Religion and Healing Spring (WR) 2018

In response to the recent changes enforced upon the Sasquatch community Hospital, the Catholic Church wishes to engage our own perspectives and insights in the on-going ethical debates relating to public subsidizing of abortion services, fertility treatments, and amniocentesis; the spiritual counselor’s role in the medical healing process; and the professional rights and duties of the tenured nurses’ opposition to performing abortion and reproductive services. As a long-tending Catholic Monsignor serving the Christian Sasquatch community for over forty-years, I believe it is my professional and religious responsibility to clarify and provide resolution to moral problems raised as a result of both the altercation to the hospital’s religious affiliation and cultural diversification of surrounding community. Through this declaration, I do not aim to settle on compromise for these complex issues, but rather, strive to uphold the status of the church as “the expert in humanity”, and further celebrate the values and means by which the church has sought to bring order in moments of moral chaos during its 2000 years of existence (Cahill et al. 142).

Throughout the centuries, when moral questions relating to advanced technology and cultural shifts have arisen, the church has provided the framework for understanding how these changes would be implemented for the human life. Questions of kinship, fertility, and the right to life are not new ethical landscapes. However, the present age has proven to pave a new pathway down this familiar terrain. Modern medicine and advancements in biotechnology now challenge the previously established framework for understanding what role humans play in the reproductive process through the introduction of new methods and technologies that allow for the human to completely dominate reproduction. Procedures such as abortion, in-vitro fertilization treatments (IVF), amniocentesis, and many more, are unnatural and yet, readily available tools that hold the power for a human to subjectively select for the life outcome of another individual. Thus, critical evaluation and formal explication from the church relating to these topics is urgently required in order to ensure that we remain grounded in our own humanity.

I should note that in no way am I claiming that I am an expert on the development of reproductive technologies or their mechanical use. However, I do not view this status as a limitation factor to the insights I may provide regarding the implications of such technologies within our immediate cultural setting, specifically the western, American small-town, predominately Christian culture. Anthropologist Rayna Rapp author of Testing Women, Testing the Fetus, describes reproductive technologies as “complex cultural objects”, and argues that the knowledge and interventions of these technologies are “culturally constituted” (Rapp 13). She further goes on to acknowledge that, “science as culture is constructed inside clinical laboratories, consulting rooms, and technical services; it is also the site of cultural intersection” (Rapp 13). Rapp’s argument is both compelling and relevant for the current events within our community. I want to emphasize that this proposal is not a call for termination of scientific and clinical research as they relate to advancements in knowledge and practice during the reproductive process. It is impossible to argue against the fact that modern medicine has improved the overall lifestyle and longevity of our western populations. However, the church and its leaders are strong cultural powers that must provide direction as we attempt to implement reproductive technologies while approaching this highly complex and congested intersection of science and culture. Therefore, I hope my suggestions and considerations will be taken seriously with respect to my expertise in the moral and ethical framework of our local culture, and further exemplify how the church’s moral perspective is remarkably reflective and aligned with American human right’s law.

Furthermore, as a Catholic Monsignor, I see it as my spiritual and professional duty to comment on the current crisis within our community. My professional duties include, but are not limited to, providing homily at every Catholic service, managing the parish education program, facilitating outreach ministries to both local and outside communities, conducting the seven sacraments, and providing guidance and counseling to members of the church who seek help. With much respect to medical professionals, who are responsible for providing relief to the physical ailments of one’s disease or condition, I see my responsibility as providing relief to the spiritual afflictions and moral concerns introduced by the condition. My professional ethics serve as the basis for my arguments, and I seek to have my opinions and concerns evaluated as both sincere and legitimate even as they apply within the medical context.

I.    Prenatal testing procedures such as amniocentesis may be subsidized for under-insured patients. However, the hospital should not subsidize abortion services or in-vitro fertilization treatments for under-insured patients, nor should the hospital permit the practice of these services to any patient. Furthermore, it is morally illicit for the hospital to collect unused embryos and use them for research and/or experimentation. 

Prenatal tests, such as amniocentesis and the triple screen test, are common procedures used to identify a possible chromosomal abnormality in the developing fetus (Ivry 3). It is my personal view that prenatal tests should not be required for mothers-to-be. However, should the test be recommended by a physician for a mother in a high-risk group (over 35), the procedure should be subsidized by the hospital. Furthermore, and more importantly, the subsidization of such procedures may in no case justify abortion of the child. As written in the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation”, “a diagnosis which shows the existence of a malformation or a hereditary illness must not be the equivalent of a death sentence” (Cahill et al. 150). Moreover, a diagnosis of a malformation and a resulting abortion may lend a cultural perception that those born with abnormalities are unworthy members of society, and further place our small community on the “slippery slope of a eugenic boutique”, where we subjectively select for the lives we deem suitable for life on earth (Rapp 37). In line with church doctrine, it is my belief that such cases should by guided by God the Creator’s good will and spirit without intervention from persons on earth.

With respect to prenatal testing, some individuals may suggest that permitting such practices conflict with church doctrine, for the miscarriage rate for using prenatal technologies is about 1/200 (Ivry 39). These individuals acknowledge the loss of life that may occur, and comply with church doctrine which suggests that “no one can in any circumstance claim for himself the right to destroy directly an innocent human being” (Cahill et al. 147). However, my own research into prenatal tests leads me to believe that significant death rates for children due to testing remains largely inconclusive (Rapp 31). I am also aware that many Catholic parishioners already use prenatal tests such as amniocentesis during their pregnancies (Rapp 157). Therefore, I uphold the woman’s right to such knowledge that can inform her of the chromosomal status of her child. In such cases where the child tests positive for chromosomal abnormality, the mother may have adequate time to prepare herself mentally, emotionally, physically, and spiritually for the child’s arrival; and furthermore, gracefully gain confidence for her prospective maternal role. 

In-vitro fertilization treatment is a reproductive medical procedure where an egg is fertilized by sperm in a test tube or elsewhere outside of the body. According to scientists, embryonic loss is a major problem after IVF (Mesrogli & Dieterle 1). IVF procedures often implant multiple embryos in order to increase the probability of pregnancy, and clinicians vary greatly in the number of embryos they suggest to transfer (Klitzman 12). Additionally, embryos left unused often become experimental materials for scientific research, or become stored in large stock freezers where they run the risk of being destroyed if never used (Beil 1). In contrast to the rate of child deaths in prenatal testing, the death rate for children through the use of IVF is significant. Although no one knows for sure how many embryos are lost or destroyed each year (Almendrara 1), reports speculate that around 93% of the 3.5 millions embryos created between 1991 and 2012 had been thrown away (Doughty, 1). Given the the highly ineffective precision techniques of IVF treatments and the significant loss of life, I demand the hospital reevaluate their position on use of such technologies for they unlawfully result in murdering the lives of millions of human beings.

The position of the Catholic Church on IVF technologies is clearly outlined in the “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation”, which states, “Heterologous artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation of the proper parents, and to the child’s right to be conceived and brought into the world in marriage and from marriage” (Cahill et al. 158). In addition to the unlawful practice of throwing away potential life, the church further emphasizes the view that IVF treatments violate the right of the child to be born through natural means. Every child must be granted the right to be brought into the world through marriage, and be raised within a marriage between a man and a woman. Children, thus, may only be naturally conceived through the proper conjugal act. Any means of reproducing otherwise not only deprives the child of his rights, but also exceeds the limits of reasonable domination of nature that overrides God’s significant power over man. Furthermore, abstaining from the practice of IVF promotes the well- being of the family unit, and its subsequent impact on how we shape our cultural society…

In response to retaliation from other my other religious counterparts, specifically Orthodox Jewish Rabbis, who defend the use of IVF by acknowledging the passage of the Old Testament that states, “be fruitful and multiple”, I defend my interpretation as I believe that it is more aligned with United States law. Although I recognize that these procedures may gift an infertile couple with a child, I do not believe the ends justify the means. In other words, the birth of one child does not justify the loss of millions unused embryos. Under our constitution, it is unlawful to kill the life of another human being, and IVF is responsible for killing millions of human beings.

Although some Orthodox Jewish Rabbis support the use of IVF, many still oppose the use of such technology due to the procedure’s questionable ethical and moral legitimacy (Kahn 144). This controversial technology not only stirs conflict within our immediate community and the rest of the United States, but also continues to ignite internal conflict within discrete religious communities. As stated before, some Jewish communities who support IVF due so on account of God’s commandment to “be fruitful and multiply”, and human technological interventions are often favorable and necessary in order fulfill God’s commandments. In these situations, the Jewish debate then switches to complex debates of kinship regarding who the actual mother of the child is (Kahn 144). Furthermore, additional debate arises as to whether the mother and the child himself will be subject to the negative and unwanted social status for having brought or having been brought into the world through acts that can be conceived to be acts of adultery (Kahn 145). It is through problems that arise such as these that I suggest use of IVF technologies should be limited all together, for they clearly burden the social status of both the mother and child within both their religious communities. I uphold the teachings of the church and United States Law when I suggest that all children should be granted the right to be brought into this world through natural means, and no child should be unlawfully murdered as a result of imprecise IVF practices.

Given the I have just provided on IVF treatment, it should be obvious that the church does not support embryos collected from IVF treatments and left unused to be employed as scientific material for experimentation. Living embryos hold the potential for human life and thus are deserving of the same rights as all individuals. As discussed in the “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation”, “If the embryos are living, whether viable or not, they must be respected just like any other human person; experimentation on embryos which is not directly therapeutic is illicit” (Cahill et al. 152). Therefore, under no circumstances may an embryo and potential human life have its human rights stripped to be used for the sake of scientific curiosity.

Furthermore, the hospital should not, in any circumstance, subsidize or perform an abortion, for these practices also exceed the limits of reasonable domination of nature. The abortion issue will be further addressed in detail in section III below.

II.    The hospital should continue to provide spiritual counseling by the Catholic clergy. Additionally, in response to the growing influx of immigrant community members of diverse spiritual and religious backgrounds, the hospital should seek employment of other religious leaders in order to satisfy the spiritual needs of all patients. 

Medical professionals primary concerns include identifying and diagnosing disease, guiding patients through treatment plans that mitigate the physical symptoms of the disease, and healing the body within the physical sphere. Religious leaders’ responsibilities focus on targeting spiritual concerns or gaps within the patient’s experience of the disease, providing guidance and counseling to the patient throughout and beyond the treatment process, and healing the human soul within the spiritual realm of existence. Just as I, a religious leader, respect the boundaries of the medical professional and do not impose my training and talents in treatment of the physiological disease, I would expect medical professionals to demonstrate the same line of respect and not interfere with my methods and pathways of spiritual healing. Therefore, given that both the medical professionals’ and religious leaders’ interests lie in healing the human composed of both body and soul, I defend the right of all religious leaders to contribute their spiritual healing specialities to the patient during the healing process. Furthermore, I preserve the right for religious leaders to provide guidance to patients challenged by moral dilemmas without intrusion from medical professionals (i.e. doctors, nurses, etc.).

Rayna Rapp’s work in Testing Women, Testing the Fetus provides further support for the spiritual intervention into healthcare institutions when she suggests that “religion and science continue to have an intertwined discursive relation… religion provides not only spiritual direction, but social and material resources to many people” (Rapp 154). Patients who actively seek out help for spiritual guidance may also mutually be seeking out assistance for medical resources and support groups. If religious organizations have access to the hospital space, then it is more likely that patients will have readily accessible resources to meet their needs. Furthermore, with religious contribution of such materials, the hospital can allocate its budget to provide more financial assistance to subsidize treatments that some patients may not be able to afford otherwise.

Rapp also acknowledges that “different religions hold diverse stances toward reproductive technologies, [and] practitioners within religions may vary widely in their interpretations of official doctrine and personal adherence” (Rapp 157). Although I also acknowledge that in future cases I may disagree with guidance provided by other religious leaders on issues such as IVF and abortion, I will vow to remain open for discussion on the moral disagreement. For example, just as in the case where I would disagree with a Jewish rabbi on IVF technologies and its use, it is likely that I may also disagree with a Muslim ayatollah in regards to IVF as a means to uphold the religious mandate of nasab. However, as religious leaders, both perspectives should see it as our duty not only to provide guidance for our patients, but to confront and make sense of our moral stances in open discussions about how such religious guidance affects our local context. Keeping in mind our local community as the ground that unites us all, it is my belief that we religious leaders can work together and peacefully administer guidance that puts the interests of larger community first. Marcia Inhorn’s work on Middle Eastern Muslim men’s discourses of adoption and gamete donation seems to agree with this line of thinking when she says, “For individuals confronting the moral stances and ambiguities of their local religious traditions, they must attempt to make sense of such religious responses while at the same invoking their own moral subjectivities to find acceptable solutions to their often dire health needs and concerns (Inhorn 96). Therefore, it is my belief that we can work together to make sense and find solutions to moral ambiguities in a way that satisfies both our religious and local social context.

