Beyond ‘Octomom’: Emerging issues in assisted reproduction

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The ethics of fertility treatments are struggling to keep up with rapid-fire advances in biotechnology. The case of Nadya Suleman, the “Octomom” who gave birth to octuplets in January 2009 through reproductive technology, is just an extreme example of the ethical dilemmas that parents, medical professionals and religious leaders are facing.

Reproductive technology sits at the nexus of numerous and often conflicting prerogatives, both moral and legal. Would-be parents believe they have a right to avail themselves of procedures that can help them conceive and bear a child. But what happens when those parents divorce and, for example, each stakes a claim to frozen embryos? Or what of the biological parent — does he or she have a greater claim to custody of a child? And what of the rights of surrogate mothers, or sperm donors?

“Assisted reproductive technologies raise the hopes of those who yearn for biologically related children, but they may also pose unreasonable health risks and an enormous financial burden,” said Kate Ott, associate director of the Religious Institute and author of a guide on religious ethics and reproductive technology. “Faith leaders must arrive at an ethical response that respects every individual’s desire to have children, while calling for accountability and equity in how these technologies are used.”

This edition of ReligionLink provides context and experts for reporting on assisted reproduction.

Background

At the time the woman at the center of the “Octomom” uproar, Nadya Suleman, gave birth on Jan. 26, 2009,  to only the second set of octuplets born in the United States, she was the unmarried and unemployed 33-year-old mother of six other babies also conceived by IVF. The births inspired controversy on both medical and moral grounds and highlighted the question of whether and how IVF should be regulated.

At present, the practice is essentially unregulated in the United States, although many other countries, including a number of European democracies, regulate it closely. Suleman’s doctor, Michael Kamrava, was expelled from the American Society for Reproductive Medicine, or ASRM. Despite the ASRM action, Dr. Kamrava retained his medical license and his right and ability to perform IVF treatments until June 2011.

Multiple births are known to be more dangerous than single births — and births of many children far more dangerous — for both mother and children, and to produce elevated levels of often-serious birth defects. In the early days of in vitro fertilization, when it was not known whether embryos would survive, implanting multiples was not uncommon. As the technology advanced and survival improved, however, expert opinion shifted toward implanting much smaller numbers of embryos.

Experts overwhelmingly regard Kamrava’s action as unsafe and irresponsible, despite the argument that Suleman, as the owner of her embryos, has the right to determine their use and she wanted them implanted at once. That right, most ethics experts agree, is not unlimited and does not outweigh issues of safety and medical judgment. Nor does it supersede the responsibility of parents to support and care for their children.

Other IVF-related issues are also emerging.

For example, the use of pre-implantation genetic diagnosis (PGD) is growing. PGD allows doctors to examine the genetic endowment of embryos and select for implantation only those that meet certain criteria. It was originally developed to save couples who are known to be carriers of deleterious genes for severe genetic diseases from giving birth to children doomed to suffer and die in infancy or childhood. Some religious traditions permit PGD as a means of preventing avoidable suffering, and others forbid it because it can result in discarding some embryos.

More recently, PGD has been used to select among embryos to prevent much less serious conditions or to choose a baby’s gender. Some suggest that it could be used to produce babies with desired traits completely unrelated to disease, such as particular talents or appearances. Whether producing such “designer” babies using PGD is in fact feasible is not known, but the possibility has ignited discussion because the practice of selectively aborting pregnancies on the basis of the fetus’ sex is already widespread in some countries.

Embryo adoptions, donations and transfers are also posing growing challenges. IVF clinics in the United States have created approximately half a million embryos, large numbers of which have been frozen for storage and potential future use. Many of these probably will never be used by the couples who own them. Some groups favor donating these unused embryos to other infertile couples, who then would have them implanted and carry the resulting pregnancies to term. The practice, variously known as embryo transfer, donation or adoption, is gaining popularity, especially among some Christians. It may now be spreading to other groups as well. This area is relatively new, and the positions of various faith communities on the practice are still emerging.

