Bioethics Discussion Blog: October 2006





Sunday, October 29, 2006

Growing Old

Apple Boxes
By Maurice Bernstein, M.D.

A stack of old wooden apple boxes
Each waiting to hold another peck
Mackintosh, Braeburn and maybe even Spitzenburg
Hoping their wooden ribs
Hold, not break and spill the contents
And be considered useful for another season.

A group of old men and women
Each waiting to hold the child
Their own great grandchild or maybe even a neighbor’s child
Hoping their arthritic hands
Grip, not let go and drop their precious contents
And be considered useful for another season.

[Photographed by me yesterday at an apple farm in San Luis Obispo County, California.]

Examples of Healthy Advice or Unhealthy Intrusions

From the Bioethics Forum October 27 2006 comes this article about frank pharmaceutical companies’ intrusions into the doctor-patient relationship all under the banner of health advice to the patient. Intrusions consist of video drug commercials on company supplied screens in the doctor’s office to company supplied laptops in the doctor’s office for the patients to enter their medical history and then the company provides specific health information to the patient. And if that isn’t enough, how about a pharmaceutical company supplying physicians with what the patients may think is their physicians own personal website but actually is a device, as described in the article, “designed to gather information about patients and to lure them to other web sites designed to trigger demands for specific drugs.” Read the article and let me know what you think. It seems that direct-to-consumer advertising in magazines and TV is not sufficient for pharmaceutical companies. Now they are inserting themselves right into the doctor-patient relationship. What better way to twist that relationship toward the direction of the drug company?

However,what I didn't get from the article was the motivation of the physicians who let the pharmaceutical companies into their offices and allow them to manipulate their patients and in effect interpose themselves into the doctor-patient relationship. Do the doctors get any financial benefit from the companies? What is the payback, if any? And does the health information provided to the patient by these various services sufficient to trump the possible unethical advertising? ..Maurice.

Saturday, October 21, 2006

Two Way Street and Compassion in Medical Care

Many of the views expressed on my blog thread ”I Hate Doctors” show little, if any, compassion for the plight or burdens that physicians must carry in their general professional life or with regard to specific patients. And yet, as I have mentioned previously, the doctor-patient relationship is not a “one-way street”. To accomplish the goal of the best medical care, both patient and physician have information and responsibilities to relate to each other, which will help to attain that goal. The physician can’t accomplish the task of diagnosis and therapy alone. The participation of the patient is also required. As part of the professional relationship with the patient, the physician must behave in a manner to engender trust with an attentive, thoughtful, considerate and particularly express compassion for the patient. But, my view, which I would like to put up for discussion here, is that the patient should not expect the best out of the doctor, if the patient is belligerent, uncooperative, angry and shows no compassion toward their physician. There are patients out in the world who present to their physicians that very way and expect that the doctor will ignore the patient’s non-productive behavior and be able,nevertheless, to do a good job. Well, doctors are human beings too and despite their education, they have weaknesses as all humans have. A good doctor will try to investigate and understand the basis for anger in an angry patient and attempt to mitigate the patient's concerns. A good patient must, however, remember that he or she is part of the treating team and their own behavior can affect outcomes. Patients should try to avoid behaviors that clearly create roadblocks toward effective treatment of their illness. The two-way street toward a satisfactory therapeutic ending should not be dead-ended by disruption of the doctor-patient relationship by either party. ..Maurice.

Saturday, October 14, 2006

Role Playing Exercise: A Case of Killing vs Letting Die

What does one do when a patient who has the mental capacity to make medical decision requests a physician to turn off a life-supportive treatment knowing that the act will lead to the patient’s death. One of the ethical issues is whether that act represents intentional killing of the patient or not killing but simply allowing the patient to die from the underlying illness. In this case example of the issue, you will be role-playing the physician. ..Maurice.

Mr. G. is a 34 year old unmarried man who has been a quadriplegic (unable to breathe without the respirator and unable to move his arms or legs) for the past 4 years since he was injured in a motorcycle accident. You, as the newly appointed physical therapy physician in a neurologic rehabilitation hospital have met and examined Mr. G. for the first time. He can talk during the respirator phase when he is exhaling and tells you his history. For most of the 4 years, the patient lives alone at home except for a full-time male aide who attends to his comfort, nursing care and feeding. During this time he was hospitalized about 5 times, twice for pneumonia and a few times for severe urinary tract infections which led to infection in the blood stream and required intensive intravenous antibiotics. This admission was a few days before you arrived and was for another urinary tract infection, now being treated and his fever is abated.

Mr. G. states that he was a city motorcycle officer for 8 years prior to his accident and had a girl friend whom he was hoping to marry living with him for the year before the accident. He speaks sadly about the fact that his girl friend left him shortly after he became quadriplegic and has not returned. Though at first he had understood he had a slim chance for some recovery, he states after additional tests that doctors told him that his spinal cord was completely severed and there can be no return of function. He says he has been evaluated by physical therapists numerous times in the past and has had whatever support and encouragement that they could provide but he has continued in an immobile state, spending most of his life of a quadriplegic in bed. The few hours the aide gets him up in a chair causes him to be exhausted easily. He finds his quality of life so poor that in the past year, he has decided that he no longer wants to live. He knows that if he could turn off the respirator, he would die fairly quickly but he is physically unable to perform the act himself. He has asked his aide to turn off the respirator so he could die. The aide refused. On two previous hospital admissions, he had asked the physicians in the hospital to turn off the respirator, but they too refused. He has been given anti-depressants in the past but they have not changed his demands to end his life.

Mr. G. now turns to you, as his new physician, and after relating his life story, he requests that you turn off the respirator and let his underlying illness cause him to die. As you talk to Mr. G., you evaluate his mental state you find that he is mentally clear and his understanding of the medical facts of his illness and the consequences of his request is excellent. You understand that every patient has the autonomous right to refuse unwanted treatment and to force treatment on a patient who has capacity to make medical decisions may even represent legal battery.

Mr. G. says to you “Doctor, I no longer want to live the way I have been living these past 4 years so now I want you to turn off the ventilator and allow me to die a natural death.” OK.. now you as Mr. G.’s physician must decide what to do next. …. Well, Mr. G. is waiting for your response. You can write the response in the Comment section of this posting.

(For your information, this has been a altered description of a real case. Some of the facts may be a bit different but the issue and ethical challenge is the same as the original case.)

Thursday, October 12, 2006

Multiple Fetal Births: Should Society Regulate?

In November 1997, Bobbi and Kenny McCaughey became parents of fraternal sextuplets in Des Moines Iowa with the help of fertility drugs. Do you remember that news item and the associated publicity? The use of fertility drugs to induce pregnancies with more than one fetus and that noted delivery led me in 1997 to put a topic on my now inactive “Bioethics Discussion Pages” regarding the ethics of society playing a role in the regulation of multiple fetal births.

Recently I got three responses from visitors to the “Pages”. I will post them here and then follow those responses below with the earlier numerous responses to the topic. How do my current visitors feel about the issue? ..Maurice.

10/8/2006 Ordinarily, I do not believe that society should interfere with family matters
like birth or multiple births. However I can also see how the multiple birth and
selective abortion issue could get out of hand if common sense is not used.
People are not puppies, and really should not be trying to put babies in jeapardy
for selfish reasons if better techniques can be utilized.
Thank You

10/7/2006 I don't think that society should have any role in this. Society, at least in most places, does not have a role in other types of birth, so why should it have one in multiple fetal births? I believe that allowing a physician or society to be able to make this type of decision for a couple would be very unfair.

I feel it is none of society's business how many children a couple has.
Whether these children come from individual pregnancies or one
pregnancy, that is their right. As long as they realize the risk for
birth defects and are willing to accept a child or multiple children
with this defect, I do not think we as a society should have any say.

Melissa Pitts
Drexel University

Should Society have a Role in Regulating Multiple Fetal Births?

The recent birth of the Bobbi and Kenny McCaughey's septuplets has stimulated discussion regarding ethical issues involved in multiple fetal births. The issues have included whether doctors should, in fact, provide assisted reproduction so that litters of babies are created and delivered or if created, should there be selective reduction (abortion) of some of the babies so that the others have a better chance to survive in a healthy state. Other issues involve the burden multiple fetal births may have immediately and in the long term on society. A controversial point would be whether assisted reproduction where multiple fetal births are possible should be a procedure to be carried out in privacy between the parents and the physician or should society enter the relationship and have a role in regulating the outcomes of such a procedure.

Here is the question:
Should society have a role in regulating multiple fetal births?

