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BRIEF UPDATE ON THE NADYA SULEMAN STORY - Tuesday, Feb. 12, 2009

There has been a fair bit of new information since I wrote the commentary (below) last week. Nadya Suleman does receive help from the state, in the form of nearly 500 dollars a month in food stamps, and disability checks for 3 of her children. The hospital where she gave birth will receive money from Medi-cal, in the hundreds of thousands, to pay for the medical expenses. Legions of people are seriously pissed off; the recession is not conducive to forgiveness of taxpayer money being spent through irresponsible choices.

According to her PR people, they have received so many hostile messages (including death threats) that Ms. Suleman and her children have been moved to an undisclosed location. The emails are full of rage about the cost to the state. Many seem to forget that however irresponsible and perhaps unbalanced Nadya Suleman may be, the infants have already been born, and terrorizing their mother and 6 older siblings will not change that fact. Nadya Suleman would not have been able to make this choice (and people make irresponsible choices all the time) without the compliance of a doctor who was not only willing to do the procedure, but to implant 6 embryos, at least 3 over the recommended limit.

As foolish and selfish as she may have been, I find it astounding that Ms. Suleman is receiving death threats when none of the CEO's of the banks that are costing the taxpayers trillions of dollars, are under threat. They have been far more irresponsible with other people's money and other people's lives, and yet the anger towards Wall Street is so generalized that individuals are appear to be safe from attack. And perhaps there is just something about a 'single' woman having too many children that enrages people to no end.

On the upside, the octuplets are surprisingly healthy (so far) and doing well. There have also been messages of encouragement and offers of food and furniture to help the octuplet mom. There are those who feel a stronger urge to be generous than judgemental. Or perhaps their judgements do not prevent their generosity.




In Vitro
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The Ethics of Reproductive 'Miracles'

Feb. 6, 2009
N. Lukanovich

It's been quite a week for reproductive miracles, or more accurately: scientifically induced miracles. The issues of reproductive rights are extending far beyond birth control or abortion. There has been no shortage of opinion and controversy in the last few days concerning two women: one who had octuplets and a 60-year-old who had twins. These reproductive 'events' have triggered much discussion concerning procreational ethics.

Nadya Suleman is a 33-year-old woman who produced 8 babies ten days ago. She made a statement about the miracle of life, but let's be clear, science, and the implantation of too many embryos than recommended is the cause of the octuplets. The general guideline for doctors performing in vitro fertilization is to implant no more than 3 embryos, due to the astronomical risks for infants in multiple births beyond triplets.

There has not yet been a set of octuplets in which all babies survived. These infants are a mere 10 days old, so no one yet knows what kind of serious medical complications they may have. She had the option to selectively abort some of the fetuses, to ensure better health for the remaining ones, but refused. Some would say she was right to refuse, but others, especially in the medical profession, would say it was the wrong choice, and she put all the fetuses at risk.

Science was also crucial in the birth of twins for a 60-year-old woman in Calgary, just two days ago. Ranjit Hayer had been trying for nearly 40 years to conceive. It was not until she was 50 that a problem with her womb was surgically corrected. By then, it was too late for her to conceive naturally, and she could not find a doctor to perform in vitro fertilization; most clinics will refuse to perform the procedure for a woman over 50. She went to India when she was 53 to have in vitro fertilization, but did not become pregnant. She and her husband returned to Canada, and worked to save the money to try again when she was 59. The procedure was a success, and she gave birth two days ago to twins. She is not, however, the oldest woman to give birth. A 70-year-old woman in India gave birth last summer to twins, and a 67-year-old woman in Spain had twins in 2006.

The media has portrayed both cases with an equal measure of shock and sensationalism, interviewing doctors that are horrified by octuplets, and doctors that are outraged by a woman giving birth at 60. But having reviewed several forums on the internet, it's clear that most people, at least women, have quite different reactions to the two cases. The attitude towards Ms. Suleman is almost unanimously negative, whereas there is almost universal understanding for Mrs. Hayer.

Why the difference? Motivation seems to be a key factor. Ms. Suleman already has 6 children, the eldest is a mere 7 years old, and the youngest are 2-year-old twins. She is a single mother living with her parents in a modest 3 bedroom house. She was married but divorced in January, 2008. Her ex-husband is not the biological father of any of the children; they were all conceived by in vitro fertilization using the same sperm donor. She was working as a psychiatric technician until a few months ago. Many people are simply stunned that Ms. Suluman would feel a need to have yet another in vitro fertilization when she has six children. Including her mother.

Grandma has already spoken to the press, and stated that she's had enough and is planning on leaving the happy homestead. One can only assume that Grandmama has been the one taking care of the 6 little ones while Ms. Suluman was at work. 8 more babies is not a blessing for Grandma but a mountain of work she cannot cope with. Many are also aghast that Nadya Suleman is a single mother and suspect she will be living off the state.

