Policy Proposal Regarding Reproductive Technologies and Prenatal Testing in Sasquatch Community Hospital
Proposer Background: I am a 50-year-old Protestant Japanese American who immigrated to the U.S. at the age of 22. During my years in the U.S., I have become a proud mother of two children and have worked as a nurse practitioner. Having watched Sasquatch Community Hospital (SCH) grow from a small clinic to a major hospital in the State and from Catholic affiliation to non-denominational during my fifteen years of working here, I truly regard SCH as my second home.
Over the last few decades, Sasquatch County Hospital (SCH) has committed to a professional and national system of healthcare. The mission of the hospital is to serve and provide equal access to all people despite religion, race, and class in the name of the Father. Adhering to our original purposes greatly, we have seen the transition of SCH to a non-denominational hospital subsidizing medical care to under-insured patients. With the continuation to thrive for inclusive service despite financial circumstances, I therefore propose subsidies on abortion services, IVF treatments, prenatal testing for under-insured patients. To accommodate the different religious backgrounds of individuals, spiritual counseling should continue to be offered with Catholic clergy, and counseling from other religions ought to be provided as well. As the adaption to new regulations requires time and knowledge, training on cultural competency for staff members will be offered. It will also be necessary to offer literacy courses in pre-natal and in-vitro fertilization (IVF) for patients.
This policy proposal is not only written to make regulations, but also to reinforce the values of Sasquatch County Hospital, and most importantly, to define our stance among the nationwide bioethics discourse as a healthcare institution. Therefore, the notions of motherhood, social stratification, and limitation to mothers’ rights as well as the embodiment of embryo rights will be central to the discussion of these policies.
The Reduction of Social Stratification through Financial Support and Scientific Literacy
Informing and providing abortion services and prenatal testing to under-insured patients will reduce stratified reproduction. Stratified reproduction refers to the varying experiences of pregnancy based on financial resources and scientific literacy. Much scholarly research has indicated how pregnancy is not conceived, medically managed, or delivered on equal social terrain (Rapps 311). For example, the scientific literacy on genetic disorders of middle class Israeli women has led to their frequent use of pre-natal testing to prevent reproductive catastrophe (Ivry 243). Similarly shaped by scientific education, the majority of women in the U.S. are usually informed by biomedical statistics and utilize biomedical technologies to evaluate their risks in pregnancy (Rapp 317). “Risk analysis” requires not only the reasoning of “risk behavior” but also steps to contain the risks. While middle class women and families have opportunities to learn about heredity, genetics, and disabilities in many places, the under-insured patients may not be well-informed of all the possibilities and risks pertaining to pregnancy due to their disadvantaged socioeconomic backgrounds. Specifically speaking, while all women know to stop smoking during pregnancy, the monitoring of folic fluid to reduce incidence of spina bifida is most likely only shared across women of more scientific literacy. Similarly, the risks of many genetic disorders may appear ambiguous to women of disadvantaged backgrounds. Access to information about risks pertaining to pregnancy should not become socially stratified based on socioeconomic backgrounds. Therefore, we as a nationally renowned hospital ought to not only provide pre-natal testing and abortion to reduce such risks, but also to let all patients gain a scientific perspective on the potential risks.
Free courses on human genetic disorders, pre-natal testing, and other biomedical technologies should be provided on weekly basis. These scientific literacy classes could help women acquire equal access to reproductive information, allowing women to make the most informed choices despite their financial situation, and thus reducing stratified reproduction. As a result, subsidies on pre-natal testing, including amniocentesis, will be offered to the under-insured. As abortion may be a possible decision following a negative result on pre-natal testing, it will be subsidized as well (other reasons for abortion subsidization will be elaborated in following sections).
One may argue that people of disadvantaged backgrounds may garner alternative resources for accepting their misfortunes (Rapp 316). Therefore, they would not benefit from the increased “scientific literacy.” In other words, understanding and eliminating potential risks of pregnancy are ways for people to gain more control; however, people may have other ways to handle the contingencies of pregnancy by simply accepting it. For example, a study of poor women in the U.S. showed that they often consider “unplanned pregnancy” as a divine blessing beyond their control (Seeman 4). Similarly, some religions may provide individuals with “comfort mechanism” as people could seek strengths in God (Hamdy 146). I do not argue that such values of accepting fate should be replaced by rational scientific literacy to limit future risks. Particularly, I am not encouraging the use of pre-natal testing to reduce risks of pregnancy. In fact, the social and cultural factors taken into consideration certainly vary among women when they make decisions regarding pregnancy. I am arguing, however, that restricted access to scientific literacy and biomedical technologies should not be the cause of submitting to other options; by providing more scientific literacy and financial subsidies on pre-natal testing, we provide women with more access to helpful information. Equipped with more scientific knowledge and less financial restraints, women will be more empowered to make sensible decisions in their best interests.