Date: Sun, Jun 6, 2004 5:59 PM From: To:
If a couple has gone through everything it takes to get to the step of infertility treatment that may or may not cause multiple births, what right does society have in regulating how many they have???? As part of an infertile couple I have had bloodwork, transvaginal ultrasounds, taken hormones, been given injections by my husband, helped produce multiple semen samples, had surgery and have been poked and prodded in ways that the average person in society can't even imagine. For those women out there who dread their annual pap's nothing compared to having 2-3 doctors, a nurse and your husband in the room while you lay in the stirrups so they can inject your husband's washed sperm into your uterus. Talk about your romantic conception!!! And after all that.still no baby. So the next step is in vitro fertilization which has an extremely small percentage of multiple births (granted, more of a percentage for average, normal, fertile couples, but still very small). And you want me to pick and choose which babies to have if by some miracle I get pregnant with more than one???? My answer would be " Go to H*$$ !!!"

Date: Thu, Apr 1, 2004 4:49 PM From: To:
How absolutely ridiculous that anyone would think society should have a hand in telling parents with muliples how many they should or should not keep and/or if they should be ALLOWED to take fertility drugs in the first place. Spoken by someone who a.) has had no difficulty having children b.)has no children of their own or c.)may live in China.
I am a mother of quadruplets. After trying for 3 years to have babies, we were finally pregnant. I knew the risk of carrying that many babies. I was in the hospital for 2 months prior to their birth. They were in the NICU for 4 months. I lost one of my children at 3 weeks from a blood clot in his heart. I buried my child. (The most painful experience that I have ever been a part of.)
I love my children very much. I am 10 credit hours from having my masters degree in counseling. My husband has an MBA. We live on a modest budget, but make due. We could be anybody off of the street. How dare you, tell me, that you know better about how many children I should have.
Further more. Who is to say I would not have had 4 babies as singletons? Who is to say that they would not have been least twins...had I not taken fertility drugs. My mother did not take fertility drugs, and I have a fraternal twin brother...and sisters that are identical twins. Oh yes, it happens! Also, any single baby can be born a happens all of the time. Any child can be born with medical problems. Any child can die.
I am sick and tired of the people who believe they are in the know, telling me how I should raise my family. Read the newspaper...take a walk...distribute flyers to help someone actually in need of your services...but do not have the arrogance to think that you are in any position to dictate to society if they should have children, and how many they should have...Many third world countries do that...and that is why they have to have mail order brides to reproduce.
--- Brett Middleton

Date: Tue, Mar 23, 2004 8:28 AM From: To:
No, people do not give these children up for adoption because they love their babies-every one of them. But they also have to understand that society has to pick up the slack of paying for the babies in one form or another. The society of the United States is already in chaos. Do we really need women to start having abnormal births to six, seven, or even eight babies at a time? I don't think so. The United States as a whole cannot put out the money that would be necessary, nor the space needed! If every family had that many children, then we would have to make artificial islands for people to live on--a very costly program--and then find out ways to keep the children healthy. No, is my overall opinion because we, the next generation, already have enough of a mess to clean up, and I don't think we need anything else to hinder it.

Date: Sat, Sep 27, 2003 8:15 AM From: To:
Yes they should! It is very unnatural. Animals have litters. The babies are not full term.That can/could cause all kinds of health problems.

Date: Tue, Aug 5, 2003 4:45 AM From: To:
No, physicians and society should not have a role in regulating multiple fetal births. They don't have a role in regulating any other births. So why this kind ? Yes, physicians should offer their strong recommendations, but society should offer the same care for these babies as for any singleton. Twins are novel and cute to everyone. They are socially acceptable. People seem to be horrified by multiple fetal births. This is not fair. They are people too. A woman knows the risk that she is taking when consuming fertility drugs by now. This is the woman's choice as is abortion. We never hear of couples with multiple fetal births giving some of their children up for adoption. This is because they want their babies - all of them. In this day and age, stillbirths and preemies happen all the time in singletons. So lets stop pretending that these situations are so rare. Perhaps technology will catch up with itself soon and multiple fetal births will meet with better medical equipment and techniques.

Date: Thu, Jun 26, 2003 10:07 AM From: To:
I believe these families need a little more screening. There needs to be some kind of criteria put in place. Yes everyone deserves to have children, even if you are poor. But I think there needs to be more counselling to these families. I dont think they realize how much it is going to cost to raise these children. And: Do they have the support system to take care of this many children? 03 10:07 AM

Date: Tue, Jun 3, 2003 4:35 PM From: To:
In my opinion, society should not have a say in this very personal and private matter. Multiple's can occur naturally, as well. The bottom line here is that this is a private matter which demands confidentiality.

Date: Mon, Jun 2, 2003 7:03 PM From: To:
Hello Doctor Mo, Im currently taking a medical ethics course with Priscilla Richardson from Boston and was introduced to this very interesting site! I believe the society in which we live in (USA), we do not have a right to intervene in regulating multiple births. This type of procedure is a consentual agreement between a doctor and a consenting adult. Furthermore if the decision is made for selective reduction painful of a decision as it may be, the family has the right of patient autonomy. A woman who feels comfortable with this type of decision and feels shes made the right moral choice shouldn't be expected to live up to societys idea of right and wrong when reproduction and abortion are legal in this country.

Date: Tue, Apr 8, 2003 8:06 AM From: To:
Personally, I do not believe that 5+ babies born at the same time are a miracle. Miracles do not occur from a mother taking fertilization drugs to enhance her egg production. If a mother naturally becomes pregnant with 2+ babies, that is the will of the world. However, when medicine interferes and multiple fetuses are formed, the lives of the fetuses must be considered. Medical interventions to prevent disease and sustain life is totally different that this type of medical treatment. The area is very gray. Do you deny a mother the right to bear children, just so fertility treaments are not given? Hopefully, in future years fertility treatments will become more of a science than a guestimate. Multiple births have a higher mortality rate than do twin and single birhs, which only proves that selective reduction should occur in SOME cases. However, I don't feel that society should have a role in choosing for the parents whether selective reduction should occur. I feel this should be a private decision between the mother, father and medical team. If society becomes involved in these decisions, strides that have been made in other women's health issues such as the right to choose (Roe v. Wade) could also be argued that society should be involved in deciding for women whether to have an abortion.

Date: Wed, Jan 29, 2003 1:47 PM From: To:
The Pro-life folks would be the ones who would want society to choose whether or not a family is allowed to have multiple fetal births. Many times I believe that the Pro-lifers are more interested in taking choices away from individuals, than preserving life. Whether or not a multiple fetal birth is come by naturally or through infertility treatments, I believe the humans involved in the pregnancy should discuss the birth with their doctor, then choose what is right for them. Their decision is between them and their God. It has no bearing on the rest of society. Their decision is not designed to hurt or help society. This is a PERSONAL decision and choice. The McCaughey septuplets have turned into a beautiful bunch of children. The parents never appeared to have any intention of sponging off of society. They never thought they would be rich with money, but now they are a family rich with love. That family's life is completely different now than it was before the septuplets, and that family has adjusted and struggled with health issues. When you have a child, the challenges and the rewards are woven together to create a bonding and unconditional love. It is no different with single or multiple fetal births. At least when infertility treatments cause multiple fetal births, the parents are usually desperate to have children to love. If an individual feels overwhelmed at the prospect of seven children, it is up to them to "pick and choose", and consider aborting some of the fetuses or putting some up for adoption. I have my own problems and challenges. I don't want to be someone else's conscience. Society should not be the conscience of someone in this difficult position. Jakki B.

Date: Thu, Sep 12, 2002 11:59 AM From: To:
After reading the article about society and their potential role in regulating fetal births, I had to ask myself why society would even be considered in this process. Since when does society have a say in a family's decision to start a family. Whose business is it to tell a person that they are limited to so many children? As for the McCaughey's, each child has brought something special into their lives. Each of these children was placed in this family for a reason; God knew that this family could handle the trials and disabilities. God is the Creator of all living beings and His Will ultimately decides the future!

Date: Tue, Aug 13, 2002 4:01 PM From: To:
Those who say society should have a role in deciding what to do with the "problem" of multiple births are suggesting that a mother has a bigger obligation to society then to her own flesh and blood. Those multiples will be taxpayers too someday and are members of society from the day they are born. How can you make judgements about who should be born or not in your own society? Multifetal selectve reduction is not the magical cure for multiple pregnancies it is made out to be. Women who go through the procedure have an up to 40% chance of miscarrying the rest of the babies. 55-60% of reduced pregnancies don't make it to term anyway. Many of those don't go past the # of weeks gestation they would have gone to if all the babies had been allowed to live and in many cases it's best to leave things alone and carry all of them. What exactly do these people think they are reducing anyway? How is reducing a pregnancy going to improve the health for the babies that die? If they are dead there is a 100% chance they are not healthy. It is not at all clear how deliberately killing a child is better then giving him a chance at life and him dying of natural causes. It is true that multiple pregnancies are risky and can be dangerous, but carrying multiple babies does not automatically mean a disasterous outcome. As for the people who say that a woman who cannot concieve on her own should not try fertility drugs, they have obviously not been through it themselves. While I do not agree with some forms of IVF because of they way the fertilized embryo's are disposed of, I do not think trying to find help when something goes wrong with your body is going against God's will. If a couple is truly meant not to have children, they will not have any, no matter what they try. To think that man and science can bypass the absolute will of God is ridiculous. Telling a woman who is infertile that God "meant" for her to be infertile so therefore she should not try fertility drugs is like telling a diabetic that God meant for their pancreas not to work and therefore should not take insulin. The consequences of being infertle and being diabetic are vastly different, but they are caused by the same thing. Something went wrong with their body. Selective reduction forces parents to to play russian roulette with their children and, by choosing which children will live and die, allows a doctor to play God. Seeing the way some doctors behave that is not a position I'm comfortable with. Which one of the septuplets should Bobbi and Kenny have allowed to been killed? That is exactly what needs to be asked, because if the pregnancy had been reduced, four to six those beautiful children would not be here. To parents, which of your children can you imagine not being here? It is TRAGIC when parents choose to carry all of the children they concieve only to have some die, but how is it better to for them to have NO CHANCE to live? Is it better to let these children at least have a chance at living then to give them no chance at all.It is also important to remember that ALL children are gifts from God no matter if they come one at a time or seven at a time.

