The Policy Proposal of Sasquatch hospital
Introduction
As a member of the ethics committee at Sasquatch hospital, I intend to propose several new policies regarding the use of assisted reproductive technologies and prenatal testing. Our hospital was run for many years under Catholic auspices and 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 killing a new life. As a result, our hospital has never previously provided abortion services.
Abortion services
Although abortion is legal today under federal law, the prohibition of abortion by the Catholic Church prevented our hospital from providing the procedure to our patients. Although there might be a 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 easily overcome through treatment innovation and design. Since our hospital recently became non-denominational, the hospital is no longer burdened by the responsibility of abiding by the rules of the Catholic church. Although the hospital would like to maintain its religious patients and donors, the hospital should begin to provide abortion services to patients who choose to use them.
As supported in Thompson’s “A Defense of Abortion,” the hospital should support the right of choice for a woman going through a pregnancy and potentially an abortion. To placate our Catholic patients and donors, our hospital will not provide subsidized abortion services for underinsured patients at present. This decision is influenced not only by the fact we are a private hospital with limited medical resources but also heavily reliant upon Catholic donors. Beginning to provide abortion services will be a significant change for many of our Catholic donors, but the hospital can ensure donor relationships remain strong by only accepting blanket donations to the hospital rather than donations to specific treatments. This is to avoid tension over some donations paying towards abortion services. The controversial nature of abortion holds true for Islamic patients and donors as well. If in the future the hospital has new donors from other cultural and religious backgrounds such as Judaism and atheism, we can start to subsidize treatment for underinsured patients. It is sometimes the case that these backgrounds are more accepting of abortion, but 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, this year the government will provide our hospital-specific funding for In Vitro Fertilization (IVF) treatments and prenatal testing including amniocentesis. Although the Catholic church may believe that any intention to “to request such a diagnosis with the deliberate intention of having an abortion” is unethical (Cahill et al 152), and some donors may not support these treatments, the use of government funding means this is detached from donor preferences.
Other than the Catholic church, the local Japanese population is similarly resistant to the use of IVF treatments. Although there is widespread access to modern and advanced medical technologies in Japan, prenatal care still focuses on “Gamburu,” or to “make an effort” (Ivry 134) Ob-gyns are viewed as coaches to guide women spiritually during the pregnancy rather than interpreting pregnancies in a genetic manner. For example, the focus of Japanese culture is to nurture the child with environmental care from the mother.
Not only is the area home to a Catholic and Japanese population, the area hosts a small but vibrant Jewish community eager to try IVF treatments, and the hospital can cater to the needs of both groups. In their views “Reproductive technologies are allowed and even encouraged as a means of furthering the Jewish bloodline and realizing God’s command to multiply. 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). Paradoxically, it seems that the traditional notions of the Jewish family are separate from those of increasing the Jewish population. Furthermore, to avoid religious conflict and show our respect to the Lebanese Shiite 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 circumvents 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.” We want to be able to provide IVF treatments while taking in the consideration of Islamic patient’s religious belief.
Furthermore, Jewish pregnant mothers are willing to use prenatal testing because Jewish pregnancy culture is acutely focused on geneticism. This 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 has the choice to stop the early pregnancy which may reduce the likelihood of physical and mental harm. It is the duty of our hospital to provide care and provide prenatal testing to all the women in the community. The decision rests on the mother on whether to use the service. Due to the fact it is important to understand a variety of factors play into a patient’s decision on whether or not to undergo medical treatment, it is important 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 poor women, 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. Due to 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. Circumventing much ethical debate, “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 about 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, the hospital will attempt to consider the needs of individual patients from various religious backgrounds. To pursue this goal, the hospital will provide religious counseling by clergies of all religions. These clergymen will not be allowed to discuss their view towards any specific medical procedure on hospital grounds, but instead are required to focus on counseling the patients spiritually in a non-medical manner. Distinct from an advisory role, clergymen would serve to ensure a deity is with the patient through illness and hardship. To ensure that these clergymen do not interfere with treatments, they will only be permitted on hospital grounds during the weekend. Furthermore, the hospital will do its best to keep clergyman and doctors separated. If the hospital receives any complaints from doctors of interference, the individual clergymen will be banned from the premises and their services will be discontinued.
Relocation of the Nursing Staff
Last but not the least, the hospital will relocate historically Catholic nursing staff who are unwilling to perform abortion and reproductive services, such as other wards of the hospital. Since we have 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 want 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 they perform well, our hospital will potentially provide them positions after training. In 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.
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).
I will respond to this -GC
Hi Kiraney,
I truly enjoyed reading your proposal. In regards to your grammar, I have emailed you your midterm with my grammar suggestions. Therefore, I can focus more on critiquing the content of your midterm.
