Month: April 2018

The three readings this week dive into the conversation regarding who is able and justified to make bioethical decisions. Leon Kass is the chair of the President’s Council of Bioethics who takes a conservative viewpoint of bioethical issues. He was criticized greatly by the public for his role as the chair. In his piece, he promotes the diversity of the Council and how that justifies the decisions that are made within the group. On the other hand, Ruth Macklin attacks the new conservative movement in her piece. She states that there was never a distinction between political ideologies in bioethics until voices from this new movement joined the conversation. Finally, Kathrin Braun is a professor at the University of Vienna. In her piece, she compares American bioethics to German bioethics. She denounces the role of politics in bioethical debates and states a different two-party system and their beliefs. Her piece is a great ending to the other two articles we were assigned to read for this week. Some main points argued include the idea that the experts in this field should only be scientists, while others believe that there should be a broader approach to ethics. I was able to understand and comprehend all three of these readings. They were all straightforward in the points they were trying to make.

In the first reading for this week, Leon R. Kass uses his own personal experience to outline the mission of the President’s Council of Bioethics, he discusses its public ways of working, and reviews the Council’s five major works during their first term. The panel was empowered to answer questions about research and bioethical technology to inform policy makers. The President’s Council of Bioethics has been the center of controversy for many years in the public’s eye. That being said, Kass’ mission in writing this article is to explain to the public the inner-workings of the Council, in order for a better understanding of future decisions made by the Council. Kass writes, “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” (Kass, 224). This quote demonstrates that Kass is showing the mission of the President’s Council of Bioethics.

He then goes on to demonstrate the diversity of the members of the Council to prove that their decision making is unbiased. He states that some members are social scientists while others are physicians. He goes on to mention the different religious and political backgrounds of each member as well. Though, no one on the committee is a representative of their own religion. I think this is a good point to make to the reader, in order to validate the conclusions made by the Council regarding hot topics like abortion and cloning. Noting the diversity and different backgrounds of the Council will help to ensure that all viewpoints are heard and taken into account.  Kass writes in a way that makes the reader believe that there is a full range of different backgrounds found within the panel. However, as we mentioned last week, there isn’t that much difference between some of the panel members. Later in the piece, Kass argues that organizations like the President’s Council of Bioethics are necessary in society “to help protect society’s basic values” (Kass, 241). He then goes on to mention counter arguments like laissez-faire ideas and solely legislative practices, and the problems that arise with those practices. Some of those problems include that the market dictates what is guided in laissez-faire ideals, and legislation can only be suitable for certain bioethical cases, and cannot be administered to all (Kass, 241). One issue I can see with using committees to inform policy, includes the strengths that Kass was talking about. I think that with the different beliefs and backgrounds found within the board members, making cohesive decisions might be very difficult to achieve. Other criticisms of the Council include the inclusion of public intellectuals on the panel that have the same right to opinions as do some of the biochemists who also take part.

On the opposite end of the spectrum, Ruth Macklin takes a liberal approach to the new conservative movement found in bioethics today. She wrote this piece for a general audience and those who are interested in the current political climate. Her tone of voice is very apparent in this piece and her distaste for the separation of sides that conservatives have brought into bioethics. In “The New Conservatives In Bioethics: Who Are They and What Do They Seek?” Macklin discusses this new movement, identifies who the conservatives are, and what characterizes their position. She argues that there have always been contributors to bioethical debates from all sides of the political spectrum. Before, there was no distinction between political party in the debates. Now, there are voices who are labeling themselves conservatives, and who are critiquing the “liberal” tradition of bioethics (Macklin, 34). Now that republicans dominate two of the three branches of government, their political ideologies are manifesting into other forms of control, moving into the bioethics sphere. This once non-political realm is becoming one separated between liberal and conservative viewpoints. Macklin takes issue with the mission statement delivered by a prominent conservative bioethicist, Yuval Levin, “to prevent our transformation into a culture without awe filled with people without souls” (Macklin, 37). She then states that the implications of this mission statement place the United States on the brink of disaster without this Council. I think it is important to remember that overall, the process of ethical debates is something that should be respected and worthwhile. Even if your own personal opinions are not the ones that influence the ultimate decision, the process itself requires a commitment to respect views that are not our own.

Katherin Braun takes a different viewpoint of ethical debates. In her article, “Not Just For Experts: The Public Debate About Reprogenetics in Germany” Braun distinguishes the differences between Germany and American bioethics committees. This piece was written for the public and argues that ethics in Germany is unlike the politically motivated ethical committees in America. She mentions the “The Bioethics Debate” that was held in Germany in 2000 and 2001 and how this proved that policies should be informed by ethical considerations. However, American policies are divided to either liberal or conservative sides, or “modernity or anti-modernity” (Braun, 43). In Germany, she distinguishes not between two political ideologies, but rather of techno-skeptics and techno-optimists. These oppositions do not coincide with liberal and conservative ideas, they simply “promote different interpretations of the problem at stake and different ideas about how to handle it” (Braun, 43). I think Braun makes a good point in her article that many aspects to American culture have now become political. Braun mentions how most debates take either a left or right approach in the States. It would be pleasant to experience a nation that was more unified on certain topics rather than so harshly divided.

 

Some Questions to consider:

In the United States, should Congress take full responsibility for health policies that are made? Or should that responsibility fall on specific experts in the field?

Is it possible to remove politics from certain aspects of American culture, for example how Braun is suggesting?

Within human cloning lies great potential for change, in orders of magnitude greater than anything else discussed so far in this class. By examining the arguments from this week’s readings, one is able to explore a wide variety of topics that extend far beyond what is apparent upon first glance. Before reading these articles, I felt any argument on human cloning would be relatively simple, and comparable to the other bioethical dilemmas we had discussed in class. After reading this week’s articles, I found by exploring the ethical, moral, and technological ideas behind human cloning I was able to gain insight into a vast array of issues. None more so than science’s role in society, and under what framework such dynamic and complex issues such as human cloning and should be examined.

Those ideas are explored in one way or another in each of the readings assigned this week, but “Human Cloning and Human Dignity” takes the most comprehensive view at the subject. This book was written by a committee appointed to the task of advising the President of United States George W. Bush on potential regulatory actions that may need to be taken against human cloning, as well as to give the American public a comprehensive idea of the moral and ethical dilemmas surrounding human cloning. What is unique about this piece in comparison to others we have read is that it does not have a single author, and rarely does the committee speak as one. Rather, they speak as a myriad of voices coming from a number of disciplines who share different perspectives on the subject of human cloning. Each person on the committee casts a vote towards different solutions to the variety of problems brought up in the book. The two main issues explored by the book are the use of human cloning for reproduction, and for biomedical research. The arguments for both were extensive and well thought out, but the topic shared by all of three articles is that of human-cloning-for-reproduction and therefore will be the one explored here.

The conclusion of the president’s committee was to place a lifetime ban on human cloning for reproduction for a variety of reasons. The main one being that by changing such a fundamental part of human reproduction numerous untold consequences could occur that our present systems of moral reasoning were not yet capable of handling. The magnitude to which it could change the view of what a family or even a human looked like, coupled with its limited use, were at the forefront of the committee’s argument against using human cloning for such purposes. The committee took such a staunch view of using cloning for reproduction that it did not even attempt to fully reconcile the discrepancies it saw using human cloning for reproduction may produce.  Rather, it states that “lacking such understanding no one should take action so drastic as the cloning of a human child.” The committee felt that the actions of a very few could thrust humanity into “uncharted waters without a map or compass.” As such, they advised that it was the United States’s imperative to put a lifetime ban on all human cloning for reproductive purposes, regardless of any circumstances.

