Restoring Meaning to "Selective Reduction"

This article is disturbing. And that’s why you should read it. The euphemism “selective reduction” will become more and more common (see here and here), so let us not forget what it’s referring to:

[O]f the three embryos that were implanted, all three took. We were faced with the news of triplets. I was shocked, knowing the burden that would entail, but since G-d gave us three, I was prepared to do whatever I needed to do to help, manage, and provide.

My wife? Something snapped. She insisted that we do a "selective reduction" from three to one, or else she would have a full abortion. She was adamant. She would not carry three. She would not carry two.

I was presented with a Coventry-esque decision: save one, or save none. I chose the former, though I tried on several occasions to convince her to at least keep twins. I failed…. My mantra became "Save one, or save none."

Before the procedure, my wife's eyes teared up; she asked the doctor over and over if they would feel pain, and was assured they would not. I asked again if my wife was sure about this because once done, it could not be undone. She said she was sure, but her tears and her looking away from the screen, deliberately, and her wanting me to not look either, told me the truth: she knew as well that this was wrong….

My wife didn't look, but I had to. I had to know what would happen to my children. I had to know how they would die.

Each retreated, pushing away, as the needle entered the amniotic sac. They did not inject into the placenta, but directly into each child's torso. Each one crumpled as the needle pierced the body. I saw the heart stop in the first, and mine almost did, too. The other's heart fought, but ten minutes later they looked again, and it too had ceased….

[T]hat emotional scar will ache my whole life. I see my child's smile every night and anticipate a new one in some months...but I think of the two smiles I will never see. Every day, returning from work, I hear "Hi Daddy!" and know there are two voices and two giggles that I will never hear. I play with and cuddle my child, looking forward to the same with the second...but I know there are two sets of hands that will never touch mine, two sets of toes that will never be counted, two hugs that will forever be absent from my arms.

This is what the dehumanization of the youngest members of our human race leads to. As the author notes, euphemisms ease guilt and make it possible to rationalize such decisions for the sake of easing the difficulties of parenthood. But in the end, which is truly easier: raising triplets, or dealing with this knowledge for the rest of your life?

I urge you to read the full article and pass it on.

(HT: Joe Carter)

Comments

[Trent]

Why can't we do that with adults and call it culling the herd? Same thing. Treating humans like farm animals to be bred.

[JDawn]

12 years ago my best friend came to me in tears as she had just found out she was carrying triplets. She was shocked and scared but never hesitated to bravely carry and delivere all three. Ladies from our church came in shifts for the first year to help this young couple care for their infants. I look at these three boys now and wonder how anyone could choose to do anything but carry and love them. Thanks for reminding me of the bravery of my friend and her husband.

[Lawrence Marquez]

I wouldn't wish this kind of agony on my worst enemy. Can't imagine how heavy a burden it must be.

[Stephen]

Ditto, Lawrence

[Brad B]

This dilemma would never have come to these people had they not intefered into Gods territory by going to extremes to become pregnant. They obviously were not prepared for the consequences of the actions they took. This occurrance is not rare at all, in fact it is common that more than one embryo will "take". Nevermind that the invitro fertilization process left many embryos with little chance of implantation and even less chance of "taking".

This is a man made mess.

I dont lack sympathy for those in this mess, the desire to be parents is strong, but I'd rather that they lament not having children than that they lament having to kill some to save one.

[.]

Here's an interesting question as a corollary to the situation in the article: how does this relate to the decline of the man's role as husband/father/protector in marriage?...

[David G]

Brad B;

I strongly dislike your statement about 'not intefered [sic] into Gods [sic] territory by going to extremes to become pregnant'. I suppose you'd probably argue that we should not use antibiotics or vaccinations, because they interfere with 'Gods territory' of healing, right?

It sounds like you've never met, or been, someone who's been faced with childlessness.

