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 continued 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 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 continue to be stagnate 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.
- How much will the hospital reflect its donor base (Catholic origins) and mixed local community?
One of GMH’s goals 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 is difficult to integrate every social and cultural agenda into each unique situation. Abortion and reproductive technologies can be handled on an individual case to ensure the best outcome for all patients, donors, and staff involved. The hospital’s donors and staff primarily consist of Catholic individuals, while the mixed local community is heavily comprised of Jewish, Caucasian and African-American people, in addition to 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 technology. As a member of the ethics committee, I have determined GMH will not provide nor subsidize abortion services for uninsured patients. In addition, the use of IVF and prenatal testing, such as amniocentesis, will not be provided nor encouraged by the GMH organization and staff. We acknowledge that this may seem to deter from GMH’s goals, but the reasons presented below address my decisions pertaining to abortion and reproductive technologies.
2. How should the hospital begin to provide and subsidize abortion services for under-insured patients?
Over the last few decades, “the access to abortion services in the United States has continued to decline,” which can be attributed to changes in legislations and court rulings that have made it easier for physicians to refuse to perform this procedure, (Meyer and Woods, 1996). Requiring [GMH’s staff] to perform [or participate] in abortions would represent a serious threat to individuals’ fundamental moral or religious beliefs (Meyer and Woods, 1996). At GMH, the hospital’s donors and nursing staff are historically known to be Catholic. I have determined that 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 perspective was formulated from Shanon, Thomas A. and Lisa Sowle Cahill’s article, Donum Vitae, and The Book of Genesis in The King James Bible; the New King James Bible is the English translation of the Christian Bible for the Church of England. This text was designed to address specific topics such as life, death, and social issues. For every situation, the Catholic Church believes the scripture will give the answer, leaving room for individuals to formulate their own perspective of the scripture.The first chapter, Genesis, sets the stage for the opinion of some religious beliefs and is known as the “creation story.” It begins directly by stating “In beginning, God [‘elohim] created the heavens and the earth” (Ball, 2000).This one sentence summarizes the entire book, while placing God as the center of creation. The novel later explains that God created men and women in his image. This Book all living things in a hierarchal order with humans at the top. These scriptures and many other are at the foundation of the Catholic Church’s opinion on abortion. The Catholic Church believes “Though Shall not kill”. This law can be broken if allowed by natural laws, but with regards to abortion this is not the case. The Catholic Church acknowledges that life begins at the time of conception,signifying that life should be protected and respected. Because GMH’s foundation is built upon the Catholic traditions, I propose that GMH should continue to define life as the site of conception. This proposal is the main reason GMH will not provide and subsidize abortion services for under- insured patients. This decision will agree with the religious moral and beliefs of the Catholic donors and nursing staff. At the same time, this proposition may clash with other religious denominations. To account for this, GMH will expand our partnerships with local clinics, while including both catholic and non-Catholic clinics. If the patient inquiries about having an abortion, we will provide them with information to other hospitals that may provide this service.
3. What about IVF treatments and prenatal testing including amniocentesis?
While multiple types of assisted reproductive treatment exist, this section will address IVF and amniocenteses. I propose that GMH should not provide IVF and prenatal testing because the provisions of this technology will negatively affect individuals socially, culturally, and religiously, which will hinder GMH goals to expand to a greater number of people in the community. The Catholic Church recognizes the critical connection between a child and parent during fetus stage (Shanon et al, 1988).They see the use of reproductive technology as a denying the child this connection. Therefore, reproductive technology should not be allowed in their eyes. In Nan T. Ball’s article, The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates, she analyzes the 1994 French bioethics debates. These bioethical laws allowed only individuals not able to conceive children, heterosexual couples of legal age to procreate, and married couples to use artificial insemination and IVF procedures (Ball, 2000). These laws were created to counter the new Enlightenment ideas of the time. IVF technology can be seen as a challenge to the traditional heterosexual family. The idea of a heterosexual family lies at the foundation of the Catholic religion. The use of IVF may challenge the cultural, social, and religious identity of the local Catholic families and Catholic staff.
In addition, reproductive technology can be viewed as defying the identity of Japanese individuals. In an article by Trsipy Ivry, she accounts the Japanese perspective on pregnancy, arguing that Japanese women take on a more “environmentalist” approach to pregnancy (Ivry, 2009). This view examines the outcome of pregnancy depending on the mother’s decision and little to chance; problems associated after birth are a reflection of the mother. Dr. Ivry accounts a story of a Japanese mother using a “screening test that used biochemical analysis of the maternal blood to estimate the probabilities of chromosomal abnormalities in the fetus. (Ivry, 2009) Her OB-GYN did not treat this matter with any urgency. This doctor views these productive testing as having little influence because of Japan’s cultural and religious beliefs. Thus, introduction of reproductive technology goes against these cultural and religious views pertaining to pregnancy.
