Author: Madison Phaneuf

Introduction

Over the past couple of months, the ethics committee of the Sasquatch Clinic has decided to create a new policy proposal that will ensure that the highest standards regarding ethical decisions will be met for the patients, faculty, and staff at the Clinic. Earlier this month, the committee released a proposal that received lots of negative feedback from the public regarding some of the decisions that were made. We have heard the complaints and are pleased to be releasing a new and improved proposal that will meet some of the wishes that the public has made. First, I want to introduce myself as the committee’s President. My name is Peter Smith and, in addition to holding the title as President of the ethics committee, I am also a Catholic priest. This position is part of the reason I was chosen in the leadership position for the committee due to the influence of the Catholic donors to the Hospital. These topics that will be addressed are of much debate in our current society. Additionally, some of these topics include the use of artificial reproductive technologies, whether we should subsidize abortion services for our under-insured patients, in addition to, discussions involving prenatal testing. Also, the policy will propose the continued use of counseling through Catholic clergy, but with the addition of clergy from other religions. Finally, the policy will introduce the new protocol set forth that will show how to handle staff that have moral restrictions against performing some of the procedures that will be mentioned. The Hospital takes pride in the relationship it wishes to maintain with the donors, and for that reason will propose the following policy.

 

Previous Policies

In the policy proposal that was sent out earlier, there were many complaints and changes that were recommended from the public as well as some of the staff from the Clinic. Some of the previous policies included the influence of Jewish law to make decisions regarding IVF treatment. As well as, quotes from the Mahabharata to make decisions regarding the use of unused embryos for research purposes. With some of the recommendations in mind, the committee has decided that taking a narrower approach to these topics will be the best fit for the Hospital. Knowing that the majority of the donations the Hospital receives come from Catholic donors and the number of predominantly Catholic staff, the committee wants to acknowledge the importance of these members to our community. We are also adding the inclusion of policies regarding a new system for religious clergy counseling services. As this topic was not discussed in the previous proposal. Finally, the committee will propose a new procedure for the nurses and staff members who find moral dilemmas when dealing with patients and their wishes regarding certain technologies and operations.

 

Assisted Reproductive Technologies

To start this proposal, the committee has concluded that the Hospital will not subsidize abortions. Unless, the patient is in a life-threatening situation as decided by the attending physician. The health of the mother is ultimately of the upmost importance during life-threatening situations. The committee sees this as the best option for the Hospital due to the number of Catholic donors currently involved with the Hospital. According to the Catholic religion, abortions are viewed as the killing of a life, regardless of how developed the child is. Accordingly, life begins at conception. “Human life must be respected and protected from the moment of conception” (Donum Vitae). With this idea in mind, respectful treatment of the unborn will be administered throughout the Hospital. The Christian faith preaches that there is a unity between soul and body. “The soul is the form of the body; together, they form an individual substance of a rational nature—a human being with spiritual faculties of intellect” (Shivinandan and Atkinson). This belief plays a major role in the pro-life arguments that Christians adhere to. The child, though they have not been born yet, still possesses a soul and an identity. In addition, there is a large emphasis on the idea of respect for the embryo found throughout the faith.  In regards to the conflict surrounding the identity of the zygote, “by recent findings of human biological science which recognize that in the zygote resulting from fertilization the biological identity of a new human individual is already constituted” (Donum Vitae). This is evidence that the zygote has an identity and a soul throughout the pregnancy.

On the other hand, abortions will be conducted solely in life threatening conditions. This includes the life of the mother. The doctors and nurses in the Clinic will be addressed to not advertise the use of abortions to patients. Though, these services will be available for those who wish to pay for it privately. The Hospital staff has been addressed to find other means to address the patient’s concerns regarding her pregnancy. This will ideally give compromise to those patients who desperately wish to undergo abortions. Again, doctors will only perform abortions on mothers who are in life-threatening danger and cannot afford the procedure themselves. As with the rest of the Hospital’s standards, this notion will be upheld to all attending physicians. This ideal will be promoted as it encourages the health and well-being of our community.

