Proposal letter

 

GMH Description and History,

On March 25, 2018, the Sasquatch Catholic Hospital (SCH) announced today it has changed its name to Grace Medical Hospital (GMH) as part of a restructure that will position the hospital to become a more dominating figure in the Sasquatch, Connecticut community. GMH is a private hospital rooted in the Catholic tradition, but is no longer formally associated with the Catholic Church. Along with this new name and structure, the church has allowed the hospital to become non-denominational and will continue subsidizing medical care for uninsured patients. This proposal incorporates five years of discussion between medical staff, donors, and local community members regarding the future of GMH and how it can best accomplish its goals. The discussion takes into consideration the predominant Irish population, the local Jewish community, a mixed Caucasian and African-American (non-Irish Catholic) community, as well as the expanding populations of Lebanese Shiite and Japanese immigrants. This proposal lays the groundwork for GMH’s long term plan that focuses on addressing various questions such as “How much will the hospital reflect its donor base (Catholic origins) and mixed local community?”, “How should the hospital begin to provide and subsidize abortion services for under-insured patients?”, “What about IVF treatments and prenatal testing including amniocentesis?”, “If the hospital does begin to provide IVF treatment, should the hospital encourage families to allow embryos to be donated for potentially life-saving research?” and  “Should the hospital continue to provide spiritual counselling by Catholic clergy?” The decisions presented in this proposal are supported by years of research to ensure the best outcome for the various groups involved.

 

GMH Needs

The main goals of GMH are to balance healthcare quality and efficiency and to improve access to care. In the healthcare industry, there are many pressing problems regarding financial, federal, and ethical issues; These difficulties have both positively and adversely affected all area of GMH. Many of these problems are part of an interrelated system of adaptations that coevolve together to shape hospitals around the country. The best outcome for GMH is to create an all-inclusive healthcare system with balanced care and quality, while simultaneously considering the Catholic traditions. If this is achieved, GMH will become a dominate figure within the community of Sasquatch, Connecticut. This proposal projects a five-to-seven-year plan to attain this goal, while concurrently reducing costs.

 

My Solution

All the data went into the development of a balanced solution to address main six questions.

1. How much will the hospital reflect its donor base (Catholic origins) and mixed local community?

One of GMH’s top priorities is to better incorporate the perspectives of the hospital’s donors, staff, and mixed local communities into the discussion of abortion and reproductive technologies, such as in-vitro fertilization (IVF) and prenatal testing (amniocentesis). Due to the diversity of all groups present, it will be a challenge to integrate every social and cultural agenda into each decision. The hospital’s donors and staff are predominantly Catholic, while the mixed local community is heavily comprised of Jewish, Caucasian, and African-American individuals. In addition, there is a growing population of Lebanese, Shiite and Japanese immigrants. This diverse community of locals and staff presents various conflicting ideas about the use of abortion and reproductive technologies. Given our Catholic history and considering where most of our funding originates, I recommend that GMH stay within the realm of the Catholic Church’s doctrines, while having the freedom to make some exceptions in specific situations. I recommend that GMH does not provide nor subsidize abortion services for any patient. In addition, the use of IVF will not be provided nor encouraged by the GMH organization and staff, while prenatal testing, including amniocentesis, will be provided and encouraged for all pregnant mothers. Requests for exceptions to these rules will be considered and determined by a hospital committee. I acknowledge this may be controversial for many individuals, but this is the position I believe is best for the hospital. I have presented my reasoning behind this recommendation for abortion, IVF, and prenatal testing.

2. How should the hospital begin to provide and subsidize abortion services for under-insured patients?

My recommendation for GMH is to stand by the doctrine of the Catholic Church and not provide nor subsidize abortion services for uninsured patients to protect human dignity. In today’s world, we have access to more resources pertaining to human procreation than ever before, and with these resources we have gained a great responsibility to protect human life from its origins. In an effort to protect human dignity, the Catholic Church has made available their position regarding the relationship between science, technology, and human life. At GMH, we share the beliefs of the Catholic Church that “from the moment of conception, the life of every human being is to be respected in an absolute way because man is the only creature on earth that God has ‘wished for himself’ and the spiritual soul of each man is ‘immediately created’ by God; his whole being bears the image of the Creator” (Shannon & Cahill, 1998: 147). Therefore, any sacrifice with the assumption that the fetus is mere tissue is seen as going against GMH’s beliefs. At GMH, the hospital’s donors and nursing staff are predominately Catholic, therefore requiring GMH’s staff to perform or participate in abortions may represent a serious threat to the individual’s fundamental moral or religious beliefs (Meyer and Woods, 1996). The provisions of abortion may facilitate a direct clash between the staff and donor’s religious beliefs; this clash could potentially deter GMH from improving care and efficiency. This recommendation will agree with the religious and moral beliefs of the Catholic donors and nursing staff. At the same time, GMH realizes this recommendation may be controversial for members of religious denominations. To accommodate for these denominations, GMH will expand our partnerships with local clinics. Patients that inquire about abortion will be provided with information to the nearest facilities that provide this service. This may be an inconvenience, but this is the position GMH should stand by to ensure human dignity and God’s will.

3. What about IVF treatments and prenatal testing including amniocentesis?

 Similar to my recommendation for abortion, I suggest that GMH stand by the doctrines of the Catholic Church in order to protect human dignity. This recommendation implies GMH will provide prenatal testing including amniocentesis, while not providing IVF treatment. A prenatal diagnosis (PND) makes it possible for parents to know the conditions of the living embryo and fetus prior to birth, which allows physicians to predict the current and future state of the fetus. This can help ensure the correct therapeutic, medical, and surgical procedure is performed. Procedures such as prenatal testing on the human embryo are rational“if the procedure respects the life and integrity of the embryo and the human fetus and is directed toward its safeguarding or healing as an individual” (Shannon & Cahill, 1998: 159). GMH should only perform these tests with the consent of the mother after she has been adequately informed by her physician of the possible outcomes. If the mother has any intention of aborting the living fetus, the test will not be performed. I acknowledge similar and contrasting views of prenatal testing exist within the Sasquatch, Connecticut community.

In Tsipy Ivry’s book, Embodying Culture Pregnancy in Japan and Israel, she describes a distinction between Israeli and Japanese cultures regarding the level of emphasis placed on reproductive environmental and genetic risk factors.Dr. Ivry claims that in Israel, pregnancy is driven by “anxiety regarding the possibility of reproductive catastrophe and notion of ‘risk’ play a central role,” (Ivry, 2009: 74). The idea of risk in pregnancy assumes a particular meaning in Israeli society. Many Israeli medical practitioners play a key role in portraying “reproductive misfortune as a key scenario of ‘threat’: to imagine that the worst is about to happen and to devise strategies to defend oneself against it,” (Ivry, 2009: 74). This medical attitude among many Jewish individuals reflects “an understanding of pregnancy that tends to ‘leave’ the fetal health to the mercy of random, unpredictable genetic and chromosomal breakages, to underestimate the role of women in fetal development, and to focus less on the health of the pregnant woman herself than on the fetus she is carrying,” (Ivry, 2009: 74). This attitude leads many Israeli practitioners to strongly emphasize the need and benefits of prenatal testing. Dr.Ivry recounts the story of Dr.Levi, an OB-GYN in Israel. Dr.Levi explains how he had to “form ‘self control’ and to accept the decision of predominately ultra-orthodox Jews not to use prenatal testing. He would understand the need to ‘count to ten’ as reflecting a deeply felt urge to express anger at his patient’s stupidity,” (Ivry, 2009: 74).This physician’sinabilityto conceive the decision of his patient not to use prenatal testing was so strong he had to find a way to accept the decisions to not use prenatal testing. Other physicians would not accept their patient’s decisions and would seek other ways to change their mind. Dr.Ravel, an OB-GYN, would not accept decisions of patients “he thinks that amniocentesis is absolutely necessary. He keeps a list of rabbis to whom he refers religious couples according to their religious affiliation,”(Ivry, 2009: 67). This is done in hopes to change the individuals mind. These examples of practitioners show the level of emphasis genetic risks factors are placed in Israeli society. This level encourages the use of prenatal testing for all individuals. In turn, GMH provision of prenatal testing technology can be seen as a “risk reducing” technology that emphasize the view of many Jewish individuals.

At the same time, GMH realizes the provision of this technology may not directly connect with the view of other groups. For many Japanese individuals, they place more emphasis on environmental risk factors rather than genetic risk factors. In her research in Japan, Tsipy Ivry found that many individuals take an environmentalist approach to pregnancy (Ivry, 2009:95). This complex approach presents the image of a baby as totally dependent on every aspect of the mother’s decisions. In multiple Japanese textbooks concerned with childbirth and care, this idea is expanded to specific theme such as postures for physical activity, bodies temperature regulation, and stability of their belly to prevent against bump. Instructions such as these are not present in the Hebrew textbooks.  “Such instructions are absent from the Hebrew textbook, and I have never heard any mention of them in clinical circumstances in Israel. Israeli theories of gestation seem to regard fetuses as ‘safely insulated’ in a womb that supplies constant thermal stability, regardless of environmental conditions outside the uterus. By the Israeli logic, the womb may be an environment but it is ‘automatically’ managed by the body. In contrast, Japanese theories hold that it is the woman who manages it herself” (Ivry, 209: 95). There can be multiple reasons why Japanese emphasize the environmental risk factor over genetic risk factors. The Japanese individuals and doctors that emphasize environmental risk factors may feel the mother’s choices are easier to control than genetic risk factors. For example, Dr.Ivry present the opinion of Dr.Tanaka, a fifty-year-old ob-gyn in Japan. This doctor recognized that women over the age of thirty-five have a greater chance of chromosomal abnormalities than younger women. Dr.Tanaka would never mention amniocentesis to these patients. She would “asked whether she [pregnant patient] is interested in having precise test. But usually I don’t speak to her at all about the kind of testing that exists” (Ivry, 209:107). If this doctor did feel the need to mention the option of prenatal testing, she would make sure to assure the woman through the entire process. This doctor’s strategy suggests that, “rather than ‘pure’ medical consideration minimizing the anxiety of the patients is one of their major concerns” (Ivry, 209:107). Alternatively, the Israeli individuals and doctors may feel emphasis on genetic factors are easier to control and test for than environmental risk factors. As one can see, many Israeli and Japanese individuals recognize environmental and genetic risk factors. The only difference is the relative emphasis placed on each factor.

Addressing my recommendation on IVF treatment, my recommendation relies on whether the situation is sufficient to ensure the dignity of human rights. In the case of IVF, the Catholic Church believes human dignity is not preserved. The Catholic Church believes “every child has the right to be conceived in marriage. The only acceptable way to reproduce is through conjugal act between spouses. Any methods that occurs outside this act is seen as non-moral” (Shannon & Cahill, 1998: 159). This includes forms of artificial insemination, in vitro fertilization, and surrogate motherhood. GMH and the Catholic Church acknowledge many sterile individuals may view this prohibition on IVF as clashing with their right to procreate.  Through in vitro fertilization and embryo transfer and heterologous artificial insemination, sterile individual may conceive though the fusion of gametes of at least one donor other than the spouse who are united in marriage. In turn, the use of this technology would affect the child’s dignity by “depriving him [the child] of his filial relationship with his parental origins and can hinder the maturing of his personal identity. Furthermore, it offends the common vocation of the spouses who are called to fatherhood and motherhood: It objectively deprives conjugal fruitfulness of its unity and integrity; it brings about and manifests a rupture between genetic parenthood, gestational parenthood, and responsibility for upbringing” (Shannon & Cahill, 1998: 159). This kind of threat may damage the child’s personal relationships and identity within a family.

While GMH and the Catholic Church acknowledged the sacredness of marriage, this does not give the couple the right to have a child. Rather, marriage gives the right to perform the natural acts of procreation. GMH sees a child as not a right, but as a gift. At GMH, we will encourage married couples who are unable to procreate to find other alternative ways to fulfill their aspirations. To assist these residents with their religious and spiritual pursuits, a hospital chaplain will be provided by GMH. This service will offer ministry and spiritual guidance to patients, family members, and caregivers. It will be the job of the hospital chaplain to provide alternative services based on the individual’s needs.

In addition,GMH acknowledge the aspiration of homosexual couples to have children.However, the implementation of these services may challenge the traditional heterosexual families in our community. In Nan T. Ball’s article, The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates, she analyzed the 1994 French bioethics debate. These “bioethical laws that the French National Assemble passed in July 9, 1994 allowed only sterile, heterosexual couples of procreative age to use artificial insemination and in vitro fertilization procedures” (Ball, 2000: 547). “These restrictions were instituted, in part, to control the threat the legislators thought these technologies posed to the traditional family structure. The unprecedented availability of ART at the end of the twentieth century appeared to further undermine the predominance of the tradition heterosexual, bi-parental family structure because the technology enabled homosexual couples, virgins, and post-menopausal women to have children” (Ball, 2000: 548). Unwilling to allow such technological advances to alter cultural norms, the French legislature restricted access to ART by supporting a normative family model. Nan T. Ball shows how ironic it is that the French Republic, an adamantly secular structure, is still making decisions that are similar to the Catholic Church’s views. The French Republic did not make these laws with anything to do with the Catholic Church in mind. They viewed their decision as conforming to good reason and good policy. Similarly, GMH sees the potential threat of IVF technology to the traditional heterosexual family structure of Sasquatch, Connecticut community as a good reason to not provide this technology.

 4. Should the hospital continue to provide spiritual counselling by Catholic clergy?

When addressing whether GMH should continue to provide spiritual counselling by Catholic clergy, my recommendation is for GMH not to continue to provide spiritual counselling by Catholic clergy. This recommendation is based entirely on financial feasibility. Due to increasing medical cost and softening patient admission and, GMH is facing greater financial losses. “In a new report form PricewaterhouseCoopers’ Health Research Institute (HRI), the medical costs have seemingly settled into a ‘new normal’ where increases have hung 6-7% per year. HRI expects this medical cost growth rate to increase by 6.5% for 2018,” (HRI, 2016). This problem has been linked to an increase in out-of-pocket costs for patients that prevents them from seeking hospital services. While GMH acknowledges the spiritual and emotional benefit of clergy, currently it is not in an adequate financial state to provide this service. The provision of these services would require GMH to cut funding from hospitals programs or hospital staff. Which in turn would lead to protest that would impede the hospital’s goals to balance healthcare quality and efficiency and to improve access to care. By not providing this service, GMH can prevent future financial problems. I recognize that the clergy perform other functions as well as helping individuals make medical decisions, but they are peripheral to the care GMH provides and GMH can not afford it.

 

Timeline

I recommend that the preliminary timeline will take one-to-two years to get the doctors and nurses on board. It is not certain how long it will take donors to accept the changes, but from prior discussions with a few select donors they support the changes recommended by my proposal. The longest timeline will be the formation of partnerships with other local hospitals and clinics. There are many legal documents and certifications that must be approved before we can begin a mutually beneficial relationship that will ensure every individual great quality care.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work cited

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.” (Crossroad, 1988).

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).

