Proposal letter
GMH Description and History,
On March 25, 2018, the Sasquatch Catholic Hospital (SCH) announced today it has changed its name to Grace Medical Hospital (GMH) as part of a restructure that will position the hospital to become a more dominating figure in the Sasquatch, Connecticut community. GMH is a private hospital rooted in the Catholic tradition, but is no longer formally associated with the Catholic Church. Along with this new name and structure, the church has allowed the hospital to become non-denominational and will continue subsidizing medical care for uninsured patients. This proposal incorporates five years of discussion between medical staff, donors, and local community members regarding the future of GMH and how it can best accomplish its goals. The discussion takes into consideration the predominant Irish population, the local Jewish community, a mixed Caucasian and African-American (non-Irish Catholic) community, as well as the expanding populations of Lebanese Shiite and Japanese immigrants. This proposal lays the groundwork for GMH’s long term plan that focuses on addressing various questions such as “How much will the hospital reflect its donor base (Catholic origins) and mixed local community?”, “How should the hospital begin to provide and subsidize abortion services for under-insured patients?”, “What about IVF treatments and prenatal testing including amniocentesis?”, “If the hospital does begin to provide IVF treatment, should the hospital encourage families to allow embryos to be donated for potentially life-saving research?” and “Should the hospital continue to provide spiritual counselling by Catholic clergy?” The decisions presented in this proposal are supported by years of research to ensure the best outcome for the various groups involved.
GMH Needs
The main goals of GMH are to balance healthcare quality and efficiency and to improve access to care. In the healthcare industry, there are many pressing problems regarding financial, federal, and ethical issues; These difficulties have both positively and adversely affected all area of GMH. Many of these problems are part of an interrelated system of adaptations that coevolve together to shape hospitals around the country. The best outcome for GMH is to create an all-inclusive healthcare system with balanced care and quality, while simultaneously considering the Catholic traditions. If this is achieved, GMH will become a dominate figure within the community of Sasquatch, Connecticut. This proposal projects a five-to-seven-year plan to attain this goal, while concurrently reducing costs.
My Solution
All the data went into the development of a balanced solution to address main six questions.
- How much will the hospital reflect its donor base (Catholic origins) and mixed local community?
One of GMH’s top priorities is to better incorporate the perspectives of the hospital’s donors, staff, and mixed local communities into the discussion of abortion and reproductive technologies, such as in-vitro fertilization (IVF) and prenatal testing (amniocentesis). Due to the diversity of all groups present, it will be a challenge to integrate every social and cultural agenda into each decision. The hospital’s donors and staff are predominantly Catholic, while the mixed local community is heavily comprised of Jewish, Caucasian, and African-American individuals. In addition, there is a growing population of Lebanese, Shiite and Japanese immigrants. This diverse community of locals and staff presents various conflicting ideas about the use of abortion and reproductive technologies. Given our Catholic history and considering where most of our funding originates, I recommend that GMH stay within the realm of the Catholic Church’s doctrines, while having the freedom to make some exceptions in specific situations. I recommend that GMH does not provide nor subsidize abortion services for any patient. In addition, the use of IVF will not be provided nor encouraged by the GMH organization and staff, while prenatal testing, including amniocentesis, will be provided and encouraged for all pregnant mothers. Requests for exceptions to these rules will be considered and determined by a hospital committee. I acknowledge this may be controversial for many individuals, but this is the position I believe is best for the hospital. I have presented my reasoning behind this recommendation for abortion, IVF, and prenatal testing.