Both “Cloning People: A Jewish Law Analysis of the Issues” and “Negotiating Life: The Regulation of Human Cloning and Embryonic Stem Cell Research” take far more limited views. Rather than attempting to analyze the impact human cloning for reproduction may have on all of humanity, they sought to view it through the moral reasoning of Jewish family law. From this vantage point the issue looked quite different than the way it did in “Human Cloning and Human Dignity” for a variety of reasons. The goal of the papers was not to look at all the different avenues which may arise from the journey and completion of the project of human cloning, but rather to only answer the question of whether human cloning for reproduction was morally permissible for Jewish communities. In the case of “Cloning People: A Jewish Law Analysis of the Issues” by Micahel Broyde, this new point of view provided for an interesting conclusion, and one that seemed a slightly “non-chalant” given the scope of the issue at hand. Rather than spelling doom for all of humanity, it concluded that in a few limited cases, cloning for the purpose of reproduction would provide a means to achieving a moral good by allowing men to achieve their mitzvah, the moral prerogative set by God in Genesis for all Jewish men to “be fruitful and increase”. The worst-case scenario spelled out by “Cloning People: A Jewish Law Analysis of the Issues” were quite different than “Human Cloning and Human Dignity” and stated simply that in the instances where a woman wished to clone herself, this act would be morally neutral, as Jewish woman are not subject to the same moral obligations to reproduce as Jewish men are. However, I feel as though the view taken by Michael Broyde was too narrow to capture the full impact taking such a step would actually have. This can be seen clearly in his conclusion where he compares the use of human cloning for reproductive purposes as similar to IVF or surrogacy saying, “cloning is a form of assisted reproduction—no different from artificial insemination or surrogate motherhood—which, when technologically feasible, should be made available to those individuals in need of assisted reproduction.” While that may be true within the context of Jewish family law, it seems more consideration is need, as the issue at hand would be much less complex and most of the fundamental dilemmas presented by this new technology would have already been solved if that were the case.

“Negotiating Life: The Regulation of Human Cloning and Embryonic Stem Cell Research” seemed to mend the two other works together well. While I read “Human Cloning and Human Dignity” many of the arguments came off as hyperbolic and, in some cases, it felt as though the committee lacked faith in humanities moral capabilities. However, Barbara Prainsack’s work put any idea of hyperbole to rest with the first scenario she put forward. She recalls a time when a Jewish woman contacted an Israeli bioethicist wishing to use human cloning to avoid the many conflicts which may occur when reproducing within the complex framework that is Jewish family law. While the women’s only desire was to have a child within the right moral bounds set up by her religion, the reasoning put forth by and her Rabbi as to why human cloning would not be morally objective were shaky, and it is by examining small interactions such as these that one can more clearly see how the use of such a technology can be more than just morally objectionable. It highlights how such technologies can begin to erode and delegitimize the moral systems of the modern world. By cloning herself this woman would be able to circumvent the complex rules set up by her religion, but that begs the question of why the rules were put into place to begin with. These rules were not written to prohibit this woman from having a baby, but rather to guide her to reproducing through a means that is morally acceptable. How then would reproducing in a manner foreign to anything Jewish family law was set up to interpret be considered morally good or bad? By avoiding such halachic conflicts, is there still leave room for the child to exist within the context of Jewish family law?

It is undeniable that human cloning has the possibility to change the entire face of humanity as we currently know it. However, whether this represents a change for better or for worse may not reside in how the changes occur, but rather how one views the changes which do occur. For these reasons I am unsure if any one kind of moral authority is equipped to address everything that human cloning encompasses and if biologist are set on proceeding with human cloning experiments, which it seems they very well are, it will take caution, humility and collaboration to ensure that such a project is completed in a manner that does not inoperably change the face of humanity to something unrecognizable to all human societies.

The scientific and moral complexities of cloning were described in great depth in this week’s three readings.

Human Cloning and Human Dignity by Leon R. Kass et al. explained the terminology for cloning, such as cloning-to-produce-children and cloning-for-biomedical research (63). These are the identified uses for cloned embryos. The former refers to creating a cloned embryo for the “goal of producing a child who will be genetically virtually identical to a currently existing or previously existing individual” (63). The latter involves using the cloned embryo to study its influence on human disease and for its stem cells, with the goal to cure diseases such as Parkinson’s, spinal cord injuries and many others (63, 145). Both involve injecting a human body cell into an egg that has had its nucleus removed rather than the union of an egg and sperm.

The President’s council on bioethics in Human Cloning and Dignity had a majority and minority recommendation at the end of the report. Both groups unanimously agreed there should be a ban on cloning-to-produce-children (231, 246). This view is in line with both Congress and many Americans as of 2002 when this report came out (232). There are potential benefits of cloning embryos for medicine such as removing genetic disease and obtaining organs that would not reject their intended user. There are also social contexts cloning could be applied, such as remaking a deceased relative and to reproduce. Despite these potential benefits, the council believes there are more ethical dilemmas than benefits. These include experiments on human beings – no matter the definition, since egg donors and gestating mothers are also involved – problems of identity, eugenics and exploitation of women for their eggs (196-106, 113-114). There is a divergence in opinion, however, for whether to allow cloning-for-biomedical-research.

Like stated before, both proposals include a ban on cloning-to-produce-children. Additionally, the majority recommendation is to have a four-year moratorium on cloning-for-biomedical research. This would delay the process for biomedical research to allow for more time to research risks and safe ways to undergo cloning. The minority recommendation is to have regulation of cloned embryos for research, thus allowing the practice to begin immediately with rules set in place (231, 246).

A large dilemma comes up, however, if the committee endorses cloned embryos for biomedical research and not reproduction. A foreseen consequence by the council is by making it illegal to use cloned embryos for reproduction, but allowing embryos to live for up to 14 days for biomedical research, this creates a “class of embryos that it would be a felony not to destroy. It would require, not just permit, the destruction of cloned embryos…the very opposite of showing…’special respect’” (189). This will need to be addressed since the definition of human life varies among the American people, and the idea of cloned embryos being mass produced and eventually destroyed could be unsettling to many. On the other hand, it is also unsettling that there are humans suffering from disease that could be cured with these same embryos, and other attempts to eradicate these diseases has been unsuccessful.

The foreseen consequence described above is one of many ways this text did a good job of coming up with anticipated arguments to all sides on the issue. I enjoyed that all views of the ethical committee were presented, rather than glossing over differences to try to make an agreement. One area that was missing in this text was a lack of citing how certain religious groups would react. This could have been written in more detail when discussing the issues of making it a felony not to destroy certain embryos. We must bear in mind though that this committee was formed by President Bush; therefore, discussions on how cloning related to religion would likely be inappropriate to include, since the committee created policy recommendations and America tolerates religious freedom.

Barbara Prainsack’s “Negotiating Life: The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel” and Michael Broyde’s “Cloning People: A Jewish View” discuss the religious views of Judaism in the context of cloning. These two authors provide us a religious point of view about cloning.

Broyde immediately tells the reader that Judaism views all bioethical technologies on a case-by-case basis (504). Broyde explains under Jewish law it is required to “procreate by having a minimum of two children – a boy and a girl” (524).  Broyde states cloning is permissible under Jewish Law because it does not have some of the technical problems seen in IVF and surrogate motherhood, such as who the donors are, or the controversy between the gestational mother and genetic mother (516). Cloning can also be a mechanism for people to reach the obligatory procreation number under Jewish law.

An area that Broyde’s article discussed that was not addressed in Human Cloning and Human Dignity are differences in who the mother and father of the clone based off whether the donor is male or female. Broyde’s article concludes that it is harder for “the mother of her cloned progeny than…for a man to be considered the father of his cloned progeny” (516). This is due to similar complications of surrogacy that questions the genetic versus the gestational mothers, whereas if some male clones himself there is no question he is the father.

Kass et al. and Prainsack’s texts both discuss the ethical dilemmas of pre-embryo stem cells versus adult stem cells. Prainsack states no government explicitly states they are in favor of cloning-to-produce-children (178). She points out that Bush failed “to prohibit reproductive cloning worldwide,” which was a “relief” for the medical and scientific community (178). I found this interesting to see this parallel between the readings for this week since the committee on Human Cloning and Dignity unanimously agreed on a ban on cloning-to-produce-children, but this view is clearly not representative for everyone.

Human Cloning and Dignity was written sixteen years ago, but there is still controversy about the right to life of embryos, as we have seen in other texts this semester such as in the abortion debate. This will be a recurring dilemma in the context of cloning, although there seems to be general acceptance of the practice among Jewish law.

