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 outraged; the recession is not conducive to the forgiveness of taxpayer-money being spent through irresponsible choices.

According to her PR people, Ms. Suleman has received so many hostile messages (including death threats), that she and her children have been moved to an undisclosed location. The emails are angry rants about the cost to the state. Many seem to forget that 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 willing 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 enduring this level of condemnation. 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 appear to be safe from attack. And perhaps there is just something about a single woman choosing to have so 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, perhaps understanding that the children's welfare is more important than condemning their mother.

In Vitro

Digital Photo Collage

The Ethics of Reproductive 'Miracles'

Feb. 6, 2009
N.J. 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 gave birth to 8 babies ten days ago. She made a statement about the miracle of life, but let's be clear: she would never have had octuplets without the discoveries of medical research and a doctor who implanted far more embryos than recommended. 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. She can spin the success of her pregnancy as a miracle, but there has never been a case of an 8 fetus pregnancy without in vitro fertilation.

There has not yet been a set of octuplets in which all babies have survived, and Suleman's infants are a mere 10 days old, too young for doctors to know whether or not they have any serious medical complications. She had the option to selectively abort some of the fetuses, to ensure better health for the remainder, 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.

Advancements in medical research were also crucial in the pregancy of Mrs. Hayer, a 60-year-old woman in Calgary, who gave birth to twins 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 refuse to perform the procedure for a woman over 50. At the age of 53, Mrs. Hayer went to India to have in vitro fertilization, but the procedure wasn't a success. She and her husband returned to Canada and saved enough money by the time she was 59 for another attempt, and she finally got her wish and became pregnant. Even more extreme in terms of age, are the 70-year-old woman in India who had twins last summer and the 67-year-old woman in Spain who had twins in 2006.

The media has portrayed the birth of the octuplets and the 60-year-old's twins 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 if the postings on forums are an indication of popular opinion, or at least women's opinions, the reaction to the two cases is quite different. 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 of which 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 to a man who is not the biological father of any of the children, as they were all conceived through in vitro fertilization using the same sperm donor. They divorced a year ago, in January, 2008. She was working as a psychiatric technician until a few months ago. Many people, including Ms. Suleman's mother, are simply stunned that Ms. Suluman would feel a need to have yet another in vitro fertilization when she already had six children. The grandmother of these octoplets has already spoken to the press, and stated that she's had enough and is planning on leaving the family home.

The general public's outrage is focused on Suleman's status as a single mother, predicting 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 had all these babies to make money, but it's more probable that she is taking advantage of an opportunity, knowing the media will be obsessed with her story whether she sells it or not.

Many are concerned about the physical and psychological welfare of the children, and these are valid concerns. In the past, when women had as many as 14 children, or even more, the older ones were old enough to help with the younger children. Expectations of individualized attention for each child, and standards for child safety, were also very different, or often non-existant.

We live in an era of car seats, super strollers, and a variety of high-tech items that most children want or may need, like Ipods, cell phones, and computers, and in the U.S. the dream of a higher education does not come cheap. The costs alone would be prohibitive for the majority of Americans, and while individualized attention may not have mattered for previous generations, it matters now because it's the norm - how does any parent have time to focus on a particular child's needs if they have 14 kids? There is a reason that the risk of mental health issues in families with multiple births is much higher, and not only for the multiples, but for the other children in the family and the parents, as well. The level of stress and conflict 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 is expressed, it's 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 take care of the children if needs be.

While there has been some commentary on the cost for the taxpayer of the sixty-year-old's 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 more than any other healthy 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 continuously produced, providing a fresh batch. But "new" sperm is old sperm divided, the risks of abnormalities or health issues for the children increase 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 shere.

Pregnancies in women over 50 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. Girls can become pregnant once they begin mensturating, this is why it is not unusual for 13-year-olds in arranged marriages to become pregnant - girls as young as 10 have carried babies to term. Even girls who are 15 are not ready physically or mentally to have a child. The condemnation of older women having babies has far more to do preconcieved notions of what is acceptable for men compared to women, than anything to do with what is deemed natural.

One medical ethicist, Arthur Schafer, has spoken publicly about this case and said that he is for "procreational liberty." Once you begin to set limits on 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," "we don't like your religion," "we think you're too stupid," "we think you're too poor," or "we don't believe a vegan diet is healthy," etc. A society that would dictate who can, and who can not bear children, would be a terrifying society, something out of science fiction novel set in a totalitarian state.

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 only getting longer, and while medical "miracles" are progressing faster than our ability to process the new and startling manifestations of scientific progress, they are also making some people's dreams come true.

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.