I am on the hospital ethics committee as the head of the nursing staff and as a nurse practitioner. I am from an Irish catholic background as are the majority of the other nurses. I have worked at this hospital for 30 years and was reluctant to see it go through the transition of becoming non-denominational. I speak for the majority of the nurses at the hospital who have expressed to me similar complaints as myself. We are aware of the controversies that have surrounded Catholic hospitals and their refusal to provide abortions. Legal challenges brought against some hospitals have not necessarily brought clarity on this extremely complex and delicate legal issue. We have followed these cases very closely (see: http://www.washingtontimes.com/news/2016/apr/11/court-nixes-suit-force-catholic-hospitals-abortion/ and https://www.aclu.org/cases/tamesha-means-v-united-states-conference-catholic-bishops). While we are no longer a Catholic hospital, the Catholic values that have been serving our community for all these years should be respected as these values are set apart to assist and preserve human dignity and human life. It is important that the standard of charity and of respect for all persons be maintained for our patients, regardless of their age, racial, religious, socioeconomic status or background.
1.
Our private hospital should continue in its longstanding tradition of not providing abortion services to our patients. Not only do our donors come from Catholic backgrounds and we would risk our funding in order to provide these services, but most importantly abortion services are immoral and do not respect the dignity of the individual. Medicine works to protect the good of human life, and healthcare staff work to assist a patient struck with illness, regardless of their insurance status (Donum Vitae 1987:145). It is important that we continue to exercise the Christian will of charity to address the needs of our poorest and most vulnerable patients by continuing to subsidize other forms of medical care. However, the most vulnerable in our society include the defenseless and those with no voice. It is therefore that as members of this community we must protect the unborn who only have us to speak up for them. It is important to note that these Catholic teachings are not only based in scriptures shared with our fellow Abrahamic religions but are also based in secular reasoning. For instance, while it is written in the book of Genesis that man was made in the image of God, rational arguments based in nature are also used by the Church to defend its positions, and those arguments can be used in any secular setting. Donum Vitae, the church’s doctrine on the respect for human life with regard to new technologies, states, “No biologist or doctor can reasonably claim, by virtue of his scientific competence, to be able to decide on people’s origin and destiny” (Donum Vitae 1987:145). It is outside of the moral bounds of any healthcare professional to be able to defend or justify their own ability to possess this deterministic value with regards to who will survive. It is our job and the job of this hospital to alleviate suffering of its patients and not to provide abortion services. While our hospital is somewhat remote from others, abortion services are not sought in emergency settings and therefore individuals who choose not to follow this mandate are able to find these services in other clinics in the state of Connecticut. The state of Connecticut follows the national precedent of Roe v. Wade and recognizes a human person after the beginning of the third trimester (although scientific advances are proving that premature babies are beginning to survive at even earlier gestation weeks than set out by the law). We argue that while the beginning of physical life at conception does not by any means “contain the whole of a person’s value nor does it represent the supreme good of man”, it does “constitute in a certain way the ‘fundamental’ value of life precisely because upon this physical life all the other values of the person are based and developed” (Donum Vitae 1987:146).
However, we are suggesting that our hospital will make exceptions in the cases where the mother’s life is at immediate risk and there is no other option but to proceed with the abortion as an indirect consequence of saving the mother’s life. Under such circumstances this action would be permissible as the life of the mother is equally as important as that of the fetus. Note that here I am suggesting an important change to the original position of our hospital as we are no longer nondenominational. Several lawsuits have been filed against Catholic hospitals due to the physicians and staff not treating women who were having dangerous miscarriages and needed to abort the child. The doctors in these cases interpreted the lesson in Donum Vitae to not treat any woman for any abortion, even when the woman was in extreme danger. However, the more recent (2009) Ethical and Religious Directives for Catholic Health Care services state: “Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child” (Ethical and Religious Directives for Catholic Health Care Services). This claim should be upheld as we are a remote hospital and it is our duty to treat women who are in extreme peril. Furthermore, as we shift to no longer being a non-denominational hospital it is important to support all of our patients who request other kinds of medical services, even those we could not ourselves support for the aforementioned reasons. This would permit our physicians and nurses to comply with the professional ethics guidelines from the American College of Obstetricians and Gynecologists which state “Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place” (ACOG). It is in this way that we can continue to serve and support all women who come to our hospital.
