Author: Grace Jarrett

Proposal 2018

To my fellow ethics committee members, I want to begin this proposal by reminding you of the unique position we happen to find ourselves in today. Sasquatch Hospital of Connecticut is at a crossroads and we have the incredible opportunity to determine its future and the future of our community’s access to medical care. Before I delve into the details of my proposal, I would like to share some information about myself. I am a woman of color and a mother of three children. have a Bachelor’s degree in Anthropology and Human Biology as well as Masters degrees in both Public Health and in Health Administration. Although I identify as a Christian and attended a Catholic high school, I pride myself on being open-minded when it comes to religious beliefs, morals, and values. With this in mind, I feel especially prepared to discuss assisted reproductive technology and its future in this hospital.

Today, we as the ethics committee have the challenging task of reconciling the “immense differences in the social and personal realities of moral life with the need to apply a universal standard to those fragments of experience” (Kleinman 70).  My primary concern, and the purpose of my proposal, is to ensure that this institution provides its patients, and the community at large, with the best possible medical care. Sasquatch Hospital of Connecticut is the only major hospital within a forty-five-minute radius and therefore, we are responsible for providing services to a large yet religiously and racially diverse population. In recent weeks, this hospital decided to no longer operate under Catholic auspices. Now our task is to discuss the ethical implications of assisted reproductive technology and determine which reproductive procedures, if any, should be performed in this hospital. The people of our growing community “embody and experience religions to varying effects” and for this reason, we can no longer prohibit all patients from receiving a reproductive procedure due to a religious reason – just like we cannot force a transfusion procedure on a patient whose religion does not permit it (Hamdy 156).

In the past, this hospital used Catholic scripture, such as the book of Genesis, and the guidance provided by Donum Vitae to place limitations on procedures such as abortion, IVF, and prenatal testing. Today, this hospital is a non-denominational, private institution. Our non-denominational status implies that we do not favor or blindly follow the moral law of a single faith. In order words, this hospital can no longer only select the Catholic interpretation of morality and force it upon everyone. The privatization of our hospital gives us a tremendous amount of freedom but also a great responsibility to address the needs of our community. As a strong proponent of diversity and utilitarianism, I believe we should take this opportunity to acknowledge the moral law of other faiths and reflect these various perspectives in our medical practices. Through qualitative and quantitative methods, I have evaluated the reproductive needs and desires of our community as well assessed the feasibility of our hospital to acquire and utilize advanced assisted reproductive technology. Below are my proposed plans on how this hospital can address our community’s medical needs via the integration of reproductive procedures while still maintaining some of the Catholic bioethics of our past.

Abortion

Abortion is a highly polarizing subject and therefore our dialogue must always remain respectful, despite contrasting beliefs. Faye Ginsburg’s ethnography, Contested Lives: An Abortion Debate in the American Community attempts to explore the reasoning behind both the Pro-Choice and Pro-Life movements in the late 1980s and early 1990s. Her work in Fargo, North Dakota employs participant observation and subject interviews to find “alternate ways of understanding” abortion, specifically how people’s lives and personal experiences shaped their perception of the debate (Ginsberg 133). In our society today, “most opposition to abortion relies on the premise that the fetus is a human being, a person, from the moment of conception” (Thomson 47). This is the foundational belief of the Catholic Church as stated by the Congregation for the Doctrine of the Faith in Donum Vitae. This set of reproductive moral guidelines state that “from the first moment of its existence, that is to say from the moment the zygote has formed… the human being is to be respected and treated as a person” and therefore, abortion is morally illicit as it disrespects human life and is a form of murder. In opposition to this, our federal and state government have made abortion a legal medical procedure nationwide and Connecticut “is one of four states that have enacted declarations affirmatively protecting a woman’s right to choose an abortion” (Kasprak, Connecticut Abortion Law, 1998).

With such conflicting narratives, it can be difficult to formulate a personal opinion on the matter let alone form a universal standard for an entire hospital. As a Christian, I find myself aligning with the position of the Catholic Church, viewing the termination of pregnancy as disrespectful to the life of the fetus. As a medical professional, I have seen a number of situations where pregnancy has put an expecting mother in a tremendous amount of danger and was ultimately fatal. The termination of those pregnancies would have prevented the loss of an adult life.

