a member of the science community, it can be hard to sometimes differentiate your views from others, but in the end, this decision will impact the lives of the patients more than it will impact the lives of the healthcare providers. I do, however, agree with Dr. Tangutoori that this may create a barrier between medical professionals and religious clergy and that there should be a certain limit to which the clergy can impose their views on the patients. As a medical professional myself, I believe the overall health of my patients is the most important factor to consider, and with that guaranteed, discussions regarding values and religion can take place. Catering to the values, traditions, and faiths of individual patients are equitable to the conversation that Swasti Bhattacharyya describes as “cultural competency” in her book Magical Progeny, Modern Technology and with what I have seen practicing medicine, this is an extremely necessary pillar of support for patients undergoing a medical decision (Page 23).
I understand that some of your nursing staff is concerned regarding the potential reproductive technologies your hospital may offer, especially since they hold conservative Catholic views. In order to provide these services and still keep the staff of your hospital satisfied, I believe the hospital administrators should send out a questionnaire to understand exactly how many members of the staff will not provide the procedures, how many are comfortable with assisting in the procedures, and how many will provide the procedures. Using this data, hospital administrators can devise teams of members who can perform the procedures. In this case, the hospital will be developing teams who are comfortable in performing prenatal testing, IVF, amniocentesis, and abortion, while also respecting the views of the primarily Catholic staff who do not want to perform the procedures. If there are not enough members to assemble a team, I recommend using the funding you have to hire other professionals who are able to perform the services you are offering. Dr. Nestor has questioned this method of developing medical teams to perform ART’s and I understand where she is coming from in saying that, as a medical professional, staff should not bring their personal views into their professional duties. In an ideal world, I would agree that regardless of their personal views, a medical professional should perform the procedures that fall under their area of specialty. With such a strong Catholic staff, I don’t believe that the hospital would benefit from forcing the staff to perform procedures that they are completely against. I fear that this force would result in resignations of staff who cannot fathom the procedures that SCH offers, leaving the hospital unable to perform other medical treatment to benefit your community. With your limited funding in mind, I would recommend against this.
Thank you for taking the time to reevaluate my policies regarding the artificial reproductive technologies you are discussing. I hope that my alternative viewpoint is helpful in finding a balance between the medical professionals at your hospital and the community you serve. If you have any additional questions or comments, please let me know and I will clarify my stance further.
Greeshma Magam, M.D.