The article titled "Too Much to Carry" posted on washingtonpost.com is a difficult read. The author, Liza Mundy, spent time with a doctor who performs "selective reductions" for women who are pregnant with multiple fetuses. To improve the chances of a successful birth of one or two of the children, the weakest one (or ones) is eliminated, or the one with a genetic abnormality, or the one most conveniently located, or the one who is not of the preferred sex.
The article is heartbreaking in terms of the women who go through this, and even more disturbing in terms of the babies who are singled out to lose their lives. Here's how one decision went that day:
The test results for Jane and Emma stacked up like this: A: XX, B: not tested, C: XY, D: XX. Two girls, one boy, one unknown. The known ones all normal. And so, for this last reduction procedure of the day, one decision had been made. Evans would reduce B, which was most accessible. As for the other one, he told the women they could have two girls -- that is, he could keep A and D -- or they could have a boy and a girl, in which case he would keep C and one of the girls. "If you want one of each, I'll keep one of each," Evans told them. They wanted one of each....
He injected the potassium chloride, and B, the first fetus to go, went still. "There's no activity there," he said, scrutinizing the screen. B was lying lengthwise in its little honeycomb chamber, no longer there and yet still there. It was impossible not to find the sight affecting. Here was a life that one minute was going to happen and now, because of its location, wasn't. One minute, B was a fetus with a future stretching out before it: childhood, college, children, grandchildren, maybe. The next minute, that future had been deleted.
What makes this all the more difficult to read is the fact that all the children were purposely implanted in the women by their choice and with their greatest hopes. All of this heartache, the choosing of who would die, and the death itself could have been avoided if the women had only implanted what they would be willing to carry to term. (The financial cost of failure is a small price to pay in light of these considerations.) But reading the account of the women's reactions throughout the article, I suspect that in their eagerness to be sure that at least one embryo implanted, they weren't thinking carefully ahead of time about what "selective reduction" would mean when they had to face it in reality.
One woman described what I know would haunt me if I were ever to go through this:
"Now that I know my two daughters, looking at them, I think: It could have been you," she continued. "You terminated an embryo that could have turned into a baby you would love as much as the ones that you have, and that's hard....
"I could have ended up with one of these being gone, and the one that is gone could have been one of these."
Heartbreaking...to say the least! We have 6 year old twins...although, during the pregnancy, the twins health was never questionable, we were still given a "talk" on selective reduction Since they were perfectly healthy, why?
Posted by: Jeff T | May 23, 2007 at 09:55 AM
That's why there are such antiseptic terms as 'selective reduction'. It takes the focus off what you're really doing.
Posted by: Mo | May 23, 2007 at 10:11 AM
"(The financial cost of failure is a small price to pay in light of these considerations.)"
What if a failure would leave them unable to undergo another procedure? Would not all of the embryos then go to waste? Would you favor universal health coverage that would cover the procedure, allowing the kind of implementation you would favor?
For those who didn't follow the link (shame on you!) here is another quote:
"The average triplet is born two months premature, significantly raising the risk of disabilities such as cerebral palsy and of lifelong damage to the infant's lungs, eyes, brain and other organs. By reducing the pregnancy to twins, the woman and her husband would decrease the risk of severe prematurity. And the risk of losing her entire pregnancy would fall from 15 percent to 4 percent."
Sometimes hard choices have to be made. In the case below would it have been better to have lost all four?
"In 1984, Evans says, he was contacted by an ob-gyn who had a patient pregnant with quadruplets from fertility treatment. The patient, not even 5 feet tall, was too small to carry four babies to term. The doctor saw no solution but to abort them. The woman, unwilling to sacrifice a pregnancy she had worked so hard for, asked whether it might be possible to do a "half-abortion." The way abortion is normally performed, through vacuum suction, this would not be possible, but the doctor called Evans to see if there might be another way.
'I don't know if it's possible, but I know how I would do it," Evans replied. The woman was sent to Evans, who, as he puts it, stabbed two of the fetuses with a needle. "Not an elegant technique," he acknowledges. But it worked. "I reduced four to two," he says, "and the two are in college right now.'"
