Batt, Nikki – Final Proposal

Dear Board Members of Sasquatch Ethics Committee:

Before I begin, I would like to introduce myself and provide information about my background, both professionally and religiously. First of all, I am a doctor, a FEMALE doctor. I personally want what is best for my patients, and I want nothing more than to reduce a person’s discomfort in the safest way possible. Secondly, I identify as a Roman Catholic. While I do skip some Sundays and in no way claim to be the most “devout” Catholic in the Church, I do resonate with a majority of Catholic laws. That being said, after attending a college where the majority of my peers were Jewish and spending time over seas experiencing new cultures, I have become very open minded and accepting to other religious practices, and I have spent a lot of time observing their role in medicine. Due to the diversity in beliefs I have been exposed to, I have definitely struggled with addressing the ethical issues presented to me while being a part of this committee. This is mainly because I value practices and ideas in both Catholicism and other religions, such as Judaism and Hinduism. I believe my proposal is legitimate because I was raised as a Catholic, yet still have an open mind that is focused on what is best for the patient, as I have taken the Hippocratic Oath as one of the doctors at this center. I hope that what I have to say next will be taken into consideration with respect and an open mind.

I find it important to note that we are essentially the only hospital in this community, and it is necessary for us as humans to help the people within our diverse community. In order to do this, we must set aside our religious differences and embrace a utilitarian approach, where we put our community first and our beliefs second. We cannot expect our community to grow and prosper without being accepting and accommodating to others. Prohibiting the procedures that are about to be introduced in this proposal may drive away many of the people in this community, as they may seek protection and help from a more cooperative hospital in another town if we do not. As mentioned by Dr. Arthur Kleinman, bioethics is faced with the challenge of “how to reconcile the clearly immense differences in the social and personal realities of moral life with the need to apply a universal standard to those fragments,” (Kleinman 1999, 70). With that in mind, I present to you my carefully crafted proposal.

This hospital, which was initially under Catholic influence, now has the opportunity to introduce quite a few procedures. The first procedure I would like to address is abortion. While abortion is a very controversial topic, we—as a hospital—must respect all views and beliefs in the growing community and consider permitting the procedure in the hospital. I personally do not align with the pro-choice movement, as I am Catholic and this procedure goes against my moral belief of “right to life from the moment of conception.” I am also aware that other religions have similar moral beliefs as Catholics do, such as the Hindu belief that people should “do no harm” to other people (Bhattacharyya, 2006). However, abortions are in fact legal in the United States, and we should be providing the service to whoever may need it, regardless of their or our own religious practices. In addition, there are several religions that are more flexible with the idea of abortion and see it as permissible, such as Judaism and Islam.

The Catholic Church makes it clear that abortion is immoral in all cases because it violates “the right to life” of a human from the “moment of conception until death.” (Shanon 1988, 146) Despite the strength of the Catholic argument along with my Catholic background, I must highlight the feminist perspective of pro-choice in contrast. Judith Thompson argues that “a woman may open a window in a house, and a burglar could climb in, yet the woman has the right to have the burglar removed from the premises.” (Thompson 1971, 58) Some people may say that this argument is unconvincing due to the major difference between a baby and a burglar. It is also clear that there is no perfect analogy to encompass every single situation that could lead to a woman’s decision to abort. However, the underlying rights of a woman stay the same; a woman should always hold the right to control what is done to her body. Not only this, but religion is a very personal matter. We cannot take only the Catholic view into consideration, no matter how strong the tie is to it.

In order to make sure our decision appeals to as many people as possible, we must set guidelines for what qualifies an abortion as “permissible.” I am suggesting that these guidelines follow closely to the United States’ guidelines listed under the Hyde Amendment. This amendment states “abortion services should only be provided when the pregnancy is a result of rape, incest, or proves to be a medical threat to the mother’s life.” This guideline should provide a fair compromise between the devout pro-life portion of the population and the growing liberal and culturally diverse portion of the population. In a perfect world, the doctor in me would suggest allowing “genetic abnormalities and disease” as an extenuating circumstance for abortion. However, this guideline would require an ethics committee to debate each case, which could be time-consuming and inefficient. Therefore, I am going to define what qualifies as a permissible abortion as one that stems from rape, incest, or threat to the mother.