Thus, in response to the recent changes that have transformed the hospital from a Catholic institution into a non-denominational institution of medical practice, I propose additional spiritual leaders from other sects of religion be hired in order to ensure the hospital continues to serve the spiritual needs of all patients. As Swasti Bhattacharyya emphasizes throughout her work on Hindu bioethics, “Globalization, pluralism, and multiculturalism all increase, not negate, the need for all to pay closer action to the cultural and religious perspectives and experiences of patients, families and healthcare providers” (Bhattacharyya 19). It is therefore, in the best interest of our community at large to welcome diverse religious perspective and guidance. Although I acknowledge that in future cases I may disagree with guidance provided by other religious leaders, I vow to remain open for discussion on the moral disagreement, and will strive to participate in peaceful debate as to how we can devise a solution that reflects the best interests of the community at large.

III.    The hospital should not offer any abortion services, and thus not force any nurse or doctor to perform such services who desire to not perform such procedures on the basis of her own professional ethics. Abortion is equivalent to first-degree murder, and thus, subject to both mortal spiritual and licit consequences.   

The United State’s constitution outlines a human’s basic rights as freedom to pursue “life, liberty, and the pursuit of happiness”. It is within Catholic Church teaching that an individual has gained their human rights from the very moment of conception. From the very first moment of human life, individuals have the right to pursue their own life with their own sense autonomy. These principles extend to our own community, where we are held responsible to uphold freedom for our citizens, and serve justice to those individuals that violate another citizen’s human rights. 
The “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation states, “The child is not an object to which one has a right nor can he be considered as an object of ownership: Rather, a child is a gift, “the supreme gift” (Cahill et al. 168). Under this reasoning, the child in the womb cannot be seen as an object, but rather, another subject. Our moral compass has evolved in recent centuries to disavow acts of human beings owning other human beings. Likewise, the mother of a child cannot claim to own the human growing inside of her as her own property. The child is another human endowed with rights, and therefore, acts such as abortion that intentionally inflict harm upon the human by another human are morally illicit and subject to the most severe legal consequences. Abortion, in the eyes of the law, is equivalent to first-degree murder, and should not be permitted under any circumstance.

Faye Ginsburg, author of Contested Lives: The Abortion Debate in the American Community, sheds light onto the pro-life movement’s arguments against abortion as the murder of another human being, and more interestingly, how abortion comes to affect on the larger society. Ginsburg states that most pro-life activists, “see abortion as symptomatic of other social problems. In particular, they are concerned that materialism and narcissism are displacing nurturant ties of kin and community” (Ginsburg 9). Although many defendants of abortion only see the pro-life movement as protecting the individual fetus, it should be acknowledged that our concerns are far more complex than they make them seem to be. As we become a more advanced society and culture, we become more susceptible to loosening the grips on our own moral standards humanity. If we progress in the mindset that abortion should be a set norm, where everyone can receive an abortion who wants one, we blindly will follow a path that no longer truly values the extraordinary and blessed process that is human reproduction. Children in the womb are beautifully innocent, and we must always welcome them into our community that continually strives to be humane and compassionate. 

An argument often proposed by pro-choice defenders in response to the abortion debate centers around the idea that “the government cannot tell a person what decisions to make about their body”. However, many governmental laws already intact do manage the way citizens conduct their bodies if it is in the interest of protecting another life. For example, the government tells all of its citizens that they are prohibited to swing their arms continuously with a knife in their hand and murder another person. Laws presently imposed on our bodies inhibit the behaviors that inflict pain or death upon another individual. Thus, laws against abortion serve to protect the life of the baby from harm intentionally imposed upon them.   

Furthermore, the hospital may not force any medical professional to perform abortion, as the action itself violates the ethical guidelines and mission in the medical field. The values driving the professional medical field including diagnosing and treating disease, while preserving the right to life and death with dignity. Performing an abortion and killing the life of a child is in direct conflict with the medical professional’s ethical mission (Ginsburg 66). Thus, nursing professionals who have voiced concern over the procedure and stated an unwillingness to perform such services must be heeded to by hospital administration. The nurses have the right to act within their own autonomy when it comes to what they believe to be their profession’s ethical boundaries.

In conclusion, the path ahead regarding the implementation of public policy standards and ethical guidelines within Sasquatch Community Hospital is far from complete. However, as new technologies advance and culture changes, the moral questions posed in response to these changes will forever persist. It is inevitable that we will face challenges and disagreements in our work geared toward preserving the humane, moral, and ethical branches of our community. As a united community, it is our responsibility to ensure that such challenges are met with the all encompassing and cultivated perspectives that ground and mold our society to be reflective of the interests of both the individual and community at large. With these goals in mind, I hope my input on the matters relating to the changes to the Sasquatch community hospital are taken sincerely and legitimately when deliberating the ethical questions ahead.    

References:

Almendrala, Anna. “No One Knows How Many Frozen Embryos Are Lost Or Destroyed Each Year”. HuffingtonPost, 19 Mar. 2018. https://www.huffingtonpost.com/entry/the-destruction-of-thousands-of-embryos-reveals-just-how-under-regulated-fertility-clinics-are_us_5aab04bfe4b0c33361af1b45

Beil, Laura. “What happens to extra embryos after IVF?”. CNN, 1 Sept. 2009. http://www.cnn.com/2009/HEALTH/09/01/extra.ivf.embryos/index.html

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

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).

Doughty, Steve. “1.7 million embryos created for IVF have been thrown away, and just 7 percent lead to pregnancy”. DailyMail, 30 Dec. 2012. http://www.dailymail.co.uk/news/article-2255107/1-7-million-embryos-created-IVF-thrown-away-just-7-cent-lead-pregnancy.html

Ginsburg, Faye. Contested Lives: The Abortion Debate in an American Community. Berkeley and Los Angles, University California Press, 1989.

Inhorn, Marcia. “‘He Won’t Be My Son’: Middle Eastern Muslim Men’s Discourses of Adoption and Gamete Donation”. Medical Anthropology Quarterly, vol. 20, no. 1, pp. 94-120.

Ivry, Tsipy. Embodying Culture: Pregnancy in Japan and Israel. New Brunswick, Rutgers, 2010.

Kahn, Susan. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Durham and London, Duke University Press, 2000.

Klitzman, Robert. “Deciding how many embryos to transfer: ongoing challenges and dilemmas.” Reproductive Biomedicine & Society Online, vol. 3, no. 1, pp. 1-15.

Mesrogli, Mahmoud. Dieterle, Stefan. “Embryonic losses after in vitro fertilization and embryo transfer.” Acta Obstet Gynecol Scand, vol. 71, no. 1, 1993, pp. 36-38.

Rapp, Rayna. Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. New York and London, Routledge, 2000.