Meyers, C, and R D Woods. “An Obligation to Provide Abortion Services: What Happens When Physicians Refuse?” Journal of Medical Ethics 22.2 (1996): 115–120. Print.

Ball, Nan T. “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” Duke Law Journal, vol. 50, no. 2, 2000, p. 545., doi:10.2307/1373097.

Health Research Institute. “The New Gold Rush Prospectors Are Hoping to Mine Opportunities from the Health Industry.” The New Gold Rush Prospectors Are Hoping to Mine Opportunities from the Health Industry, May 2011, www.pwc.com/il/en/pharmaceuticals/assets/the-new-gold-rush.pdf.

 

 

 

Dear Sasquatch Connecticut Ethics Committee,

As a new member of this committee, I have written a policy proposal on the use of assisted reproductive technologies and prenatal testing for our hospital. My previous position on the Ethics Committee of the Medical Board at the Mount Sinai Hospital allowed me to gain experience in a diverse community. Being one of the few female doctors on the ethics committee at Mount Sinai, I learned that at times one must put the patient’s needs over their own personal views or the views of the majority. It is often difficult to make policy decisions that pleases everyone when it comes to controversial topics, such as assisted reproductive technology and prenatal testing. In a hospital that recently became non-denominational in a varied community that is seeing an influx of minority immigrants, its policy should reflect what patients need. The more services the hospital provides, the more patients and potential donors it will attract. A variety of services will increase patient satisfaction; however, the convictions of the healthcare provider should still be considered. Therefore, my proposal would attempt to find a middle ground where both our predominantly Irish Catholic donors and diverse community will be content. It would be insensitive for a healthcare provider that provides services to patients of different backgrounds and beliefs to have one unwavering view for hospital policies. The goal of a hospital should be to improve outcomes and create more satisfied patients.

After reviewing my initial hospital policy on abortion, I have decided to make some changes. I acknowledge that the donor base is still prominent Irish families, who will most likely have a Catholic stance on abortion: “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae). However, the community is not made up of only Irish Catholics and the hospital should accommodate women in the community not of the same religion or beliefs. In hopes of reaching a middle ground, the hospital will not be providing abortion to the general public but only for extreme circumstances. These extreme circumstances that the hospital deem acceptable for abortions include pregnancies from rape and pregnancies that jeopardize the mother’s life. Although the hospital will offer prenatal testing, regardless of the results patients will have to go to another hospital if they want to abort their unborn child. “If pregnancy is highly risky, birth seems even more so”; therefore, for us as a hospital we need to do right by the patient (Ivry). If a mother’s life is in danger, the hospital can abort the unborn child out of self-defense. Rights advocates would say that one must consider the fetus’s rights as a person; however, if killing in self-defense is not punishable then aborting an unborn child that is killing the mother should not be condemned. What about the rights of the mother? This same question applies to whether or not it is okay to abort a fetus resulting from rape. The mother’s rights were violated when the rape occurred. It would be cruel to add insult to injury and make the mother keep the baby as a constant reminder of the rape. Some will argue that by aborting the fetus, there would be two instances of rights violation instead of one. For Pro-Life supporters, abortion is murder. However, if the potential mother cannot get an abortion her original life is “ending” in a way as well. Her life could potentially be ruined and forever changed, not by her own volition. For these extreme cases, the hospital will subsidize abortion services for under-insured patients.

As for In Vitro Fertilization (IVF), Sasquatch Hospital will only provide treatments for husbands and wives that are looking to start a family. According to the Catholic Church, artificial reproductive technology goes against “natural” law and Scripture. Those people that are faithful to the religion should not use artificial reproductive technologies. Since the Church associates IVF with abortion because during IVF not all embryos are implanted; therefore, an “act against the life of these human beings” (Shannon and Cahill, 154). However, it is acceptable for a husband and wife who cannot conceive to seek other options such as IVF. The prominent Irish Catholic donors should not take issue with these conservative terms and continue to donate to Sasquatch Hospital. Similar to Israel, where IVF is subject to both medical and Jewish religious oversight Sasquatch Community Hospital will offer religious counseling for patients. The interpretation that reproduction is an “imperative religious duty” prevalent in the Jewish community would encourage people to support IVF (Kahn). The option for IVF will also benefit the Lebanese Shiite and Japanese immigrants. This condition that IVF at Sasquatch hospital can only take place between a husband and wife also satisfies the religious beliefs of the Lebanese Shiite since “most Shia scholars […] argue that the act of fertilization of the woman’s egg with the sperm of a man other than her husband’s is not allowed” (Naef). The child will be considered illegitimate depending on whether or not gaze or touch occurred.

A few years ago, Athersys, a biopharmaceutical focused on stem cell research approached Sasquatch Hospital for a collaboration. The deal was that Athersys would donate funds to the hospital if doctors encouraged patients to donate their embryos to potentially life-saving research. This collaboration will be made transparent to all of the participants/patients and they can opt in to donate their embryos or pay to freeze them for later use. This potentially life-saving research can also lead to a more efficient and less invasive prenatal testing while also helping out the hospital. Since only one embryo is carried to term, the rest would either be disposed or frozen. If “extra embryos are frozen and can be kept over a period of several years for later use without significantly losing their potential develop successfully into human beings through pregnancy” then we should not let this potential go to waste (Eich). Similar to how society condemns human testing unless given informed consent one can argue that no consent was given by the donated embryo therefore a violation of rights. One opposing view is that the hospital is obligated to abide by “the inflexible principle that utter helplessness demands utter protection” (Kass). The question is at point does one considers the embryo a human being and whether or not an embryo deserves to be treated with respect.

Prenatal testing such as amniocentesis will be offered to women and families who want to reduce contingency. However, as a hospital in a predominantly Irish Catholic community we want to emphasis that these genetic tests are done not for the purpose of terminating difficult pregnancies if there is a defect but more so to allow families to make arrangements early in light of the knowledge. The hospital will not push mothers to undergo amniocentesis but they will be made aware that it is an option. If a family has a history of birth defects then and only then can the doctor suggest to the mothers to undergo prenatal testing. Since “Japanese ob-gyns are often reluctant to mention prenatal diagnosis even to older women […] some of the Israeli ob-gyns I interviewed said that they offer prenatal diagnosis to each and every patient, regardless of her age” (Ivry), the doctors at SCH will allow the patients to make the decision themselves. With this policy, I was hoping to help the Japanese immigrants feel less of a culture shock. Making prenatal testing available will also allow mothers in the Jewish community to have agency in their pregnancies.

In addition to social workers and genetic counselors, Sasquatch Hospital previously provided spiritual counseling by the Catholic clergy who often interfered with some doctors’ work. I propose that we either discontinue this in-house spiritual counseling by Catholic clergy unless we allow other religions to have counseling as well. This clash between the medical staff and the Catholic clergy does not provide a healthy environment for the patients. The fact that the Catholic clergy are interfering with patient care is unacceptable especially if the patient is not even part of the Catholic community. Bringing in other spiritual counselors of different religions such as Islam and Buddhism, Judaism will make our diverse community feel included.

The hospital’s historically Catholic nursing staff that refuse to perform these procedures can put in a request to be transferred to a different section of the hospital. Since Sasquatch Community Hospital is only offering abortions to extreme cases, switching out nurses should not be an issue. Since the budget for new hires is extremely limited, the hospital cannot replace all of the nurses and the alternative would be to transfer nurses from different wards of the hospital. I understand that it may be uncomfortable for the nurses who are devout Catholics to assist in performing these procedures but I would like them to kindly reflect upon the reasons they chose to become a nurse before asking for a transfer. If their convictions against abortion for extreme circumstances trumps helping their patients then they should request a temporary transfer. These abortions will adhere to the principle of beneficence, where medical intervention is done to make the patient better. The principle of beneficence and the principle of autonomy will hold for all procedures done at Sasquatch Community Hospital.

-Selina

 

 Works Cited (and Consulted):

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.” (Crossroad, 1988).

 Shirin Garamoudi Naef, “Gestational Surrogacy in Iran,” In Marcia C. Inhorn and Soraya Tremayne editors, Islam and Assisted Reproductive Technologies (Berghahn Books, 2012).

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).

Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66.

Leon R. Kass, Human Cloning and Human Dignity (2002).

Thomas Eich, “Decision Making Processes among Contemporary ‘Ulama’: Islamic Embryology and the Discussion of Frozen Embryos.” In Jonathan E. Brockopp and Thomas Eich, Muslim Medical Ethics From Theory to Practice (University of South Carolina, 2008), 61-77.

Arthur Kleinman, “Moral Experience and Ethical Reflection: Can Ethnography reconcile them? A quandary for the new Bioethics.” Daedalus 128 (1999): 69-97.

 

 

 

Victoria Rice

Professor Don Seeman

Religion and Bioethics, REL358WR (Spring 2018)

 

Saint Paul Hospital Ethics Committee Policy Proposal

It is my belief that the proposal of new policies for services conducted at Saint Paul Hospital should be fully aligned with the mission statement and legacy of the institution:

“Since 1867, our mission at Saint Paul is to put the patient first. Our duty is to give tangibility to Christ’s healing mission and the mercy of the Catholic Church to care for and ensure the wellbeing and good health of our community.”

As a long-term member of the Saint Paul Hospital Ethics Committee, deacon of the Saint Paul Church, and active member of the Sasquatch community, my commitment is not only to the Catholic church but to the people of our wonderful town. To my fellow council members, I propose the following policies on assisted reproductive technologies:

The purpose and legacy of Saint Paul does not align with assisted reproduction procedures. Saint Paul should refuse to provide for any patients, including both insured and under-insured patients, unless the life of the child is unsalvageable and the health of the mother is at risk. It is in our historical Catholic faith to respect the human being “from the very first instant of his existence” (Donum Vitae) and our policies reflect the “premise that the fetus is a human being, a person, from the moment of conception.” (Thomson, 47) Respectful treatment of the unborn child from the moment of conception does not permit abortion.

Abortion operations should only be conducted under extremely special circumstances. In order for a termination of pregnancy, it should be diagnosed by a medical professional that the child’s life is unsustainable and the continuation of the pregnancy will only put the life of the mother at risk. In such a situation, the mother would be referred to Loch Ness Falls Regional Hospital. Loch Ness Falls, Connecticut is located 62 miles west of Sasquatch. This position is aligned with our Catholic roots and mission statement, as it promotes the greater health of our community whilst putting the patient’s health first.

Subsidized In-Vitro Fertilization treatments for under-insured patients should only be referred from Saint Paul Hospital under certain circumstances. IVF treatments that introduce a third-party, such as surrogate, are an unnecessary procedure that would only negatively affect the community at large. The introduction of third or fourth parties into reproduction serve to threaten the identity of the child (Shivanandan, Atkinson, 138) and would also disrupt “the unity and stability of the family with damaging effects on society.” (Donum Vitae) It has been widely documented that many women find motherhood deeply desirable and in multiple religious, including Jewish faith, has been cited as an “imperative religious duty.” (Khan, 3) In Christian faith procreation is highlighted, as stated in the first chapter of Genesis, “And God blessed them. And God said to them, “Be fruitful and multiply and fill the earth and subdue it.” (Genesis, 1:28) The usage of IVF between a married heterosexual couple may be discussed, and if deemed necessary, referred to nearby institution that conducts these procedures.

Saint Paul Hospital should not conduct IVF procedures because they typically result in the embryo exterminations as the number of eggs that become fertilized is uncontrollable by the procedure. Allowing IVF procedures to occur inside our institution would only increase the demand for abortion services at Saint Paul Hospital, which is why referring patients to a nearby institution seems the most reasonable option. Although the intentions of such services may be in good faith, the decision to not provide in-vitro fertilization at Saint Paul Hospital would not only appease the Catholic faith but also serve to better serve the community as IVF treatments largely are not in the best interest of the community. The policy of whether to conduct In-Vitro Fertilization treatments should be reflective of the mission of Saint Paul Hospital to ensure the wellbeing of our community.

I support the stance that Saint Paul Hospital should conduct pre-natal testing (including amniocentesis) as the early detection of possible medical issues have the potential to be beneficial for both the mother and child. These tests would be utilizing the “significance of present and projected uses of biotechnology to serve human goals beyond healing disease and relieving suffering and to satisfy widespread human desires.” (Kass, 234) The purpose of these tests should be to give time to the family and community of the unborn child to prepare if it is discovered that the child will be born will special needs.

The information discovered from pre-natal testing should not be used to determine whether or not to end the pregnancy as “malformation or a hereditary illness must not be the equivalent of a death sentence.” (Donum Vitae) Some argue that amniocentesis may lead to miscarriage. Recent National Institute of Health statistics claim that the pre-natal testing technology is “a very safe technology, adding less than one-half of a percent (.5 percent) to the miscarriage rate.” (Rapp, 32) Pre-natal testing has been deemed safe and is already being widely used by Catholic women. (Rapp, 157) If Saint Paul Hospital discourages the use of In-Vitro Fertilization technologies, there should be a lessened discussion of the usage of unused embryos. Mothers who have undergone IVF treatments at other institutions should be made aware of opportunities in nearby cities to donate their embryos to be used in medical research.

In addition to pre-natal testing, genetic and spiritual counseling should continue to be conducted at Saint Paul Hospital. Catholic belief is that “intervention in this field is inspired also by the Love which she owes to man, helping him to recognize and respect his rights and duties.” (Donum Vitae) Spiritual guidance is a right given to Saint Paul patients that should continue to be honored. Although spiritual counseling has historically been given by Catholic clergy, Saint Paul will be inviting the clergy of other religions to better represent the diverse community the hospital serves. I believe that the Catholic values of Saint Paul Hospital should be reflected in the hospital policies but not forced upon our patients. The ultimate decision of whether to accept any services provided by Saint Paul Hospital should be given to the patient, this includes assisted reproductive technologies and late term genetic testing belongs to the patient. Saint Paul Hospital will be effective in treating all of her patients from all backgrounds as “particular religious or cultural traditions will be heard if the doctors are adept at hearing the voices of their patients.” (Bhattacharyya, 24) The spiritual counseling provided by Saint Paul Hospital is to serve as support to patients and their medical decisions, if desired. Although encouraged, it should not be mandatory for any patients at Saint Paul Hospital.

As the abortion and reproductive services offered at Saint Paul via these policies reflect the mission statement and long-legacy of the institution, it is unlikely that the Saint Paul Foundation and nursing staff will take offense. Elective operations to terminate human life will only be had under emergency conditions. Any nursing staff unwilling to perform these procedures will be reminded that the nature of the operation is for the betterment of the patient and the community. I believe that all of the policies proposed here are a considerate compromise honoring our community’s diversity and our historic Catholic faith. It would be immoral and unjust to conduct procedures deemed unethical by the Saint Paul Foundation, as without them there would be no hospital.

Thank you and God bless.

