Chung, Final

Introduction

Before starting my proposed policies, I would like to establish my identity. I am an American graduate student in Philosophy. I am heavily influenced by the work of Aristotle, Agamben, and Foucault. While I will not explicitly address Foucauldian thinking in this proposal, I consider Foucault’s influence in my education to be profound. In regards to my ties to religion, I was raised in a Presbyterian household and continue to practice Presbyterianism.

I believe Sasquatch Mercy Hospital should follow a policy discourse that aims to remain non-partial to any specific religion. I propose we deviate from our Catholic founding in order to strive for nondiscriminatory hospital policies. This deviation is due to our hospital being the only major hospital within a forty-five-minute radius and the expanding religious and racial diversity of the local population.

In this proposal, I aim to address hospital 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 should provide and subsidize abortions for up to 13 weeks for underinsured patients. The hospital should continue to provide abortions past 13 weeks; however, should not subsidize those abortions to underinsured patients as the cost for an abortion increases the later the term. While it is my hope for all abortions to be subsidized, as I will argue that the rights of the woman trumps the rights of the fetus, I am cognizant of the budget restrictions that the hospital is currently under. Thus, Dilation and Evacuation (D & E) abortions, the most common procedure for ending pregnancy at 14-21 weeks, will not be subsidized due to the requirement of an anesthesiologist and the longer surgical time required in comparison to medical abortions (taken orally with a pill) or Suction or Aspiration abortions (a surgery that is roughly 15 minutes).

Diverging from the hospital’s Catholic founding that “human life must be absolutely respected and protected from the moment of conception” (Donum Vitae), I propose the hospital to utilize Jewish legal thinking that “born human life is always given priority over human life in development” (Prainsack, 181). Thus, I argue, the rights of the mother should be prioritized over the rights of the fetus.

An Aristotelian understanding of natural inequality also influences my prioritizing of the mother’s rights—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. As the pregnant woman is in an unequal relationship with the fetus where she is the provider of the necessary nutrients and incubation for fetal development and growth, I argue that the rights of the woman should be prioritized over that of the fetus’. Also, the pregnant woman is more likely to be an already established member within society—where she is already considered a citizen and the fetus, even if brought to term, will not be given full citizen rights until it reaches 18 years of age. Thus, the principle of Aristotle’s natural inequality would place the mother in a higher hierarchical position than that of the fetus.

While the Aristotelian argument of natural inequality mainly applies to documented citizens, in order to be more inclusive of undocumented citizens and teenage mothers, I utilize the analogy 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 [or a blood clot that forms in a vein].” (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. As there appears to be a moral law against abortion, because pregnancy induces a physical state of exception within the mother, this moral law can be disregarded at the discretion of the woman. Thus, the hospital should recognize and treat the pregnant woman’s authority and decisions with the highest importance and regard.

Lastly, I would like to bring to the committee’s attention the historicity of the criminalization of abortions. Faye Ginsburg in her ethnography Contested Lives traces the history of abortion where “The push to criminalize abortion anytime after conception began in the latter half of the nineteenth century as part of a concerted effort by regular physicians to gain control of the practice of medicine in the United States” (Ginsburg, 2006: 25). However, prior to this time period, abortion was “relatively common as well as [an] accepted practice” (2006: 24). A study published in the Lancet medical journal in May 2016 analyzing abortion rates across the world found that abortion procedures were similar in number regardless of the legality of abortions. University of California San Francisco professor Diana Green Foster says, “The obvious interpretation [of the findings] is that criminalizing abortion does not prevent it but, rather drives women to seek illegal services or measures” (Foster, 2016). Thus, in order to protect pregnant women seeking unsafe abortions, it would be in the best interest of Sasquatch Mercy Hospital to practice legal abortions.

IVF Treatments and Prenatal Testing

Sasquatch Mercy Hospital should provide in vitro fertilization treatments; however, will not subsidize the costs to underinsured patients. This decision, similar to my reasoning for my proposed abortion policy, is purely due to the limits of the hospital budget. IVF treatments are significantly more costly than abortions and it would not be in the hospital’s best interest from an economic standpoint to subsidize IVF treatments at this current time.

