Octuplets raise multiple ethical issues / LJWorld.com

Archive for Sunday, February 8, 2009

By Ellen Goodman

February 8, 2009

Boston — Maybe we owe an apology to the doctors who made the birth announcement with such pride and excitement. The delivery of eight babies in five minutes was, they exhaled, “amazing.” The mom was “incredibly courageous.” All in all it was a “very exciting day,” a feat for which the 46-member medical team at the California hospital expected kudos and high fives.

But instead of smiles, they saw jaws drop. Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.

It turned out that Nadya Suleman already had six kids at home. The Suleman Fourteen don’t have a father, they have a sperm donor. They were apparently all conceived by in vitro fertilization with the last eight presumably implanted en masse. For good measure, their mother doesn’t have a job. And her family recently filed for bankruptcy.

Before she left the hospital, before the babies left intensive care, the whole country had gone from “gee whiz” to “are you kidding?” Everything that we don’t really want to talk about in terms of pregnancy and child rearing — marital status, money, individual choice, responsibility and technology — had converged in the shouting and blogging over Nadya Suleman’s womb mates.

Does anyone have a right to tell anyone else how many kids to have? Can only people who can afford them bear children? Do you need a husband to have a baby? These are questions that make us feel queasy when we are talking about old-fashioned families. But they take on a new flavor in the unregulated wild west of fertility technology.

Need we review exactly what’s happened since Baby Louise came out of a petri dish and reproduction became a family business? We now have tens of thousands of healthy children born every year through fertility drugs and IVF to delighted families.

Fertility doctors don’t say no — nor should they — to single or gay patients or those who already have children. Doctors do not do home visits or psychological evaluations or socioeconomic profiles on patients who want children. At most, doctors do what bioethicist Arthur Caplan calls “a wallet biopsy” to see if they can pay the bill.

We are far more rigorous about accepting people for adoption or foster care than for fertility treatments. But shouldn’t there be limits?

Suleman’s mother now famously describes her daughter as “obsessed with children,” and wishes that she’d chosen to be a kindergarten teacher. But it turns out that you can have six children and still be treated for “infertility.” And, here we get to the heart of this case, it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.

As bioethicist Lori Andrews says, “Women’s bodies are not large enough to hold a litter.” If, as we are told so far, Nadya Suleman was implanted with eight embryos left over from her earlier treatments, it is something akin to malpractice. If she wanted all eight implanted knowing she would refuse to terminate any, it’s close to mal-mothering.

The reason why we haven’t seen Nadya’s fertility doctor on “Larry King Live” (yet) is that it’s against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, anyone who endangers patients ought to lose their license.

This is more than an individual decision. Suleman’s babies weighed between 1 pound 8 ounces and 3 pounds 4 ounces. They will cost at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies. The meter is running at the neonatal unit.

I wish these eight little people well. I tip my hat to the delivery team for dealing with an octuplet of problems they didn’t create. If Suleman’s brand new publicist succeeds in selling her as a “smart,” “joyful” mother with a “wonderful sense of humor” who is grateful “for the miracle of life,” maybe this mother will be able to roll her degree in child development into a reality program that supports them all.

But right now, a reproductive business that generates so much controversy has produced a remarkable consensus. Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is “nuts.”

— Ellen Goodman is a columnist for Washington Post Writers Group.

Discussion

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8 February 2009
at 3:46 a.m.

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jmadison (Anonymous) says…

Should the government interfere between a woman and her doctor?
8 February 2009
at 7:07 a.m.

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grammaddy (Anonymous) says…

It's all about choice. Her choice. Who among us has the right to interfere with that?
8 February 2009
at 9:21 a.m.

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repaste (Anonymous) says…

A million bucks plus so far, we all are paying, not her, since her lawsuit money ran out. “Slip and fall retirement plan”
8 February 2009
at 12:22 p.m.

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grammaddy (Anonymous) says…

Since Welfare is a state entitlement program and she lives in Maine, I doubt that anyone in Lawrence is contributing a dime to this. How many dollars did you contribute to Bush's Iraqi death machine??!
8 February 2009
at 2:21 p.m.