This week’s readings focus on the ethics surrounding human cloning and the possibilities for human dignity—who (or what) qualifies to be treated and considered as human. Human Cloning and Human Dignity: The Report of the President’s Council on Bioethics is written within an American context and meant to provide George W. Bush a “…fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology…” (The President’s Council on Bioethics, 2002: xvii-xviii). The report does not necessarily offer a religious perspective. The next two pieces, “Negotiating Life: The Regulation of Human Cloning and Embryonic Stem Cell Research” by Barbara Prainsack and “Cloning People: A Jewish Law Analysis of the Issues” by Michael Broyde are written utilizing Jewish law. Prainsack focuses specifically within the Jewish-Israeli context where she discusses Western ethical and moral concerns within Israel. Broyde offers a short discussion juxtaposing the American legal system with Jewish law regarding cloning before delving into his analysis that touches upon the possibilities of humanness.

The first reading, Human Cloning and Human Dignity: The Report of the President’s Council on Bioethics is an official report for the President of the United States. After the successful, but controversial cloning of Dolly the Sheep in 1997 and the isolation of human embryonic stem cells in 1998, President George W. Bush created the President’s Council on Bioethics to discuss and address the “…the ethical and policy ramifications of biomedical innovation” (2002: xv). The goal of the seventeen-member council that was headed by Leon Kass was to provide a concrete policy recommendation for President Bush. The result was the Council’s unanimous recommendation to ban cloning-to-produce-children and a four-year suspension on cloning-for-biomedical research. In this report, the Council distinguished between two types of cloning, cloning-to-produce children and cloning-for-biomedical research. When discussing the Prainsack reading, I will delve more into this distinction. I thought the document brought to light a lot of interesting questions in its discussion on cloning-for-research such as the potential exploitation of women to supply a large and indefinite amount of eggs, the questions of what we owe to the suffering of the embryo and to greater society, and the repeated warning of the crossing of a moral line.

In connecting this reading to the last lecture about surrogacy and the reality that women of lower socioeconomic status are more likely to surrogates to those of higher socioeconomic status, the exploitation of women of lower socioeconomic statuses is a realistic possibility. The Council writes, “The removal of eggs remains an unpleasant and (owing to the hormone treatments needed to hyperstimulate the ovaries) a risky medical procedure for women” (2002: 163). While it is not stated explicitly, one can assume that in order to get women to donate their eggs and undergo a risky procedure, a monetary incentive will most likely be offered. Even in regards to egg donation in America, women donating their eggs on average make around $8,000 and can earn up to $14,000 depending on the individual’s qualifications and the number of eggs produced (Center for Human Reproduction, 2018). Thus, women who are more likely to need the money will most likely be donors. Also thinking through the power dynamics at play where the destruction of those women’s embryonic cells would potentially allow for the creation of life-saving procedures for patients of higher socioeconomic status—as the privatized American healthcare system offers top-notch quality care and services often only to those who can afford it.

The second reading, ‘Negotiating Life: The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel” by Barbara Prainsack is an article written in the Social Studies of Science, a multi-disciplinary journal aimed at an academic global audience. Prainsack begins by providing a brief historical narrative where she writes about two incidents regarding embryonic stem cell research. The first one being the controversial visit of German Prime Minister Wolfgang Clement to Israel inquiring about the potential collaboration in embryonic stem cell research. In response to the Prime Minister’s visit and Israel’s response, the German public expressed outrage and incredulousness at Israel’s “…[capability] of ‘disregarding human dignity’ by allowing almost unrestricted research on human embryos’ (2006: 174). The second scenario happening ten years prior in 1990 where a Jewish woman wanted a child via cloning. The woman’s desire stemming from the conflict between not being able to produce eggs on her own and the potential halachic (Jewish Law) conflict relating to IVF. Within Jewish tradition, one’s “…personal and halachic status of a person is derived from the mother…” (2006: 174). Thus, in the woman’s case, her child could be considered illegitimate and “…the product of a sexual relationship between a man and a ‘forbidden’ woman” (2006: 174). To further complicate things, it would be unclear if the intended mother would be granted parenthood of the child as Jewish law recognizes the gestational mother as the legal parent.

Prainsack’s focuses on answering the question, “Why do Israelis seem to embrace these kinds of newly emerging medical technologies, whereas the mere thought of it gives people shivers in many other parts of the world?” (2006: 175). Her main arguments surround Israel’s demographic problem in order to maintain a Jewish majority and the pro-natalist Israeli culture that enables the state’s biopower to reproduce the nation at the individual level. To give a quick explanation of what biopower is, biopower is a concept developed by Foucault that allows for the power over individual bodies to control populations. Israel identifies itself as a Jewish state. In order to maintain a Jewish identity, Israel has developed a specific terminology that centers an Us vs. Them narrative—where the Jewish population must fight to protect future generations of the ‘demographic threat’ of non-Jews residing in Israel.

Prainsack also distinguishes therapeutic or research cloning from reproductive cloning by the goals of the cloners where “In the case of research cloning, the aim is to obtain tissue that will be needed for medical research and treatment, whereas the goal for reproductive cloning is the creation of a fully fledged human being” (2006: 178). In other words, reproductive cloning involves a somatic cell nuclear transfer where the newly created embryo is placed in a uterus to develop while in research cloning, the embryo is created similarly, but is not implanted in a female’s uterus. Contrary to Prainsack, The Council on Bioethics rejects the terminology ‘reproductive cloning’ and ‘therapeutic cloning’. The rejection for the term reproductive cloning is due to ‘the argument that all cloning is considered reproductive—thus the term “…does not necessarily imply that such a being is fully human or ‘one of us,’ hence deserving of the moral and social protection accorded ‘persons’” (The Council on Bioethics, 2002: 49). The rejection of the term ‘therapeutic cloning’ is based on similar grounds where “The act of cloning embryos may be undertaken with healing motives. But it is not itself an act of healing or therapy” (2002:50). The term also neglects to imply the destruction of embryonic cells for the benefit of the hypothetical future patient. As a result, the Council utilizes the terms ‘cloning-to-produce-children’ and ‘cloning-for-biomedical-research’ in order to emphasize the same act of cloning, but undertaken with significantly different intentions—one resulting in the potential for a new human being and the other in the destruction of embryonic cells.

The last reading “Cloning People: A Jewish Law Analysis of the Issues” by Michael Broyde is an article written in the Connecticut Law Review, a journal catered to an academic audience with a specific professional legal interest. Broyde, a Jewish rabbi and senior lecturer at Emory University School of Law, argues “…that while there are a variety of technical issues related to cloning that have to be addressed, fundamentally cloning is a form of assisted reproduction—no different from artificial insemination or surrogate motherhood—which, when technologically feasible, should be made available to those individuals in need of assisted reproduction” (1998: 505). He also establishes that human beings created via cloning are to be entitled to and treated as unique human beings—separate from the humans they were originally cloned from. Broyde juxtaposes the American legal system with the Jewish one and concludes that within the American system, kinship is not necessarily tied to genetics, but one of law—where within American law, it does not necessarily matter who the parent to a child is, as the courts have the power to change kinship determinations. Contrary to American law, Jewish law places kinship as immutable and determined at birth. In short, within Jewish law, “Children cannot be adopted; they can merely be raised by someone other than their parents, and these pious wonderful people who are raising a child in need of a home are doing a great act of kindness, but are never considered the child’s parents” (Broyde, 1998: 507).

Prainsack and Broyde utilize Jewish law in formulating their arguments. Both authors write within a Jewish morality system that is contrary the Christian hegemonic discourses. Within Christianity, exists a spectrum where on one end is the conservative Catholic Church who believes that human life starts at the time of conception and thus deserves rights. As a result of this belief, the terminology surrounding the debate on embryonic research are placed within a dichotomy on the ‘life’ for the embryo or individual autonomy and consent. Divergent from Catholic doctrine, Jewish Law does not view embryos outside the uterus as human life and prioritizes human born life over developing life. Prainsack and Broyde also place their analyses within the Jewish context where “The moral and ethical assessment of ‘interference with God’s creation’ will therefore always take place on a case-by-case basis and depend on the context of the particular action and the underlying motivations and objectives” (2006: 183). Broyde immediately dismisses the common argument of ‘playing God’ as he argues that medical intervention in general is an interference to divine providence—God’s intervention in the universe (1998: 535). Prainsack uses the example of circumcision where humans are explicitly commanded by God to interfere with God’s creation—thus the interference with God’s creation is morally permissible. Contrary to Prainsack and Broyde, the Council on Bioethics appears to operate utilizing Christian hegemony, as exemplified as the unanimous recommendation to ban cloning-to-produce-children and its discussions regarding what is owed to the embryo. Where the Council cannot treat the embryo in its early stages similar to that of any other human cells as it would then “…[deny] the continuous history of human individuals from zygote to fetus to infant to child…” (2002: 175).

