Final Assignment – Petar Zotovic

Assisted Reproductive Technologies and Prenatal Testing Policy Proposal

Dear Ethics Committee of Sasquatch Medical Center,

Upon reviewing all the comments made on my original policy proposal, I have taken into deep consideration the various beliefs and suggestions made. Even though I respect the opinions of my colleagues, I have decided to remain firm on my initial suggestions regarding in vitro fertilization (IVF) and spiritual counseling. However, I do agree with the vast majority of the committee that I fell subject to generalizing religious groups, and as a result, I have attempted to correct this mistake in the following revised proposal. My reason for not altering positions on a specific issue are explained in the respective section of the proposal.

As you all are familiar with, my name is Petar Zotovic and I am a fertility physician here at Sasquatch Medical Center (SMC). Recently, the Catholic Church has allowed our hospital to become non-denominational, one of the reasons being due to the diverse and growing population of Sasquatch, Connecticut. Sasquatch has deep Irish Catholic roots and this was an important factor to consider while constructing the policy proposal. Upon analyzing the differing religious beliefs in Sasquatch, I am proposing a policy which allows the use of all ARTs available to the hospital; in addition, prenatal screenings are only allowed if the intention is to not abort a fetus if an abnormality is found to exist. My policy proposal attempts to satisfy the diverse population in Sasquatch, while still attempting to adhere to its Catholic roots regarding prenatal testing.

In attempts to abide by the still prevalent and dominant Catholic faith in Sasquatch, all attempts at abortion will not be executed. In the past, Sasquatch was a safe haven for Irish Catholics and was once ruled by Catholic auspices, so retaining some of their beliefs is still important. In addition, I agree with Cahill et al. in Donum Vitae when they state that “The human being must be respected- as a person- from the very first instant of his existence” (1988: 147). As a result, subsidies will not be granted in abortion cases. In alliance with my stance on abortion, prenatal screenings may only be conducted in order to examine a fetus for abnormalities. No attempts at termination may be done once such tests have been performed. The main goal of performing prenatal screenings (e.g. amniocentesis) is to prepare a mother for the possibility of her fetus having a defect. In screenings that confirm fetus abnormalities, the mother will have the opportunity to cope and discuss her feelings with a hospital counselor.

All ARTs, including IVF, will be subsidized by the hospital for under-insured patients. Through this advancement, both Caucasians and African-Americans living in poverty will have the ability to become pregnant without major financial setbacks; in recent years, the poverty rate in Connecticut among these groups has increased by four percent, with most of the individuals being under-insured (Armstrong, Plowden 2012: 652). In addition to assisting the poor, the subsidization of ARTs will benefit both the thriving Jewish and Japanese community; with regards to IVF and other reproductive procedures, Jewish ethicists commonly cite God’s first commandment: “Be fruitful and multiply, and fill the Earth, and subdue it…” (Bible Hub, Genesis. 1.28). The IVF protocol will contain a provision which will respect Islamic law; the provision will state that Shiite Muslims are eligible to participate in IVF if it involves a husband and wife couple. I am stating this because of Morgan Clarke’s ethnographic study in Lebanon in which she concluded that Islamic law plays a crucial role in determining rules by which females must abide by if they want to undergo IVF treatment (Clarke 2007: 72). In her study, she comments “The prime principle at stake here is whether such scenarios are analogous to, if not identical with, the heinous crime of zina, that is sexual relations between parties not bound by a contract of marriage…” (Clarke 2007: 74-75). The preceding quote demonstrates the necessity of a husband and wife couple when performing IVF on Muslims. Of course, IVF treatment not between a husband and wife couple will be allowed if the patient and donor both agree and/or if no religious beliefs are interfered with. The following protocol on IVF will show the emerging minority population that their beliefs are heard of and will be respected at SMC.

A common criticism of my initial proposal was that allowing IVF treatment indirectly leads to more abortions, thus contradicting my stance on a zero-tolerance abortion policy. The accusation was formed on the basis that IVF leads to the creation of unnecessary embryos which ultimately end up being destroyed. Patients often decide to undergo IVF treatment because of their inability to have a child due to infertility reasons. If IVF treatment is successful, the likelihood that the mother will deliver the baby to term is ninety-three percent. Out of all abortion cases, only seven percent are a result of fetal/mother health complications and sixty-nine percent are due to the mother not being emotionally and socially fit to care for a child (“U.S. Abortion Statistics” 3). If a mother has decided to proceed with IVF, it is reasonable to conclude that she sees herself fit to raise a baby. In addition, the course of action regarding unused embryos at SMC will obey the following provision. Frozen embryos may be used for life-saving research if they have not been placed inside the mother’s uterus and if the mother provides consent. With regards to the provision, I respect the Islamic belief that an embryo is not considered human if it is not inside the mother’s uterus; the embryo outside the uterus will not survive if it is unfrozen and is therefore not considered human (Eich 2008: 63). In “Decision Making Processes Among Contemporary ‘Ulma’: Islamic Embryology and the Discussion of Frozen Embryos”, Thomas Eich describes ‘Abd al-Salam al-Ibadi’s view on the topic by mentioning “Concerning the question of frozen embryos, he argued that the majority of classical fuqaha would have opposed abortion. Therefore, the use of frozen embryos for research could not be allowed, and the embryos should be implanted in the mother’s uterus” (2008: 68). I disagree with Ibadi’s statement because a large number of Muslims have differing views from the classical fuqaha he describes. Instead, expected costs and benefits, such as the opportunity to save a life, should be analyzed when deciding to donate frozen embryos for research. Due to the provisions and reasons listed above, the use of embryos for life-saving research is not considered abortion in my opinion and is why I have decided to remain firm on the issue.