 

Works Cited:

1. Congregation for the Doctrine of Faith, “Donum Vitae:  Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation: Replies to certain questions of the Day”. February 22, 1987.
2. Judith Jarvis Thomson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66.
3. Shivanandan, Mary, and Joseph C. Atkinson. “Person As Substantive Relation and Reproductive Technologies: Biblical and Philosophical Foundations.” Logos: A Journal of Catholic Thought and Culture, vol. 7, no. 3, 2004, pp. 138.
4. Kass, Leon. “Reflections on Public Bioethics: A View from the Trenches.” Kennedy Institute of Ethics Journal, vol. 15, no. 3, 2005, pp. 234.
5. Kahn, Susan Martha. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press, 2000.
6. Book of Genesis, Chapters 1-2. New International Version. Biblica, 2011. Web.
7. Rapp, Rayna. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. Routledge, 2000.
8. Bhattacharyya, Swasti. Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.

Introduction

The ethics committee of Sasquatch Mercy Hospital seeks to address research activities and patient care carried out within the hospital. With the recent transition from the hospital’s Catholic founding to one of religiously non-denominational practicing, Sasquatch Mercy Hospital has found itself needing to clarify and reevaluate prior hospital policies. In order to aid the ethics committee to reach a consensus on future hospital policies, I offer proposed policies changes for the committee’s humble consideration.

Before starting my proposed policies, I would like to establish my identity. I am an American graduate student in Philosophy. I am heavily influenced by the work of Aristotle, Agamben, and Foucault. While I will not explicitly address Foucauldian thinking in this proposal, I consider Foucault’s influence in my education to be profound. In regards to my ties to religion, I was raised in a Presbyterian household and continue to practice Presbyterianism.

I believe Sasquatch Mercy Hospital should follow a policy discourse that aims to remain non-partial to any specific religion. I propose we deviate from our Catholic founding in order to strive for nondiscriminatory hospital policies. This deviation is due to our hospital being the only major hospital within a forty-five-minute radius and the expanding religious and racial diversity of the local population.

In this proposal, I aim to address hospital policies regarding abortion, IVF treatments and prenatal testing, spiritual counseling, and hospital employee codes of conduct regarding administering potentially controversial treatments.

Abortion Policies

The hospital should provide and subsidize abortions for up to 13 weeks for underinsured patients. The hospital should continue to provide abortions past 13 weeks; however, should not subsidize those abortions to underinsured patients as the cost for an abortion increases the later the term. While it is my hope for all abortions to be subsidized, as I will argue that the rights of the woman trumps the rights of the fetus, I am cognizant of the budget restrictions that the hospital is currently under. Thus, Dilation and Evacuation (D & E) abortions, the most common procedure for ending pregnancy at 14-21 weeks, will not be subsidized due to the requirement of an anesthesiologist and the longer surgical time required in comparison to medical abortions (taken orally with a pill) or Suction or Aspiration abortions (a surgery that is roughly 15 minutes).

Diverging from the hospital’s Catholic founding that “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae), I propose the hospital to utilize Jewish legal thinking that “born human life is always given priority over human life in development” (Prainsack, 181). Thus, I argue, the rights of the mother should be prioritized over the rights of the fetus.

An Aristotelian understanding of natural inequality also influences my prioritizing of the mother’s rights—where there is a distinction between virtue in a moral sense and virtue regarding rights and political life. Aristotle in his Politics writes “… if it is impossible for a city to consist entirely of excellent persons, yet if each should perform his own work well, and this [means] out of virtue, there would still not be a single virtue of the citizen and the good man, for it is impossible for all citizens to be similar.” (Aristotle, 1984). There is a necessary inequality between individuals regarding the virtue of citizenship. Through this inequality, divisions of wealth and labor are created within the larger metropolis. In respect to the current American system—where citizenship is not given to everyone, our hospital takes into consideration the natural inequality of modern-day life. As the pregnant woman is in an unequal relationship with the fetus where she is the provider of the necessary nutrients and incubation for fetal development and growth, I argue that the rights of the woman should be prioritized over that of the fetus’. Also, the pregnant woman is more likely to be an already established member within society—where she is already considered a citizen and the fetus, even if brought to term, will not be given full citizen rights until it reaches 18 years of age. Thus, the principle of Aristotle’s natural inequality would place the mother in a higher hierarchical position than that of the fetus.

While the Aristotelian argument of natural inequality mainly applies to documented citizens, in order to be more inclusive of undocumented citizens and teenage mothers, I utilize the analogy of the state of exception. Agamben defines the state of exception where, “In every case, the state of exception marks a threshold at which logic and praxis blur with each other and a pure violence without logos claims to realize an enunciation without any real reference” (Agamben, 2005). The state of exception, synonymous to a state of emergency, allows one to disregard and transcend law for the greater good—relegating control and authority to a singular entity. In pregnancy, the pregnant mother undergoes substantial physiological and anatomical changes. These changes affect all organ systems throughout the woman’s body and have potential to be life threatening to the pregnant woman. Priya Soma-Pillay et. al examine the physiological changes in pregnancy, one example being, “Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery). The concentrations of certain clotting factors, particularly VIII, IX and X, are increased. Fibrinogen levels rise significantly by up to 50% and fibrinolytic activity is decreased. Concentrations of endogenous anticoagulants such as antithrombin and protein S decrease. Thus pregnancy alters the balance within the coagulation system in favour of clotting, predisposing the pregnant and postpartum woman to venous thrombosis [or a blood clot that forms in a vein].” (Soma-Pillay, Nelson-Piercy, Tolppanen & Mebazaa, 2016). Once a woman gets pregnant, her body enters a state of exception as her body becomes more susceptible to complications such as increased risk for blood clots, mental health conditions, high blood pressure, among other difficulties. As there appears to be a moral law against abortion, because pregnancy induces a physical state of exception within the mother, this moral law can be disregarded at the discretion of the woman. Thus, the hospital should recognize and treat the pregnant woman’s authority and decisions with the highest importance and regard.

Lastly, I would like to bring to the committee’s attention the historicity of the criminalization of abortions. Faye Ginsburg in her ethnography Contested Lives traces the history of abortion where “The push to criminalize abortion anytime after conception began in the latter half of the nineteenth century as part of a concerted effort by regular physicians to gain control of the practice of medicine in the United States” (Ginsburg, 2006: 25). However, prior to this time period, abortion was “relatively common as well as [an] accepted practice” (2006: 24). A study published in the Lancet medical journal in May 2016 analyzing abortion rates across the world found that abortion procedures were similar in number regardless of the legality of abortions. University of California San Francisco professor Diana Green Foster says, “The obvious interpretation [of the findings] is that criminalizing abortion does not prevent it but, rather drives women to seek illegal services or measures” (Foster, 2016). Thus, in order to protect pregnant women seeking unsafe abortions, it would be in the best interest of Sasquatch Mercy Hospital to practice legal abortions.

IVF Treatments and Prenatal Testing

Sasquatch Mercy Hospital should provide in vitro fertilization treatments; however, will not subsidize the costs to underinsured patients. This decision, similar to my reasoning for my proposed abortion policy, is purely due to the limits of the hospital budget. IVF treatments are significantly more costly than abortions and it would not be in the hospital’s best interest from an economic standpoint to subsidize IVF treatments at this current time.

Inhorn in her ethnographic account on reproductive technologies in the Muslim world writes, “New reproductive technologies, including donor technologies, seem to be giving infertile couples, both Sunni and Shi’ite Muslims, new hope that their infertility problems can be overcome, thereby increasing sentiments of conjugal love and loyalty” (Inhorn, 2006). I hope the ethics committee can recognize the benefits of IVF treatments on marriages and women’s agency, and feel the importance of providing IVF to patients that can afford it.

In regards to whether the hospital should encourage families to allow unused embryos to be donated for potentially life-saving research, I propose a mandate on notifying the patients of the option to donate; however, under no circumstances should hospital staff pressure patients to donate or not. I am cognizant that this suggestion might be in disagreement with the Catholic faith where human life is believed to begin at the moment of conception, which might be a cause of worry for the Catholic donors and nurses. I propose viewing an alternative way of thinking of when human life begins. In 2001, the Bioethics Advisory Committee in Israel issued a report regarding the ethics surrounding stem cell research. The report utilized the reasoning that “…embryos outside the uterus are not regarded as human life…” (Prainsack, 2006: 181). Thus, unused embryos not suitable for implantation in the uterus can be used for research, as those embryos are not considered human life and will not be able to mature into a viable human being. However, embryos suitable for implantation in the uterus should not be used for research due to the potentiality of its human capabilities.

Prenatal testing will be provided and subsidized for all underinsured patients. The option for amniocentesis for pregnant women will also be offered. I propose that prenatal testing and amniocentesis should not be required of all patients, but merely an option for women who would want additional information in regards to their fetuses’ development. Rayna Rapp in her ethnography Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America writes about women undergoing prenatal testing as “moral pioneers” who “submitted to the discipline of a new reproductive technology in order to reap its biomedical benefits” (Rapp, 2004: 307). Prenatal testing and amniocentesis give women greater awareness of potential situations that they may face with their fetuses, such as disabilities, which can allow women to mentally prepare themselves in bringing a disabled fetus to term. In response to prenatal testing being used as a reason to get an abortion, I propose providing women with information about taking care of children with disabilities and alerting them of local resources. This information should be given via written material as well through an on-site genetic counselor. Once the woman is well informed, her choice for an abortion is to her discretion.

Spiritual Counseling

The Sasquatch Mercy Hospital should continue to provide spiritual counseling via the Catholic clergy. I propose to expand the spiritual counseling program to include other religions in response to the changing demographics of Sasquatch, Connecticut. However, in order to address the slight conflict between the Catholic clergy and the doctors, all religious spiritual counselors must sign a contract to issue a verbal disclaimer at the start of each counseling session that their spiritual beliefs do not reflect the views or practices of Sasquatch Mercy Hospital.

Medical Employee Code of Conduct

Sasquatch Mercy Hospital respects and values its Catholic nursing staff. I believe that no nurse will be compelled to have direct involvement in a procedure she/he objects to based on her/his religious, moral, ethical, or cultural values. In compliance with Connecticut law that only a physician may perform an abortion (Conn. Agency Reg. § 19-13-D54), no nurse will be responsible for administering abortions. I propose all nurse staff to be required to undergo a cultural competency program in order to better understand the diverse religious and cultural backgrounds of the patients that they serve. I also suggest all nurses and physicians be made aware of the power dynamics involved from a patient-nurse perspective. Nurses are placed in a position of authority and trust with patients who are dependent on them for their healthcare. In order to work towards eliminating systematic discrimination towards vulnerable populations, I request the nurses and donors to reflect and think on whether their decisions are disregarding the rights of the people that they serve. After completion of the cultural competency program, nurses will alert the hospital of whether she/he cannot provide or aid abortion or reproductive services based on moral or religious grounds. Thus, the hospital will enact structural changes regarding reallocation of workload for nursing staff based on each nurse’s moral and religious convictions.

In the case that all current nurses state that they cannot aid in performing abortions, I propose an internship program for nursing school students at the nearby university. These nursing students will undergo training specializing in abortions and prenatal testing and will be dispersed within the hospital where needed.

Budget

As the hospital will not subsidize later term abortions and IVF treatments, I propose the creation of the Sasquatch Mercy Hospital Finance Committee. This committee will have the sole responsibility for managing the hospital budget in order to ensure that the hospital will be able to continue its operation for prosperity. The Finance Committee will be required to give bi-monthly briefings to all hospital staff regarding the hospital budget and allocate funds for new hires. In the case that Sasquatch Mercy Hospital’s Catholic donors will not fund the hospital, it will be the Finance Committee’s responsibility for developing a business plan and reaching out or partnering with various organizations in line with the hospital’s new policies.

Conclusion

In this proposal, I attempted to address the various issues that Sasquatch Mercy Hospital is currently facing. I prioritize the rights of the mother over the fetus utilizing Jewish legal thinking, Aristotle’s concept of natural inequality, and the analogy of Agamben’s state of exception. I encourage hospital availability of IVF treatments; however, due to the budget constraints of the hospital, do not see subsidizing the treatments for underinsured patients as economically viable—as IVF treatments are expensive and I am intending the loss of support from some Catholic donors in my proposed deviation from the hospital’s Catholic founding. In response to the possibility of all current Catholic nurses deciding not to assist in abortion and other practices against their religious beliefs, I am proposing an educational internship program utilizing nursing students to learn how to administer various medical procedures. Lastly, I propose the creation of the Sasquatch Mercy Hospital Committee in order to be responsible for hospital funding and budgeting.

While this proposal is controversial, I attempt to propose policies that I feel will benefit Sasquatch Mercy Hospital for the better.

Works Cited

Axelrod, C. (2017, October 06). “I’m an OB-GYN who had a 2nd-trimester abortion. The 20-week ban bill is dangerous.” Retrieved from https://www.vox.com/first-person/2017/10/6/16438352/20-week-abortion-ban-obstetrician

Donum vitae = The gift of life: Instruction on respect for human life in its origin: And on the dignity of procreation:. Washington, D.C.: National Catholic Bioethics Center.

Dube, N., & Csere, M. (2013, May 28). Abortion Clinics in Connecticut. Retrieved from https://www.cga.ct.gov/2013/rpt/2013-R-0238.htm

Fiala, C., & Arthur, J. H. (2014). “Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection. Woman – Psychosomatic Gynaecology and Obstetrics,1, 12-23. doi:https://www.sciencedirect.com/science/article/pii/S2213560X14000034

Foss, D. R. (1991, October 3). Aristotle and Natural Inequality. Retrieved from http://www.shlobin-foss.net/papers/unequal.html

Ginsburg, F. D. (2006). Contested lives: The abortion debate in an American community. Berkeley, CA: University of California Press.

Harvard Health Publishing. (2013, February). Abortion (Termination Of Pregnancy). Retrieved from https://www.health.harvard.edu/womens-health/abortion-termination-of-pregnancy-

Inhorn, M. C. (2006). “He Wont Be My Son”. Medical Anthropology Quarterly,20(1), 94-120. Retrieved from http://www.jstor.org.proxy.library.emory.edu/stable/pdf/3655508.pdf?refreqid=excelsior:d10faeb192e7e627fce0b85a5b164fcd

Pappas, S. (2012, October 19). Fact Check: Yes, Pregnancy Can Kill. Retrieved from https://www.livescience.com/24127-fact-check-walsh-pregnancy-can-kill.html

Prainsack, B. (2006). ‘Negotiating Life’ The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel. Social Studies of Science,36(2), 173-205. doi:10.1177/0306312706053348

Pregnancy Complications. (2016, June 17). Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregcomplications.htm

Rapp, R. (2000). Testing women, testing the fetus: The social impact of amniocentesis in America. New York, NY: Routledge.

Schotsmans, P. T. (2009). Christian Bioethics in Europe: In Defense against Reductionist Influences from the United States. Christian Bioethics,15(1), 17-30. Retrieved from https://academic-oup-com.proxy.library.emory.edu/cb/article/15/1/17/297565.

Soma-Pillay, P., Nelson-Piercy, C., Tolppanen, H., & Mebazaa, A. (2016). Physiological changes in pregnancy. Cardiovascular Journal of Africa,27(2), 89-94. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928162/.

