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Enough With the Eight-is-Enough Judgments

By Rebeldad Brian Reid

It's rare that a parenting controversy comes along in which nearly everyone ends up on one side of the issue, and the strange case of Nadya Suleman -- the mother of the octuplets born last week -- is one of those issues. But it isn't the eight newborns that is driving the media frenzy now: It's the new revelation that she has six other kids, which has prompted howls of criticism that extends from Nadya's mother ("It can't go on any longer") to bioethicist Art Caplan.

From the sketchy facts available, Nadya didn't set out to give birth to eight. There's no evidence that she's an unfit mother or unable to support her brood. And for all of the medical hand-wringing, the consequences of the birth are less severe than seen in thousands of other births each year. But even leaving that aside, all of this moral judgment leaves me hugely uncomfortable.

While 14 kids -- or a staggeringly high-risk pregnancy -- strikes me as lunacy (hell, I'm not sure that families where the kids outnumber the parents is a wise move), these were not my choices, and I'm not the person to say if 14 kids is not an acceptable number. The unspoken implication to the wall-to-wall coverage has been that there ought to be limits: Maybe we shouldn't let women have more than 10 kids (or 12 kids or eight kids). Or maybe there ought to be some sort of requirement that you can prove you can support a family that large. Maybe we should mandate selective reductions. Maybe we need proof of a father's involvement. Maybe "Jon and Kate Plus 8" is OK, but no more.

In reality no one is talking about drawing these kinds of explicit lines in the sand because it sounds spooky and a gross violation of autonomy and privacy, but -- let's face it -- that's what everyone is driving when they toss brickbats at Nadya Suleman.

I'm not so naive to think that this isn't a legitimate human-interest story -- octuplets is a pretty amazing occurrence -- but I could do without the ethical naval-gazing. Millions of people make decisions every day that I'd never make. But unless it has some kind of impact on society, do we really need wall-to-wall analysis of that?

(And -- please, please, for the love of Pete -- may I live out my life without seeing this made into a reality TV show.)

Brian Reid writes about parenting and work-family balance. You can read his blog at rebeldad.com.

By Brian Reid |  February 2, 2009; 7:00 AM ET  | Category:  Babies , Newsmakers
Previous: Goodbye, Mom and Nana | Next: Tight-Lipped Moms are Mad at Dad

Comments


"But even leaving that aside, all of this moral judgment leaves me hugely uncomfortable."

LOL! No judging = no blog.

Posted by: jezebel3 | February 2, 2009 11:23 AM | Report abuse

Brian, agree with the bandwagon issue. I'm not going to judge someone for wanting another child -- personally, having 6 or 7 kids would make me tear my hair out, but I've known a lot of people with/from large families who handle it magnificently.

My problem is with her fertility clinic. If this was IVF (as has been reported), then someone actually chose to implant 8 or more embryos (ok, best-case, maybe 6, if a few split into twins and all survived). Simply put, no ethical doctor or clinic would/should do that, because of the very serious risks to both the mom and all her babies.

We didn't have to go all the way to IVF, but the clinic that we worked with was very, very clear that they would never implant more than 3 embryos at a time (and they encouraged 2), because of how quickly risks multiply once you get past twins. Even with less-invasive methods (i.e., fertility drugs), the clinic can easily do an ultrasound to see how many eggs are ripening, and warn you off if there are too many.

Yes, there is a temptation to do more -- from the mom's perspective, she wants a baby and can't afford multiple cycles; from the clinic's perspective, they want to report higher success rates. But that's why the industry has tried to develop ethical standards that limit implantations to much lower levels -- and more reasonable payment options that enable moms to afford multiple attempts.

So, no, I'm not mad at her. But I want to know what idiot doctor thought 8 embryos would be a good idea.

Posted by: laura33 | February 2, 2009 12:03 PM | Report abuse

There's a difference between saying "Suleman's obsession with having children marks her as crazy" and saying "the Government (or the doctor, or someone else) should step in and stop this."

