Month: April 2018

Dear Sasquatch Connecticut Ethics Committee,

As a new member of this committee, I have written a policy proposal on the use of assisted reproductive technologies and prenatal testing for our hospital. My previous position on the Ethics Committee of the Medical Board at the Mount Sinai Hospital allowed me to gain experience in a diverse community. Being one of the few female doctors on the ethics committee at Mount Sinai, I learned that at times one must put the patient’s needs over their own personal views or the views of the majority. It is often difficult to make policy decisions that pleases everyone when it comes to controversial topics, such as assisted reproductive technology and prenatal testing. In a hospital that recently became non-denominational in a varied community that is seeing an influx of minority immigrants, its policy should reflect what is most beneficial to those it serves. The goal of a hospital should be to improve outcomes and create more satisfied patients.

On abortion, I acknowledge that the donor base is still prominent Irish families, who will most likely have a Catholic stance on abortion: “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae). However, the community is not made up of only Irish Catholics and the hospital should accommodate women in the community not of the same religion or beliefs. Personally, I believe that women should have a control in what happens to her body and have the choice whether or not to carry out a pregnancy. “If pregnancy is highly risky, birth seems even more so”; therefore, for us as a hospital we need to do right by the patient (Ivry). In hopes of reaching a middle ground, the hospital will provide and subsidize abortion services for under-insured patients with terms. One of the terms will be that abortions can only be performed within the first trimester before the fetus is able to feel any pain. There will only be a set number of abortions given per month and the process of signing up for an abortion will include a talk with the doctor performing the abortion. Extreme cases such as rape will automatically be pushed through.

As for In Vitro Fertilization (IVF), Sasquatch Hospital will only provide treatments for husbands and wives that are looking to start a family. According to the Catholic Church, artificial reproductive technology goes against “natural” law and Scripture. Those people that are faithful to the religion should not use artificial reproductive technologies. Since the Church associates IVF with abortion because during IVF not all embryos are implanted; therefore, an “act against the life of these human beings” (Shannon and Cahill, 154). However, it is acceptable for a husband and wife who cannot conceive to seek other options such as IVF. The prominent Irish Catholic donors should not take issue with these conservative terms and continue to donate to Sasquatch Hospital. In Israel, IVF is a state policy versus in America it is purely private. Different from Israel, religious experts here will not be involved in the day-to-day process at Sasquatch, but medical experts will be involved. The interpretation that reproduction is an “imperative religious duty” prevalent in the Jewish community would encourage people to support IVF (Kahn). The option for IVF will also benefit the Lebanese Shiite and Japanese immigrants. This condition that IVF at Sasquatch hospital can only take place between a husband and wife also satisfies the religious beliefs of the Lebanese Shiite since “most Shia scholars […] argue that the act of fertilization of the woman’s egg with the sperm of a man other than her husband’s is not allowed” (Naef).

A few years ago, Athersys, a biopharmaceutical focused on stem cell research approached Sasquatch Hospital for a collaboration. The deal was that Athersys would donate funds to the hospital if doctors encouraged patients to donate their embryos to potentially life-saving research. This collaboration will be made transparent to all of the participants/patients and they can opt in to donate their embryos or pay to freeze them for later use. This potentially life-saving research can also lead to a more efficient and less invasive prenatal testing while also helping out the hospital.

Prenatal testing such as amniocentesis will be offered to women and families who want to reduce contingency. However, as a hospital in a predominantly Irish Catholic community we want to emphasis that these genetic tests are done not for the purpose of terminating difficult pregnancies if there is a defect and more so to allow families to make arrangements early in light of the knowledge. The hospital will not push mothers to undergo amniocentesis but they will be made aware that it is an option. If a family has a history of birth defects then and only then can the doctor suggest to the mothers to undergo prenatal testing. Due to our influx of Japanese immigrants, we do not want them to feel pressured into prenatal testing their unborn child since “Japanese ob-gyns are often reluctant to mention prenatal diagnosis even to older women […] some of the Israeli ob-gyns I interviewed said that they offer prenatal diagnosis to each and every patient, regardless of her age” (Ivry). Making prenatal testing available will also allow mothers in the Jewish community to have agency in their pregnancies.

In addition to social workers and genetic counselors, Sasquatch Hospital previously provided spiritual counseling by the Catholic clergy who often interfered with some doctors’ work. I propose that we discontinue this in-house spiritual counseling by Catholic clergy but refer patients to certain spiritual counseling based on their religion and who they would like to confide in. This clash between the medical staff and the Catholic clergy does not provide a healthy environment for the patients. The fact that the Catholic clergy are interfering with patient care is unacceptable especially if the patient is not even part of the Catholic community. The hospital’s historically Catholic nursing staff that refuse to perform these procedures can put in a request to be transferred to a different section of the hospital. I understand that it may be uncomfortable for the nurses who are devout Catholics to assist in performing these procedures but I would like them to reflect the reasons they chose to become a nurse before asking for a transfer. Since the budget for new hires is extremely limited, the hospital cannot replace all of the nurses and the alternative would be to transfer nurses from different wards of the hospital.

 Works Cited

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.” (Crossroad, 1988).

 Shirin Garamoudi Naef, “Gestational Surrogacy in Iran,” In Marcia C. Inhorn and Soraya Tremayne editors, Islam and Assisted Reproductive Technologies (Berghahn Books, 2012).

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).

 

Introduction

Before I delve into the details of my proposal, I would like to introduce myself. My name is Grace and as a twenty-something black female, I am excited to bring some youth and diversity to this ethics committee. I identify as Episcopalian but I do not consider myself to be a religious person. I attended a single-sex, catholic high school where I was taught Catholic moral law. I continued my education at a private, liberal arts university where I studied anthropology – a discipline that involves examining perceived differences in human experiences. Professionally, I have worked and volunteered in both clinical settings and for public health, nonprofit organizations. In addition, I have significant experience working in women’s health. With this background, I feel especially prepared to discuss assisted reproductive technology and its relationship to religion in the context of this hospital.

 

Assisted Reproductive Technologies

Although this hospital is no longer run by Catholic auspices, it continues to limit itself to what is deemed acceptable by Catholic morality. Day by day, our patient population becomes increasingly more diverse and I believe that it is time to embrace this diversity. This is the only major hospital within a forty-five-minute radius and therefore, we are responsible for providing medical services to a large yet religiously and racially diverse population. These people “embody and experience religions to varying effects” and for that reason, it would be wrong to strictly enforce a single, strict religious (Catholic) perspective in terms of medical treatment (Hamdy 156).

In the past, this hospital has used Catholic scripture, such as the book of Genesis, and the guidance provided by Donum Vitae to prohibit procedures like abortion and amniocentesis as well as various other assisted reproductive technologies like IVF treatments and prenatal testing. Today, this hospital is a non-denominational, private institution. In order to carry out this status, we are required to acknowledge the moral law of other faiths and reflect these perspectives in our medical practices. In order words, this hospital can no longer only select the Catholic interpretation of morality and force it upon everyone.

We must give patients the opportunity to undergo assisted reproductive procedures if they so desire because ultimately, “everyday life experience in communities and networks – no matter how influenced we are by global forces of communication, commerce, and the flow of people –  centers on what is locally at stake” (Kleinman 70).  By evaluating the needs of our community and providing patients with the option to pursue various medical treatments, including those that Catholicism denounces, this hospital will become a pillar of advanced and excellent care.

 

Spiritual Counseling  

For some, faith is an essential component to the healing process and as a result, they choose to seek religious guidance while undergoing medical treatment. Because of this, spiritual counseling must remain an available option to all of our patients. In the past, we have had Catholic clergy provide such services but going forward, this counseling must be expanded to clergy of other prominent religions. With this, patients can find comfort in their own faith by discussing their treatment with a religious leader of their choosing.

