Monday, February 02, 2009

How Many is Too Many?

Unless you've been hiding under a rock this last week, you're aware of the octuplets born to California single mom Nadya Suleman, and the intense ethical debate surrounding her pregnancy. Even before it was revealed that she has six other children (apparently all from IVF, although details are a bit fuzzy), medical experts were ready to lynch the IVF specialist who implanted that many embryos into Ms. Suleman. And since then, the information that has come out has been more and more dismaying. The problem is, much of the information coming out is still speculation, and few solid facts are known. This makes it difficult to do more than speculate and contribute to the signal to noise ratio, which at the moment is definitely loudly on the side of noise.

So rather than continue to discuss the particulars of Ms. Suleman's case, which will have to be dissected in its own due time, I want to open to forum to a related question that has been repeated in the discussion of her story: how many children is too many children? Not how many implanted embryos is too many embryos, but at what point (if any) do fertility doctors say sorry, no more kids? Should Ms. Suleman have had any embryos implanted at all, given her six other children? Or is the ability to pay for IVF the only thing that should be considered? Should the financial state of the individual or couple be considered? Job? Income? What factors should go into deciding whether to treat for infertility via IVF? And should the "how many is too many" question be posed to adoptions, as well (Angelina Jolie and Brad Pitt clearly coming to mind)?

Or put another way: is the problem with the birth of the octuplets the fact that they were born all at once, and if Ms. Suleman had continued to quietly have eight more children via IVF, no one would have said a thing?

It seems like this single question - if an outside source is utilized to have children, is there a point at which it can be determined that the person has too many children to have more - is fraught with the potential of paternalism and of violating the choice of family construction.

I don't even begin to have an answer to this; I doubt I've even begun to tease out all of the potential questions wrapped in what is an incredibly thorny issue. But let's open it to debate - what do you think?
-Kelly Hills


Anonymous said...

I think that if both parents have two children, they should be denied IVF to have more children. So, I'd grant an exception to a blended family if they wanted to have an additional pregnancy together.

I don't think it's a question of how many is too many, but of how many is enough. 2 is enough.

Kelly Hills said...

Kaylen - why is two enough, though? "Three" seems to still be a pretty normal number of kids for people to have (I know I'm the oldest of three). Why do you draw the line at two, instead of three or five?

Sue Trinidad said...

Maybe not quite what you're asking, Kelly, but I think there ought to be a clinical rule about how many fetuses is too many, at least in the context of ART. As I've noted here before, multiple pregnancies are dangerous to the mother and to the babies. These kids are subject to substantial health and developmental problems. As to family size--different issue, and one I feel a lot less of a stake in.

Kelly Hills said...

Oh, definitely Sue - I don't think anyone even disagrees with that idea (which is why I didn't ask it). ASRM has some pretty clear guidelines, and it would be nice for that to be actual law.

I think my interest in family size comes from the fact that people are saying 14 is too many. This may very well be, and it's hard to argue that eight at once isn't too many! But if 14 is too many, is 13? 12? Is it even a question fertility doctors should ask? Or if you can pay and are healthy, is that good enough?

Andie said...

I definitely don't know the answer to this question. To my mind, it seems like having 2 (replace yourselves, basically) should be enough, considering world overpopulation issues. But obviously when it comes to adoption we want more children adopted, so there are other factors to consider.

I don't really think there's a place for legislating personal family construction choices, though, so I guess the moral/legal issues have to be sorted out separately.

Driver said...

Americans are long accustomed to having anything they want as long as they're willing to shell out the shekels.

I mean, individual autonomy is wired into us from day one. Do your own thing, mind your own business, it's your thing do whatcha wanna do, don't fence me in, I gotta be me, I gotta be free.

And advertisers know that mommies are a cash cow. So they play up mommydom and mommy guilt and especially mommy vanity.

I've stayed out of the parenting business so my eye is somewhat colder than anyone who's been a parent. So be it. I love children, but I see too many of them sacrificed to self-centered parents who see their child as a lifestyle accessory and resume builder.

It amazes me that Suleman wants to be on television, with the inevitable separation that would involve, as some sort of commentator. The preening self-satisfaction of this female is something I find eminently slappable. (All right, all right, physical abuse against women is always wrong, etc., etc. I'm just riffing, okay?)

Anonymous said...

If someone has the means and support I don't have a problem with IVF for more kids though apparently six embryos at a time is not advised by medical professionals for someone at her age and medical history.

This person is apparently single, unemployed, and already has six children. Some reports claim she's filed for bankruptcy. IVF is not cheap implying there's no "rational" rationalization for what she and the doctors did.

emmapeelDallas said...

She has no partner, no job, she hasn't finished school, she's been on disability for several years, and she decides she can adequately parent 14 children under the age of 8, and people are debating whether she can do it? There is no way she can adequately do this. She's a narcissist, if not outright delusional. And having 8 at once is completely different from having 8 over a period of time. Start with the length of pregnancy and birthweights, and go from there...