Dear Sasquatch Connecticut Ethics Committee,
As a new member of this committee, I have written a policy proposal on the use of assisted reproductive technologies and prenatal testing for our hospital. My previous position on the Ethics Committee of the Medical Board at the Mount Sinai Hospital allowed me to gain experience in a diverse community. Being one of the few female doctors on the ethics committee at Mount Sinai, I learned that at times one must put the patient’s needs over their own personal views or the views of the majority. It is often difficult to make policy decisions that pleases everyone when it comes to controversial topics, such as assisted reproductive technology and prenatal testing. In a hospital that recently became non-denominational in a varied community that is seeing an influx of minority immigrants, its policy should reflect what patients need. The more services the hospital provides, the more patients and potential donors it will attract. A variety of services will increase patient satisfaction; however, the convictions of the healthcare provider should still be considered. Therefore, my proposal would attempt to find a middle ground where both our predominantly Irish Catholic donors and diverse community will be content. It would be insensitive for a healthcare provider that provides services to patients of different backgrounds and beliefs to have one unwavering view for hospital policies. The goal of a hospital should be to improve outcomes and create more satisfied patients.
After reviewing my initial hospital policy on abortion, I have decided to make some changes. I acknowledge that the donor base is still prominent Irish families, who will most likely have a Catholic stance on abortion: “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae). However, the community is not made up of only Irish Catholics and the hospital should accommodate women in the community not of the same religion or beliefs. In hopes of reaching a middle ground, the hospital will not be providing abortion to the general public but only for extreme circumstances. These extreme circumstances that the hospital deem acceptable for abortions include pregnancies from rape and pregnancies that jeopardize the mother’s life. Although the hospital will offer prenatal testing, regardless of the results patients will have to go to another hospital if they want to abort their unborn child. “If pregnancy is highly risky, birth seems even more so”; therefore, for us as a hospital we need to do right by the patient (Ivry). If a mother’s life is in danger, the hospital can abort the unborn child out of self-defense. Rights advocates would say that one must consider the fetus’s rights as a person; however, if killing in self-defense is not punishable then aborting an unborn child that is killing the mother should not be condemned. What about the rights of the mother? This same question applies to whether or not it is okay to abort a fetus resulting from rape. The mother’s rights were violated when the rape occurred. It would be cruel to add insult to injury and make the mother keep the baby as a constant reminder of the rape. Some will argue that by aborting the fetus, there would be two instances of rights violation instead of one. For Pro-Life supporters, abortion is murder. However, if the potential mother cannot get an abortion her original life is “ending” in a way as well. Her life could potentially be ruined and forever changed, not by her own volition. For these extreme cases, the hospital will subsidize abortion services for under-insured patients.
As for In Vitro Fertilization (IVF), Sasquatch Hospital will only provide treatments for husbands and wives that are looking to start a family. According to the Catholic Church, artificial reproductive technology goes against “natural” law and Scripture. Those people that are faithful to the religion should not use artificial reproductive technologies. Since the Church associates IVF with abortion because during IVF not all embryos are implanted; therefore, an “act against the life of these human beings” (Shannon and Cahill, 154). However, it is acceptable for a husband and wife who cannot conceive to seek other options such as IVF. The prominent Irish Catholic donors should not take issue with these conservative terms and continue to donate to Sasquatch Hospital. Similar to Israel, where IVF is subject to both medical and Jewish religious oversight Sasquatch Community Hospital will offer religious counseling for patients. The interpretation that reproduction is an “imperative religious duty” prevalent in the Jewish community would encourage people to support IVF (Kahn). The option for IVF will also benefit the Lebanese Shiite and Japanese immigrants. This condition that IVF at Sasquatch hospital can only take place between a husband and wife also satisfies the religious beliefs of the Lebanese Shiite since “most Shia scholars […] argue that the act of fertilization of the woman’s egg with the sperm of a man other than her husband’s is not allowed” (Naef). The child will be considered illegitimate depending on whether or not gaze or touch occurred.
