Author: Rasika Tangutoori

To Whom It May Concern,

Background Information

            My name is Zoraiz Ahmed. I am a general surgeon currently working at the private hospital in Sasquatch, Connecticut. I identify as a Lebanese Shi’ite Muslim male. My family and I moved to Sasquatch 10 years ago, at which point we were the only Lebanese family in the community. However, there has been an influx of Lebanese immigrants and I am proud to say that I was recently elected as the president of the new Lebanese Cultural Association. With the growing immigrant populations in our community and my medical expertise, I am humbled to serve on this ethics committee as we transition to becoming a non-denominational hospital.

Amendments to Initial Proposal   

After submitting my initial proposal to the Sasquatch Hospital ethics committee, I received several comments and suggestions from my fellow peers on the ethics committee. I have thought long and hard about the critiques of my proposal and I have amended a portion of my initial pitch regarding the use of reproductive technology. My suggestions for IVF treatments, prenatal testing, and abortion have stayed the same, but I expanded on my reasoning. However, I have decided to compromise with my peers on the donation of unused embryos. I have also stood by my original recommendations for regulations of the counseling and medical staff.

Final Policy Proposal

Reproductive Technology Use

IVF Treatments and Prenatal Testing

I believe the Sasquatch Hospital should begin to provide in-vitro fertilization (IVF) treatment and prenatal testing including amniocentesis. Though, the risk of miscarriage during an amniocentesis procedure is 1 in 200 (Rapp 97), which is the equivalent to the probability of babies born with Down syndrome, patients in our community deserve to have the right to know about possible birth abnormalities. Furthermore, with the growing diversity in population and thereby increased risk of genetic diseases, the availability of this procedure is essential as genetic diversity is also increasing.

I acknowledge that the results of prenatal natal testing can cause a great amount of anxiety and psychological trauma to the patients and families involved, but I support the fact that access to knowledge outweighs this distress and the risk of miscarriage. As a physician, I believe parents in the Sasquatch community have the right to be given all relevant information to make a well-informed medical decision regarding their unborn child. However, as medical personnel looking out for the overall well-being of our patients, we can provide hospital services to alleviate distress post-test results. These are addressed in propositions for counseling staff regulations.

Abortion

            The hospital should not provide abortion services, unless extenuating circumstances persist. These circumstances fall in line with the United States federal guidelines listed under the Hyde Amendment. Abortion services should only be provided when the pregnancy is a result of rape or incest or is a medical threat to the woman’s life. Although this federal amendment was made in regards to funding of abortion services, I have chosen to use the guidelines as a line of compromise between the devout population against abortion and the new growing liberal and diverse population in the Sasquatch society.

Though the hospital has become non-denominational, we must still consider the prevalent religious practices present in our community. IVF and prenatal testing allow for the expansion of knowledge, but abortion by two out of the three dominant religions in this community (Catholicism and Shi’ite Islam) prohibit the murder of a living being and an unborn fetus can be considered living as it is in the mother’s womb. The holy Quran teaches that “God had given people their bodies as a trust (amana) and that (we are) therefore responsible to take care it (Hamdy 151).” As a devout Muslim, I do not think it is ethical to break the amana that God has bestowed upon mankind and my fellow Catholic staff feels the same.

However, I also know that I have taken the Hippocratic oath and will follow all means to help patients live healthily. Thus, I propose that this hospital only provide abortion services when it is a medical necessity as explained at the onset of this section. I define “extenuating circumstances” as rape and incest and nothing more. There will always be compelling arguments for genetic abnormalities and diseases as extenuating circumstances for abortion, but this opens up a vast spectrum of new cases. Given the general limitation of new hires and the limited time of the ethics committee to handle a case-by-case analysis these situations, I have chosen to strictly define what qualifies as extenuating in this policy proposal.

Unused Embryos

After careful consideration of my colleagues’ critiques, I retract my original suggestion that unused embryos should be donated to research. I still agree that from a medical standpoint that research from unused embryos could lead to life-saving results. However, I believe slow policy reform will bring about the most fruitful change at Sasquatch Hospital. Under the same religious reasoning as above, the Catholic community is still dominant and many believe that embryos are living and thereby destruction of living embryo is still murder. Though that is a very controversial thought, I was swayed by my colleague who pointed out that there is no way we ensure that the donated embryos will not be destroyed or just thrown out by researchers who deem them to be unfit for their purposes.