Stein, R. (2011, November 27). New Jersey nurses charge religious discrimination over hospital abortion policy. Retrieved from https://www.washingtonpost.com/national/health-science/new-jersey-nurses-charge-religious-discrimination-over-hospital-abortion-policy/2011/11/15/gIQAydgm2N_story.html?utm_term=.9b42c4e0ce5c

Policy Proposals of Sasquatch Hospital

 

Author Background

I am a 28-year-old Chinese woman raised in Virginia. Although I am an atheist physician who believes in the power of the modern medicine, I respect all religions and their practice. As a member of the ethics committee at Sasquatch hospital, I intend to propose several new policies regarding the use of abortion services, reproductive technology, embryo donation, and religious counseling.

Abortion services

Sasquatch hospital was run for many years under Catholic auspices and continues to be supported by Catholic donors. These auspices influenced the provision of reproductive services because of the belief by the Catholic Church that “from the time that the ovum is fertilized, a new life begins” (Cahill et al 145). According to Catholic doctrine, the fetus is a human being from the moment of conception. Therefore, it is also Catholic belief that abortion is equivalent to murdering a new life. As a result, our hospital has never previously provided abortion services. Although abortion is legal under federal law, the prohibition of abortion by the Catholic Church has prevented our hospital from providing the procedure to our patients. Despite the possibility of the religious backlash to the provision of abortion services, our goal as the largest hospital in the area should be to provide better and more comprehensive health care services to our patients. The religious beliefs of our patients “should not be seen as passive, as anti-science, or as constraints to medical treatment” (Hamdy 156), but rather as individual qualities that can be overcome through innovative treatments and convincing results.

Due to our hospital’s recent religious transition to non-denominational practice, the hospital is no longer subject to the rules of the Catholic Church. Although the hospital would like to maintain its religious donors, the hospital should begin to provide abortion services to patients who choose to use them. As supported in Thompson’s book “A Defense of Abortion,” the hospital should support the right of choice for a woman going through a pregnancy and potentially an abortion. Thompson proposes a thought experiment involving an unconscious, famous violinist to explain her point: you are the only person that can cure a famous violinist of his fatal kidney ailment, so the Society of Music Lovers kidnaps you and “plugs” you into the violinist. If you unplug yourself, the violinist will die (Thomson 60). He uses this analogy as a description of the mother bearing a child. He argues that choosing to unplug from the violinist is self-centered but not unjust as the violinist originally does not have the right to use it (Thomson 61). I agree with Thompson’s thesis that mother has the right to have the abortion, just as one has the right to “unplug” themselves from the violinist because essentially mother and fetus are different individuals. The mother has the right to carry the fetus to term and build a mother-child relationship. On the other hand, the mother also has the right to have the abortion. Our hospital will not force anyone to accept abortion but if patients need the abortion, we will provide the services to them.

Although our hospital should provide optional abortion services, our hospital should not subsidize these services for underinsured patients at present. This decision is influenced not only by the fact that we are a private hospital with limited resources, but also that our hospital is reliant on Catholic donors. The hospital must ensure donor relationships remain strong by accepting both blanket donations and donations that exclude abortion services. This donation procedure will avoid tension over certain donations paying towards abortion services. The controversial nature of abortion holds true for donors of other religions, such as adherents to Islam as well. If the hospital begins to accrue a donor base of more accepting religious and cultural backgrounds, we can start to subsidize treatments for underinsured patients in the future. The bottom line is that the hospital should provide subsidized abortion services based on the financial grounds of the hospital rather than the religious preferences of the patients.

IVF treatments and Prenatal Testing

Although at present the hospital cannot provide subsidized abortion services, the government is beginning to provide our hospital-specific funding for In Vitro Fertilization (IVF) treatments and prenatal testing including amniocentesis. According to the Protestant and Catholic understanding of the Genesis, women regard one of their missions in life as to “reproduce and multiply.” Therefore, this funding for IVF treatments and prenatal testing is to help more women in the area to give birth to healthy children. It will cover the general service fee and post-surgical care. Although the Catholic Church and donors believe that any intention “to request [amniocentesis] with the deliberate intention of having an abortion” (Cahill et al 152) is unethical, and some Catholic donors may not support these treatments, the use of government funding allows the hospital to make this decision detached from donor preferences. Furthermore, there is an increasing number of Japanese, Jewish and Lebanese Shiite immigrants population nearby who require greater reproductive service accommodation based on their religious and cultural preferences.

In addition to Catholic Church, the local Japanese population is less willing to use IVF treatments and prenatal testing. The Japanese often express discomfort and distrust with prenatal testing(Ivry 2009, 11). Although there is widespread access to modern and advanced medical technologies in Japan, prenatal care still focuses on the notion of “Gamburu,” or to “make an effort” (Ivry 134).  Ob-gyns are viewed as coaches to guide women spiritually during the pregnancy rather than as a physician who interprets pregnancies in a genetic manner. The focus of Japanese culture is to nurture the child with environmental care. The goal of our hospital is also to create a “no pressure” environment that patients can feel comfortable in. We want to grant our patients the choice of whether they would like to use prenatal testing. Therefore, the hospital should offer cultural training to Ob-gyns, such as those who treat Japanese patients, to better offer spiritual guidance.

Not only does our hospital serve a Catholic and Japanese population, but our hospital also serves a vibrant Jewish community that tends to be comfortable with the idea of using IVF treatments. Under Judaism, “Reproductive technologies are allowed and even encouraged as a means of furthering the Jewish bloodline and realizing God’s command to multiply (Kahn 5). Reproduction is an ‘imperative religious duty’ sanctioned by the very specific economic, political, social, and historical contexts that have given rise to the use of new reproductive technologies as a way to satisfy that duty” (Kahn 3). As the result, Jewish women strongly support IVF treatments because they feel the need to have a child to be fully accepted into society.

Furthermore, to avoid religious conflict and show our respect to the Lebanese Shia immigrants, our hospital will only “authorize the insemination of the woman’s egg with the donor’s sperm in a lab dish, and then implantation of the fertilized egg into the wife’s uterus” (Marcia C. 165). According to Marcia C., this procedure circumvents the concerns of adultery, as “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”(Marcia C. 170). Our hospital would like to provide IVF treatments while also taking in the consideration of Islamic patient’s religious belief.

With regards to prenatal testing, Jewish pregnant mothers are more willing to use prenatal testing because Jewish pregnancy culture tends to focus on geneticism rather than environmentalism (Ivry 250). This different focus derives from the belief that if a Jewish woman experiences premature birth and miscarriage, the cause is viewed as a genetic defect of the fetus. As a result, the mother needs the choice to terminate a pregnancy to reduce the likelihood of physical and mental harm to the mother (Ivry 263). As a result, the duty of our hospital is to provide care and prenatal testing to all the women in the community, but the final decision should still rest on the mother on whether to use this service.

It is important to understand that a variety of factors play into a patient’s decision on whether or not to undergo medical treatment. Therefore, it is necessary that the hospital provide prenatal testing. According to Hamdy, the decision to receive treatments is “extremely complex and highly variable, depending on the patient’s changing circumstances” (Hamdy 156). Nonetheless, we know that “middle-class patients (disproportionately white) usually accept the test while poorer women (disproportionately from ethnic-racial minorities) are more likely to refuse it” (Rapp 168). Since government funding is available, we can reduce the price of prenatal testing, which may encourage more women of lower socioeconomic status, including ethnic minorities, to receive treatments without making it appear as the hospital is subsidizing such procedures.

Donation of Unused Embryos to Research

If our hospital begins to provide IVF treatment, the hospital should also encourage families to allow their unused embryos to be donated towards potentially life-saving research. This decision rests on the fact that “more embryos or fertilized eggs are created than are usually needed for a single treatment. Those extra embryos are frozen and can be kept over a period of several years for later use without significantly losing their potential develop successfully into human beings through pregnancy” (Eich 64). Once a couple is satisfied with their number of kids, they should be encouraged to sign an agreement to donate their frozen embryos. These extra embryos could be used for research purposes so that their inevitable destruction would serve some benefit to science. I am aware that the Catholic Church teaches that all life is sacred from the moment of conception until death (Cahill et al 180). Circumventing this ethical debate, a strong case can be made that, “a fertilized egg before nidation differed significantly from an embryo after nidation and therefore did not have the same human rights, the rights of bodily integrity”(Eich 66). If the fertilized egg was not implanted, they are simply cells and can be used to study stem cell regeneration. The Catholic Church has argued against the use of fertilized eggs due to concerns over their use for cloning, but our hospital will set specific regulations banning the use of these fertilized eggs for cloning research.

Onsite Religious Counseling

In addition to providing new treatments, our hospital also wants to consider the needs of individual patients from various religious backgrounds. To pursue this goal, the hospital should provide religious counseling by clergies of all religions because of the sometimes therapeutic benefit they provide (Ginsburg, 37). However, clergymen will not be allowed to discuss their view towards any specific medical procedure such as abortion and prenatal testing. As stated in Testing Women, Testing the Fetus, “A counselor should, as a matter of principle, support whatever decision regarding testing and pregnancy outcome that a woman or a couple makes” (Rapp, 58). Distinct from an advisory role, clergymen should serve to ensure a deity is with the patient through illness and hardship. Every week Clergyman and doctors will have a one-hour meeting to share their opinions and suggestion on specific patient cases for providing better patients services in the future. I believe if we keep the communication open, the tension between doctors and clergymen can be gradually resolved. If the hospital still receives multiple complaints from doctors about interference, the ethics committee will start to investigate the case. If clergymen are found to be interfering with the doctor-patient relationship, the clergymen will be given warnings or a temporary suspension.

Relocation of the Nursing Staff

Last but not the least, the hospital should relocate historically Catholic nursing staff unwilling to perform abortion and reproductive services to other wards within the hospital. Since the hospital has a limited budget, we will hire a nursing professor who specializes in teaching abortion care and reproductive services rather than hiring new, specialized nurses. Education will be available to all nurses who are willing to perform abortion and reproductive services. At the same time, the hospital will welcome nursing school students to volunteer in the hospital for one or two semesters. If the volunteers perform well, the hospital could potentially provide them part-time positions after training.

Conclusion

I propose that our hospital start to provide abortion services, IVF treatments, prenatal testing, and religious counseling services to accommodate the increased diversity of the local community. Donors and nurses who are resistant to the new changes can be accommodated through changes to the hospital financing structure and assignment allocations as explained above. I am confident that this proposal will allow us to move towards a brighter future for our hospital and the local community.

 

Works Cited

 

Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing Unplanned

Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine,

Anthropology, Theory 3 (2016): 29-54.

 

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial

Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in its

Origin and on the Dignity of Reproduction.” (Crossroad, 1988).

 

Faye Ginsburg, Contested Lives: The Abortion Debate in an American

 

Inhorn, Marcia C., and Soraya Tremayne, editors. Islam and Assisted Reproductive Technologies:  

Sunni and Shia Perspectives. 1st ed., Berghahn Books, 2012. JSTOR,

 

Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971):

47-66.

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

 

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.

 

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel

(Duke University Press, 2000).

 

Thomas Eich, “Decision Making Processes among Contemporary ‘Ulama’:Islamic Embryology

and the Discussion of Frozen Embryos.” In Jonathan E. Brockopp and Thomas Eich, Muslim Medical Ethics From Theory to Practice (University of South Carolina, 2008), 61-77.

 

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).

Community (University of California Press, 1989).

 

 

Policy Proposal Regarding Reproductive Technologies and Prenatal Testing in Sasquatch Community Hospital

Proposer Background: I am a 50-year-old Protestant Japanese American who immigrated to the U.S. at the age of 22. During my years in the U.S., I have become a proud mother of two children and have worked as a nurse practitioner. Having watched Sasquatch Community Hospital (SCH) grow from a small clinic to a major hospital in the State and from Catholic affiliation to non-denominational during my fifteen years of working here, I truly regard SCH as my second home.

 

Over the last few decades, Sasquatch County Hospital (SCH) has committed to a professional and national system of healthcare. The mission of the hospital is to serve and provide equal access to all people despite religion, race, and class in the name of the Father. Adhering to our original purposes greatly, we have seen the transition of SCH to a non-denominational hospital subsidizing medical care to under-insured patients. With the continuation to thrive for inclusive service despite financial circumstances, I therefore propose subsidies on abortion services, IVF treatments, prenatal testing for under-insured patients. To accommodate the different religious backgrounds of individuals, spiritual counseling should continue to be offered with Catholic clergy, and counseling from other religions ought to be provided as well. As the adaption to new regulations requires time and knowledge, training on cultural competency for staff members will be offered. It will also be necessary to offer literacy courses in pre-natal and in-vitro fertilization (IVF) for patients.

 

This policy proposal is not only written to make regulations, but also to reinforce the values of Sasquatch County Hospital, and most importantly, to define our stance among the nationwide bioethics discourse as a healthcare institution. Therefore, the notions of motherhood, social stratification, and limitation to mothers’ rights as well as the embodiment of embryo rights will be central to the discussion of these policies.

 

The Reduction of Social Stratification through Financial Support and Scientific Literacy

 

Informing and providing abortion services and prenatal testing to under-insured patients will reduce stratified reproduction. Stratified reproduction refers to the varying experiences of pregnancy based on financial resources and scientific literacy. Much scholarly research has indicated how pregnancy is not conceived, medically managed, or delivered on equal social terrain (Rapps 311). For example, the scientific literacy on genetic disorders of middle class Israeli women has led to their frequent use of pre-natal testing to prevent reproductive catastrophe (Ivry 243). Similarly shaped by scientific education, the majority of women in the U.S. are usually informed by biomedical statistics and utilize biomedical technologies to evaluate their risks in pregnancy (Rapp 317). “Risk analysis” requires not only the reasoning of “risk behavior” but also steps to contain the risks. While middle class women and families have opportunities to learn about heredity, genetics, and disabilities in many places, the under-insured patients may not be well-informed of all the possibilities and risks pertaining to pregnancy due to their disadvantaged socioeconomic backgrounds. Specifically speaking, while all women know to stop smoking during pregnancy, the monitoring of folic fluid to reduce incidence of spina bifida is most likely only shared across women of more scientific literacy. Similarly, the risks of many genetic disorders may appear ambiguous to women of disadvantaged backgrounds. Access to information about risks pertaining to pregnancy should not become socially stratified based on socioeconomic backgrounds. Therefore, we as a nationally renowned hospital ought to not only provide pre-natal testing and abortion to reduce such risks, but also to let all patients gain a scientific perspective on the potential risks.

 

Free courses on human genetic disorders, pre-natal testing, and other biomedical technologies should be provided on weekly basis. These scientific literacy classes could help women acquire equal access to reproductive information, allowing women to make the most informed choices despite their financial situation, and thus reducing stratified reproduction. As a result, subsidies on pre-natal testing, including amniocentesis, will be offered to the under-insured. As abortion may be a possible decision following a negative result on pre-natal testing, it will be subsidized as well (other reasons for abortion subsidization will be elaborated in following sections).

