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?

The Children's Bible

There was a thunderstorm last week. After some impressive thunder and lightening, BoBo exclaimed, "Mama Mama, God is angry!"

"Why do you think God is angry?" I asked, not wanting to miss an educational opportunity.

YehYeh, aka "Know It All", started to educate me about Noah. "it's going to rain for forty days and forty night!", she predicted as a matter of fact. BoBo nodded in agreement, looking very worried.

YehYeh proceeded to sing, "who built the ark, who build the ark..." for her multimedia presentation. "Noah, Noah" jointed the boys in refrain, to support their sister.

All together, for the finale, "brother Noah built the ark". Much clapping, thank you, thank you.

After the song, they took turns naming all the animals they can think of , including exotic creatures such as the mommy and daddy wombats.

Searching for more passengers, YehYeh enlisted Mary, Joseph, and their camel.

"Don't forget Sam!", BoBo shouted. He loves Samson, and just as much, the Sam in Green Egg and Sam. I think he thinks they are the same person.

"Two by two, three by three, four by four..." chanted the children in unison. "Then there was baby Jesus", YehYeh concluded.

Blasphemy, blasphemy, please forgive her God, for she knows not what she is saying.

Scott finally came home half an hour later. BoBo threw a tantrum because BaBa refused to build a boat.

"Why can't you build a boat", I implored.

"But I just finished twelve hours of surgery, now I have to build a boat?" Scott complained.

"Built him a boat while I make you some fried rice", I ordered.

BoBo got a paper boat, and Scott, some fried rice.

Then they all went to bed.

Amen

Was It Meant to Be?

I stumbled on a Korean adoptee blog today that bothered me more than others. The author also adopted from Korea, and has a bio daughter. She did not make her motivation to adopt clear on her blog. I do not find the author malicious in anyway. I do not believe her blog has an agenda or a cause. I think she writes about what she feels when she feels the need to write about it. I am almost certain that she is a pretty nice person, someone I would know from church etc. I felt the urge to respond to her opinions and observations, but I just don't have the heart to comment negatively on someone else's personal blog. She is not writing to me or for me. I read many of her recent entries to try to gain a more complete picture and to understand her writing style. The problem with reading blogs is that posts can be easily taken out of context. I think I read enough to know that while she appears happy with her life, she is not happy being a trans-racial adoptee.

What troubles me the most is her post that portrays adoptive parents as selfish insensitive people who thoughtlessly build their happiness upon the pain of the "birth parents". Specifically, she found adoptive parents' sentiment that the adopted children were "meant to be" their children distasteful and insulting to the children's birth parents. The fact that she over romanticizes the birth parents is obvious, or should be to anyone old enough to reproduce. Her reproach of parents who are just trying to express their love for their adopted children is not particularly charitable or helpful to those adopted. When I describe my relationship with my daughter as "meant to be", it does not imply that the events which lead to her adoption were also meant to be. Nothing bad that happens in our world is "meant to be". We chose with our free will to disobey God, and had to leave the Garden of Eden...after that, EVERYTHING was not meant to be. That is what is meant by the original sin. When I talk or think that my daughter is meant to be my daughter, I am talking about the grace of God that saves, protects, and blesses me, my daughter, her bio parents, infertile couples, China, USA, all of us, etc, despite all the things that are not meant to be. It's a miracle, and should be appreciated as such. Referring to my previous post, me, the child, her bio parents all knocked, and we were all answered, given the constraint of our inperfect word that is of our own doing. Please feel free to improve the world so the future is a better place. The past is what it is. I do understand and agree with her that there are adoptive parents with an attitude of entitlement that's hard to stomach. I complained quite loquaciously about them myself. But they are that way about everything in their life, they are not that way because they are adoptive parents. It dawn on me though, that her perspective is very much that of a sheltered American based on her somewhat romantic view of poverty, and child abandonment. while her views simply refect who she is and how she feels, they do lack insight and scope. ( If any one finds the term "sheltered American" insulting, realize at least that many in the world envy that dubious privilege.) In answer to her question, if I had to give up a child due to war, famine, extreme poverty,etc. I would be so thankful not to mention relieved that my child was loved and well cared for and did not die, I would have no problem over looking his or her adoptive parent's lack of talent for creative prose, or even their sense of undeserved entitlement. But that's just me. (By the way, bio parents with insight, do not feel entitled to their bio children either.)

