To Whom It May Concern,
Background Information
My name is Zoraiz Ahmed. 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.
Amendments to Initial Proposal
After submitting my initial proposal to the Sasquatch Hospital ethics committee, I received several comments and suggestions from my fellow peers on the ethics committee. I have thought long and hard about the critiques of my proposal and I have amended a portion of my initial pitch regarding the use of reproductive technology. My suggestions for IVF treatments, prenatal testing, and abortion have stayed the same, but I expanded on my reasoning. However, I have decided to compromise with my peers on the donation of unused embryos. I have also stood by my original recommendations for regulations of the counseling and medical staff.
Final 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 equivalent to the probability of babies born with Down syndrome, patients in our community deserve to have the right to know about possible birth abnormalities. Furthermore, with the growing diversity in population and thereby increased risk of genetic diseases, the availability of this procedure is essential as genetic diversity is also increasing.
I acknowledge that the results of prenatal natal testing can cause a great amount of anxiety and psychological trauma to the patients and families involved, but I support the fact that access to knowledge outweighs this distress and the risk of miscarriage. As a physician, I believe parents in the Sasquatch community have the right to be given all relevant information to make a well-informed medical decision regarding their unborn child. However, as medical personnel looking out for the overall well-being of our patients, we can provide hospital services to alleviate distress post-test results. These are addressed in propositions for counseling staff regulations.
Abortion
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. Although this federal amendment was made in regards to funding of abortion services, I have chosen to use the guidelines as a line of compromise between the devout population against abortion and the new growing liberal and diverse population in the Sasquatch society.
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. I define “extenuating circumstances” as rape and incest and nothing more. There will always be compelling arguments for genetic abnormalities and diseases as extenuating circumstances for abortion, but this opens up a vast spectrum of new cases. Given the general limitation of new hires and the limited time of the ethics committee to handle a case-by-case analysis these situations, I have chosen to strictly define what qualifies as extenuating in this policy proposal.
Unused Embryos
After careful consideration of my colleagues’ critiques, I retract my original suggestion that unused embryos should be donated to research. I still agree that from a medical standpoint that research from unused embryos could lead to life-saving results. However, I believe slow policy reform will bring about the most fruitful change at Sasquatch Hospital. Under the same religious reasoning as above, the Catholic community is still dominant and many believe that embryos are living and thereby destruction of living embryo is still murder. Though that is a very controversial thought, I was swayed by my colleague who pointed out that there is no way we ensure that the donated embryos will not be destroyed or just thrown out by researchers who deem them to be unfit for their purposes.
Under-insured Patients
Subsidized funding for underinsured 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. Under my own Muslim doctrine it can be stated “Shi’ites practice a form of individual religious reasoning known as ijtihad (Inhorn 18).” Medical choices of any sort are extremely personal and hence I advocate for individual religious reasoning in the decision-making process. 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 assisted 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.
Additionally, there should be an increased number of trained inter-religious clergy specifically available at the prenatal testing facilities of the hospital. This aims to alleviate the arduous decision making process that some patients and families might undergo after receipt test results.
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 significant 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.
Closing Remarks
My final proposal encompasses my best attempt to view the situation in an open-minded manner while staying true to my medical and religious values. I believe the best method to allow for a smooth transition at our hospital is slow reform. As a physician, I support the advancement of new scientific technologies, but I also acknowledge the importance culture and religion within the Sasquatch community. Though our hospital is becoming non-denominational, I stand strong under the opinion that a complete and drastic change to the current policies will not prove successful in such a short period of time. I have done my best to find a middle ground between the conservative and liberal perspectives on abortion and prenatal testing services at play in the larger Sasquatch community. Thank you for your time and consideration of my policy proposal.
Sincerely,
Dr. Zoraiz Ahmed, M.D.
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).
Hello Dr. Ahmed,
Thank you for your well-thought out proposal for Sasquatch hospital. I am glad to see you involved in this conversation. As a prominent member of the Lebnanese Shi’ite community you can provide great insights from a perspective that is too often not voiced in our majority-Catholic community. Also, as a doctor you have seen how concerns of ethics often permeate the provision of healthcare.
I support your position on IVF, prenatal testing, and abortion, but as the CEO of this hospital I am wondering how we will pay for some of the services you propose. You say you hope to subsidize prenatal testing for underinsured patients. Unless we receive new donors from other subgroups in our community, we rely on Catholic donors for our financial resources. Some of these Catholic donors may reject the idea of prenatal testing even if we do not allow abortions. They may see it as giving the expectant mother a reason to abort her child at another hospital. I agree that it’s important that we provide prenatal testing because parents should be able to prepare for challenges that come with a genetic disability; but we should not subsidize it for underinsured patients unless we attract new donors from other religions. You also suggest hiring spiritual counselors from a variety of religions in addition to hiring non-denominational counselors. What do you think these non-denominational counselors will contribute that the religious counselors cannot? In my first proposal, I suggested hiring spiritual counselors from different disciplines just as you did. But it has been brought to my attention that it will be difficult and costly to hire these counselors. In light of this argument, I have changed my position. I agree with you that we need to serve our diverse population, but hiring counselors from every religion is inefficient. It is not a good use of our financial resources. Thus, I proposed that we only hire non-denominational spiritual counselors and hire counselors from specific religions on a case by case basis when necessary. I have seen this kind of policy be put to good use regarding translators. An Arabic-speaking patient could not communicate with his doctors. There was no Arabic translator working full-time at the hospital, so the hospital hired one to work for the length of the patient’s stay. I believe hiring non-denominational counselors is the best way to maximize efficiency and appeal to diverse populations. The comments I made above should be taken into consideration as we continue to define the policy of our hospital.
Dear Dr. Ahmed,
I very much appreciate the updates you have made to your original proposal, though I still notice many inconsistencies. You have a unique perspective on this discussion as both a scientist and a devout Muslim. Your attempt to reconcile these two integral aspects of your identity is reflected in your proposed. As a Muslim you are inclined to allow religious law to dictate bioethics, but as a scientist and physician you are inclined to allow science to do so. You have decided to allow IVF and amniocentesis procedures to be performed at this hospital because you believe patients have the right to knowledge, yet you strictly oppose abortion, which would perhaps be the preferred outcome after families are given the results of an amniocentesis. Additionally, you have decided not to donate unused embryos to scientific research. I am glad you hear you were swayed by my (and others’) opposition to that proposal as you cannot be certain of the fate of the embryos, however you are still choosing to provide IVF treatments and abortion in some cases. You will now be faced with the fact that you will still be throwing away or murdering embryos. You oppose abortion because Shari’a law deems it murder, so how is IVF any different? Finally, you have decided abortion is permissible under “extenuating circumstances” of rape and incest. However, the actions that lead to the conception of a child have absolutely nothing to do with the fact that abortion is still murder according to the Muslim and Catholic bioethics you cite in your argument.
As I said earlier, these inconsistencies seem to be reflective of a greater inner conflict between religion and science. This brings up several very interesting questions, especially as we attempt to build a bioethics that takes both religion and the Hippocratic oath into account. Can both of these things have equal influence in these types of decisions? Is there a way to give into one without compromising a stance on the other? I do not think there are any easy answers to these questions, which is much of the reason why I proposed that we simply deny these treatments to patients of this hospital. An institution with such strong ties to a Catholic bioethics cannot easily compromise this position to allow abortion and IVF procedures, as is evident in your attempt to find a middle ground.
Sincerely,
Hannah