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denak (Anonymous) says…

This isn't about “choice” or abortion. This is about an industry that does not have enough regulatory oversight and the readiness of some individual to put profit over what is best for the mother and for the child/ren involved.No woman, who already has six children, should be treated for “infertility.” Especially if said woman has no job and very little support. This is a tragedy. Who is going to take care of 14 children under the age of 7? This woman even wants one more. She thinks she will be able to take care of them once she “goes back to school in the fall to complete her Masters” Just how does she honestly think she is going to be able to do that when she has 14 children, 8 of them special needs, some possibly severely.*If* by some huge miracle(and other people raising her children) she is able to do that, she is still only going into a field that will pay her 40-50 thousand a year.14 children on 45 thousand….get real! The mom is dilusional. This is about a woman who felt so unloved/lonely as a child that she now thinks that her children will feel that void. That isn't parenting. A baby doesn't “love” his or her parent. A baby “needs” his or her parent. By having 14 children under the age of 7, she has gaurenteed that her children, at least some of them, will grow up with the same feelings of loneliness as she did/does.This is nothing more than a big ol' cluster…. and I feel sorry for the grandparents and the children because this is just a huge mistake and the state of Maine better look into putting better regulations in place so that these types of tragedies don't occur more often.Dena
8 February 2009
at 3:52 p.m.

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KEITHMILES05 (Anonymous) says…

I dont' give a flying fvck if this is all done privately and HER insurance (not Medicaid or Medicare of ANY government insurance) covers the cost.She wanted these kids. She can take care of them.There should be no fund raising or feeling sorry for her.NONE.
9 February 2009
at 10:10 a.m.

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mom_of_three (Anonymous) says…

If she was a millionaire, no one would blink twice about her ability to care for 14 kids. But she isn't, so people are wondering if this is right. She had 6 kids, and was still being treated by an infertility specialist. The ethics by the infertility doctor can definitely be questioned. She has six kids, so let's plant 6 more in there.

9 February 2009
at 10:24 a.m.

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cheeseburger (Anonymous) says…

jmadison (Anonymous) says… Should the government interfere between a woman and her doctor?Alright JM, but that goes both ways! When she shows up at the public assistance counter, I hope the government says no to her request for monetary assistance, saying 'we don't want to interfere'!
9 February 2009
at 10:48 a.m.

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rooster (Anonymous) says…

#1 Grammaddy she lives in California. At her parents house. #2 They live just above squalor. The house is trashed and packed. Clothes everywhere and food on the walls. Please see radaronline.com to see this small unkept house of 17 people.#3 She received over 150K in a settlement and never told her parents who were paying all of her expenses. The money is now gone. #4 We as taxpayers have a right to know about this situation and to have it investigated as everyone on this board just adopted 8 more kids to the 6 we already did for her. She is flat broke and we as a society are paying the bill. To anyone who bring the whole should gov't do this or that into the debate remember this woman is not self sufficient and we are now caring for her so maybe the government should step in. I mean where does it end. Next year someone will try to 1 up her an have 20 kids just to get money.
9 February 2009
at 10:56 a.m.

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DMH1983 (Anonymous) says…

It infuriates me that my husband and I waited five years to have a child so we are secure, have health insurance, a decent home and jobs. Meanwhile, people like Ms. Suleman decide to literally have 14 kids without any security to offer them and weget to foot the bill so she she can fulfill her dream! Why didn't she use the money she paid for the fertility treatments to find a suitable home for her first 6 children!
9 February 2009
at 11 a.m.

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DMH1983 (Anonymous) says…

Furthermore, I do not feel sorry for those Doctors that didn't get their moment in the spot light! They took an oath to do no harm…I see adding 8 kids to a family w/ 6 kids on assitance, living in squalor, with an unstable mother and no father as doing harm!
9 February 2009
at 11:06 a.m.

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disgustedagain (Anonymous) says…

The whole story is sad. Clearly the woman has emotional, possibly psychiatric, issues. Raising 1-3 children is a challenge for someone in good financial standing with a supportive, extended family; for a single, unemployed woman with a family filing for bankruptcy to have 14 children is hugely irresponsible. No, I don't think this is a legislative issue, but where were the responsible adults in her life?? Why did the doctors go along with such a medically dangerous and ethically challenged procedure?? The fertility doctors responsible should face a severe (punitive!) review of their ethical standards and medical judgment by whatever medical boards are appropriate. In the current economy for anyone to blithely give birth to 8 premature children (i.e., requiring expensive and extensive medical care) with no thought given to their uncertain financial and medical future (not to mention their emotional care!) is appalling. The outrage is not about the 8 children, it's about the mother's lack of judgment and maturity. No responsible adult would do such a thing. Those poor kids.
9 February 2009
at 11:09 a.m.

