Cartolano – FINAL

To Whom It May Concern:

As we all are aware, Sasquatch Community Hospital has recently become non-denominational and is now functioning as a public community hospital. I am certain this change was an appropriate step in the community’s effort to encourage newcomers. It is true now that by transitioning to a non-denominational hospital we will better reflect the growing religious and ethnic diversity of our community. New and varying patient populations with different beliefs from some Catholic health practitioners and donors are on the rise. Certain desires for treatments previously not offered will now need to be addressed so that the hospital can run smoothly through this transition.

What is not diverse is our donor population. There was no conflict when the community was predominantly Irish Catholic and the hospital was associated with the Catholic Church. As we know, Sasquatch Community Hospital has kindly subsidized care for patients who are under-insured. This was made possible by generous Catholic donors. It will be difficult to maintain donors if money is suddenly used to fund medical procedures against the Catholic faith. It is of utmost importance to create a vast donor population as medical treatments only become more expensive and the patient population grows.

One of my colleagues has suggested we reach out to the businesses of non-Catholic members of our community to help fundraise for procedures that will be addressed later on such as IVF treatments, abortions, and pre-natal testing including amniocentesis. In my opinion this is a great idea for four reasons: 1) Communication with new community members will further show our welcoming of them, some of which are experiencing life in America for the first time. 2) It will introduce the process of raising money for procedures that certain groups will wish to obtain. 3) It will simultaneously provide financial security to the hospital so that essential functions can remain in full swing, such as the maternity ward, emergency room, and cancer ward, made possible by current donations. 4) It will give new members a place to directly contribute to their community and make a difference.

Though these are only minority groups now, we need to prevent a mismatch between procedures offered and our patient population. We are the only major hospital in a roughly hour drive and it is our duty to provide care. Since we are now a public hospital we must serve the public, not just cater to our current religious donors.

To prevent losing Catholic donors we must be transparent about where donations are distributed so that donors are consenting to funding procedures and departments of their liking. This is essential to prevent a disaster of donors pulling out of the hospital entirely because they do not know if their money is funding procedures against their faith. We can tell donors that they can donate to the hospital overall. We can also tell donors they can pick which areas to distribute their money. Another one of my colleagues anticipates this resulting in Catholic donors immediately allocating their money to services that do not go against their faith. To prevent this, we could in the short term split current government funds more unevenly to allot for new reproductive services, in addition to it already serving other areas of the hospital. Then, as we accumulate more money from non-Catholic donors from fundraising, we can lessen the proportion of government funding towards services not all patients will want to utilize. Another idea mentioned by a colleague is applying for a government grant that covers reproductive services including IVF, abortions, and pre-natal testing. I like this idea because then there is a set amount of money designated to these procedures and it does not dip into the funding of other departments. We should move forward with all of these ideas so that we can accumulate money quickly. We can contact the board members who oversee the hospital budget to better understand how we can support the many new services we wish to provide.

Assisted reproductive technologies do not conflict with all non-Catholic faiths. For example, a growing Jewish population might want to utilize IVF treatments. In Israel, IVF is an alternative way to become a mother for both single and married women. Some single Jewish women consider IVF to be more honest and cleanly, whereas sexual intercourse can be the opposite (Kahn 22). This concept comes from some Israeli women believing sexual intercourse with strangers to get pregnant is “ethically wrong” because it is a form of “stealing” (Kahn 22). To address these concerns of single women in particular who desire to get pregnant, we must support IVF and sperm donors. This is because unmarried Israeli women have been denied by hospitals running under “rabbinic auspices” in the past, and we are a public hospital that no longer has religious affiliations, thus no traditional family image to maintain (Kahn 24). Additionally, unprotected sexual intercourse with strangers could result in sexually transmitted diseases, and IVF treatment is a safe way to allow some women to reach motherhood without compromising their health from STDs. Some Catholic nurses might to respond to single women, or married women utilizing IVF treatment as a conflict to “the gift of human life…actualized in marriage through the specific and exclusive acts of husband and wife” (Donum Vitae 147). Since a required team member for IVF treatment is nurses, I recommend explaining two arguments presented below to the nurses:

Gilbert Meilaender, author of religious and ethical texts, reminds us that although the Bible does not speak of a method like IVF for procreation, there is an imperative value on procreation itself. This is because infertility is considered a “sorrow” in this faith (Meilaender 1638). He further explains stressors placed on infertile couples from their community. In such events, he references the work of Paul Simmons, a Christian ethics author, who believes “biotechnical parenting” does in fact highlight the “symbolic value” of parenting that relates to biblical principles. These principles include having offspring by choice, or parenting as a “calling, not due to accident or mere biological capacity.” (Meilaender 1639). Furthermore, “biotechnical parents” will not “resent” a pregnancy, since they are going through difficult means to commit to becoming parents; thus, a child of IVF is guaranteed “caring love” (Meilaender 1639). This concept, in addition to the next one described below are very different ways to look at procreation. I find them to be compelling arguments in support of reproductive technologies such as IVF because they use evidence that is based on interpretations of the Bible, rather than just stating their own opinion on the matter.

Joseph Fletcher, a biomedical ethicist, states that Jesus says God is supposed to be loved more than an individual’s mother and father. This can be applied towards what “constitutes” a family from being “grounded in ‘blood’ or genes or genital origin’” to “shared caring and concern,” through loving God above all others (qtd. in Meilaender 1643). To continue, Fletcher interprets loving God more than your parents as good because it means that “human reproduction is no longer centered in the genitalia” (Meilaender 1643). Instead, it is an act that results in children who can have a relationship with God, regardless of their “genital origin” (Meilaender 1643). If Catholic nurses state their personal beliefs are in moral conflict with adhering to IVF treatments, we should explain Simmons concept of how “biotechnical parents” are meeting similar biblical routes to parenthood, and Fletcher’s analysis that the “genital origin” of parenthood will never be as important as shared values, using the example of the primary importance of a loving relationship to God. Both Simmons and Fletcher’s arguments are ways to support members of our patient population who want to utilize IVF. If this argument still does not encourage the most devout Catholic nurses to administer care in these procedures, we can look to reorganize the departments in which this subset of nurses work.

Similar to Catholic faiths, the growing Lebanese Shiite population will raise concerns about IVF treatments, though there are some instances where they will be welcomed for Shiites. Overall there is more leniency in receiving egg donors than sperm donors for Shiites. Some male Shiites disapprove of sperm donors with the thought that “’the child would not be from me – it would be like raising some other man’s child’” (Inhorn 104, 112). It is critical to note that this view is not universal by Lebanese Shiite males. Other men have accepted IVF treatment and 60 IVF treatment clinics can be found in Egypt (Inhorn 97). Some accepting men are infertile themselves and others have wives who are infertile. Their motivation for seeking IVF treatment is “to achieve fatherhood and happiness in their marriages” (Inhorn 97). Understanding the perspective of Jewish women and both viewpoints of Lebanese Shiites has influenced my proposal, because while not all infertile Lebanese Shiite immigrants will want to utilize IVF treatment, we should have it as a treatment option considering we have an active population that will want access to these procedures to become parents.

As IVF treatments become more accepted among our patient population it is possible that some Catholic patients will also desire IVF treatments. Barbara Katz Rothman, author of texts about reproductive technologies and women, states that Catholic women are “over-represented” in terms of IVF (Rothman 1605). This is due to pressure placed upon women to have children and their worthiness depending on this practice. In such cases, women might undergo treatments that go against their religious faith to be welcomed socially in their community (Rothman 1605). Although this is not a guarantee that Catholic families will engage in IVF treatments if they are suddenly available at the hospital, it does show evidence that there could be an additional population that would use IVF treatment.