Posted by: tomtildrum | February 2, 2009 12:04 PM | Report abuse

OK - let's see. All of her children were conceived via IVF (according to her mother, the children's grandmother). The mother claimed she was being paid to have the children, vs. paying for the IVF treatments out of pocket (like most in the US). She has no job. And her mother has said that when she gets home from the hospital, grandma is leaving, and mom can raise all these kids she wanted.

And you want to tell me there isn't an ethical boundary that was crossed here? A woman being paid to have kids (I'm not talking about surrogate situations, or approved research here)? A woman has 6 kids and no job, and wants more? A fertility dr who implants more than a few embryos, in a young woman who's had a number of successful IVFs already?

If it walks like a duck, and it talks like a duck.....

Posted by: JHBVA | February 2, 2009 12:26 PM | Report abuse

You said it -- if this gets turned into a reality show, I will save all of my righteous indignation for the network that airs it. Yes, people can have as many kids as they want but the moment they pimp them out as television entertainment every person in the world has the right to comment on their choices.

Posted by: DCFem | February 2, 2009 12:51 PM | Report abuse

What drives me nuts about this story and others like it is it provides ammunition for people to rail against procedures like IVF, even though cases like this are extremely rare and clearly the result of unethical and irresponsible treatment. Limiting the number of embryos transferred in a single cycle is NOT just an issue of choice; there are demonstrated dangers in carrying high-order multiples, both for mom and the babies. And since it would clearly be wrong (and impossible) to force women to have selective reductions, then it's incumbent on the doctor to draw the line and refuse to transfer more embryos than can be carried healthily.

It's cases like this one that lead to the unreasonably strict limits like the one just passed in the UK, which now only allows one embryo to be transferred per cycle, regardless of the individual patient's circumstances and likelihood of success.

And finally, a public education note: In IVF, embryos are transferred, NOT implanted. In other words, the embryos are simply inserted into the uterus and allowd to float around until they (maybe) implant. Implantation is what happens when the embryo attaches to the woman's uterus and starts to grow there, and is the ultimate goal of IVF. If doctors were capable of implanting embryos, IVF would have a far higher than 25-40% chance of success per cycle.

Posted by: newsahm | February 2, 2009 1:24 PM | Report abuse

The UK may limit doctors to 1 embryo tranferred per cycle, but that's possible in large part because the government insurance plan covers IVF. I'm definitely against a similar medical system in the US, but when you are paying out-of-pocket for everything - the drugs, the fertilization, the storage, the implantation, and all of the doctors visits and tests that go along with fertility treatment, I can understand the choice to introduce 2, or even 3 embryos into the uterus. At $10,000-$30,000 a pop, most families can't afford repeated attempts.

Posted by: JHBVA | February 2, 2009 1:38 PM | Report abuse

I would likely go completely nuts with 14 kids. I have 2 part-time and have hit my limit. But not my family so it makes no difference what my limits are.

I once worked with someone who was 1 of 12 or 13 kids. He seemed perfectly happy with that environment and seemed like a normal person. A large family is not wrong in and of itself.

If you can't manage it without indulging in government hand-outs? Then I have a bone to pick because you are subsidizing your family with my tax dollars. Hopefully family planning includes planning to support your family.

Posted by: Billie_R | February 2, 2009 2:12 PM | Report abuse

Nobody has reported the name of the fertility doctor who transferred the embryos. Why not? He (or she) is the one who breached ethical standards. Was the doctor the person who was paying her?

This is really, really weird.

Posted by: NobodyImportant | February 2, 2009 2:28 PM | Report abuse

I think it's a form of child abuse for a woman to agree to be implanted with 8 eggs, and then carry them to term without selective abortion. (Yes, I said abortion, and for those who are against it, let's chat for a bit about playing God with IVF.) At a Superbowl party last night, a pediatrican friend told me there is "no chance" that any of those babies will be "normal in terms of physical health". Some one of them will almost certainly have issues that require long term, perhaps lifelong, care that will be draining on the pocketbook, never mind the strain on a parent.

