Final Assignment – Rachel Spector

As the CEO of Sasquatch Hospital, I have been asked to craft a new policy proposal regarding assisted reproductive technologies and prenatal testing. I accepted this job just as the hospital was shifting away from its official association with the Catholic religion a few years ago. Over the past few years, I have gotten to know the many different populations that make up Sasquatch, Connecticut. I have also been in communication with anthropologists who, over the past year, have been talking in depth with our patients about their feelings on these assisted reproductive technologies. Although these conversations are limited in their confinement to the hospital setting, interview format, and absence of long-term relationships, they offer the best perspective we have on the population we are trying to serve. With such a diverse array of individuals in our lively community, we must take every voice into consideration. Nonetheless, it is impossible to please everyone in our quest to set regulations on healthcare. This new policy proposal certainly does not set a unified front for all the voices in our community; But I have worked diligently to address everyone’s concerns in a way that fosters cooperation between different religions and cultures.

The inevitable solution to a situation in which different groups of people have different objectives is to provide most services but restrict their usage. It is also important to appeal to our largely Irish Catholic donor base because without them, we cannot run this hospital. We should take their perspective into account when making policy influencing pregnancy. We should not subsidize abortion or IVF services because doing so would contribute money from donors towards initiatives they do not approve of. Additionally, the Department of Social Services (DSS) in Connecticut funds all abortions that are medically necessary as per Doe v. Maher in 1986. Medical necessity is decided by the physician of a patient. It includes “health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring. (Cohen, 2010: 1). We should fully cooperate with the DSS of Connecticut to allow under-insured patients to receive abortions under conditions where they are medically required. To reduce instances of abortion and unnecessary killing of what many Catholics deem as life, we should only allow it to be performed in situations when the mother’s or fetus’ life is at risk during the pregnancy or in instances of rape (Cardinal Joseph Ratzinger and Archbishop Alberto Bovone, 1987: 149). We should justify this position to non-Catholics who might seek abortions in other instances by claiming the need to reflect our Catholic roots to some degree. These patients would have to seek treatment elsewhere if they want abortions in other instances.

In addition to abortions, prenatal testing and amniocentesis are necessary provisions to allow people to exercise precautions in their pregnancy. In particular, members of the Jewish community utilize these resources (Ivry, 2010: 11). Individuals using this service at our hospital would not be able to terminate a pregnancy based on any genetic conditions they discover, however, because under my policy proposal the hospital wouldn’t allow voluntary abortions. Instead, they could use this information to prepare for the consequences of the genetic disease once the child is born. These services would also allow healthcare providers to ensure the health of the fetus and mother during the progression of the pregnancy. The restrictions placed on abortions, prenatal testing, and amniocentesis would appeal to our Irish Catholic donor base, so our hospital can continue to run under their generous financial contributions.

We should also provide In Vitro Fertilization (IVF) treatments for our patients. Studies have shown that a small but significant portion of the Jewish and Lebanese Shi’ite communities use IVF as a way to overcome infertility. Though these studies were not conducted in the United States, the anthropologists at Sasquatch hospital have made similar conclusions among the Jewish American and American Lebanese Shi’ite communities. The statement made in Genesis that we should “be fruitful and multiply” has been interpreted by the Jewish community to be a commandment. The Jewish community places an emphasis on reproduction. Additionally, most religious leaders agree that life does not begin at conception. These reasons among others lead to the general acceptance of IVF among Jews (Kahn 2000:3). Shi’ite Islam promotes decision-making through the use of individual thought processes, also known as ijtihad, but practicing Shi’ites also hold the guidance of local religious leaders in high esteem. Most of these leaders have approved of IVF technology provided that certain precautions are taken. Shaikh Fadlallah, one of such religious leaders, and a Sunni religious leader both agreed that IVF is permissible when the gametes are provided by the couple that wishes to conceive through this process (Inhorn, 2006: 111). IVF is valued by important segments of our population, so we need to provide these services to them. It has been argued that the policies outlined above may offend the hospital’s Catholic donors. We may risk losing our funding from Catholic donors, but we hope the policy initiatives will attract new donors from different religions. If we attract enough new donors, we can reconsider subsidizing abortions and IVF.  Some Catholics will object to the use of IVF on the grounds that it gives scientists god-like power to make decisions on life and death.  They see life as beginning from conception. (Cardinal Joseph Ratzinger and Archbishop Alberto Bovone, 1987:156). They may point to the fact that some embryos are inevitably not transferred to a woman’s uterus, so they are left to expire.  The expiring of embryos is seen as equivalent to abortion. I would not try to convince these people to change their views, but I would remind them that the beginning of life is a subjective matter. As a non-denominational hospital, we cannot simply align our views with that of the Church’s. For example, many Jews believe life doesn’t begin until many days after conception Jews (Kahn 2000:3). But we should not also simply align our views with that of other religions like Judaism. Thus, we should only allow IVF in instances of sterility; so, for instance, a woman would not be allowed to utilize IVF if she wants a child but lacks a partner. This would limit IVF to cases where it is absolutely necessary.