I anticipate that a number of our healthcare providers will take issue with this option as patients may choose against abortion, prenatal testing and other forms of intervention due to religious sentiments. In this case, it will become important for our staff to relinquish the “powerful myth that religion always opposes scientific and technological progress” (Hamdy 144). The job of a medical provider is to present their patients with all of the options medicine has to offer. It is then up to the patient, and the patient alone, to decide what is best for them. If a patient wants to turn to religion, potentially against medical interference, this is up to them. When it comes to pregnancy and the use reproductive technology, a patient’s “cost-benefit calculations about medical intervention” becomes increasingly weighty as it also involves an unborn child (Hamdy 144). Ultimately, I would remind frustrated providers that religious sentiments “should not be seen as passive, as anti-science, or as constraints to medical treatment” (Hamdy 156). Instead, it is our duty to provide patients with every resource that could assist them in their decision-making process.

 

Hospital Budget

With our previous budget, the hospital was being able to subsidize medical care for our under-insured patients. This act of good will has allowed thousands of patients to receive first-class care without having to endure tremendous financial burdens. My future goal would be to resume this practice but with the introduction of expensive reproductive technology, this will no longer be possible. At its core, this hospital is a private business and therefore it should be run like one.

There is a possibility that historically Catholic hospital donors will not support our new mission and refuse to continue funding our hospital. In event of this occurring, we will seek funding from organizations who support and encourage the use and development of reproductive technologies. With IVF treatments now being offered, some families will authorize the use of their unused embryos to be donated for life-saving reproductive research. This potential for research opportunities will attract innovation-driven physicians, as well as research grants, to our hospital. With this, we can grow our research teams and improve facilities, hopefully making great contributions to this area of medical research in the near future.

There is a second financial challenge to overcome if we change our policies. Members of our clinical staff who do not support the use of assisted reproductive technology may be disinclined to perform related procedures. Our goal should be to provide education and scheduling options for these staff members, but in the case this does not work, these members will be retrained in new specialties or, in rare cases, let go. If necessary, the money recovered from no longer subsidizing under-insured care will be redistributed to our hiring budget.

 

Conclusion

This ethics committee is tasked with determining if, and how, Catholic morality should influence the practices of this hospital. In the words of Arthur Kleinman, we must reconcile the “clearly immense differences in the social and personal realities of moral life with the need to apply a universal standard to those fragments of experience” (70). After examining this hospital’s location, patient population, previous religious affiliation, and ability to access medical technologies, I strongly believe that our hospital should no longer allow Catholic moral teaching to control the types of procedures we offer. I propose that we begin offering all available assisted reproductive technologies, such as abortion services, IVF treatments, and prenatal testing, to our prospective patients.

 

Works Cited

1. Arthur Kleinman, “Moral Experience and Ethical Reflection: Can Ethnography reconcile them? A quandary for the new Bioethics.” Daedalus 128 (1999): 69-97.
2. Book of Genesis, Chapters 1-2. New International Version. Biblica, 2011. com.
3. 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).
4. Sherine F. Hamdy, “Does Submission to God’s Will Prevent Biotechnological Intervention?” In Jeremy Stolow editor, Deus In Machina: Religion, Technology and the Things In-between (Fordham University Press, 2013), 143-57.

 

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

Abortion is a procedure that is perceived very differently by individuals, and religion and culture play a large role for many individuals in their formulation of opinions on abortion. Since the Catholic church has recently allowed the hospital to become non-denominational, I believe this topic should be addressed through a more personalized, patient-care lens rather than a religious lens. In the book Contested Lives: The Abortion Debate in an American Community, author Faye D. Ginsburg looks at both the pro-life and pro-choice side of the abortion debate. Striking to me in this debate is that pro-life individuals believe that the foundation and cause of abortions are based on the idea that abortions are due to irresponsible choices such as unprotected sex. This misconception for the need for abortion makes understanding and regulating abortion policies difficult. Additionally, abortions can be very risky medical procedures and should be done only by doctors in a hospital. Our main goal as a hospital should be keeping patients as safe and healthy as possible. It is important to recognize that Ginsburg is analyzing abortion in America, a country with a multitude of religious and cultural backgrounds, which makes the abortion debate that much more challenging to address. We have talked extensively about control and the importance of having control of your own body. If women are unable to control what is happening to their body at one of the most vulnerable times in being pregnant, they lose that right. Furthermore, if they do not have the financial means of obtaining such control, they risk bringing in more people to this world that will also suffer their financial burden. As a hospital, we should not be endorsing potentially detrimental long-term implications. Donum Vitae emphasizes that as soon as the embryo forms, it should be regarded as a human being. For patients who view an embryo as a life from the moment of creation, we must respect this belief and give the patients control to move forward with their pregnancies. Similarly, the same choice should be given to those who believe otherwise. Many religions emphasize the importance of reproduction and see it as the woman’s role and sole purpose in life. Tsipy Ivry addresses pregnancy from an interesting cross-cultural, comparative perspective, focusing on geneticism versus environmentalism. There is so much cultural influence, almost to the point where it takes away the individualistic aspects of pregnancy. Because of the overpowering and contradictory influences when it comes to abortion, I believe individualism, control, and accessibility for the women should be prioritized over culture and religion when it comes to abortion.

In Vitro Fertilization (IVF) treatments and prenatal testing also should be considered with a woman’s control of her body except that it comes from a standpoint for creating a life rather than aborting one. Kinship and the way various groups understand it differently influence the implantation of IVF treatments. Depending on how we understand kinship, we are likely to support such treatments or fully contest them. For example, if we can understand kinship as strictly nuclear or consanguineal, IVF could have negative implications because we may not “know” who the father is. However, for our Jewish patients it is important we value their emphasis on reproduction and provide the means for them to be able to reproduce. In the chapter “Ethnography, Exegesis, and Jewish Ethical Reflection: The New Reproductive Technologies in Israel” author Don Seeman heavily focuses on the importance of reproductive technology in Israel. He points out a strong religious disagreement between Jews and Christians on the topic of “traditional” marriage and reproduction:

“There is no reason to deny that Jewish Orthodoxy today also holds up this kind of marriage as an ideal, but the halachic or Jewish legal grounding for claims about it permitted and forbidden reproductive practices begins not with Genesis but Leviticus, whose largely non-narrative focus on rules of consanguinity and rules of purity constitutes the main corpus of biblical kinship norms that underlie later Jewish family law. This simple fact is one of the reasons that Jewish law experts (passim) have tended to be so much more favorably inclined towards artificial reproductive technologies than many of their Christian counterparts, just as the State of Israel has been more supportive than many other Western states” (346).

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

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

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

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

As the President of the ethics committee at the Sasquatch Clinic I am pleased to introduce the new policy proposal that will be implemented at the Hospital come January 1^st. It is in my role that I find the best possible solutions for the good of the hospital. Some of the conclusions in this proposal may be disagreed with, however I stand by my committee’s ability at addressing matters in a fair, and logical way. Today, I am writing to address many ethical issues involving our local hospital, Sasquatch Clinic. These topics are of much debate in our current society. Additionally, some of these topics include the use of artificial reproductive technologies, whether we should subsidize abortion services for our under-insured patients, in addition, discussions involving prenatal testing. As we know, much of our donors are predominately of Irish-Catholic descent. Therefore, we want to keep their interests in mind, while also adhering to our new non-denominational values here at the Sasquatch Clinic. We serve a diverse group of patients in Connecticut that we want to respect and value their opinions regarding these subject matters. Ultimately, this proposal was created to best fit the multiple interests at hand while adhering to the values held at Sasquatch Clinic.

First, regarding the subject of subsidizing abortions the hospital will take a firm stance and not allow the subsidizing of abortions due to the magnitude of donations from a predominately Catholic group. According to their religious beliefs, Catholics do not believe abortion should be allowed. Therefore, Sasquatch Clinic will not provide financial support for these procedures to be done. This does not include if the patient is insured or can pay for the procedure themselves. The Christian faith believes that life begins at the moment of conception, and anything following that time would be killing a life. “Human life must be respected and protected from the moment of conception” (Donum Vitae 22). The basis for this decision is that majority of our donors are from the Catholic faith, and do not support the idea of abortion, especially if it was financially funded by the hospital. “The conclusions of science regarding the human embryo provide a valuable indication for discerning by the use of reason a personal presence at the moment of this first appearance of a human life” (Donum Vitae 26). This quote demonstrates the idea in the Catholic faith that the embryo itself holds human value, and therefore considered as equal to a fetus later on during pregnancy. Christianity promotes this argument with a centrality in the US, that other religions have not. That is why Christianity was the major contributor to addressing the topic at hand. Again, in the best interest of the Sasquatch Clinic, the ethics committee has concluded that the hospital will not subsidize abortion procedures due to the mass funding by Catholic donors.

