Final- Shauna Kupershmidt

Health and illness are both complex and broad terms that people understand differently based on a variety of disciplines such as culture, religion, profession, gender, and more. When we take into account culture and religion, there is so much overlap and simultaneously contradicting ideas between the two. As a member of the committee of ethics for Sasquatch hospital, I aim to take advantage of the fact that our hospital is now non-denominational. While it is important to value the predominant religion of the donor base (Irish Catholic), my aim is to encourage them to value the diverse religious demographic that this hospital will attract. We have patients from various religions and cultures including Jews, Muslims, African Americans, and Japanese immigrants. It is crucial to delve deeply into the complications and foundations of both culture and religion in order to provide the best healthcare possible. As a member of the ethics committee, I will be focusing on similarities and differences between these two facets of the human condition in order to form the most well-rounded policies and regulations while retaining the value and importance of the diverse background and history of this hospital, the patients, and the staff. Transition in regulation and policy is always challenging especially when it comes to sensitive and controversial topics.

Abortion is a procedure that is perceived very differently by individuals, religion and culture. Different cultural and religious beliefs play a large role for many individuals in their formulation of opinions on abortion. Since the Catholic church has recently allowed the hospital to become non-denominational, I believe this topic should be addressed through a more personalized, patient-care lens rather than a religious lens. In the book Contested Lives: The Abortion Debate in an American Community, author Faye D. Ginsburg looks at both the pro-life and pro-choice side of the abortion debate. Striking to me in this debate is that pro-life individuals believe that the foundation and cause of abortions are based on the idea that abortions are due to irresponsible choices such as unprotected sex. Additionally, abortions can be very risky medical procedures and should be done only by doctors in a hospital (Ginsburg, 1989). Our main goal as a hospital should be keeping patients as safe and healthy as possible. It is important to recognize that Ginsburg is analyzing abortion in America, a country with a multitude of religious and cultural backgrounds, which makes the abortion debate that much more challenging to address. We have talked extensively about control and the importance of having control of your own body. Pregnancy is a very vulnerable time in a woman’s life as they are adapting to their body changing. If they don’t have autonomy over their body, they lose their right to choose the type of medical care they want. Furthermore, if they do not have the financial means of obtaining such control, they risk bringing in more people to this world that will also suffer their financial burden. It is our responsibility as a hospital to help women make the most informed decision for themselves and for their potential offspring. By giving them resources and support to procedures such as abortions, we prevent them from bringing unsupported life of human beings into the world.  It is our duty to protect patients and provide them with the services they need to feel well and healthy. If women are put into circumstances where they have to bring children into this world without the will or means to do so, we are neglecting our values and mission as a hospital. In addition, it is crucial to acknowledge the complexity behind abortions and the decision-making process of bringing new life into this world. Judith Jarvis Thomson brings forward valuable insight on understanding abortions through a more holistic lens rather than simply distinguishing an embryo as human or not. She emphasizes to look and understand the decision beyond the fetus, by focusing on the experience the mother could be having. She brings up an analogous circumstance where a famous violinist’s circulatory system is plugged into a woman and if she unplugs herself from him before nine months, it would result in his death. She states a hypothetical response from a hospital director: “tough luck, I agree, but now you’ve got to stay in bed, with the violinist plugged into you, for the rest of your life, and violinists are persons. Granted, you have the right to decide what happens in and to your body, but a person’s right to life outweighs your right to decide what happens in and to your body”(Thomson, 2007). This comparison is extremely powerful and outlines the consideration we must have for woman as patients and their needs. Donum Vitae emphasizes that as soon as the embryo forms, it should be regarded as a human being (Congregation for the Doctrine of Faith, 1987). For patients who view an embryo as a life from the moment of creation, we must respect this belief and give the patients control to move forward with their pregnancies. Similarly, the same choice should be granted to those who believe otherwise. Tsipy Ivry addresses pregnancy from an interesting cross-cultural, comparative perspective, focusing on geneticism versus environmentalism (Ivry, 2009). There is so much cultural influence, almost to the point where it takes away the individualistic aspects of pregnancy. Because of the overpowering and contradictory influences when it comes to abortion, I believe individualism, control, and accessibility for the women should be prioritized over culture and religion when it comes to abortion.