Some questions to consider:

1. At what point is a group of cells considered human life?
2. To what extent is terminology important in framing issues surrounding human cloning? (ie: the Council’s rejection of popular terms ‘reproductive cloning’ and ‘therapeutic cloning’)
3. Where do you draw the line in human cloning—do you consider a certain aspect or stage of human cloning to be crossing a moral line? Why so?

The three readings for this unit show how Iran and Israel differ in the reception of assisted reproduction, surrogacy and the social relationships formed through the process through ethnographic methods by authors Shirin Garamoudi Naef and Elly Teman. Arthur Kleinman’s article touches upon the failure of bioethics in the lack of consideration of the poor when discussing bioethics and policies. I believe that one should read Kleinman’s article first and then reflect on how often the socioeconomic class of the people interviewed came up in the first two readings.

In Shirin Garamoudi Naef’s “Gestational Surrogacy in Iran” covers surrogacy in a Muslim society. Naef focuses on Shia thought on assisted reproduction involving a third party. Naef was able to take an ethnographical approach by interviewing people in infertility clinics undergoing ART procedures similar to Teman interviewing surrogate mothers. Naef’s in depth research and methodology gives her credibility. I appreciated how she presented the differing views of Shia religious scholars on assisted reproduction. Unlike Sunni thought, most Shia scholars do not consider surrogacy as zina (“adultery”) because it does not involve sexual intercourse. Naef argues that Shia notion of zina depends on the “illegitimate physical act that occurs through illicit sexual intercourse between a man and a woman and not on the act of conception itself” (Naef 158). The transfer of bodily substances in order for assisted reproduction to happen is not considered zina. Senior Shia clerics give their take on when it is acceptable for another man’s sperm to fertilize the woman’s egg. Permissibility of another man’s sperm fertilizing the woman’s egg mostly depended on physical contact and whether or not a gaze, a touch or illicit sexual intercourse transpired. I found it interesting that one cleric took issue with placing a stranger’s sperm directly into the woman’s uterus despite the lack of physical contact. Due to the presentation of diverse views on the subject and extensive research, I believe that Naef wrote this article for scholars who want to learn more about surrogacy in Iran. I found her chapter to be informative and the differing views she refers to does not take away from her argument.

 

Elly Teman’s “‘Knowing’ the Surrogate Body in Israel” touches upon the concept of “authoritative knowledge” and the relationship between intended mothers and surrogate mothers. She argues that the surrogates and intended mothers along with the professionals involved in the surrogacy process collectively determine what relationship the surrogate and the genetic mother would have. The concept of “authoritative knowledge” refers to the way knowledge is produced and received in interactions. Intuitive, technological and medical knowledge come together to provide “authoritative knowledge” for the intended mothers. Intuitive knowledge is when the intended mother senses or feels what the surrogate mother feels during the pregnancy: “Masha vouched that her intended mother, Tova, would call her ‘knowing’ that the baby inside her had just kicked, or that she was feeling cramps in her left side” (Teman 265). Although there is no physical evidence, these accounts given by intended mothers and their surrogates should be considered quantitative data.

Technological intervention in surrogacy further allows the intended mother to picture and conceptualize her unborn child. I find it interesting that all the surrogates interviewed acknowledged the importance of having the intended mother at every ultrasound appointment versus the film we watched in class where the surrogate and the genetic parents do not meet during the process. Where’s the concern that surrogate will grow attached to the fetus? I partly attribute this openness between the surrogate and intended mother to Israel’s cultural view of fertility and “Israel’s pronatalist impulse” (Teman 262). Technological and medical knowledge are closely linked together. The medical system structures surrogacy so that there is a hierarchy in which information is provided and to whom. This allows the intended mother to decide if she wants to “generate alterations in received scripts about the maternal nature of pregnant bodies and the non-maternal makeup of infertile bodies” and share that information with the surrogate to create a stronger relationship with the surrogate (Teman 262).

In Arthur Kleinman’s article criticizes bioethics for not considering “local cultural realities”. He believes that bioethics are removed from the socioeconomic status of the people and therefore irrelevant. “The irrelevance of ethics can be seen when considering universal ethical formulations of justice and equity that do not begin with the local moral conditions of poor people” reminds me of our discussion on natural laws in Unit 3 (Kleinman 72). It is difficult to agree on whether there is a shared human nature moreover universal ethics. I agree with Kleinman that more often than not bioethics and medical policies neglects the poor and underprivileged. They do not receive the same benefits and information as those who are able to pay for procedures and treatments. Kleinman suggests that bioethics require an ethnographic approach to connect “moral context with ethical reflection” (76). Kleinman refers to the ethnographic works of Paul Farmer and Rayna Rapp towards the end of his article as examples of ways to create an argument that fulfills his beliefs that “bioethics require both approaches: it must possess a method for accounting for local moral experience and a means of applying ethical deliberation” (73).

Proposal letter

GMH Description and History,

On March 25, 2018, the Sasquatch Catholic Hospital (SCH) announced today it has changed its name to Grace Medical Hospital (GMH) as part of a restructure that will position the hospital to become a more dominating figure in the Sasquatch, Connecticut community. GMH is a private hospital rooted in the Catholic tradition, but is no longer formally associated with the Catholic Church. Along with this new name and structure, the church has allowed the hospital to become non-denominational and continued subsidizing medical care for uninsured patients. This proposal incorporates five years of discussion between medical staff, donors, and local community members regarding the future of GMH and how it can best accomplish its goals. The discussion takes into consideration the predominant Irish population, the local Jewish community, a mixed Caucasian and African-American (non-Irish Catholic) community, as well as the expanding populations of Lebanese Shiite and Japanese immigrants. This proposal lays the groundwork for GMH’s long term plan that focuses on addressing various questions such as “How much will the hospital reflect its donor base (Catholic origins) and mixed local community?”, “How should the hospital begin to provide and subsidize abortion services for under-insured patients?”, “What about IVF treatments and prenatal testing including amniocentesis?”, “If the hospital does begin to provide IVF treatment, should the hospital encourage families to allow embryos to be donated for potentially life-saving research?” and  “Should the hospital continue to provide spiritual counselling by Catholic clergy?” The decisions presented in this proposal are supported by years of research to ensure the best outcome for the various groups involved.

 

GMH Needs

The main goals of GMH are to balance healthcare quality and efficiency and to improve access to care. In the healthcare industry, there are many pressing problems regarding financial, federal, and ethical issues; These difficulties have both positively and adversely affected all area of GMH. Many of these problems are part of an interrelated system of adaptations that coevolve together to shape hospitals around the country. The best outcome is to create an all-inclusive healthcare system with balanced care and quality, while simultaneously considering the Catholic traditions. If this is achieved, GMH will continue to be stagnate within the community of Sasquatch, Connecticut. This proposal projects a five-to-seven-year plan to attain this goal, while concurrently reducing costs.

 

My Solution

All the data went into the development of a balanced solution to address main six questions.