The Right to Motherhood
In-vitro fertilization (IVF) should also be provided for under-insured female patients. Despite the diverse religious and cultural ideologies in Sasquatch county, motherhood is regarded as a state that is highly significant in a woman’s live. Women across all cultures make great effort to acquire motherhood. Therefore, it behooves us to remove the technical and financial impediments to motherhood. If physical conditions prohibit women from bearing children, IVF could provide them with the opportunity of motherhood; if financial situation is in the way of motherhood, we will do our best to provide the subsidies. The population in Sasquatch county consists of an Irish, Jewish, a mixed white and African American population, with growing influx of Lebanese Shitte and Japanese immigrants. According to the Protestant and Catholic understanding of the Genesis, women regard one of their missions in life as to “reproduce and multiply.” Similarly, reproduction is viewed as an “imperative religious duty” and even “honor and prestige of the family” within the view of Jewish women (Kahn 4 & 44). Borrowing language from the great protestant theologian Karl Barth, motherhood is “a basic form of humanity” (Meilander, 1641). Besides, the varying political views of pro-life and pro-choice activists even consent upon the significant meanings of pregnancy to women. As pro-choice activists view pregnancy as an essential right for women, pro-life activists view pregnancy as an indispensable responsibility embodying the uniqueness of feminism (Ginsburg 216). “Starting over ones live” and “blessings” are often associated to motherhood in the study of homeless mothers in the southeastern U.S. (Seeman 36). In other words, motherhood brings hope to woman’s lives, especially among the young and disadvantaged population. Women from different backgrounds not only consider motherhood as essential components of their lives, but also view it as an earned state. In the Japanese culture, the “Gamburu”, or “make an effort” ideology is embedded in the image of ethical self. Japanese women often bear the responsibilities of the babies’ nurturance to themselves and highly pride themselves for it. The avid users of IVF of both the Catholic and Jewish communities also demonstrate the eagerness of women to motherhood. Equal access to IVF is necessary as it will largely benefit Sasquatch county’s under-insured population by removing impediments to motherhood. Therefore, subsidies on IVF treatments to the under-insured should be offered.
Nevertheless, as one may argue that subsidies would result in the abuse of the technology, the subsidies on successful IVF treatments will only be provided once to each individual. In addition, IVF treatment will only be performed on women with no children. A maximum of three attempts is allowed for each patient. Attempts exceeding the indicated number will no longer be subsidized by the hospital. Subsidies on IVF treatments to conceive an additional child (more than one) will also not be offered.
The Limitations to Mothers’ Choices and the Embodiment of Embryo Treatment
The encouragement of embryonic donation for scientific research should be prohibited. As illustrated above, the choice of pregnancy, IVF treatments, prenatal testing, and abortion concerns the mother of the child greatly. In these cases, the mother bears the responsibilities for reproduction as well as the quality of life the child would have; therefore, they have the right to make choices in terms of their interests and their children’s. However, the decision of donating the embryo to research does not pertain to the interest of the mother at all. Instead, only the rights of the embryo ought to be considered in this case. In the book A Defense on Abortion, Thomson uses the analogy of one sustaining the life of a violinist by letting him use one’s kidney as a description of mother bearing a child. He argues that not providing the violinist with the kidneys is self-centered but not unjust as the violinist originally does not have the right to use it (Thomson 61). Similarly, if you decide to no longer sustain the life of the violinist, you do not have the right to determine whether the organs of the violinist should be donated or not. Thus, the decision of abortion is justified as the right of the mother. However, when the lives of the embryos’ no longer pertain to the mothers’ interests, the mothers do not have the right to choose for them. Therefore, embryonic donation should not be encouraged as it is not within the rights of the mother.
Furthermore, the encouragement of donating human embryos challenges our commitment to equality and humanity as medical institutions. As universally understood, the embryo is not “a clump of cells” but an integrated, self-developing whole, capable of the continued organic development characteristic of human beings (Kass 174). It is a state where we all come from. We could not simply ignore its potential development due to its insignificance. Humanism calls for greater respect and care for the weak. In other words, humanism shows “the inflexible principle that utter helplessness demands utter protection” (Kass 182). The way we treat the embryos signifies how we treat the weak in our society, thus setting the boundaries of humanity. As a hospital committed to humanity, or benevolence, the treatment of embryos matters significantly. Inhumane treatments create suffering of the embryo and embody the lack of compassion of SCH as a medical institution.
The limitations of the mothers’ rights to choose for the embryo and the humanism embodied by the treatment of embryos are central to the matter of embryonic donation. One may likely suggest that from the standpoints of scientific scholar communities, embryonic research advances our understandings of many biological processes. This is true. By gene modification and stem cell cloning from embryos, remarkable findings on genetic diseases have been uncovered (Kass 77). However, women undergo considerable stress after abortion, both mentally and physically. Regardless of how abortion was decided upon, it would still be emotionally challenging to render the aborted embryo to the hands of others. The emotional state of the woman deserves our serious attention when attempting to encourage embryonic donation. Encouraging embryo donation may do more harm than good in these cases. Although embryos may somehow contribute to the scientific community, the donation may become a lifetime regret for the woman since it was an encouraged or pressurized decision made during an emotionally unstable state.
Nevertheless, I would also like to clarify that the ultimate choice of embryonic donation lays upon the families themselves. Not encouraging embryonic donation merely suggests the position of Sasquatch Community Hospital as an institution that values humanity; as embryonic donation is a nationally lawful act, the policy of no encouragement is independent from any personal decisions on embryonic donation to scientific research.