Both personally and professionally, I strongly believe that individual choice ought to be paramount yet only when a person has full control and awareness. I think abortion is a women’s choice because the fetus is not aware of what is going on in their environment. In the case of terminating a born child, there is a level of awareness and connection to the outside world. The born child has made a physical connection with the world around it and now has autonomy of their body, no longer attached to their mother through an umbilical cord. Also, in the case of born children, adoption is a viable option. If the mother is unable to take care of her child, there are many couples in the country that have fertility issues and would be willing and able to be parents. In the case of euthanasia, if the person is mentally conscious and aware of the decisions they are making, it is their right to terminate their life. They are suffering anyways, so they should have control of how they leave this world. The way we approach these complex topics does not necessarily have a right or wrong answer but there is a definitive point in time where we begin having awareness and when we end having awareness. The beginning only takes place when there are a connection and some sort of interaction with the outside world both physically and mentally. When I think about procedures that have the potential to end life, it is the respect of individuals total awareness that takes precedence over religious ideals and laws. Leon R. Kass’s frame of thinking resonates with me deeply when he explains how we should interact with the patient’s experience:

“Our first listed function is deeply philosophical, anthropological, and cultural, and it gives this Council a novel orientation: we are charged first not to judge whether deed “x” or “y” is moral or immoral, or whether technology “p” or “q” should be funded or banned. We are summoned to search into deep human matters in order to articulate fully just what is humanly at stake at the intersection of biology and biography, where the life lived experientially encounters the results of life studied scientifically” (Kass, 2005).        

Birth and death are very life-altering experiences for the individual as well as for their loved ones. Because of this, it is imperative that individuals have the means to make knowledgeable decisions about their body and that even in the most unpredictable and uncertain circumstances, we grant accessibility and control to our patients.                        

In Vitro Fertilization (IVF) treatments and prenatal testing also should be considered with a woman’s desires for reproduction both currently and in the future. The same idea of control that women should have abortion applies to IVF. The only difference is that that it comes from a standpoint of creating a life rather than ending one. Usually, people who undergo IVF treatment have the intention to reproduce while women undergoing abortions for various reasons have the opposite intention. The focus of reproduction is very prevalent in certain religions, especially in Judaism. According to Susan Martha Kahn, Reproduction is valued so much so that individuals in Judaism are encouraged not to stigmatize offspring born through incestuous relationships or from non-married couples (Kahn, 2000). Kinship and the way various groups understand it differently influence the implantation of IVF treatments. Depending on how we understand kinship, we are likely to support such treatments or fully contest them. For example, if we can understand kinship as strictly nuclear or consanguineal, IVF could have negative implications because we may not “know” who the father is. However, for our Jewish patients it is important we value their emphasis on reproduction and provide the means for them to be able to reproduce.  In the chapter “Ethnography, Exegesis, and Jewish Ethical Reflection: The New Reproductive Technologies in Israel” author Don Seeman heavily focuses on the importance of reproductive technology in Israel. He points out a strong religious disagreement between Jews and Christians on the topic of “traditional” marriage and reproduction:

“There is no reason to deny that Jewish Orthodoxy today also holds up this kind of marriage as an ideal, but the halachic or Jewish legal grounding for claims about it permitted and forbidden reproductive practices begins not with Genesis but Leviticus, whose largely non-narrative focus on rules of consanguinity and rules of purity constitutes the main corpus of biblical kinship norms that underlie later Jewish family law. This simple fact is one of the reasons that Jewish law experts (passim) have tended to be so much more favorably inclined towards artificial reproductive technologies than many of their Christian counterparts, just as the State of Israel has been more supportive than many other Western states” (Seeman, 2010).