Another thing to think about is that not doing selective reductions might well lead to fewer IVF pregnancies. I knew a fellow whose wife had triplets - the delivery bill was $80,000. That was just to start. Facing that possibility with our current health care system might tip the balance towards deciding not to begin the process.
Rather then waxing sentimental and using your energies to pass criminal laws, why not take a look at how our current social policies contribute to this?
Also this from "feministing" might be interesting;
http://feministing.com/archives/007065.html#comments
(copy to this line to link)
Posted by: alan aronson | May 23, 2007 at 10:58 AM
Has anyone seen the movie Gattaca?
This seems insane to some of us, but unfortunately it is a logical next step after a society accepts abortion.
Posted by: Lars | May 23, 2007 at 11:04 AM
>>Sometimes hard choices have to be made. In the case below would it have been better to have lost all four?
It would be better to implant the number of embryos you're willing to carry to term and then care for. Sometimes hard choices have to be made. Better to lose money than to put yourself in a position where you "have to" kill your child.
Posted by: Amy | May 23, 2007 at 11:08 AM
Alan,
There are a number of IVF practitioners who will only attempt to conceive and implant the number of humans that the mother is able to safely carry. I spoke to one at a medical conference last July who was forced to resign because her practice was decreasing the "success rate" from the IVF clinic. The pregnancy rate of IVF clinics are frequently included in their advertisements (a fact I included in my post at the Life Training Institute blog).
Your comment about the cost of birthing triplets is quite interesting. First, all of these couples went through the costly process of IVF. Are you saying that these couples are willing to pay to conceive a child but not willing to finance the birth of the same?
The bottom line is this - IVF is a completely elective procedure that entails significant risk to the mother and, even more so, significant risk to the lives that are created through the process. As a health care professional, I see cases in which there are hard decisions that are the result of what occurs naturally. In this case, the decision to kill one's child was predicated on a previous decision to have one at all costs. That is very unfortunate.
Serge
Posted by: Serge | May 23, 2007 at 11:32 AM
Hi Amy, I don't believe you read the story closely. The woman was carrying quads due to fertility treatments not IVF and with such treatments quads and worse are common and unavoidable. Given the woman's size she likely would have lost all four perhaps at some risk to her. Walk a mile in those shoes first.
It's easy to recite mantras but would you back changes in our health care practices and polices that helped eliminate the things you object to?
Hi Serge, does your colleague's implementation practices foreclose the process to some people due to financial considerations? In that case are there not less babies than we would otherwise have? Would we be a better society if we just covered these things?
One of the other things not mentioned is that the majority of parents with disabled kids wind up getting divorced. I'm not willing to require others to gamble everything on a theological notion.
One lesson I generalized from a field botany class I took long ago was that if one winds up in a problematic section of the key relative to the plant in hand, one probably has erred in ones initial assumptions. That concept works quite well in life and certainly in doing public policy.
Posted by: alan aronson | May 23, 2007 at 12:03 PM
People could adopt babies rather than try to get pregnant through something like IVF. I realize not being able to have one's own child could be hearbreaking, but that doesn't mean people ought to go through all the accessible means to have one's own child. Furthermore, it's heartbreaking how often people are unwilling to adopt another person's children.
And although some of you still will be angered by what I say, and this doesn't influence whether or not I'm correct in what I said, I will point out that I have had doctors guess I will not have children easily. I am not saying what I have as someone insensitive to the desire to have children. I want children someday, but I have health reasons to cause me a fair amount of suspicion that even if I marry in time to be young enough to bear them I won't be able to have them. So I just pray that God will heal any emotional wounds with time, give me great love for motherless children, and use my maternal drives in other ways in His kingdom.
Posted by: L. | May 23, 2007 at 03:51 PM
and furthermore that He will use any emotional wounds to make me more effective for His kingdom
Posted by: L. | May 23, 2007 at 03:52 PM
>>Walk a mile in those shoes first.