 

One may argue that people of disadvantaged backgrounds may garner alternative resources for accepting their misfortunes (Rapp 316). Therefore, they would not benefit from the increased “scientific literacy.” In other words, understanding and eliminating potential risks of pregnancy are ways for people to gain more control; however, people may have other ways to handle the contingencies of pregnancy by simply accepting it. For example, a study of poor women in the U.S.  showed that they often consider “unplanned pregnancy” as a divine blessing beyond their control (Seeman 4). Similarly, some religions may provide individuals with “comfort mechanism” as people could seek strengths in God (Hamdy 146). I do not argue that such values of accepting fate should be replaced by rational scientific literacy to limit future risks. Particularly, I am not encouraging the use of pre-natal testing to reduce risks of pregnancy. In fact, the social and cultural factors taken into consideration certainly vary among women when they make decisions regarding pregnancy. I am arguing, however, that restricted access to scientific literacy and biomedical technologies should not be the cause of submitting to other options; by providing more scientific literacy and financial subsidies on pre-natal testing, we provide women with more access to helpful information. Equipped with more scientific knowledge and less financial restraints, women will be more empowered to make sensible decisions in their best interests.

 

The Right to Motherhood

 

In-vitro fertilization (IVF) should also be provided for under-insured female patients. Despite the diverse religious and cultural ideologies in Sasquatch county, motherhood is regarded as a state that is highly significant in a woman’s live. Women across all cultures make great effort to acquire motherhood. Therefore, it behooves us to remove the technical and financial impediments to motherhood. If physical conditions prohibit women from bearing children, IVF could provide them with the opportunity of motherhood; if financial situation is in the way of motherhood, we will do our best to provide the subsidies. The population in Sasquatch county consists of an Irish, Jewish, a mixed white and African American population, with growing influx of Lebanese Shitte and Japanese immigrants. According to the Protestant and Catholic understanding of the Genesis, women regard one of their missions in life as to “reproduce and multiply.” Similarly, reproduction is viewed as an “imperative religious duty” and even “honor and prestige of the family” within the view of Jewish women (Kahn 4 & 44). Borrowing language from the great protestant theologian Karl Barth, motherhood is “a basic form of humanity” (Meilander, 1641). Besides, the varying political views of pro-life and pro-choice activists even consent upon the significant meanings of pregnancy to women. As pro-choice activists view pregnancy as an essential right for women, pro-life activists view pregnancy as an indispensable responsibility embodying the uniqueness of feminism (Ginsburg 216). “Starting over ones live” and “blessings” are often associated to motherhood in the study of homeless mothers in the southeastern U.S. (Seeman 36). In other words, motherhood brings hope to woman’s lives, especially among the young and disadvantaged population. Women from different backgrounds not only consider motherhood as essential components of their lives, but also view it as an earned state. In the Japanese culture, the “Gamburu”, or “make an effort” ideology is embedded in the image of ethical self. Japanese women often bear the responsibilities of the babies’ nurturance to themselves and highly pride themselves for it. The avid users of IVF of both the Catholic and Jewish communities also demonstrate the eagerness of women to motherhood. Equal access to IVF is necessary as it will largely benefit Sasquatch county’s under-insured population by removing impediments to motherhood. Therefore, subsidies on IVF treatments to the under-insured should be offered.

 

Nevertheless, as one may argue that subsidies would result in the abuse of the technology, the subsidies on successful IVF treatments will only be provided once to each individual. In addition, IVF treatment will only be performed on women with no children. A maximum of three attempts is allowed for each patient. Attempts exceeding the indicated number will no longer be subsidized by the hospital. Subsidies on IVF treatments to conceive an additional child (more than one) will also not be offered.

 

The Limitations to Mothers’ Choices and the Embodiment of Embryo Treatment

 

The encouragement of embryonic donation for scientific research should be prohibited. As illustrated above, the choice of pregnancy, IVF treatments, prenatal testing, and abortion concerns the mother of the child greatly. In these cases, the mother bears the responsibilities for reproduction as well as the quality of life the child would have; therefore, they have the right to make choices in terms of their interests and their children’s. However, the decision of donating the embryo to research does not pertain to the interest of the mother at all. Instead, only the rights of the embryo ought to be considered in this case. In the book A Defense on Abortion, Thomson uses the analogy of one sustaining the life of a violinist by letting him use one’s kidney as a description of mother bearing a child. He argues that not providing the violinist with the kidneys is self-centered but not unjust as the violinist originally does not have the right to use it (Thomson 61). Similarly, if you decide to no longer sustain the life of the violinist, you do not have the right to determine whether the organs of the violinist should be donated or not. Thus, the decision of abortion is justified as the right of the mother. However, when the lives of the embryos’ no longer pertain to the mothers’ interests, the mothers do not have the right to choose for them. Therefore, embryonic donation should not be encouraged as it is not within the rights of the mother.

 

Furthermore, the encouragement of donating human embryos challenges our commitment to equality and humanity as medical institutions. As universally understood, the embryo is not “a clump of cells” but an integrated, self-developing whole, capable of the continued organic development characteristic of human beings (Kass 174). It is a state where we all come from. We could not simply ignore its potential development due to its insignificance. Humanism calls for greater respect and care for the weak. In other words, humanism shows “the inflexible principle that utter helplessness demands utter protection” (Kass 182). The way we treat the embryos signifies how we treat the weak in our society, thus setting the boundaries of humanity. As a hospital committed to humanity, or benevolence, the treatment of embryos matters significantly. Inhumane treatments create suffering of the embryo and embody the lack of compassion of SCH as a medical institution.

 

The limitations of the mothers’ rights to choose for the embryo and the humanism embodied by the treatment of embryos are central to the matter of embryonic donation. One may likely suggest that from the standpoints of scientific scholar communities, embryonic research advances our understandings of many biological processes. This is true. By gene modification and stem cell cloning from embryos, remarkable findings on genetic diseases have been uncovered (Kass 77). However, women undergo considerable stress after abortion, both mentally and physically. Regardless of how abortion was decided upon, it would still be emotionally challenging to render the aborted embryo to the hands of others. The emotional state of the woman deserves our serious attention when attempting to encourage embryonic donation. Encouraging embryo donation may do more harm than good in these cases. Although embryos may somehow contribute to the scientific community, the donation may become a lifetime regret for the woman since it was an encouraged or pressurized decision made during an emotionally unstable state.

 

Nevertheless, I would also like to clarify that the ultimate choice of embryonic donation lays upon the families themselves. Not encouraging embryonic donation merely suggests the position of Sasquatch Community Hospital as an institution that values humanity; as embryonic donation is a nationally lawful act, the policy of no encouragement is independent from any personal decisions on embryonic donation to scientific research.

 

Inclusive Spiritual Counseling

 

In order to reflect the Catholic Origin of Sasquatch Community Hospital, spiritual counseling should be continued but reduced to one Catholic clergyman. Additional counseling of other religions should be allowed but limited to one clergyman as well. As mentioned previously, our job as the hospital is to provide patients with equal information and access to reproductive strategies. Counseling by Catholic Clergy reflects Sasquatch Community Hospital’s current majority Catholic donor-base. The classes on assisted reproductive technologies and late term genetic testing echoes the mainstream American “risk analysis” take on pregnancy. Similarly, in order to balance the existing socio-cultural influences on patients, the voices of other religions ought to be heard. Patients from these other religions will find the spiritual counseling reassuring as some of their values will be reinforced in their decision making process. The dynamic input of other religions not only reinforces Sasquatch Community Hospital’s commitment to inclusiveness and diversity, but also leads to a broader nationwide discourse on biotechnologies, addressing biomedical issues as social issues (Braun, 47).

 

Inevitably, some medical staff have complained and will continue to complain about the Catholic Clergy or Clergy of other religions who interfere with their work by opposing assisted reproductive technologies. The class offered on weekly basis thus also serves as a medium through which the medical staff could express their professional opinions. As long as all sides have equal opportunities to express their views, the woman will be more empowered with her decision, no matter what she will choose. As medical staff and religious clergy, we ought to respect the decisions of patients no matter what their reasoning is.

 

The class material, however, should be reviewed by the committee every month in order to prevent the transmission of biased statistical information or inappropriate messages. Similarly, medical staff members are allowed to observe spiritual counseling sessions but are not allowed to intervene while the patient is in the room. Issues brought up in the biomedicine classes and counseling sessions will be reviewed by the Sasquatch Community Hospital’s ethics committee and further regulations will be proposed.

 

Due to their Catholic affiliation, some nursing staff would likely be unwilling to perform the procedures of abortion and reproductive services. It is thus crucial to provide the nursing staff with necessary training to develop their cultural competency and reinforce their responsibilities as healthcare providers acting on behalf of patients. Therefore, mandatory training to improve the understandings of different local cultures and religions ought to be provided for the staff members every month. Overall, the goal of the curriculum is not to convince staff members to become pro-choice activists. Instead, the goal is to enhance the understandings of how other genetic, religious, and cultural factors result in the consideration of abortion. While the staff may hold on to their religious beliefs concerning abortion, it is necessary for them to respect the choices originating from other belief systems. The specific contents of the training curriculum will be discussed and implemented by the ethics committee. With more appreciation of the distinctive socio-cultural forces affecting pregnancy, nursing staff may gain new perspectives to the local population they are serving and may become willing to provide abortion services.

 

If one still insists upon no provision of abortion and reproductive services, she or he ought to leave the obstetrics – gynecology department or leave the hospital. Other nursing staff from other departments of the hospital would replace the leaving staff member. Further replacement or hiring of staff members ought to reflect the mission of equal service and commitment to Sasquatch county’s diverse population. The feasibility of replacement of nurses by those of other departments or by new hires will be determined as we move along the process.

 

Dedication to reduce socioeconomically stratified healthcare, protection to the rights of women and embryos, and commitment to serve our culturally diverse population with compassion have been reflected in Sasquatch Community Hospital’s past. With thoughtful consideration and careful implementation of the above proposed actions, I believe that Sasquatch Community Hospital will continue to thrive on the path of serving the local population. Continuation of excellent service will thus attract an increasing number of potential donors from other religious and cultural backgrounds and more funding from local agencies and state government may be granted in the future.

 

With preservation of values through the implementation of the above policies, Sasquatch Community Hospital plays an essential role in the discourse on biomedical reproductive technologies. The proposal suggests that stratified reproduction, the right to motherhood, the humanistic culture embodied within an embryo, and various religious views have been our major concerns as a modern medical institution in the U.S. The policy proposed reflects our reasoning that obliges to the diverse interests in Sasquatch County. I therefore encourage other hospitals and clinics to refer to our policy and adjust it accordingly to accommodate their locally served populations. Lastly, I sincerely invite other healthcare institutions to offer their perspectives on the above policies as our voices matter significantly in the worldwide biotechnology discourse.

 

 

Work Cited

 

1. Book of Genesis, chapters 1-2
2. Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: AnInquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.”(Crossroad, 1988).
3. Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel(Duke University Press, 2000).
4. Rayna Rapp, Testing Women, Testing the Fetus(Routledge, 2000).
5. Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine, Anthropology, Theory3 (2016): 29-54.
6. Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community(University of California Press, 1989).
7. Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs1 (1971): 47-66. Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel(Rutgers University Press, 2009).
8. Gilbert Meilander, “New Reproductive Technologies: Protestant Modes of Thought.” Creighton Law Review (1991): 1637-46.
9. Leon Kas, Human Cloning and Human Dignity(2002).
10. Kathrin Braun, “Not Just for Experts: The Public Debate about Reprogenetics in Germany.” Hastings Center Report 35 (2005).

Health and illness are both complex and broad terms that people understand differently based on a variety of disciplines such as culture, religion, profession, gender, and more. When we take into account culture and religion, there is so much overlap and simultaneously contradicting ideas between the two. As a member of the committee of ethics for Sasquatch hospital, I aim to take advantage of the fact that our hospital is now non-denominational. While it is important to value the predominant religion of the donor base (Irish Catholic), my aim is to encourage them to value the diverse religious demographic that this hospital will attract. We have patients from various religions and cultures including Jews, Muslims, African Americans, and Japanese immigrants. It is crucial to delve deeply into the complications and foundations of both culture and religion in order to provide the best healthcare possible. As a member of the ethics committee, I will be focusing on similarities and differences between these two facets of the human condition in order to form the most well-rounded policies and regulations while retaining the value and importance of the diverse background and history of this hospital, the patients, and the staff. Transition in regulation and policy is always challenging especially when it comes to sensitive and controversial topics.

Abortion is a procedure that is perceived very differently by individuals, religion and culture. Different cultural and religious beliefs play a large role for many individuals in their formulation of opinions on abortion. Since the Catholic church has recently allowed the hospital to become non-denominational, I believe this topic should be addressed through a more personalized, patient-care lens rather than a religious lens. In the book Contested Lives: The Abortion Debate in an American Community, author Faye D. Ginsburg looks at both the pro-life and pro-choice side of the abortion debate. Striking to me in this debate is that pro-life individuals believe that the foundation and cause of abortions are based on the idea that abortions are due to irresponsible choices such as unprotected sex. Additionally, abortions can be very risky medical procedures and should be done only by doctors in a hospital (Ginsburg, 1989). Our main goal as a hospital should be keeping patients as safe and healthy as possible. It is important to recognize that Ginsburg is analyzing abortion in America, a country with a multitude of religious and cultural backgrounds, which makes the abortion debate that much more challenging to address. We have talked extensively about control and the importance of having control of your own body. Pregnancy is a very vulnerable time in a woman’s life as they are adapting to their body changing. If they don’t have autonomy over their body, they lose their right to choose the type of medical care they want. Furthermore, if they do not have the financial means of obtaining such control, they risk bringing in more people to this world that will also suffer their financial burden. It is our responsibility as a hospital to help women make the most informed decision for themselves and for their potential offspring. By giving them resources and support to procedures such as abortions, we prevent them from bringing unsupported life of human beings into the world.  It is our duty to protect patients and provide them with the services they need to feel well and healthy. If women are put into circumstances where they have to bring children into this world without the will or means to do so, we are neglecting our values and mission as a hospital. In addition, it is crucial to acknowledge the complexity behind abortions and the decision-making process of bringing new life into this world. Judith Jarvis Thomson brings forward valuable insight on understanding abortions through a more holistic lens rather than simply distinguishing an embryo as human or not. She emphasizes to look and understand the decision beyond the fetus, by focusing on the experience the mother could be having. She brings up an analogous circumstance where a famous violinist’s circulatory system is plugged into a woman and if she unplugs herself from him before nine months, it would result in his death. She states a hypothetical response from a hospital director: “tough luck, I agree, but now you’ve got to stay in bed, with the violinist plugged into you, for the rest of your life, and violinists are persons. Granted, you have the right to decide what happens in and to your body, but a person’s right to life outweighs your right to decide what happens in and to your body”(Thomson, 2007). This comparison is extremely powerful and outlines the consideration we must have for woman as patients and their needs. Donum Vitae emphasizes that as soon as the embryo forms, it should be regarded as a human being (Congregation for the Doctrine of Faith, 1987). For patients who view an embryo as a life from the moment of creation, we must respect this belief and give the patients control to move forward with their pregnancies. Similarly, the same choice should be granted to those who believe otherwise. Tsipy Ivry addresses pregnancy from an interesting cross-cultural, comparative perspective, focusing on geneticism versus environmentalism (Ivry, 2009). There is so much cultural influence, almost to the point where it takes away the individualistic aspects of pregnancy. Because of the overpowering and contradictory influences when it comes to abortion, I believe individualism, control, and accessibility for the women should be prioritized over culture and religion when it comes to abortion.