Addressing the Donum Vitae, it is believed that the most important Catholic rule is to make sure “all lives are being respected.” (Shanon 1988, 145-7) I think pro-life supporters do a fine job at protecting the life of the potential human; however, I think they also forget that the pregnant woman must also be protected. My main argument concerns potentiality versus actuality. While I do believe the fetus has much potential to be an outstanding human, I do not believe that this “human potential” trumps the safety and comfort of an inarguably living woman. Going along with this claim, I do not believe it is fair for that woman to be shamed for taking the necessary steps to protect herself. If we dive even deeper into the Catholic scriptures, we find that no one is without sin. Even a morally wrong woman caught in the act of adultery was “still loved and shown compassion” by Jesus Himself. (John 8:1-11) Perhaps, like Jesus, we Catholics should “break bread” with women that choose to terminate their pregnancies, regardless of how immoral the decision may seem. (Mark 2:13-17) With all that said, I believe we should provide the opportunity of abortion, so long as the woman qualifies for one under the proposed guidelines.

With these guidelines in place comes the question of dealing with the under-insured patient. My personal belief is that we should subsidize abortion; however, I can see the problem with providing funding for every abortion. There is potential that women would abuse this opportunity and this could prove to be an economic disaster for our hospital. Unfortunately, it is also seen that one-third of abortions are repeat abortions. Therefore, my proposition is that we should not subsidize more than ONE abortion per patient. As a catholic and a mother, I would like to our community members to practice safe sex and/or abstinence until they are ready to bear and take care of the child. By subsidizing only one abortion, we will be able to avoid these repeat abortions as well as promote safer sexual habits in our community. I think this will not only create a more sexually conscious environment in our community, but also address any concerns coming from our financial donors and our more conservative hospital members. While it is possible that a woman may be in a situation qualifying for a second abortion, I think the best we can do for that woman is to refer her to another hospital or specialist. This way the woman will still be kept in our interest, while we can stay true to our own hospital’s policy.

In regards to our doctors, while we should allow abortion to be an option, we should NOT openly suggest abortion as an option to patients. Advertising such a controversial procedure may drive away some patients that are pro-life, such as our large Catholic group. Our first goal is to respect the patient’s request, and if that request is abortion, then we must honor that request without judgment. However, our second goal is to minimize the number of abortion procedures we conduct. Our doctors should suggest alternative solutions, such as adoption or following through with the pregnancy. Perhaps introducing a policy that financially or emotionally supports a pregnant woman considering adoption could aid in reducing the amount of abortions that occur.

As mentioned, I struggle with the idea of abortion as a Catholic. However, I fully support prenatal testing, so long as it “respects the life and integrity of the embryo and the human fetus.” My belief is “directed toward safeguarding or healing,” and I do believe prenatal testing can be extremely beneficial in catching disease before it becomes fatal. (Shanon 1988, 149) As stated by someone who had undergone prenatal testing, “what harm can a test do if it’s going to provide you with important information?” (The Burden of Knowledge: Moral Dilemmas in Prenatal Testing, 1994) Despite its potential benefits, the procedure of amniocentesis can prove to be stressful for many women and may even induce a dangerous environment for the fetus to grow in. I suggest, similarly to abortion, that we do not advertise it to our patients. This will also prevent any offense it may bring to people with strong feelings against it. For example, the Japanese often express discomfort and distrust with prenatal testing; therefore, we should consider their beliefs just as we would consider pro-natal testing beliefs. (Ivry 2009, 11) This test is not a necessity, as plenty of women have gone through pregnancy without prenatal testing and have given birth to perfectly healthy babies. That said, I want to make it clear that we should not BAN this procedure because there are in fact women that find assurance in undergoing these prenatal tests, as seen in Rayna Rapp’s ethnography, Testing Women, Testing the Fetus. Thus, if a woman requests it or expresses interest on her own, then the hospital should provide it for her.

Our hospital needs to keep in mind that Sasquatch is a very diverse area, and it is important to evaluate the needs of every community member equally. I stand firmly with the idea that we should allow our patients the opportunity to use prenatal testing as a means to alleviate any concerns with or about the health of their potential child. With this integration of prenatal testing, we can appeal to our Jewish patients, who are typically concerned with “geneticism” and strongly favor genetic testing. (Ivry, 2009) At the same time, we can appeal to our Japanese patients, who rarely request amniocentesis, by not promoting or suggesting the procedure to them. Our goal should be to create a “no pressure” environment that patients can feel comfortable in, whether they favor genetic testing or not (Ivry, 2009).

