Author: Petar Miroslav 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.

 

 

 

 

The two readings from this week discussed the issue of surrogacy from a feminist  and Protestant point of view. The first article, “Reproductive Technologies and Surrogacy: A Feminist Perspective”, outlines the disadvantage females face when dealing with surrogacy, emphasizing a branch of gender inequality (Rothman 1599). The second article, “New Reproductive Technologies: Protestant Modes of Thought”, focuses on a Protestant perspective, which consists of adhering to biblical tests rather than accepted religious notions of a church (Meilander 1637).

In “Reproductive Technologies and Surrogacy: A Feminist Perspective”, Rothman forms arguments against surrogacy which are quite different from accepted religious views. She begins by mentioning the misinterpreted definition of “patriarchy”; instead of meaning overall “sexism or men’s rule”, Rothman defines it as “…a system in which men rule all over the world” (1599-1600). In general, the word of a female is not taken into consideration while the bond between a father and son is the dominating familial relationship. Rothman continues to state that females are not even referred to by name, but rather as “daughters of men who bear them children” (1600). This disregard for female importance brings up the issue of control. Man always feels a need to have control over a situation, but once impregnating a female, this sense of control becomes lost for nine months. As a result, males attempt to control females, which is one of the many reasons why females’ voices are not taken seriously in Rothman’s eyes (Rothman 1600-1601).

In addition to the problem with “patriarchy”, Rothman describes the issue of incest. She begins by stating that incest is socially constructed and varies by culture. For example, some societies believe children are siblings if they were breast-fed from the same female. Other societies believe children are siblings if they came from the same uterus. Numerous other cultures have beliefs different from the preceding two, pointing to the fact that what might be incest at one place may be completely normal in another location. This leads to the following controversial topic: Should marriage be accepted between a male and female if they were both born to the same mother who underwent two separate surrogate pregnancies? Modern United States society  would see the marriage as acceptable because there is no genetic relationship, but other societies would see this as incest (Rothman 1600-1601). The question of what constitutes incest is still a sensitive topic and most likely will continue to be debated in the coming years.

A third topic Rothman sheds light on is the issue of unfair custody over a child. Due to the male dominance explained above, men in the 1980s won custody over children at much higher rates than women. At this time period, children were seen as a status item and because men had higher incomes and more assets, they were able to win the legal battle (Rothman 1603). Overall, Rothman described the situation as “When men want custody, they get custody” (1603).

In “New Reproductive Technologies: Protestant Modes of Thought”, Meilander focuses on biblical texts, as opposed to the views of the church, to form his arguments. Even though the Bible places mass importance on procreation, it stresses that our first priority should be towards God, not family. James McDowell refers to  Jesus’s statement in which he tells us not to love our mother and father more than him. This does not serve to undermine the familial relationship, but emphasizes the need to put God first (Meilander 1638).

In addition to prioritizing God over family, Meilander refers to David Smith’s view on surrogacy. Smith states that if a married couple is unable to have a child and turn to “a reproductive technology that involves the person or gametes of a third party, then the fertile partner is purchasing authentic parenthood for himself or herself…” (Meilander 1640). As a result, this may cause all three parties to be of unequal status, complicating the topic of who the real parents are. Due to the probable predicament, Smith urges for the discontinuation of artificial insemination by donor (Meilander 1640).

The two articles described above both outline the issues of surrogacy, but from two different perspectives. Rothman’s feminist approach outlines the gender inequality women face, stressing the need for women to have more voice and status in society (1599). In contrast, Meilander’s biblical approach focuses on scriptures of the Old and New Testament, allowing him to form his view in a different manner (1637). Overall, both readings related to the topic of kinship, which was discussed in week two of the course. It allowed questions to be raised about whether consanguineous or fictive kinship should be the dominating force in determining how related two individuals are. Personally, I align more strongly towards the view of consanguineous kinship because fictive kinship seems to imply that people would like to be related, even though society might not accept them as relatives. The issue of kinship discussed in week two and its references in this week’s readings continue to play a significant role in modern society and only more debate and questions will allow our understanding of the situation to evolve.

 

Questions to Consider:

When the word “patriarchy” comes to mind, what is your first thought on its definition?

Do you feel Rothman’s argument was persuasive? If not, where do you feel she could have improved?

Two weeks ago, we discussed how translation through time could cause some information to be lost or misreported. Do you think Meilander could have fallen subject to this? Do you think he should have used more sources outside the Bible?

How do you connect the two above readings to the concept of kinship discussed in week two of class?

 

Assisted Reproductive Technologies and Prenatal Testing Policy Proposal

 

Dear Ethics Committee of Sasquatch Medical Center,

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. As you all know, Sasquatch has deep Irish Catholic roots and this was an important factor to consider while constructing the policy proposal. To members of the committee who do not fully understand the beliefs of each group in Sasquatch, I will state them briefly to you.