1. How much will the hospital reflect its donor base (Catholic origins) and mixed local community?

One of GMH’s goals is to better incorporate the perspectives of the hospital’s donors, staff, and mixed local communities into the discussion of abortion and reproductive technologies, such as in-vitro fertilization (IVF) and prenatal testing (amniocentesis). Due to the diversity of all groups present, it is difficult to integrate every social and cultural agenda into each unique situation. Abortion and reproductive technologies can be handled on an individual case to ensure the best outcome for all patients, donors, and staff involved. The hospital’s donors and staff primarily consist of Catholic individuals, while the mixed local community is heavily comprised of Jewish, Caucasian and African-American people, in addition to a growing population of Lebanese Shiite and Japanese immigrants. This diverse community of locals and staff presents various conflicting ideas about the use of abortion and reproductive technology. As a member of the ethics committee, I have determined GMH will not provide nor subsidize abortion services for uninsured patients. In addition, the use of IVF and prenatal testing, such as amniocentesis, will not be provided nor encouraged by the GMH organization and staff. We acknowledge that this may seem to deter from GMH’s goals, but the reasons presented below address my decisions pertaining to abortion and reproductive technologies.

2. How should the hospital begin to provide and subsidize abortion services for under-insured patients?

Over the last few decades, “the access to abortion services in the United States has continued to decline,” which can be attributed to changes in legislations and court rulings that have made it easier for physicians to refuse to perform this procedure, (Meyer and Woods, 1996). Requiring [GMH’s staff] to perform [or participate] in abortions would represent a serious threat to individuals’ fundamental moral or religious beliefs (Meyer and Woods, 1996). At GMH, the hospital’s donors and nursing staff are historically known to be Catholic. I have determined that the provisions of abortion may facilitate a direct clash between the staff and donor’s religious beliefs; this clash could potentially deter GMH from improving care and efficiency. This perspective was formulated from Shanon, Thomas A. and Lisa Sowle Cahill’s article, Donum Vitae, and The Book of Genesis in The King James Bible; the New King James Bible is the English translation of the Christian Bible for the Church of England. This text was designed to address specific topics such as life, death, and social issues. For every situation, the Catholic Church believes the scripture will give the answer, leaving room for individuals to formulate their own perspective of the scripture.The first chapter, Genesis, sets the stage for the opinion of some religious beliefs and is known as the “creation story.” It begins directly by stating “In beginning, God [‘elohim] created the heavens and the earth” (Ball, 2000).This one sentence summarizes the entire book, while placing God as the center of creation. The novel later explains that God created men and women in his image. This Book all living things in a hierarchal order with humans at the top. These scriptures and many other are at the foundation of the Catholic Church’s opinion on abortion. The Catholic Church believes “Though Shall not kill”. This law can be broken if allowed by natural laws, but with regards to abortion this is not the case. The Catholic Church acknowledges that life begins at the time of conception,signifying that life should be protected and respected. Because GMH’s foundation is built upon the Catholic traditions, I propose that GMH should continue to define life as the site of conception. This proposal is the main reason GMH will not provide and subsidize abortion services for under- insured patients. This decision will agree with the religious moral and beliefs of the Catholic donors and nursing staff. At the same time, this proposition may clash with other religious denominations. To account for this, GMH will expand our partnerships with local clinics, while including both catholic and non-Catholic clinics. If the patient inquiries about having an abortion, we will provide them with information to other hospitals that may provide this service.

3. What about IVF treatments and prenatal testing including amniocentesis? 

While multiple types of assisted reproductive treatment exist, this section will address IVF and amniocenteses. I propose that GMH should not provide IVF and prenatal testing because the provisions of this technology will negatively affect individuals socially, culturally, and religiously, which will hinder GMH goals to expand to a greater number of people in the community. The Catholic Church recognizes the critical connection between a child and parent during fetus stage (Shanon et al, 1988).They see the use of reproductive technology as a denying the child this connection. Therefore, reproductive technology should not be allowed in their eyes. In Nan T. Ball’s article, The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates, she analyzes the 1994 French bioethics debates. These bioethical laws allowed only individuals not able to conceive children, heterosexual couples of legal age to procreate, and married couples to use artificial insemination and IVF procedures (Ball, 2000). These laws were created to counter the new Enlightenment ideas of the time. IVF technology can be seen as a challenge to the traditional heterosexual family. The idea of a heterosexual family lies at the foundation of the Catholic religion. The use of IVF may challenge the cultural, social, and religious identity of the local Catholic families and Catholic staff.

In addition, reproductive technology can be viewed as defying the identity of Japanese individuals. In an article by Trsipy Ivry, she accounts the Japanese perspective on pregnancy, arguing that Japanese women take on a more “environmentalist” approach to pregnancy (Ivry, 2009). This view examines the outcome of pregnancy depending on the mother’s decision and little to chance; problems associated after birth are a reflection of the mother. Dr. Ivry accounts a story of a Japanese mother using a “screening test that used biochemical analysis of the maternal blood to estimate the probabilities of chromosomal abnormalities in the fetus. (Ivry, 2009) Her OB-GYN did not treat this matter with any urgency. This doctor views these productive testing as having little influence because of Japan’s cultural and religious beliefs. Thus, introduction of reproductive technology goes against these cultural and religious views pertaining to pregnancy.

While I have presented the Japanese and Catholic’s view of reproductive technology, one can see how the provision of this technology would clash with the ideals of these, which would not be the case for the local Jewish families. In Israel, pregnancy is driven by “anxiety regarding the possibility of reproductive catastrophe” (Ivry, 2009). In the Jewish religion, the idea of the pregnancy is thought to be predetermined, therefore, reproductive technology is seen as a “risk reducing” procedure that emphasizes Jewish beliefs. Taking all these perspectives into consideration, I believe that if GMH hopes to accommodate more people, then reproductive technology should not be provided. This would only diminish the cultural and religious identities of its local members and discourage people from visiting GMH.

4. Should the hospital continue to provide spiritual counselling by Catholic clergy?

 When addressing the topic of spiritual counselling by Catholic clergy, I personally believe spiritual counselling can be an effective tool in helping individuals make decisions pertaining to help. In Sherine F. Hamdy’s ethnographic account, Does Submission to God’s Will Prevent Biotechnological Intervention?, she explains the story of two Muslim individuals’ denial of organ transplantations due to ethical and social concerns. While these patients would have benefited from organ transplants, they decided not to proceed. Their doctors believed their decision was made entirely based on religion. These patients did not believe that “religious sentiments, should not be seen as passive, as anti-science, or as constraints to medical treatment,” (Hamdy, 2013). These individuals looked at their entire situation and determined the financial strain on their family was not worth saving his life. Using this case, I propose GMH should not provide spiritual counseling by Catholic clergy. The use of spiritual counselling may contribute to an individual making the best decision, but will not be the only factor affecting their decision. I view GMH the use of economic resources to acquire spiritual counselling is not worth giving for a multiple factor decisions. In addition, doctors have filed complaints pertaining to clergy interference with their work. The presence of these clergy make it hard for our staff to do their jobs. By not providing this service, GMH improves the overall quality and efficiency of care.

 

Administration

I have determined that the preliminary timeline will take one-to-two years to get the doctors and nurses on board. It is not certain how long it will take donors to accept the changes, but from prior discussions with a select few donors they seem on board with the changes facilitated by the proposal. The longest timeline will be the formation of partnerships with other local hospitals and clinics. There is a lot of legal documents and certifications that must be approved before we can start a mutual beneficial relationship that ensure every individual will receive great quality care. Even though this will be a length process, it gives use more time to encourage donors to help support the financial burden of this project.

Kimberly Farmer, Midterm

Given the history of this hospital and the diverse community it supports, policy should be put in place to ensure that issues surrounding the hospitals 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. 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, only turning away patients who cannot afford an abortion makes a value statement against abortions that is rooted in the Catholic church. 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 hospitals values and proceedings. Given that the hospital previously subsidized services for under-insured patients, the hospital should subsidize abortion services as well. This would include IVF treatments and prenatal testing, including amniocentesis, since a non-denominational church wouldn’t have adverse feelings toward such treatments. In addition, 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,147) meaning that there must be respect to human embryos. Since a large portion of the hospitals users will likely find the suggestion to provide unused embryos for research offensive, this service should not be advertised nor encouraged. Patients may be informed of such opportunities, but there should be no pressure or encouragement to comply.

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. Doctor 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). In turn, physicians should respect religious beliefs and not force the biomedical model onto their patients.