[Bennett]

David,

Agreed. God commanded us to "be fruitful, and multiply." I don't see anything in Scripture to suggest that he'd condemn using medicine to help that. However, I will say that if a couple chooses IF, they have to be prepared for one of these multiple pregnancies. Don't go in thinking that you can dictate what God's going to do with all those embryos. Go in with eyes open, ready for several kids, or one, or none. Just like I'd hope you would with an ordinary pregnancy. Otherwise it really is "playing God."

[Brad B]

"It sounds like you've never met, or been, someone who's been faced with childlessness."

No, that would be wrong. But even so, are you then arguing that the desire to have children should be quenched by an extreme measure that included the high probability that the intentional killing of embryos would be the cost?

As far as the vaccination issue, Bennett said similar to what I would say. He owns the womb and opens and closes it at His pleasure, and yet at the same time gives approval to use the plants and medicinal remedies.

[Moe]

I think in all things..in all areas of our life..we are to seek the Holy Spirit and ask. If God says no then do not..but if He says yes then pray and get ready. He has a plan either way! This woman will have to face her decision at some point and it will not be a easy thing! But isn't that one main reason Why God gave us His son..so we can have hope in our worst mistakes.

[jennifer wingo]

To the father who wrote this, you are not alone. My heart goes out to all of the unborn. no doubt on judgement day when we ask why a prayer went unanswered, the Lord will say, " I sent the one to answer and you killed them before birth."

[Richard Wedderburn]

I was just here thinking as I read the article and I could understand the pain and the guilt that the man had to endure,but we can't deny in this case that we clearly have a couple who got what they asked God for, and for lack of faith in God's providence and provision, or fear,they rejected the fulness of God's gift to them--and they did it knowing that it was wrong. Some of us may see the simple sin in that but it's actually more broad then that. Whether it was inadvertently or not,they mocked the fulness of God's gift,they lacked belief and faith in His promise to help them through(or else they would not have minded keeping the whole three). They mocked God altogether by going through with the procedure,knowing already that they would face guilt of murder. They refused to stop the procedure and worst of all,they tried to sugar-coat it by asking the surgeon if the killing would be painful as if they really felt compassion for destroying the two altogether--Come on! Is this for real? As if the procedure of stopping their hearts was more painful for them than the killing itself. This is an outright deprivation of life for the two children who could have lived complete and successful lives--who knows? Here's the uncomprehendable spiritual reality: God gave them the gift already knowing that they would reject the fulness of it! Whoa! That's serious. There are people out there who want children and can't have them at all,and this couple mocked all that. How will God respond? He'll forgive them but it comes at a high cost!

[Ken Crawford]

To those who argue IVF is moral because it's medicine, I'd like to clarify what makes IVF different than most medicine and even other forms of medical help in having a baby.

Most medicine is in the business of repairing the human body. Get rid of the illness. Heal the wound. Generally trying to make body whole. Even organ transplants are using the body, someone else's, to repair ones own.

IVF has the purpose of SUBSTITUTING for the natural process, not repairing it. There's no desire to repair the natural human process.

So while hormone replacement or surgery to repair the womb are all things that just about everyone from Atheists to Methodists to Baptists to Evangelicals and Pentacostals to Catholics can agree on as solid, worthwhile medicine, IVF is something different.

[Steve Abernathy]

My heart aches for the father and mother in this terrible story. Should any of us forget Mathew 7:1-5 in our observations of whether they were "playing God" in creating the children, or in taking their lives? God forgives. And He can not be mocked. Galatians 6:7

[becky swensen]

No one needs to be childless. There are scared pregnant teens and young adults who would love to know that a loving family would be willing to adopt their baby. God is able to give you a love for another child that will match the love of your birth child.
Do a little research and ask God for his leading to bring it all together.

[Steve]

When that "saved one" finds out that there were two others beside themselves, I fear for the emotional, and yes spiritual crisis that ensues. And the mother and the father will be called to account.

[Bennett]

Steve,

Speaking from experience, you are most likely correct.

[RonH]

Each retreated, pushing away, as the needle entered the amniotic sac.