After recent discussions between the administration of St. Mary’s hospital and the Catholic Church, both parties have agreed that it has come time to change the relationship St. Mary’s and the Church once had. St. Mary’s will be reclassified as non-denominational and any medical or administrative personnel officially affiliated with the Church will no longer be employed by the hospital. To reaffirm this decision, the hospital will be renamed to Sasquatch Community Hospital. Along with renaming the hospital, the new administration would like to take this opportunity to form new bonds with the Sasquatch community by filling all administrative positions left vacant from this change with qualified Sasquatch residences. It is the position of the hospital that no one knows how to serve the community of Sasquatch, Connecticut better than its own residents, and SCH looks forward to building a stronger more intimate relationship with the community it has the pleasure of serving.
In addition to these changes, an ethics committee was formed to review the policies set in place by the old administration. In the past Catholic doctrine has been used as a means of justification for many of the decisions made at this hospital. This will no longer be the case, and religious doctrine alone will no longer constitute sufficient reason to enact a policy. As such all policies which have been made in this manner needed to be reviewed by this newly formed ethics committee. To ensure that any policy decisions were made in a manner representative of the new vision Sasquatch Community Hospital has for itself, a great deal of care was put into deciding who should sit on the committee.
Due to the rural nature of Sasquatch, Connecticut, SCH is the only major healthcare provider available to many of its residents. It was imperative that the committee be able to account for the diverse health requirements of Sasquatch residences, while at the same time not compromising our community values. Using a similar model to President Bush’s own council on Bioethics, the hospital appointed me, Dr. Holland, to be the chairman of this committee. My first task was to decide what such an ethics committee should look like and by what means it should be formed. I looked to the wisdom of the President’s own council chairman, Leon Kass, to help guide me during this process. In “Reflections on Public Bioethics: A View from the Trenches,” Leon Kass speaks about some of the roadblocks his committee faced. He articulates how his committee struggled to find legitimacy within the scientific community, an important audience his committee needed to persuade, due to the circumstances under which it was commissioned and how regardless of the fact that the committee’s goal was “to help protect society’s basic values,” the origin of his committee continues to plague their findings even today (Kass 241). I saw this as a warning to myself that I should be careful in how I assemble my committee, but I also felt that his essay illustrated the power to which a committee’s origins can affect the interpretation of its findings. I hoped use this to my advantage by finding a means in which my committee could be formed that gave it additional legitimacy in the eyes of the hospital’s new administration and the people of Sasquatch.
In order to accomplish this, I felt it was imperative to allow the residents of Sasquatch to have a say in the composition of their hospital’s ethics committee. This was done by first reaching out to the local government and holding multiple town meetings to hear the community’s thoughts on what such a committee should look like. Using the information gathered from these meetings, I was able compile a list of 40 potential local community leaders to invite to sit on the committee. This was then brought before the community once more, and 20 members were voted to serve as the hospital’s ethics committee. In addition to the 20 members picked by the community, the hospital administration included 10 additional people it felt had the expertise to help lead these members to a practical consensus.
With the help of this newly formed committee, SCH has chosen to examine the basis for which St. Mary’s administration formed its policies and compile a list of revisions which fall in line with the new identity of the hospital. Not every decision made will result in a change in policy, but the process by which we come to our conclusions will look markedly different. All decisions have been made with extra consider for the needs of Sasquatch residents and the values we uphold as a community. The hospital is also bound by practical limitations as all hospitals are. SCH would love to provide everyone with the healthcare that they feel is right for them, but what is right for one person may not be right for a community or an institution, and when these conflicts arouse tough decisions had to be made. We hope that by being transparent about the process in which we came to our conclusions, we will be able to implement these changes as smoothly as possible.
We will begin first by highlighting some of the new procedures SCH is proud to be offering Sasquatch. The first is the procedure of In Vitro Fertilization. St. Mary’s did not provide this procedure due to the violations of the Magisterium’s teachings outlined in the Donum Vitae. The Catholic Church places a large emphasis on the sanctity of human life and the institution of marriage. SCH wishes not to stray far from what the church has to say about such manners and we hope to employ the same cautious approach to all procedures which have the potential to violate the dignity of human life or the institute of marriage. However, SCH does digress from the Church in what it constitutes as a violation of these sacred institutes. The Donum Vitae states that “artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation proper to parents and the child’s right to be conceived and brought into the world in marriage and from marriage (Donum Vitae, 159).” Catholic doctrine also wishes for all humans to “conform their actions to the creative intention of God” and any modifications to the model for reproduction, such as IVF, violates the clear intentions of God’s creation and should be prohibited (Humanea Vitea). SCH’s new administration recognizes these sentiments but does not feel it holds the authority to decide whether or not other community members should be bound by these same rules. Some members of the committee cited how many Hindu myths revolve around “the active role some women take in controlling their reproductive choices (Bhattacharyya, 6). Other citizens see their ability to reproduce as a means of anchoring their place in society (Kahn 44). And to others in our town, such as those in our Jewish communities are bound by a hole commandment to reproduce. In light of all of these facts, it seems our community disagrees on what constitutes a violation to the institution of marriage or God’s plan, and as such SCH feels they have no place in making the distinction for its citizens.
Still, several members of the committee shared reservations concerning other ethical dilemmas which may arise during the IVF process. It is an unfortunate fact that during the procedure of IVF many embryos are created, but only one of them is carried to term (Brockopp and Eich, 61). This is another qualm the Church has with the use of IVF and was a major reason IVF was never offered at St. Mary’s. The fear that by condoning IVF, the hospital will play a direct role in the creation and destruction of human life is of grave concern to SCH’s administration. It was at this crossroads that the ethics committee went back to the community for guidance. Using a method similar to what Sue Kahn did when writing Reproducing Jew, the committee set out to interview the medical professionals currently working at IVF clinics in similar areas to ours, as well as the women who wished to seek this treatment at SCH (Kahn 4). Through these interviews the committee learned that the desire to use IVF was not restricted to Israeli citizens, or even the Jewish women in our own community. All the women and medical personnel we heard from told stories about the effects infertility can have on a women’s life and her place in society (Kahn, 3). The intense emotions these women felt and the lengths to which they expressed they would go to become mothers was inspiring and reminded the committee just what it was IVF could bring to our community (Made in India). By seeing these stories and the impact IVF could have on the well-being of families, the committee was able to unanimously support the implementation of IVF given that additional considerations were taken to mitigate any risk of violating the dignity of the embryos created through this process.
One of these stipulations, suggested by committee member Dr. Batt, was the formation of a review board to oversee all IVF procedures with the purpose of ensuring that “only one embryo is created at once and that it is handled with the ‘utmost dignity and care.’” All committee members agreed that reducing the number of embryos created during IVF would constitute a moral good, however by doing this the hospital would be requiring that women seeking IVF be subject to multiple rounds of hormone treatment which is generally considered unsafe (Brockopp and Eich, 61). Due to this the committee did not feel that this was a feasible option at this time. However, the idea of a review board overseeing each IVF procedure and ensuring that staff giving the “utmost dignity and care” during these procedures was extremely popular. So, the administration asked that a small review board be assembled from staff members currently employed at SCH with the duty of protecting the rights of the embryos during each IVF procedure. This board is to operate in similar fashion to the existing ones found in Israel which are overseen by the PU’AH group. We hope by doing this we can protect all embryos created at SCH and by doing this a similar supportive culture between this board, the doctors and the new mother will emerge as it has in Israel (Kahn 89). In addition to their obligations to the embryos created, the board will also have the duty of deciding whether a woman qualifies for IVF treatment. In an attempt to reduce the number of embryos destroyed at SCH, IVF will not be made available to all woman of Sasquatch. IVF will be restricted to women and couples who have been unsuccessful in reproducing through other means, and who are not of the financial standing to afford more expensive, but less risky procedures such as surrogacy. A special exception from this rule will be made to patients who have religious conflicts with the use of other forms of artificial reproduction technologies. An example of this would be individuals within our Jewish communities whose “halachah (religious law) makes no provision for the formal transference of maternal identity from a birth mother to another woman-the birth mother remains the mother for many halachic purposes no matter who may raise the child,” making the use of technologies such as surrogacy complicated (Seeman, 342). By drawing up these policies, we hope to strike a balance between the needs our patients, while not compromising any of the community’s values.
By offering IVF, SCH must make guidelines on proper procedures for disposing of all unused embryos created during the process of IVF. It is the goal of Sasquatch Community Hospital to place moral decision making into the hands of its patients whenever possible and this is one of those times where we feel giving our patients autonomy to decide what is best for them is the right thing to do. During the committee’s deliberations it became clear that the members of our community hold different beliefs on when human life begins and even what the definition of an embryo is (Brockopp and Eich, 65). Many pointed out that almost all religions have separate stories describing the formation of a fetus within a womb and that there is great variation between what each says. Judeo-Christian religions often point to in Psalms 139:13, “For you created my inmost being; you knit me together in my mother’s womb” to show the role that God has a hand in our creation from the first steps of development. While Hindu scriptures believe “The fetus is produced out of the Soul” when the soul enters the fetus, which often occurs at the time of conception, however this can only occur within the setting of a uterus (Bhattacharyya 85). In order to account for these varying views, the hospital has set up a framework by which the parents of these embryo are allowed to decide their preferred method of disposal. The ethics committee has drawn up pamphlets which are to be given out to patients at the beginning of the IVF process which outlines a variety of options. If the patients wish to donate their embryos to scientific organizations, then a list of different research groups will be provided, and they will have the option to choose the group which they would prefer it be donated to. If they do not wish to donate their embryos, then all unused embryos will be disposed using similar methods to other IVF clinics in the country.
Many of SCH’s staff brought up that not all patients who come in have a clear understanding of what their religion has to say about many different medical procedures, and that IVF will be no exception (Stolow 144). It is extremely important to the hospital that patients have access to the appropriate religious counsel at all times so SCH would like to make that possible by providing a communal worship space dedicated to religious counseling of all kinds. This will have no effect on the Catholic chaplains who are currently operating in the hospital and the space which has been historically dedicated to them will to be allowed to stay open. While they will continue to enjoy the full support of the SCH administration, the portion of the annual budget which was once dedicated exclusively to these chaplains will have to be shared with all religious leaders who may have a need for it. SCH’s new commitment to religious diversity is rooted in a belief that access to the appropriate counsel can play an integral role in the healing process. SCH provides more services than just IVF, and many clinical studies have shown the benefits religion can have on the success of patient treatment (Coruh et al). By mirroring Sasquatch’s religious diversity within our hospital, we hope to see improvements in our own medical treatments as well as patient satisfaction.
Abortion services will not be provided to patients at SCH under any circumstances.This was not an easy decision for the administration to make it was not one done flippantly. The committee recommended that the hospital begin allowing abortion services with no restrictions. They came to this conclusion using similar reasoning used for condoning IVF procedures. However, SCH understands that this is not the view shared by many of our residents, and that due to the political climate of surrounding abortions, the issue needs to be considered within the proper cultural setting. Abortion represents more than a moral qualm in the American psyche, and this is seen best “Contested Lives” where Faye Ginsburg describes how women from both pro-life and pro-choice sides see “their work as a corrective to, cultural currents” and have such an intimate relationship with their role in the movement that it has become the basis by “which their own moral identity is drawn” (Ginsburg 128). To stay in line with the other statements SCH has illustrated in this text, abortion services would be provided with no limitations, but abortion occupies a different place in the psyche of our residents. Those at the highest levels of both the pro-life/choice movements are the zealous about their work where it is often seen through a complex moral lens, with Ginsburg going so far as define it as “holy work for physicians who believed that the United States was damning itself as a society by continuing to commit moral sins on a massive scale without even realizing it. The theme of saving America from itself was a common leitmotif…” Such sentiments have trickled down to people who play smaller roles in the movement. The Catholic Church’s involvement in the origin of this movement can also not be understated. SCH feels that this departure from our Catholic origins is too abrupt for both our staff and community to undergo at this time. It is a legitimate fear of this administration that the staff and citizens of Sasquatch will prioritize their beliefs on abortion to such an extent that it will have decrease their willingness to seek out healthcare in non-emergency situations. It is the goal of the committee and administration to consider all viewpoints on these issues and decide based on what would provide the community with the best available healthcare. So, it is the decision of this administration to break with the committee’s recommendation in the hopes of preserving the unity of our hospital and the relationship it has built with the community.
With regards to St. Mary’s approach to amniocentesis and prenatal testing, day to day operations of such procedures will change very little. However, the policies of administration surrounding such procedures will change. St. Mary’s offered prenatal testing at the recommendation of a doctor but going forward we feel as though it is best to allow mothers to seek this choice free from any obstruction. One objection to allowing such a change is that more mothers will seek an amniocentesis with the idea that if the diagnosis comes back positive for a terminal disease or disorder the mother may seek to terminate the pregnancy (Donum Vitae 1987). Since such types of abortions will not be performed at SCH, we have the moral freedom to fully endorse the use of this procedure. In allowing anyone to seek request and amniocentesis we are allowing mothers an opportunity to have the pregnancy experience they feel is best suited to their needs. However, SCH is aware of the propensity for some doctors to place their own beliefs onto their patients through indirect means such as aggressively recommending tests, and genetic counselors are not immune to this bias (Ivry 74). SCH does not wish to contribute to a culture in which our patients feel it is necessary for them to have an amniocentesis and we will be teaching all genetic counselors and doctors on proper ways of advising their patients so that all mothers have the amount of medical information that they desire (Ivry 76).
These are all the new procedures which will be offered at SCH for now, but there are a few things left to address regarding the implementation of these policies. St. Mary’s used to provide subsidizes to under-insured patients who were unable to afford their medical bills. This funding came primarily from prominent Catholic officials and families within our communities. We understand the reservations these donors may have towards continuing to donate to SCH in light of these changes. We would like to address these concerns and the reservations of all donors, both large and small, who may be reconsidering whether or not to donate to us in the future. Traditionally donations have been made to the hospital and the administrators has allocated it as they see fit. This will no longer be the case, and in the form used to donate money to the hospital a new stipulation has been added to allow donors to strictly prohibit their funds from being used in any manner they deem undesirable. In addition to this, we will also be allowing people to stipulate where they would like to see their funds go to. If a citizen of Sasquatch did not donate to SCH due to its association with the Catholic Church, we would like to invite you now to donate free of these reservations. By instituting this change, we hope to keep all historical donors while also drawing in a new set of donors which can help SCH better serve its community.
All of these changes will take time to implement and many things need to occur before any of the procedures will be made available to the public. During this time all staff currently employed at SCH are asked to come forward if they have any problems with the new changes or feel any part of these new policies will affect their ability to do their job. SCH wishes not to punish any staff who feels they cannot morally perform any of these procedures and the administration promises to work with the staff to ensure these changes go over smoothly. SCH will not be hiring any additional workers to help with these procedures and it is our plan to train existing staff members on how to perform these new procedures. All staff who do feel comfortable performing these additional services are encouraged to step forward. As a way of showing SCH’s appreciation for these employees, anyone willing to assist in implementing these policies will be given a small raise in addition to any additional compensation for hours worked while training for these positions.
The administration looks forward to the new ways in which our hospital will serve our community and hope that all the procedures SCH is offering will be warmly embraced by the Sasquatch community.
Work Cited
Coruh B, Ayele H, Pugh M, Mulligan T. Does religious activity improve health outcomes? A critical review of the recent literature. Explore (NY) (2005) 1(3):186–91. doi:10.1016/j.explore.2005.02.001
Donum Vitae = the Gift of Life: Instruction on Respect for Human Life in Its Origin : and on the Dignity of Procreation : [replies to Certain Questions of the Day]. Washington, D.C: National Catholic Bioethics Center, 2000.
Brockopp, Jonathan E, and Thomas Eich. Muslim Medical Ethics: From Theory to Practice. Columbia, S.C: University of South Carolina Press, 2008.
Kahn, Susan M. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press Books, 2012.
Stolow, Jeremy. Deus in Machina: Religion, Technology, and the Things in between. New York: Fordham University Press, 2013.
Birenbaum-Carmeli, Daphna, and Yoram S. Carmeli. Kin, Gene, Community: Reproductive Technologies Among Jewish Israelis. New York, N.Y: Berghahn Books, 2010.
Ivry, Tsipy. Embodying Culture: Pregnancy in Japan and Israel. New Brunswick, N.J: Rutgers Univ. Press, 2010.
Bhattacharyya, Swasti. A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.
Paul, . Encyclical of Pope Paul Vi, Humanae Vitae, on the Regulation of Birth: And Pope Paul Vi’s Credo of the People of God. Glen Rock, N.J: Paulist Press, 1968. Print.

Central Lee Hospital Ethics Committee Policy Proposal on Assisted Reproductive Technologies

                              by Saeyoung Lee

Introduction

For many years, Central Lee Hospital has been a cornerstone of wellness in the community of Sasquatch Connecticut, providing high-quality healthcare to those in need. Even though we were under Catholic auspices for many years, recently we have decided to allow the hospital to become non-denominational, and subsidize medical care for under-insured patients.

With the increase in the population and diversity in our community in addition to the fast advancement in new technologies, we felt that there is a need to form a new policy regarding the use of assisted reproductive technologies in our hospital. As a member of the ethics committee at the Central Lee Hospital, I, Saeyoung Lee, was assigned to introduce a new policy proposal that addresses the use of assisted reproductive technologies. Before I begin, I want to emphasize that this is a proposal with an ultimate goal of providing the best medical care to our diverse population needs as much as possible. However, it is very recent that our hospital became non-denominational, which is a huge policy change for us. Therefore, it is impractical to accept all of the assisted reproductive technologies at once due to still prevalent religious practices in our community. As of now, we are not a catholic institution anymore, and we shouldn’t feel obligated to adhere strictly to the Catholic policies. However, I want to emphasize that I am broadly pro-life. This means that I do not support abortions, but I am pro-life in a sense that I am in favor of helping people exercise their right to procreate and not to terminate.