Under-insured Patients

Subsidized funding for underinsured patients should be provided only for testing purposes, not abortion services even when extenuating circumstances persist. It is a pretty common standard around the Western world for governments to provide these funds. For example, “The French government normally reimburses medical procedures up to 80%, but in the case of infertility diagnosis and treatment, the national health insurance system covers the cost of the entire process (Ball 547).” Thus, I do not believe our hospital which condones abortion overall should provide funding for abortion services of those under-insured since they can get the funding elsewhere. Indeed the United States can currently use federal funds to fund under-insured patients with extreme cases for abortion.

Counseling Staff Regulations

Spiritual counseling by clergy should be continued, but the clergy should be opened to other religions that have recently become more prevalent within the Sasquatch community. Under my own Muslim doctrine it can be stated “Shi’ites practice a form of individual religious reasoning known as ijtihad (Inhorn 18).” Medical choices of any sort are extremely personal and hence I advocate for individual religious reasoning in the decision-making process. Thus, I believe all patients to this hospital across all religions should be able to have access to religious counseling in order to determine their course of medical action. Given that the vast majority of the community served is religious in some way, the inter-religious clergy will aid in daily smooth function of our hospital.

I propose implementing a mandatory training program for all counseling staff including social workers, genetic counselors, and clergy. This training program will educate counseling staff on official hospital policy regarding assisted reproductive technology and prenatal testing. It will give guidelines as to how staff can counsel under their own religious doctrines, while still adhering to hospital policy and national law.

Additionally, there should be an increased number of trained inter-religious clergy specifically available at the prenatal testing facilities of the hospital. This aims to alleviate the arduous decision making process that some patients and families might undergo after receipt test results.

Medical Staff Regulations

            Furthermore, I propose a similar training program for all medical staff at the hospital. All staff will not be required to be in agreement with hospital policies proposed, but rather should be aware of official hospital policy. The staff should be willing to uphold the official policies at the very least.

I know there is currently significant tension among the Catholic nursing staff to perform these procedures. I do not think any of the staff should ever be required to perform procedures that are against their religious beliefs. Thus, a team of new hires and a few of the current staff who are willing will be chosen to make a team designated for all the procedures stated in this policy proposal. Nonetheless, as stated in the above training program, the staff unwilling to perform the procedures will still have to acknowledge that the procedures are being conducted at this hospital under structured circumstances.

Closing Remarks

My final proposal encompasses my best attempt to view the situation in an open-minded manner while staying true to my medical and religious values. I believe the best method to allow for a smooth transition at our hospital is slow reform. As a physician, I support the advancement of new scientific technologies, but I also acknowledge the importance culture and religion within the Sasquatch community. Though our hospital is becoming non-denominational, I stand strong under the opinion that a complete and drastic change to the current policies will not prove successful in such a short period of time. I have done my best to find a middle ground between the conservative and liberal perspectives on abortion and prenatal testing services at play in the larger Sasquatch community. Thank you for your time and consideration of my policy proposal.

Sincerely,

Dr. Zoraiz Ahmed, M.D.

 

Works Cited

Nan T Ball, “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” Duke Law Journal 50 (2000): 545-587.

Marcia Inhorn, He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly 20 (2006): 94-120.

Sherine F. Hamdy, “Does Submission to God’s Will Prevent Biotechnological Intervention?” In Jeremy Stolow editor, Deus In Machina: Religion, Technology and the Things In-between (Fordham University Press, 2013), 143-57.

Rayna Rapp, Testing Women, Testing the Fetus (Routledge, 2000).

This week’s readings are both from Volume 25 of the Creighton Law Review and analyze different perspectives on reproductive technologies. “New Reproductive Technologies: Protestant Modes of Thought” by Gilbert Meilander is a review of the perspectives presented by various contemporary Protestant theological ethicists. On the other hand, “Reproductive Technologies and Surrogacy: A Feminist Perspective” is an opinion article by Barbara Rothman, who identifies as a feminist. Both readings specifically place an emphasis on the notion of surrogacy, religion as a guiding factor, and reflect many of the other readings/discussions we have had in class this semester.