That she was allowed to do this as a single, unemployed mother escapes me completely. I suppose if she's independently wealthy (and I mean, loaded), she would at least be able to afford 14 children, but let's be real here. Her doctor ought to be stripped of his/her license to practice. IVF is so important to people who cannot have children on their own, and to have it abused in this manner by this woman shouldn't be allowed. I do think it's unethical, and I think it should be criminal.

Posted by: WorkingMomX | February 2, 2009 3:38 PM | Report abuse

I could sure do without the reference to those babies as a "litter" such as I've seen in many posts - implying contempt and that they are animals rather than human. I do have my concerns about this whole case and think that there were things done that are not right. But let's leave out the ad hominem attacks against the woman involved. I wish her the best in coping with the situation she's gotten herself into. And I do hope that the IVF clinic involved gets investigated for improper conduct.

Posted by: catherine3 | February 2, 2009 3:55 PM | Report abuse

"I do think it's unethical, and I think it should be criminal."

I agree that it's unethical for the doctor to have transferred 8 embryos, but not because the mom is single and/or poor or because she already had several children. The health concerns of HOMs are valid ones, and from where I'm sitting, they are the ONLY valid reason for denying or restricting fertility treatment. Otherwise, who gets to decide if someone deserves help?

Should infertile women have to submit to income checks, visits from social workers, and/or parenting classes before being allowed to try to have the families that most women get to take for granted? And if the woman is dealing with secondary infertility, does some lawmaker or doctor get to tell her when he thinks her family is complete? Where is that line? Once child? Two? Ten?

I know that my own experiences make me biased on this particular issue (for those who don't know, I suffered from secondary infertility an ultimately underwent IVF and FET), but I firmly believe that reproductive decisions are best made between a woman and her doctor. Better to have one or two nutball cases like this one happen than deny thousands (millions?) of women/couples the opportunity to deal with their infertility in the manner that works best for them.

Posted by: newsahm | February 2, 2009 4:02 PM | Report abuse

newsahm -- those are good questions, and they made me think. And under normal circumstances, I would say no, those kinds of background checks should not be done. I know that medically, they ask questions about how many pregnancies/children have you had in that situation. I would think that, if someone's in there saying "I have six but I just want one more girl", great, implant 2 embryos and hope for the best. It's not like they didn't know IVF didn't work on this woman. But when someone is attempting to have 8 babies all at once through a sperm donor, and has 6 other children already, I think a little reeling in is necessary. The kindest thing to do to that woman would be to put her in touch with a social worker. IVF is not meant to be used to have huge numbers of babies all at once. It's meant to allow women who can't conceive on their own to have a child, or maybe a few children. Not 14, which from the sound of things will grow up to be a burden to taxpayers.

Posted by: WorkingMomX | February 2, 2009 4:18 PM | Report abuse

On Balance, A Classic


I can't link to this. What is the topic? Any idea why WP posted it today?

Posted by: jezebel3 | February 2, 2009 4:26 PM | Report abuse

Are people really serious in saying it isn't right to inquire about her state of mind and question the ethics of the doctors/clinics involved? Absolutely we have a right to judge. These children will certainly be subsidized by us. There are some serious psychological issues going on in this woman's mind to ask for/accept 8+ embryos. Especially considering she can't support the 6 she has and has to live with mom and dad, the ball was seriously dropped here and it just makes me sad for all those children involved.

Posted by: lafilleverte | February 2, 2009 5:47 PM | Report abuse

Not that you can believe everything you read, but according to this little blurb she has already hired a public relations firm to handle her media requests.

http://www.foxnews.com/story/0,2933,486645,00.html

Posted by: thosewilsongirls | February 2, 2009 8:48 PM | Report abuse

Coming to this discussion rather late, but this women seems a little off her rocker. #1) she is single with 14 children #2) no job.

What in the world was the doctor thinking by transferring 8 embryos. Even if she was loaded, it is physically dangerous.

There is one thing that doesn't make sense. If she just wanted a girl baby, why didn't they just transfer female embryos. They can determine gender prior to transfer. Something in that story doesn't make sense.

