The ethics committee of Sasquatch Mercy Hospital seeks to address research activities and patient care carried out within the hospital. With the recent transition from the hospital’s Catholic founding to one of religiously non-denominational practicing, Sasquatch Mercy Hospital has found itself needing to clarify and reevaluate prior hospital policies. In order to aid the ethics committee to reach a consensus on future hospital policies, I offer proposed policies changes for the committee’s humble consideration.
Before starting my proposed policies, I would like to establish my identity. I am an American graduate student in Philosophy. I am heavily influenced by the work of Aristotle, Agamben, and Foucault. While I will not explicitly address Foucauldian thinking in this proposal, I consider Foucault’s influence in my education to be profound. In regards to my ties to religion, I was raised in a Presbyterian household and continue to practice Presbyterianism.
I believe Sasquatch Mercy Hospital should follow a policy discourse that aims to remain non-partial to any specific religion. I propose we deviate from our Catholic founding in order to strive for nondiscriminatory hospital policies. This deviation is due to our hospital being the only major hospital within a forty-five-minute radius and the expanding religious and racial diversity of the local population.
In this proposal, I aim to address hospital policies regarding abortion, IVF treatments and prenatal testing, spiritual counseling, and hospital employee codes of conduct regarding administering potentially controversial treatments.
The hospital should provide and subsidize abortions for up to 13 weeks for underinsured patients. The hospital should continue to provide abortions past 13 weeks; however, should not subsidize those abortions to underinsured patients as the cost for an abortion increases the later the term. While it is my hope for all abortions to be subsidized, as I will argue that the rights of the woman trumps the rights of the fetus, I am cognizant of the budget restrictions that the hospital is currently under. Thus, Dilation and Evacuation (D & E) abortions, the most common procedure for ending pregnancy at 14-21 weeks, will not be subsidized due to the requirement of an anesthesiologist and the longer surgical time required in comparison to medical abortions (taken orally with a pill) or Suction or Aspiration abortions (a surgery that is roughly 15 minutes).
Diverging from the hospital’s Catholic founding that “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae), I propose the hospital to utilize Jewish legal thinking that “born human life is always given priority over human life in development” (Prainsack, 181). Thus, I argue, the rights of the mother should be prioritized over the rights of the fetus.
An Aristotelian understanding of natural inequality also influences my prioritizing of the mother’s rights—where there is a distinction between virtue in a moral sense and virtue regarding rights and political life. Aristotle in his Politics writes “… if it is impossible for a city to consist entirely of excellent persons, yet if each should perform his own work well, and this [means] out of virtue, there would still not be a single virtue of the citizen and the good man, for it is impossible for all citizens to be similar.” (Aristotle, 1984). There is a necessary inequality between individuals regarding the virtue of citizenship. Through this inequality, divisions of wealth and labor are created within the larger metropolis. In respect to the current American system—where citizenship is not given to everyone, our hospital takes into consideration the natural inequality of modern-day life. As the pregnant woman is in an unequal relationship with the fetus where she is the provider of the necessary nutrients and incubation for fetal development and growth, I argue that the rights of the woman should be prioritized over that of the fetus’. Also, the pregnant woman is more likely to be an already established member within society—where she is already considered a citizen and the fetus, even if brought to term, will not be given full citizen rights until it reaches 18 years of age. Thus, the principle of Aristotle’s natural inequality would place the mother in a higher hierarchical position than that of the fetus.