“New Reproductive Technologies: Protestant Modes of Thought” by Gilbert Meilander

From the onset, Meilander admits that his article will not be all encompassing of the Protestant attitude towards reproductive technologies, especially because “there is no one ‘Protestantism’ (1637).” Hence, he presents the perspectives of six theological ethicists who analyze biblical themes and the duality of human nature. The search for guidance in the Bible reminded me a lot of our class discussion on Hinduism and the Mahabharata. Like Hinduism, since Protestantism has no single authority, people look to biblical stories to find answers to modern issues.

The first ethicist discussed, McDowell tries to “appeal to biblical passages and themes, attempting to cull from them some general direction and guidance (1638).” She concludes that the Bible emphasizes that priority in one’s life is first to God, and then to family and hence does not approve of surrogacy. She admits that though surrogate motherhood is compassionate, it is compassion gone too far and is not appropriate behavior particularly because God always comes first. O’Donnovan builds on this loyalty to God by stating “faith affirms that God has made us through human begetting (1644).” He argues that new reproductive technologies turn begetting into making and hence should not be allowed. Simmons also echoes this thought by saying that sexual intercourse is intimate and does not have to lead to childbearing. Hence, he supports planning for children and believes a child is a gift from God, so one should not mess with this divine process. I found it interesting though all the ethicists who looked to the Bible were against reproductive technologies, they all used different biblical themes as support. Meilander shows that this is a classic example within theological anthropology.

• Do you agree with these biblical themes and the conclusions made by the ethicists?
• Based off our class discussions, are these biblical stories or themes that support new reproductive technologies?

Meanwhile, the theological ethicists that focused on the duality of human nature disagreed on their conclusions. Smith and Ramsey both agree that humans are “finite and free,” but that new reproductive technologies are a destruction of humanity in a larger sense. Unlike Simmons, Smith claims that you cannot separate sex and reproduction and so technologies intervene in this process. His opinion is that “such techniques are within our power and are an expression of the marvelous freedom that characterizes human nature, they will, Smith judges, be destructive of the other, equally important, aspects of self (1640).” Ramsey goes further and believes that the duality of nature approach is also against IVF. He makes a powerful claim that “in turning against the basic form of humanity that is parenthood and that holds together the love-giving and life-giving dimensions of our nature, we are losing a sense of what is truly human (1641).” Ramsey believes that the technologies are dehumanizing from a Protestant perspective.

On the other hand, Fletcher believes that the most important aspect of being human is the right to being free and rational. He believes this is the main “victory of mankind” and thus cannot be violated. He thinks that kinship is a social construct and having children aren’t the greatest thing in the world. This comment on kinship got me thinking back to our very first class and how Fletcher is a clear example of the cultural constructionist approach. He does not believe kinship is rooted in blood relationships. Meilander opposes Fletcher’s opinions with the other ethicists and finally shares his own thoughts. He thinks that the evidence presented by Smith/Ramsey is much stronger than Fletcher’s and I agree. Meilander concludes that overall “it may still be that faith is most likely to give rise to understanding of what is truly human (1646).” I feel like this is the case in many cultures around the world and something I relate to personally. Though I don’t consider myself to be super religious, whenever I’m in a bad situation or I’m anxious about something, I turn to prayer. I believe in a higher power because life just doesn’t make sense sometimes. Never will everyone agree on what is truly human, and hence I agree that is when faith steps in.

• Do you agree with Smith/Ramsey or Fletcher on the duality of nature?
• Do you believe it is an inherent right for humans to be completely free? Is this right lost when humans do not act rationally?
• Has your definition of kinship changed over the course of the semester?

