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“ Octomom ”: Ethical Problems in the Nadya Suleman Case

“ Octomom ”: Ethical Problems in the Nadya Suleman Case. Jan Hare, Ph.D. Human Development and Family Studies Dept. The Wild West of Medicine: Infertility Industry. Unresolved: Is infertility a disease or a misfortune? Many clinics oversell their success rates

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“ Octomom ”: Ethical Problems in the Nadya Suleman Case

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  1. “Octomom”: Ethical Problems in the NadyaSuleman Case Jan Hare, Ph.D. Human Development and Family Studies Dept.

  2. The Wild West of Medicine: Infertility Industry • Unresolved: Is infertility a disease or a misfortune? • Many clinics oversell their success rates • No centralized licensing to enforce guidelines • No regulation of infertility industry • Anything goes if patients can pay.

  3. In-Vitro Fertilization • Begin oral contraception • GnRH Agonist Administration • Ovarian Stimulation • Monitoring of Follicle Development • Final Oocyte Maturation and hCG Administration • TransvaginalOocyte Retrieval • Insemination of Oocytes • Embryo Transfer • Progesterone Supplements • Pregnancy Test

  4. Patients’ “dispositional authority” over leftover embryos • Whether or not to freeze • Whether either parent can use in event of death or divorce • Whether their frozen embryos can be • discarded • donated to other would-be parents • donated to research

  5. Laws regarding practice • United Kingdom: no more than 2 • Australia: no more than 3 • Italy: only 3 eggs fertilized in vitro for married women, all must transfer simultaneously. • United States: no centralized licensing, no control authorities, no laws

  6. Professional Guidelines • Society for Assisted Reproductive Technologies (SART) • American Society for Reproductive Medicine (ASRM) • Number of embryos transferred • Child-rearing ability of patient

  7. Day 5

  8. Guidelines pertaining to embryo transfer

  9. The Problems • Multi-fetal pregnancy • Risk of poor outcome directly proportionate to number of fetuses in womb. • Care-giving load: • 168/hrs in week. 6 month old triplets require 197.5/wk of mother’s time for care.

  10. The Perfect Storm • Plunging national economy • Near bankruptcy of California • Fragile state of our health care system • Into this: the birth of octuplets in Bellflower, CA

  11. Nadya Suleman • Age 33 • Single • 6 children via IVF (4 singletons, 1 set twins) • Ages 3-7, 1 child autistic • Unemployed, receiving public assistance • Living with parents – partially estranged • Medicaid to pay medical costs

  12. 2008 treatment • 6 embryos thawed, transferred • All implanted • 2 split • Kamrava offered Suleman MFPR; she refused • Result: 1/26/09 birth of octuplets at 31 weeks • Birth weights: 1# 8oz – 3# 4 oz

  13. West Coast IVF Clinic • Michael Kamrava

  14. Questions fall into 3 categories • Role of Reproductive Endocrinologists • Distributive Justice • Regulation of ART

  15. Ethical Questions • Related to role of reproductive endocrinologists: • Who should make the ultimate decision regarding how many embryos to transfer? • Should Dr. Kamrava have accepted Ms. Suleman as a patient? • Related to distributive justice: • Who bears the cost of delivery and NICU? • Who bears the cost of services (sometimes lifelong) for children with special needs?

  16. Legal questions: • Do the children have a right to seek financial compensation from the fertility clinic/hospital? • Do the children have a right to financial compensation for any television/book deals relative to their conception, birth and lives?

  17. In her own voice • Nadya Suleman interview with Ann Curry

  18. Ethical Questions • Related to role of reproductive endocrinologists: • Who should make the ultimate decision regarding how many embryos to transfer? • Should Dr. Kamrava have accepted Ms. Suleman as a patient? • Related to distributive justice: • Who bears the cost of delivery and NICU? • Who bears the cost of services (sometimes lifelong) for children with special needs?

  19. Arguments • Adoption standard should be applied to fertility treatments. • Hijacking health care $ by irresponsible decisions

  20. References • Armour, K. & Callister, L. (2005). Prevention of triplets and higher order multiples: Trends in reproductive medicine. J. Perinat Neonat Nurs, 19, 2, 103-111. • Kurtz, M. (2009). More than a village: Meeeting the health care needs of multiples. Hastings Center Report, 39, 3, 25-26. • Johnston, J. (2009). Judging Octomom. Hastings Center Report, 39, 3, 23-25. • Murray, T. (2008). Commentary: Are eight babies more than enough? Retrieved : http://www.cnn.com/2009/HEALTH/02/04/murray.octuplets/index.html • Robertson, J. (2009). The octuplet case – Why more regulation is not likely. Hastings Center Report, 39, 3, 26-28. • Williams, P. (2009, March 2). Eight is enough. The Nation, p. 9.

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