However, it appears that Ms. Suluman is shrewd and has already hired a PR person and is looking to sell her story. Some now suspect that she did it to make money. But since you can't control the number of embryos that will become fetuses, this seems rather unlikely. It's more probable that she knows the media will be obsessed with her story whether she sells it or not and she has the opportunity to make enough money to support the babies.

Many are concerned about the physical and psychological welfare of the children, and these are valid concerns. When women used to have as many or more than 14 children, they did it over many more than 7 years. The older ones could help with the younger children, and it was a different time, a time when individual children did not require or expect as much attention as children in the industrialized world do now.

We live in an era of car seats and super strollers, and costly education, and imagine Ipods for 14 kids, or cell phones, or clothing or more importantly, having quality one-on-one time for 14 kids all close in age. There is a reason that there is a much higher risk of mental health issues in families with multiple births, and not simply for the multiples, but the other children in the family, and the parents as well (high rates of divorce, although in this case it may be Grandma divorcing her daughter). The stress levels could be enormous.

So what about the 60 year old with twins? Almost every comment I have read by a woman is sympathetic to Mrs. Hayer's desire to have a child. The motivation is within the realm of normal. She is not being greedy, she simply wanted a baby. More than a few women on these forums pointed out that men often have children in their older years and the reaction, if there is one, is more of an admiration for the display of virility than criticism. When concern was expressed, it was in regards to the likelihood that the children may lose their parents earlier in life, but in this case, the parents have a close extended family, members of which have already spoken out to say they would step in if something happened to the parents.

While there has been some commentary on the cost for the taxpayer of her month long stay in hospital prior to the birth, and the care of the twins at the hospital (they are premature), it is likely that once home, the twins will not cost the system anymore than other children.

The health risks for octuplets borne by a 33 year old are off the charts in comparison to the health risks for twins borne by a 60 year old. The guideline to limit embryos to 3 is reasonable. However, the guideline to refuse in vitro to women over 50 is not as well supported. The main reason for the guideline is that it is not natural for a woman to have a child past this age. Dr. Cal Greene, of the Regional Fertility Program in Calgary, was quoted in The Gazette as saying: "We believe that people should have babies in their normal reproductive age group, [] we think parents should be around to take care of their children."

Does this mean that men over 50 should be forced to have vasectomies? There is a common misconception that 'new' sperm is produced by males and so there is always a fresh batch. The fact is that 'new' sperm is simply old sperm divided, and the older men become the higher the chances are that the sperm is not so great. That is why there is a higher risk for abnormalities or health problems for children with older fathers. Oddly, this is an issue that seems to exist only in the journals of medical science, and never makes it to the public.

Pregnancies in women over fifty do come with higher risks, but there are also higher risks for the mother and/or child in the case of women who are obese, diabetic, haven't been vaccinated for German measles, or who have a health condition of any kind that may affect the fetus. Dare I mention the higher risk for infants in natural pregnancies of women over 35? The issue is whether or not the risk is high enough to prohibit the pregnancy.

The argument that it is not natural for an older woman to have a child is not reasonable in the context of modern medicine. In vitro fertilization is not natural for a woman of any age. Not much in medical science is natural, and natural is not always good. A 13 year old can get pregnant, but this does not mean that she is ready physically or mentally to have a child. And a 13 year old boy can get a girl pregnant, and while this doesn't put him at physical risk, the likelihood of him being a terrific dad is slim.

One medical ethicist, Arthur Schafer, has spoken publicly about this case and said that he is for 'procreational liberty'. Once you start defining who can and can't have children, where do you stop? Do you start sterilizing anyone that may produce a risky pregnancy? Are statistics the best way to decide on individual cases? Should we put into force a law that only people between the ages of 22 and 26 should have babies because the optimum age physically is 24? Or what about a license to have children: "I'm sorry, you don't qualify, we think you're lazy", or "we don't like your religion", or "we think you're too stupid" or "we think you're too poor" or "we don't believe a vegan diet is healthy", etc. Will the children of a 60 year old mother be worse off than the children of a 30 year old who might get cancer at 32? Or get hit by a bus?

In an era when so many women are choosing to have their first child over 30, or even 40, it should not be surprising that a few will choose to have children when they are in their fifties or sixties. Life expectancy is rapidly become longer and longer and medical 'miracles' are progressing faster than our ability to process the new and startling manifestations of such miracles.

Before long, men will be able to bear children (through some sort of artificial implanted womb), and there will be men who choose to do so. This would be far from natural, but why not? If men could bear children the relations between the sexes could be vastly improved. We have entered a new era that will bring with it new issues, and eventually what seems bizarre will become acceptable. When it comes to in vitro fertilization, the guidelines to refuse the procedure should be based on extreme physical and psychological risk factors for the potential infants, not on socially accepted norms.







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