As a woman gave birth to octuplets at a hospital near Los Angeles on Monday, she let loose an intense debate about the ethics of megamultiple births.
The six boys and two girls — as yet unnamed — are in stable condition; half are feeding on breast milk and all are breathing on their own. Still, they are by no means out of the woods.
"I don't know any case where some of the children were not severely disabled," Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania tells NPR's Madeleine Brand.
The hospital isn't saying how they were conceived, but it's almost certain that some sort of fertility treatment was involved. This raises a host of ethical questions about fertility treatments and megamultiple births, Caplan says.
The likelihood of physical and mental disabilities are only one downside to such pregnancies. Giving birth to megamultiples is dangerous for the mother, it exhausts hospital resources — it took 46 medical personnel to deliver the recent octuplets — and it's extremely expensive.
Naturally, we want to celebrate birth, Caplan says, but doctors should adapt their approach.
"I think you have to move away from a value-neutral position, which is 'Here's the information: These babies will be at risk, you'll be at risk; here's what you need to decide' to a more directive kind of counseling — similar to what your doctor says if you are smoking three packs at day," he says. "They don't just say, 'You got to decide,' they say, 'You gotta stop.' "
If these babies were the result of in vitro fertilization — where the embryos are fertilized outside the womb and then implanted — and seven to eight embryos were transferred at one time — "it's close to malpractice," Caplan says.
And if fertility drugs were involved, he says the doctors should have been monitoring the number of eggs very closely.
"If you see too many eggs — I think you better advise them, they better not have sexual relations or artificial insemination," he says.
There's also another option that's "terrible and difficult" but important to consider, says Caplan, in terms of managing megamultiples: selective reduction.
"You can sometimes reduce the number of babies by literally ending the life of a couple fetuses in utero," he says. "I think you have to present that option when you see megamultiples. Because you can end up killing the mother and killing every baby."
Beyond affecting a single family unit, megamultiple births are also negatively affecting society, some argue, because of the enormous costs involved.
"The costs will be borne by us all," Caplan says. "You are going to have millions of dollars spent keeping these babies in the neonatal ICU. It's either going to show up in the insurance premium or the Medicare budget of the state. And we can go further and say there is a huge financial cost trying to raise eight babies all at once."
For this reason, everyone has a vested interest in changing the way families and doctors are thinking about fertility treatments, Caplan says.
"It's not cold; it's realistic to say we all have a stake in how this goes ... It's something you want to avoid, not something you want to encourage," he says.
Join the discussion on host Madeleine Brand's blog entry on the matter.