Author: Diana Cagliero

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>.

 

This week we read three very different texts. Two of these works, “Gestational Surrogacy in Iran” and “The Social Construction of surrogacy research: An anthropological critique of the psychosocial scholarship on surrogate motherhood” addressed the issue of surrogacy from different perspectives, both using various ethnographic methods. The third text by Arthur Kleinman discussed how ethnographic research ties into the field of bioethics.

Shirin Garmaroudi Naef’s work “Gestational Surrogacy in Iran” lays out an interesting perspective on Shia Islam and the acceptance of gestational surrogacy as a morally licit practice. This text reminded me of the reading for Unit one, specifically the works by Marcia Inhorn and Morgan Clarke. Naef takes a similar ethnographic approach and conducts the study with both participant observation in infertility and IVF clinics in Tehran as well as talking to scholars at the center for Shia scholarship in Iran. The work is consequently grounded in two sections: one focusing on the religious and scholarly viewpoints with regard to surrogacy and the other focusing on gestational surrogacy in practice.

-Do you find it helpful that Naef’s work includes the opinions of both religious scholars and of individuals going through the surrogacy process?

Naef’s thesis is grounded in opposition to the work done by French anthropologist Heritier. Heritier bases much of his argument on the practice of milk kinship, in which the woman who breastfeeds a child becomes linked to the child in the sense that incest taboos prevent any type of relationship between these two individuals and their future kin. In this sense, incest is linked by the transmission of bodily fluids. In contrast, Naef’s thesis shifts the definition of incest to illicit sexual acts:

“I argue that the definition of incest in Shia thought and practice does not depend on the transfer or contact of bodily substances. Rather, it depends on the illegitimate physical act of illicit sexual intercourse, and not on the act of conception itself” (163).

It is through this thesis that Naef explains the permissibility of several practices of artificial reproductive technology in the Sunni religion. Through interviewing several religious leaders, the conclusion drawn is that:

“the distinction made here between physical contact and the transfer and contact of bodily substance in definition of adultery makes the fertilization of the woman’s egg with the sperm of another man other than her husband and then the implantation of the embryo in the woman’s womb religiously permissible” (165).

Naef continues to draw distinctions between Sunni and Shia scholarly thoughts with regard to maternal relatedness. While several Shia scholars of the past and most Sunni scholars believe that the mother is the person who gave birth to the child (citing a verse in the Quran), most Shia scholars today believe that the producer of the egg is the mother of the child (166).

Naef also finds support for the thesis of illicit sexual activity, not bodily fluid contact to be the reasoning behind the acceptance of surrogacy in Shia Islam when conducting interviews.

“The distinction that Farideh makes here between the act of gestation and the physical proximity through the (illicit) sexual act is a further reinforcement of this Shia thought. In other words, there is also a fundamental difference between reproduction and sexual intercourse in her thinking. Almost all the informants I interviewed referred to this distinction” (177).

-Did this reading change your perception with regard to how surrogacy is viewed within two sects of the same religion?

-Did you think Naef did enough to describe why Sunni and Shia Islam diverge with regard to the incest taboo and what is considered adultery?

The second article for today was “The social construction of surrogacy research: An anthropological critique of the psychosocial scholarship on surrogate motherhood” by Elly Teman. I liked that this article really challenged a lot of assumptions I had about surrogacy in the US, especially due to the portrayal of surrogacy in the media. Teman began by simply stating that over 99% of surrogate mothers willingly relinquish the child after birth (1104). When faced with individuals surprised with this statistic, Teman states “I suggest that this public uneasiness with the idea of surrogacy and the meta-narrative it engenders—of the surrogate who regrets her actions or refuses to relinquish—is more illustrative of the cultural anxieties that surrogacy encapsulates than that of the actual majority of cases” (1105).

-Were you surprised that 99% of surrogates willingly relinquish the child? Why or why not?

Teman bases her arguments on two assumptions set out by psychosocial literature on surrogacy. Teman states that these arguments have led to bias in the way that data on surrogacy is collected.

The first assumption is that surrogates are not “normal” women. Teman illustrates that the view of a woman who is willing to carry another woman’s child implies something about sexual deviance and adultery (1106).

-Does the link between surrogates and adultery described in Teman’s article seem similar to the issues raised in Sunni and Shia Islam?

The second assumption made in surrogacy research is that women who are surrogates can be “normal”, but only if then must they have a good reason to go through this process. I think that this is really captured well in the following passage:

“Whatever reason is proffered for her choice, the surrogate is constructed as deviant: Her altruism ranges beyond normative boundaries; her desire for money is constituted as greed or as a function of extreme poverty; or her reparative motive is indicative of past sins for which she must punish herself. By finding ways of constructing the surrogate as deviant, the scholarship “proves” that a “normal” and “natural” woman would not make such a choice unless compelled by a circumstance” (1108).

-Do you find this argument problematic? Do you see this issue reflected in the film we watched in class last week?