“Reproductive Technologies and Surrogacy: A Feminist Perspective” by Barbara Rothman

Rothman presents a narrative of how her perspective, a feminist stance, has developed over the ages. She begins by stating that feminists and religious leaders are both opposed to surrogacy, but makes it clear that feminists “are coming from a very different place, and we are going to a very different place (1599).” Rothman’s main strategy in her argument is to define words we commonly use and give hypothetical/example situations to prove her point. She believes that the feminist opposition to surrogacy stems from issues in the language we use and defining a woman’s place in society. She asserts, “when one analyzes the language used by members of society, the assumption of that society are often revealed (1604).”

Throughout her article, Rothman defines words like patriarchy, kinship, incest, genetics, inheritance, motherhood, pregnancy, and the sanctity of family. By define, I mean explains how these words are used in society and what effects they have. I found her explanations to be very compelling. Rothman clarifies that patriarchy used as a synonym for sexism or men’s rule is actually wrong and rather defines it as “system in which men rule as father (1600).” It is an old system within many societies that affects views of childbearing. Rothman uses the analogy of a child as a seed to explain how patriarchal values make it seem like the fathers have rights to the children and mothers are just vehicles for growth. Hence, surrogacy is considered fine under this system because the surrogate mother is just another vehicle. I found it interesting that Rothman made it all boil down to a power struggle as she said that men “maintain control of the seed” by maintaining control of women during pregnancy. She also references the Bible, and points out the terminology of “man described as having begotten his first-born son (1600).” Unlike O’Donnovan from Meilander’s article, Rothman focus not on the idea of begetting but who is said to have begotten. Both perspectives show the importance of begetting children and how it affects views on surrogacy.

Rothman’s use of analogies was also successful because they got me thinking outside of the box about the issues she presented. In describing the outcome of the famous Baby M case, she paints a hypothetical scenario of the same case with a man who has sex with an underage girl, sends her gifts, and claims custody. This is an interesting case because on either end how does one decide who has rights over a child when they are not half and half? It opens an entire new can of worms and Rothman argues that our society struggles with this issue mainly because of “the position women find themselves within out society (1603).” This parallels back to Ginsburg’s book last week that displayed that most women focus on advancing feminist ideals and their place in society as a reason for activism within the abortion debates.

Furthermore, Rothman also connects it back to kinship when discussing the issues of through surrogacy. Incest is a social construct as explained by Rothman, but it does also have a biological significance when considering genetic defects of the children. However, what exactly is considered incest is culture dependent and certain things are just considered distasteful, even when there is no direct genetic relatedness. She places this root of this issue on what constitutes relation as she points out “just because two children have the same father, the children are not really related (1601).” Hence, this reading depicts how our discussions from early on the semester about kinship and relatedness make up how reproductive technologies are viewed.

Rothman finally presents her perspective at the end of the reading by stating “we need to find a perspective as a society that does not discard the intimacy, nurturing, and growth that grows between generations, but a perspective that supports, develops, and encourages intimacy. We need to reject the very concept of surrogacy (1607).” She shows that from a woman’s standpoint every child is precious, genuinely her own, and limited. Hence, the loss of an actual baby in any sense is devastating and women should not be treated as a societal resource. It is impossible to find a uniform solution for every case, but regardless women should have choice in these endeavors despite societal undertones. However, Rothman does acknowledge how difficult of a task this is to accomplish given how deep-rooted these societal values, positions, and terms are.

• Can you think of other words we commonly use in society that could reveal assumptions about society?
• How do you define incest?
• How do you think surrogacy would be viewed in a matrilineal society?

This week’s readings center on the abortion debate in the United States that began in the mid 1900s and is still of large concern today. Contested Lives: An Abortion Debate in the American Community by Faye Ginsburg is an ethnography that analyzes the conflict of abortion by utilizing Fargo, North Dakota as a microcosm of a larger American society. The second reading is a chapter excerpt from Hadley Arkes’s First Things: An Inquiry Into the First Principles of Morals and Justice and it explores the ethics behind the Roe vs. Wade decision in 1973 and its implications on society. Finally, the last reading, which was published earliest, is Judith Thomson’s “A Defense of Abortion” which explores the philosophy behind the right to life movement and argues against it. The readings this week encompass the moral reasoning and consequences of the pro-choice vs. pro-life debate in American society throughout the 1970s-80s.