Furthermore, In-Vitro Fertilization treatments will not be subsidized by the Clinic. As these treatments conflict with the Catholic faith. First, the faith declares that fertilization must occur within the sanction of marriage. “The procreation of a new person, whereby the man and the woman collaborate with the power of the Creator, must be the fruit and the sign of the mutual self-giving of the spouses, of their love and of their fidelity” (Donum Vitae). This quote demonstrates the validity of the need for precreation to occur within marriage. From the beginning, Genesis chapter one states that “God blessed them and said to them, Be fruitful and increase in number; fill the earth and subdue it” (Genesis 1.28). Another demonstration that procreation is a blessing from God in a marriage. Therefore, IVF is “contrary to the unity of marriage, to the dignity of the spouses, to the vocation proper to parents, and to the child’s right to be conceived and brought into the world in marriage and from marriage” (Donum Vitae). The commitment man and wife make to each other during marriage will be violated with the use of IVF practices. Respect for the marriage includes the conception of a child during marriage. According to Catholic faith, conception through IVF is considered conception outside of marriage.  We recommend that patients who wish to receive subsidized IVF treatments try to find other health clinics to accommodate their needs. The only exception to the IVF policy, involves the husband donating his own sperm to his wife. This still upholds the values of marriage and can be considered cohesive with the Hospital’s standards.

Others may have differing opinions regarding subsidizing IVF treatments for patients. Some may hold the opinion that any women can be given the opportunity to conceive a baby through these treatments, regardless of marriage status (Kahn 10). However, this goes against the notion and values bestowed upon a couple through marriage. “Marriage possesses specific goods and values in its union and in procreation which cannot be likened to those existing in lower forms of life” (Donum Vitae). Again, the Bible is often cited with “be fruitful and multiply” as a commandment to procreate (Seeman 348). With this thought process in mind, it is often encouraged to receive many different types of ART in order to produce offspring. This reiterates the disregard for the promises made by man and wife in marriage.  One of the many advantageous aspects to marriage, is the gift of procreation whether through natural or artificial means. Marriage is an important aspect to the creation of human life. Without it, the unborn will have a difficult journey to discover its nature and identity (Donum Vitae).

The next section will address the policies regarding prenatal testing including amniocentesis. To clarify for the public, amniocentesis is the testing of the amniotic fluid to determine whether the fetus has developed genetic abnormalities. The Clinic will take the following stance on prenatal testing: if the testing of the embryo respects the life and integrity of the unborn, then the testing is considered moral and therefore the Hospital will subsidize these treatments. “Such diagnosis is permissible, with the consent of the parents after they have been adequately informed, if the methods employed safeguard the life and integrity of the embryo and the mother, without subjecting them to disproportionate risks” (Donum Vitae). As stated earlier, the respect of the embryo is held to a high regard at the Clinic. The use of genetic testing can be beneficial for both baby and mother, in respect to their health. The role a mother has in protecting her child’s safety can be applied to knowing certain genetic abnormalities and preparing to treat those abnormalities if the tests come back positive. One aspect that the ethics committee would like to warn the public about is the slippery slope that may arise with the freedom to perform genetic testing. Again, the Clinic will subsidize genetic testing. However, if the knowledge of the results from a genetic test lead parents to wish to complete an abortion, the Hospital stands with the policy of not funding that procedure. The patients will be given a full disclosure agreement stating these conditions before they wish to proceed with a genetic test. The Hospital sees this as the best way to accommodate the wishes of the parents as well as the safety of the child. With this in mind, the Hospital advises against the use of a genetic test for the sole purpose of deciding whether or not to receive an abortion. I would like to also mention that many mothers have gone through pregnancies without the use of genetic testing and have given birth to wonderfully healthy babies.

Additionally, the Hospital will make a statement regarding the use of unused embryos for research. To reiterate, the Hospital will not subsidize IVF treatments, however the families may choose to pay for them privately through insurance or out-of-pocket means. With the use of IVF treatments comes the question of, what to do with the unused embryos? The Hospital will advise that the use of unused embryos for research will only be allowed with explicit consent from the donors, as well as, the promise that the dignity of the embryo can be ensured. “It follows that all research, even when limited to the simple observation of the embryo, would become illicit were it to involve risk to the embryo’s physical integrity or life by reason of the methods used or the effects induced” (Donum Vitae). Furthermore, the Hospital will ensure the proper respected removal for dead fetuses or embryos. “The corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings” (Donum Vitae). To reiterate, the respect for the embryo is the main point of concern for the staff at the Clinic. If respect for the embryo’s life can be maintained, then the physician will deem it appropriate to ask the genetic donors if they wish to donate their unused embryos. The Clinic will not subject its mission and name for the sake of recognition with potentially immoral research practices, involving donated embryos.

