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America's Other Litter Problem

By Scott Shuger
Posted Friday, July 20, 2001, at 8:30 PM ET
Illustration by Robert Neubecker

Last week in Washington, D.C., a Saudi woman gave birth to septuplets, only the third set ever to have survived labor. The Washington Post fronted the story under the headline "SEPTUPLET JOY" and reported without analysis the family's two-bedroom apartment, the father's job as a high-school teacher, and his wish for a large family of "ideally, 12 children." The story was peppered with supportive statements from the doctor in charge.

Forgive me for not celebrating with a cigar (or seven). Yes, the babies are innocents, and of course it's sad that the couple had previously lost one child at 6 months and another at age 3, and, yes, it's unfortunate that the mother had trouble getting pregnant again. But it was indulgent of the parents to use a fertility treatment that tends to produce a high-multiple pregnancy, and it was socially irresponsible of their doctors to make it available to them.

Multiple births and fertility technology don't trouble me, per se. If a couple finds out that they are going to have triplets, that's a blessing, albeit a rather taxing one. And if an otherwise infertile woman makes use of in vitro or in utero technologies to have a baby or two, I'm with her and her doctors. But they lose me when they opt for fertility technologies associated with mega-births, which are essentially the only way to produce quads, quints, and more.

The immense amount of medical care (prompted by premature deliveries and low birth weights) and logistical support mega-babies require for years is a staggering diversion of public resources from the many to the few. An ordinary birth is usually presided over by one doctor and no more than a few nurses, but the delivery of the D.C. septuplets took a team of 50. At most hospitals, a single birth costs about $10,000. The medical costs incurred by the Washington septuplets before they get released from the hospital—they'll be there for months—will be about $2 million. That would pay for essential medical services for many, many non-mega-kids. And the same argument applies to all the subsequent non-medical costs.

It's fine if Bill Gates wants to pursue this nuttiness and write a check for the whole thing, but don't you think it's just a tad reckless for a high-school teacher? He claims that the Saudi royal family will pay for everything, but if true, that's luck, not a plan. The same can be said for the McCaughey family, who had their drug-induced septuplets in Iowa in 1997. The state and various local businesses built them a 6,400-square-foot house and bought them a 15-seat van. You can't expect society to keep rewarding wanton ovulation this way, especially if, thanks to the current boosterish atmosphere, it were to become more common.

Would-be mega-parents and their co-conspirator doctors seem to rely on two key assumptions: 1) A family's wish to have children is morally decisive, justifying the use of all available relevant technologies; and 2) foreseeable but avoidable complications from fertility treatments (i.e., seven kids with lots of problems) are on the same moral footing as unforeseen and/or unavoidable ones.

These assumptions are obviously false. Regarding 1): A wish may be a mere wish, not supported by the required underlying physical or financial capacity, which therefore has no moral force. I wish to be richer and have a bigger house. This by itself has no more weight than my wish to win the Nobel Prize in Physics. (It's only in the Bible that it says ask, and it will be given to you, an explanation perhaps of why mega-parents tend to be deeply religious.) In many non-obstetrical areas medical procedures are often denied to people who want but don't need them. Years ago, when a knee injury interfered with my running, my doctor did not offer me the perfected but expensive ligament repair then only being performed on professional athletes.

It is not wonderful, but selfish in the extreme, to pursue the mega-wish: It's unfair to other children, including those the parents in question already have, and it's even unfair to the mega-children themselves, whose lives will be dogged by the physical problems and psychological deficits that inevitably come with broods.

Regarding 2): It's glorious that doctors can wield their technologies to save a premature infant, but there is clearly a difference between their doing so when they just happen to be confronted with struggling life and their doing so when they have knowingly created that struggle with fertility treatments. We should encourage suitably trained people to run into burning buildings to save occupants, but we should not encourage suitably trained people to set fire to buildings and then run into them to save occupants.

Mega-parents live in a world where wished-for-children are on a par with (or are even more important than) wished-for-and-sustainable children and with actual children. But actually in that hierarchy, wished-for-children should finish last.