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disgustedagain (Anonymous) says…

Well, actually, I am also outraged about the 8 kids. It's appalling at every level.
9 February 2009
at 11:10 a.m.

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just_another_bozo_on_this_bus (Anonymous) says…

“unnatural selection, it is the opposite of euginics (what this society needs)”You're right, invictus, and I've decided that I'm the best one to decide who breeds and who doesn't, and I regret to inform you that you didn't make the cut (or should I say, you will get the cut?)
9 February 2009
at 12:43 p.m.

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beatrice (Anonymous) says…

It makes me think of Aliens, when the “queen” is pumping out egg after egg after egg. This is beyond pathetic. invictus, just an fyi: your sperm in the gutter doesn't actually make a next generation. A woman would need to be involved.

9 February 2009
at 12:50 p.m.

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just_another_bozo_on_this_bus (Anonymous) says…

“Too late, I have already spawned the nest generation the old fashioned way, “We can only hope that your sociopathology doesn't have a genetic cause.
9 February 2009
at 1:06 p.m.

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Mixolydian (Anonymous) says…

beatrice (Anonymous) says… invictus, just an fyi: your sperm in the gutter…=====================================A Jethro Tull reference? Is Invictus Thick as Brick?
9 February 2009
at 1:31 p.m.

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jonas_opines (Anonymous) says…

“Is Invictus Thick as Brick?”Brick's not that thick. Try lead. For the story: They couldn't keep track of all of her kids in the womb. They were surprised by the 8th that was hidden by the rest. If they can't keep track of all of them in a space the size of a purse, how's the woman going to keep track of them when they can move under their own power?
9 February 2009
at 2:23 p.m.

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badger (Anonymous) says…

You know, I think that the fertility treatments that allow childless people to conceive and bear children are awesome and wonderful. Likewise, I think that the plastic surgery that allows someone to have her face reconstructed after a disfiguring accident is awesome and wonderful. I think antidepressant drugs that let someone with a chemical imbalance function on a normal emotional level are awesome and wonderful.But what all these things have in common is their potential misuse. People like Nadya Suleman should not be treated for infertility, which is a *medical condition* she did not have. The woman who just flew to Brazil to get larger breast implants than the US allows was abusing plastic surgery. And people who pop antidepressants for ten years without ever doing so much as ten minutes of therapy after their initial visit to get the prescription are being irresponsible with their mental health.I think it's a combined failure on the part of patients and doctors. Doctors need to be a lot more proactive about saying, “No, you can't have that procedure/treatment/prescription the TV ads say you need, because you don't actually need it.” And patients need to be a lot more willing to listen to doctors who tell them that no, just because you can't throw a football through a tire swing, that doesn't mean you need more drugs.And I think maybe we need to get a little more serious about penalizing doctors for performing and prescribing unnecessary treatments.
9 February 2009
at 3:12 p.m.

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jaywalker (Anonymous) says…

Every single one of them up for adoption. Mom in prison for gross negligence. Clinic closed and doctors' licenses revoked. This is nauseating and might not be criminal now, but it's comin'. Just need some jackass to do the unthinkable so the law can be written.
9 February 2009
at 4:24 p.m.

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beawolf (Anonymous) says…

Badger,I actually agree with you on this one, however your comment “The woman who just flew to Brazil to get larger breast implants than the US allows was abusing plastic surgery. And people who pop antidepressants for ten years without ever doing so much as ten minutes of therapy after their initial visit to get the prescription are being irresponsible with their mental health.” ……..pertains to personal choices and that's where it gets tricky. I'd be more inclined to lay the fault on the provider of these services mainly because it's easier to enforce and does not trample on personal rights.Personally, I can't see a law that tells you how many children you should have or to be pre-screened when you want to have children, but the imbecile of a doctor who planted those embryos should have their license revoked..
9 February 2009
at 6:24 p.m.

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jaywalker (Anonymous) says…

I don't want a law dictating number of children either, beawolf, but when the article asks whether someone shouldn't be allowed to have a child if they can't afford one I would have to shout “YES!!!”