As a non-denominational institution, Sasquatch Hospital of Connecticut cannot solely employ the strict Catholic point of view, despite its former relationship with the Church. My proposed solution is to permit abortion procedures to take place within the hospital, a policy that complies with federal and state laws. But with this, I believe that this hospital should respect the various religious sentiments of our patients when it comes to abortion. To do this, our hospital staff should not advertise or promote our abortion services unless the pregnancy poses a medical threat to the mother. If a patient requests an abortion, with no apparent medical necessity, we will complete this request within the provisions of our state laws. I believe this to be a fair compromise between pro-life supporters and our diverse client-base who may come to this hospital seeking abortion services.

ART: In Vitro Fertilization (IVF) & Prenatal Testing

In addition to abortion services, this hospital must evaluate the ethics behind assisted reproductive technologies such as in vitro fertilization (IVF) and prenatal testing. As a mother myself, I support these procedures because I deeply understand a woman’s desire to have children and strong believe that this hospital can be instrumental in fulfilling this wish. Permitting IVF at Sasquatch Hospital of Connecticut will appeal to many members of our local community. Susan Khan’s ethnographic work, for instance, illustrates that Jewish-Israeli women are encouraged to undergo IVF procedures since having children is an “imperative religious duty” (3). According to Dr. Morgan Clarke’s ethnographic research, Lebanese Shiite women are also huge proponents of IVF because Shiite society equates motherhood with social acceptance. Shiite women are even willing to jeopardize their religious life for motherhood. Overall, it can be said that being a mom is “a deeply natural desire and goal” for women of all cultures and all religions (Kahn 62). In other to satisfy this desire for family, this hospital should provide female patients with the opportunity to have children via in vitro fertilization.

With the authorization of IVF procedures, I anticipate members of our community (particularly Catholics) growing concerned about unused embryos being disrespectfully discarded. Donum Vitae stresses that “human embryos obtained in vitro are human being and subjects with rights” and therefore it is morally illicit to destroy embryos as “biological material”. To ensure that embryos are treated respectful and not destroyed, I think our hospital should encourage families to donate their unused embryos to Sasquatch Hospital of Connecticut. These embryos can then be used to fulfill another woman’s dream of motherhood or, if the family agrees, they can be used for life-saving medical research. If we safeguard these embryos and ascertain they are being treated with dignity, I believe this hospital can avoid negative sentiments towards IVF and ultimately benefit.

Prenatal diagnosis technology allows expecting parents to explore the health and genetic condition of their baby whilst still in the womb. Amniocentesis is a form of this technology that is “used to screen fetuses from chromosomal anomalies and neural tube problems during the second trimester of pregnancy” (Rapp 1). I strongly believe that if a couple requests this testing, Sasquatch Hospital of Connecticut should perform it. If this process is performed with respect to the “life and integrity of the embryo and the human foetus”, I see no ethical limitations (Donum Vitae). Our hospital staff should never assume a family wants to undergo prenatal testing as different religions hold different opinions on the procedure. According to Tispy Ivry’s Embodying Culture: Pregnancy in Japan and Israel, there exists a tremendous cultural difference between Jewish and Japanese pregnancy. Jewish families favor “geneticism” and as a result, strongly favor genetic testing during pregnancy. Japanese families, on the other hand, favor “environmentalism” and typically distrust genetic tests. Altogether, if a woman specifically shows interest in prenatal testing on her own accord, our hospital should be there to provide it.

Spiritual Counseling

For many, 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, I believe this counseling should be extended to clergy of other 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 policy 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). Medical providers have a responsibility to present their patients with all medical options that are safe and feasible, a process that should be done without the inclusion of personal ethics. 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 more important as it also involves an unborn child (Hamdy 144). Ultimately, I would remind frustrated or disheartened providers that religious sentiments “should not be seen as passive, as anti-science, or as constraints to medical treatment” (Hamdy 156). Instead, it is their duty to provide patients with every resource that could assist them in their decision-making process.