Similarly to the reasoning behind refusing abortion services, I continue to believe that the hospital should not allow for IVF treatments when such treatments result in the discarding of “extra” embryos. It is important to reflect on this position from both a rational and moral lens, examining the fundamental values of life and whether or not it is permissible for technological interventions to replace human procreation and to affect a human in the first stages of development (Donum Vitae 1987: 146). In fact this teaching has been backed by science in the sense that “modern genetic science brings valuable confirmation. It has demonstrated that, from the first instant, the program is fixed as to what this living being will be: a man, this individual man with his characteristic aspects already well determined. Right from fertilization is begun the adventure of a human life” (Donum Vitae 1987:148). IVF treatment disrupts the development of a new life, and therefore changes the natural course of events in human’s biology. The human life is an incredible gift, and with the arrival of technologies the importance of this can be diminished. In order to protect human life and uphold it’s dignity, the disruption of biological processes for the gain of others should not be permissible.
Technology is so advanced that today individuals can choose embryos based on lack of disability, or even gender. This type of selectivity puts the physician and the parents as usurpers of the place of God, as they will be “the master of the destiny of others inasmuch as [they] arbitrarily chooses whom [they] will allow to live and whom [they] will send to death and kills defenseless human beings” (Donum Vitae 1987:154). To prevent IVF is to safeguard against what could approach becoming a new type of eugenics, pitting parents against children of disability or children of a certain sex. We as a hospital ethics board must continue to prevent these future immoral acts. We acknowledge that such position may conflict with the goal of serving a broader population. It may even have negative financial consequences for our hospital as some patients or insurance companies may decide not to make use of our services. However, this is an area where we believe we are not in conflict with the goal of providing necessary care to the ill and the vulnerable. Our Catholic tradition can still guide us in making what we believe are fundamental, life-respecting choices. The fact that IVF is not morally permissible still rests on the fact that “extra”, disposable embryos are being created and are therefore destroyed or used for testing, and are not being treated with the dignity of human life. This rests as the greatest moral harm done by IVF treatment. Secondly, IVF does not maintain the naturalness of human life and of human reproduction. Thirdly, IVF technologies have advanced so far in that parents and doctors are able to “choose” their child based on characteristics they personally prefer, which can be seen as allowing for a type of eugenics.
Furthermore, I maintain that IVF testing is a procedure that should not be allowed in our hospital because of additional ethical considerations based more on social justice than on religious beliefs. In one sense, allowing for any form of IVF will have socioeconomic limitations over which sort of patients may benefit from these procedures. As couples throughout the world and across all socioeconomic statuses can – or cannot — be blessed with the gift of a child, it is unfair for us to provide a treatment that, because of its costs and potential lack of insurance coverage, will allow only wealthy couples to benefit from the gift of a new life via artificial technologies. Additionally, allowing for IVF invites an incredible amount of complications for our ethics committee to handle. Would only heterologous, same-sex, married couples be allowed to have this procedure? Would we allow for donations or surrogates to be impregnated in our hospital? These issues are handled in a wide, complex array of levels from different religions and cultures. And while we may upset some people in our community by not being “convenient” for them to be able to receive IVF, we would be treating each individual in the same manner regardless of their background.
Finally, prenatal diagnosis is acceptable under the moral lens of the church, and I believe that we should continue to assist expecting mothers in all ways possible including prenatal testing. Prenatal testing can assure mothers that they are expecting a healthy baby, or it can make it possible for mothers to plan for accommodating disability or future medical procedures to be carried out on the child (Donum Vitae 1987:150). However, amniocentesis may only be performed if it is believed to “safeguard the life and integrity of the embryo and the mother, without subjecting them to disproportionate risks” (Donum Vitae 1987:150). Amniocentesis is becoming an increasingly safe practice with a trained professional so we believe the evaluation of the risks should be performed and explained to the mother on a case-by-case basis. While I believe that on a hospital-level prenatal diagnosis must continue to be performed, it is important to note that we as medical professionals should not “induce expectant mothers to submit to prenatal diagnosis planned for the purpose of eliminating fetuses which are affected by malformations or which are carriers of hereditary illness, is to be condemned as a violation of the unborn child’s right to life” (Donum Vitae 1987:150). The purpose behind prenatal diagnosis should not be to result in abortion but rather to provide reassurance or assistance to expecting mothers. It is important that as medical professionals we inform mothers of the nature of the testing or at the minimum remain value neutral in order not act in favor of terminating life based on whatever characteristics are considered “better”.
2.
The community based around this hospital is increasingly diverse, and I believe that we as a hospital system should grow in our spiritual counseling to reflect that diversity. The Church holds the utmost respect for other religions and I believe that we should diversify our counseling group to reflect this. In less centralized religions such as Islam or Judaism, the advice of different counselors is especially important to families, as there is less of a unified mandate compared to that of the Catholic Church. The values placed on new families may also be different. For instance, instead of focusing on natural law and the human person, Islam bases much of its reproductive ethics on the legitimacy of kinship relation (Clarke 2007: 82). These different methods of guidance should be available to our patients, and all our patients should be informed of resources that are currently not provided by our hospital on a case-by-case basis.