 

Spiritual Counseling

In the previous proposal that was published, there was no policy regarding a sanction for the use of religious clergy as counselors within the Hospital. Genetic and pre-natal counseling services will be provided to families and patients who wish to participate in the service. It has been proven that counseling services can be therapeutic to patients during trying times (Ginsburg 37). However, unlike most of the policies in this proposal, the committee has decided that clergy from multiple religious backgrounds will be used in the Hospital. This will ideally cover the diverse population served at the Clinic. Many denominations will be included in the counseling services to accommodate the different religious backgrounds the patients practice. Those included in the clergy may include: Rabbis, Priests, Pastors, and Islamic Cleric. To start, the Catholic Church believes “intervention in this field is inspired also by the Love which she owes to man, helping him to recognize and respect his rights and duties” (Donum Vitae). Ideally, these counselors give our patients hope for the decisions they are required to make. It is in the best interest of the Clinic to acknowledge the diverse population present. Therefore, the different clergy will answer the needs that our population brings forth. Knowing that difficult times are ever present in a hospital setting, we have now acknowledged the recommendations for including spiritual counselors into the new policy proposal.

 

Doctors and Nursing Staff

As with policies regarding counseling services, questions arose regarding the discomfort of our staff involving new treatments and policies that the Hospital will be implementing. In the previous proposal, there was no policy regarding cultural competency with our staff.  It is important for our primarily Catholic staff to understand the diverse needs of our patients. Any business, company, or program can only be successful if it is willing and able to meet the needs of all of those who are involved. As we are all aware of the sad reality that many hospitals are now run like businesses, it is true that the success of the hospital relies on the happiness of its patients. With this in mind, the committee proposes that if a staff member has an issue with the treatment plan for a patient, he or she will be advised to visit our Office of Diversity Inclusion to speak with a member of our faculty who can explain different cultural approaches to healthcare. Personally, I don’t see this as becoming a major issue due to the primarily Catholic standards set forth by the committee. In reality, this might deter certain patients from attending our Clinic knowing the cultural background of the Sasquatch Clinic. Nonetheless, the committee will approach this issue and include a policy to be set in place, in case a problem does arise within our staff.

 

Conclusion

To conclude this proposal, I want to remind the readers that the Clinic wants all needs from the patients to be met, while still upholding the standards the ethics committee is promoting within our community. This policy addressed many bioethical topics that are popular in today’s political climate. Some of these topics include the practice of abortions, IVF treatments, genetic testing, the use of spiritual counselors, and disagreements involved with staff. The Clinic is a predominantly Catholic based institution, and therefore the policies that were created adhere to the standards upheld in the Catholic community. These policies were thought to be the best possible answers to the questions that the Sasquatch Clinic has been asked to answer. Furthermore, the Clinic takes pride in approaching each topic in a respectful, logical manner. Any further problems with our agenda can be answered by e-mailing the ethics committee secretary.

The three readings this week dive into the conversation regarding who is able and justified to make bioethical decisions. Leon Kass is the chair of the President’s Council of Bioethics who takes a conservative viewpoint of bioethical issues. He was criticized greatly by the public for his role as the chair. In his piece, he promotes the diversity of the Council and how that justifies the decisions that are made within the group. On the other hand, Ruth Macklin attacks the new conservative movement in her piece. She states that there was never a distinction between political ideologies in bioethics until voices from this new movement joined the conversation. Finally, Kathrin Braun is a professor at the University of Vienna. In her piece, she compares American bioethics to German bioethics. She denounces the role of politics in bioethical debates and states a different two-party system and their beliefs. Her piece is a great ending to the other two articles we were assigned to read for this week. Some main points argued include the idea that the experts in this field should only be scientists, while others believe that there should be a broader approach to ethics. I was able to understand and comprehend all three of these readings. They were all straightforward in the points they were trying to make.