Both personally and professionally, I strongly believe that individual choice ought to be paramount yet only when a person has full control and awareness. I think abortion is a women’s choice because the fetus is not aware of what is going on in their environment. In the case of terminating a born child, there is a level of awareness and connection to the outside world. The born child has made a physical connection with the world around it and now has autonomy of their body, no longer attached to their mother through an umbilical cord. Also, in the case of born children, adoption is a viable option. If the mother is unable to take care of her child, there are many couples in the country that have fertility issues and would be willing and able to be parents. In the case of euthanasia, if the person is mentally conscious and aware of the decisions they are making, it is their right to terminate their life. They are suffering anyways, so they should have control of how they leave this world. The way we approach these complex topics does not necessarily have a right or wrong answer but there is a definitive point in time where we begin having awareness and when we end having awareness. The beginning only takes place when there are a connection and some sort of interaction with the outside world both physically and mentally. When I think about procedures that have the potential to end life, it is the respect of individuals total awareness that takes precedence over religious ideals and laws. Leon R. Kass’s frame of thinking resonates with me deeply when he explains how we should interact with the patient’s experience:

“Our first listed function is deeply philosophical, anthropological, and cultural, and it gives this Council a novel orientation: we are charged first not to judge whether deed “x” or “y” is moral or immoral, or whether technology “p” or “q” should be funded or banned. We are summoned to search into deep human matters in order to articulate fully just what is humanly at stake at the intersection of biology and biography, where the life lived experientially encounters the results of life studied scientifically” (Kass, 2005).        

Birth and death are very life-altering experiences for the individual as well as for their loved ones. Because of this, it is imperative that individuals have the means to make knowledgeable decisions about their body and that even in the most unpredictable and uncertain circumstances, we grant accessibility and control to our patients.                        

In Vitro Fertilization (IVF) treatments and prenatal testing also should be considered with a woman’s desires for reproduction both currently and in the future. The same idea of control that women should have abortion applies to IVF. The only difference is that that it comes from a standpoint of creating a life rather than ending one. Usually, people who undergo IVF treatment have the intention to reproduce while women undergoing abortions for various reasons have the opposite intention. The focus of reproduction is very prevalent in certain religions, especially in Judaism. According to Susan Martha Kahn, Reproduction is valued so much so that individuals in Judaism are encouraged not to stigmatize offspring born through incestuous relationships or from non-married couples (Kahn, 2000). Kinship and the way various groups understand it differently influence the implantation of IVF treatments. Depending on how we understand kinship, we are likely to support such treatments or fully contest them. For example, if we can understand kinship as strictly nuclear or consanguineal, IVF could have negative implications because we may not “know” who the father is. However, for our Jewish patients it is important we value their emphasis on reproduction and provide the means for them to be able to reproduce.  In the chapter “Ethnography, Exegesis, and Jewish Ethical Reflection: The New Reproductive Technologies in Israel” author Don Seeman heavily focuses on the importance of reproductive technology in Israel. He points out a strong religious disagreement between Jews and Christians on the topic of “traditional” marriage and reproduction:

“There is no reason to deny that Jewish Orthodoxy today also holds up this kind of marriage as an ideal, but the halachic or Jewish legal grounding for claims about it permitted and forbidden reproductive practices begins not with Genesis but Leviticus, whose largely non-narrative focus on rules of consanguinity and rules of purity constitutes the main corpus of biblical kinship norms that underlie later Jewish family law. This simple fact is one of the reasons that Jewish law experts (passim) have tended to be so much more favorably inclined towards artificial reproductive technologies than many of their Christian counterparts, just as the State of Israel has been more supportive than many other Western states” (Seeman, 2010).

This is a clear example of how impactful differences in interpretation of religion, law, and text can lead to drastically opposing perspectives on reproductive technology. In order to provide patients with equity in getting the kind of treatment they believe is right, we as a hospital will allow IVF for patients who wish to receive it. Fundamentally, our goals are to provide the best care for patients. If we deny our Jewish patients IVF, we are essentially ignoring one of their main beliefs which is accessibility to reproduce. However, as a hospital, we also have to be able to run a business financially. We will not be subsidizing IVF treatment. While we respect patient’s religion and culture, there must be a level of personal accountability. One of my main goals is for patients to feel in control of their own decisions and beliefs, but we cannot always take responsibility for supporting that control financially. When it comes to abortion, there is not an effective alternative to value everyone’s beliefs besides granting them the procedure regardless of finances. In contrast, when it comes to reproducing and creating a family, based on certain kinship perspectives there are alternative ways to create a family such as adoption. As amniocentesis has the power to impact the mothers and baby’s health in a transformative way, we will subsidize this procedure on the premise that other standard tests show risk factors that would call for amniocentesis. When it comes to unused embryos, that is a personal decision for the patient and their family. If we are aiming to provide a well-rounded treatment approach, encouraging potentially counter-cultural and religious actions would promote the opposite from our end. In Geetz’ article, Geetz argues that there is a sense that culture is a mechanism that drives everything. However, in this case, I would stand by the idea that there are personal concerns that aren’t reducible to culture (Geetz, 1973).

Social workers and genetic counselors will remain to be integral employees of our hospital. We will keep spiritual Catholic clergy, but we will also be adding representatives from all of our patient pool’s religions. This way we will simultaneously respect our donor group’s faith but also successfully broaden our policies and resources for our other patients. We will implement strict regulations for these employees in order not to impact negatively the patients’ care by interfering with the doctors. It will be optional for patients to seek counsel for their treatment, but the counselors will not be allowed to interact with the doctors directly. This will support the individualized control of the patients that we are aiming to attain and will allow the doctors to do their best work. The counseling services will be optional for the patients, and perhaps this optional service can alleviate some pressure and stress for the patients. For example, Japanese mothers who are more familiar with an environmental approach to medical practice may lack this approach in an American hospital. If they have access to some personalized guidance, they can experience a more fulfilling treatment. In the article “Does Submission to God’s Will Preclude Biotechnological Intervention?” author Sherine F. Hamdy focuses on organ transplant in Egypt among religious leaders, physicians, and patients. Hamdy emphasizes a strong ethical conflict that patients face with this procedure. While it is not directly linked to the rules of their religion, the story of the two men declining this procedure does stem from their connection with God. This dichotomy is complicated, and at scenarios like this, personalized religious/spiritual counseling could potentially provide critical support to the patients. (Hamdy, 2012). There is a level of concern I have with bringing in various leaders in unintentionally creating extra tension and conflicts internally between the staff. I will address this by creating extensive training prior to bringing on the new team.

Lastly, managing staff under new regulations and policies results in challenging obstacles. For the nurses that are unwilling to perform these procedures, we will need to replace them. While the hospital used to be affiliated with the church, it is important to recognize and respect the separation. I hope that with respecting the beliefs of Catholic donors in other ways and by also respecting all of the various beliefs our patient pool brings in, the donors will be willing to increase the budget for new hires. We cannot move forward in respecting all patients’ values and beliefs if we have staff who is unwilling to cooperate. As one of my main goals is placing treatment in the patients’ control and making the treatment as individualized as possible, keeping the nurses who refuse care will counteract that entire effort. If there is no possible way to increase the budget, we will have to hold off hiring a new team of spiritual/religious counselors. While I believe this would be a very beneficial asset to our hospital, having cooperative nurses would take priority.

In efforts for the smoothest and most efficient transition, there should be full transparency between the donors, board, and physicians. If we want to implement new policies and regulations successfully, we will have to continuously respect and value everyone’s personal beliefs and focus on providing the best medical care we can.

 

Dear esteemed Members of the Sasquatch Committee on Ethics,

 

I am honored to speak to you today regarding some propositions and urgencies concerning some very controversial legislation placed here before us today. We are tasked with the decision to vote on the use of certain new reproductive technologies and tests. As ethics committee members, it is our responsibility and sole duty to protect our close-knit small town values and represent the people of our great town of Sasquatch, Connecticut.

 

Before I address the very specific and nuanced technologies to which I refer, I want to remind you all that we must protect the dignity of procreation and human life by leaving them in God’s hands as much as we can. It’s all too easy to get caught up in the clinical setting of a hospital that we end up forgetting what we are truly considering here at Sasquatch Mercy Hospital: life and death. Real people, real bodies and real lives are affected by technological reproductive interventions. We must consider that any “intervention of the human body affects not only the tissues, the organs and their functions, but also involves the person himself…” (144, Donum Vitae).

 

Here in my proposal I stay true to the values and truths presented in the Holy Catholic Church’s decree: Donum Vitae. This precious document humbles us and reminds us that we walk the fine line of “going beyond the limits of reasonable dominion over nature” (Gen 1:28 as cited in Donum Vitae 141) when we tamper with the natural world by using too many technological interventions in a beautiful, natural, God-given miracle like reproduction. If we begin to make excessive exceptions for the use of these technologies, then we have ignored God’s decree of trusting in Him and His will.

 

For reasons unbeknownst to me, Sasquatch Mercy has recently dropped its affiliation with the Sasquatch Catholic Church. Surely, our community is ever changing, and we have new members of different faiths, but we are all a God fearin’ folk here in Sasquatch. Whether we are Jewish, Christian, or Islamic, we all uphold conservative values that place God and His will as first and foremost in our minds and hearts. To best serve the people we represent, we- as members of the Committee on Ethics- must consider the core values these faiths have in common when it comes to the question of reproductive technologies. However, because our hospital has historically served members of the Catholic Church and receives generous donations from the Church and its members, we must place those values as first and foremost. As you all know, Sasquatch Mercy is in no position to turn away or discourage any financial support. We need all the help we can get if the hospital is to continue providing free care for the under-insured residents of our town.

 

Let us take a moment to review each of the reproductive technologies that we are currently considering in an effort to regard each intervention as we rightfully should.

 

In the case of providing abortion services for underinsured patients, the hospital should not provide these services, save for the case in which both the baby and mother’s lives are threatened by the pregnancy, i.e. in the case of ectopic pregnancy. Here, both the mother and her baby are at risk and would not survive such this specific unsafe gestational circumstance. All other cases should not be subsidized by Sasquatch Mercy Hospital.

In subsidizing abortions (aside from those that would save both the mother and her child), the hospital would essentially place an unwarranted stamp of approval on abortions. In essence, this would also be a stamp of approval on disrupting the sanctity of human procreation as God intended.

 

Performing abortions (aside from for ectopic pregnancy) negates the foundational basis of society as nature and God intended: exemplified by the conjugal union. In her exposition, Contested Lives, Faye Ginsberg has worded the sentiment of right-to-life proponents eloquently here: “…biological reproduction becomes representation of the continuity of cultural life as well” (Ginsberg 109). The love and unity found in the conjugal union, consisting of man and wife, forms the basis of our society. To haphazardly allow abortion procedures is to go against the ways of nature and the laws of society. Abortion is analogous to withdrawing and denouncing “unconditional, self-sacrificing nurturance” found in the conjugal union (Ginsberg 109). We will examine later how important this union is in the process of human procreation and why we must protect its sanctity.

 

Considering that a majority of the nurses and physicians at Mercy Hospital abide by Catholic morality, the will be relieved to know that abortions will only be performed in those rare, absolutely necessary circumstances. Due to the rarity of those aforementioned pregnancies, those staff who still feel uncomfortable with performing the procedure will be allowed a temporary transfer into a different hospital department, if they happen to be at work on the day of said rare procedure. We shall not allow any other type of abortion procedure on the sole basis that as faithful Catholics we cannot support infringement on the dignity of human reproduction as God has so blessed us with.

 

It has been brought to my attention, by Ms. Marmeno, that some patients would be willing to pay for abortion services in full. However, we cannot allow this either (based on the rationale above). Even though our hospital is in need of financial gain, we must remain strong in our moral convictions. Again, only that one particular case, in which a pregnancy is life-threatening to both the mother and child, would warrant performing an abortion.

 

Since the last time we met as a committee, certain queries regarding a “defense” of abortion have been posed. One argument of particular interest, presented by Judith Jarvis Thomson in her writings on the permissibility of abortion, deserves ample consideration and rebuttal. Thompson’s assertions do not hold water, are often self-contradictory and in complete opposition to the teachings of Catholicism as I will demonstrate below.

 

Let us examine her analogy on kidney ailment. Thompson asks her readers to imagine themselves having woken up to an unconscious individual with a fatal kidney ailment. She writes, “[his] circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own…. the violinist now is plugged into you. To unplug you would be to kill him. But never mind, it’s only for nine months. By then he will have recovered from his ailment, and can safely be unplugged from you” (Thompson 48-49). Thompson asks, “Is it morally incumbent on you to accede to this situation? No doubt it would be very nice of you if you did, a great kindness. But do you have to accede to it? What if it were not nine months, but nine years? Or longer still? What if the director of the hospital says, ‘Tough luck, I agree, but you’ve now got to stay in bed, with the violinist plugged into you, for the rest of your life.’ Because remember this. All persons have a right to life…you have a right to decide what happens in and to your body, but a person’s right to life outweighs your right to decide what happens in and to your body” (Thompson 49).

 

Although creative and striking at first, upon further examination, Thompson’s proposed hypothetical scenario is in no way analogous to human procreation, especially when we logically consider the process by which a woman becomes pregnant. The conjugal act affords the child dignity and unity with his parents in a way that no stranger “in need of kidney dialysis” would ever be afforded.

Additionally, Thompson’s analogy seems to equate motherhood and/or pregnancy as some type of ‘theft of the body’ for at least nine months. She insinuates that pregnancy occurs in way that is completely against the mother’s will, and that somehow pregnancy involves exchange of the mother’s life, agency, or freedom due to the pregnancy.  This theme of bodily theft is captured most clearly here: “They have therefore kidnapped you, and last night the violinist’s circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. The director of the hospital now tells you, ‘Look, we’re sorry the Society of Music Lovers did this to you-we would never have permitted it if we had known’” (Thompson 49). Again, this reasoning in Thompson’s analogy does not equate the true experience of human procreation. Therefore, Thompson’s arguments- founded upon her notions of usurped agency during pregnancy- are invalidated here.

Now, let us consider the case of prenatal testing. We must keep in mind that the human embryo should be treated with utmost respect, as human beings must be respected from the very first moment in which they exist: from the time at which they are conceived (Donum Vitae 147). Prenatal testing, including amniocentesis will be allowed at Sasquatch Mercy Hospital. Prenatal testing is considered acceptable by the Catholic Church as these tests are advanced enough to not pose a serious threat to the fetus and may ultimately benefit parents in gaining knowledge of potential special (health) circumstances their child may possess.