2. How should the hospital begin to provide and subsidize abortion services for under-insured patients?
My recommendation for GMH is to stand by the doctrine of the Catholic Church and not provide nor subsidize abortion services for uninsured patients to protect human dignity. In today’s world, we have access to more resources pertaining to human procreation than ever before, and with these resources we have gained a great responsibility to protect human life from its origins. In an effort to protect human dignity, the Catholic Church has made available their position regarding the relationship between science, technology, and human life. At GMH, we share the beliefs of the Catholic Church that “from the moment of conception, the life of every human being is to be respected in an absolute way because man is the only creature on earth that God has ‘wished for himself’ and the spiritual soul of each man is ‘immediately created’ by God; his whole being bears the image of the Creator” (Shannon & Cahill, 1998: 147). Therefore, any sacrifice with the assumption that the fetus is mere tissue is seen as going against GMH’s beliefs. At GMH, the hospital’s donors and nursing staff are predominately Catholic, therefore requiring GMH’s staff to perform or participate in abortions may represent a serious threat to the individual’s fundamental moral or religious beliefs (Meyer and Woods, 1996). The provisions of abortion may facilitate a direct clash between the staff and donor’s religious beliefs; this clash could potentially deter GMH from improving care and efficiency. This recommendation will agree with the religious and moral beliefs of the Catholic donors and nursing staff. At the same time, GMH realizes this recommendation may be controversial for members of religious denominations. To accommodate for these denominations, GMH will expand our partnerships with local clinics. Patients that inquire about abortion will be provided with information to the nearest facilities that provide this service. This may be an inconvenience, but this is the position GMH should stand by to ensure human dignity and God’s will.
3. What about IVF treatments and prenatal testing including amniocentesis?
Similar to my recommendation for abortion, I suggest that GMH stand by the doctrines of the Catholic Church in order to protect human dignity. This recommendation implies GMH will provide prenatal testing including amniocentesis, while not providing IVF treatment. A prenatal diagnosis (PND) makes it possible for parents to know the conditions of the living embryo and fetus prior to birth, which allows physicians to predict the current and future state of the fetus. This can help ensure the correct therapeutic, medical, and surgical procedure is performed. Procedures such as prenatal testing on the human embryo are rational“if the procedure respects the life and integrity of the embryo and the human fetus and is directed toward its safeguarding or healing as an individual” (Shannon & Cahill, 1998: 159). GMH should only perform these tests with the consent of the mother after she has been adequately informed by her physician of the possible outcomes. If the mother has any intention of aborting the living fetus, the test will not be performed. I acknowledge similar and contrasting views of prenatal testing exist within the Sasquatch, Connecticut community.
In Tsipy Ivry’s book, Embodying Culture Pregnancy in Japan and Israel, she describes a distinction between Israeli and Japanese cultures regarding the level of emphasis placed on reproductive environmental and genetic risk factors.Dr. Ivry claims that in Israel, pregnancy is driven by “anxiety regarding the possibility of reproductive catastrophe and notion of ‘risk’ play a central role,” (Ivry, 2009: 74). The idea of risk in pregnancy assumes a particular meaning in Israeli society. Many Israeli medical practitioners play a key role in portraying “reproductive misfortune as a key scenario of ‘threat’: to imagine that the worst is about to happen and to devise strategies to defend oneself against it,” (Ivry, 2009: 74). This medical attitude among many Jewish individuals reflects “an understanding of pregnancy that tends to ‘leave’ the fetal health to the mercy of random, unpredictable genetic and chromosomal breakages, to underestimate the role of women in fetal development, and to focus less on the health of the pregnant woman herself than on the fetus she is carrying,” (Ivry, 2009: 74). This attitude leads many Israeli practitioners to strongly emphasize the need and benefits of prenatal testing. Dr.Ivry recounts the story of Dr.Levi, an OB-GYN in Israel. Dr.Levi explains how he had to “form ‘self control’ and to accept the decision of predominately ultra-orthodox Jews not to use prenatal testing. He would understand the need to ‘count to ten’ as reflecting a deeply felt urge to express anger at his patient’s stupidity,” (Ivry, 2009: 74).This physician’sinabilityto conceive the decision of his patient not to use prenatal testing was so strong he had to find a way to accept the decisions to not use prenatal testing. Other physicians would not accept their patient’s decisions and would seek other ways to change their mind. Dr.Ravel, an OB-GYN, would not accept decisions of patients “he thinks that amniocentesis is absolutely necessary. He keeps a list of rabbis to whom he refers religious couples according to their religious affiliation,”(Ivry, 2009: 67). This is done in hopes to change the individuals mind. These examples of practitioners show the level of emphasis genetic risks factors are placed in Israeli society. This level encourages the use of prenatal testing for all individuals. In turn, GMH provision of prenatal testing technology can be seen as a “risk reducing” technology that emphasize the view of many Jewish individuals.