Date: Sat, Jul 27, 2002 5:22 PM From: To:
I think it should be up to the parents to decide what to for fetal abortions, can you honestly look at your children, and pick you & you, and you......that's God's business, so let Him intervene

Date: Wed, Jul 10, 2002 7:09 PM From: To:
To whom it may concern:
I read the topic and frankly am appalled. Why is there always something? We as a "society" can NEVER let well enough alone. Let these people have ten children if they wish. However, now if we were talking of a single parent who was a welfare respondent or something of the sort, then its the welfare of the child/children at stake. For now, Its a couple who wanted children and after a long struggle and finally blessed. There are couples who have 6-7 children one at a time, hence, what's the big deal if they are born at the same time. GOD BLESS those babies. Leave that family be, stop starting these posts about them and let them live their lives happily.
Thank for your time, Ryann L, Upstate New York

Date: Wed, Jun 12, 2002 10:35 PM From: To:
I have a sister in law who wanted to have a baby and couldn't . So she looked into fertility help. She did receive the fertility help and has had not one but 2 separate pregnancy's. 2 little girls. I thought that was such a wonderful gift she had received. Now she has decided to have another baby. Her and her husband cannot conceive naturally, like I said earlier so they had to have fertility help. Now she is pregnant with quads! When will the selfishness stop? I thought It was wonderful for her to have a couple of children with help. But to selfishly risk her life ,and the four babies she is caring is foolish, not to mention if she dies she is also putting her 2 little girls at risk of not having their mommy .Not to mention the fact that her husband could be left to raise all these children alone! Its insane! I will say this. If people would sit back and realize what they have and be appreciative of what they have and not be so selfish then I would say leave it to the parents and Doctors. But if society continues on its materialistic "I have more then you" rollercoaster then the government should be involved. We as a society cause our own problems.

Date: Sun, Apr 7, 2002 2:44 PM From: To:
To all those who say leave it to God to decide how many babies a person should have, I agree. If God lets you get pregnant then go ahead and have it. If God decides you should not have a baby then don't intervene with drugs. Accept God's will or leave God out of it, you can't have it both ways. I believe that all babies should be wanted and the parents should be able to provide for them or aborted.

Date: Sat, Feb 23, 2002 1:38 PM From: To:
I think that every child is a blessing. Who is the government to decide who many children we can have at one time? China does that not America the land of the free. I believe that everything happens for a reason. The good Lord decides when children are born and when they are not. Who does the government think they are? They have no right to tell women if they can carry multiple fetuses or not. I understand there are a lot of risk with carrying more the one baby at a time but there are also risk carrying just one baby as well. The decision of reduction should be made by the parents and no one else because it is the parents who are going to have to deal with the lost of that child, not the government. Besides what do they care. Its not like they are footing the bill when these babies are born. If the government is allowed to tell us how many children to have at one time what is to say they are not going to tell us how many children to have in all. Uncle Sam does not have to raise these children the parents do. The parents are the ones that are going to have to do the late night feedings and changing the diapers and kissing boo-boos away. If they think they are up for it then I say let them do it. The government is getting to nosey these days and it seems like they are trying to put a leash on us. That is not what America is all about. Let the parents and God decide. They are the only ones who will be taking care of these little miracles.
Christina Cordier

Date: Fri, Jan 25, 2002 1:24 PM From: To:
Reading some of the answers from those who think society should have a roll in regulating this is ludicrus. Most multiple birth children grow to be tax payers just like those who write their comments. It's no different than those non-tax payers having several single-birth children. The couples that are going through the fertility treatments are doing well financially and aren't the ones living on "tax-payers" money, and are tax payers themselves. I don't have any multiple birth children, but have had 4 single birth babies, 2 which we've lost, and trying one more time for a healthy baby. I am now on a "ovulation stimulator" fertility drug, and I (probably like most other women on fertility treatments) just want a healthy baby, and if God happens to bless us with more than one, so be it. ALL babies are Gods work. Some women are just fortunate to be fertile. How many of the people that have written that think society should have a roll in this, have infertility problems--probably very few!! To all of the multiples...God Bless you, what a miracle. It's sad to know that some day, most of these "miracles" will be paying the taxes and social security on these "simple minded" people that are complaning about paying for them now.
Signed: Hoping to soon be mom of any amount of babies God will bless me with!

Date: Tue, Jul 10, 2001 1:11 PM From: To:
I had to laugh at the person who ranted about tax payers paying for the children that result from multiple birth pregnancies. I thought it was common knowledge that in almost every case, multiple births of triplets or more are a result of fertility treatments. Having just completed a round of in vitro fertilization and (joyfully) expecting twins in December, I KNOW how much those treatments cost and I am fairly certain that people who are too poor to support their children certainly could NOT afford these kinds of infertility treatments.
This is my body, not the rest of the world's, and if we had found that we had a litter of children rather than just two, it would be no one's business but mine and my husband's what we decided to do about it, if anything.

Date: Sat, Jul 7, 2001 1:24 PM From: To:
I live in the UK and after a perfectly normal conceived pregnancy in 1988 had my first child.However after trying for a second for several months I was put on a daily fertility injection called METRODIN which produced Quadruplets.Although this came as a bit of a shock after being told I would only have one child, I carried on with the pregnancy well and in 1993 gave birth to healthy babies.I would also like to take the opportunity to reply to one of your recent replies which is that I have never received any financial help what so ever, and even though my Quads are celebrities in my area we have never been offered any help and we wouldnt accept it anyway. We were given the choice to have all four and we have to live with the financial difficulties, we are blessed to have such healthy children however we conceive.

Date: Sun, Jun 17, 2001 5:55 PM From: To:
I have to assume that if a couple has made the decision to have a child and received help to conceive one ( or more), they are willing to accept the challenge of multiple children. I feel decisions on the number of children a person can have at one time will vary from person to person. That decision needs to be made between the family and the doctor. I couldn't imagine a law telling me how many children I could carry in my body or how many I could take home from the hospital after completing 40 weeks of gestation. This article discuses a family having trouble conceiving children and getting help. If they wind up with 4 fetuses growing well and will accept the challenge, they should be supported by society.

Date: Tue, Apr 3, 2001 6:29 PM From: To:
My question is what if I WANT multiples? I want more than 1 child but after my first pregnancy I don't think I could do it again. I was hospitalized 13 times and had morning sickness 24 hours a day including migraines that required high powered drugs to control from my 4th month on so my question is, what do you use that has a high percentage for birthing multiples. We have the money, love and room for 2-3 more but cant do it that many times.

Date: Tue, Feb 6, 2001 8:03 PM From: To:
I believe that there should be a regulation on multiple births. Many people can not even have one child and yet here we have people going out and having so many that most times the children are in some way neglected. It is a fact of life that if you can't have a child on your own then you simply find a way o have it created for you. I don't think it is right to add more stress on everyone by trying to increase the number of births in one pregnancy. Thisaffects everyone in society so therefor I think society should have a say in what goes on. It's our tax money that pays for those who can't afford it so we should have SOME say in how it is spent. You can't always get what you want in life so people should learn they need to distinguish between what they want and what they need.

Date: Thu, Feb 1, 2001 5:04 PM From: To:
When the issue is with someone far away it seems like the a miracle. But, if the person was in a group insurance plan that I belonged to my attitude may change. Society, at this point, seems to come to the rescue for these births with donations of physical item and money. Limiting the number of children by aborting some of the fetus would be something that I would not agree with. This is the risk that is being taken for the chance to have a child with out adopting. I think the decisions has already been made, if we are allowing the use of these fertility drugs, then to be fully responsible, allowing the multiple births must continue.
Terry Moeckel

Date: Sun, Jan 28, 2001 11:46 PM From: MMUGNA@DADA.IT To:
We are Italian students and we think that our society should not have a relevant role in regulating multiple fetal births because men and women (parents) should not decide the destiny of another person who is not able to defend himself. Only God should decide what it is best for us.

