Because we can?

One of the big news stories this week was the California woman who had octuplets through in vitro fertilization. She has six other children, and all were born using in vitro techniques. From what I've read, it looks as though she is not working, and has always had somewhat of an obsession with having children.

A while back, I wrote about the sorry state of our healthcare system and how we need to rethink the way we look at things. The situation with this woman who decided to become her own little baby factory brings up all sorts of ethical and practical issues.

Bioethics is defined as "The study of the ethical and moral implications of new biological discoveries and biomedical advances, as in the fields of genetic engineering and drug research." Ethics has been a part of medicine since medicine's inception as a field (part of the Hippocratic oath is to do no harm), but as medical technology continues to advance, bioethics has moved from a mainly philosophical exercise to an interdisciplinary one that encompasses not only physicians and philosophers, but also other healthcare workers, theologians, and lawyers.

Some of the thorny issues involved range from organ transplants to organ donation; reproductive rights to infertility treatments; euthanasia to population control; gene therapy to gene privacy and discrimination; and stem cell research to the rights of an embryo. We could debate until we're blue in the face about some of these, but the topic at hand is this woman's infertility treatments and multiple births.

My own parents come from large families. There were 9 kids in my Mom's family and 7 in my Dad's, with a couple of stillbirths and early deaths in each family, as well. People had a lot of kids back then because 1) there was no birth control and 2) kids ended up helping on the farm or with taking care of the younger kids. The world has moved on, and there is birth control readily available to everyone and no need to bring that many children into the world, especially when you cannot support them. Even beyond that, the California woman did not have these children naturally, she had them with the aid of infertility treatments.

Several years ago, I remember hearing a comedian talking about a multiple birth through fertility treatments. I believe it was either sextuplets or septuplets. The woman said, "It's God's will." The comedian said, "Bullshit! God's will was that you have ZERO! You screwed it up!" A little extreme, I know, but these are exactly the kinds of situations we need to look at if we're going to address the multitude of problems in our healthcare system.

The hard truth is that these octuplets are going to cost millions from the cradle to the grave. They are very tiny, and although apparently doing well, will need to spend about a month in the hospital. Over 40 physicians and other staff assisted in the birth alone. Let me ask you a rhetorical question: who do you think is going to pay for that? Let me answer my own question: WE are. Whether through increased hospital costs or increased insurance premiums, we will absorb it. This is where bioethics come in. There are no easy answers, but shouldn't we set some sort of limit on the burden that an individual can place upon society and upon our healthcare system? How is having 14 kids reasonable in today's world? Why did the infertility specialist treat this woman instead of sending her for counseling? Is a physician obligated to treat such a patient, or can they refuse?

The argument doesn't stop with multiple births. At what point do we put a limit on procedures, whether the number of surgeries or the age of the patient? I've seen it happen in my own family. An elderly relative was diagnosed with prostate cancer, but they didn't treat him for such a slow-moving cancer...his life expectancy was exceeded by the amount of time in which he'd succumb to cancer. (And indeed, he died of something else.) I know these are not fun things to think about, but at some point, we have to ask the question, "Why should we do this procedure?" If the answer is simply, "Because we can," we need to come up with a better answer.