While the Aristotelian argument of natural inequality mainly applies to documented citizens, in order to be more inclusive of undocumented citizens and teenage mothers, I utilize the analogy of the state of exception. Agamben defines the state of exception where, “In every case, the state of exception marks a threshold at which logic and praxis blur with each other and a pure violence without logos claims to realize an enunciation without any real reference” (Agamben, 2005). The state of exception, synonymous to a state of emergency, allows one to disregard and transcend law for the greater good—relegating control and authority to a singular entity. In pregnancy, the pregnant mother undergoes substantial physiological and anatomical changes. These changes affect all organ systems throughout the woman’s body and have potential to be life threatening to the pregnant woman. Priya Soma-Pillay et. al examine the physiological changes in pregnancy, one example being, “Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery). The concentrations of certain clotting factors, particularly VIII, IX and X, are increased. Fibrinogen levels rise significantly by up to 50% and fibrinolytic activity is decreased. Concentrations of endogenous anticoagulants such as antithrombin and protein S decrease. Thus pregnancy alters the balance within the coagulation system in favour of clotting, predisposing the pregnant and postpartum woman to venous thrombosis [or a blood clot that forms in a vein].” (Soma-Pillay, Nelson-Piercy, Tolppanen & Mebazaa, 2016). Once a woman gets pregnant, her body enters a state of exception as her body becomes more susceptible to complications such as increased risk for blood clots, mental health conditions, high blood pressure, among other difficulties. As there appears to be a moral law against abortion, because pregnancy induces a physical state of exception within the mother, this moral law can be disregarded at the discretion of the woman. Thus, the hospital should recognize and treat the pregnant woman’s authority and decisions with the highest importance and regard.
Lastly, I would like to bring to the committee’s attention the historicity of the criminalization of abortions. Faye Ginsburg in her ethnography Contested Lives traces the history of abortion where “The push to criminalize abortion anytime after conception began in the latter half of the nineteenth century as part of a concerted effort by regular physicians to gain control of the practice of medicine in the United States” (Ginsburg, 2006: 25). However, prior to this time period, abortion was “relatively common as well as [an] accepted practice” (2006: 24). A study published in the Lancet medical journal in May 2016 analyzing abortion rates across the world found that abortion procedures were similar in number regardless of the legality of abortions. University of California San Francisco professor Diana Green Foster says, “The obvious interpretation [of the findings] is that criminalizing abortion does not prevent it but, rather drives women to seek illegal services or measures” (Foster, 2016). Thus, in order to protect pregnant women seeking unsafe abortions, it would be in the best interest of Sasquatch Mercy Hospital to practice legal abortions.
IVF Treatments and Prenatal Testing
Sasquatch Mercy Hospital should provide in vitro fertilization treatments; however, will not subsidize the costs to underinsured patients. This decision, similar to my reasoning for my proposed abortion policy, is purely due to the limits of the hospital budget. IVF treatments are significantly more costly than abortions and it would not be in the hospital’s best interest from an economic standpoint to subsidize IVF treatments at this current time.
Inhorn in her ethnographic account on reproductive technologies in the Muslim world writes, “New reproductive technologies, including donor technologies, seem to be giving infertile couples, both Sunni and Shi’ite Muslims, new hope that their infertility problems can be overcome, thereby increasing sentiments of conjugal love and loyalty” (Inhorn, 2006). I hope the ethics committee can recognize the benefits of IVF treatments on marriages and women’s agency, and feel the importance of providing IVF to patients that can afford it.
In regards to whether the hospital should encourage families to allow unused embryos to be donated for potentially life-saving research, I propose a mandate on notifying the patients of the option to donate; however, under no circumstances should hospital staff pressure patients to donate or not. I am cognizant that this suggestion might be in disagreement with the Catholic faith where human life is believed to begin at the moment of conception, which might be a cause of worry for the Catholic donors and nurses. I propose viewing an alternative way of thinking of when human life begins. In 2001, the Bioethics Advisory Committee in Israel issued a report regarding the ethics surrounding stem cell research. The report utilized the reasoning that “…embryos outside the uterus are not regarded as human life…” (Prainsack, 2006: 181). Thus, unused embryos not suitable for implantation in the uterus can be used for research, as those embryos are not considered human life and will not be able to mature into a viable human being. However, embryos suitable for implantation in the uterus should not be used for research due to the potentiality of its human capabilities.