Date: Mon, Dec 4, 2000 4:05 PM From: To:
I feel that society should not have a role in regulating multiple fetal births. It is a personal decision. For those who feel it is Gods right to decide ( and I am a Christian) let me say this, who do you think made all of this possible, all of the fertility medication and methods? God, that's who. If one decides to selectively abort, that is that persons decision, and should be no one else's. NO one should be called a sinner, for we are all sinners and no one sin is greater than the other. Also, the bible says that we should not judge one another, only God should judge. Society should let a person judge for themselves what is right for them and what they feel is right. This is America, we have the freedom of speech and the freedom of choice, and no one should take that away.

Date: Wed, Nov 15, 2000 2:10 PM From: To:
Absolutely. America becomes so busy raising money and collecting toys for those babies but they don't even think about the other mothers out there that have that many children if not more. Some people adopt or just have the children in a natural way. Yet they get no recognition for their wonderful commitment to parenting. The government also sees this birth as a miracle while they call a mother who had seven children, one every year for seven years irresponsible! All that Bobbi did was put herself and each of her seven babies in incredible danger for their lives. They were lucky enough not to loose any of their babies, but most people are not so lucky. Society should not waste their time trying to help the careless. They should spend their time on someone more thoughtful.

Date" Sat, Oct 28, 2000 1:48 PM From: To:
I realize you were merely wanting to discuss the ethical issues regarding high order multiples, but I thought you might be interested in the article below, this is exactly what I was trying to say in my post to you a few months ago, I'm glad that someone is finally looking into this! Maybe the question should be "Who should be paying for these infertility procedures?". Is it a person's "right" to receive medical coverage for these procedures? I believe so, but I doubt that a person who can conceive "naturally" would feel this way. I would think that there could be a sort of happy compromise, like a limitation in the number of procedures that would be covered. Hopefully this will become a national priority considering the increasing rate of high order multiples.
Sincerely, Kristin Smith
Friday 27 October 2000 'Outdated' fertility drugs not worth the risk: expert Sharon Kirkey, with files from Joanne Laucius The Ottawa Citizen SAN DIEGO -- The most common form of fertility treatment in the world should be all but abandoned because of the risk of multiple births, a leading infertility expert says. Super-ovulation drugs that force a woman's ovaries to churn out far more eggs than her body ever could produce naturally are the most common cause of "high-order" multiple births -- triplets, quadruplets and more -- Dr. Norbert Gleicher, of Chicago's Center for Human Reproduction, said yesterday at a gathering of reproductive experts. Yet the standard tests used to determine how a woman is responding to the drugs are "basically worthless" at predicting whether she's at risk of giving birth to three or more babies, he said. "It's probably time to say good-bye (to the fertility drugs) and move those patients over to IVF," Dr. Gleicher told reporters after a panel discussion on ways to reduce multiple births. His comments shocked other physicians. "It's a radical departure" from standard fertility practice, said Dr. Steve Ory, chair of the American Society of Reproductive Medicine's practice committee. "It's going to come as a surprise to most of the medical community." Fertility doctors around the world are grappling with the consequence of assisted conception -- a dramatic rise in the number of multiple birth babies. In Canada, there were approximately 8,700 multiple births in 1997. That's up from 6,200 births in 1977. In the U.S., the number of multiple births involving triplets or more soared 400 per cent between 1980 and 1997. The increase is a huge concern because of the risk to the mother and child. Babies born in multiple deliveries are born earlier and smaller than single-birth babies, they're less likely to survive their first year of life and are far more likely to suffer long-term disability when they do survive, says a recent report by the U.S. department of Health and Human Services. The Parents of Multiple Births Association of Canada has urged doctors to warn fertility patients of the potential problems associated with premature and multiple births before the patient undergoes fertility treatment. "There should be a full expose of what could go wrong if you have quadruplets," said Lynda Haddon, a past president of the association and mother of twins who offers bereavement support to parents who lose one or more children of a multiple birth. "Success does not mean pregnancy. It means the baby grows to be a healthy adult person," she said. Women undergoing fertility treatment are often starry-eyed at the possibility of two, three or more babies, said Ms. Haddon. But 90 per cent of triplets, quadruplets and quintuplets are born early, leading to a greater chance of disabilities including vision, hearing and respiratory problems. "People who really want a child have a fantasy," said Ms. Haddon. "They don't realize that the children could be premature, and they could have anomalies." Critics have pegged the blame on sophisticated new baby-making technologies such as in vitro fertilization, which involves collecting eggs from a woman, mixing them with her partner's sperm and transferring the resulting embryos into her uterus. Until recently, doctors have routinely put in three, four or more embryos to increase the odds that at least one would implant and a baby would result. Experts heard yesterday how a relatively new technique that allows embryos to be incubated in the lab for five days instead of the usual three before being transferred into the woman can dramatically lower the multiple birth rate while actually increasing a woman's shot at getting pregnant. Growing embryos to "blastocyst" stage gives doctors more time to determine which embryos are the healthiest and more likely to implant. Blastocyst transfer could one day lead to doctors transferring no more than two, and even one embryo, during every attempt at in vitro fertilization. But Dr. Gleicher, of Chicago, says in vitro fertilization isn't driving the explosion in multiple births. "Old-fashioned" fertility treatments are. In fact, 80 per cent of multiple births are due to the powerful drugs that stimulate ovulation induction. Two years ago, a Houston woman gave birth to the world's first octuplets after taking fertility drugs. At one point in her pregnancy, she had to be suspended nearly upside down in a hospital bed to relieve the pressure on her expanding belly. Seven of the babies survived. Just this month, the fourth of eight babies born to an Italian woman in September after she took fertility drugs died. And in 1996, a British woman who took fertility drugs attempted to carry all eight of the resulting fetuses to term despite warnings from her doctor. None of the babies survived. In Ottawa, the Forgie quintuplets were born after their mother took even a low dose of fertility drugs. The most common fertility drugs are gonadotropins, naturally occurring hormones that the brain produces to stimulate the ovaries to produce hormones and prepare eggs for release. The drugs bypass a woman's normal process of egg development and release and induces ovulation in women who don't ovulate on their own. The problem, Dr. Gleicher said, is that doctors and patients have no control over how many eggs end up being fertilized after insemination. With in vitro fertilization, "we can decide how many embryos to transfer," he said. "We exert some control" over the process. His team reviewed more than 4,000 cycles of treatment using fertility drugs followed in most cases by artificial insemination. They found that blood tests and ultrasound examinations used to monitor the development of egg follicles weren't reliable at predicting the risk of a multiple pregnancy, he said. Lowering the drug levels could reduce the risk of multiple births, but it would also significantly lower overall pregnancy rates as well, he said. "The whole treatment then becomes very inefficient." "The treatment we use most today is probably outdated considering where we are" with in vitro fertilization, Dr. Gleicher concluded. Although he said doctors shouldn't "completely throw out" super-ovulating drugs, the number of patients who should get them "is very, very small." He said younger women, those under 30 who tend to produce lots of eggs after fertility treatment, should instead use in vitro fertilization. So too should older women "who have very little time left" to get pregnant, he said. "It's logical to use the most efficient treatment, and IVF gives us two-and-a- half to three times the pregnant rate of ovulation induction" per attempt in these women. But Dr. Ory, of the American Society of Reproductive Medicine, said the sheer cost of IVF makes it an option many couples can't simply afford. IVF can cost four to six times what it costs a woman to take fertility drugs alone, he said. And many doctors believe more research needs to be done before they can completely rule out ultrasound in predicting risk for multiple pregnancies, he said.

Date: Sat, Oct 14, 2000 10:22 PM From: To:
I do not belive that society has the right to make a decision about the actually aspect of multiple fetal births. This is a decision that is so private and personal, and only a couple and there doctor should be involved in that decision. But I feel that what is bothering society the most is that these couple seem to get more support then other couples who have single or double births. I feel that if that couple has the money to participate in a fertility program , and know that multiple births are a possibility,and that they can't make a decision to eliminate any of the fetuses,then they should be responsible for the care of those newborns. It is not fair that these couples receive so much support from various companies to assist their every need. There are so many mothers and fathers who need that same support and do no get it ,worst it is not even offered. I believe that children are a blessing, one blessing is still as special as multiple blessings. And this is what I feel seems to make the public outraged. I know that it is not possible for these companies to contribute to everyone who needs there assistance but they could do a better job. And what is more upsetting these companies are just doing it for the media and public attention,what every it takes to get their name out there and it's probably tax deductible. No business is going to do anything that is really FREE, it is all about the money.

