Thursday, February 5, 2009

Ethics and Octuplets

As reported in various news outlets this week, Nadya Suleman gave birth to octuplets – only the second reported case of live octuplets being born in the United States. At present, Suleman, a single woman, has not yet revealed whether the births are a result of artificial insemination or any details concerning the conception of the children. However, the possibility that a fertility doctor implanted Suleman with eight embryos is causing concerns within the profession.

Whether artificial insemination is performed in vitro or intrauterine, doctors typically only work with two to four embryos. American Society for Reproductive Medicine (ASRM) guidelines call for no more than two embryos for women in their thirties seeking in vitro fertilization. A spokesperson for ASRM, Eleanor Nicoll, stated regarding Suleman, “"It should not have happened. Eight children should not have been conceived and born."

The reasoning behind the ASRM guidelines centers on the health of the embryos and mother. Multi-birth pregnancies create a higher risk for premature labor and delivery. The developing embryos have a higher risk for brain injuries, underdeveloped lungs and intestines, and cerebral palsy.

The apparent violation of these guidelines gives rise not only to medical concerns for the children and mother, but also to ethical questions. Lawrence Werlin, medical director of the Coastal Fertility Center in Irvine, indicates that prior to artificial insemination, questions are asked of the woman regarding how long she has attempted to get pregnant and the existence of other children. Given that Suleman already had six children, Werlin states, “I can't believe that she came in and said to the doctor that 'I want eight more children.' I can't believe that. And if she did, I would say, 'I'm sorry, I'm not the person for you.'" However, it appears that somebody may have done just that, whether Ms. Suleman asked for only one more child or did in fact ask for eight.

David C. Magnus, director of the Stanford Center for Biomedical Ethics, states that current guidelines are not as strict as in some other countries, and use the word “should” in many places. Magnus states that the only true remedy for those affected for violations of these guidelines is tort law. As of yet, medical organizations have failed to tighten up guidelines and/or create additional remedies.

No matter what one thinks about Ms. Suleman, this event has definitely resulted in many people thinking about multi-birth pregnancies. No matter whether these people agree or disagree with the propriety of artificial insemination giving rise to such pregnancies, this Washington Post article raises issues that require resolution. As David C. Magnus states, the current state of in vitro fertilization is basically an unregulated marketplace; if this marketplace remains unregulated, "there will be abuses." Until Ms. Suleman tells her full story, many will assume that such an abuse may have already taken place.

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