Dear Esteemed Members of the Ethics Committee here at Sasquatch Hospital,
Sasquatch hospital is seeing an influx of women and men minority groups into our region of care; minority not for the color of their skin but for the religion that they believe. Ever since our founding, Sasquatch has been predominantly Irish Catholic—with this influx of newcomers our hospital is starting to see a change in reproductive requests. In conjunction with the state and our donor basis we aim to provide all of our patients with affordable and efficient healthcare—but as a community of historically Irish Catholics we cannot forget our faith and our morals when treating our new neighbors. Our donor base has been kind enough to aid us in the subsidizing of healthcare for underinsured patients but they have made it clear that they will not support our healthcare system if we begin to provide abortions to all those seeking them. They have also made it clear that if our efforts to provide our patients with successful reproduction go beyond the scope of the sanctity of marriage they will not be pleased.
To accommodate our new neighbors I propose that as a community we work together to be more supportive of young women and their reproductive decisions; a key component to this will be to provide abortions on a case-by-case basis wherein the family will have to meet with a reproductive health counselor in order to get permission to abort. Reproductive health counselors will be trained and hired from reproductive health counseling programs such as EngenderHealth. Trainees in programs such as this are taught to develop “knowledge about, skills in, attitudes toward, and comfort with effective communication and counseling in all areas of reproductive health,” along with training in “addressing the realities of and exploring the reproductive health priorities of the communities in a culturally appropriate manner” (EngenderHealth, 2003). Counselors will not be evaluated on their religion or political views; when doing their job their priority is to put the patient and their health and safety first. Counselors will work with each patient to make sure that the patient is fully informed of every opportunity surrounding unintended pregnancy—such as adoption. Counselors will conduct risk evaluations with each family seeking an abortion and will only approve abortions for pregnancies that are putting the life of the mother or child in danger. As a healthcare system we must respect the human body “as a person—from the very first instant of his existence” (Donum Vitae). Staying true to our faith, and the faith of our donors, we will respect the unborn child from the moment of conception and will keep it our priority to make the best decision for the life of the child and for the life of the family. We acknowledge both sides of the argument for and against abortion and we agree with Jean Carton that “abortion on demand erodes a sense of collective responsibility for the woman in actual crisis” and that supporting abortion mindlessly without “addressing the causes which make a particular pregnancy a problem [we leave] the woman in stress [to be] forsaken” (Ginsberg, 1989).
On the opposing side of this, we must also acknowledge that not all women in our growing community are Irish Catholics and that most women perceive a “tension…between human and divine agency” and that not all “women’s reproductive experiences can be clearly derived from particular religious doctrines” (Seeman, 2016). Due to these realities, as a healthcare system we must strive to meet every woman’s expectation of exceptional care when they arrive in our waiting room. Thus—we acknowledge that by either fully accepting or completely denying abortion services we will be turning a blind eye to some groups of people in our community. As the only major hospital in the surrounding area we would ideally like to accommodate all but, this is not a logistical reality. Thus I encourage you, members of the ethics committee, to find it in your hearts to realize that “binary taxonomies of intended and unintended pregnancy may elide important distinctions between unplanned, unwanted, or merely mistimed pregnancies,” and that “reproduction cannot be wholly scripted and that human attempts to do so are frustrated not just by caprice or bad planning but by the transcendent purposes and plans of divine agency” (Seeman, 2016). Our counselors will do all they can to provide patients with the tools needed to choose to continue with their pregnancies but in the case that abortion is the only answer for the patient, as decided by the patient with the help of the reproductive health counselor, we will provide the service.