Developments

  • “‘Octomom’ doctor expelled from fertility group”

    The American Society for Reproductive Medicine, the nation’s chief professional organization for physicians who treat infertility, expelled Dr. Michael Kamrava, the Beverly Hills fertility specialist responsible for the eight babies born in January 2009 to Nadya Suleman. As this USA Today story reports, the society confirmed in October 2009 that its disciplinary committee took the action against Kamrava for repeatedly violating its standards by implanting more embryos than guidelines recommend.

  • “Octuplet mom’s doctor accused of negligence”

    In December 2009 the state medical board of California filed a complaint against Kamrava accusing him of “gross negligence.” Read about the complaint a  Jan. 4, 2010, article from CNN.

  • “Design-a-kid clinic puts offer on hold”

    A Los Angeles doctor, Jeff Steinberg, provoked an uproar in March 2009 when he offered to help prospective parents choose embryos based on eye and hair color. He later retracted the offer and said he would limit the selection to screening for genetic diseases. Read about it in a March 3, 2009, article from the New York Daily News.

  • “A Legal Puzzle: Can a Baby Have Three Biological Parents?”

    Read a Jan. 25, 2010, New York Times story about advances in fertility technology and the potential and current ethical and legal problems they pose.

  • “Life-Giving Love in an Age of Technology”

    In November 2009, the Catholic bishops of the United States approved a document called “Life-Giving Love in an Age of Technology,” which explains the Catholic Church’s opposition to a range of infertility treatments and addresses certain developments in biotechnology in light of church teaching. Among other things, the document notes that while the church regards frozen embryos as human life that should be protected, it cannot sanction “embryo adoption” for other ethical reasons.

  • “A Time to be Born: A Faith-Based Guide to Assisted Reproductive Technologies”

    The Religious Institute, a multifaith organization based in Westport, Conn., in September 2009 published “A Time to be Born: A Faith-Based Guide to Assisted Reproductive Technologies.” The guide is descibed as “the first multifaith resource to address the scientific and ethical complexities of reproductive technologies from a religious perspective.”

  • “Open Letter to Religious Leaders on Assisted Reproductive Technologies”

    In February 2009, the Religious Institute published an “Open Letter to Religious Leaders on Assisted Reproductive Technologies,” calling on the nation’s religious leaders to “engage the ethical considerations of assisted reproductive technologies and to become stronger counselors and advocates for the safety, effectiveness and accessibility of these technologies.”

Resources

Organizations

  • American Society for Reproductive Medicine

    The American Society for Reproductive Medicine, an organization of physicians, has issued reports and statements by its ethics committee on various beginning-of-life issues.

  • Center for Biomedical Ethics & Humanities

    The Center for Biomedical Ethics & Humanities at the University of Virginia combines the study of health care and illness with social science and humanity disciplines. Daniel M. Becker is director.

  • Embryo Adoption Awareness Center

    The Embryo Adoption Awareness Center was established in 2007 by Nightlight® Christian Adoptions after receiving a grant award from the U.S. Department of Health and Human Services specifically to increase awareness regarding embryo donation and adoption as a family building option.

  • National Embryo Donation Center

    The National Embryo Donation Center (NEDC) is a non-profit organization which strives to protect human embryos by promoting, facilitating and educating about embryo donation and adoption. Email through the website.

    Contact: 865-777-2013.

  • Online Ethics Center for Engineering and Research

    The Online Ethics Center for Engineering and Science is maintained by the National Academy of Engineering. It is part of the Center for Engineering, Ethics, and Society. The Online Ethics Center provides information on ethics as related to science and engineering.

  • Stanford Center for Biomedical Ethics

    The Stanford Center for Biomedical Ethics at Stanford University does interdisciplinary research in biomedical ethics. David Magnus is director.

National sources

  • Dr. Jeffrey Botkin

    Dr. Jeffrey Botkin is professor of pediatrics and adjunct professor of human genetics at the University of Utah School of Medicine in Salt Lake City. He previously served as chair of the Committee on Bioethics for the American Academy of Pediatrics.