A few years ago, Athersys, a biopharmaceutical focused on stem cell research approached Sasquatch Hospital for a collaboration. The deal was that Athersys would donate funds to the hospital if doctors encouraged patients to donate their embryos to potentially life-saving research. This collaboration will be made transparent to all of the participants/patients and they can opt in to donate their embryos or pay to freeze them for later use. This potentially life-saving research can also lead to a more efficient and less invasive prenatal testing while also helping out the hospital. Since only one embryo is carried to term, the rest would either be disposed or frozen. If “extra embryos are frozen and can be kept over a period of several years for later use without significantly losing their potential develop successfully into human beings through pregnancy” then we should not let this potential go to waste (Eich). Similar to how society condemns human testing unless given informed consent one can argue that no consent was given by the donated embryo therefore a violation of rights. One opposing view is that the hospital is obligated to abide by “the inflexible principle that utter helplessness demands utter protection” (Kass). The question is at point does one considers the embryo a human being and whether or not an embryo deserves to be treated with respect.
Prenatal testing such as amniocentesis will be offered to women and families who want to reduce contingency. However, as a hospital in a predominantly Irish Catholic community we want to emphasis that these genetic tests are done not for the purpose of terminating difficult pregnancies if there is a defect but more so to allow families to make arrangements early in light of the knowledge. The hospital will not push mothers to undergo amniocentesis but they will be made aware that it is an option. If a family has a history of birth defects then and only then can the doctor suggest to the mothers to undergo prenatal testing. Since “Japanese ob-gyns are often reluctant to mention prenatal diagnosis even to older women […] some of the Israeli ob-gyns I interviewed said that they offer prenatal diagnosis to each and every patient, regardless of her age” (Ivry), the doctors at SCH will allow the patients to make the decision themselves. With this policy, I was hoping to help the Japanese immigrants feel less of a culture shock. Making prenatal testing available will also allow mothers in the Jewish community to have agency in their pregnancies.
In addition to social workers and genetic counselors, Sasquatch Hospital previously provided spiritual counseling by the Catholic clergy who often interfered with some doctors’ work. I propose that we either discontinue this in-house spiritual counseling by Catholic clergy unless we allow other religions to have counseling as well. This clash between the medical staff and the Catholic clergy does not provide a healthy environment for the patients. The fact that the Catholic clergy are interfering with patient care is unacceptable especially if the patient is not even part of the Catholic community. Bringing in other spiritual counselors of different religions such as Islam and Buddhism, Judaism will make our diverse community feel included.
The hospital’s historically Catholic nursing staff that refuse to perform these procedures can put in a request to be transferred to a different section of the hospital. Since Sasquatch Community Hospital is only offering abortions to extreme cases, switching out nurses should not be an issue. Since the budget for new hires is extremely limited, the hospital cannot replace all of the nurses and the alternative would be to transfer nurses from different wards of the hospital. I understand that it may be uncomfortable for the nurses who are devout Catholics to assist in performing these procedures but I would like them to kindly reflect upon the reasons they chose to become a nurse before asking for a transfer. If their convictions against abortion for extreme circumstances trumps helping their patients then they should request a temporary transfer. These abortions will adhere to the principle of beneficence, where medical intervention is done to make the patient better. The principle of beneficence and the principle of autonomy will hold for all procedures done at Sasquatch Community Hospital.
Works Cited (and Consulted):
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).
Shirin Garamoudi Naef, “Gestational Surrogacy in Iran,” In Marcia C. Inhorn and Soraya Tremayne editors, Islam and Assisted Reproductive Technologies (Berghahn Books, 2012).
Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).
Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).
Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66.
Leon R. Kass, Human Cloning and Human Dignity (2002).
Thomas Eich, “Decision Making Processes among Contemporary ‘Ulama’: Islamic Embryology and the Discussion of Frozen Embryos.” In Jonathan E. Brockopp and Thomas Eich, Muslim Medical Ethics From Theory to Practice (University of South Carolina, 2008), 61-77.
Arthur Kleinman, “Moral Experience and Ethical Reflection: Can Ethnography reconcile them? A quandary for the new Bioethics.” Daedalus 128 (1999): 69-97.