In terms of pre-natal testing and amniocentesis, there is not a uniform desire for such tests in our patient population. It is understood in Donum Vitae that pre-natal testing for malformations through amniocentesis is morally illicit if followed by an abortion (Donum Vitae 150). This text does support “therapeutic procedures” that are directed towards the “healing [or] the improvement” of the conditions of an embryo (Donum Vitae 151). This is due to the belief that embryos must be respected like any human and procedures that risk or deliberately end of the life of embryos are illicit (Donum Vitae 152). Similarly, the Japanese immigrant group comes from a country that prohibits abortions for “eugenic reasons.” In other words, it is publicly understood in Japan that abortions are for “choosing when to have children rather than what kind of children” (Ivry 82). Therefore, if a woman wants to have an abortion in Japan it is available, but not in the case for terminating a disabled fetus. In a few such instances that these types of abortions have occurred, they were through “legal reasons” (Ivry 19). This does differ from the Catholic belief that does not allow abortion in any context. It is worth showing the beliefs of these two groups because in Jewish populations pre-natal testing for chromosomal abnormalities is a routine procedure and covered by Israeli national health insurance (Ivry 38). In general, Japanese pre-natal care includes attention to maternal nutrition and fetal environment rather than genetic abnormalities (Ivry 11). These values will not necessarily be ingrained in all Japanese immigrants that enter our hospital, but show us the common beliefs of their home country. Contrasting greatly, the pregnancies of Jewish women in Israel hold large importance on pre-natal tests, some of which, like chromosomal biomarker tests are not common procedures in Japan (Ivry 3). While the origins in the Jewish population in Sasquatch are not necessarily known, this group can look to Israel as a model to base their reproductive technology use. For this reason, our Jewish population might look to use pre-natal testing like amniocentesis. A compromise between the varying views of our Catholic, Jewish and Japanese populations about pre-natal testing will be described in the next paragraph.

We should allow pre-natal testing, including amniocentesis, that is only conducted for therapeutic intentions, which Donum Vitae supports (Donum Vitae 150-152. This means that pre-natal testing will be available for parents to learn of any conditions their fetus has so that they can properly prepare for what their baby will need. I want to clarify that the hospital will allow abortions, but will follow the Japanese methodology for administering these procedures, in that abortions are available for only non-eugenic reasons, such as a woman not being ready to be a mother for any child (Ivry 82). We will be able to make sure people are not using abortion services for eugenic reasons because amniocentesis typically occurs at 15-20 weeks of pregnancy and 92% of abortions occur in the first 13 weeks of pregnancy (“Amniocentesis;” “Abortion After the First Trimester”). Therefore, we can regulate the use of services by looking at the duration of pregnancies.

Until there is a more widespread donor population, the hospital should not provide and subsidize abortion services for under-insured patients. If the government grant for reproductive services is approved, we will revisit subsidizing abortions for the under-insured. Until then, we want to prevent Catholic donors from pulling out from the hospital because their money is being used to perform abortions. I cannot stress enough that if we lose our donor population the hospital will be forced to close, closing all non-reproductive services with it. Therefore, I suggested earlier to diversify our donors so that we can fund reproductive technologies. Until that moment, however, abortions should only be administered to those who can have one without needing hospital funding, due to the current largely Catholic donor base.

To remind everyone, this means that there is a Jewish population, Lebanese Shiite population, and potential Catholic population that would utilize IVF treatments. Although there are many groups listed above that could potentially utilize IVF, the hospital should not publicly advertise that unused embryos should be donated to research. On one hand, I do not see why the Jewish or Shiite populations would disagree with this decision, as they are more open to IVF treatments. On the other hand, in Donum Vitae, Catholics are urged not to allow procedures on live embryos, unless there is “certainty of not causing harm to the life or integrity of unborn child and the mother” (Donum Vitae 152-153). Therefore, science experiments that hold no therapeutic advantage to the embryo violate human dignity. To compromise on these differing beliefs, I propose unused embryos to be donated on the discretion of the people undergoing IVF treatment, and not based upon a hospital policy. To summarize, donating unused embryos should not be considered a standard procedure offered by the hospital, with the goal to avoid risks of losing Catholic donors. This proposal will hold true even if we do diversify our donor population because there is no need for the hospital to make donations of unused embryos the norm. Instead, we should educate those undergoing IVF treatment about both options and train our staff to do so in an objective, thus neutral manner, that does not show the hospital supports one decision over another. As I push for diversified donors and more education about treatment options, I must speak about expanding the spiritual clergy that historically have come to Sasquatch Community Hospital.