Irish Catholics are vastly against the use of Assisted Reproductive Technologies (ARTs) and prenatal testing (in cases of abortion), such as amniocentesis (Cahill et al. 1988: 143). In recent years, the city has seen a rise in population of minority groups which hold differing beliefs regarding ARTs and prenatal testing. The Jewish community favors the idea of ARTs, noting God’s first commandment, “Be fruitful and multiply, and fill the Earth, and subdue it…” (Bible Hub, Genesis. 1.28). With regards to prenatal testing, the Jewish population supports and even encourages procedures which may benefit a mother and fetus (NISHMAT 2000: 2). The Caucasian and African American population also support the use of ARTs and prenatal screenings if prices are affordable. The majority of African Americans in Sasquatch who live in poverty has increased by four percent in the past decade, and most are under-insured (Armstrong, Plowden 2012: 652). I am mentioning this because these individuals will qualify as patients for which the hospital will subsidize their medical care. In addition, Lebanese Shiites are proponents of ARTs as long as they are able to preserve their faith in Allah during the procedures. Similarly, they support prenatal screenings (Inhorn 2006: 96-97). The increasing Japanese population advocate the use of ARTs, especially in vitro fertilization (IVF), but opt out on prenatal testing. They prefer to abide by an “environmentalist” approach, which states that the mother is directly responsible for her fetus and is to make sure she does not gain excessive weight or engage in any unhealthy activities (Ivry 2009: 11). After taking into consideration the various beliefs of the people 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 to examine a fetus for abnormalities. No attempts at termination may be done once tests have been performed. If the results of a prenatal test, such as amniocentesis, return with negative results, then the patient will have the opportunity to discuss their feelings and find ways to cope with a hospital counselor. All ARTs, including IVF, will be subsidized by the hospital for under-insured patients. IVF protocol will have 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; 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 their beliefs are heard of and will be respected at SMC.

With regards to unused embryos being used for life-saving research, SMC must abide by two provisions. The first provision states that SMC will not be allowed to abort any embryos, keeping in line with Catholic roots in Sasquatch. The second provision states that frozen embryos may be used for life-saving research if they have not been placed inside the mother’s uterus and if the patients’ give consent. With regards to the second provision, I align with 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.  Above all listed priorities, patient consent is paramount. Only once patients have been fully informed about the research process, they will be able to donate their frozen embryos for research. This will eliminate any confusion on behalf of the patient and enable them to have more confidence in their decision.

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 and 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.

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.

All other sources are from class readings.

 

 

 

 

 

 

 

 

 

 

Both Testing Women, Testing the Fetus and “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health” shed light on the social and moral view regarding mothers and their babies. Even though this weeks stance may be slightly different from previous weeks discussions regarding Assisted Reproductive Technologies, the decision about whether to continue with a pregnancy still plays a critical role in understanding the medical ethics, laws, and societal viewpoints that exist in modern-day.

Rayna Rapp wrote Testing Women, Testing the Fetus following her decision to have an abortion once prenatal diagnosis (PND) confirmed her fetus had Down Syndrome. Her decision to write the book led her to conduct fifteen years of extensive research on PND and analyze interactions between doctors and patients (Rapp 5). In her book, she mentions that miscommunication between patient and doctor are not just caused by differences in language, but also because of differences in philosophy. The branch of philosophy she mentions includes beliefs about what makes up a supportive parent and beliefs about the moral standing of a fetus. Another argument Rapp makes is that full cooperation between patients and physicians can never be accomplished because of two main reasons: lack of objectivity on the side of the physician and the complexity of a patients belief structure. She continues to mention that common social indicators such as race and gender are not enough to fuel this mutual cooperation (Rapp 79). With regards to PND, the above issues exercise a huge burden on the pregnant mother; if PND confirms Down Syndrome or some other disease, the mother faces a decision regarding her future if she were to continue with the pregnancy.  This entails more commitment to the child, which involves less occupational opportunities and more emphasis regarding health standards of the child (Rapp 165).

Rayna Rapp’s book ties in well with the first week’s discussion regarding if abortions should be allowed in circumstances affecting the health of the mother/fetus. Numerous women take this question into account when finding out that their fetus has Down Syndrome or some other disease. Arguments over whether abortion should be allowed in this matter still exists, but the book by Rapp sheds light on reasons why abortions do take place in these circumstances; they include the belief systems of a patient and the risk measures in play (Rapp 53).

“Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health” is an article which discusses “unintended blessings” and contraception in Naomi’s house. Naomi’s house is a shelter located in the southeastern portion of the United States and specializes in providing clients with childcare and educational resources to make them more economically and emotionally independent (31). The “unintended blessings” in this article refers to women becoming pregnant without intentions to do so. Even though numerous women at Naomi’s house agreed the “unintended blessings” came as a shock/scare at first thought, they admitted that it provided them with the opportunity to begin a fresh start in life (34). A example can be seen through the following quote: “Naomi’s house residents frequently described pregnancy or motherhood as effectively beyond their control…that motherhood provided the context for them to start over, receive blessings, or triumph over adversity” (35). Eva, one of the residents, decided to go back and finish high school, not allowing two unplanned pregnancies deter her from receiving a diploma. With regards to contraception, the issues of poverty and access to contraceptives play an important role. An example is seen when a resident named Regina became pregnant when her local pharmacy stopped carrying the birth control pills she used (39-40).

“Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health” is an article which has a focus on a mother’s outlook on an unplanned pregnancy. The article reminded me of week three’s class discussion where it was brought up that the needs of pregnant  mothers and hospital patients are sometimes not discovered because the question of what issues surround the individual at hand are never asked. While reading, I felt that the researchers that went to Naomi’s house kept this question in mind and it helped them better understand the residents. Examples include asking Regina why she stopped using contraceptive methods and what determined patients such as Eva and Demetria to go back to school to receive a diploma (35,40).

Overall, both readings provided a detailed analysis of the situations pregnant mothers face. The complex intertwine of differing ideologies and moral obligations still continue to cause conflicting feelings among individuals, but they play an important role in revealing the beliefs of people, which ultimately help progress the discussion of medical ethics in society.

Questions to Consider:

What connection do you see between the two readings?

Why do you think there exists a lack of connection between physicians and patients?

What steps can be taken to improve physician-patient interaction?

How do you interpret the word “blessing” when it refers to unplanned pregnancies?