 

Abortion Policy

First, our hospital should NOT provide any abortion services. Due to our strong Catholic background and support from many Catholics, the majority of people in our ethics committee agrees “that the human being must be respected, as a person, from the very first instant of his existence” and “that human life must be absolutely respected and protected from the moment of conception” (Vitae). In this view, the first moment of existence is considered to be the moment the zygote is formed, meaning that from the time that the ovum is fertilized, a new life has begun which is independent from his or her mother or father. Therefore, it is the life of a new human being with his or her own growth. While I do not quite agree that life begins at conception or the formation of zygote is equivalent to a human life, I do agree that human life must be respected and protected. Therefore, I wish to continue discouraging abortion in our facilities.

Furthermore, I see abortion as symptomatic of other social problems. In particular, I am concerned that materialism and narcissism are affecting communities and the ways we view kinship. In other words, discouraging abortions could be interpreted as a desire to reform the more dehumanizing aspect of contemporary capitalist culture (Ginsburg, 1989). The reason that I think this way is because abortion can lead to additional concern with the social and cultural devaluation of dependent people such as the “unborn child,” the elderly, the unwed mother, and the handicapped.

However, it is important to recognize that some patients who request abortions for a valid reason such as medical emergencies when the life of the mother is at stake. Because the life of the mother is equally as important as that of the fetus, I believe there is no other option but abortion to save her life if the mother has contributed anyhow at least a little to the present society who is in front of our eyes. Even though I think this would be the only legitimate reason to request an abortion, I understand that many people have different perspective towards who is allowed for an abortion or not. Therefore, we should implement a special referral services for those who desperately request abortions with different reasons to be seen in another hospital. Although our hospital should not perform any abortion services to any patients, we should be nonjudgmental about the choices they make. In order to get a special referral, a patient will have to inform her OB-GYN although patient does not necessarily have to explain her reasoning. Then, the specialist will send a referral to the closest hospital (Hope Connecticut Hospital) that performs many different assisted reproductive technologies including abortions for the patient to be seen. Please note that this alternative hospital is within two-hour drive from our community of Sasquatch Connecticut, and it will be the patient’s responsibility to get to the Hope Connecticut Hospital.

 

IVF Treatments and Prenatal Testing Policies

Even though our hospital ought to reflect its Catholic origins to some extent, we must recognize technological advancement and cultural shifts worldwide, including those in our community. In addition to the dominant Irish Catholic population, the local area is also home to a small but vibrant Jewish community, a mixed white and African American (non-Irish Catholic) community, and a growing influx of Lebanese Shiite and Japanese immigrants. In order to cope with these changes, our hospital needs slowly start welcoming different religious perspectives. Therefore, in addition to becoming non-denominational, we should accommodate to services such as IVF treatments, and prenatal testing including amniocentesis to those in the unity of heterosexual marriage. However, we must make it clear that these services will only be provided after careful evaluations from our reproductive health professionals with clinical disciplinary perspectives.

Before I go into more detail, I would like to present a counterargument to for those who think that allowing IVF treatments indirectly leads to more abortion. I do not want to affiliate with Catholic, but I am pro-life in a different way. Development of the practice of in vitro fertilization has required innumerable fertilizations and destructions of human embryos. Even though the Catholic church still thinks the embryos obtained in vitro are human beings, and we should not cause harm to life or integrity of the unborn child, I am not necessarily against the termination of all embryos. Through a careful consideration, I want to put more emphasis on the fact that every married couple has a right to become a father and a mother. Therefore, a child is a gift and blessing of God, and a confirmation and completion of their reciprocal self-giving. Therefore, by accommodating to IVF treatments, I am in favor of creating more life at the end rather than less.

Furthermore, unused or frozen embryos collected from IVF treatments should not be donated or used as scientific materials for life-saving research because such experiment will cause harm leading to death without a potential of becoming the fruit of marriage. However, I understand that since we would be performing IVF treatments, we would have unused embryos that expire anyways. Therefore, we should encourage the donation of extra gametes to other heterologous married couples that are infertile. This alternative can lead to family formation as ways to preserve their loving marriage, satisfy their fatherhood desires, and challenge religious dictates for those who argue that such a child “won’t be my son” (Inhorn 94). The reason some of Muslims are against gamete donation is due to the importance of purity of lineage. Islam privileges or even mandates the biological descent and inheritance. Therefore, the origin of a child is thought to be very important and morally imperative. However, many men including the male religious leaders that are Muslim recently have allowed adoptions and gamete donation practices in their community to achieve fatherhood and happiness in their marriages in addition to solving the problem of infertility. With many advantages, we have seen multiple cases of Islamic and Jewish couples accepting the donation of gametes, so I am sure that those patients in our community can benefit from this provision in addition to reducing the wasting of unused embryos.

Next, Prenatal testing including amniocentesis should be provided only if prenatal diagnosis respects the life and integrity of the embryo and the human fetus and is directed toward its safeguarding or healing as an individual (Vitae). This means that prenatal testing is only allowed to make and to anticipate earlier and more effective therapeutic, medical or surgical procedures for a better outcome of birth and life. With that said, this testing should not be performed when it is done with the thought of possibly inducing an abortion depending upon the results such as malformation or a hereditary illness which are not equivalent of a death sentence. Such diagnosis will be only permissible with the consent of the parents after they have been adequately informed of our policy that it would be opposed to the moral law when the diagnosis is done with the possibility of abortion. However, if the diagnosis suggests death risk of the mother, further consulting should be done with the medical professionals to weigh the risk and benefits. If the result confirms more than 50% death risk for the mother, special referral request will be sent to another hospital for consideration of abortion. In this case, transportation fee will be paid by our hospital.

 

Spiritual Counseling Policy

Patients consider spiritual and physical health to be of equal importance, and our hospital recognizes that managing spiritual health may be difficult during illness. With the increase in population and diversity around our community, we should provide clergies of other religious communities such as Jewish, Shia Islamic, and Buddhist clergies in addition to social workers and genetic counselors in order to fully support our non-denominational policy. Furthermore, we should hire new reproductive health professionals including doctors and nurses with different religious perspectives to limit any religious interferences conflicting patients and medical staff’s decision making. These new additions to our hospital will make sure that all of our patients are receiving the best medical care regardless of their status. However, our staff and new hires should agree upon our policies of assisted reproductive technologies during the contract renewals and hiring processes. Those who make accommodations outside of our policy will be terminated.

 

Conclusion

As we all know, due to our Catholic origins, we still are predominantly funded and run by Catholics. The possibility that the hospital will now provide reproductive services has alarmed some of the hospital’s funders and its historically Catholic nursing staff. Nonetheless, it is impossible to please everyone in our quest to set regulations on healthcare. As a member of ethics committee, I strongly oppose forcing anyone to perform any medical procedures against their religious beliefs. Therefore, our Catholic nurses should not have to perform any procedures related to assisted reproductive technologies. In addition, eligible Catholic nurses should have the option to transfer to other departments such as Cardiology and Endocrinology. In order to fill in the gap, we should ask if any nurses from other department to voluntarily transfer over to the Reproductive Health Department.

Even though my proposal does not have all the answers to the questions we may have, I have proposed a plan that constructs a moral vision informed by several different perspectives. Although these proposed policy changes may not be suitable for some people, we must remember that changes in our society and technological advancement have altered what is considered to be the norm. I hope that these new policy changes will expose individuals to different cultural and religious beliefs and practices. In addition, we will have the opportunity to broaden our own perspectives, thus enriching our stock of conceptual and axiological resources from which to draw when making difficult decisions for ourselves (Bhattacharya, 2006).

 

 

Works Cited:

Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: AnInquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.”(Crossroad, 1988).

Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community(University of California Press, 1989).

Marcia Inhorn, He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly20 (2006): 94-120.

Swasti Bhattacharya, Magical Progeny, Modern Technology: A Hindu Bioethics of Reproductive Technology(Suny University Press, 2006).

 

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.

To Whom It May Concern:

As we all are aware, Sasquatch Community Hospital has recently become non-denominational and is now functioning as a public community hospital. I am certain this change was an appropriate step in the community’s effort to encourage newcomers. It is true now that by transitioning to a non-denominational hospital we will better reflect the growing religious and ethnic diversity of our community. New and varying patient populations with different beliefs from some Catholic health practitioners and donors are on the rise. Certain desires for treatments previously not offered will now need to be addressed so that the hospital can run smoothly through this transition.

What is not diverse is our donor population. There was no conflict when the community was predominantly Irish Catholic and the hospital was associated with the Catholic Church. As we know, Sasquatch Community Hospital has kindly subsidized care for patients who are under-insured. This was made possible by generous Catholic donors. It will be difficult to maintain donors if money is suddenly used to fund medical procedures against the Catholic faith. It is of utmost importance to create a vast donor population as medical treatments only become more expensive and the patient population grows.

One of my colleagues has suggested we reach out to the businesses of non-Catholic members of our community to help fundraise for procedures that will be addressed later on such as IVF treatments, abortions, and pre-natal testing including amniocentesis. In my opinion this is a great idea for four reasons: 1) Communication with new community members will further show our welcoming of them, some of which are experiencing life in America for the first time. 2) It will introduce the process of raising money for procedures that certain groups will wish to obtain. 3) It will simultaneously provide financial security to the hospital so that essential functions can remain in full swing, such as the maternity ward, emergency room, and cancer ward, made possible by current donations. 4) It will give new members a place to directly contribute to their community and make a difference.

Though these are only minority groups now, we need to prevent a mismatch between procedures offered and our patient population. We are the only major hospital in a roughly hour drive and it is our duty to provide care. Since we are now a public hospital we must serve the public, not just cater to our current religious donors.

To prevent losing Catholic donors we must be transparent about where donations are distributed so that donors are consenting to funding procedures and departments of their liking. This is essential to prevent a disaster of donors pulling out of the hospital entirely because they do not know if their money is funding procedures against their faith. We can tell donors that they can donate to the hospital overall. We can also tell donors they can pick which areas to distribute their money. Another one of my colleagues anticipates this resulting in Catholic donors immediately allocating their money to services that do not go against their faith. To prevent this, we could in the short term split current government funds more unevenly to allot for new reproductive services, in addition to it already serving other areas of the hospital. Then, as we accumulate more money from non-Catholic donors from fundraising, we can lessen the proportion of government funding towards services not all patients will want to utilize. Another idea mentioned by a colleague is applying for a government grant that covers reproductive services including IVF, abortions, and pre-natal testing. I like this idea because then there is a set amount of money designated to these procedures and it does not dip into the funding of other departments. We should move forward with all of these ideas so that we can accumulate money quickly. We can contact the board members who oversee the hospital budget to better understand how we can support the many new services we wish to provide.

Assisted reproductive technologies do not conflict with all non-Catholic faiths. For example, a growing Jewish population might want to utilize IVF treatments. In Israel, IVF is an alternative way to become a mother for both single and married women. Some single Jewish women consider IVF to be more honest and cleanly, whereas sexual intercourse can be the opposite (Kahn 22). This concept comes from some Israeli women believing sexual intercourse with strangers to get pregnant is “ethically wrong” because it is a form of “stealing” (Kahn 22). To address these concerns of single women in particular who desire to get pregnant, we must support IVF and sperm donors. This is because unmarried Israeli women have been denied by hospitals running under “rabbinic auspices” in the past, and we are a public hospital that no longer has religious affiliations, thus no traditional family image to maintain (Kahn 24). Additionally, unprotected sexual intercourse with strangers could result in sexually transmitted diseases, and IVF treatment is a safe way to allow some women to reach motherhood without compromising their health from STDs. Some Catholic nurses might to respond to single women, or married women utilizing IVF treatment as a conflict to “the gift of human life…actualized in marriage through the specific and exclusive acts of husband and wife” (Donum Vitae 147). Since a required team member for IVF treatment is nurses, I recommend explaining two arguments presented below to the nurses:

Gilbert Meilaender, author of religious and ethical texts, reminds us that although the Bible does not speak of a method like IVF for procreation, there is an imperative value on procreation itself. This is because infertility is considered a “sorrow” in this faith (Meilaender 1638). He further explains stressors placed on infertile couples from their community. In such events, he references the work of Paul Simmons, a Christian ethics author, who believes “biotechnical parenting” does in fact highlight the “symbolic value” of parenting that relates to biblical principles. These principles include having offspring by choice, or parenting as a “calling, not due to accident or mere biological capacity.” (Meilaender 1639). Furthermore, “biotechnical parents” will not “resent” a pregnancy, since they are going through difficult means to commit to becoming parents; thus, a child of IVF is guaranteed “caring love” (Meilaender 1639). This concept, in addition to the next one described below are very different ways to look at procreation. I find them to be compelling arguments in support of reproductive technologies such as IVF because they use evidence that is based on interpretations of the Bible, rather than just stating their own opinion on the matter.

