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 culturally non-denominational practicing, Sasquatch Mercy Hospital has found itself needing to clarify and reevaluate prior hospital policies. The ethics committee has come to the consensus of the importance of the separation between church and state as a founding American principle that is codified in the First Amendment. Thus, Sasquatch Mercy Hospital will follow a policy discourse that aims to remain non-partial to any specific religion, while acknowledging our religious founding. While our founding has been based on, “The Lord as healer of the sick [as] the icon for all healing professions: “Come to me, all of you who labor and are overburdened, and I will give you rest … (Matthew 11:25–30)”” (Schotsmans, 2009), the ethics committee strives for nondiscriminatory hospital policies.
In this proposal, we aim to address our 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 will provide and subsidize abortions for up to 25 weeks for underinsured patients. While our hospital is in line with our Catholic founding that “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae), in regards to abortion, we recognize and prioritize the rights of the mother over the fetus. Our prioritizing of rights follows an Aristotelian understanding of natural inequality—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. Thus, the pregnant woman’s rights take precedence over the fetus’ rights.
However, our hospital recognizes the potential transgression that abortion carries, namely murder. Thus, the ethics committee expands upon Agamben’s analysis of Carl Schmitt’s concept 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. This increased risk is present from the first trimester and for at least 12 weeks following delivery” (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. Thus, the hospital recognizes the mother’s role within her physical state of exception that her pregnancy has induced—the mother’s authority and decisions should be treated with the highest importance and regard.
IVF TREATMENTS AND PRENATAL TESTING
Sasquatch Mercy Hospital will provide in vitro fertilization treatments; however, will not subsidize the costs to underinsured patients. 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). The ethics committee recognizes the benefits of IVF treatments on marriages and women’s agency, and feels 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, the ethics committee will not actively encourage hospital patients to donate unused embryos. Doctors and hospital staff will be required to notify patients of the option to donate; however, encouragement for the donation of unused embryos is at the digression of hospital staff. As our hospital is not a research hospital, while we truly value advancement in science, we prioritize providing high quality patient care over making strides within the scientific community.
Prenatal testing will be provided and subsidized for all underinsured patients. The option for amniocentesis for pregnant women will be offered as early as twelve weeks and as late as twenty-five weeks, the latest week for a hospital sanctioned abortion. The ethics committee remains cognizant that “About half of fetuses with serious anomalies won’t be detected until an ultrasound at 20 weeks” (Axelrod, 2017). Thus, Sasquatch Mercy Hospital, will offer a mandatory ultrasound at twenty weeks.
SPIRITUAL COUNSELING
The Sasquatch Mercy Hospital will continue to provide spiritual counseling via the Catholic clergy. The ethics committee proposes 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. The ethics committee believes 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. The ethics committee requests all nurse staff to 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.
Lastly, the ethics committee would like to bring to light that 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, the hospital requests its nurse and donors to reflect and think on whether their decisions are disregarding the rights of the people that they serve.
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:. (n.d.). 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
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
Pregnancy Complications. (2016, June 17). Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregcomplications.htm.
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
I will comment!
Grace,
You have a very well written proposal. However, I have some suggestions on how to make this proposal more clear and effective.
Your introduction paragraph is great—I liked how you clearly explained what the proposal was about and why there was a need for change. You mention that the hospital will remain non-partial (I think ‘impartial’ may be a better word) yet still acknowledge the Catholic religious founding. This sentence seems contradictory so maybe you can explain how you will be able to do both. If you’re arguing for separation of church and state then it may be hard to also argue that you can acknowledge the Catholic founding.
In your “Abortion Policies” section you used your sources very well. You should definitely elaborate on why you chose 25 weeks for the cut-off for abortions. Adding this explanation will add clarification because later on in the section you say the mother is at risk throughout her entire pregnancy. In addition, I think you could add a sentence to explain why abortions should be subsidized, but not IVF treatments. If “human life must be absolutely respected” then why wouldn’t IVF treatments to create human life be subsidized? All of your other claim are well supported!
I think you should either rethink or expand upon the sentence “encouragement for the donation of unused embryos is at the digression of hospital staff”. In your introduction you say that you’re striving for non-discriminatory hospital policies, however, putting this in the hands of staff members may lead variations in how the policy is conducted. I think it would be beneficial to create a solid, unwavering policy on this issue.
In your spiritual counseling paragraph, I think you come up with a good solution. You may also want to add something that addresses physicians’ tendencies to disregard spirituality when proposing treatments.
In the first sentence of your last paragraph I think you can omit the word ‘that’ to make the sentence clearer. Also, you may want to elaborate on how your policy changes will affect donors and funders. Right now it seems that you are only going to ask them to reconsider their beliefs, but what if the donors and funders pull out entirely?
Overall I was very impressed by your proposal. I can tell you spent a lot of time thinking this through and your sources were all relevant. I hope these suggestions help make your proposal more clear and effective.
-Kimberly Farmer
Dear Grace and Kimberly,
Excellent! This is without question the most creative proposal I have read so far. I agree with most of Kimberly’s suggestions and have added a few others below. Keep up the good work!
1. culturally non-denominational practicing. Should be religiously non-denominational practice.
2. “The Lord as healer of the sick [as] the icon for all healing professions: “Come to me, all of you who labor and are overburdened, and I will give you rest … Where does the first quote end? Is icon part of the quote? Otherwise, this is probably not the right word. Not sure what you mean.
3. digression of hospital staff. Should obviously be discretion of hospital staff. Proof read!
4. This needs to be expanded. The section on states of emergency needs to be much more explicit so that you explain exactly why this is relevant here. And you should be explicit that this is an analogy, not a straightforward application of political science theory.
5. Also, the section on Aristotle is not all that clear. You need to explain how your argument leads you to prioritize mothers over fetuses– this is not explained. Nor is it explained how this can jive with Catholic teaching. Are you arguing as a Catholic ethicist that the Church’s policy should be different? Are you breaking with the Church’s teaching? Offering a secular alternative?
6. You have brought to bear some fascinating outside readings, but I want to see you engage a bit more with readings from the course.
Otherwise, excellent. Keep up the good work.
DS
Hi Grace,
I thought your proposal was well argued and the structure of your paper was clear and concise.
I did, however, see some inconsistencies in your arguments not pointed out in the comments above. While small, I think you should look for another source to support the hospital’s choice to become non-denominational. The first amendment is only applicable to government agencies and has no mention of church and state. However, I am not sure that a source is needed for this as it can be due to something as simple as it is just the direction the hospital wants to go in.
Second, I think your argument for allowing abortion is strong but I think it would benefit from more information about the view the hospital has concerning the fetus. You mention the hospital is placing the rights of the mother over the rights of the fetus, but this is such a change from the Catholic view that it may benefit you to speak more to how you are considering the fetuses rights, even if your conclusion remains the same. I think a good place to put this would in your argument about allowing embryonic research as that part was a little unclear to me and I think this may be an opportunity to strengthen the argument surrounding abortion and clarify the hospitals stance on embryo research.
You mention that you will have mandatory ultrasounds for pregnant women, I am not sure that such a thing is possible or necessary. Most woman will seek out ultrasounds on their own fruition and I am not sure the hospital has the authority to mandate anyone to such a procedure. Softer language may be required for that passage.
You mention that if any nurse has objections to any of the new procedures being offered they should seek to work things out with the administration. How might that come to fruition? I had a similar argument, but it was pointed out that by simply allowing staff to work based on their own beliefs, that could interfere with the hospital’s day to day functioning. How might you solve that if that were an issue?
Other than those things I loved your paper and how well you used both outside and in class sources. Good work!