Your opening paragraph is good, but I think you can strengthen your proposal through providing more details of your identity. The assignment already implies that you are a member of the ethics committee, but who are you as an individual writing this proposal? Are you a female graduate student that was raised in the Catholic Church? Or are you a male doctor? If you contextualize your identity, the readers of your proposal will be able to have a clearer understanding as to why you take a particular stance on a certain policy. For example, if I say that I am writing as a queer, feminist, Asian American college student, it carries additional meanings to the reader than if I say that I am just a member of the ethics committee. I would also suggest that you provide in the introduction a firm stance on all the policies that you will be going over in your proposal—as it will give the reader a clear roadmap of what you will be covering.
In regards to your abortion policies, I would suggest you make clear in the first paragraph who you consider a hospital patient. It sounds like you are prioritizing the rights of the woman rather than that of the fetus, which should also be stated clearly in the first paragraph. Lastly, it appears that your stance on whether you offer subsidized abortion policies in the future is dependent on the financial status of the hospital. If this is your stance, you should make this clear in the first paragraph as well.
Something that you clarify is that even with a blanket donation, the Catholic donors would still be donating to the hospital that provides abortions. I commend you for making the distinction between a blanket donation and a donation towards a specific treatment; however, this distinction would not necessary get rid of the tension—as the blanket donation would still be used to pay for abortion services. Maybe you could offer an option for the donors to choose where their money goes to? If you offer this option, you will need to take into account the potential scenario where all Catholic donors might choose not to support the abortion sector of the hospital. In order to address this scenario, your stance on not providing abortion services to underinsured patients, could be useful here—where the fully paid abortion services could help finance the abortion clinic. However, this is just my personal opinion.
In regards your IVF policies, I encourage you to think more long-term. The hospital will only receive government aid for one year, what will happen after the year is up? I also like how you utilized class readings in you response to the Japanese population that the hospital services. I encourage you to think beyond just stating how Japanese culture views amniocentesis to think about what the hospital will do for these Japanese patients. For example, knowing that Japanese patients might view OB-GYNs as coaches, which is significantly different from that of the quintessential American patient who might view OB-GYNs as a one who diagnoses their pregnancy, it might be beneficial to offer cultural training for OB-GYNs when they deal with Japanese patients.
In your third paragraph of the IVF portion, you need to mention the Muslim population in the first sentence. When you mention the Muslim population later in the paragraph, it is too sudden of a transition—you have not addressed Muslims at all in your proposal so far, so mentioning them now without context is too abrupt.
I like your idea of the hospital providing a reduction of price for women of lower socioeconomic backgrounds; however, you will need to go into more detail as to why and how this reduction of price will work. You might want to look into possible insurance policies that the hospital can accept or might create a hospital policy that allows patients of lower socioeconomic status to apply for a reduced price.
In your Donation of Unused Embryos portion, I suggest that also think about the cost of IVF treatments. Often times, women need to undergo multiple IVF treatments in order to have a successful pregnancy. The cost of treatments is expensive and because you will not subsidize IVF treatment, what happens to the couple that hasn’t produced a child, but has paid for multiple IVF treatments? What if the couple is split on wanting to donate—where the wife wants to donate the unused embryos, but the husband is not or vice versa? Also, you should make clear who is benefitting from the donation of embryos for research.
Your policy regarding the clergy, you might need to take into consideration the weekend Sabbaths for both Jewish and Christian leaders. For the Jewish faith, Saturday is considered the Sabbath—meaning that the Jewish spiritual counselors would only be available on Sunday. In regards to the Christian faith, Sunday is considered the Sabbath, which might limit these counselors to work only on Saturday. Also, you might want to rethink the sentence, “These clergymen will not be allowed to discuss their view towards any specific medical procedure on hospital grounds, but instead are required to focus on counseling the patients spiritually in a non-medical manner.” How will you account for religions that explicitly state that [insert something] is a sin? The clergymen might just be reiterating the official dogma of the religion. I’m thinking more along the lines concerning the Catholic clergy where the Donum Vitae explicitly states that the Catholic Church does not condone abortion etc. A clergyman might not input his personal beliefs in his counseling, but what if patients ask him the official Catholic position on IVF treatments? Will he be penalized and barred from entering hospital grounds for telling patients the official stance of the Church?
In regards to you last portion regarding nursing staff, I think you might want to think about mentioning an internship program that could lead to a full-time position at the hospital to nursing students. You kind of allude to an internship-like program, which is why I am suggesting this.
Overall, I really enjoyed reading your proposal. I think you really did a phenomenal job approaching this assignment and can’t wait to read your final product! I really like how you incorporated different class readings, which I felt really strengthened your overall arguments. Great job!
