The traditional arguments don’t seem to apply in the case of Nadya Suleman, the 33 yo woman who delivered 8 babies last week after undergoing IVF. Normally, I would say “stop targeting a single mom and focusing a disproportionate amount of attention on her.” But the fact that Ms. Suleman is a single mom actually matters. Who will help her care for 14 young children? Apparently Ms. Suleman’s parents have their hands completely full taking care of the 6 she already has, while Nadya is in the hospital recovering. The fact that she is not married should not be the issue, but rather whether both she and the children will have adequate social support.
However, the support she receives can be dictated by our social response. Recall that when Nkem Chukwu had octuplets following IVF in 1998, she was given a great deal of corporate support through free diapers and a new home. Was the public enthusiasm there because she was married, religiously motivated to keep all of the children, because this was novel, or because we were in better economic times in 1998, when access to government resources was not on everyone’s lips? (One thing that interests me is that we really know nothing about why Ms. Suleman decided to keep all 8 embryos, rather than selectively terminating some, but perhaps because we know she is single, people are making all kinds of assumptions about what her reasoning must have been).
The second argument I would pull from the archives would be, “We don’t want to turn into China with the government regulating how many children we each have. Let her decide whether IVF is a good option for her…we don’t know her unique circumstances.” But we do know she already had 6 kids through IVF. Can it really be that the government would allow a physician to insert 8 embryos into this woman, knowing the serious risks it would pose not just to her, but also to the developing fetuses?
During an interview on MSNBC, Ms. Suleman’s neighbors brought up the big elephant in the room, that few ethicists want to talk about, which is the cost. Who is going to pay for the health care and education of these children? This is related to the paragraph above, as state-sponsored, utilitarian assessments of how many children we can conceive would probably not pass a 14th Amendment substantive due process challenge, and it would appropriately be met with a very strong (and negative) social response.
Ms. Suleman has hired a spokesperson, who says that the mother did not know she would be having multiple births, and it was just as much a “surprise to her” as it was to everyone else. This cannot be true, unless the IVF clinician was negligent in explaining the process to her. If Ms. Suleman had 6 babies previously through IVF, and she knew she had 8 embryos implanted this time, she had to at least be aware of the strong possibility of having more than one child. But should we be investigating her motives or decision making process at all, or should we just focus on the potential harm to her and to her children?
Should it matter that she already had undergone IVF, and is the public outcry in response to a sense that she is “being greedy?” Recall that the Duggar family, highlighted on the show “17 Kids and Counting” had even more children, though none were conceived using IVF. On the show’s website, the Duggar’s choice is explained this way: “With values rooted in their strong personal faith, Jim Bob and Michelle firmly believe that every child is a gift to be cherished.” Why were they a “pop culture phenomenon” and generally well received, when Ms. Suleman is being publicly shamed? Surely it cannot be because their births were “natural.” Relying on what’s natural in this case confuses the issues – first, because the word is almost meaningless, and second, because we do not shame any number of other medical interventions that interrupt the “natural” course of our lives. What’s different here? Perhaps the difference between the two families is that Ms. Suleman is single and her support system has been questioned (though, I cannot claim to know what it will actually be – for all I know she has a huge support system of extended family…)
What should be done in these delicate situations, where we want to balance the privacy and liberty rights of the mom-to-be against the rights of the children she will be raising, and the government’s interest in protecting them? Should there be a limit on the number of embryos that can be implanted if it’s your first time? Or only if it’s your second time using IVF? Should we rely on tort law to sue negligent IVF clinicians, or should we have tighter regulations in place at these clinics for the safety of the mom and the babies?
Please send us your thoughts, and let’s hope that the babies and the new mom continue to do well. Right now as she recovers and attends to her small children, I hope she is insulated from all of the public shaming. – Teneille Brown
p.s. – Thanks to Dov Greenbaum for directing me to the article, IVF Results: Optimize, Not Maximize. As David Magnus points out in the MSNBC link above, there are lots of professional norms about implating embryos, and implanting 8 is apparently well outside of the norm. Could this be malpractice if it’s outside of the standard of care? Absent any legal bite, there will be clinicians who will push the ethical limits.