Second, the ethics committee has been approached regarding the funding of IVF testing as well as prenatal testing in the hospital. As with the above discussion about abortion, the committee has decided to approach this topic with our patients in mind. Sasquatch clinic serves many patients with Jewish backgrounds. Furthermore, their beliefs and values will be taken into account regarding our decision behind funding IVF and prenatal testing. The committee has decided to fund the use of IVF, prenatal testing, and other artificial reproductive technologies. This was concluded based on fundamental beliefs in Judaism that a portion of our patients adhere to. In Israel, reproductive technologies are often encouraged as a way of maximizing the Jewish bloodline. Reproduction is considered as a duty bestowed upon by God in the faith, and if women and men are not able to complete the duty naturally, then technologies can be a way to complete that duty (Kahn 3). Since, the hospital serves a population of Jewish Americans, it is deemed as necessary to adhere to part of their belief system when discussing IVF, prenatal testing, and other forms of ART. Even women who are unmarried are held to hold the duty of maintaining the nuclear family through treatments of IVF (Kahn 45). This idea demonstrates the importance kinship has in the Jewish faith. Moreover, this is the basis as to why the hospital will subsidize ART technologies, IVF, and prenatal testing.

Finally, with the inclusion of ART technologies in the financial budget comes the discussion regarding the use of unused embryos for donation to potentially participate in research. For this topic, the committee focused on the Hindu approach to bioethical issues. As the Hindu population is large in Connecticut, the hospital values their beliefs if they are to be treated at Sasquatch Clinic. The Mahabharata is a Sanskrit epic that many Hindus look at for ethical questions and answers. In regards to the use of unused embryos, the committee has decided that families may choose to donate their unused embryos for research to a certain extent. This extent includes screenings for ethical research, and explicit consent given from the family. Restraint and limiting the use of this technology is encouraged according to the Mahabharata (Bhattacharyya 53). This idea encourages the use of reproductive technologies, while respectfully approaching the situation as well. Due to these beliefs, and the opinionated Hindu population found at Sasquatch Clinic, the committee has agreed to allow donation of unused embryos with certain limitations.

In conclusion, the ethics committee at Sasquatch Clinic takes pride in approaching each situation in a respectful, logical manner. The outcomes agreed upon discussed in this policy were concluded based on the greatest utility found within each decision. Sasquatch Clinic treats many people with many cultures, and who practice many religions. With this in mind, the committee found it fit to find the answers to these ethical questions in the best interest of some of our patient populations. In the question of subsidizing abortion procedures, IVF treatments, and prenatal testing the committee looked at the belief system of our patients when deciding the outcome of those solutions. Additionally, the question of donating unused embryos for research was also approached in this same manner. The ethics committee believes we have approached these decisions in the way that will benefit the hospital in the most successful way.

 

 

Works Cited

Bhattacharyya, Swasti. Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.

“Donum Vitae.” Catholic Information Network (CIN), 2009, www.cin.org/vatcong/donumvit.html.

Kahn, Susan Martha. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke Univ. Press, 2006

To Whom It May Concern:

As you all know recently Sasquatch Community Hospital has become non-denominational. This change will better reflect the growing religious and ethnic diversity of our community. New and varying patient populations with different beliefs from our largely Catholic health practitioners and donors are on the rise. These changes need to be addressed so that the hospital can run smoothly through this transition.

What is not diverse is our donor population. There was no conflict when the community was predominantly Irish Catholic and the hospital was associated with the Catholic Church. As we know, Sasquatch Community Hospital has kindly subsidized care for patients who are under-insured. This was made possible by generous Catholic donors. It will be difficult to maintain donors if money is used to fund medical procedures against their faith. It is of utmost importance to create a vast donor population as medical treatments only become more expensive and the patient population grows. We must attempt to spread the donor population to reflect newer religious and cultural groups in the area. Though these are only minority groups now, they have differing beliefs to the Catholic Church and will want access to procedures previously not offered. We need to prevent a mismatch between procedures offered and our patient population. We are the only major hospital in a roughly hour drive and it is our duty to provide care.

To reduce the risk of losing Catholic donors, we should strategize where donor money can be funded. We can tell donors that they can donate to the hospital overall. We could also tell donors they can pick where to allocate their money, such as the maternity ward, the cancer ward, emergency services, or the reproductive services ward, to name a few.

The reproductive technologies subset of the hospital will include procedures that do not conflict with non-Catholic faiths. For example, a growing Jewish population might want to utilize IVF treatments. In Israel, IVF is an alternative to motherhood for single women. Some Jewish women believe it to be more honest and cleanly, whereas sexual intercourse can be the opposite (Kahn 22). Some Catholic donors and nurses might to respond to single women, or married women utilizing IVF treatment as a conflict to “the gift of human life…actualized in marriage through the specific and exclusive acts of husband and wife” (Donum Vitae 147). Since a required team member for IVF treatment is nurses, I recommend using the argument presented below:

Gilbert Meilaender, author of religion and ethics, reminds us that while the Bible does not speak of a method like IVF for procreation, there is an imperative value on procreation itself. Infertility is  considered a “sorrow” (Meilaender 1638). He further explains stressors placed on infertile couples from their community. In such events, he references the work of Paul Simmons, a Christian ethics author, who believes “biotechnical parenting” does in fact highlight the “symbolic value” of parenting that relate to biblical principles. These principles include having offspring by choice, or parenting as a “calling, not to accident or mere biological capacity.” This has large implications for people seeking IVF treatments, and even pre-natal testing and amniocentesis. “Biotechnical parents” will not “resent” a pregnancy, since they are going through difficult means to commit to becoming parents; thus, a child of IVF is guaranteed “caring love” (Meilaender 1639). We should disclose this morale of “biotechnical parents” on Catholic nurses because there are biblical routes to parenthood in this format.

Similar to Catholic faiths, the growing Lebanese Shiite population will raise concerns about IVF treatments, though there are some instances where they will be welcomed for Shiites. There is more leniency in receiving egg donors than sperm donors for Shiites. Controversy arises for sperm donors due to opinion that “’the child would not be from me – it would be like raising some other man’s child’” (Inhorn 104, 112). Still, infertile couples would seek egg donors and completing pregnancies through IVF treatments if they were offered at the hospital.

In terms of pre-natal testing and amniocentesis, there is not a uniform desire for such tests in our patient population. Pre-natal testing for malformations through amniocentesis is morally illicit if followed by an abortion (Donum Vitae 150). Similarly, the Japanese immigrant group comes from a country that prohibits abortions for “eugenic reasons.” In other words, it is publicly understood in Japan that abortions are for “choosing when to have children rather than what kind of children” (Ivry 82). Therefore, if a woman wants to have an abortion in Japan it is available, but not in the case for terminating a disabled fetus. In a few such instances that these types of abortions occurred, they were through “legal reasons” (Ivry 19).  In majority cases, Japanese pre-natal care includes attention to maternal nutrition and fetal environment (Ivry 11). These values will not necessarily be ingrained in all Japanese immigrants that enter our hospital, but show us the common beliefs and values of their home country. Contrasting greatly, the pregnancies of Jewish women in Israel hold large importance on pre-natal tests, some of which, like chromosomal biomarker tests are not common procedures in Japan (Ivry 3). While the origins in the Jewish population in Sasquatch are not necessarily known, this group can look to Israel as a model to base their reproductive technology use. For this reason, this Jewish group might look to use pre-natal testing like amniocentesis.

