Modern healthcare has established that the odds of complication and disease increase significantly in multiple-birth pregnancies. In the case of Nadya Suleman, who recently gave birth to octuplets, six of the eight children were of low birthweight (slightly above 2 lbs.) and the other two were of extreme low birth weight (2 lbs. or less). The question then begs to be asked, “Where do we draw the line?” And what kind of role should the doctors play in advising patient decisions? In this to-be-continued series, Wade Roberts, assistant professor of philosophy, discusses the aspect of medical ethics.

Should doctors play more of a consultant role in decisions such as this (regarding in vitro fertilization)?

The operation of fertility clinics is currently unregulated. In 2008 the American Society for Reproductive Medicine adopted guidelines which encouraged fertility doctors to limit the number of embryos transferred to women under thirty-five, but they’re not legally binding. Doctors must take their ethical obligations ensuring patient safety seriously, and if they’re failing to give patients all the information they need concerning the risks of having six, seven or eight babies at a time, then they’re breaching basic ethical requirements with regard to informed consent.

Should Suleman have been more informed on the risks?

It’s unclear what Suleman did or didn’t know.

If completely knowledgeable of the risks, can there be any justification found in the decision to still go through with having eight children, regardless the probable complications?

In an interview with Ann Curry she insists that she was warned about the risks, and decided to proceed. If she was adequately informed, there’s no good justification for the decision she made. But there’s a larger issue here, and the world-renowned bioethicist Arthur Kaplan raised it: assuming the doctors understood the immense risks (not only to Suleman, but also to the babies) they had an obligation to step in and refuse to perform the procedure. We shouldn’t forget the basic premise of Hippocratic ethics: first and foremost, the physician should do no harm.

Given situations like these as reminders, is it necessarily safe at all times to employ a standard of patient autonomy?

I don’t think any ethicist would defend the idea that patient autonomy is absolute. Assume, for example, that a perfectly healthy patient strolled into a doctor’s office and demanded a heart transplant. No physician in his or her right mind would comply with the request. The Suleman case is a good example of what happens when there are no sensible limits on patient autonomy.

Christopher Bender ’10, Juniata Online Journalist