After recent discussions between the administration of St. Mary’s hospital and the Catholic Church, both parties have agreed that it has come time to change the relationship St. Mary’s and the Church once had. St. Mary’s has been reclassified to a non-denominational private hospital. Any medical or administrative personnel officially affiliated with the Church is no longer be employed by the hospital. To reaffirm this decision, the hospital has renamed itself to Sasquatch Community Hospital. Along with renaming the hospital, SCH will be filling all administrative positions left vacant from this change with qualified Sasquatch residences.
In addition to these changes, SCH commissioned the formation of an ethics committee tasked with writing a new set of hospital policies. Catholic doctrine was regularly used to justification many of the decisions made at St. Mary’s, but at SCH this means of reasoning will no longer be considered sufficient for deciding hospital policy. As such all policies which were made in this way needed to be reviewed by this newly formed ethics committee. To ensure that any policy decisions were made in a manner representative of the new vision Sasquatch Community Hospital has for itself, a great deal of care was put into deciding who should sit on the committee.
Due to the rural nature of Sasquatch, Connecticut, SCH is the only major healthcare provider available to many of its residents. It was imperative that the committee be able to account for the diverse health requirements of Sasquatch residences, while at the same time not compromising our community values. Using a similar model to President Bush’s own council on Bioethics, the hospital appointed me, Dr. Holland, to be the chairman of this committee. My first task was to decide what such an ethics committee should look like and by what means it should be formed. I looked to the wisdom of President Bush’s own council chairman, Leon Kass, to help guide me during this process. In “Reflections on Public Bioethics: A View from the Trenches,” Leon Kass speaks about some of the roadblocks his committee faced. He points out how his committee struggled to find legitimacy within the scientific community, an important audience his committee needed to persuade, due to the circumstances under which it was commissioned. Regardless of the fact that the committee’s goal was “to help protect society’s basic values,” the origins of his committee continues to plague their findings even today (Kass 241). I saw this as a warning to myself that I should be careful in how I assemble my committee, but I also felt that his essay illustrated the power to which a committee’s origins can affect the interpretations of its findings. I hoped to use this to my advantage by finding a means in which my committee could be formed that gave it additional legitimacy in the eyes of the hospital’s new administration and the people of Sasquatch.
In order to accomplish this, I felt it was imperative to allow the residents of Sasquatch to have a say in the composition of their hospital’s ethics committee. This was done by first reaching out to the local government and holding multiple town meetings to hear the community’s thoughts on what such a committee should look like. Using the information gathered from these meetings, I was able compile a list of 40 potential local community leaders to invite to sit on the committee. This was then brought before the community once more, and 20 members were voted to serve as the hospital’s ethics committee. In addition to the 20 members picked by the community, the hospital administration included 10 additional people it felt had the expertise to help lead these members to a practical consensus.
With the guidance of SCH’s newly formed ethics committee, the hospital’s administration has chosen to examine the basis for which St. Mary’s hospital policy was formed iand compile a list of revisions which fall in line with the new identity of the hospital. Not every decision made will result in a change in policy, but the process by which we come to our conclusions will look markedly different. All decisions have been made with extra consider for the needs of Sasquatch residents and the values we uphold as a community. The hospital is also bound by practical limitations as all hospitals are. SCH would love to provide everyone with the healthcare that they feel is right for them, but what is right for one person may not be right for a community or an institution. When these conflicts arouse tough decisions had to be made. We hope that by being transparent about the process in which we came to our conclusions, we will be able to implement these changes as smoothly as possible.