As IVF treatments become more accepted among non-Catholic populations the newer patient population will desire these treatments. It is possible that some Catholic patients will also desire IVF treatments. Barbara Katz Rothman, author of texts about reproductive technologies and women, states that Catholic women are “over-represented” in terms of IVF. This is due to pressure placed upon women to have children and their worthiness depending on this practice. Women might undergo treatments that go against their religious faith to be welcomed socially in their community (Rothman 1605). Although this is not a guarantee that Catholic families will engage in IVF treatments if they are suddenly available at the hospital, it does show evidence that Catholics are not necessarily as much of a homogenous group on this topic as they make public. This text demonstrates a clear desire for reproductive treatments that are not unheard of in all contexts of the Catholic faith.

To remind everyone, this means that there is a Jewish population, Lebanese Shiite population, and potential Catholic population that would utilize IVF treatments. Although there are many groups listed above that could potentially utilize IVF, I only suggest unused embryos to be donated with reservations. I do not see why Jewish or Shiite groups would disagree with this decision, as they are more open to IVF treatments. On the other hand, in Donum Vitae, Catholics are urged not to allow procedures on live embryos, unless there is “certainty of not causing harm to the life or integrity of unborn child and the mother.” Therefore, science experiments that hold no therapeutic advantage to the embryo violate human dignity (Donum Vitae 152-153). I believe unused embryos should be donated based on the discretion of the people undergoing IVF treatment. Donating unused embryos should not be the status quo offered by the hospital, with the goal to avoid risks of losing Catholic donors.

Until there is a more widespread donor population, I do not think the hospital should provide and subsidize abortion services for under-insured patients. We want to prevent Catholic donors pulling out from the hospital because their money is being used to perform abortions. We also want to prevent nurses from refusing treatments that cut into their employer’s money, but most importantly also their values. Our Catholic nursing population might be most opposed because the Catholic faith prohibits abortions “of any kind” (Donum Vitae 149). We cannot risk losing our donor population, or the hospital will be forced to close, closing all non-reproductive services with it. Therefore, I suggested earlier to diversify our donors so that we can fund reproductive technologies. If in the future there are donors that are not against abortion that want to help fund these services, I see no problem in allowing this to occur. Until that moment, however, abortions should only be administered to those who can have one without needing hospital funding, due to the current largely Catholic donor base. The reason I am separating the allowance of IVF treatment from abortion is that there are more groups that support IVF than abortion in this new patient population. As I push for diversified donors, I must speak about diversifying spiritual clergy that historically have come to Sasquatch Community Hospital.

Although the hospital is now non-denominational I fully expect Catholic clergymen to continue to come to the hospital, despite medical staff disliking their presence due to interference. I believe this counseling option should now include clergy and community members from other religions and cultural groups that now accompany our patient population. This will include clergymen or community members of Jewish, Shiite Muslim, non-Irish Catholic and Japanese people. I want to emphasize that this is an optional service. It should be known to patients that it must be requested, and will not occur without request. For this reason, I want to propose we allow people to sign up for slots with clergy and community members. If this changes the mindset of patients to decide to forgo reproductive technologies, the medical staff must accept this form of autonomy in patients.

I look forward to your responses on behalf of my proposal to allow IVF, and abortion services with proper funding. A large part of my proposal includes efforts to diversify our donor population. I am in favor of the use of assisted reproductive technologies because I believe there is substantial evidence that many members of our patient population could benefit from these treatments. I believe abortions and pre-natal testing must be handled separately and be funded through donors who support these services due to the risk of losing Catholic donors that fund all areas of the hospital. By allocating new donors to reproductive technologies these services will be made possible, while keeping the hospitals many other essential services intact.

                 

Works Cited

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.

Inhorn, Marcia. “He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly, vol. 20, no. 1, 2006, pp. 94-120.

Ivry, Tsipy. Embodying Culture: Pregnancy in Israel and Japan. Rutgers University Press, 2009.

Kahn, Susan Martha. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press, 2000.

Meilaender, Gilbert. “New Reproductive Technologies: Protestant Modes of Thought.” Creighton Law Review, 1991, pp. 1637-46.

Rothman, Barbara Katz, “Reproductive Technologies and Surrogacy: A Feminist Perspective.” Creighton Law Review, 1991, pp. 1599-1607.

 

 

 

INTRODUCTION

The ethics committee of Sasquatch Mercy Hospital seeks to address research activities and patient care carried out within the hospital. With the recent transition from the hospital’s Catholic founding to one of culturally non-denominational practicing, Sasquatch Mercy Hospital has found itself needing to clarify and reevaluate prior hospital policies. The ethics committee has come to the consensus of the importance of the separation between church and state as a founding American principle that is codified in the First Amendment. Thus, Sasquatch Mercy Hospital will follow a policy discourse that aims to remain non-partial to any specific religion, while acknowledging our religious founding. While our founding has been based on, “The Lord as healer of the sick [as] the icon for all healing professions: “Come to me, all of you who labor and are overburdened, and I will give you rest … (Matthew 11:25–30)”” (Schotsmans, 2009), the ethics committee strives for nondiscriminatory hospital policies.

In this proposal, we aim to address our policies regarding abortion, IVF treatments and prenatal testing, spiritual counseling, and hospital employee codes of conduct regarding administering potentially controversial treatments.

ABORTION POLICIES

The hospital will provide and subsidize abortions for up to 25 weeks for underinsured patients. While our hospital is in line with our Catholic founding that “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae), in regards to abortion, we recognize and prioritize the rights of the mother over the fetus. Our prioritizing of rights follows an Aristotelian understanding of natural inequality—where there is a distinction between virtue in a moral sense and virtue regarding rights and political life. Aristotle in his Politics writes “… if it is impossible for a city to consist entirely of excellent persons, yet if each should perform his own work well, and this [means] out of virtue, there would still not be a single virtue of the citizen and the good man, for it is impossible for all citizens to be similar.” (Aristotle, 1984). There is a necessary inequality between individuals regarding the virtue of citizenship. Through this inequality, divisions of wealth and labor are created within the larger metropolis. In respect to the current American system—where citizenship is not given to everyone, our hospital takes into consideration the natural inequality of modern-day life. Thus, the pregnant woman’s rights take precedence over the fetus’ rights.

However, our hospital recognizes the potential transgression that abortion carries, namely murder. Thus, the ethics committee expands upon Agamben’s analysis of Carl Schmitt’s concept of the state of exception. Agamben defines the state of exception where, “In every case, the state of exception marks a threshold at which logic and praxis blur with each other and a pure violence without logos claims to realize an enunciation without any real reference” (Agamben, 2005). The state of exception, synonymous to a state of emergency, allows one to disregard and transcend law for the greater good—relegating control and authority to a singular entity. In pregnancy, the pregnant mother undergoes substantial physiological and anatomical changes. These changes affect all organ systems throughout the woman’s body and have potential to be life threatening to the pregnant woman. Priya Soma-Pillay et. al examine the physiological changes in pregnancy, one example being, “Changes in the coagulation system during pregnancy produce a physiological hypercoagulable state (in preparation for haemostasis following delivery). The concentrations of certain clotting factors, particularly VIII, IX and X, are increased. Fibrinogen levels rise significantly by up to 50% and fibrinolytic activity is decreased. Concentrations of endogenous anticoagulants such as antithrombin and protein S decrease. Thus pregnancy alters the balance within the coagulation system in favour of clotting, predisposing the pregnant and postpartum woman to venous thrombosis. This increased risk is present from the first trimester and for at least 12 weeks following delivery” (Soma-Pillay, Nelson-Piercy, Tolppanen & Mebazaa, 2016). Once a woman gets pregnant, her body enters a state of exception as her body becomes more susceptible to complications such as increased risk for blood clots, mental health conditions, high blood pressure, among other difficulties. Thus, the hospital recognizes the mother’s role within her physical state of exception that her pregnancy has induced—the mother’s authority and decisions should be treated with the highest importance and regard.

