Taking Responsibility for Children

EIGHT: Could There Be a Right Not to Be Born an Octuplet?

157 x EIGHT Could There Be a Right Not to Be Born an Octuplet? LAURA M. PURDY Twice in the last few years the bioethics sensation of the week has been the arrival of high-order multiple births (or “supertwins”), first the McCaughey septuplets in Des Moines, Iowa, then the Chukwu octuplets in Houston, Texas. The media commentary on the cases tended to focus, as usual, on short-term issues—the need for hundreds of diapers, the images of babies on ventilators, and the expense. But little scholarly work has yet appeared on the subject, perhaps because of media formats that inhibit in-depth exploration and, also, the peculiar lack of sustained interest in children’s issues. The Context There has been a spectacular increase in the number of multiple births: since 1971, such births have quadrupled in the United States because of treatment for infertility.1 Powerful new drugs can cause many eggs to ripen and, if the woman has intercourse, be fertilized simultaneously. If she is undertaking in vitro fertilization (ivf), as many as seven or eight embryos might be placed in her uterus to increase the chances of a successful pregnancy . Women’s bodies are designed for singleton pregnancies. The greater the number of fetuses, the greater the strain on her body,2 and the greater the risk of disability or death for the fetuses. Babies born of supertwin pregnancies are always seriously premature and require intensive medical care to survive. For example, Mrs. Chukwu delivered thirteen weeks early, and none of her babies weighed even two pounds.3 There are several interesting perspectives on the supertwin phenomenon that cry out for critical analysis. Among them is the glorification of motherhood (one is reminded of the old Soviet heroines of the republic, women who had had ten or more children), the implication that no sacri- fice is too great in the production of such births (Mrs. Chukwu spent weeks in the hospital, head down to reduce the pressure on her cervix4), the inconsistency in the McCaugheys’s and Chukwu’s expecting God to help them cope with what high-tech medicine created, and more. But here I want to focus on the outcome for children. Health Risks Premature infants born weighing less than two pounds often have breathing difficulties and brain damage. Many infants die, and those who survive may suffer from long-term problems: Studies of low-birth-weight children (not from multifetal pregnancies but from premature births) have shown that approximately 20 percent have severe disabilities; among those weighing less than 750 grams (1.7 pounds) at birth, 50 percent have functional impairments. A recent study that followed these very small infants to school showed that up to 50 percent of them scored low on standardized intelligence tests, including 21 percent who were mentally retarded. In addition, nine percent had cerebral palsy, and 25 percent had severe vision problems. As a result, 45 percent ended up enrolling in special-education programs.5 These statistics tend to be obscured in the media flurries attending the births, and follow-up bulletins are sparse. For example, the Chukwu babies have pretty much disappeared from the scene except for a terse announcement several months after their birth that three of them were released, in good health, from the hospital.6 The others remained in hospital, three of them critically ill.7 I picked up another story about the harsh reality facing a family with quintuplets on an e-mail discussion list: “All of Aymond’s 6year -old quints have medical problems. One is blind. Four of them are in speech therapy, three in occupational therapy and three in physical therapy .”8 Given such outcomes, it seems reasonable to raise the question whether it is morally permissible to take such risks to have babies. Notice that this chapter considers only the moral issue, as there is an enormously greater 158 LAURA M. PURDY burden of proof needed to support any legal regulation of reproductive behaviour. Other Risks Most of the criticism of parents who knowingly go forward with higher order multiple pregnancies has focused on the risk of death or disability such pregnancies involve for the resulting babies. Morally serious though I believe this risk to be, few have commented on other problems facing these children. In fact, the only somewhat detailed discussion I have found is by Ezekiel Emanuel, who writes: Equally important, but rarely...