We will begin first by highlighting some of the new procedures SCH is proud to be offering Sasquatch. The first is the procedure of In Vitro Fertilization. St. Mary’s did not provide this procedure as it went against the Magisterium’s teachings on the right to life and dignity of marriage (Donum Vitae, 158). The Catholic Church places a large emphasis on the sanctity of human life and the institution of marriage and SCH wishes not to stray far from what the church has to say about such manners. We hope to employ the same cautious approach to all procedures which have the potential to violate the dignity of human life or the institute of marriage. However, SCH does digress from the Church in what it constitutes as a violation of these sacred institutes. The Donum Vitae states that “artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation proper to parents and the child’s right to be conceived and brought into the world in marriage and from marriage (Donum Vitae, 159).” Catholic doctrine also wishes for all humans to “conform their actions to the creative intention of God” and any modifications to the model of reproduction given to man by God, such as IVF, violates the clear intentions of God’s creation and should be prohibited (Humanea Vitea). SCH’s new administration recognizes these sentiments but does not feel it holds the authority to decide whether or not other community members should be bound by these same rules. Some members of the committee cited how many Hindu myths revolve around “the active role some women take in controlling their reproductive choices” as an integral part of a woman spiritual journey to motherhood (Bhattacharyya, 6). Other citizens see their ability to reproduce as a means of anchoring their place in society and feel as though existing within their religious cosmology is more important to their beliefs than any institution could be (Kahn 44). Still others in our town, such as those in our Jewish communities, may agree that it is important to remain within the reproductive framework the Lord has given them but disagree with Catholics on what that framework constitutes. In light of all of these facts, it seems our community disagrees on what constitutes a violation to the institution of marriage or God’s plan, and as such SCH feels they have no place in making this distinction for its citizens.
Still, several members of the committee shared reservations concerning other ethical dilemmas which may arise during the IVF process. It is an unfortunate fact that during the procedure of IVF many embryos are created, but only one of them is carried to term (Brockopp and Eich, 61). This is another qualm the Church has with the use of IVF and was the major reason IVF was never offered at St. Mary’s. The fear that by condoning IVF, the hospital will play a direct role in the creation and destruction of human life is of much importance to SCH’s administration. It was at this crossroads that the ethics committee went back to the community for guidance once more. Using a method similar to what Sue Kahn did when writing Reproducing Jew, the committee set out to interview the medical professionals currently working at IVF clinics in similar areas to ours, as well as the women who wished to seek this treatment at SCH (Kahn 4). Through these interviews the committee learned that the desire to use IVF was not restricted to Israeli citizens, or even the Jewish women in our own community. All the women and medical personnel we heard from told stories about the effects infertility can have on a women’s life and her place in society (Kahn, 3). The lengths to which many women expressed they would go to become mothers was inspiring and reminded the committee of how important these technologies are to our community (Made in India). By seeing these stories and the impact IVF could have on the well-being of families, the committee was able to unanimously support the implementation of IVF given that additional considerations were taken to mitigate any risk of violating the dignity of the embryos created through this process.
One of these stipulations, suggested by committee member Dr. Batt, was the formation of a review board to oversee all IVF procedures with the purpose of ensuring that “only one embryo is created at once and that it is handled with the ‘utmost dignity and care.’” All committee members agreed that reducing the number of embryos created during each IVF procedure would constitute a moral good, however by doing this the hospital would be requiring that women seeking IVF be subject to multiple rounds of hormone treatment which is generally considered unsafe (Brockopp and Eich, 61). Due to this the committee did not feel that this was a feasible option at this time. However, the idea of a review board overseeing each IVF procedure and ensuring that staff taking the “utmost dignity and care” during these procedures was extremely popular.
The administration asked that a small review board be assembled from staff members currently employed at SCH with the duty of protecting the rights of the embryos during each IVF procedure. This board is to operate in a similar fashion to the existing ones found in Israel which are overseen by the PU’AH group (Kahn 89). In addition to their obligations to the embryos created, the board will also have the duty of deciding whether a woman qualifies for IVF treatment. In an attempt to reduce the number of embryos destroyed at SCH, IVF will not be made available to all woman of Sasquatch. IVF will be restricted to women and couples who have been unsuccessful in reproducing through other means, and who are not of the financial standing to afford more expensive, but less risky procedures such as surrogacy. A special exception from this rule will be made to patients who have religious conflicts with the use of other forms of artificial reproduction technologies. An example of this would be individuals within our Jewish communities whose “halachah (religious law) makes no provision for the formal transference of maternal identity from a birth mother to another woman-the birth mother remains the mother for many halachic purposes no matter who may raise the child,” making the use of technologies such as surrogacy complicated (Seeman, 342). By drawing up these policies, we hope to strike a balance between the needs our patients, while not compromising any of the community’s values.
