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 is most beneficial to those it serves. The goal of a hospital should be to improve outcomes and create more satisfied patients.
On abortion, 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. Personally, I believe that women should have a control in what happens to her body and have the choice whether or not to carry out a pregnancy. “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). In hopes of reaching a middle ground, the hospital will provide and subsidize abortion services for under-insured patients with terms. One of the terms will be that abortions can only be performed within the first trimester before the fetus is able to feel any pain. There will only be a set number of abortions given per month and the process of signing up for an abortion will include a talk with the doctor performing the abortion. Extreme cases such as rape will automatically be pushed through.
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. In Israel, IVF is a state policy versus in America it is purely private. Different from Israel, religious experts here will not be involved in the day-to-day process at Sasquatch, but medical experts will be involved. 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).
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.
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 and 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. Due to our influx of Japanese immigrants, we do not want them to feel pressured into prenatal testing their unborn child 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). 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 discontinue this in-house spiritual counseling by Catholic clergy but refer patients to certain spiritual counseling based on their religion and who they would like to confide in. 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. 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. 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 reflect the reasons they chose to become a nurse before asking for a transfer. 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.
Works 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).
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).
I will comment on your post.
I will comment on your post
-NB
Hello Selina,
To start off, I wanted to say that I appreciate and agree with your statement about the goals of a hospital, and I support your opinion about having policies that reflect the community that it is serving. With that said, I have a couple questions and concerns that came to mind after reading your proposal and I hope you will consider the following for your next draft of your policy.
In terms of abortion, I am glad you recognize that not everyone in our community is Catholic, and that we may have to move away from the Catholic ties in our hospital. Due to the fact that our community is growing and Catholics are no longer the ONLY audience, we definitely need to adjust policy in our hospital. I appreciate that you are planning on having terms that guide the decision on whether or not an abortion is permissible. However, I don’t necessarily agree with the piece about subsidization. I fear that a “set number of abortions per month” may wind up being too big or too little of a number, which could cause multiple problems. For example, if the number is too large, we may lose a lot of our donors, who are already likely upset with the idea of allowing abortion. In contrast, if the number is too little, then we may not be able to provide for all of the patients that need, want, or qualify for it.
Moving onto to topic of IVF, I am glad that you are supporting it. I also appreciate how you backed up your claim with examples and quotes from Jewish and Shi’ite cultures, which are both growing in numbers in our community. I like the way you were also able to keep Catholic rule within the policy, making sure only a married man and woman can go through with IVF. However, as our society becomes less traditional and women without husbands desire kids, how will you address them? What if they are widows? Is the answer a definitive no, or are there exceptions to this? If there are exceptions, where is the line crossed between a permissible case and an impermissible case?
Next, I think your proposition about collaboration with bio-pharmaceutical companies is a fantastic one, and it seems like a sure-fire way to get both a company involved in the hospitals research as well as encourage women to donate eggs and put them to good use. I honestly cannot find a flaw with this idea, and I hope no other community member can find one because I think it would greatly benefit all parties involved.
Looking at your policy about genetic testing, I agree with your statement about not encouraging genetic testing, but still having it as an option for women that express interest in it, such as Jewish women. This will appeal to several variations of religious beliefs in my opinion, and I don’t think anyone in our community would be opposed to this proposition. However, how can you distinguish whether a woman will or will not see the results and then consider abortion if they turn out to be undesirable results? Try as you might to prevent this from happening, but after a woman receives negative test results, she could easily be tempted by abortion. And, based on your proposal, as long as she meets the time frame, she could have a good chance of following through with it.
Finally, I would like to address your plan with the spiritual counselors. This is the only point in your proposal that I strongly disagree with. After I spent time abroad, I witnessed many cultures not only be open to other religions, but also INTEGRATE religion into the healing process in their hospitals. Patients were able to seek spiritual guidance in their darkest of times, and I truly believe religion can play a positive role in medicine. Taking away these religious counselors also takes away our patients ability to immediately heal any mental stress they are feeling due to their test results, their decision about abortion, or their procedure. Perhaps instead of taking the counselors away, more of them could be recruited and from several different cultural/religious backgrounds. I think a hospital could turn into a dark place if it is stripped of faith; and if doctors and social workers are the only staff, there is no “professional” that is qualified enough to take on that role of healing the mind and soul. With that said, the hospital could mediate these counselors and make sure they are not forcing their faith on any patient, and that they are strictly there to provide spiritual strength and support that doctors and nurses may not be able to provide.
I hope you will consider my concerns and questions, and I look forward to hearing about how you will address them!
Regards,
Nikki Batt — a concerned Sasquatch community member
Hi Selina and Nikki,
Thanks for this. Selina, your writing is pretty good but could use some further help and editing. I have included a few specific comments below and you should take your commentator seriously too. Remember that your job is not just to state your opinions, but to do so in a way that people will find persuasive. That means using the readings to formulate the strongest arguments possible and to predict the arguments of your opponents. Do you think anyone will be appeased by a “quota” on abortions? How will that quota be set?
Selina, I appreciate your commitment to the patient’s welfare. Other than saying so, why do you think that their ability to receive a wide variety of services ought to trump the convictions of health care providers? This needs to be argued out a little more.
Also, I do not think that your “compromise” on abortion will be greeted with pleasure by anyone. For rights advocates it constitutes a severe curtailment of personal rights in your hospital; for life advocates it is really not a compromise at all– it is still termination. Also, unless you have evidence that fetuses cannot feel pain during the first trimester you should take care with this argument. If it turns out that you are wrong about this, will your policy change? In addition to stating your own position you need to try to foresee major objections to your argument and proactively address them.