In Vitro Fertilization (IVF), as a means of reproducing within a sanctified marriage, will be a procedure that we will allow done. With respect to our Jewish community and their halakha, we will make IVF “available to individuals who need assisted reproduction” (Broyde, 2005). Couples wanting to undergo IVF must first meet with a reproductive health counselor to get permission and must also use both the husband’s and wife’s gametes. This is the only way to keep the sanctity of marriage when using IVF, and the only way to respect our own historical faith and the faith or our donor base. The decision will inherently leave many infertile couples with the notion that our hospital is not supportive of their quest to procreate or serve as “social” parents (Inhorn, 2006). As an alternative to IVF for these infertile couples we will suggest adoption, or for our new Shiite neighbors—temporary polygamous marriage. We have made the decision to retain IVF treatments only for those couples who wish to do so in the sanctity of marriage not just for our Catholic donors but also to respect our Shiite neighbors whose Islamic roots “agree that it is absolutely forbidden to borrow sperm or eggs from a person other than the involved couple;” the borrowing of gametes is “seen as an act of adultery because the husband [or wife] will not be the true biologic father [or mother]” (Inhorn, 2006). Our Jewish neighbors, with their religious stake in the use of IVF, also see IVF as threat to their religious freedom—particularly that “the status of an individual as an inherent part of a particular family and as the child of a particular set of biological parents is crucial in Jewish Law” (Prainsack, 2006). As such IVF treatments are limited among observing Jews to be within the sanctity of marriage just as in Catholicism and Islam. Any couple who wishes to utilize IVF without adhering to our policies regarding the use of gametes will have to seek out these services elsewhere. In this way we are respecting both marriage and life.
Any unused embryos will be left to the discretion of the mother with three options: they can pay to have their embryos frozen and stored in which case they can use them when they are ready to get pregnant again, they can donate their unused embryos to stem cell research, or they can have their unused embryos inserted during a period where the vagina is not conducive to a fertilized egg. Although the Catholic Church has said that “destructive research on human embryos” is “intrinsically evil” and “must always be opposed” (USCCB, 2015) we have chosen to allow such research in the quest for great advances in stem cell research. The United States Catholic Conference of Bishops calls on all nations to “protect the right to life by seeking effective ways to” meet the basic human rights such as the “right to access those things required for human decency—food and shelter… [and] health care” (USCCB, 2015). Stem cell research respects the human life encapsulated in the unused embryo by allowing it to contribute to the common good of society by helping make possible life-saving treatments that have the ability to “combat diseases such as Parkinson’s, Alzheimer’s, multiple sclerosis and a number of other neurodegenerative diseases,” (Prainsack, 2006) and well as make healthcare affordable for those patients who would otherwise not have access to them. In all of the three options we consider and respect the life of the child and the soul of the mother.
In line with these beliefs amniocentesis’ and other prenatal testing will also be allowed. As a healthcare facility our first priority is both the health of the mother and the health of the unborn child—as such any tests that will make more apparent the health needs of the child will be allowed, but not encouraged. Our donors will be pleased to know that in this regards our stance highly aligns with the Catholic teachings presented in Donum Vitae, which states “prenatal diagnosis makes it possible to know the condition of the embryo and of the fetus when still in the mother’s womb. It permits, or makes it possible to anticipate earlier and more effectively, certain therapeutic, medical or surgical procedures. Such diagnosis is permissible” (Donum Vitae). Due to the slippery slope that may occur with the employment of these tests—all of our patients seeking them will have to meet with our reproductive health counselors to decide if prenatal tests are the right choice for the life of the mother and child. These tests can cause stress to the mother who is already under enough stress and can force her to make decisions regarding her pregnancy that she never would have had to make without the information these tests provide. In cases where the tests come back with results that reflect complications with the pregnancy or complications with the fetus, the mother and father of the unborn child will again meet with a reproductive health counselor to decide the best course of action—whether that be abortion or birth. Although the Second Vatican Council has stated that “abortion and infanticide are abominable crimes,” (Donum Vitae) we must respect the lives of the mothers and situational contexts in which the abortion would or should take place.