Human love is by nature possessive. I claim my child, my child claims me, that's called attachment. Children need to attach, it's part of normal development. How would an adopted child feel growing up if she thinks that her parents would willingly, with gladness reunite her with her bio parents should they happen to show up on the front door? Only God is capable of the true unconditional love that is perfectly pure. The rest of us can only love in a way that God approves, allow God to guide us in our choices and trust in his timing. To think otherwise is hubris.

Her perspective about female Asian stereotypes is also very much that of an American woman (of whatever ethnicity) rather than that of an Asian. Ironically, it's the fact that she is so very American (and nothing wrong with that, by the way) that she sees it as a racial issue. I have no doubt that everything she described happened. However, if I were to be in those situations, it's the perversity that would offend me, not the fact that these people view me as Asian. Chinese is what I am, whoever that chooses to look at me. As an Asian women who grew up with a world filled with other Asian women of all ages, shape and sizes, ugly and beautiful but mostly just plain, the concept of all Asian woman as sexual beings is just too preposterous to be entertained even under duress. Bad men sexualize women, their hatred is universal. They would not treat white women or even their own wives or daughters any better. It puzzles me that anyone should find sexual perverts' opinion on women of any significance. I don't seek opinion on children from pedophiles. Of course these people are also racist. They are the same group that robs the poor and beats the elderly. They exist in all countries. Unfortunately certain percentage of the human population suffers from this particular form of "congenital defect", and are truly "learning disabled". One simply stay away from places where these people are likely to hang out (in the real world and on the internet) because these places are bad places for many other reasons. No energy left to comment on the sisterly comments she received. Maybe they view her as a threat because she is attractive, again it's not that she is Asian. I am starting to feel a little bad about myself. I don't seem to have her problem...I guess I am that ugly.

A lot of her complaints are also complaints of second or third generation Asians, they are only relevant to her adoption in the sense that had she not been adopted, she would have grown up in Korea. These are not issues caused by adoption. These are issues of immigration, and she is an immigrant though she is not likely to view herself as such. Other children don't get to choose if their family immigrate or not either, their parents make that decision for them, just like hers.

It's getting late, so I'll cut it short. If you get nothing else from this blog, please just remember that Google search is not a research tool (if one needs an example of something that is not meant to be... )It's the definition of selection bias by design. Besides, pornography is the number one use (or at least one of the top uses) of the Internet. Try to Google white women in an Asian country and see what happens. This is just a pet peeve about one of the failures of our liberal arts education.

Words to Live By

I was working on a post about being an Asian American or more specifically a Chinese American. After a a few days, I got bored. It's just not a problem or even much of an issue for me so what I wrote sounded contrived...as if I was having an academic argument for the argument's sake. Same as if I try to give people insights on how to loose weight. Even after gaining 40 plus pounds with my last pregnancy, I would only diet until the next meal. I still lost all the weight and some more in three months. I have no insight at all on weight loss because I never have to work much to lose weight. That certainly does not mean that obesity is not a problem, just not mine. Ditto for being a 1.5 generation Chinese American.

Fortunately for my blogging career I happened to chance upon the book "Words to Live By", a selection of C.S. Lewis's writings, at Borders today.

"for Scripture here cometh to our aide with this excellent reason, that we respect not what men merit of themselves but looke only upon God's image which they bear."

So often in the hospital , especially in the ICU, I question the value of my work. Many of my patients seem so "unworthy and irredeemable". So many of their illnesses stem directly from repeated self abuse and total disregard for the cost incurred to their families and society. Yet I and most of my colleagues carry on, repeatedly patching these people up just so they can return again in a few weeks. I have always thought that I do what I do because it's my job and I just want to do it well, and besides, it's business, I am just providing a service that I get paid for. Tonight, I am both humbled and inspired by that quote. I am reminded again of how important and powerful the influence of Christianity is on our society and how infrequently we give credit to the Bible.

Tomorrow is Sunday, we are taking our children to a new Chinese church close to my parents house so they can participate in Sunday school. If they learn nothing from me, they will learn how to be Christians.