Wednesday, February 18, 2009

Ethics of reproduction

In a vein related to the story of the single mom of 14, whose fertility doctor transferred more than the generally accepted two embryos even though she'd already given birth to six children before her octuplets were born, this recent story came out of Canada about a 60-year-old woman who went to India in order to conceive her twins.

Obviously, apart from the sensationalistic quality of the media stories, and the debates about whether this is or is not acceptable, will come the discussions about regulating the fertility industry (overseas treatments notwithstanding) so that doctors are held responsible for "over-fertilizing" certain patients.

And, of course, this discussion will beg the question of who is acceptable and who is not? Who decides? Should there be uniform laws, or clinic-by-clinic policies? Should psychiatric evaluations be required of all candidates? Just single ones? Non-heterosexual ones? Candidates over the age of 40? 50? Should one counselor, or one doctor, be the arbiter?

In my view, the octuplets story focus has been skewed by the fact that she is a single woman. Regardless, implanting six embryos in an IVF procedure for a 33-year-old woman who has successfully delivered six children already, should certainly have raised red flags by the fertility doctor -- even if she was married. That she could pay for the expensive treatment does not mean that she could also pay for the caretaking of that many children, with the potential health issues of multiple births. And even though she requested it, any fertility doctor knows that a woman (or couple) willing to have that many children at once is not thinking clearly about long-term ramifications.

In the donor industry in general, I know that there have been concerns raised in other countries that if parents are required to use an open-identity donor, as they now are in the U.K., for example, it would restrict the number of donors available and curtail the ability of people requiring insemination to build a family.

While there are different recruitment practices that can keep donors coming through the door, my strong view is that yes, it might be harder to create children if there is a restriction placed on what donated gametes can be used, but if there is a strong reason that compels that restriction, then it should be employed. In the case of the U.K., and several other countries, government did decide that it is IN THE BEST INTEREST OF THE CHILD to have the ability to know something of their biological "other half" should they desire it, based on research with adopted and donor-conceived adults.

In the U.S., I do not see open-identity as becoming a requirement, since we are a country too vast and too wedded in choice to require it.

Nor, octuplet publicity aside, do I see being a single parent as becoming a deterrent. Even if we were to move toward greater regulation of the industry, the case is quite strong that single parents can and do raise great children (the isolated statistics in troubled non-Choice families notwithstanding).

Now it is a matter of more people in policy-making power of certain states, adoption agencies and clinics to recognize as well that non-heterosexual parents also do a great job of raising kids.

On the other hand, there is to my mind NO compelling reason for anyone to potentially have six or more children at once. The desire of someone to "increase the odds" of a successful (costly) IVF procedure by implanting more than two at once is uncalled for and should, indeed, become a regulation based on common sense.

What is your opinion? Are regulations uncalled for? Or warranted?

Here is one of the earliest reactions to the octuplets story, taking root in Georgia.


Anonymous said...

please see the link >

Beth said...

I have had so much trouble with the whole issue, as I do see that the consequences can be great... but I really believe in the doctors policing themselves. Different women respond differently to fertility treatments, a woman can be implanted with 6 embryos and only have one survive to birth. Do I think that it is a risk that I would take, 'no', but I haven't had an IVF treatment yet, so I can't really say what I would risk. We don't have the octomom's medical records, but if each time she had an IVF treatment, she had 6 implanted, and only 1 to 2 survived, there is less actual risk due to her personal history. And to be honest, with the staggering cost of the procedure, I understand overcompensating to ensure that one will 'take'. If medical insurance had to cover the procedures, and the cost was more reasonable, then I would be more likely to support a limit. Also, the GA bill includes some very scary pro-life language that makes this whole debate even more urgent, without actually solving any problems. And finally... why should recipients of fertility treatments be held to a higher ethical standard than parents-to-be who do it the traditional way. I do think a doc should be able to refuse a patient if he/she feels they are not prepared, but I don't think it should be a law so that the doctors don't have any subjectivity in the matter.

gravitygarden said...

Some IVF companies are addressing this problem by donating IVF treatment cycle to couples looking to conceive. Over the past decade these groups have provided this service as a way to assist couples wanting a baby. As a result, there are several success stories of would be parents that owe their ability to have a baby to these groups and are ever grateful for the opportunity they were given.

With the costs of IVF treatments going into the tens of thousands of dollars, there are IVF treatment centers who offer a "freebie" to partners who may be lucky enough to win the opportunity. In addition, there are treatment centers like the Cleveland Clinic offering a second treatment to couples making less than 100K who have paid for their first one but were unsuccessful.

Choice Mom said...

Gravity: Have you encountered any IVF center that will allow single women to get scholarship or "freebies"?

They tend to work ONLY with couples, don't they?