Hospital Budget

Based on the previous budget, Sasquatch Hospital of Connecticut was able to subsidize medical care for all underinsured patients. This act of goodwill allowed thousands of patients to receive first-class care without them having to endure a tremendous financial burden. If my policies regarding reproductive procedures are implemented, subsidizing medical will no longer be possible due to the cost of expensive technology. My goal would be to resume subsidizing care in the near future but at its core, this hospital is a private business and therefore it must be run like one.

With my proposed changes, there is also the possibility that our historically Catholic hospital donors will not support our new mission and refuse to provide funding to our hospital. In event of this occurring, I propose the formation of a new funding committee whose mission is to seek support from organizations who encourage the use and development of reproductive technology. With the support of these organizations, both scientifically and financially, as well as the authorization of unused embryos from IVF to be utilized for research, I envision Sasquatch Hospital of Connecticut becoming a hub for advanced reproductive research. This immense potential will attract innovation-driven physicians, as well as research grants, to our hospital. With this, we can grow our research teams and improve our facilities, hopefully making great contributions to this area of medical research in the near future.

I predict a secondary financial challenge if we change our policies to permit more “controversial” treatments. Members of our clinical staff, primarily those who work in women’s health departments, may not support the use of assisted reproductive technology due to religious convictions. This may lead to reluctance from these staff members to perform related treatments. The goal of my proposal is establish a hospital that embraces all faiths so we cannot ignore the faith our employees in order to promote this message. In the case of unwilling staff, our goal should be to provide education and increased scheduling options. If this is unsuccessful, the hospital will provide a small stipend for clinical staff to be retrained in a new specialty. In very limited cases, inflexible and obstructive employees will be let go. If necessary, the money recovered from no longer subsidizing care will be redistributed to our hiring budget.

Conclusion

This proposal encompasses my best attempt to address the various ethical problems facing Sasquatch Hospital of Connecticut in an open-minded manner while staying true to my own medical and religious beliefs. I have done my best to find compromise between the conservative and the progressive concerns presented to me. I have also tried to take a utilitarian stance in this proposal in order to provide beneficence to the majority of our population. We must remember that we are in a growing community that is becoming increasingly culturally diverse. In order to provide the best medical care, we need to remain aware of the religious differences across our patient base. We are a hospital, not a religious institution, and our main purpose is to serve and heal the people who need us, regardless of their upbringing, religion, culture, or social class.

Our staff should pressure no person into any procedure but should inform the patient of all available options, so long as they are safe and feasible. Our staff may practice their own beliefs freely, but may not force their beliefs onto any other staff member or onto our patients. My hope is that implementing this proposal will create an atmosphere of culturally sensitive staff as well as hopeful, healthy, and happy patients 

Thank you.

 

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. Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community(University of California Press, 1989).
5. Judith Jarvis Thomson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66. Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel(Rutgers University Press, 2009)
6. Rayna Rapp, Testing Women, Testing the Fetus(Routledge, 2000).
7. 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.
8. Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel(Duke University Press, 2000).
9. Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).Community (University of California Press, 1989).

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.

“Thick Description: Towards an Interpretative Theory of Culture” – Clifford Geertz

Clifford Geertz, one of the most influential cultural anthropologists in the U.S., applies his knowledge and anthropological foundation  to science and the nature of evidence. I found this reading quite challenging to follow as it was dense, detailed and used relatively complex language. Ultimately, there were two main points I got from this reading:

First, Geertz emphasizes ethnography as the crucial method of anthropological analysis, allowing for the development of theories and large-scale ideologies. From one point of view, ethnography is “establishing rapport, selecting informants, transcribing texts, taking genealogies, mapping fields, keeping a diary, etc”. From Geertz’s point of view, ethnography lies in “thick description”. Borrowed from Gilbert Ryle, Geertz defines thick description as the meaningful structures behind what is being observed. Anthropological research also heavily relies on the interpretations of the ethnographer and how they perceive the culture of others, because “understanding a people’s culture exposes their normlessness without reducing their particularity” (pg. 14). Essentially, anthropological writings are interpretations and Geertz believes the best ethnographies are those full of “thick descriptions” that “take us into the heart of that of which it is the interpretation” (pg.18).

