9/22/2007

The Wrongful Birth


I have been reading about the Australian lesbian couple suing their fertility doctor because their IVF resulted in two instead of just one baby. I am pretty informed about the process involved in IVF, having been through it a few times myself, and read enough about it to pass a board exam. From the information available through the Internet, the case did not impress me as an unusual malpractice suit. Perhaps there was a procedural, or system flaw that resulted in an error. If an "error" occurred, it only occurred by the narrowest definition...the birth mother's informal verbal request at the last moment of a very long medical process which contradicted her explicit written consent. The error did not occur because the IVF protocol was not followed; the error occurred because the mothers involved behaved in an unexpected and exceptional manner, outside of the scope covered by the protocol. I am not sure how things work in Australia, (is IVF really publicly funded?), but these harassment suites happen all the time in the US, and the society at large absorbs the cost because, well, our society obviously feels that it's worth the cost...However, now that I have expressed my bias, rather than using this case as yet another excuse to bemoan the plights (of which there are many) of the modern physician (of which I am one), I think this case is very important because it focuses the general public's attention on the ethical controversies surrounding IVF.

Legal merits of the case aside, what was to have happened to the embryo had it (she) not been transfered? What should have happened to the embryo if it were not transferred? Would the hypothetical embryo who is now a real three year old agree with your answer? Who had the right to decide, you me, the public, these women, or the three year old who was then an embryo? Here are two women complaining, to the point of filing a law suite that, two human embryos that they chose to deliberately and artificially create because of their sexual orientation, were transferred instead of one, therefore, the accusation being, resulting in the birth and existence of their two, instead of one, daughters. As they are raising their two daughters today, they are able to state with unwavering conviction, that they were wronged and harmed because both of these two equally viable embryos were allowed to grow into little girls, when they, the parents, wanted just to allow for one. In other words, While proclaiming that they love and cherish their daughters equally they are suing for damages because one of them is not dead, literally. Dead, NOT does not exist mind you, because they were both already created at the time of the transfer.

Unlike most IVF patients with "extra" embryos, these women actually have the unique opportunity to know and love (?) the "embryos" they created but did not initially want. Yet, to this very day, they still actively wish for the destruction of one of these embryos so fiercely that they are suing for compensation. They, and their lawyer, claim with righteousness that they are "injured" because their doctor caused the continuing survival of both of their daughters instead of killing one off as they really had wanted. Am I the only one alarmed by these people's attitude? If they were indeed "wronged" by the system, would it have been more right for one of the little girls to have been destroyed as an embryo? Would that hypothetical little embryo who is now growing up to be a real woman not have been more "wronged" if it was indeed discarded? It is understandable for the rest of the world to feel impersonal and unattached to hypothetical embryos for the sake of ethical discussion, but when a specific embryo escaped the protocol and proved to the world that it too can be a real human being, we, the rest of the world should reconsider the fate of all the other embryos that were not so fortunate. These women who are suing should serve as a cautionary tale for the rest of us, reminding the world how easy it is for people to devalue human life when it serves their(?our) self interest to do so.

Regardless of what any one's philosophical definition of when human life begins, from the perspective of the embryo, it is as alive as it can be at it's every point in life until it dies, no more or less than what any one of us can claim. After insemination, a healthy embryo divides and grows at a predictable and known fashion until, in the case of IVF, it's transferred into the perspective mother's uterus, where it will hopefully implant and continue to develop and grow. Sometimes the embryo does not implant, and dies (hence the practice of transferring more than one embryo, IVF is not the exact science some people believe it to be). Sometimes, the embryo implants, grows in to a fetus, but dies before being born. Sometime, the embryo implants, grows into a fetus, then an infant, but dies as a baby, or a child, or an young adult. Sometime, the embryo gets to die as a 100 year old demented nursing home patient on the ventilator. Nobody can predict the exact fate of any particular human embryo. Should anyone, as an individual or as members of the human society have the right to condemn an embryo to death? If so, under what bases? The entitlement of the biologic parents? What about the sperm donor? He was more biologic then the birth mother's lesbian partner by definition.