What, they said: Uh oh! Here comes trouble?

How?

RonH

[Bennett]

Ron,

Dead baby jokes. Really?

[Austin]

I'm with Becky here. While I can understand a desire to conceive biological child, if it is unsuccessful, adoption should be the first alternative. My little sister is adopted from China-- she was abandoned on the side of the road by her father as a toddler. There are millions of children in the world who are forced to fend for themselves, grow up in an abusive foster care system or else die.

If my future wife will agree, I would not be upset to only adopt and never conceive, though I understand it is unlikely that she will. Either way, I plan to adopt and would encourage everyone else to do the same whether they choose to also have biological children or not.

[Christine Barney]

Years ago, before Roe v Wade, we marched, did mailings, phoning, etc. One speaker that we listened to said "Today, they call it tissue and cells, but if it is made legal to abort, the day will come when they will say it is a human being and we don't care." The next thing to come is post-abortion, giving the parents the right to kill their baby right after birth. I am angry at the Church for not speaking up against this evil. Where were you? Please forgive us God.

[RonH]

Bennet,

The joke is about the fiction of the story.
Really.

RonH

[Gabriel]

Ron,

How do you know it was fiction? If you saw for yourself that a baby moved away from the needle that was going to kill it, would you argue? I think you would, if only to justify something in your own mind. Watch a video of a abortion being done on ultrasound. It may make you think twice about your comment.

[Bennett]

Ron,

I'm not sure how it entered your mind that infanticide--even 'fictional' infanticide--is a subject for levity. If you have an opinion on this matter (and I have no doubt that you do, as always), it might be best to state it seriously and offer serious reasons, rather than pop off. Time and a place for jest, and this one ain't it. Any good comic considers his audience.

[Amy]

Ron, it's unclear to me whether you're saying the whole story is a fiction (based on...?) or if you're saying the responses of the children were a fiction. If it's the second, the article does not say they said, "Here comes trouble," the article says they tried to escape the needle. If you'd like to see an example of this happening for yourself, you can go to YouTube and watch an ultrasound of an abortion. But I'm curious, why would you think that wouldn't happen?

[Matt]

Let's turn our energy to pray for this family. That God would help the parents to see the depth of their sin, that they would repent and be reconciled. Let's pray that the living child knows Christ. And that reconciliation and grace can come from this story. They may have known they were doing something wrong when they had the procedure but God can use this for our good and His glory by bringing to light the seriousness of what "selective reduction" really represents-murder. We are all sinners, and all need God's grace desperately. We're not above these parents so we mourn with them, and we also learn from them so that we can honor God at deeper levels of commitment.

[RonH]

Hi Amy,

Reduction is usually done at around 10 weeks. The part of the story I referred to doesn't line up with this video of a 10 week fetus.

Supposing that problem somehow solved, the story sounds to me like (not very good) fiction. Your mileage may vary.

If, by baring this scar for others to see, I can prevent an abortion...

That's clearly what he (if it is a he) is trying to do. Well, some have gone much farther than making up a story to prevent an abortion.

You call 'reduction' a euphemism.

I grant the term has that result and that result is probably often intended.

But to simply say 'abortion' instead would incorrectly imply that the pregnancy ends.

Does anyone know what the writer means by 'Coventry-esque'?

RonH

[Brad B]

RonH, I found this:

"Noun 1. Coventry - the state of being banished or ostracized (excluded from society by general consent); "the association should get rid of its elderly members--not by euthanasia, of course, but by Coventry"

that might answer your question. Anotgher euphemism to minimize the seriousness of the procedure.

[Amy]

Ron, you can watch the 12-week abortion that's available online to see the baby's reaction to the invading instrument. And certainly, by 10 weeks, the baby is already moving around. I don't see why you think that's incompatible with the story.

On fetal reduction:

Fetal reduction is a transabdominal procedure performed under ultrasound guidance. A needle with potassium chloride is injected into the thorax of the targeted fetus(es). It is done between 10 and 13 weeks gestation, and is usually performed on 2 fetuses at a time.