Date: Sun, Oct 8, 20000 9:46 AM From: To:
I am so tired of hearing that " If God wanted you to be able to have children then he would of made it possible for you to do it naturally with out the help of fertility drugs" I've have noticed though that the people saying these things are the people who don't have a clue about what it feels like to not be able to have children. So who are they to tell people like me that we are going against God because we want to be able to love a child of our own. Unless you have been in our place then you really have no idea what you are talking about.
As far as multiple births go. If you people did would look at the research you would see that most fertility drugs and invitro fertilizations end up in singleton births. With the occasional twins or triplets. Very rarely do pregnancies of four or more result from these procedures. ( If they happened all the time the the media wouldn't make a big deal out of it when it happens now would they. )
My husband and I are just looking to have a healthy baby of our own. We know about the slim chance of a multiple birth and all of the risks and decisions me may end up facing. But those are our risks and our desisions no one has the right to make them for us. We thank God every day for giving us the strength ( And our doctor the skills and knowledge) to see us through this.

Date: Sun, Jul 30, 2000 1:45 PM From: To:
First of all, it is a ridiculous argument to say that people who seek infertility treatments are going against God's will. If that is true then that means that any medical intervention from treating diabetes to immunizations is going against God's plan to control population. Don't you think that God gives us (at least some of us) the intelligence needed to improve health and living conditions of mankind? This ridiculous argument concludes that all doctors and scientists must be working for Satan.
Secondly, as a mother of triplets I do admit that having higher order multiples has been a financial and physical strain, but I would do it again in a heartbeat! The vast majority of triplets, even when premature, grow into healthy children!
Lastly, I would like to comment that the majority of pregnancies that result from infertility treatments consist of only ONE baby. The pregnancies that result in most of these very large multiple pregnancies (quintuplets, sextuplets, septuplets, etc) are usually conceived by using highly powerful ovulation inducing drugs which are extremely difficult to control. Most infertility specialists have much better control with assisted reproductive technology which includes invitro fertilization (IVF). However, most insurance companies do not cover IVF which can run around $10,000, so couples are faced with the much more affordable option of doing a cycle of the ovulation inducing drugs which runs about $2000, thus increasing the risk of higher order multiple births. If only insurance companies would weigh the cost of an IVF cycle (even several IVF cycles) compared to the millions of dollars required for a very high multiple pregnancy which they do have to cover.
In conclusion, my suggestion is more insurance coverage for less risky and better controlled infertility procedures. Prevention of these terribly high risk pregnancies should be our biggest priority. No mother should have to face the extraorindarily difficult decision of selective reduction.

Date: Tue, Jun 13, 2000 10:02 AM From: To:
Society should definitely have a role in regards to multiple births! We pay for these kids, we build the family houses and supply them with life long diaper services and basically reward these folks for their selfishness! I can see these kids being supplied with any toy, computer, etc. for the rest of their lives due to their 'celebrity'. I think I have even heard that they are guaranteed college funds by some business.
I think of the struggles of raising my own 2 kids. We were never assisted by society. We were limited to 2 children, as that was all we could feed and clothe! My son will be going to college next year, and we will be either working another job or assuming more debt for a loan in order to send him. He is a good kid, has never been in trouble and that is the best that he can get. Sure, he can get partial scholarships; wish he could have gotten a full one! But he will not be rewarded because his parents could only have kids one at a time and pay for them themselves.
There is also something to be said about the ability to have children. Some people cannot. Perhaps it is a built in population control by nature. There are plenty of children that need families! So, science has enabled people to conceive when their bodies physically cannot by normal means. Will science now make me a champion figure skater, because I demand it? Will society pay for my ice time and world famous skating coaches? Will they supply me with sequin encrusted tutus for my skating career? Will they pay for the operation on my brain, bestowing me with the talent and the reorganization of my muscles, so that I may tolerate skating? Yes, the above sounds crazy, but that is what multiple births are. I am a pediatric nurse and I see these kids when they are older with their g-tubes and their weak lungs, suseptible to any bug that comes down the pike. When we intubate these kids and put them at further risk of illness, doesn't anyone feel responsible for this? We pay for this. We make these children suffer and suffer, all because their parents had a right to have children. Thanks for listening.

Date: Sun, Apr 30, 2000 2:48 PM From: To:
New technological advances constantly bring forward new ethical dilemmas such as what is the case in the assisted reproduction field. The role of the medical profession and the society in general is of course not to interfere with or to regulate individual decision-making; it is to highly publicize the pros and cons of the new technology so that better informed and more cautiously meditated decisions could ensue. It is inappropriate for the society to dictate what is right and what is wrong, but it sure should not keep its mouth shut in terms of what is better and what is worse. Most people outside the medical profession derive their knowledge and understanding through advocacy and education. If they are totally left on their own to make blindfolded decisions, it is then not the freedom of choice but the irresponsibility out of ignorance. In the case of multiple births, it defies the mode endorsed by natural selection and will potentially pose high stress and various disadvantages to both parents and offspring biologically, financially and functionally. So it should not really be promoted as a standard or even preferred method in assisted reproduction. If the prospective parents choose to pursue this option, no one can and should prevent them, however, it has to be made clear to them that it may not be a wise choice, given current conditions.

Date: Fri, Mar 24, 2000 1:38 PM From: To:
In regulating multiple fetal births, it seems that society is attempting to play the role of God in deciding who has the right to live and who does not. God intended for diversity in the human race. Genetic defects as a result of multiple fetal births are a part of this diversity. In fact, there have been many noted instances where there was a multiple fetal birth, and all children survived and were healthy. This is even supported by the previous response of the registered nurse. I also work in the birthplace of a hospital as a volunteer and seen a case of multiple births turn out very well. I therefore believe no one, including the court or society as a whole, should have the right to allow certain children in multiple fetal births to be aborted.

Date: Fri, Mar 24, 2000 9:15 AM From: To:
I do not believe so, each child should have an equal chance for survival and should not be chosen by mother or doctor.

Date: Tue, Mar 21, 2000 11:13 PM From: To:
As a means of population control, regulating multiple births would be a logical place to start. It would be so easy-- when a doctor diagnosed more than one fetus developing in the womb, he could perform a short easy elimination of the fetus (or plural) he chose. It could be standard procedure. However this is unthinkable in the modern US, land of the free and the American dream--which includes children and a lot of room to lay down roots-- and is morally repugnant as well. Plus, the US is not exactly at the point where it needs to implement population control programs. Even in China, where couples are encouraged and bribed by government benefits to only have one child, the choice is left to the parents. I'm not sure how 'society' is being defined on this website, but government regulation of multiple births, unless it were a regulation which provided a mortgage and diaper service for the overwhelmed parents, has absolutely no place in American democracy. I am staunchly pro-choice, and would support a mother's decision to selectively eliminate fetuses to provide a chance for better health for the remaining fetuses, but neither should it be the mother's obligation to do so. What is growing in a woman's womb is the responsibility of the mother, not society (and I am speaking in the cases of typical, healthy women, not child-beaters/molesters/drug addicts or the like).

Date: Tue, Mar 21, 2000 4:49 PM From: To:
I believe that it is a wonderful thing that we can now help the infertile have children. However, it is a sad thing that it has become a circus lately when a couple has an abnormal number of children. I believe that we should possibly impose restrictions on the amount of fertility drugs that can be given to a couple (if it is possible to do so and still improve chances of conceiving) so that these great numbers of babies are not born at once. Because we as humans were not meant to give birth to large numbers at a single time, the chance for survival for these babies is lowered when such a thing happens. Also, it is probably very difficult for the parents to take care of so many children of the same age. However, I do not believe that we have the right to selectively abort children in cases of multiple births. We should do all that we can to help them survive outside the mother, and those that are meant to live will live.
I definitely agree that the couples taking the fertility drugs would be among the most loving parents, and I believe that society has no business telling them that they can only have a set number of children.
Ken Byrd

Date: Sun, Mar 19, 2000 8:49 PM From: To:
I see this as being an issue that should be handled by the family and physician after the particular situation is discussed. These situations vary from one family to the next. Under these circumstances, it is impossible to allow society to form a general regulation on whether multiple fetal births should be allowed. I have heard of numerous instances where multiple fetal births occurred, and all newborns survived and were healthy. It is a fact that newborn survival rates decrease with multiple births. Yet, it must be left to the family, not society or the court, to decide whether their moral feeling about abortion should take priority over the health and survival of their children.
-Jon Taylor, Univ. of South Carolina

Date: Sun, Mar 19, 2000 4:47 PM From: To:
We are very fortunate to life in a society that allows for breakthrough medical technology as amazing as assisted reproductions. However, progress is almost always complicated by problems such as this. It is wonderful that couples hoping to start a family can do so even if nature dictates otherwise. At the same time, it poses some significany societal risks. The "burden" of multiple births on the families which receive them are nonexistent. They may suffer a bit financially or make several sacrifices in daily life. However, these are the same people who desperately sought after life after nature told them it was not possible to create it. In the context of society, multiple births could lead to long term problems. Genetically, there will obviously be problems according to Darwin's "Survival of the Fittest" theory. Also, the threat of overpopulation is a major concern today. However, the actual occurence of these multiple fetal births is relatively small, comparitively speaking, and will not have an overwhelming effect on either of these societal concerns in time in the near future. I think doctors should be able to guide their patients in ways that will be most conducive to their health. They must council them on the possiblilities and risks involved in assisted reproduction. However, I feel that it is wrong to destroy a life, intentionally created, in order to help its siblings. What if your parents, during hard times, decided that though they wanted you at one time in their lives you were now a "burden"? Would you want them to blatantly diregard the life they had created to make life a little more convenient and comfortable for them?

