Crazy Eights

Arthur Caplan

How quickly the story shifted. Initially, the birth of eight children to thirty-three-year-old Nadya Suleman was greeted with gushing stories throughout the media. But the story soon went south, as it should have. For the birth of eight babies to a single woman who has six other young children under the age of eight, no home of her own, no job, and whose own mother worries that her daughter is “obsessed” with having babies is an ethical disaster. And it reminds us that reproductive technologies, despite our desire to respect reproductive choice, need more regulation.

The main justification behind increasing regulatory oversight of how infertility treatment is done in the United States is the birth of eight babies all at once. A clinic put at least seven embryos into Suleman. Whether she wanted that done or not, it never should have happened.

The eight babies that resulted (one embryo may have split into twins) spent extensive time in a neonatal nursery in various states of prematurity. It is likely that a few of them will be damaged for life due to their very low birth weights. No clinic should be putting more than two or three babies into even a younger patient who has already shown she can create children through success in previous rounds of in vitro fertilization. If the only way to prevent such outrageous treatment is to pass a law penalizing any doctor who implants numerous embryos under such circumstances, then let’s get such a law passed.

Suleman had infertility problems linked to blocked Fallopian tubes. She could make healthy eggs, but they could not be fertilized naturally due to the blockage. She used IVF and sperm donation to make the embryos that became her fourteen children.

After undergoing treatment to cause her to make many more eggs than the one per month women normally produce, her eggs were surgically removed from her body. They were then fertilized in laboratory dishes. Some were put back into her body. That is how her first six children were made. Unhappy with only six, Suleman sought out further fertility treatment and had at least another seven of her embryos defrosted and put into her body. There they all developed, producing the much-discussed octuplets who, after a Caesarean section, went straight to intensive care at Kaiser Permanente Medical Center in the Los Angeles suburb of Bellflower.

Aside from the inexplicable decision to put seven or more embryos into this woman, thereby risking a megamultiple birth, the remaining pressing ethical question raised by this sad saga is: How did Nadya Suleman become a repeat fertility patient? How did she get further fertility treatment when she already had six young children to care for—in a tiny house that she did not own and without a partner or an income? Her parents thought she was mentally ill for wanting to have more children for whom she could not possibly care.

The answer is that some fertility doctors say that it is not their job to decide how many children a person can have. “Who am I to say that six is the limit?” said Dr. Jeffrey Steinberg, medical director of Fertility Institutes, which has clinics in Los Angeles, Las Vegas, and New York City. “There are people who like to have big families.”

Dr. James Grifo, a renowned fertility specialist at New York University, had little use for those wondering why Suleman was a patient. “I don’t think it’s our job to tell them how many babies they’re allowed to have. I am not a policeman for reproduction in the United States.” With all due respect, the idea that doctors should not set limits as to who can use reproductive technology to make babies is ethically bonkers.

Say, just hypothetically, that a woman comes to a clinic with a history of child molestation, active drug addiction, a highly contagious and dangerous disease, no job, no partner, and a rap sheet with various serious felonies. Should the fertility doctor simply say, “If you have the money, I will make all the babies you want?” That gives “cash and carry” a whole new meaning when it comes to IVF.

Now, there will be those who argue that we should never regulate reproduction. It is not our place to tell others what to do when it comes to having babies. This is quite simply an immoral view of infertility treatment.

Yes, everyone has a right to be left alone when it comes to reproduction. But you do not have a right to the means to reproduce. If you cannot find a mate with whom to reproduce, the state does not have to provide one to you. There is a negative right with respect to reproduction—privacy. But there is no entitlement to the means of reproduction.

Doctors have an obligation to consider patient requests for treatment, but they are not obliged to honor them. One very good reason not to do so is if they believe they would be putting children at grave risk if they did as the patient requested. “Do no harm” still applies for those who perform fertility treatment. Putting eight embryos into a woman is exactly that—putting kids at grave risk. Putting eight babies into a family where a single mom is trying to cope with six other young kids with her own psychological issues, no money, and little help is putting children at grave risk. Whoever the doctors were who made Suleman a patient engaged in grossly unethical conduct.

The other major ethical problem raised by this story is the hijacking of health-care dollars by a mom acting irresponsibly. Suleman had to know that to start a pregnancy with the risk of creating eight tiny lives was to risk killing herself and one or more of the babies and severely disabling several of the others. Thankfully, she made it through the pregnancy, but the cost of hospital care for her children will probably exceed a million dollars. And when they are discharged from intensive care, more millions of dollars await in likely medical costs, not to mention the help she will need just to handle her children’s basic needs.

If the medical profession is unwilling or unable to police its own, then government needs to get involved. We already have rules governing adoption and foster care. If you want bariatric surgery you have to undergo psychological evaluation. Shouldn’t these minimal requirements be extended to infertility treatment? And shouldn’t some limit be set on how many embryos can be implanted at one time along with some rules about what to do with embryos that no one wants to use?

Other nations, such as Britain, keep a regulatory eye on today’s reproductive technologies and those who wish to use them, knowing that their use can put children at risk in ways that nature never envisioned. We owe it to children born in America by means of reproductive technology to do the same.

Arthur Caplan

Arthur Caplan is director of the University of Pennsylvania’s Center for Bioethics and a nationally prominent voice in the debates over cloning and other bioethical concerns.

How quickly the story shifted. Initially, the birth of eight children to thirty-three-year-old Nadya Suleman was greeted with gushing stories throughout the media. But the story soon went south, as it should have. For the birth of eight babies to a single woman who has six other young children under the age of eight, no …

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