Although the hospital is now non-denominational I fully expect Catholic clergymen to continue to come to the hospital, despite medical staff disliking their presence due to interference. It is a known conflict that the clergymen also feel disrespected when the medical staff gets annoyed by them. To minimize conflict for both sides, I propose that clergymen visits become an optional service that requires a sign up that clergymen and community members must abide. With a schedule established, clergymen cannot show up unannounced, which would bother medical staff, and medical staff cannot be annoyed when clergymen arrive, because the patient has made an appointment. It should be known to patients that such appointments must be requested; thus, will not occur without request. I believe this counseling option should now include religious members from other groups that now accompany our growing patient population. If these appointments cause patients to decide to forgo reproductive technologies, the medical staff must accept this form of autonomy in patients, regardless of their personal opinions.

I want to give special consideration to a critique by my colleague who has previously stated my ideas alienate the local Catholic population. I believe my proposal is a compromise to both the Catholic population and the new members of our community. I have thought about how I could revise my ideas to satisfy the Catholic population, but that would not make sense considering the hospital is no longer a Catholic hospital. The changes in the hospital’s policies comes the need for members of the population to adjust to new protocols. In theory, it is possible that some members of the community may go to a different hospital for non-essential problems if they disagree with some of the new policies. However, I find it less likely in a practical day-to-day lifestyle for someone to do so because after all, we are the only major hospital within a 45 minute drive, and when you are sick, you will likely seek treatment in the most convenient fashion.

I look forward to your responses of my proposal to consider the following: 1) To allow IVF treatment. 2) To allow abortion services and prenatal testing, including amniocentesis, if both are for non-eugenic reasons. 3) To not provide subsidies for abortions for under-insured patients until we have proper funding through new donors and/or a government grant. 4) To educate patients about the options for unused embryos in a neutral manner so that the hospital does not publicly endorse donating embryos to scientific experiments. 5) To create a schedule that patients can use to sign up for clergyman visits and both medical staff and clergymen must accept the terms.

I am in favor of assisted reproductive technologies because there is substantial evidence that many members of our patient population desire and would benefit from these treatments. A large part of my proposal includes efforts to diversify our donor population and to apply to get a government grant. By allocating new donors to reproductive technologies these services will be made possible, while keeping the hospital’s many other essential services intact.

Thank you for your time and I hope to see some of my proposals being put to action.

 

Works Cited

“Abortion After the First Trimester in the United States.” Planned Parenthood, www.plannedparenthood.org/files/5113/9611/5527/Abortion_After_first_trimester.pdf

“Amniocentesis” Mayo Clinic, 9, Jan. 2018, www.mayoclinic.org/tests-procedures/amniocentesis/about/pac-20392914

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.

Inhorn, Marcia. “He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly, vol. 20, no. 1, 2006, pp. 94-120.

Ivry, Tsipy. Embodying Culture: Pregnancy in Israel and Japan. Rutgers University Press, 2009.

Kahn, Susan Martha. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press, 2000.

Meilaender, Gilbert. “New Reproductive Technologies: Protestant Modes of Thought.” Creighton Law Review, 1991, pp. 1637-46.

Rothman, Barbara Katz, “Reproductive Technologies and Surrogacy: A Feminist Perspective.” Creighton Law Review, 1991, pp. 1599-1607.