Date: Sat, Mar 18, 2000 9:39 AM From: To:
I don't believe that society should be involved in the personal matter of births within any family. Multiple fetal births should be no exception, in acquired naturally. When the multiple births are engineered in the laboratory, society should still not be involved, but there is more room for ethical dilemmas when this doesn occur. In the case of Bobbi and Kenny McCaughey's septuplets, it happened naturally, and things are working out well. There are serious complications, as I am sure we are all aware, that can arise when there is more than one fetus attempting to survive within the mother's womb. However, this too is a concern for doctor and patient, not society. Decisions of selective abortion for the sake of other fetuses or for the sake of the mother are very important. Doctors are expected to acknowledge any dilemma that arises, and they are to offer their expertise in determining what the patient's should do. In no way should society be in charge of regulating these happy births. It is a personal/family matter. When the discussion of engineered multiple births arises, there is an enormous gray area in which complication is evident. I believe, as long as in-vitro, etc. continues that parents should be able to decide how many attempts are made. With this occurring, it might be helpful to have a pre-set number within the couple as to how many fetuses they will attempt to keep alive after successful fertilization. But again it is an intimate decision-not spanning society's realms. In the large spectrum of birth/pregnancy (I do not know the exact figures), multiple septuplet births are rare. So as for the societal strain this might cause, I see none. The McCaughey's situation brought smiles and happiness to so many faces and families. It also produced unity throughout the nation in many aspects. Healthy for a society, if you ask me.

Date: Fri, Feb 11, 2000 10:49 AM From: To:
What an interesting question. I also read many interesting answers. I humbly offer my own opinion. The multiple births I have witnessed as a labor and delivery nurse, whether artificially induced or not, have been joyous occasions for loving, caring families. These babies survived despite the odds, this can be said of single births also, and so why should society or anyone say who should live and who should die. Despite the politically correct term 'selective reduction' it still adds up to murder. So, enough said, we have no right to kill any of these babies. Thanks,
C. J.

Date: Wed, Feb 2, 2000 5:40 PM From: To:
If these multiple births are the result of medical assisstance to naturally infertile couples, or couples having genetic complications with conventional reproduction, then we are producing such evolutionary pressures that we face the exitinction of the naturally reproducing homo sapien. It is survival of those most effective at reproducing as the proportion of organism possessing their genes will become highest in a population.

Date: Wed, Jun 2, 1999 7:55 PM From: To:
Society as a whole should not have a role in regulating multiple births. If the multiples occur thru a natural process (i.e no fertility drugs or other such methods used), than total autonamy should be given to the mother and/or father whether there will be any selective abortions. Dangers to the fetus' and the mother alike should be well conveyed to the parties involved; any and all decisions should be made by the mother and/or father in conjunction with the doctor. Nature is still an ever-present force, if an egg should spontaneously divide and " multiple " situation arise, decisions should be made by only parties involved, not society.
However, I'm assuming you are talking about fertility/biomedically engineered multiple's. In this case, still society should not be involved. Who should be involved?...the doctors who are aiding in the process. Be it the doctor who is dosing the fertility drugs, or the fertility clinic who is preforming the egg inplantations. During inplantations generally many many eggs are used with the hope that one or two will " make it ", as we've seen lately such is not the case. In using fertility drugs, on the first sign of multiple's it should be made clear to the parties involved that human beings are not meant to, and never have birthed liters.
The controls for regulating multiple births has nothing to do with society. Studies have shown that children born as multiples tend to do much better in socialization, and self-gratification; these children tend to go the extra mile to stave off immeadiate self-gratification. That type of behavior does not pose a threat to society, rather it would be welcome. The problem lies in that most multiples, a hand full, develop correctly in respects to health and mental apptitude. There in lies the reason for some sort of control of " engineered " multiple births. Possibly implementing some type of contractual aggrement between parties involved that should multiple births of X number or more be detected, this number X will have to be selectively aborted. And so many of us tend to forget that between black and white there is an enormous gray area. In that I mean that specific parameters could be used to decide upon safety of mother and children alike; i.e first pregnancy, age of mother, health of mother, etc.

Date: Wed, Mar 24, 1999 5:42 PM From: To:
I think that the parents should not implant so many eggs because their is that chance of all of the babies to be a success. They should start out with two to four eggs. I believe that it's the parents right to choose if they want to abort any of the embroys. I'm not certain how i feel on the situation where they are given the right to choose which sex should live.Since some parents are implanting such a large number in at a time the should at least understand that if they do not abort some of the embros that all of the babies could die.This is the reason i believe a small number should be implanted at a time.

Date: Wed. Feb 24, 1999 2:26 PM From: To:
I DO NOT believe society should have any say so what so ever in the choice of selective reduction. This is obviously a choice that is clearly a hard one to make and should only be between the family and the Dr. I am the proud mother of very Healthy and Happy 11 month old quadruplet girls that are loved very much by their entire family, they are also cherished very much by their older brothers 11, and 13, We couldnt be happier, however selective reduction was not a choice for us, yes we were told about this option but we never considered it.

Date: Wed, Feb 10, 1999 3:28 PM From: To:
I do not feel that society should play any type of role in regulating multiple births. I feel as though that is between the doctor and the patient. I am currently undergoing intensive treatment for IVF and my husband and I know the risks that go along with the procedure. I don't think anyone could possibly understand the frustrations of not being able to conceive naturally unless they have experienced it first hand. I personally feel that God will be using my doctor as tool when I go in for the IVF procedure and no one could make me ever think otherwise.
Part of the problem with couples having multiples is the insurance companies. They are the reason that people are so desperate that they want several embryos transferred. Insurance companies don't want to cover infertility procedures, especially assisted reproductive procedures. The assisted procedures are their only chance for conceiving and if most people are like myself, can only afford one procedure therefore taking a risk of having more than one baby. So if you want someone to blame for multiple births, blame it on the insurance companies who squirm when they hear the word "infertility". Don't blame the infertile couples who just want to have a family and have to mortgage their homes or take out high loans for a one time procedure that makes them so desperate that it doesn't matter how many babies they have. The babies that are born to infertile couples are the most wanted children in the world.
If you want to worry about the well being of children, worry about the children who are born to the people who don't want them, the children who are beaten and neglected everyday.
Cherie M.

Date: Sat, Jan 2, 1999 5:16 PM From:
To September 1st.
I am a person who doesn't say alot or reply to articles on the internet. But after reading your response, I couldn't pass up a chance to put my two cents worth in. First, I understand that handling multiple births is a big responsibility. Second, I understand that there are people who do use fertility drugs sometimes( I do mean sometimes) abuse this privilidge to have more than two or three births. Where I have the rub, is the saying about GOD not wanting loving parents to bring his children to earth. I am a father who is going through fertility drugs to have a child that my wife and I have wanted for some time. We feel that the Lord himself has brought us through this process. We understand the complications that go with using fertility drugs and we are prepared to take responsibilty. You can't even experience the feeling of wanting a child and going through the process to concieve one. We feel that the Lord has blessed us with the opportunity. Unil you have walked a mile in our footsteps, please reconsider what you have written.

Date: Tue, Dec 15, 1998 9:36 PM From: To:
I don't believe that society should have any say over multiple births. I am 24 years old and am infertile. After trying to have a baby for two years I was told that I had a disease called Polycystic Ovarian Syndrome. Because of this I will never be able to have children through natural means. After I was diagnosed my husband and I had many disuddions about fertility drungs and multiple births. Three years ago we decided to risk it and I am very happy to say that I now have a beautiful 2 1/2 year old son that I love and adore. But, we would still like to have one more child. I am currently on my thrid month of Clomid and have not gotten pregnant. I am now faced with the option of higher doage of drugs or to try new drugs. This is a decision that only my family can make. It would not be fair to have the government or the general population to tell me that I can not go on. Infertility is something that is very hard to cope with. Even with drugs it is still a miracle to actually conceive a child. Unless you have walk a mile in my shoes and know what it is like to see your friends with babies and know that you can never have this, you can judge those of us who are infertile for wanting to take the risk of being blessed with children.

Date: Sat, Nov 21, 1998 12:33 PM From: To:
I just wanted to respond that no one can make a human. It is God that creats us. Even if people do use fertility drugs to help the process there is no way they 'create' a person. They cannot construct the intricucies of the eye and how it sees, the brain and how it works, blood and how it brings nutrients to the body, etc. Only God can create these things. A human is a human because God made them. They are made in the image of God. God knew them before God knit them in their mothers womb. God predestined us before we were conceived and knows every day of our life - and has given life to us. I personally think it is great that couples can use the assistance of medicine to have babies. One point I would like to make is that if there are multiple fetus the couple has a responsiblity to these little humans [babies] to birth them so they can have life. Removing them before birth is killing them.
Sincerely, jan

Date: Fri, Nov 20, 1998 5:23 PM From: To:
I think that there is no need to regulate the presence of multiple births. While they are fascinating to some, they tend to also create a strong bond between the multiples, their parents, and those who are close to them. Every baby should be given a chance, even if they were no naturally created!

