Ethics evolve with technology

It's been well over a week since the New York Times published a provocative piece where women are interviewed who, after using fertility drugs and procedures, become pregnant with twins and decide to undergo "selective reduction" for lifestyle reasons. That's a euphemism for the killing in utero of one perfectly healthy twin in a pregnancy. It's an unbelievably difficult read if you're of the mind that ending these lives is a major human rights crisis. But I can't help but think it's a difficult read even if you support the right of people to abort any child for any reason at any time in the pregnancy. I wanted to write about it all week but found it too difficult to broach. Reporter Ruth Padawer and the New York Times itself have been criticized for the treatment of the story. Blogger Bad Rachel uses choice words to compare the twin-culling of Josef Mengele with the practice and asks: "Is there one member of Jill Abramson’s religious order who views the subject of this article ... as a piece of awfulness? Maybe not."

I suppose the interviews with these women do bring to mind one of the most amazing pieces I ever read in the New York Times, that 2004 "Lives" column by an abortion rights activist who took the lives of two of her unborn children because otherwise, and I quote, "I'll have to start shopping only at Costco and buying big jars of mayonnaise." And I literally think of that each and every time I'm at Costco buying bulk food to feed my non-selectively reduced children.

But I actually thought this story was pretty darn good. I didn't think it praised the practice and, in fact, I think it was good journalism that permitted people to tell their own stories without any gaming. There are perspectives that are left untreated, to be sure, but on the whole, the piece was well done, I thought. It begins by emphasizing the consumer nature of in vitro fertilization and referring to the reduction practice as "almost as if having half an abortion." Later we learn about the practice:

The procedure, which is usually performed around Week 12 of a pregnancy, involves a fatal injection of potassium chloride into the fetal chest. The dead fetus shrivels over time and remains in the womb until delivery.

The moral quandary is not shied away from. It's presented up at the top of the story, in fact. We learn quite a bit about how fear motivates the women who reduce their pregnancies. The fear of twins taking up too much time from the parents. One parent justifies taking the one twin's life by saying she thought she couldn't give them both enough attention. So, she says, "This is bad, but it’s not anywhere as bad as neglecting your child or not giving everything you can to the children you have." We learn that no one, not even the surviving twin, will be told about what happened to his mate in the womb.

The writer asks a provocative question:

What is it about terminating half a twin pregnancy that seems more controversial than reducing triplets to twins or aborting a single fetus? After all, the math’s the same either way: one fewer fetus. Perhaps it’s because twin reduction (unlike abortion) involves selecting one fetus over another, when either one is equally wanted. Perhaps it’s our culture’s idealized notion of twins as lifelong soul mates, two halves of one whole. Or perhaps it’s because the desire for more choices conflicts with our discomfort about meddling with ever more aspects of reproduction.

I would have loved for the article to answer that question more. I mean, from the pro-life perspective, the taking of life in the womb is what's controversial or problematic. That question really needs to be put to others. I wish that it had been. We do learn that one anonymous commenter at a mothering site said she couldn't sleep at night after having terminated her daughter's twin brother, but what about some more prominent folks?

Times conservative columnist Ross Douthat said the practice showed the "failure of liberal bioethics." He points to a section where we learn that Mark Evans was among the first to reduce a pregnancy and in 1988 he issued ethical guidelines including that reducing below twins was a violation of ethical principles. A couple of years later, he said such reductions cross "the line between doing a procedure for a medical indication versus one for a social indication" and he urged his colleagues to resist becoming “technicians to our patients’ desires.” Within 20 years, though, we learn that he had completely reversed course and supported these terminations on social grounds:

In 2004, however, Evans publicly reversed his stance, announcing in a major obstetrics journal that he now endorsed twin reductions. For one thing, as more women in their 40s and 50s became pregnant (often thanks to donor eggs), they pushed for two-to-one reductions for social reasons. Evans understood why these women didn’t want to be in their 60s worrying about two tempestuous teenagers or two college-tuition bills. He noted that many of the women were in second marriages, and while they wanted to create a child with their new spouse, they did not want two, especially if they had children from a previous marriage. Others had deferred child rearing for careers or education, or were single women tired of waiting for the right partner. Whatever the particulars, these patients concluded that they lacked the resources to deal with the chaos, stereophonic screaming and exhaustion of raising twins.

