IEET > Rights > HealthLongevity > Directors > George Dvorsky > Innovation > ReproRights
When 8 is more than enough: It’s time for some meaningful regulation
George Dvorsky   Feb 2, 2009   Sentient Developments  

Like a lot of people last week, I was shocked to find out that Nadya Suleman, the mother of the octuplets born last week in Los Angeles, already has 6 children—all between the ages of 2 and 7.

And that she is a single mother who has already filed for bankruptcy, and that she is a self-described “professional student” who lives off education grants and parental money.



And that she has a psychological condition which compels her to keep wanting to have more babies.

Now, I’m a huge advocate of reproductive freedoms and equal access to repro-tech, but something clearly failed to happen here. In this case, the fertility clinic that performed the procedure failed to exercise both restraint and common sense. They also showed a complete disregard for guidelines—a strong indication that, while regulation exists for repro-tech procedures, it’s not being enforced strongly enough. This needs to change.

Questionable practices

First off, it sounds like Suleman should have failed the screening test. Prospective parents must undergo an evaluation of their psychological and sociological circumstances before qualifying for IVF treatment. According to R. Dale McClure, president of the American Society for Reproductive Medicine, an investigation had started into the case, but that: “Concerns for confidentiality preclude us from making any additional comments at this time.”

Would it be unfair of me to interpret this as an acknowledgment that their investigation failed to raise the necessary warning flags? Or that they lacked the resolve to act on them?

Again, I don’t mean to bemoan the desire of some parents to have large families, but it appears that there were extenuating circumstances in this case that would should have precluded the mother from having more babies, namely her questionable mental state and motives for wanting to have more children.

This is more than just an issue of procreative liberty—it’s also a quality of life issue for those children being introduced into the world.

Given that Suleman passed the screening test, it would appear that the assessment criteria and investigative processes should be overhauled

Second, the fertility clinic implanted (at least) 8 viable embryos. Most (responsible) clinics will only implant a pair of embryos to reduce risk (both to mother and children). And this is made all the more troubling considering that Suleman has already delivered twins; the fertility clinic knew she had a predisposition for multiple births, yet they didn’t adjust their treatment accordingly.

By implanting 8 embryos in a mother predisposed to multiple births, they put her health at risk and they significantly increased the likelihood of her introducing a multiplicity of babies into a family that was already over-extended.

According to Michael Tucker of the Georgia Reproductive Clinic, Atlanta, clinics are policed by the American Society for Reproductive Medicine, which frowns upon implanting more than two or three embryos at a time. “It is remarkable,” says Tucker, “that any practitioner would undertake such a practice.”

Well, it would only have been remarkable if the ASRM had the teeth to enforce their policies. If the Suleman case is any indication, their reach and influence is insufficient.

Regulation is only regulation if it is enforced

Looking at this case one gets the feeling that some fertility clinics look upon their patients as nothing more than customers. Given the nature of their work, however, this attitude will simply not do.

A lassez-faire approach to repro-tech won’t work to protect the interests of those hoping to use these technologies and to protect those lives that are created as a result. I agree that regulation should be very liberal and accommodating to a diverse set of interests, but complete de-regulation would be both dangerous and facile.

But establishing regulations and guidelines is one thing, enforcing it is quite another.

In some cases, this one included, it would be perfectly reasonable for the state to intervene and deny access, or at the very least compel clinics to follow a strict set of guidelines to prevent this sort of thing from happening. It’s time to empower groups like the ASRM—particularly now as new reproductive technologies are emerging quickly. This way, fertility clinics will be compelled to follow the rules and be held accountable for their actions.

It’s clear that this has to happen. Clinics won’t regulate themselves.

But why should we have expected them to? They’re not the ones who now have to raise these children.

George P. Dvorsky serves as Chair of the IEET Board of Directors and also heads our Rights of Non-Human Persons program. He is a Canadian futurist, science writer, and bioethicist. He is a contributing editor at io9 — where he writes about science, culture, and futurism — and producer of the Sentient Developments blog and podcast. He served for two terms at Humanity+ (formerly the World Transhumanist Association). George produces Sentient Developments blog and podcast.



COMMENTS

George, your points are well taken - this is reproductive autonomy run amok. The costs to the mother, the grandmother, the siblings, and children themselves, and to society, are overwhelming.  I agree that it represents an abuse of the technology and is an illustration of the need for regulation and oversight.

ASRM and SART are voluntary organizations where only members need to report data. While they can revoke memberships, I don’t believe they have the power to shut clinics down.

The CDC, however, has a mandatory reporting policy and, as a branch of the federal government, could enforce some kind of policy on maximum allowable embryos transferred per cycle. I, personally, think this is a good idea.

Interesting to note, that while the CDC and SART both publish annual reports detailing the national averages for things like average number of embryos transferred and percentage of live birth rate, they expressly prohibit clinics from making comparative analysis to other clinics or even the national averages.

With this in mind, we created a web site, based on the SART data that allows prospective patients to compare clinics on this very important data. We feel that while there are other factors to consider in choosing treatment, the comparison of success rates and treatment methods should be encouraged not thwarted.

Our IVF Success Rate Reports can be seen here:

http://fertilitysuccessrates.com

I’ve heard conflicting statements on the number of embryos Ms. Sulleman had introduced; originally I had read there were three that multiplied, but here you say eight.

Could you shed light on that?

Should we use outliers to define the parameters of this or any other debate about social policy?  Outliers often provoke anxiety and anger.  If this even is as rare as it has been portrayed as being, there is little to be gained to use it to define any sort of policy.

I tend to agree with WilsonD: we should be very careful before we use the existence of outliers as a reason to introduce even more regulation in an area like this. We might condemn what happened in this case, but it by no means follows that there’s some mischief sufficiently widespread (or so damaging in even a small number of cases) that we need to enact legislation ... which immediately invites influential people and organisations to seek restrictions that go far beyond those that are strictly necessary to address the mischief. All our experience with the state suggests that we should be reluctant to let it get involved in reproductive decisions, even at the cost of a small number of people making crazy, or perhaps morally wrong, ones.

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