The last article of the week was “Moral Experience and ethical reflection: Can ethnography reconcile them? A Quandary for ‘The New Bioethics’” by Arthur Kleinman. In this article Kleinman discussed how important it is on a clinical and policy level for bioethics to relate “ethical deliberation to local contexts” through the use of ethnography (70).

Kleinman goes on to discuss how bioethics acts with principles that are out of touch with the status of many people it acts to help. “The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not being with the local moral conditions of poor people, those experiencing the systematic injustice of higher disease rates and fewer health-care resources because of their positioning at the bottom of local social structures of power” (72). I found this really compelling because I feel like a lot of the new bioethics issues (think IVF, cloning, abortion procedures) are resources that are unequally available to only the wealthiest of people that perhaps discussing these exclusively ignores the ethical issues that are still affecting people living in countries with issues we think we’ve “solved” (disease rates, hygiene service, etc.).

To resolve this discrepancy, Kleinman suggests ethnography. He explains how “ethical standards can be applied in each case because a shared human nature assumes that, regardless of context, humans will universally bear the same moral sensibilities” (73). However, Kleinman also says that there “is no agreement on what human nature is” (74).

-Do you think humans have a shared human nature? If so, do you think that human nature is something that can be defined? (Think of how it is defined by the Catholic Church for instance)

Kleinman praises the ethnographic works of Paul Farmer, the famous physician-anthropologist for his work in Haiti as well as Rayna Rapp’s ethnography that we read in class. In the final section of his paper, Kleinman discusses what he considers to be a layout of the best methods anthropologists can use to present a compelling argument in the same way that Farmer and Rapp do. Some of these points are similar to what we discussed in class, such as the ethnographer discussing their position in the research, as a way of being self-reflective (91).

Overall I felt that Kleinman’s argument was well presented and interesting when it comes to focusing on what he considers a significant gap in bioethical works. What did you think of it?

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.

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 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 works 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 needed in emergency settings (unless of course 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 which this action would be permissible as they life of the mother is equally as important as that of the fetus) and therefore individuals who choose not to follow this mandate are able to find these services in 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).

Similarly to the reasoning behind refusing abortion services, I 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 a rational 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). Therefore IVF treatment disrupts the development of a new life, and therefore changes the natural course of events in human’s biology. Technology is so advanced that now 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.

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 assume 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 basic. 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 centralized mandate compared to that of the 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.

While many of these religions are more permissible and flexible with regards to ARTs, abortion and prenatal testing, it does not require us as a hospital to provide these different services. 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). 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. 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.

With regard to the claim that Catholic clergy are interfering with the doctors’ work, it is important to understand that families absolutely always have the right to 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 unable to recommend against these procedures for the reasons stated earlier 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.

3.

Clearly as the head of the nursing staff and a nurse practitioner I believe that new nurses should absolutely not be hired based just on their willingness 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. 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.

Susan McKinnon’s work “On Kinship and Marriage: A Critique of the Genetic and Gender Calculus of Evolutionary Psychology” explores how the ways that psychologists view kinship, through the lenses of nature and nurture, do not always account for the vast diversity of kinship relationships that are captured in anthropology. McKinnon spends the chapter exploring different types of kinship relations discovered by anthropologists and poses a critique to the argument of evolutionary psychologists. Evolutionary psychologists argue that for an organism to maximize its reproductive success it must have knowledge of a clearly defined boundary for which organisms are a part of their kin-groups and which organisms are not (106).

“Evolutionary psychologists reject the idea that the evolved human brain manifests a generalized capacity to create a wide array of cultural forms and learn a diverse range of behaviors” (McKinnon 108)

McKinnon uses multiple examples throughout the paper to explore how anthropologists have discovered a wide array of kinship relations, and many of these relations are not defined by the sharing of genetic material. She explains how through “even a simple perusal of systems of kinship terminology demonstrates that there is no single straight line between any underlying biological ‘reality’…and the social categories of motherhood” (110). McKinnon goes on to describe other kinship relations such as marriage, and argues that for humans, marriage involves social groups and relations not simply just the individuals in search for a mate driven by evolved preference mechanisms (McKinnon 122). Overall McKinnon’s closing argument against using evolutionary psychology as a primary lens for evaluating kinship relationships goes as follows:

“By reducing the variety of human systems of kinship and marriage to a ‘core mindset’ that looks suspiciously Euro-American in its valorization of the individual, of genetics, of utilitarian theories of self-maximization, and of an idealized 1950s version of gender relations, evolutionary psychologists erase what we know about the complexity of kinship and marriage around the world” (McKinnon 128).

• What do you think of McKinnon’s closing argument? Do you agree with her critique of evolutionary psychology?

Warren Shapiro’s work is a direct critique of Susan McKinnon’s paper. In the abstract Shapiro refers to two positions commonly found when examining literature on kinship studies. He refers to McKinnon’s work as “collectivist”, or as assigning the group priority over the individual when making an analysis. Shapiro mentions the phenomenon of “focality”, which refers to focusing in on a different perspective, which is a feature he claims McKinnon’s analysis lacks.

