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Multiple Choice

Octuplets Case Presents Hard Choices About Regulating IVF

row of 8 multiple choice bubbles, a through h SOURCE: SP Questions about whether to regulate fertility treatments differ in distinct ways from debates over the regulation of abortion care.

The story of “Octomom,” the single, unemployed mother of six children who just gave birth to eight more, seems perfectly designed to grab people’s attention-and their outrage and scorn. Across the political and ideological spectrum, people have been quick to condemn Nadya Suleman and her doctor.

Social conservatives are outraged that an unmarried woman was allowed access to fertility services. Fiscal conservatives scream about tax money being used to subsidize “irresponsible” decisions. Child welfare advocates worry about the children and how any mother could nurture and care for so many. Medical ethicists debate the question of whether the state should have a greater role in regulating or sanctioning unethical medical behavior.

As reproductive rights activists, we see how situations like this one challenge our basic assumptions about a woman’s right to control her body and make reproductive decisions for herself. If this case involved abortion, we would know where we stood: the woman is the only one who can make this most private decision; we trust her to make a thoughtful informed decision about her body and her family makeup; all her doctor can do is make sure she’s fully informed and then provide the services she requests; the government should not interfere with her decision and should in fact help her to act on her decision if she cannot afford the constitutionally-protected medical services she seeks.

But somehow these arguments ring hollow in the context of newborn octuplets who likely face significant, lifelong medical problems and who will eventually join their six older siblings in a three-bedroom bungalow with a single, unemployed, potentially mentally unstable mother. While we fully support the right of every woman to end a pregnancy she does not want or cannot continue, once a woman decides to carry a pregnancy to term, it seems to us that she does have certain obligations to try to ensure the wellbeing of the ensuing child or children. Government and society should not police a pregnant woman’s behavior and decisions, but a different calculus is involved before and after pregnancy, when the interests of others-including potential or existing children-takes on greater weight. Thus, questions about whether to regulate fertility treatments differ in distinct ways from debates over the regulation of abortion care. 

Passing judgment-especially in extreme cases like this-is easy. The hard part is determining whether and how to regulate fertility practices in a way that appropriately balances competing values, interests, and rights. The policy options are limited and each has its own “slippery slope,” leading to places few people want to go.

To demonstrate the difficulty, we have prepared a pop quiz based on the current story of Suleman and her doctor. Choose an answer, and see where it takes you:

1. The doctor violated standard medical practice by transferring six embryos to a woman under 35, knowing there were significant health risks for those involved. He:

a) Should be reprimanded and kicked out of his professional association, but that should be it. The industry is capable of regulating itself.

b) Should lose his license and not be able to practice medicine again. He is responsible for this situation and should be forced to pay the medical costs of the patient and her children, and perhaps even pay the costs of raising the children.

c) Should not be blamed. Given the patient’s medical history, which included past IVF cycles that yielded no more than twins, the doctor used decent medical judgment and reasonably did not anticipate that his patient would conceive and bear octuplets. He was only doing what she asked.

2. The patient knew the risks of carrying a multiple pregnancy to term and yet consented to the transfer of six embryos. Once she knew she was pregnant with multiples, she decided not to reduce the number, even though this would have been safer for herself and the remaining babies. She:

a) Should have been subjected to economic and mental screening before being allowed to have fertility treatments.

b) Should be applauded for giving all her embryos a chance to grow and be born and choosing not to abort any of them.

c) Had a right to make whatever decision she wanted and we should trust her judgment even if we wouldn’t make the same decisions ourselves. 

3) The government has a stake in protecting women’s health and promoting healthy childbearing and healthy families. It should:

a) Set limits on the number of embryos transferred in IVF cycles.

b) Create incentives for doctors and patients to transfer only one embryo at a time by covering IVF costs through public or private health insurance.

c) Stay away from telling doctors how to practice medicine and let the market correct itself.

Unfortunately, there is no teacher’s guide with all the answers-indeed we’re not satisfied with any of them-but it should be clear that crafting policy based on an emotional response to Suleman’s situation is fraught with problems. Every policy choice brings certain consequences. Failure to regulate means more high order multiples and the adverse health outcomes they bring, not to mention the economic costs for families and taxpayers. Too much regulation risks injecting the government into decisions that we might rather have people make for themselves and limiting family size in a way that echoes China’s one-child policy and our own ugly history of forced sterilization.

Yet just because there are no easy answers does not mean we can fail to act. We ought to proceed-but with thoughtfulness, deliberation, and caution. Rushing to judgment is probably the worst choice of all.

Jessica Arons is the Director of the Women’s Health and Rights Program and a member of the Faith and Progressive Policy Initiative at the Center for American Progress. Shira Saperstein is a Senior Fellow at American Progress and the Deputy Director and Program Director for Women’s Rights and Reproductive Health at the Moriah Fund.

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