Date: Tue, Sep 1, 1998 9:11 AM From: To:
I would like to voice my opinion on the multiple birth issue.
I have triplets. They are identical girls and were concieved naturally, without the use of fertility drugs or treatments. I am a fraternal twin. I also have two boys who are seven and nine.
I know firsthand how hard it is to raise just one baby at a time, let alone three. We are coping, all my children are happy and healthy, with no disabilities.
However, this can not be said for many multiples, and therein lies the rub. I do not believe that a woman should use artificial means to have children. These women who use the drugs and doctors to have twins or higher are just playing God, and the children often pay the price. Many multiples suffer from things such as hearing loss, eye problems, cerebral palsy, mental retardation, the list goes on.
I know that some might say that any child can be afflicted with these problems, but multiples have a much higher chance of suffering from life-long medical problems than singletons.
I also think that women who use the drugs and treatments should not say that God gave them their children. They made them in the lab themselves. If God had chosen to give them children, they would already have had them. Many women who resort to medically-assisted gestations SEEM to be deeply religious, but in truth, if they were, they would not have done what they did. It seems to me that by using artificial means to get pregnant, you are telling God that He made a mistake, and you will correct it, therefore, you are mightier than God.

Date: Wed, Aug 5, 1998 11:31 PM From: To:
I don't think anyone except God has a right to regulate multiple births. Even though fertility drugs and other fertility aids (such as IVF) raises the chance of multiple births, it is still a miracle. I know it can be dangerous to both mother and babies, but families that end up with many babies at one time need support.
Patricia White

Date: Sat, May 30, 1998 11:22 AM From: "" To:
In my personal opinion I do not feel that society has the right to intervene in any couple's personal decisions, especially those that involve important matters, such as children.

Date: Wed, Mar 18, 1998 11:29 AM From: To:
Assisted reproduction has definately raised new ethical questions which must be addressed. I do not feel that society should play a role in making decisions about multiple fetal births. The decision to reduce a multiple pregnancy or to continue the full pregnancy should be that of the parents and the doctors, not society. Although multiple fetal births do pose difficult dilemmas, it is the responsibilty of the parents and the doctors to discuss the situation and make an educated decision that will be best for the infants and the parents. With advanced technology, parents and doctors are increasingly being placed in the position to "play" God. Now that the technology is available, there is no turning back. Technology marches on, leaving pending ethical dilemmas. Technology has made life and death decisions mighty tricky!
Sarah Alice Miller, E&H Box 159, P.O. Box 9001, Emory, VA 24327-9001, Phone:(540)944-6526

Date: Thu, Feb 26, 1998 4:04 PM From: To:
My thoughts on this subject are simple. Multiple births are not to be desired. They leave most babies premature, making birth defects or disabilities much more likely. They put the parents in the unhappy position of having to choose between reduction and the possible loss of all the babies. And when they are born, multiple birth babies place an enormous strain on the mothers and fathers...of course, it does depend on how many babies you have at once, but the fact remains that to have more than one baby is much harder. However, I do not feel it is society's right to intervene. Too many parents want babies desperately. It is not fair to stop all fertility treatments for everyone just because some people have multiple births. If you did that you could argue that every person in one room should be punished because one of the people did something bad. Therefore, my solution is to make fertility counseling much more thorough. This means that parents should know all the problems with multiple births. Also, doctors should not be allowed to give so much of a fertility drug that it makes the woman release seven eggs. And finally, it should be that only three eggs can be implanted during the In-vitro Fertilization process. Such restrictions, while not completely stopping the problem, would at least stop the growth of multiple births and perhaps make them become more rare.

Date: Thu, Jan 8, 1998 11:54 AM From: To:
No, I don't think society should, in any way, have a say in the regulations of multiple births. If the parents feel they can successfully raise a family of more than three children then they should be allowed to. Society doesn't comment on any other couples pregnancies, then why should they have something to say against couples who have, for so long, been trying to have a child and now have finallyl become successful? The fact that there will be three or more babies born doesn't have anything to do with them and so why should they have a say in the regulations of multiple births? Again, if the couple feels that they are ready for a family and believe that they can do a good job then they should be allowed to, without others determing the outcome of their children's lives.

Date: Wed, Jan 7, 1998 6:40 PM From: To: DoktorMo@aol.comj
I am studying about reproductive technologies in my bioethics class now. I do not think that people should have sooo many options for having children. I think that if the person was meant to have children, that God would have made it that way. I am sure that it is a very sad and stressful situation to be in, but that is the way it happened. Doctors should not provide assisted reproduction to people that would cause them to have "litters" of children. Only animals are meant to have litters of children. Humans are not built for it. Take any person who has had more than three children at one time for an example. The mother can become very sick and unable to do things during her pregnancy. If the mother gets too sick, selective reduction may be recommended by the physician. Is that really the right thing to do? the mother took the chance in having more than one embryos with the possibility of growing implanted. An innocent life should not have to suffer the consequences. If the mother does decide to go through with selective reduction, how will it effect her? If I was in her situation, I would always wonder what the child would look like and what it would act like. On the other hand, if the mother does go full term without selective reduction, one or more of the children, when born, can become very sick and die. A lot of multiple births will have a long term effect on the society. There are already hardly enough jobs available to todays socity. HOw will there be enough jobs for double or triple the amount of people. Will there be enough housing, food, jobs, and enough room in schools for all the children? I don't think that society will be able to handle it. It is something that is very hard to decide what is right and what is wrong. That is why i believe that nature should never have been messed with. People should not play God. Although i do not agree with this, i do believe that it should stay between the parents and the doctor. I do not think that the pregnancy of the mother should be spread all over the news and the babies born shouldnt be filmed from the second they are born and watched over like eagles. So, no i do not believe that society should be involved in regulating multiple births.

Date: Wed, Dec 31, 1997 12:26 AM From: To:
I'm not a physician but I do encounter women in this position almost on a daily basis. I'm a counselor for expectant/new mothers (parents) of multiples. I really don't think that society, in general, should or could have a choice in this matter. Yes, these children could end up being supported by the "tax-payers" but these chances aren't really higher than any other large family. If interested parties wish to voluntarily take part in the financial, emotional or physical support of these families then they should be encouraged to do so but no one is forcing people to "help" if they choose not to. The families who seek out specialist in the field of infertility are usually quite "desperate" people. People looking for that, perhaps, last chance at a biological family. They should be counseled in great length and explained of the realistic risks involved and the true chances of having "more than one". However, the vast majority of these families ignore these words of caution and are often willing to accept anything providing they indeed get pregnant. Some go into the process realizing they may conceive twins but very few of them think much beyond that. (And the truth of the matter still remains that actually very FEW really even conceive, much less, carry through to viable birth, two or more babies at once. What makes the news and what gets public reaction is only the very rare exception to the rule.) I know several infertility specialist and I don't think any of them have ever had a case of more than 4 fetuses and all of them counsel their patients about selective reduction even with only triplets - which, in my opinion is too extreme. Once a pregnancy is "in tact" I personnally feel the choice should NO longer be that of the physician much less that of the public but only should remain and remain alone with the parents. They should be offered (even strongly advised) to receive counseling to help them make the right choice for them as a family and the health of the mother. It takes courage like no other to be able to make a choice like the McCaughey family made and luckily so very few families are in such an extreme position to have to make such a choice. I look up to these people and encourage them however I can. They love their children and that should be admired. No one can predict the future and what might be in store for these seven babies or any family of children (I have 6 myself - including twins). And... What about the chances that nature itself played a significant role in the McCaughey pregnancy and other "higher-order multiple" pregnancies?? If a woman's body is not capable of being pregnant with multiples then her body will not allow it to continue. The female body was made for only one - what does that fact do to the odds of a body able to accept successfully a multi-fetal pregnancy?? Does anyone know for sure that two or more of the McCaughey babies aren't monozygotic?? That possibility would then have NOTHING to do with the assisted pregnancy!! That is nature pure. I have encountered many of these pregnancies (whether IVF, Clomid or Pergonal - or similar drugs - induced) that result in all or partially monozygotic siblings! I hope I've made a reasonable point.
Thank You, Robin Rabenschlag San Antonio, TX.

Date: Tue, Dec 16, 1997 7:48 PM From: To:
I don't think that the individualistic society in which we live is in any position to take a consistent position on multiple births. If it frowned on them, with the physician as its "operative" tool, consistency would demand that it have similiar positions on births that were ordinally separate, on parental responsibility, on a host of "Brave New World " issues, etc. But the key, and thankfully that for now, is that we live in an individualistic society and I see little evidence that society has some collective notion, conscience, or will, in this regard.