By offering IVF, SCH must make guidelines on proper procedures for disposing of all unused embryos created during the process of IVF. It is the goal of Sasquatch Community Hospital to place moral decision making into the hands of its patients whenever possible and this is one of those times where we feel giving our patients autonomy to decide what is best for them is the right thing to do. During the committee’s deliberations it became clear that the members of our community hold different beliefs on when human life begins and even what the definition of an embryo is (Brockopp and Eich, 65). Many pointed out that almost all religions have unique stories describing the formation of a fetus within a womb. Judeo-Christian religions often point to in Psalms 139:13, “For you created my inmost being; you knit me together in my mother’s womb” to show the role that God has a hand in our creation from the first steps of development. While Hindu scriptures believe “The fetus is produced out of the Soul” when the soul enters the fetus, which often occurs at the time of conception. However, this can only occur within the setting of a uterus (Bhattacharyya 85). In order to account for these varying views, the hospital has set up a framework by which the parents of these embryo are allowed to decide their preferred method of disposal. The ethics committee has drawn up pamphlets which are to be given out to patients at the beginning of the IVF process which outline a variety of options. If the patients wish to donate their embryos to scientific organizations, then a list of different research groups will be provided, and they will have the option to choose the group which they would prefer it be donated to. If they do not wish to donate their embryos, then all unused embryos will be disposed using similar methods to other IVF clinics in the country.
During the committees deliberation’s many members realized that due to the complexity of these bioethical issues, many of the patients presented with these problems may not have a clear understanding of what their religion has to say about, if anything, these medical procedures (Stolow 144). The hospital felt it had a duty to reduce such instances and in order to ensure all SCH patients have access to the appropriate religious counsel at all times, it would like to make open a communal worship space dedicated to religious counseling of all kinds. This will have no effect on the Catholic chaplains who are currently operating in the hospital and the space which has been historically dedicated to them will to be allowed to stay open. While they will continue to enjoy the full support of the SCH administration, the portion of the annual budget which was once dedicated exclusively to these chaplains will have to be shared with all religious leaders who may have a need for it.
SCH’s new commitment to religious diversity is rooted in a belief that access to the appropriate counsel can play an integral role in the healing process. SCH provides more services than just IVF, and many clinical studies have shown the benefits religion can have on the success of patient treatment (Coruh et al). By mirroring Sasquatch’s religious diversity within our hospital, we hope to see improvements in our own medical treatments as well as patient satisfaction.
Abortion services will not be provided to patients at SCH under any circumstances. This was not an easy decision for the administration to make it was not one done flippantly. The committee recommended that the hospital begin allowing abortion services with no restrictions. They came to this conclusion using similar reasoning used for condoning IVF procedures. However, SCH understands that this is not the view shared by many of our residents, and that due to the political climate surrounding abortions, the issue needs to be considered within the proper cultural setting. Abortion represents more than a moral qualm in the American psyche, and this is seen best “Contested Lives” where Faye Ginsburg describes how women from both pro-life and pro-choice sides see “their work as a corrective to, cultural currents” and have such an intimate relationship with their role in the movement that it has become the basis by “which their own moral identity is drawn” (Ginsburg 128). Sasquatches views on abortion are no different, and many within our community have themselves constructed moral constructs surrounded around the idea of abortion. We recognize that to stay in line with the other statements SCH has illustrated in this text, abortion services would be provided with no limitations, but due to the importance of this issue, we cannot currently condone such procedures be performed at ours facilities. The Catholic Church’s involvement in the origin of this movement can also not be understated. SCH feels that this departure from our Catholic origins is too abrupt for both its staff and community. It is a legitimate fear of this administration that the staff and citizens of Sasquatch will prioritize their beliefs on abortion to such an extent that it will have decrease their willingness to seek out healthcare in non-emergency situations. It is the goal of the committee and administration to consider all viewpoints on these issues and decide based on what would provide the community with the best available healthcare. So, it is the decision of this administration to break with the committee’s recommendation in the hopes of preserving the unity of our hospital and the relationship it has built with the community.