Joseph Fletcher, a biomedical ethicist, states that Jesus says God is supposed to be loved more than an individual’s mother and father. This can be applied towards what “constitutes” a family from being “grounded in ‘blood’ or genes or genital origin’” to “shared caring and concern,” through loving God above all others (qtd. in Meilaender 1643). To continue, Fletcher interprets loving God more than your parents as good because it means that “human reproduction is no longer centered in the genitalia” (Meilaender 1643). Instead, it is an act that results in children who can have a relationship with God, regardless of their “genital origin” (Meilaender 1643). If Catholic nurses state their personal beliefs are in moral conflict with adhering to IVF treatments, we should explain Simmons concept of how “biotechnical parents” are meeting similar biblical routes to parenthood, and Fletcher’s analysis that the “genital origin” of parenthood will never be as important as shared values, using the example of the primary importance of a loving relationship to God. Both Simmons and Fletcher’s arguments are ways to support members of our patient population who want to utilize IVF. If this argument still does not encourage the most devout Catholic nurses to administer care in these procedures, we can look to reorganize the departments in which this subset of nurses work.

Similar to Catholic faiths, the growing Lebanese Shiite population will raise concerns about IVF treatments, though there are some instances where they will be welcomed for Shiites. Overall there is more leniency in receiving egg donors than sperm donors for Shiites. Some male Shiites disapprove of sperm donors with the thought that “’the child would not be from me – it would be like raising some other man’s child’” (Inhorn 104, 112). It is critical to note that this view is not universal by Lebanese Shiite males. Other men have accepted IVF treatment and 60 IVF treatment clinics can be found in Egypt (Inhorn 97). Some accepting men are infertile themselves and others have wives who are infertile. Their motivation for seeking IVF treatment is “to achieve fatherhood and happiness in their marriages” (Inhorn 97). Understanding the perspective of Jewish women and both viewpoints of Lebanese Shiites has influenced my proposal, because while not all infertile Lebanese Shiite immigrants will want to utilize IVF treatment, we should have it as a treatment option considering we have an active population that will want access to these procedures to become parents.

As IVF treatments become more accepted among our patient population it is possible that some Catholic patients will also desire IVF treatments. Barbara Katz Rothman, author of texts about reproductive technologies and women, states that Catholic women are “over-represented” in terms of IVF (Rothman 1605). This is due to pressure placed upon women to have children and their worthiness depending on this practice. In such cases, women might undergo treatments that go against their religious faith to be welcomed socially in their community (Rothman 1605). Although this is not a guarantee that Catholic families will engage in IVF treatments if they are suddenly available at the hospital, it does show evidence that there could be an additional population that would use IVF treatment.

In terms of pre-natal testing and amniocentesis, there is not a uniform desire for such tests in our patient population. It is understood in Donum Vitae that pre-natal testing for malformations through amniocentesis is morally illicit if followed by an abortion (Donum Vitae 150). This text does support “therapeutic procedures” that are directed towards the “healing [or] the improvement” of the conditions of an embryo (Donum Vitae 151). This is due to the belief that embryos must be respected like any human and procedures that risk or deliberately end of the life of embryos are illicit (Donum Vitae 152). Similarly, the Japanese immigrant group comes from a country that prohibits abortions for “eugenic reasons.” In other words, it is publicly understood in Japan that abortions are for “choosing when to have children rather than what kind of children” (Ivry 82). Therefore, if a woman wants to have an abortion in Japan it is available, but not in the case for terminating a disabled fetus. In a few such instances that these types of abortions have occurred, they were through “legal reasons” (Ivry 19). This does differ from the Catholic belief that does not allow abortion in any context. It is worth showing the beliefs of these two groups because in Jewish populations pre-natal testing for chromosomal abnormalities is a routine procedure and covered by Israeli national health insurance (Ivry 38). In general, Japanese pre-natal care includes attention to maternal nutrition and fetal environment rather than genetic abnormalities (Ivry 11). These values will not necessarily be ingrained in all Japanese immigrants that enter our hospital, but show us the common beliefs of their home country. Contrasting greatly, the pregnancies of Jewish women in Israel hold large importance on pre-natal tests, some of which, like chromosomal biomarker tests are not common procedures in Japan (Ivry 3). While the origins in the Jewish population in Sasquatch are not necessarily known, this group can look to Israel as a model to base their reproductive technology use. For this reason, our Jewish population might look to use pre-natal testing like amniocentesis. A compromise between the varying views of our Catholic, Jewish and Japanese populations about pre-natal testing will be described in the next paragraph.

We should allow pre-natal testing, including amniocentesis, that is only conducted for therapeutic intentions, which Donum Vitae supports (Donum Vitae 150-152. This means that pre-natal testing will be available for parents to learn of any conditions their fetus has so that they can properly prepare for what their baby will need. I want to clarify that the hospital will allow abortions, but will follow the Japanese methodology for administering these procedures, in that abortions are available for only non-eugenic reasons, such as a woman not being ready to be a mother for any child (Ivry 82). We will be able to make sure people are not using abortion services for eugenic reasons because amniocentesis typically occurs at 15-20 weeks of pregnancy and 92% of abortions occur in the first 13 weeks of pregnancy (“Amniocentesis;” “Abortion After the First Trimester”). Therefore, we can regulate the use of services by looking at the duration of pregnancies.

Until there is a more widespread donor population, the hospital should not provide and subsidize abortion services for under-insured patients. If the government grant for reproductive services is approved, we will revisit subsidizing abortions for the under-insured. Until then, we want to prevent Catholic donors from pulling out from the hospital because their money is being used to perform abortions. I cannot stress enough that if we lose our donor population the hospital will be forced to close, closing all non-reproductive services with it. Therefore, I suggested earlier to diversify our donors so that we can fund reproductive technologies. Until that moment, however, abortions should only be administered to those who can have one without needing hospital funding, due to the current largely Catholic donor base.

To remind everyone, this means that there is a Jewish population, Lebanese Shiite population, and potential Catholic population that would utilize IVF treatments. Although there are many groups listed above that could potentially utilize IVF, the hospital should not publicly advertise that unused embryos should be donated to research. On one hand, I do not see why the Jewish or Shiite populations would disagree with this decision, as they are more open to IVF treatments. On the other hand, in Donum Vitae, Catholics are urged not to allow procedures on live embryos, unless there is “certainty of not causing harm to the life or integrity of unborn child and the mother” (Donum Vitae 152-153). Therefore, science experiments that hold no therapeutic advantage to the embryo violate human dignity. To compromise on these differing beliefs, I propose unused embryos to be donated on the discretion of the people undergoing IVF treatment, and not based upon a hospital policy. To summarize, donating unused embryos should not be considered a standard procedure offered by the hospital, with the goal to avoid risks of losing Catholic donors. This proposal will hold true even if we do diversify our donor population because there is no need for the hospital to make donations of unused embryos the norm. Instead, we should educate those undergoing IVF treatment about both options and train our staff to do so in an objective, thus neutral manner, that does not show the hospital supports one decision over another. As I push for diversified donors and more education about treatment options, I must speak about expanding the spiritual clergy that historically have come to Sasquatch Community Hospital.

Although the hospital is now non-denominational I fully expect Catholic clergymen to continue to come to the hospital, despite medical staff disliking their presence due to interference. It is a known conflict that the clergymen also feel disrespected when the medical staff gets annoyed by them. To minimize conflict for both sides, I propose that clergymen visits become an optional service that requires a sign up that clergymen and community members must abide. With a schedule established, clergymen cannot show up unannounced, which would bother medical staff, and medical staff cannot be annoyed when clergymen arrive, because the patient has made an appointment. It should be known to patients that such appointments must be requested; thus, will not occur without request. I believe this counseling option should now include religious members from other groups that now accompany our growing patient population. If these appointments cause patients to decide to forgo reproductive technologies, the medical staff must accept this form of autonomy in patients, regardless of their personal opinions.

I want to give special consideration to a critique by my colleague who has previously stated my ideas alienate the local Catholic population. I believe my proposal is a compromise to both the Catholic population and the new members of our community. I have thought about how I could revise my ideas to satisfy the Catholic population, but that would not make sense considering the hospital is no longer a Catholic hospital. The changes in the hospital’s policies comes the need for members of the population to adjust to new protocols. In theory, it is possible that some members of the community may go to a different hospital for non-essential problems if they disagree with some of the new policies. However, I find it less likely in a practical day-to-day lifestyle for someone to do so because after all, we are the only major hospital within a 45 minute drive, and when you are sick, you will likely seek treatment in the most convenient fashion.

I look forward to your responses of my proposal to consider the following: 1) To allow IVF treatment. 2) To allow abortion services and prenatal testing, including amniocentesis, if both are for non-eugenic reasons. 3) To not provide subsidies for abortions for under-insured patients until we have proper funding through new donors and/or a government grant. 4) To educate patients about the options for unused embryos in a neutral manner so that the hospital does not publicly endorse donating embryos to scientific experiments. 5) To create a schedule that patients can use to sign up for clergyman visits and both medical staff and clergymen must accept the terms.

I am in favor of assisted reproductive technologies because there is substantial evidence that many members of our patient population desire and would benefit from these treatments. A large part of my proposal includes efforts to diversify our donor population and to apply to get a government grant. By allocating new donors to reproductive technologies these services will be made possible, while keeping the hospital’s many other essential services intact.

Thank you for your time and I hope to see some of my proposals being put to action.

 

Works Cited

“Abortion After the First Trimester in the United States.” Planned Parenthood, www.plannedparenthood.org/files/5113/9611/5527/Abortion_After_first_trimester.pdf

“Amniocentesis” Mayo Clinic, 9, Jan. 2018, www.mayoclinic.org/tests-procedures/amniocentesis/about/pac-20392914

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.

Inhorn, Marcia. “He Won’t Be My Son: Middle Eastern Men’s Discourses of Gamete Donation.” Medical Anthropology Quarterly, vol. 20, no. 1, 2006, pp. 94-120.

Ivry, Tsipy. Embodying Culture: Pregnancy in Israel and Japan. Rutgers University Press, 2009.

Kahn, Susan Martha. Reproducing Jews: A Cultural Account of Assisted Conception in Israel. Duke University Press, 2000.

Meilaender, Gilbert. “New Reproductive Technologies: Protestant Modes of Thought.” Creighton Law Review, 1991, pp. 1637-46.

Rothman, Barbara Katz, “Reproductive Technologies and Surrogacy: A Feminist Perspective.” Creighton Law Review, 1991, pp. 1599-1607.

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).

Dear Esteemed Members of the Ethics Committee here at Sasquatch Hospital,

Sasquatch hospital is seeing an influx of women and men minority groups into our region of care; minority not for the color of their skin but for the religion that they believe. Ever since our founding, Sasquatch has been predominantly Irish Catholic—with this influx of newcomers our hospital is starting to see a change in reproductive requests. In conjunction with the state and our donor basis we aim to provide all of our patients with affordable and efficient healthcare—but as a community of historically Irish Catholics we cannot forget our faith and our morals when treating our new neighbors. Our donor base has been kind enough to aid us in the subsidizing of healthcare for underinsured patients but they have made it clear that they will not support our healthcare system if we begin to provide abortions to all those seeking them. They have also made it clear that if our efforts to provide our patients with successful reproduction go beyond the scope of the sanctity of marriage they will not be pleased.

