Ethicist: Doctors Should Do More To Avoid Octuplets 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 risky and expensive megamultiple births. Physicians need to take a firmer stance in preventing such pregnancies, one bioethicist argues.
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Ethicist: Doctors Should Do More To Avoid Octuplets

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Ethicist: Doctors Should Do More To Avoid Octuplets

Ethicist: Doctors Should Do More To Avoid Octuplets

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Speaking of risk, there's a lot of it for the mother during the pregnancy and for the babies. The octuplets in Los Angeles are in stable condition in the hospital. All eight, as yet unnamed, are breathing on their own. Half are feeding on breast milk. Still, they are by no means out of the woods. Preemies face a lot of problems. They're more prone to lifelong mental and physical disabilities, such as cerebral palsy. And the story just brings up a lot of ethical questions.

Here to answer them is Arthur Caplan. He's director of the Center for Bioethics at the University of Pennsylvania. And the hospital is not saying how these babies were conceived, but it's almost certain that some form of fertility treatment took place, right?

Dr. ARTHUR CAPLAN (Director, Center for Bioethics at the University of Pennsylvania): Oh, I think that is for sure. The only issue is whether the mother underwent drug treatment that caused her to have many more eggs than the one you normally per months or whether they transferred embryos into her using in vitro fertilization.

BRAND: Do the doctors in these cases have any sort of ethical obligations with regards to the number of embryos?

Dr. CAPLAN: I think they really do. Mega multiple births - seven, eight babies - are, as you pointed out, hugely risky, very dangerous to the mother. I don't know of any case where some of the children were not severely disabled as a result of prematurity or complications. The doctors have to try and do what they can to avoid it. And to be blunt, anybody who would transfer embryos - seven or eight embryos at a time - into a woman, I think, is basically close to malpractice.

And if you super-ovulated a woman using drugs, you've got to monitor that woman very, very closely. And if you see too many eggs, I think you need to advise them they better not have sexual relations or artificial insemination. They're going to make too many babies.

BRAND: So if that took place, if the latter took place, what could they say to the mother and what they can legally do? I mean, isn't really up to the mother whether or not she carries these babies?

Dr. CAPLAN: Hmm. Legally, you can't do much. No one comes in anybody's bedroom and tells someone you can't have sexual relations with your partner. But you have to move away from what's sometimes called a value-neutral position, which is, here's the information, these babies are going to be at risk, you're going to be at risk, it's up to you to decide. I think to a much more directive kind of counseling, similar to what your doctor says if you're smoking three packs a day. They don't just say, here's the facts. You decide. They say, you got to stop.

And there's a further step, a terrible, awful one they have to discuss, but you can sometimes reduce the number of babies by literally ending the life of a couple of the fetuses in utero. It's called selective reduction. I think you have to present that option when you see multiple pregnancy as well.

BRAND: But with selective reduction, can't you just take those embryos in and freeze them, put them on ice?

Dr. CAPLAN: If you have the embryos, and you're transferring them, you don't put them all in. So the way to avoid that is to freeze some of them. If you're doing this give you the medicine, and you make a lot of eggs, and then you look in there, and you think, oh my goodness, you've got seven or eight fetuses now developing. That's where selective reduction comes up. That's a terrible, awful choice, particularly for someone who's trying to have babies and hasn't been able to. All of a sudden, you're talking about you've got too many. We're going to get rid of some of them. But that's part of managing mega multiples.

BRAND: Well, I hate to be really cold about this, but this isn't just affecting the mother or the babies. It's affecting society in general because of the enormous causes involved. And so, shouldn't society have some sort of say when these cases occur?

Dr. CAPLAN: Well, you know, it does affect all of us. And when you're using technology in ways that make children come into the world in ways that were unprecedented, then you have to look out for the kids and try to make - protect their interests. And the costs are going to be born by us all.

You're going to have millions of dollars spent keeping these babies in the neonatal ICU. it's either going to show up in your insurance premium, or it's going to show up in the Medicaid budget of the state. I don't know too many families who can afford this. And then, we can go further and say there's a huge financial cost to try to raise eight babies born all at once. It's not cold. It's realistic. It's something you want to avoid. It's not something you want to encourage. ..TEXT: BRAND: That's Arthur Caplan. He is director of the Center for Bioethics at the University of Pennsylvania. Thank you very much.

Dr. CAPLAN: My pleasure.

BRAND: And if you want to weigh in on what you think is ethical in this situation, you can go to our blog,

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