This is a clear example of how impactful differences in interpretation of religion, law, and text can lead to drastically opposing perspectives on reproductive technology. In order to provide patients with equity in getting the kind of treatment they believe is right, we as a hospital will allow IVF for patients who wish to receive it. Fundamentally, our goals are to provide the best care for patients. If we deny our Jewish patients IVF, we are essentially ignoring one of their main beliefs which is accessibility to reproduce. However, as a hospital, we also have to be able to run a business financially. We will not be subsidizing IVF treatment. While we respect patient’s religion and culture, there must be a level of personal accountability. One of my main goals is for patients to feel in control of their own decisions and beliefs, but we cannot always take responsibility for supporting that control financially. When it comes to abortion, there is not an effective alternative to value everyone’s beliefs besides granting them the procedure regardless of finances. In contrast, when it comes to reproducing and creating a family, based on certain kinship perspectives there are alternative ways to create a family such as adoption. As amniocentesis has the power to impact the mothers and baby’s health in a transformative way, we will subsidize this procedure on the premise that other standard tests show risk factors that would call for amniocentesis. When it comes to unused embryos, that is a personal decision for the patient and their family. If we are aiming to provide a well-rounded treatment approach, encouraging potentially counter-cultural and religious actions would promote the opposite from our end. In Geetz’ article, Geetz argues that there is a sense that culture is a mechanism that drives everything. However, in this case, I would stand by the idea that there are personal concerns that aren’t reducible to culture (Geetz, 1973).

Social workers and genetic counselors will remain to be integral employees of our hospital. We will keep spiritual Catholic clergy, but we will also be adding representatives from all of our patient pool’s religions. This way we will simultaneously respect our donor group’s faith but also successfully broaden our policies and resources for our other patients. We will implement strict regulations for these employees in order not to impact negatively the patients’ care by interfering with the doctors. It will be optional for patients to seek counsel for their treatment, but the counselors will not be allowed to interact with the doctors directly. This will support the individualized control of the patients that we are aiming to attain and will allow the doctors to do their best work. The counseling services will be optional for the patients, and perhaps this optional service can alleviate some pressure and stress for the patients. For example, Japanese mothers who are more familiar with an environmental approach to medical practice may lack this approach in an American hospital. If they have access to some personalized guidance, they can experience a more fulfilling treatment. In the article “Does Submission to God’s Will Preclude Biotechnological Intervention?” author Sherine F. Hamdy focuses on organ transplant in Egypt among religious leaders, physicians, and patients. Hamdy emphasizes a strong ethical conflict that patients face with this procedure. While it is not directly linked to the rules of their religion, the story of the two men declining this procedure does stem from their connection with God. This dichotomy is complicated, and at scenarios like this, personalized religious/spiritual counseling could potentially provide critical support to the patients. (Hamdy, 2012). There is a level of concern I have with bringing in various leaders in unintentionally creating extra tension and conflicts internally between the staff. I will address this by creating extensive training prior to bringing on the new team.

Lastly, managing staff under new regulations and policies results in challenging obstacles. For the nurses that are unwilling to perform these procedures, we will need to replace them. While the hospital used to be affiliated with the church, it is important to recognize and respect the separation. I hope that with respecting the beliefs of Catholic donors in other ways and by also respecting all of the various beliefs our patient pool brings in, the donors will be willing to increase the budget for new hires. We cannot move forward in respecting all patients’ values and beliefs if we have staff who is unwilling to cooperate. As one of my main goals is placing treatment in the patients’ control and making the treatment as individualized as possible, keeping the nurses who refuse care will counteract that entire effort. If there is no possible way to increase the budget, we will have to hold off hiring a new team of spiritual/religious counselors. While I believe this would be a very beneficial asset to our hospital, having cooperative nurses would take priority.

In efforts for the smoothest and most efficient transition, there should be full transparency between the donors, board, and physicians. If we want to implement new policies and regulations successfully, we will have to continuously respect and value everyone’s personal beliefs and focus on providing the best medical care we can.


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