Twelve weeks is certainly within that.

Why else do you find it sounds like fiction to you? Because it's disturbing? Because it agrees with our opposition to it? Would you similarly distrust a story about a person who had a "reduction" and was happy about it? I've posted testimonies on that before, and I don't recall you protesting them as false, even though the stories were clearly told in order to persuade that what they did was fine--i.e., that's what they were "clearly trying to do."

[RonH]

Amy,

Which video? I showed you one.

Moving around is not the same as 'retreating'.

Answers to questions in last paragraph. No, no, and depends on whether the story sounded.

I've posted testimonies on that before, and I don't recall you protesting them as false, even though the stories were clearly told in order to persuade that what they did was fine--i.e., that's what they were "clearly trying to do."

So?

RonH

[RonH]

Correction: "depends on whether the story sounded..." like it was made up.

This gets to the other question: Why else...?

It's something about the way the story is told. I suspect we could go back and forth for a long time on this without conclusion. I accept that the story rings true to you.

I don't accuse you of believing it because it suits your purpose.

Do me the same. Please.

RonH

[Amy]

You showed me a video of an ultrasound of an undisturbed baby, not a video of an abortion. Look it up. Also, according to the article I just linked to, the babies in this story might have been three weeks older. Here's a video of fetal development at that stage (not a pro-life site). It's active and kicking. Could easily move away from things.

"Retreating" is merely "moving away from." All that's required for that is the ability to move away from something that's moving towards you.

So?

I'm merely pointing out the inconsistency. You can do with it what you will.

[Daron]

Reason and Evidence RonH strikes again.

To tell the truth, this account does feel to me as well like one of those fictional accounts conglomerating the experiences of others.

I hope you enjoyed that contentless bit of subjective autobiography.

[Daron]

RonH says "How?".
How and when babies can respond to stimuli:
http://www.deathroe.com/baby_development/

[RonH]

"Retreating" is merely "moving away from." All that's required for that is the ability to move away from something that's moving towards you.

Can't you retreat even if it's not moving toward you?

People say 'flood waters retreat' but in this case we are talking about active retreat for a reason.

Each retreated, pushing away, as the needle entered the amniotic sac.

And I think you knew that.

RonH

[Amy]

Yes, they actively retreated (moved back from) something that was approaching them. Fetal humans respond to stimuli, and they're agitated when something intrudes into their space. I think I might be misunderstanding what your issue is, because I can't see the problem you're having with this.

[Daron]

Each retreated, pushing away, as the needle entered the amniotic sac. What, they said: Uh oh! Here comes trouble?

How?

Babies don't learn to speak until many months after birth.

I think you knew that.

[RonH]

Amy,

I read the story to my commuting partner. I just said I want his take on this story. That's it. I read charitably. He laughed at 'retreat'. He said it was well written. He said it might be 'pure propaganda'.

The fiction option better explains the doctor's lie about the injection. It's intentional malpractice.

The fiction option better explains the couple's disagreement on what to do about multiple pregnancy. Most, if not all couples would know about the possibility of multiple embryos implanting. Counselling would cover the topic. The question is likely asked explicitly in counselling: How would you feel about twins? Triplets?

RonH

[RonH]

Brad B,

Thanks for the info on coventry. I gave up too easily!

RonH

[Bennett]

RonH,

I have to say, your explanation has been somewhat enlightening.

[Daron]

The fiction option better explains the couple's disagreement on what to do about multiple pregnancy.

No it doesn't. This is not a rare disagreement:

One of Stone’s patients, a New York woman, was certain that she wanted to reduce from twins to a singleton. Her husband yielded because she would be the one carrying the pregnancy and would stay at home to raise them. They came up with a compromise. “I asked not to see any of the ultrasounds,” he said. “I didn’t want to have that image, the image of two. I didn’t want to torture myself. And I didn’t go in for the procedure either, because less is more for me.” His wife was relieved that her husband remained in the waiting room; she, too, didn’t want to deal with his feelings.

http://www.nytimes.com/2011/08/14/magazine/the-two-minus-one-pregnancy.html?pagewanted=all

Since there are multiple doctors involved along the way it is very likely that parents have not been faced with their choices or discussed the chances of multiple fetuses. It is only when faced with them that the issue is considered.