It's fascinating. The headline is actually a quote from the doctor himself.

The article does include a couple of interesting religion angles. One comes from the story of Dr. Ronald Wapner, director of reproductive genetics at Columbia and a reduction pioneer who now refuses to do elective reductions. He used to do them:

As word spread, a stream of patients called Wapner’s office, scheduling reductions to a singleton. A few months later, after the last patient of the day left, the sonographer who had worked with Wapner for nearly 20 years stopped at his office. She told me what happened next, on condition of anonymity because she doesn’t want her relatives to know everything her work entails: “I told him I just wasn’t comfortable doing a termination of a healthy baby for social reasons, and that if we were going to do a lot of these elective reductions, I thought he should bring in someone else who was more comfortable. From the beginning, I had wrestled with the whole idea of doing reductions, because I was raised in the church. And after a lot of soul searching, I had decided there were truly good medical reasons to reducing higher-order multiples to twins. But I had a hard time reconciling doing reductions two to one. So I said to Dr. Wapner, ‘Is this really the business we want to be in?’ ”

Wapner met with his staff and all of them -- the sonographer, the genetic counselors, the schedulers -- said they weren't cool with the elective reductions.

The article includes some interesting details about how consumerism has spread to other areas where technology and infertility collide. We learn a bit about how some parents pick children based on sex -- a major issue in other countries, of course. A bioethicist talks about how the seemingly limitless bounds of choice has placed greater burdens on women and that choices are not always as liberating or empowering as they seem, sometimes. In other words, if you have the choice about whether to give birth to a child, rather than receiving it as a blessing (or curse!), you're suddenly held more socially responsible for how well you provide for the child or how difficult life is made for your previous children.

The article includes a brief discussion of the psychological effects that the reduction might have on the surviving child. And there's a discussion about how the reasons for reducing a pregnancy aren't that different from aborting because of a child's imperfections. Obstetrician Naomi Bloomfield goes on record saying she would have aborted one of them if one of them had "an anomaly." She further states that this is not selfish but "Parents who abort for an anomaly just don’t want that life for themselves, and it’s their prerogative to fashion their lives how they want. Is terminating two to one really any different morally?”

The author reveals that she had twins just a couple years after her first daughter. She talks both about how difficult it was and also what a blessing. The piece ends with a discussion of a lesbian couple that each got pregnant with twins after rounds of IVF. They also have a 14-month-old son. They decided to reduce one pregnancy and the other pregnancy miscarried shortly thereafter:

For the sake of the boy they already had, they decided to reduce A.’s pregnancy to one, and right after that A.’s partner lost her whole pregnancy. “I don’t wish this on anyone,” A. says. “I’m very grateful that we had this option at our disposal, that it can be done safely and in a legal way, but it was very difficult for both of us. I still wonder, Did we choose the right one? — even though I wasn’t the one who chose. That idea, that one’s gone and one’s here, it’s almost like playing God. I mean, who are we to choose? Even as it was happening, I wondered what the future would have been if the doctor had put the needle into the other one.”

I'm curious what you all think of the article. Was it a barbaric endorsement of twin-culling? Or a powerful indictment of the current mentality of childbirth as consumer and lifestyle choice? The article, with all of its emphasis on ethics, certainly should have had much more discussion of religious views on the topic. Anything else missing? Either way, it read much differently to me than the Associated Press story cheerily headlined at the Beaumont Enterprise "One-child policy a surprising boon for China girls." The alive ones, I'm guessing.

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