To accommodate our new neighbors I propose that as a community we work together to be more supportive of young women and their reproductive decisions; a key component to this will be to provide abortions on a case-by-case basis wherein the family will have to meet with a reproductive health counselor in order to get permission to abort. Reproductive health counselors will be trained and hired from reproductive health counseling programs such as EngenderHealth. Trainees in programs such as this are taught to develop “knowledge about, skills in, attitudes toward, and comfort with effective communication and counseling in all areas of reproductive health,” along with training in “addressing the realities of and exploring the reproductive health priorities of the communities in a culturally appropriate manner” (EngenderHealth, 2003). Counselors will not be evaluated on their religion or political views; when doing their job their priority is to put the patient and their health and safety first. Counselors will work with each patient to make sure that the patient is fully informed of every opportunity surrounding unintended pregnancy—such as adoption. Counselors will conduct risk evaluations with each family seeking an abortion and will only approve abortions for pregnancies that are putting the life of the mother or child in danger. As a healthcare system we must respect the human body “as a person—from the very first instant of his existence” (Donum Vitae). Staying true to our faith, and the faith of our donors, we will respect the unborn child from the moment of conception and will keep it our priority to make the best decision for the life of the child and for the life of the family. We acknowledge both sides of the argument for and against abortion and we agree with Jean Carton that “abortion on demand erodes a sense of collective responsibility for the woman in actual crisis” and that supporting abortion mindlessly without “addressing the causes which make a particular pregnancy a problem [we leave] the woman in stress [to be] forsaken” (Ginsberg, 1989).

On the opposing side of this, we must also acknowledge that not all women in our growing community are Irish Catholics and that most women perceive a “tension…between human and divine agency” and that not all “women’s reproductive experiences can be clearly derived from particular religious doctrines” (Seeman, 2016). Due to these realities, as a healthcare system we must strive to meet every woman’s expectation of exceptional care when they arrive in our waiting room. Thus—we acknowledge that by either fully accepting or completely denying abortion services we will be turning a blind eye to some groups of people in our community. As the only major hospital in the surrounding area we would ideally like to accommodate all but, this is not a logistical reality. Thus I encourage you, members of the ethics committee, to find it in your hearts to realize that “binary taxonomies of intended and unintended pregnancy may elide important distinctions between unplanned, unwanted, or merely mistimed pregnancies,” and that “reproduction cannot be wholly scripted and that human attempts to do so are frustrated not just by caprice or bad planning but by the transcendent purposes and plans of divine agency” (Seeman, 2016). Our counselors will do all they can to provide patients with the tools needed to choose to continue with their pregnancies but in the case that abortion is the only answer for the patient, as decided by the patient with the help of the reproductive health counselor, we will provide the service.

In Vitro Fertilization (IVF), as a means of reproducing within a sanctified marriage, will be a procedure that we will allow done. With respect to our Jewish community and their halakha, we will make IVF “available to individuals who need assisted reproduction” (Broyde, 2005). Couples wanting to undergo IVF must first meet with a reproductive health counselor to get permission and must also use both the husband’s and wife’s gametes. This is the only way to keep the sanctity of marriage when using IVF, and the only way to respect our own historical faith and the faith or our donor base. The decision will inherently leave many infertile couples with the notion that our hospital is not supportive of their quest to procreate or serve as “social” parents (Inhorn, 2006). As an alternative to IVF for these infertile couples we will suggest adoption, or for our new Shiite neighbors—temporary polygamous marriage. We have made the decision to retain IVF treatments only for those couples who wish to do so in the sanctity of marriage not just for our Catholic donors but also to respect our Shiite neighbors whose Islamic roots “agree that it is absolutely forbidden to borrow sperm or eggs from a person other than the involved couple;” the borrowing of gametes is “seen as an act of adultery because the husband [or wife] will not be the true biologic father [or mother]” (Inhorn, 2006). Our Jewish neighbors, with their religious stake in the use of IVF, also see IVF as threat to their religious freedom—particularly that “the status of an individual as an inherent part of a particular family and as the child of a particular set of biological parents is crucial in Jewish Law” (Prainsack, 2006). As such IVF treatments are limited among observing Jews to be within the sanctity of marriage just as in Catholicism and Islam. Any couple who wishes to utilize IVF without adhering to our policies regarding the use of gametes will have to seek out these services elsewhere. In this way we are respecting both marriage and life.

Any unused embryos will be left to the discretion of the mother with three options: they can pay to have their embryos frozen and stored in which case they can use them when they are ready to get pregnant again, they can donate their unused embryos to stem cell research, or they can have their unused embryos inserted during a period where the vagina is not conducive to a fertilized egg. Although the Catholic Church has said that “destructive research on human embryos” is “intrinsically evil” and “must always be opposed” (USCCB, 2015) we have chosen to allow such research in the quest for great advances in stem cell research. The United States Catholic Conference of Bishops calls on all nations to “protect the right to life by seeking effective ways to” meet the basic human rights such as the “right to access those things required for human decency—food and shelter… [and] health care” (USCCB, 2015). Stem cell research respects the human life encapsulated in the unused embryo by allowing it to contribute to the common good of society by helping make possible life-saving treatments that have the ability to “combat diseases such as Parkinson’s, Alzheimer’s, multiple sclerosis and a number of other neurodegenerative diseases,” (Prainsack, 2006) and well as make healthcare affordable for those patients who would otherwise not have access to them. In all of the three options we consider and respect the life of the child and the soul of the mother.

In line with these beliefs amniocentesis’ and other prenatal testing will also be allowed. As a healthcare facility our first priority is both the health of the mother and the health of the unborn child—as such any tests that will make more apparent the health needs of the child will be allowed, but not encouraged. Our donors will be pleased to know that in this regards our stance highly aligns with the Catholic teachings presented in Donum Vitae, which states “prenatal diagnosis makes it possible to know the condition of the embryo and of the fetus when still in the mother’s womb. It permits, or makes it possible to anticipate earlier and more effectively, certain therapeutic, medical or surgical procedures. Such diagnosis is permissible” (Donum Vitae). Due to the slippery slope that may occur with the employment of these tests—all of our patients seeking them will have to meet with our reproductive health counselors to decide if prenatal tests are the right choice for the life of the mother and child. These tests can cause stress to the mother who is already under enough stress and can force her to make decisions regarding her pregnancy that she never would have had to make without the information these tests provide. In cases where the tests come back with results that reflect complications with the pregnancy or complications with the fetus, the mother and father of the unborn child will again meet with a reproductive health counselor to decide the best course of action—whether that be abortion or birth. Although the Second Vatican Council has stated that “abortion and infanticide are abominable crimes,” (Donum Vitae) we must respect the lives of the mothers and situational contexts in which the abortion would or should take place.

In addition to reproductive health counselors we will have social workers working alongside our medical staff, it will be the duty of these staff members to make sure that all of our patients are receiving the best medical care for themselves, their families, and their situations. We considered saying goodbye to our religious counselors and staff—but after much deliberation we have decided that their presence in Sasquatch hospital is both necessary to the wellbeing of our patients but also necessary to our Catholic heritage. Due to the influx of new denominations and from the complaints of the medical staff we have decided to hire more diverse spiritual counselors. These counselors can be sought after by our patients at their own will. Although our healthcare system is historically Catholic and we try to maintain this faith in all of our procedures, we will not subject our patients to our specific religious viewpoint during an already stressful time. All of our counselors, both spiritual and reproductive, will work to ensure our patients are exceptionally informed, happy with their decision, and trusting of our medical experts. As previously stated, any woman seeking abortion or an abortion-like procedure, must meet with our counselors anyway—in this way all of our patients should be informed from a well-being and holistic perspective. Those patients wishing to explore a more religious perspective, of any denomination, can do so within our healthcare system with the experienced and diverse spiritual counselors we will employ.

Due to our historically Catholic nursing staff we have received some inquiries about whether or not we will be forcing our staff to partake in the execution of procedures that are against their religion. This will not be the case. In order to appease both our staff and our donor base we will be initiating a system of referrals. Any abortion that is deemed necessary or acceptable, after informed deliberation between our counselors and patients, will be scheduled in our facility or will be granted a referral to another facility in a neighboring town. Using our limited budget for new hires we will hire one doctor or nurse that is certified to execute abortions—if for some reason there is no doctor or nurse eligible for hire, we will pay a doctor from the town of Swesquet (two hours away) to visit our facility twice a month to execute abortions. We have already been in communication with a doctor from Swesquet that would be willing to make the drive twice a month in order to aid our patients in their search for convenient and trustworthy healthcare. Again, if our hiring search for a doctor that would permanently reside in Sasquatch fails, the doctor from Swesquet would be introduced to our facility and put on pay roll. In this event, any patient who is in need of immediate care or cannot wait for the scheduled day will be given a referral to an abortion clinic or abortion friendly hospital in the nearest location. Although this will be an inconvenient trip for our patient they will have to both understand and respect our healthcare providers spirituality and agency in their decisions to deny abortion procedures.

We understand that our medical staff and you, our loyal donor base, have Catholic roots that are both very well respected in this community and that are the majority in Sasquatch but it is time we open our minds and hearts to the diverse groups of people that are choosing to call Sasquatch home. “If [our] doctors, nurses, and other healthcare professionals desire to administer quality, culturally competent care, they must take both their own and their patients’ religious perspectives and commitments into serious consideration” (Bhattacharyya, 2006). This is the goal of my proposal to you—to show that we can be both culturally competent and steadfast in our faith at the same time while also providing exceptional healthcare.

Thank you all for your time and consideration,

Dr. Marmeno

 

 

Works Cited:

1. Congregation for the Doctrine of Faith, “Donum Vitae:  Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation: Replies to certain questions of the Day”. (1987).
2. Bhattacharyya, Swasti. A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.
3. Broyde, Michael J. Marriage, Sex, and the Family in Judaism. Rowman & Littlefield, 2005.
4. Comprehensive Counseling for Reproductive Health: An Integrated Curriculum. EngenderHealth, 2003.
5. Ginsberg, Faye D. Contested Lives: The Abortion Debate in an American Community. University of California Press, 1989.
6. Inhorn, Marcia. “‘He Won’t Be My Son.’” Medical Anthropology Quarterly, vol. 20, no. 1, 8 Jan. 2008, anthrosource.onlinelibrary.wiley.com/doi/abs/10.1525/maq.2006.20.1.94.
7. Prainsack, Barbara. “‘Negotiating Life’: The Regulation of Human Cloning and Embryonic Stem Cell Research in Israel.” Social Studies of Science, vol. 36, pp. 173–205., journals.sagepub.com/doi/pdf/10.1177/0306312706053348.
8. Seeman, Don, et al. “Blessing Unintended Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine Anthropology Theory, vol. 3, no. 1, pp. 29–54.
9. United States Conference of Catholic Bishops. Forming Consciences for Faithful Citizenship. USCCB, 2015.

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 continued 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.

1. 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 recommend 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). Such testing is only permissible, with the consent of the mother, after being adequately informed of the outcome, but this testing is highly opposed when performed with the possibility of aborting the living fetus. I acknowledge there exist similar and contrasting view of prenatal testing 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 culture regarding the level of emphasis placed on reproductive environmental and genetic risk factors.Dr. Ivry claims 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 patience 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 environment. In multiple Japanese textbook 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 patience, 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? (No)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, GMH currently is not in a good 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.

 

Administration

I recommend that the preliminary timeline 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 select few 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 is a lot of legal documents and certifications that must be approved before we can start a mutual beneficial relationship that ensure every individual will receive great quality care.

 

 

Policy Proposal Regarding Reproductive Technologies and Prenatal Testing in Sasquatch Community Hospital

 

Proposer Background: I am a 50-year-old Protestant Japanese American who immigrated to the U.S. at the age of 22. During my years in the U.S., I have become a proud mother of two children and have worked as a nurse practitioner. Having watched Sasquatch Community Hospital (SCH) grow from a small clinic to a major hospital in the State and from Catholic affiliation to non-denominational during my fifteen years of working here, I truly regard SCH as my second home.

 

Over the last few decades, Sasquatch County Hospital (SCH) has committed to a professional and national system of healthcare. The mission of the hospital is to serve and provide equal access to all people despite religion, race, and class in the name of the Father. Adhering to our original purposes greatly, we have seen the transition of SCH to a non-denominational hospital subsidizing medical care to under-insured patients. With the continuation to thrive for inclusive service despite financial circumstances, I therefore propose subsidies on abortion services, IVF treatments, prenatal testing for under-insured patients. To accommodate the different religious backgrounds of individuals, spiritual counseling should continue to be offered with Catholic clergy, and counseling from other religions ought to be provided as well. As adaption to new regulations require time and knowledge, it will be necessary to offer literacy courses in pregnancy and pre-natal testing for patients. Training on cultural competency for staff members will be offered as well.