 

The question of whether or not to perform amniocentesis tests has come up, as there is a chance of miscarriage, however, recent technological advancements allow doctors to perform these tests while monitoring the baby in order to ensure a safer procedure. Doctors are no longer blindly poking around in the amniotic fluid without knowing whether they will harm the child. According to Rayna Rapp, in her book Testing Women, Testing The Fetus, when sonograms were finally employed in combination with “experimentally invasive techniques of the womb” they became safer and “miscarriage rates attributable to these procedures dropped dramatically” (Rapp 29). So, with the use of sonograms we may provide amniocentesis tests here at Sasquatch Mercy. Ultimately, prenatal tests can be a great way to help parents prepare adequately for the specific and special needs of their child (Donum Vitae 150).

 

 

With respect to the consideration of in-vitro fertilization treatments, let us consider the viewpoints of our fellow religious citizens here in Sasquatch. Jewish Halakhic law, and Sharia law allow the usage of IVF with varying particularities, but the consensus is that in a married infertile couple, IVF treatment is permissible (Kahn 2). Sharia law establishes that as long as the procedure does not breach the sanctity of the couple’s marriage (i.e. placing another man’s sperm into the married woman would breach the terms of marriage), IVF is allowed. Shirin Garmaroudi Naef writes, “Fertilizing the ovum of a woman with the sperm of her husband outside of her body and implanting it in the wife’s womb is not forbidden in Islam, and the resulting child is the legal offspring of the married couple” (Naef in Inhorn and Tremayne 166). In Halakhic law the issues with IVF stem from protecting and promoting kinship relations which can be complicated by whether the gestational mother is Jewish or whether donated sperm is from male belonging a particular sect of Judaism (Broyde 316). In also considering our Catholic law, we do see a consensus with Jewish and Muslim sharia law, particularly with respect to placing the unity of marriage as first and foremost (when considering morally licit unities for the aim of producing children). However, when we examine Catholic moral law, we see that the usage of IVF treatments is in direct opposition to the naturally afforded dignity that the conjugal act bestows upon the child.

 

Donum Vitae states, “It is a child’s right to be conceived and brought into the world in marriage and from marriage” (163). The child must be “the fruit of a conjugal act” because the conjugal act demands that a person has “dignity in his origin” because he is the product of “the conjugal act specific to the love between spouses” (Donum Vitae 163). This love between spouses places the child and his parents on an equal plane because of the parents’ self-giving act and unity required to create the child in the conjugal union. Ultimately, in-vitro fertilization and embryo transfer dissociates the child from the conjugal act, essentially depriving the child the dignity that is supposed to be natural to him.

 

Thus, in order to appease our Catholic donors and honor the legacy of this historically Catholic hospital, IVF therapies will not be allowed at Sasquatch Mercy Hospital. We must protect the dignity and sanctity of what is natural to human procreation; we must honor the love and unity present in the conjugal act.

 

In sum, prenatal testing should be confined to the specific use of preserving, protecting, and anticipating potential treatments and procedures the human embryo may require to aid in after birth. Consequently, Embryo donation should not be allowed at the hospital. The human embryo should be treated with utmost respect, as human beings must be respected from the very first moment in which they exist from the moment of conception (Donum Vitae 147). The embryo is human from the moment of conception because of the simple fact that that embryo will develop into a human, and human alone. Therefore, we consider the embryo as human and deserving of utmost care and protection. The use of embryos for scientific research is not in line with respect towards the human embryo.

 

Spiritual counseling is essential for those dealing with loss, sickness, an emotional distress caused by health issues. Here at Sasquatch Mercy Hospital we take pride in our ability to not only attend to our patient’s physical needs, but also to their emotional and spiritual needs. It is so important for us to keep our faith strong in the midst of life’s trials and tribulations and keep faith in God’s divine will. As a community open to those of all walks of life and faiths, we should open our hearts and provide safe spaces in which patients can get in touch with their own spirituality. We will open our spiritual counseling to members of Jewish, Christian, and Islamic faiths so that each person is able to consult God in his or her own way during their time of need. But, each clergy representative of each religious background shall only be called upon by the request of the patient. Otherwise, these clergymen should give the patient, their family, and attending physician family ample space by not intervening in the patient’s chosen medical care. To ensure this, we will place clergy offices in the back office rooms located on the Sasquatch Mercy’s lobby floor.

 

My dear friends; brothers and sisters of the board, please remember that “science without conscience can only lead to man’s ruin” (143, Donum Vitae) and it is up to us, and us alone, to uphold this sacred value. Please vote with God’s divine will in your minds, heart, and spirit.

 

Thank you,

 

Rev. John Doe

 

Sources Consulted

 

Michael J. Broyde, “Modern Reproductive Technologies and Jewish Law,” In Michael J. Broyde and Michael Ausubel editors, Marriage, Sex and the Family in Judaism (Rowman and Littlefield, 2005), pp. 295-328.

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.” (Crossroad, 1988).

Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community (University of California Press, 1989).

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000)

Shirin Garamoudi Naef, “Gestational Surrogacy in Iran,” In Marcia C. Inhorn and Soraya Tremayne editors, Islam and Assisted Reproductive Technologies (Berghahn Books, 2012).

Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66.

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

Kimberly Farmer- Final Proposal

Sasquatch Hospital is undergoing major policy reform in light of the decision to depart from the Catholic church and cater to community members of different religious denominations. Given the history of this hospital and the diverse community it supports, policy should be put in place to ensure that issues surrounding the hospital’s services, namely assisted reproductive technologies and prenatal testing, are addressed. In creating this policy, we, the hospital, will give community members the knowledge and autonomy necessary to choose their own medical treatment plans. I am writing this proposal as a member of the ethics board and a professor of ethics at Sasquatch University. In this position, my role is to solve conflicts and create a proactive policy in order to help the hospital accommodate to the needs of the community. I am trained to remain as unbiased and impartial as possible in order to support all individuals. Our plan is to create an inclusive environment that caters to all cultures and religious backgrounds without putting one above another.

One of the first issues to be addressed is whether to subsidize abortions and related services for under-insured patients. Private hospitals have the right to turn anyone away who they don’t think can pay. However, we need to consider the religious, financial, and medical components of such a decision. Only turning away patients who cannot afford abortions and related services makes a value statement against abortions that is rooted in the Catholic Church since the Church suggests “these technologies not only threaten but defy the existence and definitions of family.” (Bhattacharyya, 92). If the hospital is in fact non-denominational, it should either turn away all under-insured patients for all services, or subsidize all services for all uninsured patients. Such a clause will ensure consistency in the hospital’s values and proceedings. Arguments have been made explaining that abortions are too costly and therefore should not be subsidized in the interest of money. In the event that funds are too low, then there should be a monetary cut-off for all subsidized procedures. While we realize that not all abortions are the result of unsafe sex and unwanted pregnancy, we will have an on-site family planning counselor who can provide confidential advice to patients. This will slightly lower the risk of unwanted pregnancy and, in turn, lower the financial and personal burden of having an abortion. This argument is further complicated by the notion of medical necessity. That being said, all mandatory, life-saving procedures and emergency mental health care (as deemed by a physician) will be subsidized for under-insured patients at all times. Given that the hospital previously subsidized services for under-insured patients, and funds are adequate at the moment, the hospital should continue to subsidize abortion services. This would include IVF treatments and prenatal testing, including amniocentesis. This is because a non-denominational church wouldn’t have adverse feelings toward such treatments since some religions reflected in the community would prefer these services to avoid “reproductive catastrophe”. (Ivry, 243)

Hospitals should not encourage families to allow unused embryos for research. According to the Catholic Church, “The human being must be respected—as a person—from the very first instant of his existence” (Donum Vitae) meaning that there must be respect to human embryos. The Catholic Church has found that “by recent findings of human biological science which recognize that in the zygote resulting from fertilization the biological identity of a new human individual is already constituted” (Donum Vitae). This means that the unused embryos have either created or have the potential to create human life. Since the Catholic Church, which represents many community members, believes that embryos should be respected, they may not want to use them as a tool for research in a lab. Patients should have complete autonomy in their decision to donate embryos, and therefore, the service should not be advertised nor encouraged. Patients may be informed of such opportunities, but there should be no pressure or encouragement to comply as we want our patients to feel comfortable in the facility. Not encouraging embryo donation does not conflict with the hospitals view on abortion related services because in both cases individuals are aware of the opportunity, but have the ability to participate or not.

In terms of clerical counseling, services should be allowed since they can be very therapeutic during the process of undergoing medical treatment (Ginsburg, 37). However, these services should not be limited to Catholic clergy as all denominations should have representation to support the diverse community. Doctors have complained that Catholic clergy often persuade patients against reproductive technologies that doctors find beneficial. Such guidance is said to be interfering with the physician’s work. Clergy allowed in the hospital should be informed of their role to provide patient support and spiritual guidance, not medical advice. As stated in Testing Women, Testing the Fetus, “A counselor should, as a matter of principle, support whatever decision regarding testing and pregnancy outcome that a woman or a couple makes” (Rapp, 58). All counselor will be informed of their role and will be prohibited from offering strictly medical advice. In turn, physicians should respect religious beliefs and not force the biomedical model onto their patients. In terms of cultural competency, “particular religious or cultural traditions will be heard if the doctors are adept at hearing the voices of their patients” (Bhattacharyya, 24). As a hospital, we need to ensure that patients are being treated holistically and with respect in all aspects of their lives.

Hospital funders should be made aware of the policy changes when they are asked to continue their funding. We recognize that many of the hospitals funders are of Catholic faith and may disagree with some of the hospital’s offerings. However, the mission statement of Sasquatch Hospital reads as follows:

“At Sasquatch Hospital our mission is to cater to the needs of the community by providing comprehensive care and respect while exceeding satisfactory healthcare expectations.”

Therefore, donating to the hospital will be considered supporting the hospital’s mission statement. Once funds are donated, they can be allocated to any of the hospitals divisions. The hospital will host an event in the near future to network with funders of other denominations as well as donors that reflect the community’s demographics.

In terms of nurses, the hospital will need to have nurses that are capable of handling a multitude of tasks. However, the historically Catholic nursing staff may have reservations about performing the hospital’s new services. It is known that, “moral and ethical questions of concern to abortion activists are intertwined in the construction of self, social action, and historical experience” (Ginsburg, 197). Therefore, it is not the hospital’s duty to unpack all of the qualms, but to ensure a consistent policy that respects all backgrounds. A patient should never encounter a nurse that is unwilling to provide a service because of a personal belief. This is because in Sasquatch hospital we stand “for a position of ethical neutrality favoring personal choice in the century-old eugenics debate about society’s responsibility to encourage or discourage reproduction in certain individuals and families” (Rapp, 53). That being said, nurses who are unwilling to perform certain reproductive procedures will be placed in a ward where they will not encounter such tasks. Nurses should not be punished for having values that conflict with the position, however they still have an obligation to the patient. This means that nurses may not openly deny a patient treatment, but rather, speak to their supervisor to find an immediate replacement. From now on, nurses being hired will be asked about their willingness to perform reproductive services and current nurses will be asked to disclose their ability to comply with these procedures. Since most of the staff’s personnel is historically Catholic, there will be mandatory training to ensure that individuals will be able to address the community’s needs properly. We know that, “providing quality medical care necessitates cultural competency […] the ultimate goal is to encourage already clinically competent physicians, nurses, and other healthcare providers to be open and willing to learn about, respect, and work with persons from other backgrounds” (Bhattacharyya, 24). Since we do not have money for all new hires, will educate all healthcare providers so that they can provide inclusive and appropriate services. Ginsburg writes, “As with any political controversy in a complex society, the abortion debate changes quickly as both the local and national situation changes. (Ginsburg, 94). In order to create an inclusive, and long lasting policy, there should be a stable and sustainable policy that neither harms the patient or staff nor creates an uncomfortable environment.

In order to truly make this policy proposal reflective of our new community, we will continually receive feedback from patients, donors, and funders to ensure that our policy is efficient and ethically sound. While a defined policy is necessary, we will be most successful if our policy addresses and adapts to the lived experiences of our community members.

 

Citations:

Bhattacharyya, Swasti. Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill. “Religion and Artificial Reproduction: An Inquiry into the Vatican “’Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.’” Crossroad, 1988.

Ginsburg, Faye D. Contested Lives : The Abortion Debate in an American Community, Updated Edition. University of California Press, 1989.

Rapp, Rayna. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. Routledge, 2000.

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel Rutgers University Press, 2009.

In response to the recent changes enforced upon the Sasquatch community Hospital, the Catholic Church wishes to engage our own perspectives and insights in the on-going ethical debates relating to public subsidizing of abortion services, fertility treatments, and amniocentesis; the spiritual counselor’s role in the medical healing process; and the professional rights and duties of the tenured nurses’ opposition to performing abortion and reproductive services. As a long-tending Catholic Monsignor serving the Christian Sasquatch community for over forty-years, I believe it is my professional and religious responsibility to clarify and provide resolution to moral problems raised as a result of both the altercation to the hospital’s religious affiliation and cultural diversification of surrounding community. Through this declaration, I do not aim to settle on compromise for these complex issues, but rather, strive to uphold the status of the church as “the expert in humanity”, and further celebrate the values and means by which the church has sought to bring order in moments of moral chaos during its 2000 years of existence (Cahill et al. 142).

Throughout the centuries, when moral questions relating to advanced technology and cultural shifts have arisen, the church has provided the framework for understanding how these changes would be implemented for the human life. Questions of kinship, fertility, and the right to life are not new ethical landscapes. However, the present age has proven to pave a new pathway down this familiar terrain. Modern medicine and advancements in biotechnology now challenge the previously established framework for understanding what role humans play in the reproductive process through the introduction of new methods and technologies that allow for the human to completely dominate reproduction. Procedures such as abortion, in-vitro fertilization treatments (IVF), amniocentesis, and many more, are unnatural and yet, readily available tools that hold the power for a human to subjectively select for the life outcome of another individual. Thus, critical evaluation and formal explication from the church relating to these topics is urgently required in order to ensure that we remain grounded in our own humanity.

I should note that in no way am I claiming that I am an expert on the development of reproductive technologies or their mechanical use. However, I do not view this status as a limitation factor to the insights I may provide regarding the implications of such technologies within our immediate cultural setting, specifically the western, American small-town, predominately Christian culture. Anthropologist Rayna Rapp author of Testing Women, Testing the Fetus, describes reproductive technologies as “complex cultural objects”, and argues that the knowledge and interventions of these technologies are “culturally constituted” (Rapp 13). She further goes on to acknowledge that, “science as culture is constructed inside clinical laboratories, consulting rooms, and technical services; it is also the site of cultural intersection” (Rapp 13). Rapp’s argument is both compelling and relevant for the current events within our community. I want to emphasize that this proposal is not a call for termination of scientific and clinical research as they relate to advancements in knowledge and practice during the reproductive process. It is impossible to argue against the fact that modern medicine has improved the overall lifestyle and longevity of our western populations. However, the church and its leaders are strong cultural powers that must provide direction as we attempt to implement reproductive technologies while approaching this highly complex and congested intersection of science and culture. Therefore, I hope my suggestions and considerations will be taken seriously with respect to my expertise in the moral and ethical framework of our local culture, and further exemplify how the church’s moral perspective is remarkably reflective and aligned with American human right’s law.