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. St. Mary’s offered prenatal testing at the recommendation of a doctor but going forward we feel as though it is best to allow mothers to seek this choice free from any obstruction. One objection to allowing such a change is that more mothers will seek an amniocentesis with the idea that if the diagnosis comes back positive for a terminal disease or disorder the mother may seek to terminate the pregnancy (Donum Vitae 1987). Since such types of abortions will not be performed at SCH, we have the moral freedom to fully endorse the use of this procedure. In allowing anyone to seek request and amniocentesis we are allowing mothers an opportunity to have the pregnancy experience they feel is best suited to their needs. However, SCH is aware of the propensity for some doctors to place their own beliefs onto their patients through indirect means such as aggressively recommending tests, and genetic counselors are not immune to this bias (Ivry 74). SCH does not wish to contribute to a culture in which our patients feel it is necessary for them to have an amniocentesis and we will be teaching all genetic counselors and doctors on proper ways of advising their patients so that all mothers have the amount of medical information that they desire (Ivry 76).
These are all the new procedures which will be offered at SCH for now, but there are a few things left to address regarding the implementation of these policies. St. Mary’s used to provide subsidizes to under-insured patients who were unable to afford their medical bills. This funding came primarily from prominent Catholic officials and families within our communities. We understand the reservations these donors may have towards donating to SCH in light of these changes. Traditionally donations have been made to the hospital and the administrators have allocated it as they see fit. This will no longer be the case, and in the form used to donate money to the hospital a new stipulation has been added to allow donors to strictly prohibit their funds from being used in any manner they deem undesirable. In addition to this, we will also be allowing people to stipulate where they would like to see their funds go to. If a citizen of Sasquatch did not donate to SCH due to its association with the Catholic Church, we would like to invite you now to donate free of these reservations. By instituting this change, we hope to keep all historical donors while also drawing in a new set of donors which can help SCH better serve its community.
All of these changes will take time to implement and many things need to occur before any of the procedures will be made available to the public. During this time all staff currently employed at SCH are asked to come forward if they have any problems with the new changes or feel any part of these new policies will affect their ability to do their job. SCH wishes not to punish any staff members who feel they cannot morally perform any of these procedures and the administration promises to work with the staff to ensure these changes go over smoothly. SCH will not be hiring any additional workers to help with these procedures and it is our plan to train existing staff members on how to perform them. All staff who do feel comfortable performing these additional services are encouraged to step forward. As a way of showing SCH’s appreciation for these employees, anyone willing to assist in implementing these policies will be given a small raise in addition to any additional compensation for hours worked while training for these positions. The administration looks forward to the new ways in which our hospital will serve our community and hope that all the procedures SCH is offering will be warmly embraced by the Sasquatch community and SCH staff members alike.
Coruh B, Ayele H, Pugh M, Mulligan T. Does religious activity improve health outcomes? A critical review of the recent literature. Explore (NY) (2005) 1(3):186–91. doi:10.1016/j.explore.2005.02.001
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Brockopp, Jonathan E, and Thomas Eich. Muslim Medical Ethics: From Theory to Practice. Columbia, S.C: University of South Carolina Press, 2008.
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Birenbaum-Carmeli, Daphna, and Yoram S. Carmeli. Kin, Gene, Community: Reproductive Technologies Among Jewish Israelis. New York, N.Y: Berghahn Books, 2010.
Ivry, Tsipy. Embodying Culture: Pregnancy in Japan and Israel. New Brunswick, N.J: Rutgers Univ. Press, 2010.
Bhattacharyya, Swasti. A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.
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