Prenatal testing will be provided and subsidized for all underinsured patients. The option for amniocentesis for pregnant women will also be offered. I propose that prenatal testing and amniocentesis should not be required of all patients, but merely an option for women who would want additional information in regards to their fetuses’ development. Rayna Rapp in her ethnography Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America writes about women undergoing prenatal testing as “moral pioneers” who “submitted to the discipline of a new reproductive technology in order to reap its biomedical benefits” (Rapp, 2004: 307). Prenatal testing and amniocentesis give women greater awareness of potential situations that they may face with their fetuses, such as disabilities, which can allow women to mentally prepare themselves in bringing a disabled fetus to term. In response to prenatal testing being used as a reason to get an abortion, I propose providing women with information about taking care of children with disabilities and alerting them of local resources. This information should be given via written material as well through an on-site genetic counselor. Once the woman is well informed, her choice for an abortion is to her discretion.
The Sasquatch Mercy Hospital should continue to provide spiritual counseling via the Catholic clergy. I propose to expand the spiritual counseling program to include other religions in response to the changing demographics of Sasquatch, Connecticut. However, in order to address the slight conflict between the Catholic clergy and the doctors, all religious spiritual counselors must sign a contract to issue a verbal disclaimer at the start of each counseling session that their spiritual beliefs do not reflect the views or practices of Sasquatch Mercy Hospital.
Medical Employee Code of Conduct
Sasquatch Mercy Hospital respects and values its Catholic nursing staff. I believe that no nurse will be compelled to have direct involvement in a procedure she/he objects to based on her/his religious, moral, ethical, or cultural values. In compliance with Connecticut law that only a physician may perform an abortion (Conn. Agency Reg. § 19-13-D54), no nurse will be responsible for administering abortions. I propose all nurse staff to be required to undergo a cultural competency program in order to better understand the diverse religious and cultural backgrounds of the patients that they serve. I also suggest all nurses and physicians be made aware of the power dynamics involved from a patient-nurse perspective. Nurses are placed in a position of authority and trust with patients who are dependent on them for their healthcare. In order to work towards eliminating systematic discrimination towards vulnerable populations, I request the nurses and donors to reflect and think on whether their decisions are disregarding the rights of the people that they serve. After completion of the cultural competency program, nurses will alert the hospital of whether she/he cannot provide or aid abortion or reproductive services based on moral or religious grounds. Thus, the hospital will enact structural changes regarding reallocation of workload for nursing staff based on each nurse’s moral and religious convictions.
In the case that all current nurses state that they cannot aid in performing abortions, I propose an internship program for nursing school students at the nearby university. These nursing students will undergo training specializing in abortions and prenatal testing and will be dispersed within the hospital where needed.
As the hospital will not subsidize later term abortions and IVF treatments, I propose the creation of the Sasquatch Mercy Hospital Finance Committee. This committee will have the sole responsibility for managing the hospital budget in order to ensure that the hospital will be able to continue its operation for prosperity. The Finance Committee will be required to give bi-monthly briefings to all hospital staff regarding the hospital budget and allocate funds for new hires. In the case that Sasquatch Mercy Hospital’s Catholic donors will not fund the hospital, it will be the Finance Committee’s responsibility for developing a business plan and reaching out or partnering with various organizations in line with the hospital’s new policies.
In this proposal, I attempted to address the various issues that Sasquatch Mercy Hospital is currently facing. I prioritize the rights of the mother over the fetus utilizing Jewish legal thinking, Aristotle’s concept of natural inequality, and the analogy of Agamben’s state of exception. I encourage hospital availability of IVF treatments; however, due to the budget constraints of the hospital, do not see subsidizing the treatments for underinsured patients as economically viable—as IVF treatments are expensive and I am intending the loss of support from some Catholic donors in my proposed deviation from the hospital’s Catholic founding. In response to the possibility of all current Catholic nurses deciding not to assist in abortion and other practices against their religious beliefs, I am proposing an educational internship program utilizing nursing students to learn how to administer various medical procedures. Lastly, I propose the creation of the Sasquatch Mercy Hospital Committee in order to be responsible for hospital funding and budgeting.
While this proposal is controversial, I attempt to propose policies that I feel will benefit Sasquatch Mercy Hospital for the better.
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