While many of these religions are more permissive and flexible with regards to ARTs, abortion and prenatal testing, this does not require us as a hospital to provide these different services. Respecting diversity does not imply that we should provide different services to hospital patients based on their religious tradition. On one hand, belief systems of patients may play a large role in why patients choose to undertake procedures that are considered morally impermissible and against natural law (Rapp 2000: 53). However, it is not the role of the hospital to interpret the moral dilemmas posed by each religion or to assess the sincerity of each person’s professed faith. At the same time, healthcare delivery in the United States is centered on choice and free will and these patients may go elsewhere to take part in these services (of course, emergency procedures are an exception to this ruling). It would be more morally impermissible for us as a hospital to create exceptions, allowing for certain religious groups to obtain these procedures and going against our traditional hospital mandate, than for us to make a blanket statement that provides equivalent and morally justified services to all of our patients. It is in this way that we are able to treat our patients equally, regardless of their background.
With regard to the claim that Catholic priests are interfering with the doctors’ work, it is important to understand that families absolutely always have the right to accept or refuse testing or ARTs, or any treatment in general. The doctors in this hospital should not be recommending that women undergo treatment that puts the fetus at unnecessary risk and should not allow for IVF treatment due to the destruction of fertilized embryos. If doctors are unwilling to subscribe this recommendation of the Catholic Church, they should at the minimum remain value neutral and refer the patient elsewhere if it is their expressed desire to undertake these morally illicit procedures. While the hospital is no longer Catholic in its administration, it is important that values that were protected by the Catholic Church such as respect for human life be maintained.
3.
Clearly as the head of the nursing staff and a nurse practitioner I believe that new nurses should absolutely not be screened and hired based on their willingness or unwillingness to assist in abortion and IVF procedures. It is in the right of a nurse or doctor to refuse partaking in these services as they do not want to be a part of a morally illicit activity that results in the death of human persons. It is morally impermissible for a hospital institution to force an individual to act against their religious beliefs with the threat of being fired. This would violate hospital policy as well as state and federal law (Title VII if the Civil Rights Act of 1964). If these services are not provided to our patients, this would no longer be an issue for the nurses at this hospital. Refusing to allow for abortion services is also important to our donor base that allows for us to run a hospital that saves the lives of individuals in this relatively remote area, an objective we as a board should prioritize above all else.
Citations:
Committee on Ethics. “The Limits of Conscientious Refusal in Reproductive Medicine.” The American Congress of Obstetricians and Gynecologists. N.p., 2016. Web. <http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/The-Limits-of-Conscientious-Refusal-in-Reproductive-Medicine>.
“Ethical and Religious Directives for Catholic Health Care Services Ethical and Religious Directives for Catholic Health Care Services.” United States Conference of Catholic Bishops. N.p., 2009. Web. <http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf>.
“Religious Discrimination.” U.S. Equal Employment Opportunity Commission. N.p., n.d. Web. <https://www.eeoc.gov/laws/types/religion.cfm>.
Nurse Cagliero,
As a fellow coworker in the Sasquatch-area hospital, I greatly appreciate your proposal and truly admire your firm stance on these highly controversial issues. I, too, am a Irish Catholic and was born and raised in Sasquatch, Connecticut. I remember the days when nearly the entire population in this region was Irish Catholic. Like you, I share many of the same views, but I have become slightly less stringent in my interpretations of texts, such as Donum Vitae.
In your proposal, you present your perspective on abortion policy in the hospital, citing Donum Vitae as a reference. You also cite Ethical and Religious Directives for Catholic Health Care services. Both of these sources are very reputable in the Catholic community. You believe that no abortions should be carried out in the Sasquatch hospital, except in the case where the mother’s life is in extreme danger. In this case, you argue that the abortion is necessary—to respect human life—and save the life of the mother.
I interpret these texts slightly differently by holding that abortions should not be performed in the hospital, except in pregnancies resulting from unfortunate circumstances, such as rape or incest. I believe the act of abortion in these cases is permitted out of respect for human life. If a woman is forced to give birth to a child she never asked for, that child will not be loved or cared for. Additionally, the responsibility of caring for the unwanted child would be forced upon the mother for the rest of her life. How could you justify bringing a baby into this world under such dire circumstances? I am hoping that you will consider cases such as these in the future.