IVF TREATMENTS AND PRENATAL TESTING

Sasquatch Mercy Hospital will provide in vitro fertilization treatments; however, will not subsidize the costs to underinsured patients. Inhorn in her ethnographic account on reproductive technologies in the Muslim world writes, “New reproductive technologies, including donor technologies, seem to be giving infertile couples, both Sunni and Shi’ite Muslims, new hope that their infertility problems can be overcome, thereby increasing sentiments of conjugal love and loyalty” (Inhorn, 2006). The ethics committee recognizes the benefits of IVF treatments on marriages and women’s agency, and feels the importance of providing IVF to patients that can afford it.

In regards to whether the hospital should encourage families to allow unused embryos to be donated for potentially life-saving research, the ethics committee will not actively encourage hospital patients to donate unused embryos. Doctors and hospital staff will be required to notify patients of the option to donate; however, encouragement for the donation of unused embryos is at the digression of hospital staff. As our hospital is not a research hospital, while we truly value advancement in science, we prioritize providing high quality patient care over making strides within the scientific community.

Prenatal testing will be provided and subsidized for all underinsured patients. The option for amniocentesis for pregnant women will be offered as early as twelve weeks and as late as twenty-five weeks, the latest week for a hospital sanctioned abortion. The ethics committee remains cognizant that “About half of fetuses with serious anomalies won’t be detected until an ultrasound at 20 weeks” (Axelrod, 2017). Thus, Sasquatch Mercy Hospital, will offer a mandatory ultrasound at twenty weeks.

SPIRITUAL COUNSELING

The Sasquatch Mercy Hospital will continue to provide spiritual counseling via the Catholic clergy. The ethics committee proposes to expand the spiritual counseling program to include other religions in response to the changing demographics of Sasquatch, Connecticut. However, in order to address the slight conflict between the Catholic clergy and the doctors, all religious spiritual counselors must sign a contract to issue a verbal disclaimer at the start of each counseling session that their spiritual beliefs do not reflect the views or practices of Sasquatch Mercy Hospital.

MEDICAL EMPLOYEE CODE OF CONDUCT

Sasquatch Mercy Hospital respects and values its Catholic nursing staff. The ethics committee believes that no nurse will be compelled to have direct involvement in a procedure she/he objects to based on her/his religious, moral, ethical, or cultural values. In compliance with Connecticut law that only a physician may perform an abortion (Conn. Agency Reg. § 19-13-D54), no nurse will be responsible for administering abortions. The ethics committee requests all nurse staff to alert the hospital of whether she/he cannot provide or aid abortion or reproductive services based on moral or religious grounds. Thus the hospital will enact structural changes regarding reallocation of workload for nursing staff based on each nurse’s moral and religious convictions.

Lastly, the ethics committee would like to bring to light that the power dynamics involved from a patient-nurse perspective. Nurses are placed in a position of authority and trust with patients who are dependent on them for their healthcare. In order to work towards eliminating systematic discrimination towards vulnerable populations, the hospital requests its nurse and donors to reflect and think on whether their decisions are disregarding the rights of the people that they serve.

Works Cited

Axelrod, C. (2017, October 06). “I’m an OB-GYN who had a 2nd-trimester abortion. The 20-week ban bill is dangerous.” Retrieved from https://www.vox.com/first-person/2017/10/6/16438352/20-week-abortion-ban-obstetrician

Donum vitae = The gift of life: Instruction on respect for human life in its origin: And on the dignity of procreation:. (n.d.). Washington, D.C.: National Catholic Bioethics Center.

Dube, N., & Csere, M. (2013, May 28). Abortion Clinics in Connecticut. Retrieved from https://www.cga.ct.gov/2013/rpt/2013-R-0238.htm

Fiala, C., & Arthur, J. H. (2014). “Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection. Woman – Psychosomatic Gynaecology and Obstetrics,1, 12-23. doi:https://www.sciencedirect.com/science/article/pii/S2213560X14000034

Foss, D. R. (1991, October 3). Aristotle and Natural Inequality. Retrieved from http://www.shlobin-foss.net/papers/unequal.html

Inhorn, M. C. (2006). “He Wont Be My Son”. Medical Anthropology Quarterly,20(1), 94-120. Retrieved from http://www.jstor.org.proxy.library.emory.edu/stable/pdf/3655508.pdf?refreqid=excelsior:d10faeb192e7e627fce0b85a5b164fcd.

Pappas, S. (2012, October 19). Fact Check: Yes, Pregnancy Can Kill. Retrieved from https://www.livescience.com/24127-fact-check-walsh-pregnancy-can-kill.html

Pregnancy Complications. (2016, June 17). Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregcomplications.htm.

Schotsmans, P. T. (2009). Christian Bioethics in Europe: In Defense against Reductionist Influences from the United States. Christian Bioethics,15(1), 17-30. Retrieved from https://academic-oup-com.proxy.library.emory.edu/cb/article/15/1/17/297565.

Soma-Pillay, P., Nelson-Piercy, C., Tolppanen, H., & Mebazaa, A. (2016). Physiological changes in pregnancy. Cardiovascular Journal of Africa,27(2), 89-94. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928162/.

Stein, R. (2011, November 27). New Jersey nurses charge religious discrimination over hospital abortion policy. Retrieved from https://www.washingtonpost.com/national/health-science/new-jersey-nurses-charge-religious-discrimination-over-hospital-abortion-policy/2011/11/15/gIQAydgm2N_story.html?utm_term=.9b42c4e0ce5c

The Policy Proposal of Sasquatch hospital

Introduction

As a member of the ethics committee at Sasquatch hospital, I intend to propose several new policies regarding the use of assisted reproductive technologies and prenatal testing. Our hospital was run for many years under Catholic auspices and supported by Catholic donors. These auspices influenced the provision of reproductive services because of the belief by the Catholic Church that “from the time that the ovum is fertilized, a new life begins” (Cahill et al 145). According to Catholic doctrine, the fetus is a human being from the moment of conception. Therefore, it is also Catholic belief that abortion is equivalent to killing a new life. As a result, our hospital has never previously provided abortion services.

Abortion services

Although abortion is legal today under federal law, the prohibition of abortion by the Catholic Church prevented our hospital from providing the procedure to our patients.  Although there might be a religious backlash to the provision of abortion services, our goal as the largest hospital in the area should be to provide better and more comprehensive health care services to our patients. The religious beliefs of our patients “should not be seen as passive, as anti-science, or as constraints to medical treatment” (Hamdy 156), but rather as individual qualities that can be easily overcome through treatment innovation and design. Since our hospital recently became non-denominational, the hospital is no longer burdened by the responsibility of abiding by the rules of the Catholic church. Although the hospital would like to maintain its religious patients and donors, the hospital should begin to provide abortion services to patients who choose to use them.

As supported in Thompson’s “A Defense of Abortion,” the hospital should support the right of choice for a woman going through a pregnancy and potentially an abortion. To placate our Catholic patients and donors, our hospital will not provide subsidized abortion services for underinsured patients at present.  This decision is influenced not only by the fact we are a private hospital with limited medical resources but also heavily reliant upon Catholic donors. Beginning to provide abortion services will be a significant change for many of our Catholic donors, but the hospital can ensure donor relationships remain strong by only accepting blanket donations to the hospital rather than donations to specific treatments. This is to avoid tension over some donations paying towards abortion services. The controversial nature of abortion holds true for Islamic patients and donors as well.  If in the future the hospital has new donors from other cultural and religious backgrounds such as Judaism and atheism, we can start to subsidize treatment for underinsured patients.  It is sometimes the case that these backgrounds are more accepting of abortion, but the hospital should provide subsidized abortion services based on the financial grounds of the hospital rather than the religious preferences of the patients.

IVF treatments and Prenatal Testing

Although at present the hospital cannot provide subsidized abortion services, this year the government will provide our hospital-specific funding for In Vitro Fertilization (IVF) treatments and prenatal testing including amniocentesis.  Although the Catholic church may believe that any intention to “to request such a diagnosis with the deliberate intention of having an abortion” is unethical (Cahill et al 152), and some donors may not support these treatments, the use of government funding means this is detached from donor preferences.