 

This policy proposal is not only written to make regulations, but also to reinforce the values of Sasquatch County Hospital, and most importantly, to define our stance among the nationwide bioethics discourse as a healthcare institution. Therefore, the notions of motherhood, social stratification, and limitation to human rights as well as the embodiment of embryo rights will be central to the discussion of these policies.

 

The Reduction of Social Stratification through Financial Support and Scientific Literacy

 

Informing and providing abortion services and prenatal testing to under-insured patients will reduce stratified reproduction. Stratified reproduction refers to the varying experiences of pregnancy based on financial resources and scientific literacy. Many scholarly research has indicated how pregnancy is not conceived, medically managed, or delivered on equal social terrain (Rapps 311). For example, the scientific literacy on genetic disorders of middle class Israeli women have led to their frequent use of pre-natal testing to prevent reproductive catastrophe (Ivry 243). Similarly shaped by scientific education, the majority of women in the U.S. are usually informed by biomedical statistics and utilize biomedical technologies to evaluate their risks in pregnancy (Rapp 317). “Risk analysis” requires not only the reasoning of “risk behavior” but also steps to contain the risks. While middle class women and families have opportunities to learn about heredity, genetics, and disabilities in many places, the under-insured patients may not be well-informed of all the possibilities and risks pertaining to pregnancy due to their disadvantaged socioeconomic backgrounds. Specifically speaking, while all women know to stop smoking during pregnancy, the monitoring of folic fluid to reduce incidence of spina bifida is most likely only shared across women of higher scientific literacy. Similarly, the risks of many genetic disorders may appear ambiguous to women of disadvantaged backgrounds. Access to information about risks pertaining to pregnancy should not become socially stratified based on socioeconomic backgrounds. Therefore, we as a nationally renowned hospital ought to not only provide pre-natal testing and abortion to reduce such risks, but also to let all patients gain a scientific perspective on the potential risks.

 

Free courses on human genetic disorders, pre-natal testing, and other biomedical technologies should be provided on weekly basis. These scientific literacy classes could help women acquire equal access to reproductive information, allowing women to make the most informed choices despite their financial situation, and thus reducing stratified reproduction. As a result, subsidies on pre-natal testing, including amniocentesis will be offered to the under-insured. Abortion will thus also be subsidized as a possible procedure following pre-natal testing.

 

One may argue that people of disadvantaged backgrounds may garner alternative resources for accepting their misfortunes (Rapp 316) and thus would not benefit from the increased “scientific literacy.” In other words, understanding and eliminating potential risks of pregnancy are ways for people to gain more control; however, people may have other ways to handle the contingencies of pregnancy by simply accepting it. For example, a study of poor women in the U.S.  showed that they often consider “unplanned pregnancy” as a divine blessing beyond their control (Seeman 4). Similarly, some religions may provide individuals with “comfort mechanism” as people could seek strengths in God (Hamdy 146). I do not argue that such values of accepting fate should be replaced by rational scientific literacy to limit future risks. Particularly, I am not encouraging the use of pre-natal testing to reduce risks of pregnancy. In fact, the social and cultural factors taken into consideration certainly vary among women when they make decisions regarding pregnancy. I am arguing, however, that restricted access to scientific literacy and biomedical technologies should not be the cause of submitting to other options; by providing more scientific literacy and financial subsidies on pre-natal testing, we provide women with more access to helpful information. Equipped with more scientific knowledge and less financial restraints, women will be more empowered to make sensible decisions in their best interests.

 

The Right to Motherhood

 

In-vitro fertilization (IVF) should also be provided for under-insured female patients. Despite the diverse religious and cultural ideologies in Sasquatch county, motherhood is regarded as a state that is highly significant in a woman’s live. Women across all cultures make great effort to acquire motherhood. Therefore, it behooves us to remove the technical and financial impediments to motherhood. If physical conditions prohibit women from bearing children, IVF could provide them with the opportunity of motherhood; if financial situation is in the way of motherhood, we will do our best to provide subsidies. The population in Sasquatch county consists of an Irish, Jewish, a mixed white and African American population, with growing influx of Lebanese Shitte and Japanese immigrants. According to the Protestant and Catholic understanding of the Genesis, women regard one of their missions in life as to “reproduce and multiply.” Similarly, reproduction is viewed as an “imperative religious duty” and even “honor and prestige of the family” within the view of Jewish women (Kahn 4 & 44). Borrowing language from the great protestant theologian Karl Barth, motherhood is “a basic form of humanity” (Meilander, 1641). Besides, the varying political views of pro-life and pro-choice activists even consent upon the significant meanings of pregnancy to women. As pro-choice activists view pregnancy as an essential right for women, pro-life activists view pregnancy as an indispensable responsibility embodying the uniqueness of feminism (Ginsburg 216). “Starting over ones live” and “blessings” are often associated to motherhood in the study of homeless mothers in the southeastern U.S. (Seeman 36). In other words, motherhood brings hope to woman’s lives, especially in the young disadvantaged population. Women from different backgrounds not only consider motherhood as essential components of their lives, but also view it as an earned state. In the Japanese culture, the “Gamburu”, or “make an effort” ideology is embedded in the image of ethical self. Japanese women often bear the responsibilities of the babies’ nurturance to themselves and highly pride themselves for it. The avid users of IVF of both the Catholic and Jewish communities also demonstrate the eagerness of women to motherhood. Equal access to IVF is necessary as it will largely benefit Sasquatch county’s under-insured population by removing impediments to motherhood. Therefore, subsidies on IVF treatments to the under-insured should be offered.

 

Nevertheless, as one may argue that subsidies would result in the abuse of the technology, the subsidies on successful IVF treatments will only be provided once to each individual, with funding on a maximum of three attempts for successful fertilization. In addition, IVF treatment will only be performed on women with no children. A maximum of three attempts is allowed for each patient. Attempts exceeding the indicated number will no longer be subsidized by the hospital. Subsidies on IVF treatments to conceive an additional child (more than one) will also not be offered.

 

The Limitations to Human Choices and the Embodiment of Embryo Treatment

 

The encouragement of embryonic donation for scientific research should be prohibited. As illustrated above, the choice of pregnancy, IVF treatments, prenatal testing, and abortion concerns the mother of the child greatly. In these cases, the mother bears the responsibilities for reproduction as well as the quality of life the child would have; therefore, they have the right to make choices in terms of their and the child’s interests. However, the decision of donating the embryo to research does not pertain to the interest of the mother at all. Instead, only the rights of the embryo ought to be considered in this case. In the book A Defense on Abortion, Thomson uses the analogy of one sustaining the life of a violinist by letting him use one’s kidney as a description of mother bearing a child. He argues that not providing the violinist with the kidneys is self-centered but not unjust as the violinist originally does not have the right to use it (Thomson 61). Similarly, if you decide to no longer sustain the life of the violinist, you do not have the right to determine how he ends his life either. The child has the right to her or his own life; when their lives no longer pertain to the mother’s interest, the mother does not have the right to choose for them. Therefore, embryonic donation should not be encouraged as it is not within the rights of the mother.

 

Furthermore, the encouragement of donating human embryos challenges our commitment to equality and humanity as medical institutions. As universally understood, the embryo is not “a clump of cells” but an integrated, self developing whole, capable of the continued organic development characteristic of human beings (Kass 174). It is a state where we all come from. We could not simply ignore its potential development due to its insignificance. Humanisms calls greater respect and care to the weak. In other words, humanism shows “the inflexible principle that utter helplessness demands utter protection” (Kass 182). The way we treat the embryos signifies how we treat the weak in our society, thus setting the boundaries of humanity. As a hospital committed to humanity, or benevolence, the treatment of embryos matters significantly. Inhumane treatments create suffering of the embryo and embodies the lack of compassion of SCH as a medical institution.

 

The limitations of human rights to choose for the embryo and the humanism embodied by the treatment of embryos are central to the matter of embryonic donation. One may likely suggest that from the standpoints of scientific scholar communities, embryonic research advances our understandings of many biological processes. This is true. By gene modification and stem cell cloning, remarkable findings on genetic diseases have been uncovered (Kass 77). However, women undergo considerable stress after abortion, both mentally and physically. Regardless of how abortion was decided upon, it would still be emotionally challenging to render the aborted embryo to the hands of others. The emotional state of the woman deserves our serious attention when attempting to encourage embryonic donation. Encouraging embryo donation may do more harm than good in these cases. Although embryos may somehow contribute to the scientific community, the donation may become a lifetime regret for the woman since it was an encouraged, or pressurized decision made during an emotionally unstable state.

 

Nevertheless, I would also like to clarify that the ultimate choice of embryonic donation lays upon the families themselves. Not encouraging embryonic donation merely suggests the position of Sasquatch Community Hospital as an institution that values humanity; as embryonic donation is a nationally lawful act, the policy of no encouragement does not influence any personal decision making on embryonic donation to scientific research.

 

Inclusive Spiritual Counseling

 

In order to reflect the Catholic Origin of Sasquatch Community Hospital, spiritual counseling should be continued but reduced to one Catholic clergyman. Additional counseling of other religions should be allowed but limited to one clergy as well. As mentioned previously, our job as the hospital is to provide patients with equal information and access to reproduction strategies. Counseling by Catholic Clergy reflects Sasquatch Community Hospital’s current majority Catholic donor-base. The classes on assisted reproductive technologies and late term genetic testing echoes the mainstream American “risk analysis” take on pregnancy. Similarly, in order to balance the existing socio-cultural influences on patients, the voices of other religions ought to be heard. Patients from these other religions will find the spiritual counseling reassuring as some of their values will be reinforced in their decision making process. The dynamic input of other religions not only reinforces Sasquatch Community Hospital’s commitment to inclusiveness and diversity, but also leads to a broader nationwide discourse on biotechnologies, addressing biomedical issues as social issues (Braun, 47).

 

Inevitably, some medical staff have and will continue to complain about the Catholic Clergy or Clergy of other religions interfering with their work by opposing assisted reproductive technologies. The class offered on weekly basis thus also serves as a medium through which the medical staff could express their professional opinions. As long as all sides have equal opportunities to express their views, the woman will be more empowered with her decision, no matter what she will choose. As medical staff and religious clergy, we ought to respect the decisions of patients despite their reasoning.

 

The class material, however, should be reviewed by the committee every month in order to prevent the transmission of biased statistical information or inappropriate messages. Similarly, medical staff members are allowed to observe spiritual counseling sessions but are not allowed to intervene while the patient is in the room. Issues brought up in the biomedicine classes and counseling sessions will be reviewed by the Sasquatch Community Hospital’s ethics committee and further regulations will be proposed.

 

Due to their Catholic affiliation, some nursing staff would likely be unwilling to perform the procedures of abortion and reproductive services. It is thus crucial to provide the nursing staff with necessary training to develop their cultural competency and reinforce their responsibilities as healthcare providers acting on behalf of patients. Therefore, mandatory training to improve the understandings of different local cultures and religions ought to be provided for the staff members every month. Overall, the goal of the curriculum is not to convince staff members to become pro-choice activists. Instead, the goal is to enhance the understandings of how other genetic, religious, and cultural factors result in the consideration of abortion. While staff may hold on to their religious beliefs concerning abortion, it is necessary for them to respect the choices originating from other belief systems. The specific contents of the training curriculum will be discussed and implemented by the ethics committee. With more appreciation of the distinctive socio-cultural forces affecting pregnancy, nursing staff may gain new perspectives to the local population they are serving and may become willing to provide abortion services.

 

If one still insists upon no provision of abortion and reproductive services, she or he ought to leave the obstetrics – gynecology department or leave the hospital. Other nursing staff from other departments of the hospital would replace the leaving staff member. Further replacement or hiring of staff members ought to reflect the mission of equal service and commitment to Sasquatch county’s diverse population. The feasibility of replacement by nurses from other departments or by new hires will be determined as we move along the process.

 

Dedication to reduce socioeconomically stratified healthcare, protection to the rights of women and embryos, and commitment to serve our culturally diverse population with compassion have been reflected in Sasquatch Community Hospital’s past. With thoughtful consideration and careful implementation of the above proposed actions, I believe that Sasquatch Community Hospital will continue to thrive on the path of serving the local population. Continuation of excellent service will thus attract an increasing number of potential donors from other religious and cultural backgrounds and more funding from local agencies and state government may be granted in the future.

