“Octomom”:

Ethical Problems in the Nadya Suleman Case

Jan Hare, Ph.D.Human Development and Family Studies Dept.

The Wild West of Medicine: Infertility IndustryUnresolved: Is infertility a disease or a

misfortune?Many clinics oversell their success ratesNo centralized licensing to enforce guidelinesNo regulation of infertility industryAnything goes if patients can pay.

In-Vitro Fertilization Begin oral contraceptionGnRH Agonist AdministrationOvarian StimulationMonitoring of Follicle DevelopmentFinal Oocyte Maturation and hCG

AdministrationTransvaginal Oocyte RetrievalInsemination of OocytesEmbryo TransferProgesterone SupplementsPregnancy Test

Patients’ “dispositional authority” over leftover embryosWhether or not to freezeWhether either parent can use in event of

death or divorceWhether their frozen embryos can be

discarded donated to other would-be parents donated to research

Laws regarding practiceUnited Kingdom: no more than 2Australia: no more than 3Italy: only 3 eggs fertilized in vitro for

married women, all must transfer simultaneously.

United States: no centralized licensing, no control authorities, no laws

Professional Guidelines

Society for Assisted Reproductive Technologies (SART)

American Society for Reproductive Medicine (ASRM)

Number of embryos transferredChild-rearing ability of patient

Day 5

Guidelines pertaining to embryo transfer<35 35-37 38-40 >40

Cleaving Embryos

1-2 2 3 5

Blastocysts

1 2 2 3

The ProblemsMulti-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.

The Perfect StormPlunging national economyNear bankruptcy of CaliforniaFragile state of our health care system

Into this: the birth of octuplets in Bellflower, CA

Nadya Suleman Age 33Single6 children via IVF (4 singletons, 1 set twins)

Ages 3-7, 1 child autisticUnemployed, receiving public assistanceLiving with parents – partially estrangedMedicaid to pay medical costs

2008 treatment6 embryos thawed, transferredAll implanted2 splitKamrava offered Suleman MFPR; she refusedResult: 1/26/09 birth of octuplets at 31 weeks

Birth weights: 1# 8oz – 3# 4 oz

West Coast IVF ClinicMichael Kamrava

Questions fall into 3 categoriesRole of Reproductive EndocrinologistsDistributive JusticeRegulation of ART

Ethical QuestionsRelated 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?

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?

In her own voiceNadya Suleman interview with Ann Curry

Ethical QuestionsRelated 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?

ArgumentsAdoption standard should be applied to

fertility treatments.Hijacking health care $ by irresponsible

decisions

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.