Ethnographic studies are typically conducted on very small scale – focusing on a single group of people in a small village or neighborhood. This is the problem that surrounds Geertz’s second point. There exists a methodological issue involving the microscopic nature of ethnographic research. Geertz denounces the “Jonesville-Is-America writ small” and the “natural laboratory” and instead believes that the important part of ethnographic findings is their complex specificness and realness. This allows for previously discovered facts to be mobilized, previously developed concepts to be used, and previously formulated hypotheses to be tried. In other words, the material produced by long-term, qualitative, highly participative studies allow anthropologists to build upon previous research and develop larger-scale theories about human nature. With this, “the aim is to draw large conclusions from small, but very densely textured facts to support broad assertions about the role of culture in the construction of collective life by engaging them exactly with complex specifics” (pg. 28).

 

“Does Submission to God’s Will Prevent Biotechnological Intervention?” – Sherine F. Hamdy

Hamdy’s ethnographic account delves into the ethics and and opinions surrounding organ transplantation in Egypt among religious leaders, physicians, and patients. Kidney transplants have been conducted for over thirty years in Egypt, even in the absence of any legal framework or a national organ donation program. Because of this, patients resort to purchasing organs on the black market or receiving live donations from friends or family. Despite the fact that almost all religious scholars, Muslim and Coptic Christian, have declared that organ donation is permissible, many patients with religious convictions struggle with the ethics behind the practice. Hamdy primarily reveals this struggle through interviews with two dialysis patients, Muhammad and Ali,  both of whom would benefit greatly from a kidney transplant but refuse to undergo the procedure. These patients did not believe that their religion prevents them from seeking beneficial treatment. Alternatively, they would rather die, ultimately meeting God, than be responsible for causing a family member harm (from the donation procedure) or be responsible for putting their family in debt (from purchasing an organ).

Hamdy’s primary argument is that “religious sentiments, should not be seen as passive, as anti-science, or as constraints to medical treatment” (pg. 156). Patients around the world learn to balance how to achieve the greatest benefit for themselves and their families, while simultaneously conforming to God’s will. This opposes the common perception that religious fatalism, or the notion that humans can exert little or no control over their own destinies, obstructs people from pursuing biotechnological intervention. In response to this, Hamdy says:

“To assume that religious practitioners refuse particular technologies or medical interventions because of their fatalism carries the dangers of missing the contingencies that inform when and under what conditions patients work to achieve this disposition.” (pg. 156)

It is important to understand all of the factors that play into a patient’s decisions on whether or not to undergo medical intervention. This can be extremely complex and highly variable, depending on the patient’s changing circumstances. Before a decision is made, patients must calculate their ethical disposition towards a particular treatment and assess its benefit and harms, while incorporating their understanding of the disease etiology and their specific experiences of the illness. The key idea here is that these conditions are not separate form, nor do they determine, the patient’s disposition towards divine will.

About the Author: Sherine F. Hamdy is an anthropologist who focuses on medical anthropology and science and technology in the Middle East. This paper seems to be written for an academic audience, but I think it could easily be read and understood by the general public.

My Thoughts

As an anthropology major, I have read a number of ethnographies on various topics, but I have never considered regarding them in the way that Clifford Geertz suggests. I often get lost in the specifics of the ethnographer’s research, losing the connection to the bigger picture. With Geertz’s ideas in mind, I read Hamdy’s article with a totally new perspective. The dichotomy between religious beliefs and modern medicine extends way beyond organ transplantation in Egypt but without Hamdy’s research on the specific troubles of Muslims in kidney failure, I would miss insights on how religion plays a positive role in medicine for some patients. Ultimately, understanding how religious tradition fits into a patient’s life can help our comprehension of ethical formations in devout patients’ lives (Hamdy, 157). Without small-scale ethnographies that are full of “thick description”, we would not gain the essential insight necessary to better this understanding.