When Nadya Suleman, dubbed “Octomom” by the media, gave birth to eight babies in January, she not only made medical news, she shone a light on America’s fertility clinics, renewing a debate already swirling around the ethics of assisted reproductive technology.
Suleman has another six children also conceived through in-vitro fertilization. Unemployed, she lives with her mother and 14 children in a three-bedroom house in California which is scheduled to be sold at auction this month because of mortgage default. Her father has returned to Iraq to work as a driver in order to support his daughter and her brood.
“Something has gone terribly wrong when a 33-year old single woman – who has no home of her own, no job, and a mother who worries her daughter is ‘obsessed’ with having children – winds up with 14 of them,” says Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania.
Caplan notes that there are no known cases of octuplets in which all escaped severe disabilities, a concern that raises ethical issues, including “the hijacking of health care dollars.” Dr. Caplan estimates the cost of neonatal care for the eight babies probably exceeded $1 million; he also notes that millions more in medical costs will be needed as the children grow.
The physician who treated Suleman, Dr. Michael Kamrava, is now under scrutiny by the California Medical Board. In addition to several malpractice suits against him, Kamrava is criticized for implanting large numbers of embryos instead of the two recommended by the American Society for Reproductive Medicine. Critics charge that he does multiple implantations in order to keep up his success rate. (Despite multiple implants, Dr. Kamrava’s success rate is actually low.) In February, Kamrava was removed from the American Fertility Association’s Physician Network pending the outcome of the Medical Board’s findings.
Dr. Kamrava’s practice is among those now advertising the “coming” availability of embryo screening for “gender, eye color, hair color and complexion.” Known as PGD or “pre-implantation genetic diagnosis,” it is already being used for sex selection.
“Assisted reproduction in America has been a Wild West for too long,” says Marcy Darnovsky, Executive Director of the Center for Genetics and Society (CGS). “Responsible oversight of extreme reproductive technologies such as embryo selection based on skin color is long overdue.” According to Darnovsky, “the U.S. is notorious for its inadequate regulation and oversight of assisted reproduction, which has become a $3 billion business in this country alone. A large majority of industrialized countries, including Canada, the UK, most of Europe, Japan, Israel, china and Australia, prohibits non-medical sex selection.”
The Center for Genetics and Society points out that “women’s well-being must be a central concern” in human biotechnology and underscores that “reproductive rights must be firmly protected.” It also sounds further alarms: While assisted reproductive technologies have helped many people become parents, the technologies are costly and invasive, and success rates remain low. Long term risks to women and children have yet to be well studied. Treating infertility is now a highly competitive business and is “notoriously” under-regulated.
There are other ethical and practical concerns. For example, paying economically vulnerable women to provide eggs for other women’s fertility treatment or to become surrogates is on the rise. (Some college-aged women are selling their eggs to pay tuition.) What next? Reproductive cloning and inheritable genetic modification? (Both are already used in animals.)
As CGS points out, “it is not uncommon for those advocating these technologies to appropriate the language of reproductive choice to argue that parents should have the ‘right’ to choose their children’s characteristics. But there are important differences between choosing when and whether to bear a child and creating a child with specified traits,” often called “enhancements” by technology advocates.
A day after Nadya Suleman gave birth to eight babies, California state senator Gloria McLeod introduced a bill that for the first time would place fertility clinics and cosmetic surgery providers in California under the jurisdiction of the California Medical Board. Under the legislation, cosmetic and fertility clinics would face a new set of regulations based on accreditation standards established by the Board. Inspection and reporting would be routine and required.
In Georgia a bill has also been introduced to provide oversight of the fertility industry. However, with support from Georgia Right to Life, it also includes banning embryonic stem cell research.
While several states are responding to the need for legislation around reproductive technology, proposed laws vary widely, creating what one policy analyst calls “a cumbersome patchwork.” Clearly, voluntary guidelines established by industry organizations have not been effective. That’s why many are calling for Congressional oversight of an unregulated industry.
“We need carefully crafted policies that don’t infringe on reproductive rights, and that bring responsible regulation to the baby business,” says Marcy Darnovksy. I agree. There’s something creepy about “designer babies.” I’ll take the regular kind any day.