As mentioned early, I am aware that the Catholic Church teaches that all life is sacred from the moment of conception until death, and I personally would not like to deviate from that path. However, I’m sure the next Catholic concern with prenatal testing is about how the results of the prenatal testing will affect the rate of abortion. While many people may argue that knowing test results will increase abortion rate, I believe that if we stay true to the idea of “limited advertisement” of abortion and prenatal testing, then there will not necessarily be a spike in abortion. I hope that this suggestion will appease Catholic concerns, ensuring them that our hospital is in no way encouraging procedures that go against the Catholic Church. Instead, we are merely building upon our Catholic foundation in order to better integrate other religions in our community. Something to consider with prenatal testing is that results could actually change a woman’s mind about abortion in a positive way. In other words, the reverse scenario may occur, where a woman takes a prenatal test and realizes that her baby would be perfectly healthy. Perhaps seeing legitimate test results showing that her baby would lead a perfectly normal life would cause her to refrain from aborting it and instead go through with the pregnancy.

Another topic of concern is assisted reproductive technology, namely in-vitro fertilization. I typically diverge from the Catholic views towards IVF, as I support it while the Church does not. I mainly support it because I resonate with women and their desire to have children. I believe it is important that we, as doctors, give any woman the ability to have a child. The Church states that “it is a gift” to have a child, and if a woman is infertile then “God has a different plan” for her. However, being a mother has given me the opportunity to realize how important and special it is to bear a child, and I want to be able to help an infertile woman experience it. The Church may claim a law against the use of reproductive technologies for building a family, but can anyone really argue against birthing a child and parenting – the most natural activity on the planet?

In the larger scope of things, allowing IVF to occur in this hospital will appeal to many members of our community. For example, Jewish women strongly support IVF because they feel that they need a child to be accepted into society. (Kahn, 2000) Kahn remarks that women in Israel seek so aggressively to have children because “motherhood itself remains understood as a deeply natural desire and goal” of Jewish people. (Kahn 2000, 62) Another example is in the Shi’ite community, where the desire for women to have children is so strong that women are willing to break bonds with their own religion or realign with a different spiritual leader, such as Ayatollah Ali Khamenie’i, in order to have a child. (Clarke 2007, 75) Clearly, there are women from all over, from all different cultures, who feel the need to be a mother. This makes it seem that motherhood is a near universal law, which argues against the Catholic Church’s Old Testament view that motherhood “is a gift.” (Genesis 1:28; Shanon 1988, 157) Therefore, I will make the point again that we should attempt to be more accommodating to other religions other than Catholicism, and recognize that there are larger universal laws that undermine Catholic laws.

In order to appease Catholic concerns about the care of embryos, we should consider setting up a review board to oversee the entire IVF process. An example of such a review board is the Israeli PUAH, which is a group of people that make sure only one embryo is created at once and that it is handled with the “utmost dignity and care.” (Kahn 2000, 89) We could also incorporate a more “Catholic” form of IVF through the use of perforated condoms given to the interested couple, allowing them perform the proper conjugal act. While this process can prove to be stressful, it may also lead to more love and support towards the other partner in order to get through the process. Therefore, permitting IVF could acknowledge multiple religions at once, and it could bring couples closer together emotionally. It can also result in the growth of the community in terms of population and diversity, and it can allow many more women the ability to be happy with their families.

Going along with this proposal of embryonic care, we should encourage other women to donate embryos by ensuring they will be put to good use. I don’t see this as controversial of a topic as abortion, amniocentesis or genetic testing because there doesn’t seem to be any life-threatening consequences from it. In fact, I think it could be beneficial to promote embryo donations, which could not only provide another woman the chance to have a child, but could also allow for more research to be conducted within the hospital. Selfishly, I think this could also be a great opportunity for the hospital to gain recognition if we are able to produce new and exciting research from these embryos. Holistically, I do not necessarily see a down side to embryo donation and the advertisement of it. With that being said, I am aware that there are concerns about the lack of “respect” toward these embryos. Perhaps we should incorporate some sort of committee to oversee the care of the embryos. Many community members expressed concern about embryos being destroyed or thrown away, and I can see how this is disrespectful to the embryos and to the mothers of the embryos. If we make sure these extra embryos are cared for in the same way that IVF embryos are cared for, I feel that we could easily mollify those concerns.

