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1. Summary of the article
In January 2009 a miraculous event in medicine happened – Nadya Suleman, 33 years old, gave birth to octuplets, six boys and two girls. This fact itself is extraordinary, but taking into account that Suleman is single, unemployed, lives with her mother and already has 6 children, this creates a serious problem concerning medical ethics. The babies were conceived by one of two possible procedures: in vitro fertilization and intrauterine insemination. For both of these procedures, the doctors work with two or three, maximum four embryos; it looks like Suleman purposefully convinced the doctor to use eight embryos. Nadya hopes that when she tells the whole story to the media, the public opinion will change and there will be no criticism.
2. A major reproductive health policy issue related to the article
There are no strict and standardized laws and regulations in the USA concerning fertility and reproduction field; the legislation in the states may be significantly different, and what is most important, there are no directive regulations since most laws are expressed in the form “you should”. As a result, there is “virtually unregulated marketplace with tort law serving as regulation in the U.S.” (Surdin, 2009).
The fertilization procedures are provided for the majority of the interested women and there is no specific number of previous children, previous attempts or the number of babies hoped for that influence the very decision about fertilization and the number of embryos to work with. However, before fertility treatment it is quite common to study the patent’s history, how many times she was pregnant and how many children she has. For the case with Nadya, this information was either not examined properly, or Suleman herself convinced the doctor to use eight embryos. The major issue with fertility treatment is that in the absence of strict regulation there might happen frequent abuses and unregulated mistakes.
3. Ethical issue concerning the case and how it is represented in the article
In terms of health ethics, the problem with Suleman’s case is that doctors have broken the principle of beneficence – doing everything to provide maximal benefit to the patient. Though in the regarded case this principle might compete with other one – autonomy – if Nadya Suleman really wanted eight children and asked the doctor about this. However, in my opinion, the principle of beneficence has to dominate if there is real threat to the health of the patient, of the children or threat to future well-being of the whole family.
In the case regarded in the article, working with more than two embryos for a woman in early thirties increased risk of premature risk and delivery, as well as created increased risk of brain injuries, underdeveloped lungs and intestines for babies. Moreover, Nadya with her social conditions now carries that responsibility for 14 children, and there are absolutely no guarantees that she will manage to provide decent life and upbringing to all of them: “the birth of eight babies to a woman who becomes responsible for 14 children is attracting a different set of worries from the medical community, particularly fertility doctors, who say it goes against the mission of their work: to minimize high-risk, multiple-birth pregnancy and safely provide a woman with a single healthy baby” (Surdin, 2009).
4. Recommended policy
There should be strict and well-defined regulations concerning the conditions and prerequisites for fertilization procedures; although all women willing to undergo this procedure have the right to be pregnant, there are cases when the doctors have to critically analyze all the factors and history of the patient thoroughly, in order to maintain decent life and health for future babies and not merely the fact of birth. The issues related with fertilization are quite complicated, and here the two principles of healthcare ethics such as autonomy and beneficence may come into confrontation. In my opinion, the principle of beneficence should still be determinative because medical professionals have better understanding of real situation compared to future mothers, in the sphere of fertilization.
Surdin, A. (2009, 4 February). Octuplet Mother Also Gives Both to Ethical Debate. Washington Post