Hospital funders should be made aware of the policy changes when they are asked to continue their funding. In terms of nurses, the hospital will need to have nurses that are capable of handling a multitude of tasks, but it is known that the historically Catholic nursing staff may have reservations about preforming 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. That being said, nurses who are unwilling to perform certain reproductive procedures will be placed in ward where they will not encounter such tasks. Nurses should not be punished for having values that conflict with the positon, 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 preform reproductive services and current nurses will be asked to disclose their ability to comply with these procedures. 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.

Citations:

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.

In response to the recent changes enforced upon the Sasquatch community Hospital, the Catholic Church wishes to engage our own perspectives and insights in the on-going ethical debates relating to the public subsidizing abortion services, fertility treatments, and amniocentesis; the spiritual counseling’s role in the medical healing process; and the professional rights and duties of the tenured nurses opposed to performing abortion and reproductive services. As a long-tending Catholic Monsignor serving the Christian Sasquatch community for over forty-years, I believe it is my professional and religious responsibility to clarify and provide resolution to moral problems raised as a result of both the altercation to the hospital’s religious affiliation and cultural diversification of surrounding community. Through this declaration, I do not aim to settle on compromise for these complex issues, but instead, strive to uphold the status of the church as “the expert in humanity”, and further celebrate the values and means by which the church has sought to bring order in moments of moral chaos during its 2000 years of existence (Cahill et al. 142).

Throughout the centuries, when moral questions relating to advanced technology and cultural shifts have risen, the church has provided the framework for understanding how these changes would be implemented for the human life. Questions of kinship, fertility, and the right to life are not new ethical landscapes. However, the present age has proven to pave a new pathway down the familiar terrain. Modern medicine and advancements in biotechnology now challenge the previously established framework for understanding what role humans play in the reproductive process through the introduction of new methods and technologies that allow for the human to completely dominate reproduction. Procedures such as abortion, in-vitro fertilization treatments (IVF), amniocentesis, and many more, are unnatural and yet, readily available tools that hold the power for a human to subjectively select for the life outcome of another individual. Thus, critical evaluation and formal explication from the church relating to these topics is urgently required in order to ensure that we remain grounded in our own humanity.

As a Catholic Monsignor, I see it as my spiritual and professional duty to comment on the current crisis within our community. My professional duties include, but are not limited to, providing homily at every Catholic service, managing the parish education program, facilitating outreach ministries to both local and outside communities, conducting the seven sacraments, and providing guidance and counseling to members of the church who seek help. With much respect to medical professionals, who are responsible for providing relief to the physical ailments of one’s disease or condition, I see my responsibility as providing relief to the spiritual afflictions and moral concerns introduced by the condition. My professional ethics serve as the basis for my arguments, and I seek to have my opinions and concerns evaluated as both sincere and legitimate even as they apply within the medical context.

The hospital should not subsidize abortion services or IVF treatments for under-insured patients, nor should the hospital permit abortion services to any patient. Prenatal testing procedures such as amniocentesis may be subsidized for under-insured patients (given the process induces no damage to the baby). However, further action or altercation to the baby as a response to the test results (i.e. abortion) is not permitted. Furthermore, it is morally illicit for the hospital to collect unused embryos and use them for research and experimentation.

In-vitro fertilization treatments are morally illicit procedures as described by the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation”, which states, “Heterologous artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation of the proper parents, and to the child’s right to be conceived and brought into the world in marriage and from marriage” (Cahill et al. 158). Children, by nature, are the fruit of marriage. Every child must be granted the right to be brought into the world through marriage, and be raised within a marriage. Children, thus, may only be naturally conceived through the proper conjugal act. Any means of reproducing otherwise not only deprives the child of his rights, but also exceeds the limits of reasonable domination of nature that overrides God’s significant power over man. Furthermore, no child must be subject to murder through abortion practices, as this act also exceeds the limits of reasonable domination of nature. The abortion issue will be further addressed in section III below.

Amniocentesis, currently used by a large proportion of Catholic mothers (Rapp 157) may continue to be used. However, the results of the test may not justify reasons for the mother to abort her child. As written in the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation”, “a diagnosis which shows the existence of a malformation or a hereditary illness must not be the equivalent of a death sentence” (Cahill et al. 150). A malformation is not the equivalent of a disease that must be eradicated. A child born with disability is still deserving of the same human rights as any other individual. Any acts that reject these rights should be subject to legal punishment.

Embryos collected from IVF treatments and left unused may not be employed as scientific material for experimentation, as living embryos hold the potential for human life and thus are deserving of the same rights as all individuals. As discussed in the “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation”, “If the embryos are living, whether viable or not, they must be respected just like any other human person; experimentation on embryos which is not directly therapeutic is illicit” (Cahill et al. 152). If the goal of the experimentation is to provide the embryo some form of therapeutic relief, then the procedure may proceed. However, if such experimentation results in death or harm inflicted upon the embryo, then the individual(s) responsible for such acts will be subject for legal consequences in rejection of human rights.

The hospital should continue to provide spiritual counseling by the Catholic clergy. Additionally, in response to the growing influx of immigrant community members of diverse spiritual and religious backgrounds, the hospital should seek employment of other religious leaders in order to satisfy the spiritual needs of all patients.

Medical professionals primary concerns include identifying and diagnosing disease, guiding patients through treatment plans that mitigate the physical symptoms of the disease, and healing the body within the physical sphere. Religious leaders responsibilities focus on targeting spiritual concerns or gaps within the patient’s experience of the disease, providing guidance and counseling to the patient throughout and beyond the treatment process, and healing the human soul within the spiritual realm of existence. Just as I, a religious leader, respect the boundaries of the medical professional and do not impose my training and talents in treatment of the physiological disease, I would expect medical professionals to demonstrate the same line of respect and not interfere with my methods and pathways of spiritual healing. Therefore, given that both the medical professionals’ and religious leaders’ interests lie in healing the human composed of both body and soul, I defend the right of all religious leaders to contribute their spiritual healing specialities to the patient during the healing process. Furthermore, I preserve the right for religious leaders to provide guidance to patients challenged by moral dilemmas without intrusion from medical professionals (i.e. doctors, nurses, etc.).

In response to the recent changes that have transformed the hospital from a Catholic institution into a non-denominational institution of medical practice, I propose additional spiritual leaders from other sects of religion be hired in order to ensure the hospital continues to serve the spiritual needs of all patients. Although I acknowledge that in future cases I may disagree with guidance provided by other religious leaders on issues such as IVF and abortion, I will vow to remain open for discussion on the moral disagreement. Furthermore, I will continue to work within the community legal system as an advocate for laws against such treatments like abortion and IVF, as I truly believe they violate the American constitutional human rights for the individual.

The hospital should not offer any abortion services, and thus not force any nurse or doctor to perform such services. Abortion is equivalent to first-degree murder, and thus, subject to both mortal spiritual and licit consequences.

As written in the “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation, “The child is not an object to which one has a right nor can he be considered as an object of ownership: Rather, a child is a gift, “the supreme gift” (Cahill et al. 168). Under this reasoning, the child in the womb cannot be seen as an object, but rather, another subject. Our moral compass has evolved in recent centuries to disavow acts of human beings owning other human beings. Likewise, the mother of a child cannot claim to own the human growing inside of her as her own property. The child is another human endowed with rights, and therefore, acts such as abortion that intentionally inflict harm upon the human by another human are morally illicit and subject to the most severe legal consequences.

The argument often proposed by pro-choice defenders in response to the abortion debate often centers around the idea that “the government cannot tell a person what decisions to make about their body”. However, many governmental laws already intact do manage the way citizens conduct their bodies if it is in the interest of protecting another life. For example, the government tells all of its citizens that they are prohibited to swing their arms continuously with a knife in their hand and murder another person. Laws presently imposed on our bodies inhibit the behaviors that inflict pain or death upon another individual. Thus, laws against abortion serve to protect the life of the baby from harm intentionally imposed upon them.

Furthermore, the hospital may not force any medical professional to perform abortion, as the action itself violates the ethical guidelines and mission in the medical field. The values driving the professional medical field including diagnosing and treating disease, while preserving the right to life and death with dignity. Performing an abortion and killing the life of a child is in direct conflict with the medical professional’s ethical mission (Ginsburg 66). Thus, nursing professionals who have voiced concern over the procedure and stated an unwillingness to perform such services must be heeded to by hospital administration. The nurses have the right to choose to act within what they believe to be their profession’s ethical boundaries.