At the same time, GMH realizes the provision of this technology may not directly connect with the view of other groups. For many Japanese individuals, they place more emphasis on environmental risk factors rather than genetic risk factors. In her research in Japan, Tsipy Ivry found that many individuals take an environmentalist approach to pregnancy (Ivry, 2009:95). This complex approach presents the image of a baby as totally dependent on every aspect of the mother’s decisions. In multiple Japanese textbooks concerned with childbirth and care, this idea is expanded to specific theme such as postures for physical activity, bodies temperature regulation, and stability of their belly to prevent against bump. Instructions such as these are not present in the Hebrew textbooks. “Such instructions are absent from the Hebrew textbook, and I have never heard any mention of them in clinical circumstances in Israel. Israeli theories of gestation seem to regard fetuses as ‘safely insulated’ in a womb that supplies constant thermal stability, regardless of environmental conditions outside the uterus. By the Israeli logic, the womb may be an environment but it is ‘automatically’ managed by the body. In contrast, Japanese theories hold that it is the woman who manages it herself” (Ivry, 209: 95). There can be multiple reasons why Japanese emphasize the environmental risk factor over genetic risk factors. The Japanese individuals and doctors that emphasize environmental risk factors may feel the mother’s choices are easier to control than genetic risk factors. For example, Dr.Ivry present the opinion of Dr.Tanaka, a fifty-year-old ob-gyn in Japan. This doctor recognized that women over the age of thirty-five have a greater chance of chromosomal abnormalities than younger women. Dr.Tanaka would never mention amniocentesis to these patients. She would “asked whether she [pregnant patient] is interested in having precise test. But usually I don’t speak to her at all about the kind of testing that exists” (Ivry, 209:107). If this doctor did feel the need to mention the option of prenatal testing, she would make sure to assure the woman through the entire process. This doctor’s strategy suggests that, “rather than ‘pure’ medical consideration minimizing the anxiety of the patients is one of their major concerns” (Ivry, 209:107). Alternatively, the Israeli individuals and doctors may feel emphasis on genetic factors are easier to control and test for than environmental risk factors. As one can see, many Israeli and Japanese individuals recognize environmental and genetic risk factors. The only difference is the relative emphasis placed on each factor.
Addressing my recommendation on IVF treatment, my recommendation relies on whether the situation is sufficient to ensure the dignity of human rights. In the case of IVF, the Catholic Church believes human dignity is not preserved. The Catholic Church believes “every child has the right to be conceived in marriage. The only acceptable way to reproduce is through conjugal act between spouses. Any methods that occurs outside this act is seen as non-moral” (Shannon & Cahill, 1998: 159). This includes forms of artificial insemination, in vitro fertilization, and surrogate motherhood. GMH and the Catholic Church acknowledge many sterile individuals may view this prohibition on IVF as clashing with their right to procreate. Through in vitro fertilization and embryo transfer and heterologous artificial insemination, sterile individual may conceive though the fusion of gametes of at least one donor other than the spouse who are united in marriage. In turn, the use of this technology would affect the child’s dignity by “depriving him [the child] of his filial relationship with his parental origins and can hinder the maturing of his personal identity. Furthermore, it offends the common vocation of the spouses who are called to fatherhood and motherhood: It objectively deprives conjugal fruitfulness of its unity and integrity; it brings about and manifests a rupture between genetic parenthood, gestational parenthood, and responsibility for upbringing” (Shannon & Cahill, 1998: 159). This kind of threat may damage the child’s personal relationships and identity within a family.