Because it's three different people, and everybody does their job to the best of their ability, but we don't really communicate too much with each other and the parents prior to the whole thing happening ... and [we] cannot make sure that what we say is being heard.

http://www.pbs.org/wgbh/pages/frontline/shows/fertility/interviews/katz.html

In fact, this doctor admits that his patients have not faced the issue prior to the implantation:
So on one hand, you don't want to be the "bad news bear" telling them, "This is what you're going to face, and here you are very happy." On the other hand, you want them to face reality. Maybe it's a little late, but this is something that needs to be dealt with ... that the biggest enemy, by far, when you deal with multi-fetal gestations, is prematurity. I give them a short description; we have some literature.

...

I know that from meeting with these couples, many times they call me Dr. Doom at the beginning, because all of a sudden they are faced with the first sign [of] bad news, which are the truth and reality. When you are out there and trying to promote an industry, there is a natural tendency to maybe underplay, under describe the downside.

Number two, the infertility doctors don't really deal with either the selective reduction and/or the prematurity later on. Their job is to get the patient pregnant. They are responsible for that particular part.

The fiction option better explains the doctor's lie about the injection.

No it doesn't. Since the procedure can involve injecting either the baby itself or the cord (as the father said he had expected) this also explains, without going to the whole-cloth invention of a fictional account, the father not knowing how the doctor was going to proceed.

Regarding a different issue, the doctor says of his patients' misinformation:

I definitely believe she should have been. I'm almost sure she got it. I'm certain that when she said she did not get it, that she does believe that she did not get any information, because of maybe the way we give it. You just don't hear certain things that, at the time, you're not open to accepting.
...
And still sometimes they just don't get it until it hits them. Even then, they think I was maybe a little too optimistic in my description. So I'm almost sure that we talked to them, but we don't verify that they heard us. I'm not sure exactly how to do it, but it is a known phenomenon that you don't always hear what you're told.

[Bennett]

It seems as if there is reason to believe that it is or is not a veridical account. But there are no independent witnesses, no other sources corroborating. So we really don't know for certain. That said, if one is uncertain as to whether a thing is fiction, I should think that investigating it more thoroughly would be a more rational course than mocking and rejecting it out of hand. Particularly when it is a sensitive matter. I think the way we read this tale is telling us more about ourselves than about "selective reduction."

[Daron]

As is often the case, Bennett.
I personally read the account and am not convinced that it is true. Every fact mentioned comports to reality (as a person will find if they read any message boards where people are talking about their experiences) but there is something in the writing that leaves me doubting.
What does this say about me? For one, I am generally skeptical and don't like being fooled. I am always slow to grab at unverifiable claims.
In an effort to be the one who is not fooled I often fool myself (Amy knows).
But since everything in the story is plausible and is an experience shared by many others, all I have is a feeling.
In place of that feeling I'd rather have reasons and evidence if I were going to call the writer a liar and make tasteless jokes. Especially if I claimed to be extremely rational.

[Daron]

Gestation ages at the time of reductions (10 weeks is low):
http://www.fertilethoughts.com/forums/selective-reduction-termination-due-health-issues/711077-what-week-were-you-when-you-had-sr.html

[Daron]

Partners who don't agree:
http://www.fertilethoughts.com/forums/selective-reduction-termination-due-health-issues/704375-thoughts-husband-who-wants-me-reduce-twins-singleton.html

[RonH]

Hi Daron,

Thanks for your response.

This is not a rare disagreement

Your Dr Stone example doesn't apply as far as I can see - not IVF.

The other (fertilethoughts) does apply.