I am well aware that this hospital holds a strong tie to Catholicism, and moving away from Catholic views may upset staff and community members. Since I am Catholic myself, I would still love to incorporate the religion into the hospital in some way. I think the best way to do this is to keep the Catholic Clergy for counseling. Mental outlook plays a very important role in the successful healing of an individual, and this can be seen in action with the use of placebos. While medicine is important in healing, there have been cases where simply telling a patient they are getting a treatment but giving them a placebo leads to patients recovering from illness. I believe spiritual counselors can act similarly to placebos in the sense that they are instilling positive thoughts into a patient, and possibly increasing their chances at a successful treatment. I have learned that healing and religion go hand in hand, and while these patients are undergoing stressful procedures they need something to keep their mental health in tact. By having a patient meet with a religious counselor, they may gain new knowledge of their faith or of a new faith that can help them make their decision more confidently. We should also strongly consider bringing counselors from various religious backgrounds into the hospital counseling staff. Meeting with a religious counselor, either Catholic or non-Catholic, can also simply provide the patients with hope. By removing this comfort, I would feel as if I was going against my oath to do no harm to any patient. As a doctor, I have come to realize that patients simply desire hope through a dark time and to know they are in the hands of a non-judgmental and supportive system. I believe keeping spiritual counseling within the hospital will provide that support and guidance that is needed by many.

It also seems that there is such a strong focus on physical results in the medical world that important spiritual and cultural information is disregarded. Medicine, in my opinion, needs to be more open and encourage free discussion between foreign viewpoints. I think a hospital needs to operate similarly to Leon Kass’ description of the conversation in the President’s Council on Bioethics, which consisted of a diverse group of “scientists, physicians, lawyers, social scientists, humanist, and theologians.” (Kass 2005, 226) In terms of this hospital, it should attempt to be more diverse in respect to viewpoints and cultures. This could lead to more knowledgeable doctors and more competent care for patients. In summary, keeping the spiritual counselors and EXPANDING our repertoire of those spiritual counselors could help the hospital keep the doctors focused on just the procedure at hand, while the counselors can take on the more spiritual-support role.

If and when we allow all of these procedures to be available at this hospital, there follows a concern involving our staff and whether or not they agree with the decision. We are bound to have nurses and doctors that differ in opinion, and it is important that we address it. The only solution I have for this, given we have a limited budget, is to expose these nurses to new cultures and practices. I became open minded after being around people with different beliefs than myself, and if we can simulate that environment in this hospital then perhaps our staff will also become more secular. This could be achieved when we bring in the various spiritual counselors into the hospital. I propose even implementing a mandatory training program for all staff members. The program’s goal will be to educate staff on hospital policy, while building their competence when it comes to cultural differences among patients. It will provide each staff member with a broad cultural foundation, allowing them to better address and counsel patients with different beliefs than themselves. In the meantime, we would have to assign staff members that are able to put religious differences aside in order to perform the procedure at hand. As stated earlier, I do not think abortion/amniocentesis rates will increase much if we do not advertise them, and I do not think we would lose staff members to this switch.

My proposal encompasses my best attempt to address the many different situations in an open-minded manner while staying true to my medical and religious beliefs. I have also done my best to compromise between the reserved and the progressive concerns presented to me. I have tried to take a utilitarian stance in this proposal in order to provide beneficence to the majority of the community. We must remember that we are a growing community that is becoming more and more culturally diverse. In order to provide proper care for all of our patients, we need to be aware of the differences in beliefs and acknowledge them. We are a hospital and our main purpose is to serve and heal any person that needs it, regardless of their upbringing, religion, culture, or social class. We should pressure no person into any procedure, and we should be sure to provide ALL information to patients about any procedure they wish to go through, so long as they qualify for that procedure. The staff may practice their own beliefs freely, but may not force their beliefs onto any other staff member or onto their patients. My hope is that implementing this proposal will create an atmosphere of “culturally competent” staff and extremely hopeful patients (Bhattacharyya, 2006).

Thank you, board members for your time and your consideration. I have faith that this proposal will allow us to move towards a promising future for this hospital and for this community.

Dr. Batt