Alan, my post was not written to condemn these women; it's about how heartbreaking this is. You can't read the article without picking that up from them. The reactions of the women going through this is heartbreaking. Even some of them were surprised about how it made them feel. I'm hoping women will think this through ahead of time (about what "selective reduction" really means) before they put themselves in this position, whether that's through IVF or any other fertility treatment.
And thank you for your thoughts, L.
Posted by: Amy | May 23, 2007 at 04:17 PM
Hi Amy , a thought occurred to me today. I can understand the mixed feelings and regret these women feel as they look at their twins and wonder about the one that was killed, however consider this: Suppose they opted not to do selection and the pregnancy went south and they lost all three or four. Suppose one or more were severely disabled. Suppose their marriages had ended over the stress of a disabled child (children). All of these are a real possibility. We can never know how things would have turned out had the reductions not taken place but i would hesitate urging someone to take a significant life risk when I had nothing at stake.
BTW, You never responded to my question on changing our health care policies to perhaps deal with some of these issues. Would you make selective reduction illegal?
Posted by: alan aronson | May 23, 2007 at 08:54 PM
Down under in kangaroo land, the aussie law only permits the implantation of two embryos at a time. A very rational move says me. No need for selective reduction.
But not only do the kids undergo “selective reduction” during the pregnancy, but during a typical IVF procedure as well. The IVF clinic will create several embryos, and of this set, they have lab-specific grading scales with which they choose the best embryos to implant.
i.e. they choose who will live and who will die. Talk about survival of the fittest!
The other embryos are either thrown away or put in cryo. Most of the embryos in cryo in America (about a million to date) are eventually also thrown away. Not to mention the fact that freezing cells damages them to various extents. i.e. putting your kids in cryo may harm or kill them.
Anyway, I’m a little surprised of the Christian’s blasé attitude toward our brave new world of human harvesting and baby freezing.
If I were still a Christian, and really believed that human constructs received their soul from God at the creation of totipotent_1, then I would have a hard time rationalizing the use of IVF. Especially when using the ovums of a women over 30 – that’s old for an ovum. And especially when we live in a world where there are so many kids running around with no parents or crappy parents.
Posted by: tony montano | May 23, 2007 at 09:23 PM
Hey Tony, who pays for IVF in Oz?
http://www.ivf.com.au/pages/dynamic/costs.php
Posted by: alan aronson | May 23, 2007 at 11:38 PM
Tony,
I have addressed IVF in my old blog right here.
http://www.imago-dei.net/imago_dei/2005/08/in_vitro_fertil.html
I believe the blase' attitude of Christians in this area is a result more of ignorance than well thought out arguments.
Alan,
I don't believe we should kill human beings that the government does not pay for. I also believe that we should protect those who are unable to protect themselves. I have no problem investigating health care policies that enable more human beings to have healthy lives - but you will need to be more specific regarding your proposed health care initiatives.
Serge
Posted by: Serge | May 24, 2007 at 07:27 AM
Hi Serge, Australia's national health plan seems to cover IVF which would seem to be a fair offset if only two embryos can be implanted at a time.
I, of course, don't believe we are dealing with persons at the developmental stage we are dealing with at implantation or selection. Human being is simply not a useful term.
This does seem to be an issue where throwing a few bucks at the problem can eliminate it, so why not do it?
There are several models of national health care, all of which perform better on balance then our clunky system. Another reason for political change.
Is it the case that more embryos will always be created then will be implanted? If so, is selection then only problematic in its effect on the parents?
Posted by: alan aronson | May 24, 2007 at 08:22 AM
>>Hi Serge, Australia's national health plan seems to cover IVF which would seem to be a fair offset if only two embryos can be implanted at a time.
Alan, 1) I don't think the government has a responsibility to provide people with children, and I don't think it owes people something just because its laws that prevent situations that lead to the deaths of children are an inconvenience to those people. The government is just doing its job if its creating guidelines for IVF that are safest for all the people involved.