But notice but that woman does say, "We did have a conversation pre-transfer, and I did say if this happened, I probably would reduce, but could not promise."

And, you need more than one or a few counter examples to show that something is not rare.

I think most couples in the general population are not in extreme conflict on reduction/abortion. Strong disagreement should be rarer among IVF couples - for the reasons I gave.

infertility doctors don't really deal with either the selective reduction and/or the prematurity later on

Not discussing the risks is failure to obtain informed consent. Do doctors sometimes fail in this way? Yes.

Do some patients fail to get the message even when the doc sends it? Yes.

So, if you grant one of these things must have happened, then the true story interpretation can accommodate this objection. You'll get no argument from me there.

RonH

[Daron]

And, you need more than one or a few counter examples to show that something is not rare.

Only if you're going to try to use some kind of statistical measure rather than a little commonsense.

I think most couples in the general population are not in extreme conflict on reduction/abortion. Strong disagreement should be rarer among IVF couples - for the reasons I gave.

You need more than your gut feeling about what you think should be the case.

These are exactly the kinds of things that people do not have whole-hearted agreement on and where communication breaks down or grudging compromises are met.
I think it would actually be far more rare that two people agree completely and are both at total peace with such a decision.
Google something like "disagree spouse family size" to see how often people disagree even without throwing in the moral dilemma of having to selectively eliminate your own children.
http://www.google.ca/search?client=safari&rls=en&q=disagree+spouse+family+size&ie=UTF-8&oe=UTF-8&redir_esc=&ei=dHBbT5HACpDViAK3hJ2lCw

Your Dr Stone example doesn't apply as far as I can see - not IVF.

What's that mean, "not IVF"? Those are exactly the people he is talking to and about. And when he meets them to talk about the risks of multi-gestational pregnancies he says that it is better late than never. I spent a couple heart-breaking hours last night reading conversations on forums about "reductions" and almost everyone saying something relevant on that point described finding out the dangers of mgp after they found out they had twins or triplets, and when the doctors started suggesting reductions. Many mention having heard about the risks early on, but how, as IVF patients they never considered them real possibilities. Because they had such poor chances of getting pregnant they thought they would be fortunate if one embryo was viable, never considering that three or more would take. As IVF patients they are more prone, not less, to have unsettled feelings on these matters (and therefore not have full heartfelt agreement) as they are acting out of a sense of urgency and desperation in the first place.

[Daron]

Oops.
My apologies, I confused Dr. Katz' examples of deciding late what to do about multiple babies with Dr. Stone's example of a husband not wanting to watch the ultrasound of his children being killed.

Regarding Stone's patients, who said that they were not an IVF couple (as though that would make this an apples and oranges situation anyway)? The entire piece is in the context of couples who have had :
" ... years of fertility bills, ovulation injections, donor eggs and disappointment — and yet here she was, 14 weeks into her pregnancy, choosing to extinguish one of two healthy fetuses, almost as if having half an abortion. ""

and
'""“Most of the two-to-one patients have gone to incredible lengths to get pregnant,”""""

and
""Plenty of infertility patients who conceive twins are ecstatic from the start about getting a two-for-one deal; some studies indicate that the majority of I.V.F. patients prefer twins.""

and
""For all its successes, reproductive medicine has produced a paradox:""

And in that context:

Sometimes, she says, couples disagree about whether to reduce a twin pregnancy, and she encourages them to see a therapist so they can be at peace with whatever they decide.

[Daron]

""Only if you're going to try to use some kind of statistical measure rather than a little commonsense.""

By this I mean that you will demand a likely non-existent statistical study of how often parents are in agreement, and then set some arbitrary level for what it means to be "rare".
I oppose this kind of gerrymandering with true examples of people who disagree, reasons why agreement is not expected to be 100% and the commonsense knowledge of people to know that disagreement is not so rare or unexpected to tilt in favour of the piece being fictional. Fabrication is not the better explanation for their disagreement. Not by a long shot.

[RonH]

'Rare' IS a statistical measure.