The procedures ascribed to dealing with unused embryos from IVF create another challenge for Sasquatch hospital. Despite the fact that we would be allowing IVF, we need to be respectful of the official Catholic position that life begins at conception. In addition to not subsidizing abortion funds, we should strongly reject any research initiative where embryos are harmed no matter what future result the research could bring. However, we should financially support any study where the embryos are completely unharmed and the research has a clear positive outlook for future patient health. Since we would be performing IVF, we would have to allow unused embryos to expire. But we should encourage the donation of extra gametes to other couples to avoid this. Some Jewish and Islamic individuals have been accepting of gamete donation, so we have people that will benefit from this provision (Ivry, 2010: 209-211; Inhorn, 2006: 111). Although I propose to not act in accordance with the official Catholic belief that every child has the right to be raised by his or her parents, donation of gametes should reduce the wasting of unused embryos (Cardinal Joseph Ratzinger and Archbishop Alberto Bovone, 1987: 158).

In regards to spiritual counseling, it is necessary to make a change in policy. We cannot provide all these assisted reproductive technology services and continue to have a solely Catholic spiritual counseling service. This would send out a conflicted message to our community that we provide these resources, but our staff vehemently discourages patients from using them. I propose that we hire non-denominational counselors for our hospital. It has been brought to my attention that it will be costly and difficult to find counselors from various disciplines. In light of this argument, I think we should hire counselors that are skilled in a variety of religions. It will certainly be less difficult to find non-denominational spiritual counselors than spiritual counselors for each religion. Additionally, we can hire fewer counselors than we would have to if we needed to find counselors from several religions. But we should set standards to ensure that these counselors have experience in the variety of religions reflected in our populace. If we have a patient that desires support that cannot be given by our non-denominational counselors, we should hire a spiritual counselor from their religion on a case by case basis. This spiritual counselor would be hired to come to the hospital to speak to that one patient. The diversity of opinions reflected by my proposal should alleviate concerns by doctors that the Catholic spiritual counseling is directly conflicting with their work. While I don’t expect secular doctors to fully support any spiritual counseling, I believe it is important for patients to be able to reach out for religious support when they see fit. Doctors are not trained to deal with the ethical issues that arise from the technologies they utilize. They should be involved in the conversation, but there should also be other voices present. Spiritual counselors have the training to contribute to discussions about when life begins and what practices are morally right.

Some staff members may oppose many of the new initiatives I propose to incorporate into our care of patients. If the hospital is going to move in this new direction, we need the full cooperation of all our healthcare staff. Therefore, we should not only provide training programs to teach our current staff how to perform these new procedures, but we should also hold informational sessions to show the staff that regardless of individual beliefs, what we are doing is the best way to satisfy the most people. If many staff members continue to resist performing these procedures, we should train a group of current staff dedicated solely to performing these procedures and ensuring that patients feel as comfortable as possible during the process. If we end up not having enough nurses to meet the demand for ARTs, we will have to limit some of our practices even further. For example, we can make a regulation to offer IVF for only one child per family. Since IVF is not a medical emergency like the abortions we perform are, that should be the first thing we restrict. Abortions in medical emergencies should be the very last thing we limit because of its threat to the life of the mother.