  • Sarah-Vaughan Brakman

    Sarah-Vaughan Brakman is associate professor of philosophy at Villanova University in Villanova, Pa., where she served as founding director of the Ethics Program from 1999-2004. She co-edited The Ethics of Embryo Adoption and the Catholic Tradition: Moral Arguments, Economic Reality and Social Analysis.

  • Michael Broyde

    Michael Broyde is a professor of law and senior fellow in the Center for the Study of Law and Religion at Emory University in Atlanta. He edited the book Marriage, Sex and Family in Judaism.

    His writings include “Cloning People: A Jewish Law Analysis of the Issues” in the Connecticut Law Review and “Pre-implantation Genetic Diagnosis, Stem Cells and Jewish Law” in Tradition: A Journal of Orthodox Jewish Thought.

  • Naomi R. Cahn

    Naomi R. Cahn is a professor at George Washington University Law School in Washington, D.C., where she has taught family law, trusts and estates. She is an expert on adoption law. She co-edited (with Joan Heifetz Hollinger) Families by Law: An Adoption Reader.

    She is the author of Test Tube Families: Why the Fertility Market Needs Legal Regulation (2009).

  • David Goldstein

    David Goldstein is a professor of genetics and development at the College of Physicians and Surgeons and director of Columbia University’s Institute for Genomic Medicine in partnership with New York-Presbyterian in New York, N.Y. Goldstein has predicted there will be a growing demand for “designer babies.”

    Contact: 212-305-0923.

  • Josephine Johnston

    Josephine Johnston is a research scholar and director of research operations at the Hastings Center in Garrison, N.Y. Her writings include “Judging Octomon” in the Hastings Review and “Reproductive Health: Control and Use of Gametes and Embryos” and “Reproductive Health: Storage and Disposal of Gametes and Embryos” for the Royal College of Physicians and Surgeons (London, UK) Bioethics Education Project.

  • Maxwell Mehlman

    Maxwell Mehlman is the Arthur E. Petersilge Professor of Law and Director of the Law-Medicine Center at the Case School of Law and Professor of Biomedical Ethics in the Case School of Medicine at Case Western Reserve University in Cleveland. He is co-author of Genetics: Ethics, Law and Policy and author of Wondergenes: Genetic Enhancement and the Future of Society.

    He is the author of Wondergenes: Genetic Enhancement and the Future of Society.

  • Dr. Eric M. Meslin

    Dr. Eric M. Meslin directs the Center for Bioethics and serves as associate dean for bioethics and professor of medicine, as well as of medical and molecular genetics, at the Indiana University School of Medicine in Indianapolis. He is also professor of philosophy in the School of Liberal Arts and co-director of the Indiana University-Purdue University Indianapolis Signature Center Consortium on Health Policy, Law and Bioethics.

  • John A. Robertson

    John A. Robertson holds the Vinson and Elkins Chair at the University of Texas School of Law in Austin. He has written and lectured widely on law and bioethical issues. His books include The Rights of the Critically Ill.

  • Darlene Fozard Weaver

    Darlene Fozard Weaver is an associate professor of theology at Duquesne University in Pittsburgh Pa. She is head of the school’s new Center for the Catholic Intellectual Tradition. Weaver co-edited The Ethics of Embryo Adoption and the Catholic Tradition: Moral Arguments, Economic Reality and Social Analysis (2008).

Regional sources

In the Northeast

  • Adrienne Asch

    Adrienne Asch is director of the Center for Ethics and Edward and Robin Milstein Professor of Bioethics at Yeshiva University in New York City. Her writings include “Assisted Reproduction,” in From Birth to Death and Bench to Clinic (2008).

  • Ronald Cole-Turner

    Ronald Cole-Turner is the H. Parker Sharp Professor of Theology and Ethics at Pittsburgh Theological Seminary, author of Transhumanism and Transcendence: Christian Hope in an Age of Technological Advancement and editor of Design and Destiny: Jewish and Christian Perspectives on Human Germline Modification.

