Kimberly Farmer- Final Proposal
Sasquatch Hospital is undergoing major policy reform in light of the decision to depart from the Catholic church and cater to community members of different religious denominations. Given the history of this hospital and the diverse community it supports, policy should be put in place to ensure that issues surrounding the hospital’s services, namely assisted reproductive technologies and prenatal testing, are addressed. In creating this policy, we, the hospital, will give community members the knowledge and autonomy necessary to choose their own medical treatment plans. I am writing this proposal as a member of the ethics board and a professor of ethics at Sasquatch University. In this position, my role is to solve conflicts and create a proactive policy in order to help the hospital accommodate to the needs of the community. I am trained to remain as unbiased and impartial as possible in order to support all individuals. Our plan is to create an inclusive environment that caters to all cultures and religious backgrounds without putting one above another.
One of the first issues to be addressed is whether to subsidize abortions and related services for under-insured patients. Private hospitals have the right to turn anyone away who they don’t think can pay. However, we need to consider the religious, financial, and medical components of such a decision. Only turning away patients who cannot afford abortions and related services makes a value statement against abortions that is rooted in the Catholic Church since the Church suggests “these technologies not only threaten but defy the existence and definitions of family.” (Bhattacharyya, 92). If the hospital is in fact non-denominational, it should either turn away all under-insured patients for all services, or subsidize all services for all uninsured patients. Such a clause will ensure consistency in the hospital’s values and proceedings. Arguments have been made explaining that abortions are too costly and therefore should not be subsidized in the interest of money. In the event that funds are too low, then there should be a monetary cut-off for all subsidized procedures. While we realize that not all abortions are the result of unsafe sex and unwanted pregnancy, we will have an on-site family planning counselor who can provide confidential advice to patients. This will slightly lower the risk of unwanted pregnancy and, in turn, lower the financial and personal burden of having an abortion. This argument is further complicated by the notion of medical necessity. That being said, all mandatory, life-saving procedures and emergency mental health care (as deemed by a physician) will be subsidized for under-insured patients at all times. Given that the hospital previously subsidized services for under-insured patients, and funds are adequate at the moment, the hospital should continue to subsidize abortion services. This would include IVF treatments and prenatal testing, including amniocentesis. This is because a non-denominational church wouldn’t have adverse feelings toward such treatments since some religions reflected in the community would prefer these services to avoid “reproductive catastrophe”. (Ivry, 243)
Hospitals should not encourage families to allow unused embryos for research. According to the Catholic Church, “The human being must be respected—as a person—from the very first instant of his existence” (Donum Vitae) meaning that there must be respect to human embryos. The Catholic Church has found that “by recent findings of human biological science which recognize that in the zygote resulting from fertilization the biological identity of a new human individual is already constituted” (Donum Vitae). This means that the unused embryos have either created or have the potential to create human life. Since the Catholic Church, which represents many community members, believes that embryos should be respected, they may not want to use them as a tool for research in a lab. Patients should have complete autonomy in their decision to donate embryos, and therefore, the service should not be advertised nor encouraged. Patients may be informed of such opportunities, but there should be no pressure or encouragement to comply as we want our patients to feel comfortable in the facility. Not encouraging embryo donation does not conflict with the hospitals view on abortion related services because in both cases individuals are aware of the opportunity, but have the ability to participate or not.
In terms of clerical counseling, services should be allowed since they can be very therapeutic during the process of undergoing medical treatment (Ginsburg, 37). However, these services should not be limited to Catholic clergy as all denominations should have representation to support the diverse community. Doctors have complained that Catholic clergy often persuade patients against reproductive technologies that doctors find beneficial. Such guidance is said to be interfering with the physician’s work. Clergy allowed in the hospital should be informed of their role to provide patient support and spiritual guidance, not medical advice. As stated in Testing Women, Testing the Fetus, “A counselor should, as a matter of principle, support whatever decision regarding testing and pregnancy outcome that a woman or a couple makes” (Rapp, 58). All counselor will be informed of their role and will be prohibited from offering strictly medical advice. In turn, physicians should respect religious beliefs and not force the biomedical model onto their patients. In terms of cultural competency, “particular religious or cultural traditions will be heard if the doctors are adept at hearing the voices of their patients” (Bhattacharyya, 24). As a hospital, we need to ensure that patients are being treated holistically and with respect in all aspects of their lives.
Hospital funders should be made aware of the policy changes when they are asked to continue their funding. We recognize that many of the hospitals funders are of Catholic faith and may disagree with some of the hospital’s offerings. However, the mission statement of Sasquatch Hospital reads as follows:
“At Sasquatch Hospital our mission is to cater to the needs of the community by providing comprehensive care and respect while exceeding satisfactory healthcare expectations.”
Therefore, donating to the hospital will be considered supporting the hospital’s mission statement. Once funds are donated, they can be allocated to any of the hospitals divisions. The hospital will host an event in the near future to network with funders of other denominations as well as donors that reflect the community’s demographics.
In terms of nurses, the hospital will need to have nurses that are capable of handling a multitude of tasks. However, the historically Catholic nursing staff may have reservations about performing the hospital’s new services. It is known that, “moral and ethical questions of concern to abortion activists are intertwined in the construction of self, social action, and historical experience” (Ginsburg, 197). Therefore, it is not the hospital’s duty to unpack all of the qualms, but to ensure a consistent policy that respects all backgrounds. A patient should never encounter a nurse that is unwilling to provide a service because of a personal belief. This is because in Sasquatch hospital we stand “for a position of ethical neutrality favoring personal choice in the century-old eugenics debate about society’s responsibility to encourage or discourage reproduction in certain individuals and families” (Rapp, 53). That being said, nurses who are unwilling to perform certain reproductive procedures will be placed in a ward where they will not encounter such tasks. Nurses should not be punished for having values that conflict with the position, however they still have an obligation to the patient. This means that nurses may not openly deny a patient treatment, but rather, speak to their supervisor to find an immediate replacement. From now on, nurses being hired will be asked about their willingness to perform reproductive services and current nurses will be asked to disclose their ability to comply with these procedures. Since most of the staff’s personnel is historically Catholic, there will be mandatory training to ensure that individuals will be able to address the community’s needs properly. We know that, “providing quality medical care necessitates cultural competency […] the ultimate goal is to encourage already clinically competent physicians, nurses, and other healthcare providers to be open and willing to learn about, respect, and work with persons from other backgrounds” (Bhattacharyya, 24). Since we do not have money for all new hires, will educate all healthcare providers so that they can provide inclusive and appropriate services. Ginsburg writes, “As with any political controversy in a complex society, the abortion debate changes quickly as both the local and national situation changes. (Ginsburg, 94). In order to create an inclusive, and long lasting policy, there should be a stable and sustainable policy that neither harms the patient or staff nor creates an uncomfortable environment.
In order to truly make this policy proposal reflective of our new community, we will continually receive feedback from patients, donors, and funders to ensure that our policy is efficient and ethically sound. While a defined policy is necessary, we will be most successful if our policy addresses and adapts to the lived experiences of our community members.
Bhattacharyya, Swasti. Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.
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.
Ginsburg, Faye D. Contested Lives : The Abortion Debate in an American Community, Updated Edition. University of California Press, 1989.
Rapp, Rayna. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. Routledge, 2000.
Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel Rutgers University Press, 2009.