Shapiro shapes his main argument by stating “evolutionary psychologists, who do not pretend to be specialists in the cross-cultural study of kinship, have managed to grasp the truth more profoundly than McKinnon”. Shapiro goes on to examine many of McKinnon’s examples and turn these on her, showing how McKinnon draws on the less practiced societal definitions of kinship and ignores the primary, consanguine link that ties most family members together through cultures. Shapiro dismisses the claim of a “West/Rest dichotomy” explaining how notions of kinship “are grounded in native appreciations of procreation, and from this base they extend to other areas of experience”.

Shapiro also argues that in the cultures that McKinnon describes as collectivist through mechanisms such as group motherhood or collective childhood are “concoctions”. He states “kinship in our species is nothing if not individual, because the bonding that we undergo, especially as children, is socially selective”. Shapiro’s opinion is that close procreative kin are universal and therefore relationships exist between them that are nearly universal.

• Does your opinion on McKinnon’s work change after reading the Shapiro text? With whom do you agree with more, or are you somewhere in the middle?
• Do you agree with Shapiro’s claim that McKinnon is a “collectivist” whereas he uses the ‘superior’ concept: “focality” when examining kinship studies?

After considering these more conceptual works on kinship and kinship theory, Marcia Inhorn’s paper “He Won’t Be My Son” provides an ethnographic study from which to analyze these concepts. In this study, Inhorn traveled to Lebanon to interview men from both Sunni and Shi’ite Muslim populations at two different IVF clinics. Inhorn gathered research on the religious mandates in both sects to examine how the mandates were observed in practice.

Inhorn begins introducing the issues associated with IVF in the Islamic faith by stating, “Islam is a religion that privileges—even mandates—biological descent and inheritance” (95). Consequently, there is high cultural resistance to adoption although many Muslim couples take it upon themselves to become legal guardians for orphans (95).

“The very concept of social parenthood is culturally contingent and is deeply embedded in ‘local moral worlds’” (96).

 First, Inhorn explains the religious mandates surrounding IVF in the Sunni sect. In the first authoritative fatwa it states “IVF of an egg from the wife with the sperm of her husband followed by the transfer of the fertilized embryo back to the uterus of the same wife is allowed…However, because marriage is a contract between the wife and her husband, no third party should intrude into the marital functions of sex and procreation” (103). In effect, using the gametes of a donor or a surrogate is not allowed because it would equate to adultery and the resulting child would be considered a bastard. The Sunni Muslim men’s narratives were nuanced and many provided deeper responses than just “it’s against my religion” while the counter narratives revealed “complex moral decision making undertaken by men who have decided, usually on their own, to ‘go against their religion’ in creating alternative family forms” (106).

In 1999 Iran’s Ayatollah Khomeini stated that “donation is not in and of itself legally forbidden…. both donors and infertile parents must abide by the religious codes regarding parenting. Thus the child of the donor has the right to inherit from him or her, as the infertile parents are considered to be like adoptive parents” (110). Furthermore, Shi’a Islam recognizes a “temporary marriage agreement” as an option for surrogacy (112). These differences in religious mandates between Sunni and Shi’a Islam perhaps accounted for the differential in the number of men interviewed by Inhorn who opposed gamete donation: 83 percent of Sunni men and 64 percent of Shi’a men.

“Ultimately, then, it should come as no surprise that the Middle Eastern IVF industry is flourishing—with and without donor gametes, in the Shi’ite and Sunni worlds, respectively. Indeed, when all is said and done, it is the love among infertile Muslim couples of both sects that has brought this industry to the Middle East” (117).

Morgan Clarke continues this analysis of how ARTs in the Middle East can offer insight into changing definitions of kinship in her work “Kinship, Propriety and Assisted Reproduction in the Middle East”. Clarke introduces two forms of kinship found in the Middle East; patriparallel cousin marriage (father’s brother’s daughter) and “milk kinship”. These concepts are tied together in “local notions of ‘closeness’, ‘honour’ and protection, all bound up with notions of gender and sexuality” and become problematic when ARTs try to find a place to fit into this kinship scheme (71). Through ART kinship is defined as a “biogenetic” relationship, this definition can come into conflict when Middle Eastern kinship structures are not always defined as solely biogenetic; rather legitimacy and inheritance are often primarily valued.

“ARTs and modern scientific understandings generally offer a challenge to traditional understandings of relatedness, and there is good reason to detect potential transformations in the Islamic Middle East, although the key issue here is, characteristically, that of the legitimacy of kinship relation, the role that the moral circumstances of a child’s birth have in constituting their kinship status” (82).

• Does Clarke’s conclusion that inheritance and legitimacy are the main facets constitute kinship in the Middle East reflective of the narratives collected by Inhorn?
• Overall what do you see as the biggest moral issue standing in the way of ARTs and kinship structures in the Middle East?