While I have presented the Japanese and Catholic’s view of reproductive technology, one can see how the provision of this technology would clash with the ideals of these, which would not be the case for the local Jewish families. In Israel, pregnancy is driven by “anxiety regarding the possibility of reproductive catastrophe” (Ivry, 2009). In the Jewish religion, the idea of the pregnancy is thought to be predetermined, therefore, reproductive technology is seen as a “risk reducing” procedure that emphasizes Jewish beliefs. Taking all these perspectives into consideration, I believe that if GMH hopes to accommodate more people, then reproductive technology should not be provided. This would only diminish the cultural and religious identities of its local members and discourage people from visiting GMH.
4. Should the hospital continue to provide spiritual counselling by Catholic clergy?
When addressing the topic of spiritual counselling by Catholic clergy, I personally believe spiritual counselling can be an effective tool in helping individuals make decisions pertaining to help. In Sherine F. Hamdy’s ethnographic account, Does Submission to God’s Will Prevent Biotechnological Intervention?, she explains the story of two Muslim individuals’ denial of organ transplantations due to ethical and social concerns. While these patients would have benefited from organ transplants, they decided not to proceed. Their doctors believed their decision was made entirely based on religion. These patients did not believe that “religious sentiments, should not be seen as passive, as anti-science, or as constraints to medical treatment,” (Hamdy, 2013). These individuals looked at their entire situation and determined the financial strain on their family was not worth saving his life. Using this case, I propose GMH should not provide spiritual counseling by Catholic clergy. The use of spiritual counselling may contribute to an individual making the best decision, but will not be the only factor affecting their decision. I view GMH the use of economic resources to acquire spiritual counselling is not worth giving for a multiple factor decisions. In addition, doctors have filed complaints pertaining to clergy interference with their work. The presence of these clergy make it hard for our staff to do their jobs. By not providing this service, GMH improves the overall quality and efficiency of care.
Administration
I have determined 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 select few donors they seem on board with the changes facilitated by the proposal. The longest timeline will be the formation of partnerships with other local hospitals and clinics. There is a lot of legal documents and certifications that must be approved before we can start a mutual beneficial relationship that ensure every individual will receive great quality care. Even though this will be a length process, it gives use more time to encourage donors to help support the financial burden of this project.
I will reply.
Garrett,
I found your midterm to be well organized, clear, and concise. I especially think that you did an outstanding job addressing each question with personalized yet evidence-based insight. Your creativity plays a large role in engaging the reader, especially the part where you change the name of the hospital. I think this is a wonderful idea and creates a space for me to want to answer the “why” question and captivates the reader’s attention in an effort to learn more. While I enjoyed reading the section on ”GMH Description and History,” I think you provide a little bit too much information. I am assuming that, when presenting to the board, they already have background on some of the history. While I think it is important to summarize it, perhaps narrowing down that section could be beneficial.
The section where you talk about the needs is very clear, but I think it could use a little bit of evidence to support why those needs are important from the text or from external resources if needed. While I understand it is just the introduction, extra support would make me even more enticed to want to support those needs moving forward. The first question is very straight forward, but I again think it needs to be backed by more support. Perhaps instead of your last sentence, you can re-structure by concluding the paragraph with some text-based analysis to explain the reasons why we should go with your policy or combine the following paragraph so the general flow is smoother. The evidence you use to answer question two is powerful and has a very strong correlation to your points. If the transition is smoother, your answer to the questions can have an even stronger stance.
Your paragraph focusing on IVF is very strong, and I think the way it is organized is done really well. When you talk about the catholic church and heterosexual families, you are making a fundamental association that is important to understand for the entirety of the proposal. I would encourage you to expand a little bit more on this point. Specifically, when you talk about the idea of challenge for heterosexual families, if you explain more it could strengthen your entire argument. The argument you make for Japanese women is slightly confusing to me. While I understand the point about focus on environmentalism, I don’t fully comprehend the connection to “defying identity.” You do a great job of connecting IVF with Judaism and its values. The end of your proposal is strong – well done! I especially enjoyed the touch of the timeline. It makes your entire proposal tangible and attainable.
Hi Garrett and Shauna,
Thanks for this. I am addressing this to both of you because I think your shared goal is now to make this the best paper possible given the coming final.
Garrett, I appreciated your creativity in addressing the problems posed in the exam prompt. one of the strongest aspects of your paper is the attempt to use specific citations from several of our readings. You should continue to build on this as you go forward.
Your writing needs some work, and I would like you, Shauna, to offer some more specific comments on the writing as we go forward (I thought your overall response was well-written and well-considered).