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Scott Shuger was a Slate senior writer and the original author of "Today's Papers." He died June 15, 2002.
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Comment from the Writer, Scott Shuger:


 In medicine as in life, probability has to be our guide. It has been suggested here [in The Fray] that the odds of having a mega-birth from the technology in question is .001. For the sake of argument, suppose that's true and that the doctors know that. Then I conclude that they are still being irresponsible in their course of action, especially if they know that nationwide at least one-thousand couples will likely receive the same treatment. To see this consider: Would you let your child play Russian roulette with a single bullet in a 1,000 shot revolver? Would you let 1,000 children play? I didn't think so.

--Scott Shuger

(To reply, click here.)


Reader Comments From The Fray:


[Notes from the Fray Editor: Yukon, below, sailed through the Fray irony test, and also brought us joy here with his heart-rending tale of being one of six children. As you might expect, adoption, choice, and rights were three words that cropped up a lot in posts. Tharasymachus (who according to Hedgehog is "changing the world one Frayster at a time") kicks off a good thread here.]


But isn't it all about choice? Well, that's how we've gotten accustomed to framing the question, isn't it? If she has the choice to abort the children, doesn't she have the choice to keep them? The columnist is simply choosing a different utilitarian denominator than the parents; and who gets the final say on which denominator is more appropriate?

This is what was almost inevitable in a consumer-oriented culture when the begetting of chidren was reduced to a matter of choice. Children are products we consume, soon to be tailored to our consumer likes and dislikes. Whatever it is, it ain't progressive, even if the vast majority of progressives are blind to the reality. If we don't like the crop we sowed here, it's time to sow a different one, because there's only more of this to come.

--Karl

(To reply, click here.)


Re choice: Perhaps there ought to be a point system of some kind so that individuals and families can flexibly exercise their rights to choose life and death for themselves or others, but things don't get out of hand. For example, if you abort two fetuses, you have to keep a senile relative alive for three years instead of killing him. If you commit suicide, you use up your family's whole allotment of "death points" for a generation. This would be fair and rational, as opposed to the present "system" in which emotional and moral issues keep producing messy and inconsistent results.

--Yukon

(To reply, click here.)


 I may never be able to have a successful pregnancy/children, and if I do, that there may never be more than one pregnancy.

So when my doctor says, "These are your options (Clomid, Gonal Shots, IVF, etc) and you face the risk of having more than 1 or 2 kids (3, 4++)"--it's a risk I am willing accept. Why? Because I know it may be my only shot at having a biological child. Do I want to have more than 3 kids at one shot? Ideally, no. I recognize there are severe, long-term health risks for both the mother and child(ren), but faced with the idea of never feeling the blessing of biological children, I'm willing to take my chances. And who says that children who have medical challenges are not worth a pregnancy? Not worth loving? Not worth accepting?

--Melfi1613

(To reply, click here.)


There is a financial reason why some couples push ahead with fertility treatment in risky circumstances. There are very few insurance plans that pay for any fertility treatment. IVF, albeit much more closely monitored and far less likely to result in multiple births, is much more expensive than IUI. If, say, you're a high school teacher pursuing fertility treatment, it makes sense to try the less invasive, less costly, less time-consuming IUI. But even the IUI costs thousands of dollars, dollars that insurance does not cover for most people. So after undergoing a variety of procedures, including earlier, less invasive cycles that didn't work, etc., you pony up the money for the fertility meds and surprise, it's working--there are nice follicles growing. The previous cycles, as I've said, haven't worked. Now you undergo a risk/benefit analysis: previous cycles haven't worked, so what are the odds that all of those little follicles are going to release an egg, and that all of those eggs will then fertilize?

I'm certainly not saying that these couples made the right choices, because I don't think they did, but given the current fee scale and lack of insurance, couples have to factor in their ability to try another cycle after walking away from one that has already cost them a lot of money

--S. Schulman

(To reply, click here.)

 (7/23)

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