While GMH and the Catholic Church acknowledged the sacredness of marriage, this does not give the couple the right to have a child. Rather, marriage gives the right to perform the natural acts of procreation. GMH sees a child as not a right, but as a gift. At GMH, we will encourage married couples who are unable to procreate to find other alternative ways to fulfill their aspirations. To assist these residents with their religious and spiritual pursuits, a hospital chaplain will be provided by GMH. This service will offer ministry and spiritual guidance to patients, family members, and caregivers. It will be the job of the hospital chaplain to provide alternative services based on the individual’s needs.
In addition,GMH acknowledge the aspiration of homosexual couples to have children.However, the implementation of these services may challenge the traditional heterosexual families in our community. In Nan T. Ball’s article, The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates, she analyzed the 1994 French bioethics debate. These “bioethical laws that the French National Assemble passed in July 9, 1994 allowed only sterile, heterosexual couples of procreative age to use artificial insemination and in vitro fertilization procedures” (Ball, 2000: 547). “These restrictions were instituted, in part, to control the threat the legislators thought these technologies posed to the traditional family structure. The unprecedented availability of ART at the end of the twentieth century appeared to further undermine the predominance of the tradition heterosexual, bi-parental family structure because the technology enabled homosexual couples, virgins, and post-menopausal women to have children” (Ball, 2000: 548). Unwilling to allow such technological advances to alter cultural norms, the French legislature restricted access to ART by supporting a normative family model. Nan T. Ball shows how ironic it is that the French Republic, an adamantly secular structure, is still making decisions that are similar to the Catholic Church’s views. The French Republic did not make these laws with anything to do with the Catholic Church in mind. They viewed their decision as conforming to good reason and good policy. Similarly, GMH sees the potential threat of IVF technology to the traditional heterosexual family structure of Sasquatch, Connecticut community as a good reason to not provide this technology.
4. Should the hospital continue to provide spiritual counselling by Catholic clergy?
When addressing whether GMH should continue to provide spiritual counselling by Catholic clergy, my recommendation is for GMH not to continue to provide spiritual counselling by Catholic clergy. This recommendation is based entirely on financial feasibility. Due to increasing medical cost and softening patient admission and, GMH is facing greater financial losses. “In a new report form PricewaterhouseCoopers’ Health Research Institute (HRI), the medical costs have seemingly settled into a ‘new normal’ where increases have hung 6-7% per year. HRI expects this medical cost growth rate to increase by 6.5% for 2018,” (HRI, 2016). This problem has been linked to an increase in out-of-pocket costs for patients that prevents them from seeking hospital services. While GMH acknowledges the spiritual and emotional benefit of clergy, currently it is not in an adequate financial state to provide this service. The provision of these services would require GMH to cut funding from hospitals programs or hospital staff. Which in turn would lead to protest that would impede the hospital’s goals to balance healthcare quality and efficiency and to improve access to care. By not providing this service, GMH can prevent future financial problems. I recognize that the clergy perform other functions as well as helping individuals make medical decisions, but they are peripheral to the care GMH provides and GMH can not afford it.
Timeline
I recommend that the preliminary timeline will take one-to-two years to get the doctors and nurses on board. It is not certain how long it will take donors to accept the changes, but from prior discussions with a few select donors they support the changes recommended by my proposal. The longest timeline will be the formation of partnerships with other local hospitals and clinics. There are many legal documents and certifications that must be approved before we can begin a mutually beneficial relationship that will ensure every individual great quality care.
Work 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).
Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).
Meyers, C, and R D Woods. “An Obligation to Provide Abortion Services: What Happens When Physicians Refuse?” Journal of Medical Ethics 22.2 (1996): 115–120. Print.
Ball, Nan T. “The Reemergence of Enlightenment Ideas in the 1994 French Bioethics Debates.” Duke Law Journal, vol. 50, no. 2, 2000, p. 545., doi:10.2307/1373097.
Health Research Institute. “The New Gold Rush Prospectors Are Hoping to Mine Opportunities from the Health Industry.” The New Gold Rush Prospectors Are Hoping to Mine Opportunities from the Health Industry, May 2011, www.pwc.com/il/en/pharmaceuticals/assets/the-new-gold-rush.pdf.