From the onset, Ginsburg states her identity and any biases that might affect her work. She states, “I was concerned, initially, that being a young, unmarried, Jewish, and urban visitor from New York City might pose serious barriers to communication with Fargo residents (5).” She was extremely aware that she was about to enter a conservative and homogenous small city in the Midwest that prides itself for having the “highest rate of church attendance of any standard metropolitan area (4).” It was interesting that Ginsburg found her New Yorker identity the hardest identity to overcome when talking to Fargo residents. I believe this to be a testament to the divide in ideologies across the country and how reactions toward abortion differed even after the 1973 Roe vs. Wade decision. Thus, I appreciated that Ginsburg started off her ethnography with a couple chapters devoted to the history of abortion debate in the U.S., before delving into her findings in Fargo starting in Chapter 4. Unlike most ethnographic studies, she spends time acknowledging that there is a larger context of conflict that is occurring at a different pace outside of this small city.

Hence, I would like to discuss Thomson’s and Arkes’s works before analyzing Ginsburg’s conclusions because both works were published before Contested Lives and set the larger framework in which Ginsburg conducted her ethnography. Judith Thomson’s “A Defense of Abortion” defends the right of choice for a pregnant woman to control her own body. This moral philosophy paper was published in 1971 and spurred a lot of discussion and critiques from both sides of the abortion debate pre-Roe vs. Wade. Thomson operates under the assumption that “most opposition to abortion relies on the premise that the fetus is a human being, a person, from the moment of conception (47).” She calls attention to the issue that opponents of abortion do not “draw the line” from which a fetus is person to where abortion starts being impermissible.

Thomson uses the thought experiment of the unconscious violinist to explain her viewpoint. She sets a scenario of a famous violinist with a fatal kidney ailment who can only be cured by you and so the Society if Music Lovers kidnaps you. The next day, the director of the hospital informs you that “we’re sorry the Society of Music Lovers did this to you (48),” but to unplug yourself from the violinist now will kill him. Thomson questions “is it morally incumbent on you to accede to this situation (48)?” She then mentions the time frame and pushes the reader to determine if the decision would change depending on if you had to be plugged in for one hour (“be a good Samaritan”), nine months (equivalent to pregnancy), or nine years (a much longer time span)?

Thomson uses this thought experiment to walk through several scenarios from the extremist view of never aborting a child even to save a mother’s life to whether or not a mother has a special responsibility for the fetus from conception. At first glance, I found Thomson’s work to be very persuasive. The analogies used throughout the paper and moral reasoning resonated with me and I even found myself nodding my head as I read. I found myself proclaiming, “of course a woman should be able to save her own life” or “it is not her fault she was raped!” Nonetheless, after contemplation, I realized I felt prey to Thomson’s rhetoric strategy of simple analogies to explain the complex issue at hand. She successfully empathized with my identity as a female who hopes to have a child one day to get her point across.

Thus, it is important to put emotions aside and note several criticisms that should be addressed from either side of the abortion debate. First off, Thomson’s argument is solely based on the fetal right to life assumption. This assumption in itself only represents a portion of the larger controversy. Additionally, the violinist analogy obviously isn’t perfect and Thomson tries to remedy this throughout her reasoning. However, nothing can be changed about the fact that the violinist is a stranger to you, unlike a fetus inside of you, or that you were kidnapped in the scenario, restricting the abortion argument to extreme cases such as rape or imminent death for the mother.

• Did you find Thomson’s argument compelling?
• Do you believe that Thomson’s use of analogies was an effective method of communication? If yes, do you think the violinist analogy is representative of getting am abortion? Can any analogy be representative of that decision?
• What do you think should be the role of a third-party in the mother’s decision to abort her child?

In the chapter titled, “The Question of Abortion and the Discipline of Moral Reasoning,” Arkes explores the interaction between morals and the law post-Roe vs. Wade decision made by Justice Blackmun. Arkes states, “Within the space of five lines, Justice Blackmun managed to incorporate three or four fallacies, not the least of which was the assumption that the presence of disagreement (or the absence of “consensus”) indicates the absence of truth (360).” The assumption referenced is that the judge’s decision was the answer to the dispute over when life begins. Arkes spends much of the chapter explaining that the judicial decision did not solve the dispute but rather added to the fuel because it brought to light even more ethical debates.