Other than the Catholic church, the local Japanese population is similarly resistant to the use of IVF treatments.  Although there is widespread access to modern and advanced medical technologies in Japan, prenatal care still focuses on “Gamburu,” or to “make an effort” (Ivry 134) Ob-gyns are viewed as coaches to guide women spiritually during the pregnancy rather than interpreting pregnancies in a genetic manner. For example, the focus of Japanese culture is to nurture the child with environmental care from the mother.

Not only is the area home to a Catholic and Japanese population, the area hosts a small but vibrant Jewish community eager to try IVF treatments, and the hospital can cater to the needs of both groups.  In their views “Reproductive technologies are allowed and even encouraged as a means of furthering the Jewish bloodline and realizing God’s command to multiply. Reproduction is an ‘imperative religious duty’ sanctioned by the very specific economic, political, social, and historical contexts that have given rise to the use of new reproductive technologies as a way to satisfy that duty” (Kahn 3). Paradoxically, it seems that the traditional notions of the Jewish family are separate from those of increasing the Jewish population.  Furthermore, to avoid religious conflict and show our respect to the Lebanese Shiite immigrants, our hospital will only “authorize the insemination of the woman’s egg with the donor’s sperm in a lab dish, and then implantation of the fertilized egg into the wife’s uterus” (Marcia C. 165). According to Marcia C., this circumvents adultery, as “the definition of incest in Shia thought and practice does not depend on the transfer or contact of bodily substances. Rather, it depends on the illegitimate physical act of illicit sexual intercourse, and not on the act of conception itself.” We want to be able to provide IVF treatments while taking in the consideration of Islamic patient’s religious belief.

Furthermore, Jewish pregnant mothers are willing to use prenatal testing because Jewish pregnancy culture is acutely focused on geneticism. This focus derives from the belief that if a Jewish woman experiences premature birth and miscarriage, the cause is viewed as a genetic defect of the fetus. As a result, the mother has the choice to stop the early pregnancy which may reduce the likelihood of physical and mental harm. It is the duty of our hospital to provide care and provide prenatal testing to all the women in the community.  The decision rests on the mother on whether to use the service. Due to the fact it is important to understand a variety of factors play into a patient’s decision on whether or not to undergo medical treatment, it is important that the hospital provide prenatal testing. According to Hamdy, the decision to receive treatments is “extremely complex and highly variable, depending on the patient’s changing circumstances” (Hamdy 156). Nonetheless, we know that “middle-class patients (disproportionately white) usually accept the test while poorer women (disproportionately from ethnic-racial minorities) are more likely to refuse it” (Rapp 168). Since government funding is available, we can reduce the price of prenatal testing which may encourage more poor women, including ethnic minorities, to receive treatments without making it appear as the hospital is subsidizing such procedures.

Donation of Unused Embryos to Research

If our hospital begins to provide IVF treatment, the hospital should also encourage families to allow their unused embryos to be donated towards potentially life-saving research. Due to the fact that “more embryos or fertilized eggs are created than are usually needed for a single treatment. Those extra embryos are frozen and can be kept over a period of several years for later use without significantly losing their potential develop successfully into human beings through pregnancy” ( Eich 64 ).  Once a couple is satisfied with their number of kids, they should be encouraged to sign an agreement to donate their frozen embryos. These extra embryos could be used for research purposes so that their inevitable destruction would serve some benefit. Circumventing much ethical debate, “a fertilized egg before nidation differed significantly from an embryo after nidation and therefore did not have the same human rights, the rights of bodily integrity”( Eich 66). If the fertilized egg was not implanted, they are simply cells and can be used to study stem cell regeneration. The Catholic church has argued against the use of fertilized eggs due to concerns about their use for cloning, but our hospital will set specific regulations banning the use of these fertilized eggs for cloning research.

Onsite Religious Counseling

In addition to providing new treatments, the hospital will attempt to consider the needs of individual patients from various religious backgrounds.  To pursue this goal, the hospital will provide religious counseling by clergies of all religions. These clergymen will not be allowed to discuss their view towards any specific medical procedure on hospital grounds, but instead are required to focus on counseling the patients spiritually in a non-medical manner.  Distinct from an advisory role, clergymen would serve to ensure a deity is with the patient through illness and hardship. To ensure that these clergymen do not interfere with treatments, they will only be permitted on hospital grounds during the weekend. Furthermore, the hospital will do its best to keep clergyman and doctors separated.  If the hospital receives any complaints from doctors of interference, the individual clergymen will be banned from the premises and their services will be discontinued.

Relocation of the Nursing Staff

Last but not the least, the hospital will relocate historically Catholic nursing staff who are unwilling to perform abortion and reproductive services, such as other wards of the hospital. Since we have a limited budget, we will hire a nursing professor who specializes in teaching abortion care and reproductive services rather than hiring new, specialized nurses. Education will be available to all nurses who want to perform abortion and reproductive services. At the same time, the hospital will welcome nursing school students to volunteer in the hospital for one or two semesters. If they perform well, our hospital will potentially provide them positions after training.  In conclusion, I propose that our hospital start to provide abortion services, IVF treatments, prenatal testing, and religious counseling services to accommodate the increased diversity of the local community. Donors and nurses who are resistant to the new changes can be accommodated through changes to the hospital financing structure and assignment allocations as explained above.

 

 

Works Cited

Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine, Anthropology, Theory 3 (2016): 29-54.

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

Inhorn, Marcia C., and Soraya Tremayne, editors. Islam and Assisted Reproductive Technologies:  Sunni and Shia Perspectives. 1st ed., Berghahn Books, 2012. JSTOR,

Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66.

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

Sherine F. Hamdy, “Does Submission to God’s Will Prevent Biotechnological Intervention?” In Jeremy Stolow editor, Deus In Machina: Religion, Technology and the Things In-between (Fordham University Press, 2013), 143-57.

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).

Thomas Eich, “Decision-Making Processes among Contemporary ‘Ulama’: Islamic Embryology and the Discussion of Frozen Embryos.” In Jonathan E. Brockopp and Thomas Eich, Muslim Medical Ethics From Theory to Practice (University of South Carolina, 2008), 61-77.

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).Community (University of California Press, 1989).

 

Central Lee Hospital Ethics Committee Policy Proposal on Assisted Reproductive Technologies

Introduction

For many years, Central Lee Hospital has been a cornerstone of wellness in the community of Sasquatch Connecticut, providing high-quality, comprehensive healthcare to those in need regardless to race, color, national origin or citizenship status, sex, gender identity or expression, pregnancy, sexual orientation, age, disability or military status. Even though we were under Catholic auspices for many years, we have decided to allow the hospital to become non-denominational, and subsidize medical care for under-insured patients.

With the increase in the population and diversity in our community in addition to the fast advancement in new technologies, we felt that there is a need to form a new policy regarding the use of assisted reproductive technologies in our hospital. As a member of the ethics committee at the Central Lee Hospital, I, Saeyoung Lee, was assigned to introduce a new policy proposal that addresses the use of assisted reproductive technologies. Before I begin, I want to emphasize that this is a proposal that makes the hospital as helpful as possible to all of our patients, regardless of my race or religious belief. However, in order keep what is the best for the hospital, we must not forget our Catholic origins.

 

Abortion Policy

First, our hospital should NOT provide any abortion services. Due to our Catholic origins and many of our important donors being Catholics, our ethics committee agrees that “the human being must be respected, as a person, from the very first instant of his existence” (Vitae). In addition, we must note that human life must be absolutely respected and protected from the moment of conception (Vitae). Therefore, I wish to share the goal of recriminalizing abortion, but also sees abortion as symptomatic of other social problems. In particular, I am concerned that materialism and narcissism are displacing nurturant ties of kin and community (Ginsburg, 1989). Thus, the Donum Vitaedoctrinal reminder provides the fundamental criterion for the solution of abortion, thus we should not promote nor provide any abortion services.

However, we understand that there are many patients who request abortions for valid reasons. Therefore, we will be implementing a special referral services for those who desperately desire abortions. In order to get a special referral, patient will only have to inform her OB-GYN. Then, the specialist will send a referral to the closest hospital (Hope Connecticut Hospital) that performs many different assisted reproductive technologies including abortions for the patient to be seen. Please note that this alternative hospital is within two hour drive from our community of Sasquatch Connecticut.