Garrett, I am offering several examples below of passages that need real work, either in terms of style or content. There are also a number of typos that I did not point out but that you need to follow up and correct. In general, I think you need a better outline of how each paragraph leads to the next (the Japan paragraph in particular seemed to come out of nowhere). Remember that this document is meant to be persuasive. It will also be helpful for you to anticipate arguments against your position and try proactively to respond to them in your final. For example, you seem to say that because people of different cultural and religious backgrounds disagree about things, the hospital is better served by simply not providing those services, including abortion, IVF and even clerical counseling. But won’t this policy just antagonize everyone? How will you handle that? Also, your paper makes some very broad and general statements about “Catholics,” “Jews,” “Japanese,” etc. You need to avoid stereotypes and make it clear that you are referring only to certain trends that scholars have noted in particular communities. The policy of the Catholic Church for example need not be reflected in the personal views of all (or most) American Catholics; Japan is a large country with many different views reflected, etc.
You’ll have plenty of time to work on the final, so I recommend you get started now and ask for help if you need it!
Now, some specifics:
1. I do not understand this sentence: “If this is achieved, GMH will continue to be stagnate within the community of Sasquatch, Connecticut.” Be stagnate? Is this a good thing? You need to reword this.
2. As a member of the ethics committee, I have determined… As a member of the ethics committee you do not determine anything. You just make recommendations.
3. “This text was designed to address specific topics such as life, death, and social issues. For every situation, the Catholic Church believes the scripture will give the answer, leaving room for individuals to formulate their own perspective of the scripture.” I think this whole statement is false. How do you know how the Bible was “designed” and that these chapters are meant to address life, death and social issues.” Does the text say so? Also, I think you need to read Cahill again. They do not say, in that article (nor did we say in class) that the Catholic Church believes Scripture will provide answers to all questions OR that individuals have room to formulate their own perspective of the Scripture. On the contrary natural law is about Scripture plus reason, and Donum Vitae claims to take precedence over anyone’s individual perspective. You need to look at this closely and clean it up.
4. “The novel later explains that God created men and women in his image. This Book all living things in a hierarchal order with humans at the top.” Not sure what to say. The Bible is not a novel. And the sentence is incomplete.
5. Therefore, reproductive technology should not be allowed in their eyes. I think this is a little awkward. How about, “therefore they do not believe that assisted reproductive technologies should be allowed”?
6. In addition, reproductive technology can be viewed as defying the identity of Japanese individuals. First, I think you mean defining, not defying, right? Second, this paragraph needs a better transition from what preceded it.
7. “Taking all these perspectives into consideration, I believe that if GMH hopes to accommodate more people, then reproductive technology should not be provided. This would only diminish the cultural and religious identities of its local members and discourage people from visiting GMH.” This is fascinating! You think that because of religious and cultural differences, the hospital can avoid offending anybody by just getting out of the reproductive services business? What do you think someone might say in opposition to this view? Try to anticipate and answer them.
8. These patients did not believe that “religious sentiments, should not be seen as passive, as anti-science, or as constraints to medical treatment,” (Hamdy, 2013). Double negative makes this hard to understand. What are you trying to say?
9. I view GMH the use of economic resources to acquire spiritual counselling is not worth giving for a multiple factor decisions. Something wrong with this sentence.
Very best wishes and good luck!
Don Seeman
Garrett,
Overall, you had good ideas for the policies for the hospital, however, I have some suggestions on how to make your argument clearer and some questions for clarification.
In your first paragraph I like that you gave context and mentioned the hospital’s name change. I think that you can clarify what you mean by ‘dominating figure’. Do you mean to say that it will be a more inclusive hospital? Also, I think you mean ‘continue’ rather than ‘continued’. Overall, I like how your introduction laid out what you were planning on discussing in the proposal.
In the GMH Needs section you have one typo (area areas). I also think you could change the heading of this section and maybe title it “GMH’s Mission Statement”. You could probably make this section a little bit more concise. I think the last two sentences are confusing and unnecessary (since you don’t really address cost that much in your proposal).
When answering your first question I’m not sure how your policy can handle abortion and reproductive technologies on ‘an individual case’ (maybe say ‘case-by-case basis’ instead). In the beginning, you mention that the hospital is now non-denominational, so this paragraph seems to conflict with your introduction.
For the second question I’m glad you used the readings to support your argument. Maybe you can restructure your paper and combine the first two questions into one section. Also, since you used the pronoun ‘I’, it may be a good idea to give some context as to who you are (a doctor? Ethicist?). You lost me a bit when you began talking about Genesis. You should also put what novel you’re referring to for clarity and the following sentence is also confusing. However, I like how you addressed non-Catholics in the last part of this paragraph.
When answering the third question I think you will need more supporting evidence to make the claim that ‘this technology will negatively affect individuals socially, culturally, and religiously’, but the evidence that you do have is relevant. Lastly, I think your solution to avoid reproductive technologies entirely may not be the best for the community. Is there any way you can create a policy where those in dire need of these services can get it at the hospital? Wouldn’t you be hurting the community even more? Also, if you aren’t providing reproductive technology services, why would hospital clergy make it more difficult for doctors to do their work? I think you could rethink this argument.
Overall, I think you can be more clear about which changes are taking place and make sure all of your policies are consistent. Before the final you should proofread again because I came across several typos. I hope this helps and if you need some push-back on your arguments I’d be happy to help!