Monday, August 04, 2008

We’ll take only one baby please…

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?


Anonymous said...

Assuming everyone who wants a baby is willing and able to take on a set of twins is crazy. Even if the mother can pay for IVF. As the mother of a set of IVF twins I did, after a while, welcome the opportunity to raise two children and I was blessed with healthy kids but, just as women choose to limit the number of children they bear by means of contraceptives they have a right to attempt to limit the number of children they have via IVF where there is a lot of expense and a lot of potential for control. Parents who use IVF to get pregnant often spend years planning to raise children and know how they would like to do that (getting multiple children beyond the risk of getting children with health difficulties because of the conditions associated with multiple pregnancy is a huge drain on the abilities of people to raise children as they would like to with a lot of parental attention or private schooling). That's why people engage in limiting the sizes of their families -- by any of the means they choose to do so whether it be "natural" or via other means of contraception. In these cases short of the occational post-transfer splitting of a blastocyst to form identical twins imposing more embreos than a woman asked for is as inapropriate as denying her access to contraception. It is also stupid and unfair. If a woman is willing to request the transfer of only one embreo she has made a clear statement and risked a lot of money and months of unpleasant and uncomfortable medical procedures on the considerable possibility of getting NO baby out of a procedure that may cost 10,000$ or more to assure she only get only one. That should be honored. If her request was not clear that is unfortunate, but ignoring a clear request is tantamount to assuming that all women who want a child want children and are eager for twins. That is rediculas. No matter what means are pursued to get kids. Should all women seeking to adopt be willing to take a set of twins (and their accompanying health problems if they have them) just because they are willing to adopt? Of course not. Many will and eagerly, others won't and no one physician or otherwise should force them to.

Jennifer Bard said...

They are suing under a theory of "wrongful life." This is the same theory used by people who thought they had been sterilized, but ended up having a child anyway.
Many states (like Texas) do not allow these claims (on the grounds that it is always better to be alive than dead) and those that do have very high standards. It is unlikely that anyone could recover for the delivery of two healthy babies--no matter what the stress or expense. Who, after all, would you sue if you had twins naturally? Almost every court would consider this one of the risks that everyone runs in becoming pregnant.
There are much more serious cases in which people have sought IVF because of grave genetic concerns but could not recover even when an embryo with the genetic trait was implanted by mistake.
A more troubling issue is why the clinic implanted two embryos--the U.S. is following the lead of many European countries who no longer implant more than one embryo for two reasons that apply here--b a) it's risky for both babies and the mother,b) if you're up to current standards, it shouldn't be necessary and one that doesn't (it is illegal in both Italy and Germany to discard embryos--you must implant any viable embryo)
I think if anything went wrong with this pregnancy and either child or the mother were harmed, then there would be a strong cause of action. Here not.
Prof. Judith Daar of Whittier Law School has a fantastic casebook on this topic and she and Professor Alicia Ouelette of Albany Law School (and many others) have written extensively on the legal issues surrounding assisted reproductive technology.
Jennifer S. Bard, J.D., M.P.H.