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). I hope the ethics committee can recognize the benefits of IVF treatments on marriages and women’s agency, and feel 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, I propose a mandate on notifying the patients of the option to donate; however, under no circumstances should hospital staff pressure patients to donate or not. I am cognizant that this suggestion might be in disagreement with the Catholic faith where human life is believed to begin at the moment of conception, which might be a cause of worry for the Catholic donors and nurses. I propose viewing an alternative way of thinking of when human life begins. In 2001, the Bioethics Advisory Committee in Israel issued a report regarding the ethics surrounding stem cell research. The report utilized the reasoning that “…embryos outside the uterus are not regarded as human life…” (Prainsack, 2006: 181). Thus, unused embryos not suitable for implantation in the uterus can be used for research, as those embryos are not considered human life and will not be able to mature into a viable human being. However, embryos suitable for implantation in the uterus should not be used for research due to the potentiality of its human capabilities.

Prenatal testing will be provided and subsidized for all underinsured patients. The option for amniocentesis for pregnant women will also be offered. I propose that prenatal testing and amniocentesis should not be required of all patients, but merely an option for women who would want additional information in regards to their fetuses’ development. Rayna Rapp in her ethnography Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America writes about women undergoing prenatal testing as “moral pioneers” who “submitted to the discipline of a new reproductive technology in order to reap its biomedical benefits” (Rapp, 2004: 307). Prenatal testing and amniocentesis give women greater awareness of potential situations that they may face with their fetuses, such as disabilities, which can allow women to mentally prepare themselves in bringing a disabled fetus to term. In response to prenatal testing being used as a reason to get an abortion, I propose providing women with information about taking care of children with disabilities and alerting them of local resources. This information should be given via written material as well through an on-site genetic counselor. Once the woman is well informed, her choice for an abortion is to her discretion.

Spiritual Counseling

The Sasquatch Mercy Hospital should continue to provide spiritual counseling via the Catholic clergy. I propose 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. I believe 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. I propose all nurse staff to be required to undergo a cultural competency program in order to better understand the diverse religious and cultural backgrounds of the patients that they serve. I also suggest all nurses and physicians be made aware of 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, I request the nurses and donors to reflect and think on whether their decisions are disregarding the rights of the people that they serve. After completion of the cultural competency program, nurses will 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.

In the case that all current nurses state that they cannot aid in performing abortions, I propose an internship program for nursing school students at the nearby university. These nursing students will undergo training specializing in abortions and prenatal testing and will be dispersed within the hospital where needed.

Budget

As the hospital will not subsidize later term abortions and IVF treatments, I propose the creation of the Sasquatch Mercy Hospital Finance Committee. This committee will have the sole responsibility for managing the hospital budget in order to ensure that the hospital will be able to continue its operation for prosperity. The Finance Committee will be required to give bi-monthly briefings to all hospital staff regarding the hospital budget and allocate funds for new hires. In the case that Sasquatch Mercy Hospital’s Catholic donors will not fund the hospital, it will be the Finance Committee’s responsibility for developing a business plan and reaching out or partnering with various organizations in line with the hospital’s new policies.

Conclusion

In this proposal, I attempted to address the various issues that Sasquatch Mercy Hospital is currently facing. I prioritize the rights of the mother over the fetus utilizing Jewish legal thinking, Aristotle’s concept of natural inequality, and the analogy of Agamben’s state of exception. I encourage hospital availability of IVF treatments; however, due to the budget constraints of the hospital, do not see subsidizing the treatments for underinsured patients as economically viable—as IVF treatments are expensive and I am intending the loss of support from some Catholic donors in my proposed deviation from the hospital’s Catholic founding. In response to the possibility of all current Catholic nurses deciding not to assist in abortion and other practices against their religious beliefs, I am proposing an educational internship program utilizing nursing students to learn how to administer various medical procedures. Lastly, I propose the creation of the Sasquatch Mercy Hospital Committee in order to be responsible for hospital funding and budgeting.

While this proposal is controversial, I attempt to propose policies that I feel will benefit Sasquatch Mercy Hospital for the better.

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:. 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

Ginsburg, F. D. (2006). Contested lives: The abortion debate in an American community. Berkeley, CA: University of California Press.

Harvard Health Publishing. (2013, February). Abortion (Termination Of Pregnancy). Retrieved from https://www.health.harvard.edu/womens-health/abortion-termination-of-pregnancy-

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

Prainsack, B. (2006). ‘Negotiating Life’ The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel. Social Studies of Science,36(2), 173-205. doi:10.1177/0306312706053348

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

Rapp, R. (2000). Testing women, testing the fetus: The social impact of amniocentesis in America. New York, NY: Routledge.

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

April 16, 2018

Unit 11: Human Cloning -Grace Chung

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

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

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

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

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

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

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

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

Some questions to consider:

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

April 2, 2018

Chung Midterm

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

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

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