References:

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).

Faye Ginsburg, Contested Lives: The Abortion Debate in an American (University California Press, 1989).

Rayna Rapp, Testing Women, Testing the Fetus (Routledge, 2000).

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 continuation to thrive for inclusive service, I therefore propose subsidies on abortion services, IVF treatments, prenatal testing for under-insured patients. Spiritual counseling should continue to be offered with Catholic clergy. In addition, literacy courses in pregnancy and pre-natal testing for patients and training on cultural competency for staff members ought to be offered.

 

Informing and providing abortion services and prenatal testing to under-insured patients will reduce stratified reproduction. Reproduction builds on one’s existing notions of “contingency” in contemporary America but it is stratified due to the variance in cultural, religious, and socioeconomic pressures on individuals. Consonant with the views from much scholarly research and models espoused by health professionals, the locus of control does not lie so exclusively in individual pregnant women; it is rather shaped by much larger socio-cultural forces. Implied by Tsipy Ivery in her research of pregnancy experiences in Israel and Japan, the power structures of the respective countries shape the schemes of “contingency” thinking upon individuals; with the “Gamburu”, or “make an effort” ideology embedded in the image of ethical self, Japanese women often bear the responsibilities of the babies’ nurturance to themselves. In contrast, the notion of selfhood and disabilities in the Israeli culture have led to their intimidation of reproductive catastrophe (Ivry 243). Similarly shaped by the socio-cultural hierarchies, the majority of women in U.S. described by Rapp are usually informed by biomedical statistics and utilize biomedical technologies to evaluate their risks (Rapp 317). However, the under-insured patients in Sasquatch county may not be well-informed of all the possibilities and risks pertaining to pregnancy due to their socioeconomic backgrounds. Although the hierarchy of information may vary across cultures in regards to pregnancy, we as a nationally renounced hospital ought to provide the patients with universally competent prenatal care in order to reduce the noted stratified reproduction based on socioeconomic backgrounds. A crucial step to reduce stratified reproduction is to offer information as well as access to pre-natal testing to the entire community, allowing them to gain a scientific perspective on pre-natal testing and equal access to abortion services just as women who are insured do. Weekly pre-natal and IVF testing literacy classes could help women acquire equal access to reproductive information. Therefore, subsidies on abortion services as well as pre-natal testing, and inclusion of relevant classes for the under-insured will help them gain equal access to reproductive information and make the most informed choices despite their financial situation.

 

In-vitro fertilization (IVF) should also be provided for under-insured female patients. Despite the diverse religious and cultural notions in Sasquatch county, the choice for women to bear children is shared among different backgrounds. If physical conditions prohibit women from bearing children, IVF could provide them with the opportunity of motherhood. The population in Sasquatch county consists of an Irish, Jewish, a mixed white and African American population, with growing influx of Lebanese Shitte and Japnaese immigrants. According to the Protestant and Catholic understanding of the Genesis, the purpose of women is to “reduce and multiply.” Similarly, reproduction is viewed as a “imperative religious duty” and even “honor and prestige of the family” in the Jewish view (Kahn 4 & 44). The African American cultures tend to view pregnancy as a blessing (Seeman 36) and in the Japanese culture, women highly pride themselves for nurturance of children. Besides, the varying political views of pro-life and pro-choice activists even consent upon the manifestation of feminist power in pregnancy. As pro-choice activists view pregnancy as a right for women, pro-life activists view pregnancy as an indispensable responsibility differentiating women from men (Ginsburg 216). No cultural forces and political structures oppose or limit the natural desire of women to bear children, so nor should socioeconomic status. Equal access to IVF is necessary as it will largely benefit Sasquatch county’s under-insured population. Therefore, subsidies on IVF treatments to the under-insured should be offered as well.

 

Nevertheless, the encouragement of embryonic donation for scientific research should be prohibited. 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 and the child’s interests. 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. According to Donum Vitae and other Christian scriptures, “the moment of life begins upon conception.” There is no justification for encouraging one to make the decision for another person on terminating their life. 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 how he ends his life either. The child has the right to her or his own life; when their lives no longer pertains to the mother’s interest, the mother does not have the right to choose for them. Therefore, encouraging embryonic donation is unjust and should be prohibited.

 

In order to reflect the Catholic Origin of Sasquatch Community Hospital, spiritual counseling should be continued but reduced to one Catholic clergyman. No additional counseling of other religions should be allowed since it is necessary to reduce reproduction stratification in the hospital through limitation of religious factors. As mentioned previously, our job as the hospital is to provide patients with equal information and access of reproduction strategies and technologies despite the other sociocultural contingencies that may be imposed upon the women. Thus, classes on assisted reproductive technologies and late term genetic testing will be offered freely to all patients once a week. The two-hour-course would not only improve the understandings of patients towards their potential reproductive options, but also equip them with the resources to make more informed reproductive decisions. Not only so, as some medical staff have and will continue to complain about the Catholic Clergy interfering with their work by opposing assisted reproductive technologies, the classes will allow the medical staff to express their professional opinion. As long as both sides have equal opportunities to express their views, the woman will be more empowered with her decision, no matter what she will choose. 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.

 

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 jobs as healthcare providers acting only on behalf of patients instead of personal beliefs. Therefore, training to improve the understandings of different local cultures and religions ought to be provided for the staff every month. With more appreciation of the distinctive socio-cultural forces effecting pregnancy, nursing staff may become more open-minded to the local population they are serving. If one insists upon no provision of abortion and reproductive services, she or he may choose to leave the obstetrics – gynecology department or leave the hospital. Other nursing staff from other departments of the hospital could replace the leaving staff member. Further hiring or replacement of staff members ought to reflect the mission of equal service and the commitment to Sasquatch county’s diverse population.

 

Dedication to reduce socioeconomically stratified healthcare, protection to the right of women and children, and commitment to serve our culturally diverse population have been reflected in Sasquatch Community Hospital’s past. With thoughtful consideration and careful implementation of the 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.

 

Work Cited

1. 1. Book of Genesis, chapters 1-2
   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).
   3. 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.
   4. Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community(University of California Press, 1989).
   5. 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).
   6. Rayna Rapp, Testing Women, Testing the Fetus(Routledge, 2000).
   7. Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel(Duke University Press, 2000).

 

After recent discussions between the administration of St. Mary’s hospital and the local Catholic church, both parties have agreed that it is time to change the relationship this hospital and its staff have with the Catholic church. The decision has been made to reclassify ourselves as a non-denominational hospital and severe any official ties the church and hospital once had. This change will affect not only the relationship between the hospital and the church but also the way the hospital interacts with the community as well. This will take the form of changes to the hospital’s existing policy towards several medical procedures and staff behavior, as well as the inclusion of some procedures not currently offered at St. Mary’s hospital.

While the hospital and the church have severed all official ties, the hospital will continue to allow for the Church to have a presence in all matters that occur at the hospital. Religion has played a large role here at St. Mary’s and we feel as though there is still room for religion in the hospital through the form of religious counsel, as well as in policy decisions made by the hospital’s administration. We will make no changes to the level of involvement that chaplains have here in the hospital. All patients here at St. Mary’s hospital will continue to have the same access to all the hospital’s working chaplains. The space that has been provided for counsel and prayer will remain open and part of the official hospital building.

St. Mary’s will now make an effort to provide our diverse community with the religious counsel best suited for all patients. We will be devoting a new space in the hospital to serve as a communal religious gathering place. This will serve as an area where patients from a variety of religious backgrounds can meet with their preferred religious counsel. We have reached out to religious leaders in the community who have expressed interest in volunteering some of their members and staff to help counsel the hospital’s staff to effectively accomplish this. We hope that the addition of these new counsel’s will allow for the patients of St. Mary’s to make informed decisions based on doctrine taught in their personal religion. Many staff at St. Mary’s have encountered instances where patients forgo procedures due to personal religious convictions that do not align with the official teachings of their religion (Stolow 2012, 144). We hope that access to the right religious counsel will help patients make more informed decisions regarding their healthcare.