 

IVF Treatments and Prenatal Testing Policies

Even though our hospital ought to reflect its Catholic origins, we understand that there has been many advanced technology and cultural shifts worldwide, including in our community. For example, most recently, we have seen some population diversities in our community. In addition to the dominant Irish Catholic population, the local area is also home to a small but vibrant Jewish community, a mixed white and African American (non-Irish Catholic) community, and a growing influx of Lebanese Shiite and Japanese immigrants.  In order to cope with these changes, our hospital needs to open its doors to different religious perspectives slowly, but step-by-step. Therefore, in addition to becoming non-denominational, we should accommodate to services such as IVF treatments, and prenatal testing including amniocentesis to those in the unity of marriage and for a reason. However, we must make it clear that these services will only be provided after cautious evaluations from our reproductive health professionals with clinical disciplinary perspectives.

Development of the practice of in vitro fertilization has required innumerable fertilizations and destructions of human embryos. Even though our Catholic church still thinks the embryos obtained in vitro are human beings and we should not cause harm to life or integrity of the unborn child, through a careful consideration, I want to put more weight on the fact that every married couple has a right to become a father and a mother. Therefore, a child is a gift and blessing of God, and a confirmation and completion of their reciprocal self-giving. Unused embryos collected from IVF treatments should not be donated or used as scientific materials for any type of research because such experiment will cause harm or death without a potential of becoming the fruit of marriage.

Next, Prenatal testing including amniocentesis should be provided only if prenatal diagnosis respects the life and integrity of the embryo and the human fetus and is directed toward its safeguarding or healing as an individual (Vitae). With that said, this testing should not be performed when it is done with the thought of possibly inducing an abortion depending upon the results such as malformation or a hereditary illness which are not equivalent of a death sentence. Such diagnosis is only to know the condition of the embryo and the fetus, and to make it possible to anticipate earlier and more effective medical and surgical procedures for better outcome of birth.

 

Spiritual Counseling Policy

Patients consider spiritual and physical health to be of equal importance and recognize that spiritual needs may increase during illness. With the increase in population and diversity around our community, we decided to provide clergies of other religious communities such as Jewish, Shia Islamic, and Buddhist clergies in addition to social workers and genetic counselors. Furthermore, we should hire new reproductive health professionals including doctors and nurses with different religious perspectives to limit any religious interferences conflicting patients and medical staff’s decision making. These new additions to our hospital will make sure that all of our patients are receiving the best medical care regardless of their status. However, our staff and new hires should agree upon our policies of assisted reproductive technologies during the contract renewals and hiring processes. Those who make accommodations outside of our policy will be terminated.

 

Conclusion

As we all know, due to our Catholic origins, we still are predominantly funded and run by Catholics. The possibility that the hospital will now provide reproductive services has alarmed some of the hospital’s funders and its historically Catholic nursing staff. As a member of ethics committee, I strongly oppose against forcing anyone to perform any tasks against their religious beliefs. Therefore, I think our Catholic nurses should not have to perform any procedures related to assisted reproductive technologies. Some of our Catholic nurses should be able to transfer to other departments such as Cardiology and Endocrinology. In order to fill in the gap, we should ask if any nurses from other department to voluntarily transfer over to the Reproductive Health Department.

Hopefully these new changes in policies will expose individuals to different cultural and religious beliefs and practices. In addition, we will have the opportunity to broaden our own perspectives, thus enriching our stock of conceptual and axiological resources from which to draw when making difficult decisions for ourselves (Bhattacharya, 2006).

 

Works Cited:

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).

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

Swasti Bhattacharya, Magical Progeny, Modern Technology: A Hindu Bioethics of Reproductive Technology(Suny University Press, 2006).

 

Saint Paul Hospital Ethics Committee Policy Proposal

The proposal of new policies for services conducted at Saint Paul Hospital are to be fully aligned with the mission statement and legacy of the institution:

“Since 1867, our mission at Saint Paul is to put the patient first. Our duty is to give tangibility to Christ’s healing mission and the mercy of the Catholic Church to care for and ensure the wellbeing and good health of our community.”

The proposed policies are as follows:

The purpose and legacy of Saint Paul does not align with assisted reproduction procedures except in extenuating circumstances. Saint Paul will refuse to provide and subsidize abortion services for under-insured patients unless the life of the patient is at risk. It is in our historical faith to respect the human being “from the very first instant of his existence.” (Donum Vitae) Respectful treatment of the unborn child from the moment of conception does not permit abortion. Abortion operations will only be conducted in circumstances where the life of the mother is at stake. This position is aligned with our Catholic roots and mission statement, as it promotes the greater health of our community whilst putting the patient’s health first.

Subsidized In-Vitro Fertilization treatments for under-insured patients will not be conducted at Saint Paul Hospital as such services are an unnecessary procedure. This decision does not only appease the Catholic faith but also serves to better serve the community as IVF treatments are not in the best interest of the community. The introduction of third or fourth parties into reproduction serve to threaten the identity of the child (Shivanandan, Atkinson, 138) but also “the unity and stability of the family with damaging effects on society.” (Donum Vitae) The policy to not conduct In-Vitro Fertilization treatments is reflective of the mission of Saint Paul Hospital to ensure the wellbeing of our community.

Pre-Natal testing (including amniocentesis) will begin at Saint Paul Hospital as the early detection of possible medical issues have the potential to be beneficial for both the mother and child. Biotechnologies told “significance of present and projected uses of biotechnology to serve human goals beyond healing disease and relieving suffering and to satisfy widespread human desires.” (Kass, 234) Saint Paul Hospital encourages the utilization of unused embryos for potentially life-saving research only in the event that such embryos can be safely harvested during an unrelated procedure.

In addition to pre-natal testing, genetic and spiritual counseling will continue to be conducted at Saint Paul Hospital. Catholic belief is that “intervention in this field is inspired also by the Love which she owes to man, helping him to recognize and respect his rights and duties.” (Donum Vitae) Spiritual guidance is a right given to Saint Paul patients. Although spiritual counseling has historically been given by Catholic clergy, Saint Paul will be inviting the clergy of other religions to better represent the diverse community the hospital serves. The ultimate decision of whether to accept the assisted reproductive technologies and late term genetic testing belongs to the patient. The spiritual counseling is to serve as a guide to these decisions, if desired. It is and will not be mandatory for any patients at Saint Paul Hospital.

As the abortion and reproductive services offered at Saint Paul via these policies reflect the mission statement and long-legacy of the institution, it is unlikely that the Saint Paul Foundation and nursing staff will take offense. Elective operations to terminate human life will only be had under emergency conditions. Any nursing staff unwilling to perform these procedures will be reminded that the nature of the operation is for the betterment of the patient and the community.

Works Cited:

1. Congregation for the Doctrine of Faith, “Donum Vitae:  Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation: Replies to certain questions of the Day”. February 22, 1987.
2. Shivanandan, Mary, and Joseph C. Atkinson. “Person As Substantive Relation and Reproductive Technologies: Biblical and Philosophical Foundations.” Logos: A Journal of Catholic Thought and Culture, vol. 7, no. 3, 2004, pp. 138.
3. Kass, Leon. “Reflections on Public Bioethics: A View from the Trenches.” Kennedy Institute of Ethics Journal, vol. 15, no. 3, 2005, pp. 234.

To whom it may concern:

Before I begin, I would like to introduce myself and provide information about my background, both professionally and religiously. First of all, I am a doctor, a FEMALE doctor. I personally want what is best for my patients, and I want nothing more than to reduce a person’s discomfort in the safest way possible. Secondly, I identify as a Roman Catholic. While I do skip some Sundays and in no way claim to be the most “devout” Catholic in the Church, I do resonate with a majority of Catholic beliefs. That being said, after attending a college where the majority of my peers were Jewish and spending time over seas experiencing new cultures, I have become very open minded and accepting to other religious practices, and I have spent a lot of time observing their role in medicine. Due to the diversity in beliefs I have been exposed to, I have definitely struggled with addressing the ethical issues presented to me while being a part of this committee. This is mainly because I value practices and ideas in both Catholicism and other religions, such as Judaism and Hinduism. I hope that what I have to say next will be taken into consideration with respect and an open mind.