Wednesday, October 11, 2006

A Role Playing Exercise: Terminal Illness and A Disbelieving Family

The case is that of a elderly mother, in her 70’s, who was found several months ago to have cancer of the pancreas. Unfortunately, cancer of the pancreas especially in the portion called “the tail” has no symptoms or signs that it is present until it is large and spreading. This lady’s symptoms started first with mid-back pain but by the time the cause of the pain was diagnosed, the cancer had spread to other parts of her body. She had seen several cancer doctors and was recently hospitalized and had radiation therapy to the main cancer. Some doctor had told the patient and family, that after the radiation, surgery would be performed. However, when the surgeons examined the patient, they told the patient and family that there was no surgery that could be done. The family, consisting of two sons and a daughter, then tried to get other surgeons to evaluate their mother but none would accept consulting on the case because of an impression by the history that the patient was terminally ill. The family then arranged to have the patient under the care of another general physician and the patient was transferred to that physician’s local hospital. When this new physician reviewed the history and examined the patient, she realized that the patient was now dying from her cancer and probably wouldn’t live more than another week or two. The patient was now sleepy and confused because of her disease and pain medication and did not have the capacity to make her own decisions. The current physician told the family that the patient was dying and there was no further treatment for the cancer available and she should be given comfort care in a hospice environment until she died.

The entire family disagreed with the prognosis and pointed out that they were told that surgery was to be done after the radiation. They refused to believe that no further treatments for the cancer could be performed. They wanted “everything done” and insisted that cardio-pulmonary resuscitation be performed if their mother’s heart stopped. They insisted that the patient be transferred to a cancer medical center in the area. The doctor said she would request the transfer but was uncertain that the cancer hospital would accept the patient for cancer treatments.

Now, role-play that you are a hospital ethics committee member and the physician is coming to you for help with her situation. What would you advise the physician. What more can the current general physician do or say to the family? (By the way this is a real, true life event but the story has been altered enough to protect patient privacy.) ..Maurice.

Tuesday, October 10, 2006

Is it Futile to Attempt to Define Medical Futility?

From my now inactive "Bioethics Discussion Pages" is a topic I first posted in 2001 but the question of what is and who defines medical futility is still being debated.
In fact, there is a view that the use of the words "medical futility" be abandoned. The visitors to my "Pages" expressed their views on the subject below (most recent at the top). What is your definition of the words and who should determine what is futile and what isn't? ..Maurice.

Current medical science and technology has given physicians new tools to treat diseases and to keep patients alive for longer periods of time than would be possible in the past. However, there are times in the management of the patient's illness when the physician finds that further energetic diagnostic test or treatment to attempt to treat the disease or try to prolong life would be futile. A treatment might not be expected to work or an expected outcome would be unlikely, particularly if the resultant quality of life would be considered poor. The treatment might, instead of prolonging life, only prolong a difficult dying. But there is still controversy amongst physicians and amongst patients along with their families as to what futile means and when a procedure or treatment can be called futile. Physicians may find one treatment approach futile but the patient or family member may disagree and deny futility. Occasionally the opposite occurs with the physician resisting discontinuing a treatment. What is needed is some consensus between physicians and the public as to what establishes a determination of futility.

Here is the question:
What represents futililty in medical practice? Under what conditions, if any, is medical treatment futile? Who should decide?


Date: Sat, May 8, 2004 10:17 AM From: To:

Since death is inevitable, it should not be a consideration in dealing with an illness that might inevitably lead to death. The only consideration should be the comfort and dignity of the patient, allowing death or a cure to arise according to the will to fight of the patient, not the family or the doctor. Sincerely, Anthony Edgington. HSA life member.
Date: Tue, Apr 1, 2003 9:52 AM From: To:

From the Aphorisms, "What diet cannot cure, drugs will. What drugs will not cure, the knife will. What the knife will not cure, fire will. What fire will not cure must be considered incurable." Medicine has always had limitations as to what it can and cannot accomplish, and though we can cure many things today that the ancients could not even dream of, despite all of our technology and knowledge, man is still mortal. Even if there is an extremely radical cure for a certain disease, as surgery and cautery certainly were in the ancient world one must consider the patient's chances of success if they receive the treatment, and the quality of life that they will experience post treatment. It is the patient's decision; of course, in the end, but as a physician one must give the patient an honest assessment upon which he can predicate his decision. Euthanasia is derived from the Greek, "good death". The good physician realizes when the limit of technology has been reached, that further attempts to save life are futile, and at that time the role of the physician changes from trying to save or prolong life, to trying to provide the best possible life for the patient in those days that remain. By no means should this be looked upon as abandoning the patient, but rather giving the patient an opportunity to die at ease with himself and the world, rather like Socrates drinking the hemlock and dying surrounded by his students and friends, at peace with his life and his mortality.
Date: Mon, Mar 31, 2003 7:51 PM From: To:

What represents futililty in medical practice? Under what conditions, if any, is medical treatment futile? Who should decide?

I think that it is important for doctors and patients alike to remember that doctors are just people doing the best they can to help. The power a doctor seems to have over a patient's well-being and life gives him a god-like status to the patient, but it is important to remember that doctors have no mythical powers; only study, preparation, skill, and perhaps intelligence separates the doctor from the patient.

It is important to remember that in the ancient days, there was no way to certify doctors and make sure that their medical skills were effective at all. We should be thankful that there is schooling for doctors today so we can have some idea as to whether or not they will be effective, but still it is important to remember that doctors are not gods. In ancient days in Greece and Rome sometimes doctors would combine their practice with religion, claiming to cure people by the power vested in them by the gods.

Many advancements have been made in medicine since ancient times and modern medical practices have deleted a good deal of the inneffective methods of old cures, but human beings are still made the same today as they have always been and all humans must be obedient to the laws of science.
Date: Mon, Jul 23, 2001 12:40 PM From: To:

There are scenarios where treatment is futile. Quality of life is a major factor in determining whether an individual with no prospects of achieving or regaining a minimal quality of life should continue to receive medical interventions that will do nothing more than mandate a marginal existence. While the issue of what level of quality should be left to the patient or the patient's surrogate, there are levels where medical professionals providing the care should be able and willing to say "no" to requests for additional care. When you have had to watch a family "pray for a miracle" while the medical staff is asked to provide care that they recognize is futile, there is a duty to act on behalf of the staff caring for that patient. Ignoring the economic issues, the emotional impact on the providers of having to continue to provide care, having to provide CPR on a patient having to use drugs to maintain the blood pressure to maintain a body that is so marginal is immoral. The medical profession must make those decisions.

Date: Fri, Jun 1, 2001 6:42 PM From: To:

Futile medicine promotes death. If the person wants the treatment the doctor can refuse to give by reason the medicine is futile. If the patient chooses to die its okay for that. I think futile medicine theory is a bad one.

Date: Sat, May 19, 2001 7:40 PM From: To:

Up to this day, to my opinion, there is no way to determine criteria on "medical futility" since it encompasses many different fields. A.o. Family's expectation (which is inflenced by level of education, culture, and beliefs), economic factors, and medical statistics. So to stop any "futile" medical treatment must be decided individually. This is part of "the art" of bioethics.

Tuesday, October 03, 2006

Do As I Say, Not As I Do

From the October 4, 2006 issue of ”The Australian” is an interesting article regarding Australian doctors and the issue of whether the doctor should follow health practices that they preach to their patients. Should an overweight doctor counsel overweight patients about their weight? The article also presents statistics from the Royal Australian College of General Practitioners that suggest that doctors have their own problems which need attention.

  • 57 per cent of general practitioners did not have their own GP, with 12 per cent nominating themselves
  • 55 per cent undertook only low levels of exercise (compared with 38 per cent of the general population)
  • 64 per cent had a post-vaccination test for hepatitis B, although almost half had a needle-stick injury in the past year
  • 90 per cent had self-prescribed antibiotics, 30 per cent sleeping pills, 6 per cent opiate painkillers and 3 per cent antidepressants
  • 26 per cent suffered from a medical condition warranting a medical consultation but felt inhibited about consulting a doctor
  • Up to 25 per cent would treat themselves or not seek treatment for conditions such as alcohol and drug abuse or excessive tiredness, and 45 per cent for insomnia or sexual difficulty
  • 19 per cent of doctors reported marital disturbance
  • 18 per cent emotional disorders
  • 3 per cent alcohol problems and 1 percent drug abuse.

A sad state of affairs for Australian GP’s; I doubt it is much better for United States physicians. One argument about whether the physician should counsel a patient with the same health issue as the patient is that the physician may have true empathy with the plight of his or her patient and this could be beneficial for the relationship.

Would you rather have an obese doctor talk to you about your need to loose weight or would you feel more comfortable if the advice came from a slim, trim physician? How about cautions against smoking by a physician who smokes? ..Maurice.