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Ellen Goodman

The ethical failures of fertility treatment

By Ellen Goodman
February 6, 2009
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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. 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 has no 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 each 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 socio-economic 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.

Meanwhile, 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's e-mail address is ellengoodman@globe.com.

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