2) I think parents do have a responsibility towards their own children. Create the embryos you're willing to implant and carry to term. If it doesn't work out, then it doesn't work out. Life is not always perfect. We have created such a culture of self-centeredness that we'll do whatever we have to to get what we want so that things are "perfect" for us. Never mind if we have to get rid of a few disabled children if our lives will be better.
Not that I think people have thought this through and decided to do this purposefully. People haven't thought it through because they're focused on their goal. We all need to get outside of ourselves and our demands on life, think about the implications of what we're doing, and accept the imperfections in this life (be it adopting or having a disabled child), protecting the weak, loving the imperfect, and growing through what we suffer for the good of others.
Posted by: Amy | May 24, 2007 at 11:25 AM
"I'm not willing to require others to gamble everything on a theological notion."
If "not killing babies" is a "theological notion," then so is "not killing adults." This is a tired old line you keep trotting out, with no support.
The "theological notion" that causes me to oppose abortion is the same one that causes me to oppose murder, since there is no morally significant difference between adults and unborn babies that justifies protecting the former and allowing the wanton killing of the latter.
Posted by: Paul A | May 24, 2007 at 11:35 AM
Alan wrote: "Suppose they opted not to do selection and the pregnancy went south and they lost all three or four. Suppose one or more were severely disabled. Suppose their marriages had ended over the stress of a disabled child (children). All of these are a real possibility."
So we should allow the killing of two children because of things that *might* happen? "But judge, I had to kill my two toddlers -- what if I lost my job tomorrow and couldn't afford to feed them? My marriage might end! They might *all* die!" Fictional ("what if") anecdotes are not a good basis for law or public policy.
Posted by: Paul A | May 24, 2007 at 11:41 AM
Hi Paul, given a chance at a wager with the odds facing those who carry triplets or quads would you bet your next pay check? If not, how can you ask them to bet everything? Women carrying triplets or more face real problems; all your examples demonstrate is that you won't or can't get that.
Amy, its not a matter of the government "owing" anyone anything, its a matter of people wising up to the potentials of a national insurance base and then deep sixing our inefficient health care system. BTW, every industrialized nation has a national health care system that works better then ours, all factors considered. Is it self-centered to oppose such a system in our country?
I have the impression that there are always more embryos created then are selected for implanting. Is this wrong? Any references for this? Is it possible to fertilize only one or two eggs and then implant them. What if one of the fertilized eggs is obviously problematic, should it be implanted or destroyed?
Posted by: alan aronson | May 25, 2007 at 02:17 AM
Hi Alan,
Sorry for my delayed response...
"Hi Paul, given a chance at a wager with the odds facing those who carry triplets or quads would you bet your next pay check?"
I'm not sure I understand what you're asking me. If the probability of complications due to multiple implantations is so high, why are they having it done in the first place? The likely answer: it's too expensive to implant just one or two and have it fail. So we're back to "it's okay to kill offspring when it becomes too expensive."
"If not, how can you ask them to bet everything?"
They already agreed to the risk when they had the procedure.
"Women carrying triplets or more face real problems; all your examples demonstrate is that you won't or can't get that."
Of course they face "real problems" -- I don't think I indicated they wouldn't. The solution, however, is not to give them a license to kill. If you think it is, when should such a license be revoked?
Posted by: Paul A | May 28, 2007 at 10:48 PM
Hi paul, I'm not opposed to measures that limit the number of procedures to which a person is subjected. That is why i found the whole PBA thing problematic. The high cost of IVF in the United States drives the process and balances risk in a less than optimum manner.
I'd like to see health care reforms that led to IVF being covered as it is in Australia. That way the number of implantations could be managed better. Remember if the risks or costs are too great, fewer kids will be born overall.
I will, of course, never agree that a blastocyst is any more than a potential person. When they are created in a dish they are sorted for fitness and those that don't measure up are destroyed. Even if implantation was restricted there would still be embryos destroyed.
There appears to be common ground here. Perhaps that should be explored?
Posted by: alan aronson | May 29, 2007 at 08:57 AM