Monday, February 2, 2009

My body, my choice

I think by now most people have heard about a woman who had given birth to octuplets last week. The facts that have been confirmed so far are as follows:
1. She had 6 other children, ages 2 to 7.
2. She was believed to carry seven fetuses, eighth was a surprise.
3. This was the result of some sort of fertility treatment.
4. The woman was given the option to reduce the number of fetuses, but refused.
5. Given the circumstances, babies and mother are doing remarkably well, though babies most likely will remain in the hospital for another 6 weeks or so.

Everything else is either appearing in the gossip magazines or unproven, and the woman herself is not speaking publicly yet. This case made a lot of people nervous, particularly those in the fertility treatment industry, and many doctors practicing in this field are trying to separate themselves from this particular case, claiming that they would never allow for this to happen on their watch. Every respectable publication and news site has published an article on the ethical dilemmas presented by this case, and most of these articles are saying the same things and nothing that I found particularly controversial. Until today, when I read this on

Overall, the article didn't say anything different from others, but two paragraphs caught my attention. They were addressing the issue of reducing the number of fetuses in extreme multiple pregnancies, and this was a view of one of the experts:

Rosenthal, on the other hand, questions the woman's capacity to make a good decision under the circumstances. Some neonatologists believe that when pregnant women are told about dangers of prematurity or have great expectations about giving birth, their judgment can be impaired, she said.

The situation raises the issue of whether a doctor ought to override a patient's wishes for the sake of saving lives, she said. Although the health care system in America gives patients autonomy in making decisions about their own bodies, when emotionally distraught, some people decide poorly, she said.

What this bioethicist Sara Rosenthal is saying (unless she is misquoted) is that pregnant women are prime candidates for impaired judgment and cannot be relied upon being reasonable when presented with tough choices. That's, of course, if they choose to not reduce the number of fetuses (or follow their doctor's advice in other matters). If they agree with their neonatologist and selectively abort, then they are perfectly reasonable.

Putting this particular case aside, what this Ms. Rosenthal is suggesting is a possibility of overriding patients' choices if they seem to be poor to their doctor. And that is a very dangerous proposition. That puts every woman who decides to carry complicated pregnancy to term in danger of having her choice overridden. Ditto for rape victims refusing the morning after pill, those pregnant with not 100% healthy fetuses, those who already have many children and refusing to use birth control ... (It could also go the other way, and if one is treated by a doctor or a hospital with a belief that all abortions are evil, even the ones to save woman's life, the emotional and "unreasonable" woman might not get the medical help of her choice.)

This wouldn't stop with pregnant women, though. The danger of not having a choice in one's treatment would also spread to cancer patients refusing chemotherapy or other invasive procedures recommended by doctors. Patients' relatives could also be considered "emotionally distraught" when refusing to cut life support of terminally ill parents/siblings/children. Overriding their choices would be the next logical step and bring euthanasia to new heights.

The bottom line is that very few people coming to the hospital, whether patients or their relatives, are NOT emotionally distraught. I don't know anyone who would choose a hospital as their vacation spot or a place to unwind. Once the choice of medical treatment is taken away from any group of people (I am talking about people with normal mental capacities and in the presence of mind), everyone is in danger of losing that choice. The questions of who would make these choices for "emotionally distraught" preggies with multiples or come up with guidelines for doctors' intervention immediately arise. And I don't trust the government or medical professional to self regulate in this matter because history and practice show that both value practical considerations over spiritual and emotional.

And on the final note, I would like to ask bioethicist Sara Rosenthal this: how ethical is it to judge someone before one has all the facts or at the very least hears the octuplets' mother's side of the story?


  1. Well, she went to a university and read some books so obviously she's now an authority on anything and everything. The mother's side of the story doesn't matter because the mother didn't read those books.

  2. That is so, so incredible disturbing.

  3. Hummm. Good points. I think the woman in this case might not have been thinking too straight even when she wasn't pregnant.

  4. Well, like I said, we don't have all the facts and we haven't heard from the woman herself. So I would withhold my judgment for now. But the fact that so-called ethicist are using this case already to show that patients don't necessarily need to be trusted to make decisions about their care is truly disturbing.

  5. the mental and emotional capacity of a couple is explored before they are allowed to adopt, it should definately be explored before implanting a single women with 7 or 8 embryos. I am a fan of capping implants to say 3 or 4 at a time. The women is an attention needing psycho, G-d help those kids after the media attention wears off..
    Fav. anonymous :)

  6. Fav. anonymous,

    I don't think that the mental capacity of any woman requesting 6 embryos to be implanted needs any exploration. Something is obviously amiss there. Anyone willing to take such a risk is clearly not thinking of what's best for her children. And I think the guidelines suggest implanting only 1 or 2 embryos, not 3 or 4.

    Whether the woman is an attention needing psycho is not quite clear. She definitely needs some medical attention, esp. in the mental department. But no one could truly know her intentions. Plus remember, this post was written before she got to tell her side of the story.

    Now that more facts have surfaced, I do think she is dusturbed, and the whole procedure was clearly misguided. But the person to blame the most is the doctor who performed it. If the woman was mentally sick or disturbed, he should've refused to do it.


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