Sunday, February 15, 2009

Ethical Questions About 'Octuplet Mom'

So the world has been asking what ‘Octuplet Mom’ Nadya Suleman was thinking about when she had 6 embryos implanted that resulted in the birth of 8 babies (2 embryos resulting in twins) to go along with the 6 babies that this single, unemployed mother already had.

NBC Today interview shows a person who appears to be warm and loving but also with self-admitted psychological issues.

“How did an only child end up with 14 children?” (Ann) Curry asked Nadya Suleman.

“That was always a dream of mine, to have a large family, a huge family, and I just longed for certain connections and attachments with another person that I really lacked, I believe, growing up,” she replied.

NBC contributor and psychiatrist Dr. Gail Saltz opined that Suleman’s statement reveals emotional issues.

“I think she’s in a bit of denial here and quite defensive, because in fact she does talk about the fact that this has been her life’s mission: to have babies, have babies, have babies. There’s an obsession to this, and I think it’s quite disturbing,” the psychiatrist said.

“When you don’t have a connection in childhood, you go see a therapist,” she added. “You don’t have 14 babies.”

I couldn’t have said it better!

There are a number of ethical questions surrounding this story. First and foremost is whether there was something that could or should have been done to keep this woman from doing what she did. After all, the financial and physical requirements to for a single person to provide quality care of 14 babies are unimaginable. In many ways this resembles animal hoarding where people with emotional problems collect far more animals than they can possibly care for.

In her interview, Ms. Suleman said that the same physician who was responsible for the in vitro fertilization of the previous 6 children was also responsible for implanting the other 6 embryos resulting in the octuplets. And while he was just doing what his patient requested, an ethical physician who is looking out for the best interests of his patient and her resulting offspring should have questioned whether Ms. Suleman was mentally fit to make such a radical decision. Economics aside, there was a great risk to her in carrying this many babies to term along with the future health risks for the premature babies. Did he at least recommend against all of this? Did he at least recommend that she seek counseling to see if she was mentally fit to make this kind of a decision? Admittedly if her request was refused, she could have simply gone to another physician but who else would have agreed to such a request from a woman who already had 6 children? Reportedly, the Medical Board of California is investigating the clinic involved which may receive
disciplinary action.

“I know I'll be able to afford them when I'm done with my schooling.” (a master's degree in counseling) Even if that were true (how many would go to her for counseling?), the care of the infants would have to be delegated out to others while she is at work. And the medical bills alone for these 8 premature infants may run into millions of dollars. According to NBC chief medical editor Dr. Nancy Snyderman:

“They’re going to watch these kids very carefully for eating problems, growing [problems], and then seizures, jaundice, heart problems, lung problems, blindness, developmental delays — there’s a laundry list of things. Long term, because some of these children will be physically or mentally challenged, there’s a looming price tag out here. The hospital bill alone will run $1.5 to $3 million. Forget about getting to college; just to get through special-needs stuff — it’s going to have to come from somewhere, either the taxpayers of California or her family or her church or the hospital. But she can’t do it alone.”

It all creates a dilemma as to how far we can let ‘pro-choice’ go, not in this instance for abortion which seeks to end pregnancies but for choices to become pregnant where the quality of life for the resulting children may be severely compromised. In Ms. Suleman’s case, she made the choice to have these additonal children but the consequences of her choice will have to be borne by many others around her. I don’t believe the government should be able to dictate to people how many children they can have. But is there any way to prevent extreme cases like this from happening again? Perhaps the answer is tighter regulation of the fertility industry.
The more details that comes out about Suleman's pregnancy, the more it screams to me about the need for tighter regulation in the fertility industry.

My outrage isn't directed so much at Suleman, but her doctors. No question, Suleman's judgment seems shaky: Should an unemployed single mother of six children ages 2 to 7, three of whom are disabled, really add to her brood? Suleman's own mother, Angela Suleman, terms the pregnancy as "unconscionable," saying her daughter has no means to support her family.

Still, Suleman certainly isn't the first person to let her heart overrule her head when it comes to having children, and the real scandal here doesn't involve parental misjudgment but medical ethics. It's one thing for Suleman to yearn for more children; it's quite another for a doctor to enable her flawed dream -- and in a fashion where the result is octuplets.

The worldwide fame this case has brought may result in a financial windfall for the family. Ms. Suleman hired a publicist to consider book and TV deals and even started a website to receive comments and donations. But the anger generated has also resulted in a torrent of nasty messages and even death threats causing the publicist to quit.

Whatever our feelings are for the mom, we can only hope her children will live the most normal lives possible. They will need all the help they can get. But let’s also hope that the worldwide publicity this has all brought won’t encourage possible Octuplet Mom wannabes to try and do the same thing.

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