This hospital, which was initially under Catholic influence, now has the opportunity to introduce the procedure of abortion. While abortion is a very controversial topic, we—as a hospital—must respect all views and beliefs in the growing community and consider permitting the procedure in the hospital. I personally do not align with the pro-choice movement, as I am Catholic and this procedure goes against my moral belief of “right to life from the moment of conception.” I am also aware that other religions have similar moral beliefs as Catholics do, such as the Hindu belief that people should “do no harm” to other people (Bhattacharyya, 2006). However, abortions are in fact legal in the United States, and we should be providing the service to whoever may need it, regardless of their or our own religious practices. With that said, there are several religions that are more flexible with the idea of abortion and see it as permissible as long as it violates no other “moral code” in the religion.

I find it important to note that we are essentially the only hospital in this community, and it is necessary for us as humans to help the people within our diverse community. In order to do this, we must set aside our religious differences and embrace a utilitarian approach, where we put our community first and our beliefs second. We cannot expect our community to grow and prosper without being accepting and accommodating to others. Prohibiting the procedure of abortion may drive away many of the people in this community, as they may seek protection and help from a more cooperative hospital in another town if we do not.

Now, let us address the under-insured patients. My personal belief is that we should subsidize abortion; however, I can see the problem with providing funding for every abortion. Unfortunately, it is seen that one-third of abortions are repeat abortions. Therefore, my proposition is that we should not subsidize more than ONE abortion per patient. As a catholic and a mother, I would like to our community members to practice safe sex and/or abstinence until they are ready to bear and take care of the child. By subsidizing only one abortion, we will be able to avoid these repeat abortions as well as promote safer sexual habits in our community. After attending University and after I had finished my time abroad, I realized that a majority of people explained that life begins 40 days after conception, not at the start of conception. With this in mind and looking beyond the laws of Catholicism, we can allow for abortions to take place ONLY within a certain time frame. This guideline should accommodate most religious practices.

In regards to our doctors, we should NOT openly suggest abortion as an option to patients. While we should allow abortion to be an option, we should not necessarily advertise it. Advertising such a controversial procedure may drive away some patients that are pro-life, such as our large Catholic group. Our first goal is to respect the patient’s request, and if that request is abortion, then we must honor that request without judgment. However, our second goal is to minimize the number of abortion procedures we conduct. Our doctors should suggest alternative solutions, such as adoption or following through with the pregnancy. Perhaps introducing a policy that supports a pregnant woman considering adoption could aid in reducing the amount of abortions that occur.

As I mentioned, I struggle with the idea of abortion as a Catholic; however, I fully support prenatal testing, so long as it “respects the life and integrity of the embryo and the human fetus.” My belief is “directed toward safeguarding or healing,” and I do think prenatal testing can be extremely beneficial, as doctors can catch or be aware of disease before it becomes fatal (Shanon, 1988). This procedure, amniocentesis, can prove to be stressful for many women, so I suggest again that we do not advertise it. If a woman requests it, then we should perform the procedure; however, plenty of woman have gone through pregnancy without prenatal testing and have given birth to perfectly healthy babies. Thus, unless the woman expresses concern, our doctors should not promote it. With the integration of prenatal testing, we can appeal to our Jewish patients, who are typically concerned with “geneticism” and strongly favor genetic testing (Ivry, 2009). At the same time, we can appeal to our Japanese patients, who rarely request amniocentesis, by not promoting or suggesting the procedure to them. This creates a “no pressure” environment that patients can feel comfortable in, whether they favor genetic testing or not (Ivry, 2009). I’m sure the next concern with this is about how the results of the prenatal testing will affect the rate of abortion. While many people may argue that knowing test results will increase abortion rate, I believe that if we stay true to the idea of “limited advertisement” of abortion and prenatal testing, then there will not necessarily be a spike in abortion. The reverse situation may even occur, where a woman realizes her baby would be perfectly healthy, and then refrains from aborting it.

Another topic of concern is assisted reproductive technology, namely in-vitro fertilization. I typically diverge from the Catholic view towards IVF, as I support it while the Church does not. This is because I resonate with women and their desire to have children. I believe it is important that we, as doctors, give any woman the ability to have a child. The Church states that “it is a gift” to have a child, and if a woman is infertile then “God has a different plan” for her. However, being a mother has given me the opportunity to realize how important and special it is to bear a child, and I want to be able to help an infertile woman experience it. If this hospital allows IVF to occur, we can appeal to many members of our community. For example, Jewish women strongly support IVF because they feel that they need a child to be accepted into society (Kahn, 2000). Another example is in the Shi’ite community, where women are willing to break bonds with their own religion in order to have a child (Clarke, 2007). Therefore, I will make the point again that we should attempt to be more accommodating to other religions other than Catholicism. Permitting IVF can result in growth in the community in terms of population and diversity, not to mention many more women may be happy with families.

In order to support the women that desire IVF, we should encourage other women to donate embryos. I don’t see this as controversial of a topic as abortion, amniocentesis or genetic testing because there doesn’t seem to be any life-threatening consequences from it, and I don’t particularly see women being opposed to or offended by it. Therefore, I think it could be beneficial to promote embryo donations, which could not only provide another woman the chance to have a child, but could also allow for more research to be conducted within the hospital. Selfishly, I think this could also be a great opportunity for the hospital to gain recognition if we are able to produce new and exciting research from these embryos. Holistically, I do not necessarily see a down side to embryo donation and the advertisement of it, but if you feel that there is a problem with it then I would love to hear your opinion on it and see how we could work out a solution.

I am well aware that this hospital holds a strong tie to Catholicism, and moving away from Catholic views may upset staff and community members. Since I am Catholic myself, I would still love to incorporate the religion into the hospital in some way. I think the best way to do this is to keep the Catholic Clergy for counseling. I have learned that healing and religion go hand in hand, and while these patients are undergoing stressful procedures they need something to keep their mental health in tact. By having a patient meet with a religious counselor, they may gain new knowledge of their faith or of a new faith that can help them make their decision more confidently. Meeting with a religious counselor, either Catholic or non-Catholic, can also simply provide the patients with hope. As a doctor, I have come to realize that patients simply desire hope through a dark time, and to know they are in the hands of a non-judgmental and supportive system. I believe keeping counseling within the hospital will provide that support and guidance that is needed by many. This also allows the doctors to remain focused on just the procedure at hand, as the counselors can take on the more spiritual-support role.

If and when we allow all of these procedures to be available at this hospital, there follows a concern involving our staff and whether or not they agree with the decision. We are bound to have nurses and doctors that differ in opinion, and it is important that we address it. The only solution I have for this, given we have a limited budget, is to expose these nurses to new cultures and practices. I became open minded after being around people with different beliefs than myself, and if we can simulate that environment in this hospital then perhaps our staff will also become more secular. If you have suggestions of ways to do this, I would love to discuss them further with you. In the meantime, we would have to assign staff members that are able to put religious differences aside in order to perform the procedure at hand. As stated earlier, I do not think abortion/amniocentesis rates will increase much if we do not advertise them, and I do not think we would lose staff members to this switch.

Finally, I will reiterate the most important points I have made. We are a growing community that is becoming more and more culturally diverse. In order to provide proper care for all of our patients, we need to be aware of the differences in beliefs and acknowledge them. We are a hospital and our main purpose is to serve and heal any person that needs it, regardless of their upbringing, religion, culture, or social class. We should pressure no one into any procedure, and we should be sure to provide ALL information to patients about any procedure they wish to go through. The staff may practice their own beliefs freely, but may not force their beliefs on other staff or their patients. My hope is that allowing these procedures to be available will create an atmosphere of “culturally competent” staff and extremely hopeful patients (Bhattacharyya, 2006).