I will comment on this
Overall I thought your paper had strong claims. Some of these claims will be strengthened dramatically if you include citations and go into more depth on your sources. This is what Dr. Seeman suggested in class on Wednesday and I see it as a good place to work on for your final paper. I will explain in some specific areas where you should focus on expanding arguments.
In the abortion sub-section I would like to see an expansion of the argument from the quote in the Hamdy source. You should provide more context to this argument because right now it feels too much like an opinion without enough evidence. It is no problem at all that your persona is showing clear distaste to the previous Catholic influence, such as saying the hospital “is no longer burdened by the responsibility of abiding by the rules of the Catholic Church” but it is important to recognize that many of these same Catholics will be donors to the hospital. For this reason, you will need more arguments for why it is okay to embark on more medical treatments in a respectful way that will not reduce the number of Catholic donors, since they are contributing to many life-saving procedures, and thus are a valuable part of the functioning of the hospital. You do go into donors in your second paragraph under abortion services but I think it will be important to weave this argument throughout, and I have a suggestion later where to do so.
I am confused about the logic of accepting donations to the hospital overall instead of specific treatments. As I see Grace also commented, this could this result in Catholic donors funding abortion services indirectly. I think you should allow donations to specific treatments so that Catholic donors can be sure of what they are funding. This is an example of where you can please Catholic donors but still offer reproductive services. I liked how you linked in other backgrounds in explaining future directions for subsidizing abortion services to the underinsured. To make this even stronger I would definitely include a citation that explains acceptance of abortions in other religious groups. This will give this section more legitimacy by showing that the possibility that there are members of the new patient population that will want access to an abortion. By just saying “Judaism and atheism” this does not show as much evidence.
In the IVF paragraph, I would explain more about “Gamburu” and how it differs from other pre-natal care such as the heavy use of pre-natal testing. This will allow you to use more of the Ivry source and it will give more breadth to this area of your paper. I liked this area of your paper a lot because you cited many sources and spoke about the patients directly; I believe this was the strongest section of your paper.
I thought you incorporated the Lebanese Shiite population well, since you found a compromise to offer IVF. Perhaps include an anticipated argument about how your idea to restrict IVF to only married heterosexual couples is not the case in Judaism, and why this restriction should still be implemented. By addressing that counter-argument you will make your own argument to only support IVF in this manner.
I would bring in a citation to your claims about pre-natal testing in “Jewish pregnancy culture.” I like your idea of reducing the price of pre-natal testing to encourage more equity in who can receive these procedures. Where do you propose to get this money?
In terms of the nursing and clergy staff I agree with Grace’s comments. I, however, would not advise you to offer full term positions after training since it is in the instructions that there is a limited budget for new hires. Going off this point, I would say this program could be successful if Catholic nurses quit.
You have a very good groundwork for your final paper. You hit on all parts of the prompt and my biggest advice to bring in more citations where I stated and to expand upon some as well.
Please feel free to reach out if you are confused about any of my suggestions!
Dear Kraney, Grace and Lindsay,
All three of these essays are really excellent. Well done. Kiraney, I agree with many of the comments made by Grace and Lindsay (including the one about more citation from our texts) and urge you to read those carefully. I will only add a few more observations below.
1. “As supported in Thompson’s “A Defense of Abortion,” the hospital should support the right of choice for a woman going through a pregnancy and potentially an abortion. ” You need more than this. What part of Thompson’s argument do you want to make use of? Why do you agree with it?
2. Furthermore, Jewish pregnant mothers are willing to use prenatal testing because Jewish pregnancy culture is acutely focused on geneticism.” This requires a citation and is also rather stereotyping, no? Can you rephrase?
3. 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). Excellent quote!
4. Distinct from an advisory role, clergymen would serve to ensure a deity is with the patient through illness and hardship. To ensure that these clergymen do not interfere with treatments, they will only be permitted on hospital grounds during the weekend. Furthermore, the hospital will do its best to keep clergyman and doctors separated. If the hospital receives any complaints from doctors of interference, the individual clergymen will be banned from the premises and their services will be discontinued.– I will personally lead a nationwide religious boycott of your hospital and all its major funders if you put this into effect. How insulting to all involved! It is clear though.
The writing is very lucid and well-thought, so I had less to say about that. Read your commentators carefully and you should be fine!
best,
DS
Hi Kiraney –After rereading my comment, I realized that I have a lot of grammatical errors that might make my comment a bit confusing to understand. I’m just reposting my comment with my fixed grammar.
I truly enjoyed reading your proposal. In regards to your grammar, I have emailed you your midterm with my grammar suggestions. Therefore, I can focus more on critiquing the content of your midterm.
