Three in a casket

One Month Old Quadruplets Leave Tongji Hospital Anyone concerned about America's fertility industry should ponder "21st Century Babies" being posted in installlments on the the New York Times website. Writer Stephanie Saul is doing an excellent job of revealing the moral dilemmas and, frankly, distress and suffering that may occur when potential parents decide to try in-vitro and intrauterine insemination.

Here's the first story, about the dangers of bearing twins.

As a person who struggled with infertility, but never had to go the hormone injections route, I read the second article with a disturbing question-- why didn't I know this already? Although she includes many quotes from parents and doctors enmeshed in the business of fertility medicine, Saul's main focus is the heartbreaking story of Thomas and Amanda Stansel :

For more than a year the Stansels had been relying on Dr. George Grunert, one of the busiest fertility doctors in Houston, to produce his industry's coveted product -- a healthy baby. He was using a common procedure called intrauterine insemination, which involved injecting sperm into Mrs. Stansel's uterus after hormone shots.

But something had gone wrong. In April, an ultrasound revealed that Mrs. Stansel was carrying not one but six babies, and Dr. Grunert was recommending a procedure known as selective reduction, in which some of the fetuses would be eliminated.

The Stansels rejected Dr. Grunert's advice and, since then, their vision of a family has collapsed into excruciating loss: the deaths of four children after their premature births on Aug. 4, including one who died late Sunday night. The two other infants remain in neonatal intensive care, their futures uncertain.

When I first read this story, three of the babies had died -- now the story has been altered to reflect the death of a fourth child.

Generally speaking, Saul doesn't mince words in delineating the awful choices that patients and doctors may have in balancing one life against others. Yet in that context is it is very odd that she places a few religious ideas so deep in her story that they almost seem to play lesser roles. And yet it is likely that they are actually quite important.

Sauls carefully notes that causing the death of some fetuses (any word choice can't capture this) is "known as" selective reduction. But the pro-life movement, as Sauls comments later in the story, call the same procedure elective abortion. The words "selective reduction" dance in and out of quotes in a way that seems to signal either ambivalance or poor editing. And the fact that this procedure has ethical and religious implications should have been closer to the top.

More crucial is where Saul mentions the faith that affected the Stansel's decision to attempt to carry the babies to term -- near the article's end.

Turns out the Stansels are Mormons.

For the Stansels, the decision was influenced by their membership in the Church of Jesus Christ of Latter-day Saints. The church generally opposes abortion. After learning that Mrs. Stansel was carrying sextuplets, the Stansels decided to meet with church elders and consult with a reduction specialist.

"It just never felt right," Mr. Stansel said. "We prayed many nights. A lot of sleepless nights. Originally we thought we might do the reduction. We chose to carry all six and, we believe, let God do what he's going to do."

In a long article, replete with details, placement means a lot. Was I the only one who read the first Thomas Stansel quote, about holding the babies before they died and thought -- boy, this guy is a bit narcissistic? After all, they "rejected" their own doctor's advice.Whether readers end up feeling empathy or not, this quote gives them more of a sense of the family's own suffering, and the discernment process they went through.

It's hard to finish the article without being aware of the suffering on all sides of some of these terrible decisions -- and that's a witness to Saul's thorough reporting. But while religion isn't a ghost here, it's more of an appendix. Throughout the story I was asking: what where they thinking? Why did they behave the way they did? Finding out at the end makes the Stansels rather two-dimensional.

Where are the voices of counselors, ethicists and clergy? Given that, as Sauls says, religious convictions are a part of what motivate many couples, they could have been threaded throughout the story.

The fertility field, supply and demand on steroids, is virtually unregulated. Thus we would be naive to expect that these stories would leave us with easy heroes and villains -- but given that so many potential parents are harnessing fertility treatments to produce babies, they really need to be told. At least then patients will have a better idea of the possibly ghastly decisions that may lie ahead.

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