As the CEO of Sasquatch Hospital, I have proposed a plan here that requires concessions from all members of the community but addresses everyone’s concerns. Rather than substituting financial stability for a coherent moral and medical vision, my proposal crafts a moral vision informed by several different perspectives. In doing this, I acknowledge the subjectivity of morality and the need to present an ideology that doesn’t enforce its own moral agenda on the population. Instead, it reflects the moral perspectives exhibited by the community. A situation as dynamic and complex as this one requires oversight and openness to change. It is necessary to assess the satisfaction of the variety of groups affected by our decisions. Therefore, we should reevaluate after a year to see how doctors feel about the change in protocol and if patients are using the services we provide. We should also see if patients are using the spiritual counseling resources in their decision making process. Though we always need to reevaluate, I am confident that the plan proposed here would allow the hospital to address the concerns of the diverse population of Sasquatch, Connecticut.

Analyst, Robin K. Cohen Principal. “STATE PAYMENT FOR ABORTIONS.” STATE PAYMENT FOR ABORTIONS. N.p., 17 Mar. 2010. Web. 21 Mar. 2017

2 thoughts on “Final Assignment – Rachel Spector”

  1. Dear Ms. CEO,

    Thank you so much for your detailed proposal for the policy changes you would like to take place at this hospital. I especially appreciated the fact that you address that all parties will have to make concessions when reaching an agreement for this proposal, which can be a challenging for people who are firm in their beliefs.
    I agree with your section on elective abortion, and I believe the arguments you make in this section are very mindful of our donor base. I am just slightly concerned with the definition you provide from Doe v. Maher in what is a medical necessity, and using this definition for abortion: “health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring”. I think that the language, especially “maintaining an optimal level of health” could potentially be problematic as many individuals argue that elective abortions should be granted to maximize the “well-being” of the mother. Other than slightly revising this definition for us as a hospital, I agree with this argument.

    My major concern with your work through the rest of the paper is that it is very much hinged on appeasing the donor base. In fact, you state that if your donor base changes in their religious denomination that you would expect policies on important issues like abortion or IVF to shift as well. I understand that you are the CEO of the hospital and the donor base is a major concern for you, however I think that arguments based in the well being of our patients should always be prioritized over the religious make-up of the donor base.

    Thank you again for your thoughtful work,

    Nurse Cagliero

  2. Hi Ms. Spector,

    Thank you for listening to the concerns of our community and revising your initial policy to agree with or argue against the feedback you received. As a physician, my viewpoint on many of the assisted reproductive technologies varies with that which you provided in your amended policy. I respect your values and understand the dilemma’s you face as you need to find a common ground between the donor base that funds the hospital, the medical professionals that you employ, and the community you serve.

    As stated in my policy proposal, I, too, think it would be beneficial to the community to offer abortion services in the instances of maternal/fetal risk, rape, and incest. I also agree that prenatal testing and amniocentesis are a necessary service that the hospital should offer. However, I disagree that results from such prenatal diagnostic testing could be used to make decisions regarding the termination of the pregnancy. Certain genetic conditions can result in the death of the child very early in life. I do not believe the hospital has the right to force a family to continue such a pregnancy that could result in more heartache for the family in the future.

    I am concerned that the policy being developed is aimed at suiting the donor base of the hospital rather than the patients in the community you serve. While I understand that the donor base is essential to run the hospital smoothly, I do not believe there should be as much emphasis in pleasing the donor base that you outline throughout your policy proposal, especially since the donor base is predominantly conservative. Now that the hospital has become non-denominational, I do not believe it should propose a policy to just suit the Irish Catholic donor base, but rather the Lebanese-Shi’ite, the Jewish, and the vastly diverse population of Sasquatch, CT. I am glad to see that you are considering this expansion, as you described potentially increasing your donor base by allowing IVF services at your hospital.

    Thank you again for your viewpoint regarding the ART’s in question and I hope that I was able to provide some additional feedback from a medical perspective to improve your policy.

    Greeshma Magam, M.D.

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