Your opening paragraph is good, but I think you can strengthen your proposal through providing more details on your identity. The assignment already implies that you are a member of the ethics committee, but who are you as an individual writing this proposal? Are you a female graduate student that was raised in the Catholic Church? Or are you a male doctor? If you contextualize your identity, the readers of your proposal will be able to have a clearer understanding as to why you take a particular stance on a certain policy. For example, if I say that I am writing as a queer, feminist, Asian American college student, it carries additional meanings to the reader than if I say that I am just a member of the ethics committee. I would also suggest that you provide in the introduction a firm stance on all the policies that you will be going over in your proposal—as it will give the reader a clear roadmap of what you will be covering.
In regards to your abortion policies, I would suggest you make clear in the first paragraph who you consider a hospital patient. It sounds like you are prioritizing the rights of the woman rather than that of the fetus, which should also be stated clearly in the first paragraph. Lastly, it appears that your stance on whether you offer subsidized abortion policies in the future is dependent on the financial status of the hospital. If this is your stance, you should make this clear in the first paragraph as well.
Something that you need might need to rethink is that even with a blanket donation, the Catholic donors would still be donating to a hospital that provides abortions. I commend you for making the distinction between a blanket donation and a donation towards a specific treatment; however, this distinction would not necessary get rid of the tension—as the blanket donation would still be used to pay for abortion services. Maybe you could offer an option for the donors to choose where their money goes to? If you offer this option, you will need to take into account the potential scenario where all Catholic donors might choose not to support the abortion sector of the hospital. In order to address this scenario, your stance on not providing abortion services to underinsured patients, could be useful here—where the fully paid abortion services could help finance the abortion clinic. However, this is just my personal opinion.
In regards your IVF policies, I encourage you to think more long-term. The hospital will only receive government aid for one year, what will happen after the year is up? I like how you utilized class readings in your response to the Japanese population that the hospital services. I encourage you to think beyond just stating how Japanese culture views pregnancy and think about what the hospital can do for these Japanese patients. For example, knowing that Japanese patients might view OB-GYNs as coaches, which is significantly different from that of the quintessential American patient who might view OB-GYNs as a doctors who diagnose their pregnancy, it might be beneficial to offer cultural training for the hospital’s OB-GYNs when they deal with Japanese patients.
In your third paragraph of the IVF portion, you need to mention the Muslim population in the first sentence. When you mention the Muslim population later in the paragraph, it is too sudden of a transition—you have not addressed Muslims at all in your proposal so far, so mentioning them now without context is too abrupt.
I like your idea of the hospital providing a reduced price for women of lower socioeconomic backgrounds; however, you will need to go into more detail as to why and how the reduced prices will work. You might want to look into possible insurance policies that the hospital can accept or create a hospital policy that allows patients of lower socioeconomic status to apply for a reduced price.
In your Donation of Unused Embryos portion, I suggest that you also think about the cost of IVF treatments. Often times, women need to undergo multiple IVF treatments in order to have a successful pregnancy. The cost of treatments is expensive and because you will not subsidize IVF treatments, what will happen to the couple that hasn’t produced a child, but has paid for multiple IVF treatments? My comment is more to the phrase “Once a couple is satisfied with their number of kids”. Also, what if the couple is split on wanting to donate—where the wife wants to donate the unused embryos, but the husband is not or vice versa? Lastly, you should make clear who is benefitting from the donation of unused embryos for research.
In your policy regarding the clergy, you might need to take into consideration the weekend Sabbaths for both Jewish and Christian leaders. In the Jewish faith, Saturday is considered the Sabbath—meaning that the Jewish spiritual counselors might only be available on Sundays. In regards to the Christian faith, Sunday is considered the Sabbath, which could limit these counselors to working only on Saturdays. Also, you might want to rethink the sentence, “These clergymen will not be allowed to discuss their view towards any specific medical procedure on hospital grounds, but instead are required to focus on counseling the patients spiritually in a non-medical manner.” How will you account for religions that explicitly state that [insert something] is a sin? The clergymen might just be reiterating the official dogma of the religion. I’m thinking more along the lines concerning the Catholic clergy where the Donum Vitae explicitly states that the Catholic Church does not condone abortion etc. A clergyman might not input his personal beliefs in his counseling, but what if patients ask him the official Catholic position on IVF treatments? Will he be penalized and barred from entering hospital grounds for telling patients the official stance of the Church?
In regards to you last portion about the nursing staff, you might want to think about mentioning an internship program that could lead to a full-time position at the hospital for nursing students. You kind of allude to an internship-like program, which is why I am suggesting this.
Overall, I really enjoyed reading your proposal. I think you really did a phenomenal job approaching this assignment and can’t wait to read your final product! I really like how you incorporated different class readings, which I felt really strengthened your overall arguments. Great job!