As I said in the beginning, I went through IVF a couple of times myself, not to mention all the other stuff preceding IVF. Fortunately for us, because I never produce many eggs per cycle, all of the embryos in every cycle were transferred, none were purposely destroyed. All six of them were excellent quality embryos, though none of them "took". I had pictures of them, they could have been part of a baby book. I confess, I did not give ethical matters much thought at the time, I just wanted a baby. Now I am mother to three. I also have ultrasound pictures of my sons (who were conceived the old fashion way after my failed IVF cycles) starting just a few days after implantation, not all that much older than these "embryos" at the time of an IVF transfer. I had these ultrasounds because I was considered a very "high risk OB". I can not imagine looking at my children now and think for a moment that I could decide if they should or should not exist, or if they should have been destroyed at any point during their lives. Can any mother? (yes yes yes, these Australian moms can). In fact, knowing what I know now, if we happen to have had embryos left from our previous attempts at IVF, I would transfer them all, one at the time, and hope that they all live. Easy to say since we don't have to deal with that situation...to actually do that is probably not economically or medically feasible. Yet these "extra" embryos are created and destroyed daily by parents who would have loved them if they were the ones transferred.

I do not believe that IVF is unethical per say. I do think that the way it's currently conducted leads to regrets, not only for the parents, but for our entire society. For example, if this couple really only wanted one child, they could have asked for only one egg to be retrieved and inseminated. If the success rate of IVF then drops to economically or medically unacceptable levels, then the procedure should be abandoned until it can be further refined. I am not even sure if it is ethical to apply IVF or other assisted reproductive technology to people without medical problems but are doing so for "life-style" choices. After all, we do not transplant a new heart into someone who's heart is perfectly fine or do dialysis on people with functioning kidneys. Quoting Rita Panahi from News.com.au
Ethicists are up in arms at the prospect of an ever increasing number of women capable of conceiving naturally but who take advantage of IVF to avoid the involvement of a male partner in producing a child.

In Britain single women and lesbians are likely to become the largest group to have donor insemination. Latest figures show they made up 38 per cent of all treatments last year, an increase from 28 per cent in 2003 and 18 per cent in 1999.

In Australia there are almost 120,000 fertilised eggs ready for use by IVF patients. Based on current success rates this equates to 12,000 children.

Fears that these lives could be traded as just another commodity are only strengthened with cases such as this, where a monetary value is being sought for the artificial creation of a life that was superfluous to the needs of the parents.
Genetic technology when coupled with the reproductive technologies already available make it possible in the near future (if not now already) for us to engineer human beings at will. My fear is that when we manipulate human reproduction for our own convenience and benefit (as almost all human endeavors are), our future generations will be created in our own image instead of that of God. These future generations will no longer be God's children, and will not be human beings as we define human beings today. Is that how we are to end?

9/20/2007

The First Song



This is YehYeh's debut performance after just three months of violin lessons!

9/06/2007

Luciano Pavarotti sings

In memory of Luciano Pavarotti

My favorite La Boheme recording is the one with Pavarotti and Freni by Decca.

9/05/2007

First Day of School


Today is the first day of school for Bo. He has been looking forward to it all summer. Last night, YehYeh sat him down at the kitchen table and gave him some pointers. "No hitting, no pushing, no teasing, be respectful, and you'll do fine", I heard her said. She gave him a hug afterwards as an encouragement. YehYeh is a bluebird (the second year) at preschool this year. She talks about kindergarten next year the way high school seniors talk about college. We haven't discussed the educational opportunities post kindergarten yet. Nevertheless, she is a natural student. She is sociable, inquisitive, competitive, and a born leader who is not easily fazed by peer pressure, or intimidated by authority. She figures out the rules for success and eagerly follows them to her own advantage.

BoBo, on the other hand, has issues (sigh). A supremely sensitive little guy with an emotional intensity beyond what his tender years can handle, he takes everything personally, and can not tolerate being misunderstood. More than the average toddler, he feels an absolute need to control his environment and is frequently frustrated and angry because of the impossibility of it all. Needless to say, preschool with all it's rules and relatively impersonal routine is very stressful for him. In his mind, it's not only an intimidating environment where his voice is drowned by many others, but also a place where right and wrong is frequently relative (to him), and arbitrary.

I am very glad that he will have two years of preschool before kindergarten. In order to succeed in formal education, he needs to learn that being unique is a state of mind, that it's not necessary or even that important to be understood, and that rules are not only not personal, they are created based on the lowest common denominator. Preschool, the toddler's little microcosm of the real world, is all about getting along, and only incidentally about right and wrong.

BoBo is only three, and I am already wanting to tell him to stop being so idealistic :-). Next year, Baby will get an entirely different message from me on his first day of school...something along the line of "the end does not justify the means".

9/02/2007

Ama's birthday



Don't forget to click play at the bottom left!
The kids really miss her. The first weekend after Ama went back to LA, they ran upstairs to her room at my parents' house looking for her. Baby asked,"Achoi hide?"