In terms of the use of prenatal testing, our opinions are very similar. We both agree that PNDs should be allowed, but we disagree on the extent to which they should be utilized. I argue that upon a signed waiver by the parents acknowledging that abortion will not be carried out, regardless of results, PNDs that do not increase the rate of miscarriage should be permitted. There are two main advantages to PNDs (aside from abortion): preparation and prevention. One problem that I have with your stance on the use of PNDs is with amniocentesis. You argue that, “Amniocentesis is becoming an increasingly safe practice with a trained professional so we believe the evaluation of the risks should be performed and explained to the mother on a case-by-case basis.” I firmly disagree with this policy. My belief is that since amniocentesis increases miscarriage rates, although marginally, its use should not be permitted in this hospital.
Overall, I agree with your general premise that we must maintain our moral roots as Irish Catholics, even though our hospital is now non-denominational. We must treat all patients with the respect and dignity that they deserve and maintain our respect for human life.
Thank you for your thoughtful proposal.
Sincerely,
Jonah Adler, M.D.
Dear Nurse Cagliero,
Thank you for your comprehensive and compelling policy proposal. I have enjoyed working alongside side you for the past 10 years and the hospital is lucky to have someone so level-minded as our head nurse. After reading and examining your provisions, as your colleague I am willing to make a compromise with you on many of the points you have raised in advocating for the Catholic majority nursing staff. However, from a medical diagnosis standpoint, I urge you to widen the restrictions you have placed on abortions at the Sasquatch hospital.
You have only specified that abortion services will be allowed if there is risk to the mother’s life. How about the opposite scenario with there is danger to fetal life. Why would there not be an exception for this case? To illustrate my point, consider a young woman, 19 years old, who comes to the hospital and is pregnant, but is within the first trimester. It is soon made clear that the woman is pregnant due to an incestuous relationship with a male member in her direct household. Though carrying this child will not necessarily affect the mother’s survival, there is an incredibly high likelihood that the child will be born with defects and many that have shown to be fatal. Not only does the prenatal testing show signs of fatal defects, the woman is starting to undergo extreme psychological distress knowing that she will have to give birth to a child that will die soon after birth. Though there is federal funding to provide these services elsewhere, what if the woman does not have transportation to another hospital that is far away? As a hospital serving our community, is it not within our best medical interests to provide abortion services to this woman? Thus, I urge you to take into account that if exceptions are made because the mother’s life is considered just as valuable as fetal life, then the same exceptions must be made for when fetal life is danger.
Overall, I am in agreement with many of the revisions you made to your original proposal. Nevertheless, I do still think we all have dilemmas to iron out in regards to abortion services at the Sasquatch Hospital. Thank you for your consideration and I hope we can continue to work together to find a middle ground between our propositions.
Sincerely,
Dr. Zoraiz Ahmed, M.D.
Dear Head of the nursing staff.
I really appreciate your policy proposal on how our hospital should go forward on these important issues. From a physician standpoint there is a lot we may disagree on, but I also think there is a way for us to overcome over differences through constructive conversation. I thought your stance on abortions and abortion rights was very interesting in that you are willing to offer abortions to mothers whose lives may be in immediate jeopardy, but not in others. At this point I would like to ask you if you would also be willing to perform abortions for rape victims, even if their lives are not jeopardized by the pregnancy? Furthermore, as someone who is supportive of abortions by physicians who are willing to perform them in our hospital, I do not really see the difference for the ‘embryo’ when the mother is in jeopardy. In both cases we are deciding to kill a human life. Even if in one case it is to to rescue the mother, we would still be deciding to ‘play God’ and kill one life to save another.
Furthermore I think by more hospitals not allowing abortions to be performed, we are not actually banning abortions, but we are just making them unsafe. Women may try to perform abortions themselves or travel to a different country to get an abortion in which this kind of procedure may be unsafe. Regarding your criticism of IVF I must also disagree with you. I agree that a child is a blessing, but I also believe that every couple should have the right to such an incredible gift and if modern technologies and laws allow us to assist couples we should not be holding them back from receiving such a gift/blessing. In fact I believe that many people who may be part of a religion that speaks out against IVF, are still willing to undergo such a procedure because of how much they want to have the gift of a child in their life. Finally, I agree with you that no medical staff should ever be forced to perform any kind of procedure and that we should not screen any employees based on that. In my opinion medical staff not willing to perform procedures such as abortions, should refer those patients to other doctors, including doctors in our hospital if available. I look forward to working through our different opinions and coming up with a final constructive policy for our hospital.
Best,
Wall, MD