Brantley Holland – Midterm

After recent discussions between the administration of St. Mary’s hospital and the local Catholic church, both parties have agreed that it is time to change the relationship this hospital and its staff have with the Catholic church. The decision has been made to reclassify ourselves as a non-denominational hospital and severe any official ties the church and hospital once had. This change will affect not only the relationship between the hospital and the church but also the way the hospital interacts with the community as well. This will take the form of changes to the hospital’s existing policy towards several medical procedures and staff behavior, as well as the inclusion of some procedures not currently offered at St. Mary’s hospital.

While the hospital and the church have severed all official ties, the hospital will continue to allow for the Church to have a presence in all matters that occur at the hospital. Religion has played a large role here at St. Mary’s and we feel as though there is still room for religion in the hospital through the form of religious counsel, as well as in policy decisions made by the hospital’s administration. We will make no changes to the level of involvement that chaplains have here in the hospital. All patients here at St. Mary’s hospital will continue to have the same access to all the hospital’s working chaplains. The space that has been provided for counsel and prayer will remain open and part of the official hospital building.

St. Mary’s will now make an effort to provide our diverse community with the religious counsel best suited for all patients. We will be devoting a new space in the hospital to serve as a communal religious gathering place. This will serve as an area where patients from a variety of religious backgrounds can meet with their preferred religious counsel. We have reached out to religious leaders in the community who have expressed interest in volunteering some of their members and staff to help counsel the hospital’s staff to effectively accomplish this. We hope that the addition of these new counsel’s will allow for the patients of St. Mary’s to make informed decisions based on doctrine taught in their personal religion. Many staff at St. Mary’s have encountered instances where patients forgo procedures due to personal religious convictions that do not align with the official teachings of their religion (Stolow 2012, 144). We hope that access to the right religious counsel will help patients make more informed decisions regarding their healthcare.

Due to a high demand from a new, growing Jewish community in our area, St. Mary’s hospital will now provide new services not offered previously at this hospital. One of the new services provided will be the use of in vitro fertilization. While previously this service was not provided due to the violation of multiple sections of the Donum Vitae, the demand for such procedures has made the addition of this new service imperative (Donum Vitae 1987). The new commitment made by the hospital to effectively serve all of our communities cultural and health needs reaffirms this decision (Kahn 2000, 2). The means in which the hospital will introduce this service will be done with the counsel of members of the church as well as other community leaders. In vitro fertilization is an extremely popular procedure in Sasquatch’s Jewish community, and since the nearest fertilization clinics are more than 15 miles away, the hospital feels as though it is the obligation of our staff and administration to include this potentially life-altering procedure. While the need for the addition of this service comes largely from the demand of our Jewish community, it will be offered to all patients and will be done in a fashion that is appeasing to both the hospital’s historical background as well as the modern needs of our diverse rural community.

The new policies surrounding the implementation of in vitro fertilization will draw heavily from the state-funded IVF institutions found in Israel. We feel as though the clinics that are being run in Israel represent some of the best and most effective fertility clinics in the world (Seeman 2010, 357). They also are some of the best equipped to handle the nuances that arise from a procedure such as this. One of the largest points of contention with IVF is the question of kinship, and we recognize that the Israeli clinics work only within the context of the Jewish cosmology. Due to this, we feel as though the means in which they address such issues can help the hospital’s staff and administration in navigating the complex relationships between cultural and biological relatedness (Kahn 2000, 109). The hospital will also be using Israel’s policy regarding who qualifies for IVF. We believe the system in Israel of allowing any woman, regardless of marital or health status to use IVF procedures should be implemented at St. Mary’s as well (Kahn 2000, 28). We believe that IVF can be helpful to all woman who wishes to seek this option, and as such St. Mary’s will not participate in any practice which discriminates against candidates based on factors beyond what our doctors and genetic counselors recommend are safe.

It is an unfortunate fact that during the process of IVF, not all embryos will be used, and due to the hospital’s history as well as the beliefs of many staff and administrators, we will be creating our own policies of what to do with the unused embryos that are a by-product of IVF (Donum Vitae, 1987).  The hospital also recognizes that the interpretation of what exactly an embryo is and what the proper treatment of embryos should be can vary from patient to patient depending on their own personal beliefs (Brockopp and Eich 2008, 65). Due to this fact, the hospital will be using more than just the teachings of the Magisterium on the sanctity of human life to guide the hospital’s policy on the disposal and use of the unused embryos. First, we will be providing all IVF staff with information on how to inform patients from a variety of religious and cultural backgrounds on the means, in which IVF is undertaken so that patients may make informed decisions with all moral and health implications taken into consideration. The hospital will also begin allowing the unused embryos, with the consent of the donating mother, to be used for research pertaining to IVF procedures in the hopes that their deaths will provide future IVF procedures with a higher success rate, therefore reducing instances of unsuccessful fertilization events(Brockopp and Eich 2008, 64).

