10 February 2009

Kiddy litter

Octuplets, an unemployed single mother now with 14 children, IVF and an unethical doctor. CyberShrink comments.

Octuplets, an unemployed single mother now with 14 children, IVF and an unethical doctor. CyberShrink comments.

When it was announced that a woman in California had given birth to octuplets, the media thought that was the story. Then we heard that the multiple birth was as a result of in-vitro fertilisation and fertility treatment, but that still wasn't the important part of the story. Nor was the fact that they are now the longest-surviving octuplets on record.

The real story is that Ms Suleman is unmarried, and already has six young children, all apparently produced by IVF. It became hard to imagine why her doctors had done something so contrary to prudence, patient care, and basic medical ethics. As more details emerge, it becomes ever harder to understand.

These sound like doctors who function with the ethical sensitivity of a car mechanic, apparently prepared to do whatever a patient requests, so long as they're duly paid. Though the hospital where the babies were born has been identified - and they clearly did an outstanding job, as shown by the survival of all eight - the mother was transferred there for the birth, having received her bizarre fertility treatment elsewhere.

Ethically and medically peculiar
It is ethically and medically peculiar, as well as ignoring sheer common sense, to have done as they did, ignoring all significant clinical, ethical and procedural guidelines.

Why offer IVF at all to a woman who already has so many children? As a single parent, with no adequate visible means of support, it's hard to see even how she could have afforded such services.

A doctor's job, as an ethical professional, includes an obligation to refuse patient requests, if to comply would not be in the patient's best interests.

It is essential to listen respectfully to a patient's wishes, but not to take dictation. In a situation like this, her request should have triggered a psychiatric referral for a thorough evaluation. The California medical licensing authorities have announced they will be investigating the conduct of the doctor involved in this case, and that is absolutely right. It is hard to see what they did as anything but grossly unprofessional and unethical.

Irregular procedures at an unnamed clinic
Most doctors would implant only one or two embryos, especially in a relatively young woman. Even having triplets greatly increases the risks to both. One wonders whether she went outside of the US for the original treatment, or used some otherwise peculiar set-up. Conspicuously nobody has named the fertility clinic responsible.

Her mother is widely quoted as saying she has been obsessed with having babies, since she was a teenager. She told the press that all the children were from the same sperm donor, who was not her ex-husband. She divorced her husband a year ago, but the papers filed with the court say that there were no children from the marriage. The birth certificates of her eldest four children list a "David Solomon", said to be a "friend", as the father. She has not lived with her ex-husband for some eight years, and her parents are divorcees, since 1999, but still living together.

In 2006 she took a BSc degree in child and adolescent development. Terrifyingly, there have been reports that she wanted to become a television expert on child care. Her publicists said she had not determined how she would support her family, but they were weighing up several media offers, including some for financial compensation, and that “people and groups” had offered to move them a larger home.

In her first interview, Ms Suleman spoke of having "always dreamed" of having a large family, though apparently not one that included a stable husband or only as many children as she could afford to care for well. Last year, the mother filed for bankruptcy, claiming over $1 million in debts, but now says she withdrew that application and has paid her debts.

The compensation case
Ms Suleman worked as a psychiatric technician (a rather unskilled post, something like a junior nursing assistant) before being injured on the job - it is reported that she was injured in 1999 in a riot in a woman's ward at a state mental hospital, after which she complained of depression. Later, up to last year, she claimed over $165 000 in compensation for work-related injury and pain.

She seems to have remained on the hospital payroll until last year.

Who's your daddy?
There is a report that suggests that on this occasion, Ms Suleman had all 8 embryos left over from her previous IVFs implanted at once. This is, in itself, an odd way of doing things. And as there is still neither sight nor sound of the man who apparently provided the sperm for the IVFs, one wonders whether the latest implantations were even done with his knowledge and consent. At the time of the donation, did he know what he was letting himself in for?

As doctors, we see people with various foolish and even dangerous requests - such as people with handsome faces who are convinced that their nose is too long, demanding plastic surgery - but we are there to be expert advisors, not obedient technicians.

(Professor M. A. Simpson, aka CyberShrink, January 2009)

(Sources:, The Guardian, London, Associated Press, New York Times, TV interviews by Mrs Suleman and her publicist)


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