Due to a high demand from a new, growing Jewish community in our area, St. Mary’s hospital will now provide new services not offered previously at this hospital. One of the new services provided will be the use of in vitro fertilization. While previously this service was not provided due to the violation of multiple sections of the Donum Vitae, the demand for such procedures has made the addition of this new service imperative (Donum Vitae 1987). The new commitment made by the hospital to effectively serve all of our communities cultural and health needs reaffirms this decision (Kahn 2000, 2). The means in which the hospital will introduce this service will be done with the counsel of members of the church as well as other community leaders. In vitro fertilization is an extremely popular procedure in Sasquatch’s Jewish community, and since the nearest fertilization clinics are more than 15 miles away, the hospital feels as though it is the obligation of our staff and administration to include this potentially life-altering procedure. While the need for the addition of this service comes largely from the demand of our Jewish community, it will be offered to all patients and will be done in a fashion that is appeasing to both the hospital’s historical background as well as the modern needs of our diverse rural community.

The new policies surrounding the implementation of in vitro fertilization will draw heavily from the state-funded IVF institutions found in Israel. We feel as though the clinics that are being run in Israel represent some of the best and most effective fertility clinics in the world (Seeman 2010, 357). They also are some of the best equipped to handle the nuances that arise from a procedure such as this. One of the largest points of contention with IVF is the question of kinship, and we recognize that the Israeli clinics work only within the context of the Jewish cosmology. Due to this, we feel as though the means in which they address such issues can help the hospital’s staff and administration in navigating the complex relationships between cultural and biological relatedness (Kahn 2000, 109). The hospital will also be using Israel’s policy regarding who qualifies for IVF. We believe the system in Israel of allowing any woman, regardless of marital or health status to use IVF procedures should be implemented at St. Mary’s as well (Kahn 2000, 28). We believe that IVF can be helpful to all woman who wishes to seek this option, and as such St. Mary’s will not participate in any practice which discriminates against candidates based on factors beyond what our doctors and genetic counselors recommend are safe.

It is an unfortunate fact that during the process of IVF, not all embryos will be used, and due to the hospital’s history as well as the beliefs of many staff and administrators, we will be creating our own policies of what to do with the unused embryos that are a by-product of IVF (Donum Vitae, 1987).  The hospital also recognizes that the interpretation of what exactly an embryo is and what the proper treatment of embryos should be can vary from patient to patient depending on their own personal beliefs (Brockopp and Eich 2008, 65). Due to this fact, the hospital will be using more than just the teachings of the Magisterium on the sanctity of human life to guide the hospital’s policy on the disposal and use of the unused embryos. First, we will be providing all IVF staff with information on how to inform patients from a variety of religious and cultural backgrounds on the means, in which IVF is undertaken so that patients may make informed decisions with all moral and health implications taken into consideration. The hospital will also begin allowing the unused embryos, with the consent of the donating mother, to be used for research pertaining to IVF procedures in the hopes that their deaths will provide future IVF procedures with a higher success rate, therefore reducing instances of unsuccessful fertilization events(Brockopp and Eich 2008, 64).

The hospital recognizes that the creation of embryos with the knowledge that all will be brought to term is one of the main points of contention the Catholic Church has with IVF (Donum Vitae 1987). The hospital has discussed means of reducing instances of unused embryos by reducing the number of frozen embryos created during the IVF process. However, many of the ways in which this can be accomplished place an undue burden on the donating mother and as such we believe all proposed alternatives constitute an unnecessary amount of risk for the mother (Brockopp and Eich 2008, 61). Due to this, St. Mary’s will be performing IVF procedures in a means similar to other modern fertility clinics.

In light of all these changes, we feel it is necessary to highlight points in which St. Mary’s will not be making any changes to the hospital’s policy. One of those instances is our policies surrounding performing abortions. We feel as though by including abortion as a new procedure, to a degree that violates any part of the Donum Vitae, would be seen as a regression from the beliefs that St. Mary’s was founded on. We also feel as though it would be in violation of both the historical upbringing of the hospital as well as the beliefs and wishes of its staff and patients. The hospital will, however, institute a small, but substantial change to the policy of informing patients who inquire about abortion. St. Mary’s will now have information readily available to any patients who wish to know more about an abortion procedure. This will entail information on the procedure itself, including all medically relevant side effects, dangers or concerns the hospital feels are relevant. Information pertaining to any religious or ethical concerns will be available to patients upon their request as well. What will not be included is any information that may show patients how to obtain an abortion at any other medical facility or in any other fashion. We feel as though informing a patient on how to obtain an abortion would be a step too far and is not one the hospital is comfortable taking at this moment.

With regards to St. Mary’s approach to amniocentesis and prenatal testing, day to day operations of such procedures will change very little. However, the policies of administration surrounding such procedures will change. The hospital currently offers prenatal testing at the recommendation of a doctor but going forward we feel as though it is best for mothers to allow them to seek this choice free from interference from hospital staff. One objection to allowing such a change is that more mothers will seek an amniocentesis with the idea that if the diagnosis comes back and is not something a mother wished to hear, then she may seek to terminate the pregnancy for reasons stemming from the diagnosis (Donum Vitae 1987).  While this is an understandable fear and is not something the hospital will support to any degree, we feel that since amniocentesis has the potential to improve both the mother’s and the fetus’s overall health St. Mary’s should make prenatal testing as available as possible (Ivry 2009). In allowing anyone to seek these procedures we are allowing mothers an opportunity to have the pregnancy experience they feel is best suited to their needs. In an effort to safeguard mothers who may not feel as though getting an amniocentesis is the right choice for them, we will be advising all genetic counselors and doctors on proper ways of advising their patients so that all mothers have the right amount of medical information that they desire (Ivry 2009).

We recognize that many of these challenges will be difficult for many of the staff members here at the hospital. St. Mary’s is aware of this and in an effort to retain some of the trust the employees and administration have built over the years, we will not be forcing any employee to participate in any activity or procedure they deem against their personal beliefs. If enough staff members have problems with our new policies to the point that it begins to affect the day to day operations of the hospital then some policies may be revisited, but it is not anticipated that such things will occur at that level of frequency.  We ask that if any staff members feel as though their job has changed to the point where they can no longer morally continue with their work to speak with their supervisor to arrange a means around such issues. Whether this will include being reassigned to other tasks or just working fewer hours will have to be determined on a case by case basis, but St. Mary’s would like to tell all of its employees that it will continue to listen and compromise so that these changes can be done in the most efficient and pragmatic way possible.

Finally, the hospital has decided that at this time it will not subsidize any of the new procedures for underinsured patients. We believe that making this decision is in the hospital’s and the community’s best interest. This will allow anyone who has donated to St. Mary’s to continue to do so without fear of encouraging any behaviors they may find morally or ethically repugnant. We also feel as though subsidizing these procedures may inadvertently ostracize some members of the Sasquatch community, and as such could have a negative impact on both the collective health of Sasquatch as well as the individual health of many patients who have objections to any part of the new policies or procedures being implemented at St. Mary’s.

 

 

 

 

 

Work cited:

1.Donum Vitae = the Gift of Life: Instruction on Respect for Human Life in Its Origin : and on the Dignity of Procreation : [replies to Certain Questions of the Day]. Washington, D.C: National Catholic Bioethics Center, 2000.

2. Brockopp, Jonathan E, and Thomas Eich. Muslim Medical Ethics: From Theory to Practice. Columbia, S.C: University of South Carolina Press, 2008.

3. Kahn, Susan M. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press Books, 2012.

4. Stolow, Jeremy. Deus in Machina: Religion, Technology, and the Things in between. New York: Fordham University Press, 2013.

5. Birenbaum-Carmeli, Daphna, and Yoram S. Carmeli. Kin, Gene, Community: Reproductive Technologies Among Jewish Israelis. New York, N.Y: Berghahn Books, 2010.

6. Ivry, Tsipy. Embodying Culture: Pregnancy in Japan and Israel. New Brunswick, N.J: Rutgers Univ. Press, 2010.