A second criticism I received involving IVF treatment was the impact it might have on a person’s dignity. As Leon Kass states in her ethical inquiry to President Bush, there “…are deeper concerns about where biotechnology may be taking us and what it might mean for human freedom, equality, and dignity” (16). Even though I agree with Kass’s statement that ARTs can result in psychological damage to a child, I feel that the statement should be approached on a case-by-case basis. The sole goal of IVF treatment is to place a fertilized egg inside a mother’s uterus; the remaining pregnancy process continues as if IVF treatment did not occur. The resultant child has genetic material of both mother and father and is not at risk of future heath complications due to the treatment. The only difference I see between a normal pregnancy and one due to IVF is the process by which an egg becomes fertilized. As a result, I do not find much justification in the argument that IVF treatment may affect one’s dignity later in life. In other forms of assisted reproduction, such as cloning, the argument changes entirely. In cloning, the process of birth is altered entirely and the clone remains at heightened risk of future health complications (Kass 17). In extreme forms of reproduction (e.g. cloning), the idea of loss in human dignity needs to be weighted differently, thus making its emotional impact distinct from that of IVF treatment.

Throughout patients’ time at SMC, they will have access to genetic and social counselors. Spiritual counseling by Catholic clergy and access to spiritual counseling of other religions will not be utilized. Genetic counselors will be tasked with informing patients of risks they might face through ARTs/prenatal screenings and social counselors will help patients cope with any negative news that result from such screenings (as mentioned earlier in proposal). Spiritual counseling of any religion will not employed because physicians and nurses (mostly Catholic) at SMC will be required to enroll in a “cultural competency” course which will enable them to better understand the beliefs of all patients. Because the hospital budget for hiring new personnel is limited, this provision will not only save the hospital money, but will also improve physician/nurse-patient communication. Swasti Bhattacharyya mentions in Magical Progeny, Modern Technology: A Hindu Bioethics of Reproductive Technology that cultural competency is “the ability to provide care that is compatible with the values, traditions, and faiths of the patient” (2006: 21). This will be a new task physicians and nurses encounter, but will ultimately prove beneficial for the functioning of the hospital.

A third criticism of my original proposal was that the lack of spiritual counseling would prove disadvantageous when attempting to understand a patient’s beliefs. I disagree with this idea because I feel there is a different goal in mind among spiritual counselors and those who engage in cultural competency. My critics of the issue argue that spiritual counselors are necessary in order to corroborate a patient’s beliefs about a situation. Through this mindset, the goal of the counseling is not find a compromise between physician and patient, but to strengthen “own personal beliefs” (“Spiritual Counselor Careers” 1). As a result, the ability to progress in treatment options becomes stifled and leaves physicians in an uncomfortable position. On the contrast, cultural competency educates physicians and nurses on the beliefs of other religions and allows them to understand the thought process of a patient (Bhattacharyya 2006: 21). As compared with spiritual counselors, physicians and nurses educated on cultural competency can find appropriate methods to continue the healing process of a patient without being too intrusive on the patient’s religious beliefs.

My job in this hospital is to be a fertility physician, which means doing anything in my power to ensure the healthy status of a fetus or baby. At the same time, I realize that the population of Sasquatch is changing rapidly and new hospital accommodations are necessary. The policy proposal I am presenting to this committee attempts to reflect the hospital’s Catholic origins, while at the same time portraying a sense of humility to the increasing minority group in Sasquatch. I urge the entire ethics committee to consider this policy proposal with open minds and to vote for the passing of the proposal only if they believe it serves a humbling and beneficial purpose to the hospital staff and patients.


Thank You,

Petar Zotovic, M.D.





Works Cited

Armstrong, Plowden. “Ethnicity and Assisted Reproductive Technologies.” NCBI,

vol. 9, no. 6, 2012, 651-658.

 The Bible. Bible Hub, Columbia International University, 1993.

“Prenatal Testing.” NISHMAT, 2000, 2.

“Spiritual Counselor Careers.” Careers Psychology, 1.

“U.S. Abortion Statistics.” Loxafamosity Ministries, Inc., 2005, 3.

All other sources are from class readings.