In addition to reproductive health counselors we will have social workers working alongside our medical staff, it will be the duty of these staff members to make sure that all of our patients are receiving the best medical care for themselves, their families, and their situations. We considered saying goodbye to our religious counselors and staff—but after much deliberation we have decided that their presence in Sasquatch hospital is both necessary to the wellbeing of our patients but also necessary to our Catholic heritage. Due to the influx of new denominations and from the complaints of the medical staff we have decided to hire more diverse spiritual counselors. These counselors can be sought after by our patients at their own will. Although our healthcare system is historically Catholic and we try to maintain this faith in all of our procedures, we will not subject our patients to our specific religious viewpoint during an already stressful time. All of our counselors, both spiritual and reproductive, will work to ensure our patients are exceptionally informed, happy with their decision, and trusting of our medical experts. As previously stated, any woman seeking abortion or an abortion-like procedure, must meet with our counselors anyway—in this way all of our patients should be informed from a well-being and holistic perspective. Those patients wishing to explore a more religious perspective, of any denomination, can do so within our healthcare system with the experienced and diverse spiritual counselors we will employ.
Due to our historically Catholic nursing staff we have received some inquiries about whether or not we will be forcing our staff to partake in the execution of procedures that are against their religion. This will not be the case. In order to appease both our staff and our donor base we will be initiating a system of referrals. Any abortion that is deemed necessary or acceptable, after informed deliberation between our counselors and patients, will be scheduled in our facility or will be granted a referral to another facility in a neighboring town. Using our limited budget for new hires we will hire one doctor or nurse that is certified to execute abortions—if for some reason there is no doctor or nurse eligible for hire, we will pay a doctor from the town of Swesquet (two hours away) to visit our facility twice a month to execute abortions. We have already been in communication with a doctor from Swesquet that would be willing to make the drive twice a month in order to aid our patients in their search for convenient and trustworthy healthcare. Again, if our hiring search for a doctor that would permanently reside in Sasquatch fails, the doctor from Swesquet would be introduced to our facility and put on pay roll. In this event, any patient who is in need of immediate care or cannot wait for the scheduled day will be given a referral to an abortion clinic or abortion friendly hospital in the nearest location. Although this will be an inconvenient trip for our patient they will have to both understand and respect our healthcare providers spirituality and agency in their decisions to deny abortion procedures.
We understand that our medical staff and you, our loyal donor base, have Catholic roots that are both very well respected in this community and that are the majority in Sasquatch but it is time we open our minds and hearts to the diverse groups of people that are choosing to call Sasquatch home. “If [our] doctors, nurses, and other healthcare professionals desire to administer quality, culturally competent care, they must take both their own and their patients’ religious perspectives and commitments into serious consideration” (Bhattacharyya, 2006). This is the goal of my proposal to you—to show that we can be both culturally competent and steadfast in our faith at the same time while also providing exceptional healthcare.
Thank you all for your time and consideration,
Dr. Marmeno
Works Cited:
- Congregation for the Doctrine of Faith, “Donum Vitae: Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation: Replies to certain questions of the Day”. (1987).
- Bhattacharyya, Swasti. A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.
- Broyde, Michael J. Marriage, Sex, and the Family in Judaism. Rowman & Littlefield, 2005.
- Comprehensive Counseling for Reproductive Health: An Integrated Curriculum. EngenderHealth, 2003.
- Ginsberg, Faye D. Contested Lives: The Abortion Debate in an American Community. University of California Press, 1989.
- Inhorn, Marcia. “‘He Won’t Be My Son.’” Medical Anthropology Quarterly, vol. 20, no. 1, 8 Jan. 2008, anthrosource.onlinelibrary.wiley.com/doi/abs/10.1525/maq.2006.20.1.94.
- Prainsack, Barbara. “‘Negotiating Life’: The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel.” Social Studies of Science, vol. 36, pp. 173–205., journals.sagepub.com/doi/pdf/10.1177/0306312706053348.
- Seeman, Don, et al. “Blessing Unintended Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine Anthropology Theory, vol. 3, no. 1, pp. 29–54.
- United States Conference of Catholic Bishops. Forming Consciences for Faithful Citizenship. USCCB, 2015.