Inclusive Spiritual Counseling
In order to reflect the Catholic Origin of Sasquatch Community Hospital, spiritual counseling should be continued but reduced to one Catholic clergyman. Additional counseling of other religions should be allowed but limited to one clergyman as well. As mentioned previously, our job as the hospital is to provide patients with equal information and access to reproductive strategies. Counseling by Catholic Clergy reflects Sasquatch Community Hospital’s current majority Catholic donor-base. The classes on assisted reproductive technologies and late term genetic testing echoes the mainstream American “risk analysis” take on pregnancy. Similarly, in order to balance the existing socio-cultural influences on patients, the voices of other religions ought to be heard. Patients from these other religions will find the spiritual counseling reassuring as some of their values will be reinforced in their decision making process. The dynamic input of other religions not only reinforces Sasquatch Community Hospital’s commitment to inclusiveness and diversity, but also leads to a broader nationwide discourse on biotechnologies, addressing biomedical issues as social issues (Braun, 47).
Inevitably, some medical staff have complained and will continue to complain about the Catholic Clergy or Clergy of other religions who interfere with their work by opposing assisted reproductive technologies. The class offered on weekly basis thus also serves as a medium through which the medical staff could express their professional opinions. As long as all sides have equal opportunities to express their views, the woman will be more empowered with her decision, no matter what she will choose. As medical staff and religious clergy, we ought to respect the decisions of patients no matter what their reasoning is.
The class material, however, should be reviewed by the committee every month in order to prevent the transmission of biased statistical information or inappropriate messages. Similarly, medical staff members are allowed to observe spiritual counseling sessions but are not allowed to intervene while the patient is in the room. Issues brought up in the biomedicine classes and counseling sessions will be reviewed by the Sasquatch Community Hospital’s ethics committee and further regulations will be proposed.
Due to their Catholic affiliation, some nursing staff would likely be unwilling to perform the procedures of abortion and reproductive services. It is thus crucial to provide the nursing staff with necessary training to develop their cultural competency and reinforce their responsibilities as healthcare providers acting on behalf of patients. Therefore, mandatory training to improve the understandings of different local cultures and religions ought to be provided for the staff members every month. Overall, the goal of the curriculum is not to convince staff members to become pro-choice activists. Instead, the goal is to enhance the understandings of how other genetic, religious, and cultural factors result in the consideration of abortion. While the staff may hold on to their religious beliefs concerning abortion, it is necessary for them to respect the choices originating from other belief systems. The specific contents of the training curriculum will be discussed and implemented by the ethics committee. With more appreciation of the distinctive socio-cultural forces affecting pregnancy, nursing staff may gain new perspectives to the local population they are serving and may become willing to provide abortion services.
If one still insists upon no provision of abortion and reproductive services, she or he ought to leave the obstetrics – gynecology department or leave the hospital. Other nursing staff from other departments of the hospital would replace the leaving staff member. Further replacement or hiring of staff members ought to reflect the mission of equal service and commitment to Sasquatch county’s diverse population. The feasibility of replacement of nurses by those of other departments or by new hires will be determined as we move along the process.
Dedication to reduce socioeconomically stratified healthcare, protection to the rights of women and embryos, and commitment to serve our culturally diverse population with compassion have been reflected in Sasquatch Community Hospital’s past. With thoughtful consideration and careful implementation of the above proposed actions, I believe that Sasquatch Community Hospital will continue to thrive on the path of serving the local population. Continuation of excellent service will thus attract an increasing number of potential donors from other religious and cultural backgrounds and more funding from local agencies and state government may be granted in the future.
With preservation of values through the implementation of the above policies, Sasquatch Community Hospital plays an essential role in the discourse on biomedical reproductive technologies. The proposal suggests that stratified reproduction, the right to motherhood, the humanistic culture embodied within an embryo, and various religious views have been our major concerns as a modern medical institution in the U.S. The policy proposed reflects our reasoning that obliges to the diverse interests in Sasquatch County. I therefore encourage other hospitals and clinics to refer to our policy and adjust it accordingly to accommodate their locally served populations. Lastly, I sincerely invite other healthcare institutions to offer their perspectives on the above policies as our voices matter significantly in the worldwide biotechnology discourse.
- Book of Genesis, chapters 1-2
- Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: AnInquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.”(Crossroad, 1988).
- Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel(Duke University Press, 2000).
- Rayna Rapp, Testing Women, Testing the Fetus(Routledge, 2000).
- Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine, Anthropology, Theory3 (2016): 29-54.
- Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community(University of California Press, 1989).
- Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs1 (1971): 47-66. Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel(Rutgers University Press, 2009).
- Gilbert Meilander, “New Reproductive Technologies: Protestant Modes of Thought.” Creighton Law Review (1991): 1637-46.
- Leon Kas, Human Cloning and Human Dignity(2002).
- Kathrin Braun, “Not Just for Experts: The Public Debate about Reprogenetics in Germany.” Hastings Center Report 35 (2005).