Arkes stresses the need for justification when making any moral decision. Arkes analyzes Blackmun’s suggestion that the “fetus becomes ‘viable’ somewhere between the 24^th and 28^th weeks, and he indicated that the state would have a stronger “’logical and biological justification’ to act at this point (376).” The next line is Blackmun’s clarification that “this justification would never be sufficiently compelling in any case to override the interest of the mother having her baby (376).” This judicial stance highlighted the importance of justification and also that the abortion debate by no means would end with Roe vs. Wade.

• Is it possible to create laws without taking morality into account? Is it justified to separate morals and laws?
• How does the need for justification change your viewpoint on the abortion debate from a mother’s, the fetal, and the physician’s perspectives?
• Do you agree with the Ann Landers argument presented by Arkes for a mother to have an abortion?

Finally, I’d like to return to Ginsburg’s work now that the other two readings for the week have set the national background under which Ginsburg was conducting her anthropological study. The abortion controversy that began once the abortion clinic open in Fargo in 1981 is a social drama. Ginsburg states it is a “sequence of phased conflicts typical of “social dramas”: breach, crisis, redress, regression to crisis, and eventually stabilization either through schism or reintegration (121).” There were many waves of strongholds on the pro-choice and pro-life sides throughout the 1980s.

In what she refers to as “procreation stories”, Ginsburg sought out life narratives from both sides of the argument. She found that pro-choice women found inequalities to be rooted in gender discrimination and choose economic and political remedies to solve the issue at hand. For pro-life women, “opposition to abortion, like other moral reform campaigns, is a gesture against what they see as the final triumph of self interest, a principle that represents both men and the market (216).” Thus, I found these overall findings to be interesting as they both point to abortion as an inherent feminism argument. All women interviewed thought that the underlying issue was with the definition of female gender identity and the placement of this identity in society.

It is important note that Ginsburg relays that there isn’t any large gap of socioeconomic class or other prominent identity that separates women on either side of the argument in Fargo. I think this is a remarkable statement because it actually highlights the intrinsic similarities between women on either side of the argument who are all trying to advance feminist values. It seems that it is the ideologies that are in opposition, not necessarily the women themselves.

Ginsburg’s goal in conducting her study was to “understand how this grass roots conflict shaped and was shaped by activists’ experiences of self, gender, family, community, and culture in a specific setting (6).” She was able to portray this inter-sectionality well, but concluded that the issue boiled down to a women’s place in society. She places a lot of significance on the role of nurturance in determining philosophical questions of either side of the abortion argument.

• After reading Ginsburg’s ethnography do you think that pro-life supporters are entirely different from their opponents, the pro-choice supporters?
• Ginsburg sheds a negative light on national media with ABC’s portrayal of the conflict in Fargo. An account is presented from a leader of the LIFE Coalition who is “disgusted and disappointed” because ABC “paid women money to interview anonymously and tell how their needs had not been met when working with the pro life groups.” Do you think the role of media has been positive or negative in the abortion debate today?
• What are your thoughts on Ginsburg’s final conclusion that any type of activist controversy “suggests a dynamic relationship between the construction of self and social action in (American) society (220)?”

Background Information

            I am a general surgeon currently working at the private hospital in Sasquatch, Connecticut. I identify as a Lebanese Shi’ite Muslim male. My family and I moved to Sasquatch 10 years ago, at which point we were the only Lebanese family in the community. However, there has been an influx of Lebanese immigrants and I am proud to say that I was recently elected as the president of the new Lebanese Cultural Association. With the growing immigrant populations in our community and my medical expertise, I am humbled to serve on this ethics committee as we transition to becoming a non-denominational hospital.