  • Kenneth A. Richman

    Kenneth A. Richman is associate professor of philosophy and health care ethics at the Massachusetts College of Pharmacy and Health Sciences in Boston. He is author of Ethics and the Metaphysics of Medicine: Reflections on Health and Beneficence. He can be contacted through his website.

In the South

  • Mark J. Cherry

    Mark J. Cherry is a philosophy professor at St. Edward’s University in Austin, Texas. He is co-editor of Allocating Scarce Medical Resources: Roman Catholic Perspectives (Georgetown University Press, 2003), senior associate editor of The Journal of Medicine and Philosophy, senior associate editor of Christian Bioethics and editor in chief of HealthCare Ethics Committee Forum. His book For Sale by Owner: Human Organs, Transplantation and the Market (Georgetown University Press, 2005), explores the ethics of selling and buying organs for transplantation. He is also co-editor of At the Roots of Christian Bioethics: Critical Essays on the Thought of H. Tristram Engelhardt Jr. (2009).

  • Jennifer Collins

    Jennifer Collins is a law professor at Wake Forest University in Winston-Salem, N.C. She is co-author of an article on issues raised by Octomom, “Eight Is Enough,” in Northwestern Colloquy.

  • Kenneth W. Goodman

    Kenneth W. Goodman is a professor of medicine at the University of Miami and the founder and director of the University of Miami Bioethics Program and its Pan American Bioethics Initiative. He is also the co-director of the university’s Ethics Programs.

  • Glenn Graber

    Glenn Graber is a philosophy professor at the University of Tennessee in Knoxville. His writings include “The Moral Status of Gametes and Embryos: Storage and Surrogacy” in Health Care Ethics: Critical Issues for the 21st Century (2nd Edition).

  • Ellen Wright Clayton

    Ellen Wright Clayton is a professor of pediatrics, law and health policy at Vanderbilt University in Nashville, Tennessee. She also holds an appointment in the university’s Center for Biomedical Ethics and Society. She has advised numerous federal and international bodies on topics including children’s health and the ethics of research involving human subjects.

In the Midwest

  • Rebecca Rae Anderson

    Rebecca Rae Anderson is the vice chair of health promotion, social and behavioral health sciences at the University of Nebraska Medical Center in Omaha.  She is a board-certified genetic counselor, a member of the Social, Ethical, Legal Issues Committee of the American College of Medical Genetics and the author of Religious Traditions and Prenatal Genetic Counseling.

In the West

  • Marilyn Coors

    Marilyn Coors is associate professor of bioethics and genetics in the department of psychiatry at the University of Colorado at Denver. She is the author of the book The Matrix: Charting the Ethics of Inheritable Genetic Modification and of “Therapeutic Cloning: From Consequences to Contradiction” in the June 2002 edition of The Journal of Medicine and Philosophy.

  • Lawrence Hinman

    Lawrence Hinman is philosophy professor emeritus and former co-director of the Center for Ethics in Science and Technology at the University of San Diego. His research focuses on emerging ethical issues in science and technology, including the issues raised by stem cell research.

  • David Magnus

    David Magnus is Chair, Program in Regenerative Medicine Sub-Committee on Bioethics and Conflict of Interest at Stanford University, where he is director of the Stanford Center for Biomedical Ethics and co-chairman of the ethics committee for the Stanford Health Center. He has written on the history and philosophy of biology and bioethics, particularly on issues concerning genetic technology. Magnus recently served on the National Research Council Ad Hoc Committee on the Bioconfinement of Genetically Engineered Organisms, and he served as a consultant for the World Bank on food security and biotechnology. He is a member of the Secretary of Agriculture’s Advisory Committee on Biotechnology in the 21st Century. He is co-editor of Who Owns Life? (Prometheus Press, 2002). He serves as associate editor of The American Journal of Bioethics.

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