1. This sentence is ungrammatical: “Personally, I believe that women should have a control in what happens to her body and have the choice whether or not to carry out a pregnancy.” It should be: …that women should have control over their bodies and….
2. “In Israel, IVF is a state policy versus in America it is purely private. Different from Israel, religious experts here will not be involved in the day-to-day process at Sasquatch, but medical experts will be involved. ” I am not sure how this sentence fits it to your argument. I would recommend rewording the sentence that starts “Different from…” How about, “Unlike in Israel, where IVF is subject to both medical and Jewish religious oversight…
3. “but refer patients to certain spiritual counseling based on their religion and who they would like to confide in.” What does this mean?
4. “Due to our influx of Japanese immigrants, we do not want them to feel pressured into prenatal testing their unborn child 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). Making prenatal testing available will also allow mothers in the Jewish community to have agency in their pregnancies.” Be careful not to assume that you know what clients will want based on their national or ethnic background. I think you need to frame this more carefully.
5. I would like them to reflect the reasons they chose to become a nurse. Should be “reflect upon the reasons…” Also, how do you suppose a devout Catholic nurse would respond to this? Do you think they would find it patronizing? What would you respond if they said, “I became a nurse to save lives, not end them”?
best wishes,
DS
Dear Ms. Liu,
Thank you for you well thought out and passionate proposal to the Ethics Committee. Here at Sasquatch Hospital we pride ourselves on being inclusive and welcoming of varied opinions and sentiments on the issues at hand. Sasquatch is slowly but surely becoming a diversified community of people of all walks of life and faiths and we must be willing to hear all voices before reaching a unanimous consensus. So, on behalf of the Sasquatch Connecticut Ethics Committee, I thank you again for reaching out to our committee with your sincere proposal.
With that said, the Committee has deliberated regarding your requests and we must take issue with some components of your proposal. Additionally, we ask for clarification regarding some of the matters you have raised in your letter.
First of all, great work with establishing your point of view early on: your aim is to be as inclusive to the population of Sasquatch as you can. Your sentence, “The goal of a hospital should be to improve outcomes and create more satisfied patients,” captures this sentiment. However, the stance you take on abortion seems to satisfy some patients but not others. In allowing abortions, you have satisfied the patients who are comfortable with the hospital offering such a procedure but, this may deter our predominantly conservative Catholic donor base from continuing their generous donations to the hospital. Are there any other possible solutions?
Upon reviewing your proposal, we felt a confusion regarding a claim in your second paragraph. You wrote, “’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).” How exactly do you mean the phrase, “do right by the patient”? We surmised that perhaps you were referring to the case of risky pregnancies in which the mother or baby would be at risk? If this is the case in which you would warrant a termination of pregnancy, please indicate that. If this is not what you meant, please elaborate here. Also, what will the pre-abortion talk with the doctor consist of? Will an ultrasound be performed? And, what is your source regarding whether or not the fetus can feel pain before the first trimester?
It seems that throughout your proposal you have chosen to adhere to the Catholic Church’s stance on some things, i.e. IVF, but not on others. Inconsistency when it comes to issue on ethics is permissible, so long as you have addressed the reason behind the inconsistency (and the fact that you will be inconsistent).
Your last sentence of the third paragraph is a tad confusing. The notion that IVF is permissible in Shiite Islamic thought is correct, however the quote you have included is a tad confusing. Perhaps you could incorporate more from the Naef text. Consider these quotes: “…the majority of Shia fuqaha (legal experts in fiqh) allow this form of assisted reproduction [gestational surrogacy] as legitimate from the point of view from Islamic law, albeit only for infertile married couple” (Naef 157) and “Most Shia authorities… do not regard assisted reproduction… as analogous to zina, since it does not involve the physical act of sexual intercourse” (Naef 158).
In the aim of strengthening your proposal, it is important to make sure there are no errors in grammar or sentence structure. These errors, although minor, tend to detract the reader from your credibility as a writer with an aim to persuade.
Within your proposal you cited various sources including Donum Vitae and Tipsy Ivry’s book, Embodying Culture: Pregnancy in Japan and Israel. However, in a few cases the quotes you referenced needed a bit more introduction before you presented them. It may help to introduce a source and its general significance before you provide a quote, as many members of the committee were unfamiliar with Ivry’s ethnographic account.
In your first paragraph, you state, “It is often difficult to make policy decisions that pleases everyone when it comes to controversial topics…” This sentence should read, “… to make policy decisions that please everyone” because “policy decisions” is your subject and it is plural. Perhaps in that second to last sentence of your first paragraph you could say, “In a hospital that recently became non-denominational in a diverse community” instead of “varied”. But, this change would only be a stylistic one, not necessarily a grammatical issue.
The paragraph on IVF reads a bit awkwardly; it requires a bit more of your own words in order to aid in transitioning from one idea to the next. It seems you present the Jewish Israeli stance on IVF and quickly move onto the Shiite stance without adequately explaining where (or why) the Jewish moral imperative to reproduce fits in here. Perhaps quote a rabbinic source on the matter? Here are some possible references: “Despite most rabbis’ insistence on the ideal of heterosexual marriage as a precondition for parenthood in other words, their more immediate technical concern with avoiding kinship disasters…while helping Jewish women to have children pushes the enforcement of this idea much lower on their list of priorities” (Seeman 353-354) and “Rabbinic attitudes towards kinship and reproduction… support the wide use of in vitro technology as long as certain requirements (like the use of non-Jewish sperm donors for married women) are met” (ideas presented by Kahn, as cited by Seeman 354).
We look forward to hearing your response to our comments on your proposal to the Sasquatch Ethics Committee. Thank you again for contributing towards a very crucial dialogue necessary for the advancement of our great city.
Sincerely,
The Sasquatch Ethics Committee