Policy Proposal

Reproductive Technology Use

IVF Treatments and Prenatal Testing

I believe the Sasquatch Hospital should begin to provide in-vitro fertilization (IVF) treatment and prenatal testing including amniocentesis. Though, the risk of miscarriage during an amniocentesis procedure is 1 in 200 (Rapp 97), which is the same as babies born with Down syndrome, patients in our community deserve to have the right to know about possible birth abnormalities. With the growing diversity in population, the availability of this procedure is essential as genetic diversity is also increasing.

Abortion Services

            The hospital should not provide abortion services, unless extenuating circumstances persist. These circumstances fall in line with the United States federal guidelines listed under the Hyde Amendment. Abortion services should only be provided when the pregnancy is a result of rape or incest or is a medical threat to the woman’s life.

Though the hospital has become non-denominational, we must still consider the prevalent religious practices present in our community. IVF and prenatal testing allow for the expansion of knowledge, but abortion by two out of the three dominant religions in this community (Catholicism and Shi’ite Islam) prohibit the murder of a living being and an unborn fetus can be considered living as it is in the mother’s womb. The holy Quran teaches that “God had given people their bodies as a trust (amana) and that (we are) therefore responsible to take care it (Hamdy 151).” As a devout Muslim, I do not think it is ethical to break the amana that God has bestowed upon mankind and my fellow Catholic staff feels the same.

However, I also know that I have taken the Hippocratic oath and will follow all means to help patients live healthily. Thus, I propose that this hospital only provide abortion services when it is a medical necessity as explained at the onset of this section.

Unused Embryo Donation

From a medical perspective, I propose that unused embryos should be donated for life-saving research. I believe this follows the same reasoning as providing abortion services to women under extenuating circumstances. Unused embryos will not become living things and if they can lead to the cure of diseases, then it is worth it for them to be used for research.

Funding under-insured Patients

Subsidized funding for under-insured patients should be provided only for testing purposes, not abortion services even when extenuating circumstances persist. It is a pretty common standard around the Western world for governments to provide these funds. For example, “The French government normally reimburses medical procedures up to 80%, but in the case of infertility diagnosis and treatment, the national health insurance system covers the cost of the entire process (Ball 547).” Thus, I do not believe our hospital which condones abortion overall should provide funding for abortion services of those under-insured since they can get the funding elsewhere. Indeed the United States can currently use federal funds to fund under-insured patients with extreme cases for abortion.

Counseling Staff Regulations

Spiritual counseling by clergy should be continued, but the clergy should be opened to other religions that have recently become more prevalent within the Sasquatch community. “Shi’ites practice a form of individual religious reasoning known as ijtihad (Inhorn 18).” Thus, I believe all patients to this hospital across all religions should be able to have access to religious counseling in order to determine their course of medical action. Given that the vast majority of the community served is religious in some way, the inter-religious clergy will aid in daily smooth function of our hospital.

I propose implementing a mandatory training program for all counseling staff including social workers, genetic counselors, and clergy. This training program will educate counseling staff on official hospital policy regarding assistive reproductive technology and prenatal testing. It will give guidelines as to how staff can counsel under their own religious doctrines, while still adhering to hospital policy and national law.

Medical Staff Regulations

            Furthermore, I propose a similar training program for all medical staff at the hospital. All staff will not be required to be in agreement with hospital policies proposed, but rather should be aware of official hospital policy. The staff should be willing to uphold the official policies at the very least.

I know there is currently some tension among the Catholic nursing staff to perform these procedures. I do not think any of the staff should ever be required to perform procedures that are against their religious beliefs. Thus, a team of new hires and a few of the current staff who are willing will be chosen to make a team designated for all the procedures stated in this policy proposal. Nonetheless, as stated in the above training program, the staff unwilling to perform the procedures will still have to acknowledge that the procedures are being conducted at this hospital under structured circumstances.

Works Cited

Nan T Ball, “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” Duke Law Journal 50 (2000): 545-587.

Marcia Inhorn, He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly 20 (2006): 94-120.

Sherine F. Hamdy, “Does Submission to God’s Will Prevent Biotechnological Intervention?” In   Jeremy Stolow editor, Deus In Machina: Religion, Technology and the Things In-between (Fordham University Press, 2013), 143-57.

Rayna Rapp, Testing Women, Testing the Fetus (Routledge, 2000).