In the first reading for this week, Leon R. Kass uses his own personal experience to outline the mission of the President’s Council of Bioethics, he discusses its public ways of working, and reviews the Council’s five major works during their first term. The panel was empowered to answer questions about research and bioethical technology to inform policy makers. The President’s Council of Bioethics has been the center of controversy for many years in the public’s eye. That being said, Kass’ mission in writing this article is to explain to the public the inner-workings of the Council, in order for a better understanding of future decisions made by the Council. Kass writes, “We are summoned to search into deep human matters in order to articulate fully just what is humanly at stake at the intersection of biology and biography” (Kass, 224). This quote demonstrates that Kass is showing the mission of the President’s Council of Bioethics.

He then goes on to demonstrate the diversity of the members of the Council to prove that their decision making is unbiased. He states that some members are social scientists while others are physicians. He goes on to mention the different religious and political backgrounds of each member as well. Though, no one on the committee is a representative of their own religion. I think this is a good point to make to the reader, in order to validate the conclusions made by the Council regarding hot topics like abortion and cloning. Noting the diversity and different backgrounds of the Council will help to ensure that all viewpoints are heard and taken into account.  Kass writes in a way that makes the reader believe that there is a full range of different backgrounds found within the panel. However, as we mentioned last week, there isn’t that much difference between some of the panel members. Later in the piece, Kass argues that organizations like the President’s Council of Bioethics are necessary in society “to help protect society’s basic values” (Kass, 241). He then goes on to mention counter arguments like laissez-faire ideas and solely legislative practices, and the problems that arise with those practices. Some of those problems include that the market dictates what is guided in laissez-faire ideals, and legislation can only be suitable for certain bioethical cases, and cannot be administered to all (Kass, 241). One issue I can see with using committees to inform policy, includes the strengths that Kass was talking about. I think that with the different beliefs and backgrounds found within the board members, making cohesive decisions might be very difficult to achieve. Other criticisms of the Council include the inclusion of public intellectuals on the panel that have the same right to opinions as do some of the biochemists who also take part.

On the opposite end of the spectrum, Ruth Macklin takes a liberal approach to the new conservative movement found in bioethics today. She wrote this piece for a general audience and those who are interested in the current political climate. Her tone of voice is very apparent in this piece and her distaste for the separation of sides that conservatives have brought into bioethics. In “The New Conservatives In Bioethics: Who Are They and What Do They Seek?” Macklin discusses this new movement, identifies who the conservatives are, and what characterizes their position. She argues that there have always been contributors to bioethical debates from all sides of the political spectrum. Before, there was no distinction between political party in the debates. Now, there are voices who are labeling themselves conservatives, and who are critiquing the “liberal” tradition of bioethics (Macklin, 34). Now that republicans dominate two of the three branches of government, their political ideologies are manifesting into other forms of control, moving into the bioethics sphere. This once non-political realm is becoming one separated between liberal and conservative viewpoints. Macklin takes issue with the mission statement delivered by a prominent conservative bioethicist, Yuval Levin, “to prevent our transformation into a culture without awe filled with people without souls” (Macklin, 37). She then states that the implications of this mission statement place the United States on the brink of disaster without this Council. I think it is important to remember that overall, the process of ethical debates is something that should be respected and worthwhile. Even if your own personal opinions are not the ones that influence the ultimate decision, the process itself requires a commitment to respect views that are not our own.

Katherin Braun takes a different viewpoint of ethical debates. In her article, “Not Just For Experts: The Public Debate About Reprogenetics in Germany” Braun distinguishes the differences between Germany and American bioethics committees. This piece was written for the public and argues that ethics in Germany is unlike the politically motivated ethical committees in America. She mentions the “The Bioethics Debate” that was held in Germany in 2000 and 2001 and how this proved that policies should be informed by ethical considerations. However, American policies are divided to either liberal or conservative sides, or “modernity or anti-modernity” (Braun, 43). In Germany, she distinguishes not between two political ideologies, but rather of techno-skeptics and techno-optimists. These oppositions do not coincide with liberal and conservative ideas, they simply “promote different interpretations of the problem at stake and different ideas about how to handle it” (Braun, 43). I think Braun makes a good point in her article that many aspects to American culture have now become political. Braun mentions how most debates take either a left or right approach in the States. It would be pleasant to experience a nation that was more unified on certain topics rather than so harshly divided.

 

Some Questions to consider:

In the United States, should Congress take full responsibility for health policies that are made? Or should that responsibility fall on specific experts in the field?

Is it possible to remove politics from certain aspects of American culture, for example how Braun is suggesting?

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

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

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

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

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

 

 

Works Cited

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

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

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