3 thoughts on “Final Assignment – Petar Zotovic”

  1. Dear Dr. Zotovic,

    Thank you for your honest and detailed policy proposal. I appreciated your direct attempts to improve your original proposal based off the suggestions of the ethics committee. As a fellow doctor who also understands how polarizing these issues can be, I urge you to find more of a middle ground between the medical implications and the religious implications of these procedures.
    The main revision I suggest for your proposal is the inconsistency between religions that are emphasized. For your policy on abortion, you use strict Catholic values and for your policy on unused embryos, you use a more liberal Islamic value. As a devout Muslim myself and as Eich stated, the topic of unused embryos has been a divisive factor within our community. Thus, I think that taking this stance could alienate the older and more conservative members of the Muslim community in Sasquatch.
    Additionally, though the strict policy on abortion will satisfy the concerns of the dominant religions within the Sasquatch society, I question how much you are analyzing this scenario from a medical standpoint. For example, imagine a 13-year old girl from a lower socioeconomic status came into your office as a victim of rape. This case is not only illegal, but will drastically affect the girl’s life as well as the fetus. As a fertility physician, would you not be prompted to suggest abortion given the amount of complications that could arise? Yes, I know there is federal funding to provide these services elsewhere, but given the girl’s economic background, what if she did not have transportation to another hospital that is far away? I believe denying this hypothetical girl medical services that could save her life goes against the Hippocratic oath we both took.
    Overall, I am in agreement with many of the revisions you made to your original proposal. Nevertheless, I do still think we all have quite a while to go before we reach a comprehensive solution to the questions regarding abortion services and prenatal testing at the Sasquatch Medical Center. Thank you for your consideration and I hope we can continue to work together to find a middle ground between our propositions.

    Dr. Zoraiz Ahmed, M.D.

  2. Dear Dr. Zotovic,

    Thank you for your proposal, I found it very interesting to read your point of view and your revised position after comments were made. While as a Catholic nurse I agree with your opinions on prenatal testing and abortion, there are some issues that still arise from my perspective with your position.

    The first comment I have is on your proposal that the hospital subsidize IVF treatment. While I think that subsidizing medical procedures for under-insured patients is a very charitable thing for us as a hospital to do, I do not think this should apply to procedures that are not necessary nor are they life saving. IVF is an extremely expensive procedure (~$12,000 per cycle) and subsidizing it would be challenging to convince Catholic donors to give this funding as well as it being unsustainable for us as a hospital. Furthermore I find it somewhat problematic that you are framing your argument in allowing for IVF through the lens of multiple different religions in order to send a message to the minority populations in our community. I think that a problem could arise in that we could be seen as a hospital with policies that shift regarding the status of the individual, something that would be most problematic. I think an overarching and thoroughly inclusive IVF policy is the best way to go in our ever-changing community.

    I appreciated you going into detail about your distinction between spiritual counseling and cultural competency, but I still maintain that both jobs are necessary to take place in our hospital. While I think cultural competency courses in the way you describe can be very helpful for our patient-staff interactions, I think there still remains the void of the helpful spiritual leader that no staff member can fill regardless of their training. I would suggest that we expand our spiritual counseling program for the benefit of our community and to show our mindfulness towards the importance of diversity.

    Thank you again for your thoughtful analysis,
    Nurse Cagliero

  3. Dear Dr Zotovic,

    This is something I’ve discussed with other members of the ethics committee: in the state of Connecticut, private and public hospitals must provide emergency care to all patients, regardless of their ability to pay (as per the Emergency Medical and Treatment Labor Act and its interpretation in Connecticut). This includes abortions in situations where the mother’s life is in danger. Therefore, I question your proposal’s ability to stand in front of the law.

    You say that all ART’s will be subsidized for under-insured patients, but will the largely Irish Catholic donor base accept this? I feel like much of this proposal is riding on their tolerant generosity, which perhaps may be naïve. I’m not sure how accepted the board will be when the biggest motivation for this change is Japanese, Jewish, and Lebanese cultures affecting a relatively old establishment. Though ART’s may be acceptable in these cultures, we cannot forget who will be paying for them in uninsured scenarios.

    Though a goal of yours was not to generalize these populations, it seems you still may have. There are many schools of thought within Judaism and Islam, and some may agree and be progressive, but there are still parts of those populations that are traditionalist and will oppose these technologies. However, it is appreciable that are available if desired for the wellbeing of patients.

    I think you tackled the sources of prior criticisms very well, and your proposal stands out as a solid one. Your discussion on spiritual counselors is interesting, and I don’t believe there is necessarily a correct answer. A shortcoming was how trusting you are of the interests of various employees at the hospital, including doctors and clergy. I think in your proposal, their opinions should cover everything— scientific and spiritual. However, from the nature of the hospital being a historically Catholic institution, I can imagine that the goals of the physicians and clergy are more aligned than they would be at a public hospital. It also seems that you tried to make everyone in Sasquatch happy, which I am slow to believe is possible, especially with how sensitive some people are with the idea with frozen embryos. I see that since you are a fertility doctor, you want to see people who aren’t able to conceive to have a baby. I appreciate your insights and hope you continue to strive for what is right.

    Dr. Elmasri

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