Furthermore, as a Catholic Monsignor, I see it as my spiritual and professional duty to comment on the current crisis within our community. My professional duties include, but are not limited to, providing homily at every Catholic service, managing the parish education program, facilitating outreach ministries to both local and outside communities, conducting the seven sacraments, and providing guidance and counseling to members of the church who seek help. With much respect to medical professionals, who are responsible for providing relief to the physical ailments of one’s disease or condition, I see my responsibility as providing relief to the spiritual afflictions and moral concerns introduced by the condition. My professional ethics serve as the basis for my arguments, and I seek to have my opinions and concerns evaluated as both sincere and legitimate even as they apply within the medical context.

I.    Prenatal testing procedures such as amniocentesis may be subsidized for under-insured patients. However, the hospital should not subsidize abortion services or in-vitro fertilization treatments for under-insured patients, nor should the hospital permit the practice of these services to any patient. Furthermore, it is morally illicit for the hospital to collect unused embryos and use them for research and/or experimentation. 

Prenatal tests, such as amniocentesis and the triple screen test, are common procedures used to identify a possible chromosomal abnormality in the developing fetus (Ivry 3). It is my personal view that prenatal tests should not be required for mothers-to-be. However, should the test be recommended by a physician for a mother in a high-risk group (over 35), the procedure should be subsidized by the hospital. Furthermore, and more importantly, the subsidization of such procedures may in no case justify abortion of the child. As written in the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation”, “a diagnosis which shows the existence of a malformation or a hereditary illness must not be the equivalent of a death sentence” (Cahill et al. 150). Moreover, a diagnosis of a malformation and a resulting abortion may lend a cultural perception that those born with abnormalities are unworthy members of society, and further place our small community on the “slippery slope of a eugenic boutique”, where we subjectively select for the lives we deem suitable for life on earth (Rapp 37). In line with church doctrine, it is my belief that such cases should by guided by God the Creator’s good will and spirit without intervention from persons on earth.

With respect to prenatal testing, some individuals may suggest that permitting such practices conflict with church doctrine, for the miscarriage rate for using prenatal technologies is about 1/200 (Ivry 39). These individuals acknowledge the loss of life that may occur, and comply with church doctrine which suggests that “no one can in any circumstance claim for himself the right to destroy directly an innocent human being” (Cahill et al. 147). However, my own research into prenatal tests leads me to believe that significant death rates for children due to testing remains largely inconclusive (Rapp 31). I am also aware that many Catholic parishioners already use prenatal tests such as amniocentesis during their pregnancies (Rapp 157). Therefore, I uphold the woman’s right to such knowledge that can inform her of the chromosomal status of her child. In such cases where the child tests positive for chromosomal abnormality, the mother may have adequate time to prepare herself mentally, emotionally, physically, and spiritually for the child’s arrival; and furthermore, gracefully gain confidence for her prospective maternal role. 

In-vitro fertilization treatment is a reproductive medical procedure where an egg is fertilized by sperm in a test tube or elsewhere outside of the body. According to scientists, embryonic loss is a major problem after IVF (Mesrogli & Dieterle 1). IVF procedures often implant multiple embryos in order to increase the probability of pregnancy, and clinicians vary greatly in the number of embryos they suggest to transfer (Klitzman 12). Additionally, embryos left unused often become experimental materials for scientific research, or become stored in large stock freezers where they run the risk of being destroyed if never used (Beil 1). In contrast to the rate of child deaths in prenatal testing, the death rate for children through the use of IVF is significant. Although no one knows for sure how many embryos are lost or destroyed each year (Almendrara 1), reports speculate that around 93% of the 3.5 millions embryos created between 1991 and 2012 had been thrown away (Doughty, 1). Given the the highly ineffective precision techniques of IVF treatments and the significant loss of life, I demand the hospital reevaluate their position on use of such technologies for they unlawfully result in murdering the lives of millions of human beings.

The position of the Catholic Church on IVF technologies is clearly outlined in the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation”, which states, “Heterologous artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation of the proper parents, and to the child’s right to be conceived and brought into the world in marriage and from marriage” (Cahill et al. 158). In addition to the unlawful practice of throwing away potential life, the church further emphasizes the view that IVF treatments violate the right of the child to be born through natural means. Every child must be granted the right to be brought into the world through marriage, and be raised within a marriage between a man and a woman. Children, thus, may only be naturally conceived through the proper conjugal act. Any means of reproducing otherwise not only deprives the child of his rights, but also exceeds the limits of reasonable domination of nature that overrides God’s significant power over man. Furthermore, abstaining from the practice of IVF promotes the well- being of the family unit, and its subsequent impact on how we shape our cultural society…

In response to retaliation from other my other religious counterparts, specifically Orthodox Jewish Rabbis, who defend the use of IVF by acknowledging the passage of the Old Testament that states, “be fruitful and multiple”, I defend my interpretation as I believe that it is more aligned with United States law. Although I recognize that these procedures may gift an infertile couple with a child, I do not believe the ends justify the means. In other words, the birth of one child does not justify the loss of millions unused embryos. Under our constitution, it is unlawful to kill the life of another human being, and IVF is responsible for killing millions of human beings.

Although some Orthodox Jewish Rabbis support the use of IVF, many still oppose the use of such technology due to the procedure’s questionable ethical and moral legitimacy (Kahn 144). This controversial technology not only stirs conflict within our immediate community and the rest of the United States, but also continues to ignite internal conflict within discrete religious communities. As stated before, some Jewish communities who support IVF due so on account of God’s commandment to “be fruitful and multiply”, and human technological interventions are often favorable and necessary in order fulfill God’s commandments. In these situations, the Jewish debate then switches to complex debates of kinship regarding who the actual mother of the child is (Kahn 144). Furthermore, additional debate arises as to whether the mother and the child himself will be subject to the negative and unwanted social status for having brought or having been brought into the world through acts that can be conceived to be acts of adultery (Kahn 145). It is through problems that arise such as these that I suggest use of IVF technologies should be limited all together, for they clearly burden the social status of both the mother and child within both their religious communities. I uphold the teachings of the church and United States Law when I suggest that all children should be granted the right to be brought into this world through natural means, and no child should be unlawfully murdered as a result of imprecise IVF practices.

Given the I have just provided on IVF treatment, it should be obvious that the church does not support embryos collected from IVF treatments and left unused to be employed as scientific material for experimentation. Living embryos hold the potential for human life and thus are deserving of the same rights as all individuals. As discussed in the “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation”, “If the embryos are living, whether viable or not, they must be respected just like any other human person; experimentation on embryos which is not directly therapeutic is illicit” (Cahill et al. 152). Therefore, under no circumstances may an embryo and potential human life have its human rights stripped to be used for the sake of scientific curiosity.

Furthermore, the hospital should not, in any circumstance, subsidize or perform an abortion, for these practices also exceed the limits of reasonable domination of nature. The abortion issue will be further addressed in detail in section III below.

II.    The hospital should continue to provide spiritual counseling by the Catholic clergy. Additionally, in response to the growing influx of immigrant community members of diverse spiritual and religious backgrounds, the hospital should seek employment of other religious leaders in order to satisfy the spiritual needs of all patients. 

Medical professionals primary concerns include identifying and diagnosing disease, guiding patients through treatment plans that mitigate the physical symptoms of the disease, and healing the body within the physical sphere. Religious leaders’ responsibilities focus on targeting spiritual concerns or gaps within the patient’s experience of the disease, providing guidance and counseling to the patient throughout and beyond the treatment process, and healing the human soul within the spiritual realm of existence. Just as I, a religious leader, respect the boundaries of the medical professional and do not impose my training and talents in treatment of the physiological disease, I would expect medical professionals to demonstrate the same line of respect and not interfere with my methods and pathways of spiritual healing. Therefore, given that both the medical professionals’ and religious leaders’ interests lie in healing the human composed of both body and soul, I defend the right of all religious leaders to contribute their spiritual healing specialities to the patient during the healing process. Furthermore, I preserve the right for religious leaders to provide guidance to patients challenged by moral dilemmas without intrusion from medical professionals (i.e. doctors, nurses, etc.).

Rayna Rapp’s work in Testing Women, Testing the Fetus provides further support for the spiritual intervention into healthcare institutions when she suggests that “religion and science continue to have an intertwined discursive relation… religion provides not only spiritual direction, but social and material resources to many people” (Rapp 154). Patients who actively seek out help for spiritual guidance may also mutually be seeking out assistance for medical resources and support groups. If religious organizations have access to the hospital space, then it is more likely that patients will have readily accessible resources to meet their needs. Furthermore, with religious contribution of such materials, the hospital can allocate its budget to provide more financial assistance to subsidize treatments that some patients may not be able to afford otherwise.

Rapp also acknowledges that “different religions hold diverse stances toward reproductive technologies, [and] practitioners within religions may vary widely in their interpretations of official doctrine and personal adherence” (Rapp 157). Although I also acknowledge that in future cases I may disagree with guidance provided by other religious leaders on issues such as IVF and abortion, I will vow to remain open for discussion on the moral disagreement. For example, just as in the case where I would disagree with a Jewish rabbi on IVF technologies and its use, it is likely that I may also disagree with a Muslim ayatollah in regards to IVF as a means to uphold the religious mandate of nasab. However, as religious leaders, both perspectives should see it as our duty not only to provide guidance for our patients, but to confront and make sense of our moral stances in open discussions about how such religious guidance affects our local context. Keeping in mind our local community as the ground that unites us all, it is my belief that we religious leaders can work together and peacefully administer guidance that puts the interests of larger community first. Marcia Inhorn’s work on Middle Eastern Muslim men’s discourses of adoption and gamete donation seems to agree with this line of thinking when she says, “For individuals confronting the moral stances and ambiguities of their local religious traditions, they must attempt to make sense of such religious responses while at the same invoking their own moral subjectivities to find acceptable solutions to their often dire health needs and concerns (Inhorn 96). Therefore, it is my belief that we can work together to make sense and find solutions to moral ambiguities in a way that satisfies both our religious and local social context.

Thus, in response to the recent changes that have transformed the hospital from a Catholic institution into a non-denominational institution of medical practice, I propose additional spiritual leaders from other sects of religion be hired in order to ensure the hospital continues to serve the spiritual needs of all patients. As Swasti Bhattacharyya emphasizes throughout her work on Hindu bioethics, “Globalization, pluralism, and multiculturalism all increase, not negate, the need for all to pay closer action to the cultural and religious perspectives and experiences of patients, families and healthcare providers” (Bhattacharyya 19). It is therefore, in the best interest of our community at large to welcome diverse religious perspective and guidance. Although I acknowledge that in future cases I may disagree with guidance provided by other religious leaders, I vow to remain open for discussion on the moral disagreement, and will strive to participate in peaceful debate as to how we can devise a solution that reflects the best interests of the community at large.

III.    The hospital should not offer any abortion services, and thus not force any nurse or doctor to perform such services who desire to not perform such procedures on the basis of her own professional ethics. Abortion is equivalent to first-degree murder, and thus, subject to both mortal spiritual and licit consequences.   

The United State’s constitution outlines a human’s basic rights as freedom to pursue “life, liberty, and the pursuit of happiness”. It is within Catholic Church teaching that an individual has gained their human rights from the very moment of conception. From the very first moment of human life, individuals have the right to pursue their own life with their own sense autonomy. These principles extend to our own community, where we are held responsible to uphold freedom for our citizens, and serve justice to those individuals that violate another citizen’s human rights. 
The “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation states, “The child is not an object to which one has a right nor can he be considered as an object of ownership: Rather, a child is a gift, “the supreme gift” (Cahill et al. 168). Under this reasoning, the child in the womb cannot be seen as an object, but rather, another subject. Our moral compass has evolved in recent centuries to disavow acts of human beings owning other human beings. Likewise, the mother of a child cannot claim to own the human growing inside of her as her own property. The child is another human endowed with rights, and therefore, acts such as abortion that intentionally inflict harm upon the human by another human are morally illicit and subject to the most severe legal consequences. Abortion, in the eyes of the law, is equivalent to first-degree murder, and should not be permitted under any circumstance.

Faye Ginsburg, author of Contested Lives: The Abortion Debate in the American Community, sheds light onto the pro-life movement’s arguments against abortion as the murder of another human being, and more interestingly, how abortion comes to affect on the larger society. Ginsburg states that most pro-life activists, “see abortion as symptomatic of other social problems. In particular, they are concerned that materialism and narcissism are displacing nurturant ties of kin and community” (Ginsburg 9). Although many defendants of abortion only see the pro-life movement as protecting the individual fetus, it should be acknowledged that our concerns are far more complex than they make them seem to be. As we become a more advanced society and culture, we become more susceptible to loosening the grips on our own moral standards humanity. If we progress in the mindset that abortion should be a set norm, where everyone can receive an abortion who wants one, we blindly will follow a path that no longer truly values the extraordinary and blessed process that is human reproduction. Children in the womb are beautifully innocent, and we must always welcome them into our community that continually strives to be humane and compassionate. 

An argument often proposed by pro-choice defenders in response to the abortion debate centers around the idea that “the government cannot tell a person what decisions to make about their body”. However, many governmental laws already intact do manage the way citizens conduct their bodies if it is in the interest of protecting another life. For example, the government tells all of its citizens that they are prohibited to swing their arms continuously with a knife in their hand and murder another person. Laws presently imposed on our bodies inhibit the behaviors that inflict pain or death upon another individual. Thus, laws against abortion serve to protect the life of the baby from harm intentionally imposed upon them.   

Furthermore, the hospital may not force any medical professional to perform abortion, as the action itself violates the ethical guidelines and mission in the medical field. The values driving the professional medical field including diagnosing and treating disease, while preserving the right to life and death with dignity. Performing an abortion and killing the life of a child is in direct conflict with the medical professional’s ethical mission (Ginsburg 66). Thus, nursing professionals who have voiced concern over the procedure and stated an unwillingness to perform such services must be heeded to by hospital administration. The nurses have the right to act within their own autonomy when it comes to what they believe to be their profession’s ethical boundaries.

In conclusion, the path ahead regarding the implementation of public policy standards and ethical guidelines within Sasquatch Community Hospital is far from complete. However, as new technologies advance and culture changes, the moral questions posed in response to these changes will forever persist. It is inevitable that we will face challenges and disagreements in our work geared toward preserving the humane, moral, and ethical branches of our community. As a united community, it is our responsibility to ensure that such challenges are met with the all encompassing and cultivated perspectives that ground and mold our society to be reflective of the interests of both the individual and community at large. With these goals in mind, I hope my input on the matters relating to the changes to the Sasquatch community hospital are taken sincerely and legitimately when deliberating the ethical questions ahead.    

References:

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