 

With preservation of values through the implementation of the above policies, Sasquatch Community Hospital plays an essential role in the discourse on biomedical reproductive technologies. The proposal suggests that stratified reproduction, the right to motherhood, the humanistic culture embodied within an embryo, and various religious views have been our major concerns as a modern medical institution in the U.S. The policy proposed reflects our reasoning that obliges to the diverse interests in Sasquatch County. I therefore encourage other hospitals and clinics to refer to our policy and adjust it accordingly to accommodate their locally served populations. Lastly, I sincerely invite other healthcare institutions to offer their perspectives on the above policies as our voices matter significantly in the worldwide biotechnology discourse.

 

Work Cited

 

1. Book of Genesis, chapters 1-2
2. Donum Vitae In Shanon, Thomas A. and Lisa Sowle Cahill, Religion and Artificial Reproduction: AnInquiry into the Vatican “Instruction on Respect for Human Life in its Origin and on the Dignity of Reproduction.”(Crossroad, 1988).
3. Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel(Duke University Press, 2000).
4. Rayna Rapp, Testing Women, Testing the Fetus(Routledge, 2000).
5. Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine, Anthropology, Theory3 (2016): 29-54.
6. Faye Ginsburg, Contested Lives: The Abortion Debate in an American Community(University of California Press, 1989).
7. Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs1 (1971): 47-66. Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel(Rutgers University Press, 2009).
8. Gilbert Meilander, “New Reproductive Technologies: Protestant Modes of Thought.” Creighton Law Review (1991): 1637-46.
9. Leon Kas, Human Cloning and Human Dignity(2002).
10. Kathrin Braun, “Not Just for Experts: The Public Debate about Reprogenetics in Germany.” Hastings Center Report 35 (2005).

The Policy Proposal of Sasquatch Hospital

Introduction

As a member of the ethics committee at Sasquatch hospital, I intend to propose several new policies regarding the use of abortion services, assisted reproductive technologies, prenatal testing, the donation of unused embryos to research, the implementation of religious counselings, and the relocation the nursing staff. I am a 28 years-old Chinese woman who grows up in Virginia. Although I am an atheist physician who believes in the power of the modern medicine, I respect all religions and their practice. Our hospital was run for many years under Catholic auspices and supported by Catholic donors. These auspices influenced the provision of reproductive services because of the belief by the Catholic Church that “from the time that the ovum is fertilized, a new life begins” (Cahill et al 145). According to Catholic doctrine, the fetus is a human being from the moment of conception. Therefore, it is also Catholic belief that abortion is equivalent to murdering a new life. As a result, our hospital has never previously provided abortion services.

Abortion services

Although abortion is legal today under federal law, the prohibition of abortion by the Catholic Church has prevented our hospital from providing the procedure to our patients. Although there might be a religious backlash to the provision of abortion services, our goal as the largest hospital in the area should be to provide better and more comprehensive health care services to our patients. The religious beliefs of our patients “should not be seen as passive, as anti-science, or as constraints to medical treatment” (Hamdy 156), but rather as individual qualities that can be overcome through innovative treatments and convincing results. Due to our hospital’s recent religious transition to one of non-denominational practicing, the hospital is no longer subjected to the rules of the Catholic Church. Although the hospital would like to maintain its religious patients and donors, the hospital should begin to provide abortion services to patients who choose to use them. As supported in Thompson’s “A Defense of Abortion,” the hospital should support the right of choice for a woman going through a pregnancy and potentially an abortion. In his book, Thompson proposed a thought experiment involving an unconscious, famous violinist to explain her point (Thomson 48). The scenario is presented as such: you are the only person that can cure a famous violinist of his fatal kidney ailment, and because of that, the Society of Music Lovers kidnaps you and “plugs” you into the violinist. If you unplug yourself, the violinist will die. He uses this analogy as a description of the mother bearing a child. He argues that not providing the violinist with the kidneys is self-centered but not unjust as the violinist originally does not have the right to use it (Thomson 61). I agree with him that mother has the right to have the abortion just as “unplugs” you from the violinist because essentially mother and fetus are different individuals. The mother has the right to carry the fetus to term and build a mother-child relationship. However, she also has the right to have the abortion and choose to not start the relationship.

To placate our Catholic patients and donors, our hospital will not provide subsidized abortion services for underinsured patients at present.  This decision is influenced not only by the fact that we are a private hospital with limited resources, but also are heavily reliant on our Catholic donors. The hospital will ensure donor relationships remain strong by accepting both blanket donations and donations towards specific treatments. This is to avoid tension over some donations paying towards abortion services. The controversial nature of abortion holds true for Islamic patients and donors as well.  If in the future, the hospital has new donors from other cultural and religious backgrounds which are more accepting of abortion, we can start to subsidize treatments for underinsured patients. The bottom line is that the hospital should provide subsidized abortion services based on the financial grounds of the hospital rather than the religious preferences of the patients.

IVF treatments and Prenatal Testing

Although at present the hospital cannot provide subsidized abortion services, the government is going to provide our hospital-specific funding for In Vitro Fertilization (IVF) treatments and prenatal testing including amniocentesis for the next five years. Although the Catholic Church and donors believe that any intention “to request [amniocentesis] with the deliberate intention of having an abortion” (Cahill et al 152) is unethical, and some Catholic donors may not support these treatments, the use of government funding allows the hospital to make this decision detached from donor preferences. Also, there are more and more Japanese, Jewish and Lebanese Shiite immigrants population nearby our Hospital so we should make accommodations to well serve our patients.

Other than the Catholic Church, the local Japanese population is similarly resistant to the use of IVF treatments.  Although there is widespread access to modern and advanced medical technologies in Japan, prenatal care still focuses on “Gamburu,” or to “make an effort” (Ivry 134) Ob-gyns are viewed as coaches to guide women spiritually during the pregnancy rather than a physician who interprets pregnancies in a genetic manner. For example, the focus of Japanese culture is to nurture the child with environmental care from the mother as mothers are viewed as “ohukuro,” or respectable bag of the children(Ivry 156). It will be beneficial to offer cultural training for Ob-gyns when they treat Japanese patients and offer more spiritual guidance.

Not only does the hospital serve a Catholic and Japanese population, but also a vibrant Jewish community who is eager to try IVF treatments. In Jewish culture, “Reproductive technologies are allowed and even encouraged as a means of furthering the Jewish bloodline and realizing God’s command to multiply (Kahn 5). Reproduction is an ‘imperative religious duty’ sanctioned by the very specific economic, political, social, and historical contexts that have given rise to the use of new reproductive technologies as a way to satisfy that duty” (Kahn 3). Paradoxically, it seems that the traditional notions of the Jewish family are separate from those of increasing the Jewish population.  Furthermore, to avoid religious conflict and show our respect to the Lebanese Shiite immigrants, our hospital will only “authorize the insemination of the woman’s egg with the donor’s sperm in a lab dish, and then implantation of the fertilized egg into the wife’s uterus” (Marcia C. 165). According to Marcia C., this procedure circumvents adultery, as “the definition of incest in Shia thought and practice does not depend on the transfer or contact of bodily substances. Rather, it depends on the illegitimate physical act of illicit sexual intercourse, and not on the act of conception itself.” We want to be able to provide IVF treatments while also taking in the consideration of Islamic patient’s religious belief.

Furthermore, Jewish pregnant mothers are more willing to use prenatal testing because Jewish pregnancy culture tends to focus on geneticism more than environmentalism (Ivry 250). This focus derives from the belief that if a Jewish woman experiences premature birth and miscarriage, the cause is viewed as a genetic defect of the fetus. As a result, the mother has the choice to terminate the pregnancy, which may reduce the mother’s likelihood of physical and mental harm (Ivry 263). It is the duty of our hospital to provide care and provide prenatal testing to all the women in the community.  The decision rests on the mother on whether to use this service. It is important to understand that a variety of factors play into a patient’s decision on whether or not to undergo medical treatment; therefore, it is necessary that the hospital provide prenatal testing. According to Hamdy, the decision to receive treatments is “extremely complex and highly variable, depending on the patient’s changing circumstances” (Hamdy 156). Nonetheless, we know that “middle-class patients (disproportionately white) usually accept the test while poorer women (disproportionately from ethnic-racial minorities) are more likely to refuse it” (Rapp 168). Since government funding is available, we can reduce the price of prenatal testing, which may encourage more women of lower socioeconomic status, including ethnic minorities, to receive treatments without making it appear as the hospital is subsidizing such procedures.

Donation of Unused Embryos to Research

If our hospital begins to provide IVF treatment, the hospital should also encourage families to allow their unused embryos to be donated towards potentially life-saving research. This decision is due to the fact that “more embryos or fertilized eggs are created than are usually needed for a single treatment. Those extra embryos are frozen and can be kept over a period of several years for later use without significantly losing their potential develop successfully into human beings through pregnancy” ( Eich 64 ).  Once a couple is satisfied with their number of kids, they should be encouraged to sign an agreement to donate their frozen embryos. These extra embryos could be used for research purposes so that their inevitable destruction would serve some benefit to science. Circumventing much ethical debate, “a fertilized egg before nidation differed significantly from an embryo after nidation and therefore did not have the same human rights, the rights of bodily integrity”( Eich 66). If the fertilized egg was not implanted, they are simply cells and can be used to study stem cell regeneration. The Catholic Church has argued against the use of fertilized eggs due to concerns over their use for cloning, but our hospital will set specific regulations banning the use of these fertilized eggs for cloning research.

Onsite Religious Counseling

In addition to providing new treatments, the hospital will attempt to consider the needs of individual patients from various religious backgrounds. To pursue this goal, the hospital will provide religious counseling by clergies of all religions because these counselings can be therapeutic during the process of undergoing medical treatment (Ginsburg, 37). However, The clergymen will not be allowed to discuss their view towards any specific medical procedure such as abortion and prenatal testing. As stated in Testing Women, Testing the Fetus, “A counselor should, as a matter of principle, support whatever decision regarding testing and pregnancy outcome that a woman or a couple makes” (Rapp, 58). Distinct from an advisory role, clergymen would serve to ensure a deity is with the patient through illness and hardship.  Furthermore, every week Clergyman and doctors will have weekly meetings to share their opinions on specific patient cases and suggestions for providing better patients service in the future. I believe if we keep the communication open, the tension between doctors and clergymen can be gradually solved. If the hospital still receives complaints from doctors of interference, the hospital will arrange one to one meeting between the doctor and the clergymen to reconcile the issue together.

Relocation of the Nursing Staff

Last but not the least, the hospital will relocate the historically Catholic nursing staff who are unwilling to perform abortion and reproductive services to other wards within the hospital. Since we have a limited budget, we will hire a nursing professor who specializes in teaching abortion care and reproductive services rather than hiring new, specialized nurses. Education will be available to all nurses who are willing to perform abortion and reproductive services. At the same time, the hospital will also welcome nursing school students to volunteer in the hospital for one or two semesters. If they perform well, our hospital will potentially provide them part-time positions after training.

In conclusion, I propose that our hospital start to provide abortion services, IVF treatments, prenatal testing, and religious counseling services to accommodate the increased diversity of the local community. Donors and nurses who are resistant to the new changes can be accommodated through changes to the hospital financing structure and assignment allocations as explained above.

Works Cited

Don Seeman, Iman Roushdy-Hammady Annie Hardison-Moody. “Blessing Unplanned Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine, Anthropology, Theory 3 (2016): 29-54.

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).

Faye Ginsburg, Contested Lives: The Abortion Debate in an American

Inhorn, Marcia C., and Soraya Tremayne, editors. Islam and Assisted Reproductive Technologies:  Sunni and Shia Perspectives. 1st ed., Berghahn Books, 2012. JSTOR,

Judith Jarvis Thompson, “A Defense of Abortion.” Philosophy and Public Affairs 1 (1971): 47-66.

Rayna Rapp, Testing Women, Testing the Fetus (Routledge, 2000).

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.

Susan Martha Kahn, Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).

Thomas Eich, “Decision-Making Processes among Contemporary ‘Ulama’: Islamic Embryology and the Discussion of Frozen Embryos.” In Jonathan E. Brockopp and Thomas Eich, Muslim Medical Ethics From Theory to Practice (University of South Carolina, 2008), 61-77.

Tsipy Ivry, Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).Community (University of California Press, 1989).