The hospital recognizes that the creation of embryos with the knowledge that all will be brought to term is one of the main points of contention the Catholic Church has with IVF (Donum Vitae 1987). The hospital has discussed means of reducing instances of unused embryos by reducing the number of frozen embryos created during the IVF process. However, many of the ways in which this can be accomplished place an undue burden on the donating mother and as such we believe all proposed alternatives constitute an unnecessary amount of risk for the mother (Brockopp and Eich 2008, 61). Due to this, St. Mary’s will be performing IVF procedures in a means similar to other modern fertility clinics.

In light of all these changes, we feel it is necessary to highlight points in which St. Mary’s will not be making any changes to the hospital’s policy. One of those instances is our policies surrounding performing abortions. We feel as though by including abortion as a new procedure, to a degree that violates any part of the Donum Vitae, would be seen as a regression from the beliefs that St. Mary’s was founded on. We also feel as though it would be in violation of both the historical upbringing of the hospital as well as the beliefs and wishes of its staff and patients. The hospital will, however, institute a small, but substantial change to the policy of informing patients who inquire about abortion. St. Mary’s will now have information readily available to any patients who wish to know more about an abortion procedure. This will entail information on the procedure itself, including all medically relevant side effects, dangers or concerns the hospital feels are relevant. Information pertaining to any religious or ethical concerns will be available to patients upon their request as well. What will not be included is any information that may show patients how to obtain an abortion at any other medical facility or in any other fashion. We feel as though informing a patient on how to obtain an abortion would be a step too far and is not one the hospital is comfortable taking at this moment.

With regards to St. Mary’s approach to amniocentesis and prenatal testing, day to day operations of such procedures will change very little. However, the policies of administration surrounding such procedures will change. The hospital currently offers prenatal testing at the recommendation of a doctor but going forward we feel as though it is best for mothers to allow them to seek this choice free from interference from hospital staff. One objection to allowing such a change is that more mothers will seek an amniocentesis with the idea that if the diagnosis comes back and is not something a mother wished to hear, then she may seek to terminate the pregnancy for reasons stemming from the diagnosis (Donum Vitae 1987).  While this is an understandable fear and is not something the hospital will support to any degree, we feel that since amniocentesis has the potential to improve both the mother’s and the fetus’s overall health St. Mary’s should make prenatal testing as available as possible (Ivry 2009). In allowing anyone to seek these procedures we are allowing mothers an opportunity to have the pregnancy experience they feel is best suited to their needs. In an effort to safeguard mothers who may not feel as though getting an amniocentesis is the right choice for them, we will be advising all genetic counselors and doctors on proper ways of advising their patients so that all mothers have the right amount of medical information that they desire (Ivry 2009).

We recognize that many of these challenges will be difficult for many of the staff members here at the hospital. St. Mary’s is aware of this and in an effort to retain some of the trust the employees and administration have built over the years, we will not be forcing any employee to participate in any activity or procedure they deem against their personal beliefs. If enough staff members have problems with our new policies to the point that it begins to affect the day to day operations of the hospital then some policies may be revisited, but it is not anticipated that such things will occur at that level of frequency.  We ask that if any staff members feel as though their job has changed to the point where they can no longer morally continue with their work to speak with their supervisor to arrange a means around such issues. Whether this will include being reassigned to other tasks or just working fewer hours will have to be determined on a case by case basis, but St. Mary’s would like to tell all of its employees that it will continue to listen and compromise so that these changes can be done in the most efficient and pragmatic way possible.

Finally, the hospital has decided that at this time it will not subsidize any of the new procedures for underinsured patients. We believe that making this decision is in the hospital’s and the community’s best interest. This will allow anyone who has donated to St. Mary’s to continue to do so without fear of encouraging any behaviors they may find morally or ethically repugnant. We also feel as though subsidizing these procedures may inadvertently ostracize some members of the Sasquatch community, and as such could have a negative impact on both the collective health of Sasquatch as well as the individual health of many patients who have objections to any part of the new policies or procedures being implemented at St. Mary’s.

 

 

 

 

 

Work cited:

1.Donum Vitae = the Gift of Life: Instruction on Respect for Human Life in Its Origin : and on the Dignity of Procreation : [replies to Certain Questions of the Day]. Washington, D.C: National Catholic Bioethics Center, 2000.

2. Brockopp, Jonathan E, and Thomas Eich. Muslim Medical Ethics: From Theory to Practice. Columbia, S.C: University of South Carolina Press, 2008.

3. Kahn, Susan M. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press Books, 2012.

4. Stolow, Jeremy. Deus in Machina: Religion, Technology, and the Things in between. New York: Fordham University Press, 2013.

5. Birenbaum-Carmeli, Daphna, and Yoram S. Carmeli. Kin, Gene, Community: Reproductive Technologies Among Jewish Israelis. New York, N.Y: Berghahn Books, 2010.

6. Ivry, Tsipy. Embodying Culture: Pregnancy in Japan and Israel. New Brunswick, N.J: Rutgers Univ. Press, 2010.