To be honest, yes, we should look into the psychological and physical aspects before IVF transfer. We do in adoption cases. The world isn't fair. And yes, any one who can physcially carry a child can have a baby with out government interference. We can only jump in after the child is born. But in the case when a parent needs extra help to create a family, we as a society need to be involved. In 99.9% of IVF cases, the parent's ability to care for the child is not relevant. Most of these kids are born to very loving and capable parents. Just the cost of the IVF usually weans out the truly poor anyway.

Who in the world paid this women to have her own kids?

Posted by: foamgnome | February 3, 2009 7:40 AM | Report abuse

Its one thing for IVF to be used for the treatment of infertility. Its another to use it to increase the number of children from 6 to the allegedly desired 10. One study found that the risks of producing at least one child with cerebral palsy were 1.5%, 8.0%, and 42.9% in twin, triplet, quadruplet pregnancies, respectively. One can postulate an increasing trend for quintuplets out to the octuplets of this case. Further, society will be asked, in this situation, to bear the cost of both the upbringing of these innocents and the cost of their significant medical challenges that were brought about by the reintroduction of so many embryos. This comes at a time when the ART community has strategies in place for the reduction of multiples and thus reducing the associated morbidities. The goal of ART is a healthy baby to those unable to have them by traditional means. The ethical questions posed here are entirely appropriate and society should demand it.

Posted by: otis1 | February 3, 2009 1:04 PM | Report abuse

I don't know, Brian. I think it may be time to start talking about screening people before IVF procedures. They conduct mental health screenings before adoptions and gastric bypass surgeries. Why not do the same before IVF implantation (or before prescribing various fertility drugs), especially if the person already has multiple children?

I think this case may also be a good impetus to discussing how the public, through our government, wants to influence people's personal child-bearing decisions. With all of its various tax credits and tax systems, the government currently rewards people financially for having large families. Certainly, the reward usually will not make up for the cost to the parents, but that remains the policy. The question we, as voters, should ask ourselves is-- is this a good idea? Personally, considering our country's population growth rate, I don't think the US needs to be encouraging its residents to have more children. So I support reducing the various tax incentives to have children, beyond, say three kids.

Posted by: Mowry | February 3, 2009 1:08 PM | Report abuse

"There's no evidence that she's an unfit mother or unable to support her brood."

Brian, are you kidding? She's unemployed and single. What evidence is there that she is ABLE to support 14 children (or any children, for that matter)?

Posted by: obamamama31 | February 3, 2009 3:50 PM | Report abuse

There's also evidence that having many siblings is related to poorer outcomes for kids. I would seriously wonder about a parent's ability to provide enough attention and care to 14 kids. What happens to the other 6 while these 8 babies require constant attention?

As someone else said, though, people make choices that are bad for their kids all the time, and we don't jump on them.

But this is too fishy -- especially with the PR firm being involved.

Posted by: skeptic421 | February 4, 2009 3:13 PM | Report abuse

Nadya Suleman's mother stated that Nadya got pregnant with these 8 children when she had her last 8 embryos implanted in her at an IVF clinic.

This 33 year old single woman is unemployed, has 6 fatherless children (one of whom has autism), lives with her bankrupt parents and decides that she wants another 8 fatherless children to fulfill her life. What a selfish and immature woman!!!

Who's going to pay for these 14 children, the bankrupt grandparents???? No, taxpayers like you and I.

Though public records show that Nadya Suleman was on the payroll at Metropolitan State Hospital until last year, it appears that she did little work (if any) after September 1999 due to a workman's compensation injury (back injury and psychiatric condition) in which she's received up to $165,000 in compensation. She filed an additional claim for worker’s compensation for a separate car accident in which she argued that this car accident wouldn’t have occurred had she not been going for medical treatment for the earlier worker’s comp. injury.

Apparently Nadya Suleman knows how to “work” the system and will have no trouble finding the funds to support her large family and stupid decisions for the next 18+ years.

Posted by: scout_march16 | February 6, 2009 10:41 PM | Report abuse

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