As we end the year 2006 on the Bioethics Discussion Blog, I want to challenge my visitors with the final ethical question of the year: Are there some areas of biology where it would not be ethical for scientists to study at all because of the concern of some groups that the potential results of such scientific biological study could potentially be used for acts which would be detrimental and not be in the best interest of those groups or others? What should be the limits of biologic research? Does the public and governmental reactions to stem cell research and cloning tell us anything?
There happens to be, currently, concerns about this matter. And where are the concern directed? Why, it’s the research that is being carried out at Oregon State University and at the Oregon Health and Science University. The research? Learning about what sets the sexual orientation of rams that makes some of them “gay”. These sheep prefer to mount other rams rather than mating with ewes. This behavior reduces the farming value of these animals. If the animal’s sexual orientation could be changed to behave in a heterosexual manner, this would be of benefit. Unfortunately, these studies are felt by some as the beginning of a slippery slope toward the “treatment” of human gay and lesbians, and therefore further studies of sexual-orientation should be stopped.
So the question is whether there is just some research in biology that should never be carried out and it would be better and safer to keep humankind ignorant of some parts the interesting world around us? You can read all about this particular issue in December 31, 2006 Timesonline. Let me know what you think.
May we all have a happy and healthy and ETHICAL New Year with or without gay sheep.
..Maurice.
Sunday, December 31, 2006
Saturday, December 30, 2006
Self-Interests and Disinterest in Science and the Patient’s Best Interests
Do you actually believe that articles written in medical journals, particularly about medications, that your doctor reads and that the science reporter on radio or TV broadcasts to the nation all are based on the facts and interpretation of the facts obtained by independent and unbiased researchers? If so, you, as patients and even we, as doctors, are sadly misinformed. Just read this article "How Great Researchers Get By-lines, Get Paid, and Get Medicine in Trouble" by Kate Jirik in the Hastings Center Bioethics Forum to get a perspective of the extent pharmaceutical companies and medical education companies are using the authority of the names of prominent and respected researchers to publish articles in prominent and respected medical journals all to promote their own goal of getting physicians to prescribe and patients to accept (and pay for) their drugs. This behavior increases the pharmaceutical company profits presumably with little regard to science, reputations, patient benefit and the social costs of medical care. And the sad part is that this behavior on the part of these companies and those researchers who are willing to get money just for their names to be attached to a “ghost written by pharmaceutical company” medical article is that it is not being substantially prevented by prompt disclosure,legal or administrative action. If physicians cannot have faith in medical research information as provided by the medical journals or other medical education resources, we will not deserve the trust of our patients who depend on us to “know and do” the right thing for them.
Go and read the article and then return and let me hear from you about this important but not well publicized aspect of medical care. ..Maurice.
Go and read the article and then return and let me hear from you about this important but not well publicized aspect of medical care. ..Maurice.
Thursday, December 28, 2006
A Suspected Piece of Evidence and the Limits of Physician Responsibility and Personal Rights
In the December 21, 2006 news from Texas: A 17 year old male allegedly has a bullet just below the skin about two inches above his eyes fired by a robbery victim. Prosecutors claim that the bullet will prove that the youth tried to fatally shoot a used car lot owner last July after he and other gang members robbed the business. His family and their attorney are fighting a court order to force him to undergo surgery to remove the projectile which prosecutors say would be the evidence that could send the teen to prison for attempted murder. On the basis of a search warrant in October, a physician evaluated a bump on the patient’s head and told prosecutors that operating room surgery under anesthesia would be needed to remove the suspected bullet. A second search warrant requested a Texas hospital to remove the bullet but the hospital refused. Prosecutors are currently trying to find a physician to perform the surgery. (Here is the link to the whole story from which I adapted the synopsis.)
This news item can raise a number of interesting ethical/professional and legal questions such as: to whom does a physician owe the trust and responsibility?: to the physician’s patient or to the police? Can the police force a physician to provide a search of the suspect's body? When does a criminal suspect become a patient? When does the individual’s right to preserve the integrity of one’s body become trumped by the duty of the police to obtain evidence in order to protect the public? Any answers? ..Maurice.
This news item can raise a number of interesting ethical/professional and legal questions such as: to whom does a physician owe the trust and responsibility?: to the physician’s patient or to the police? Can the police force a physician to provide a search of the suspect's body? When does a criminal suspect become a patient? When does the individual’s right to preserve the integrity of one’s body become trumped by the duty of the police to obtain evidence in order to protect the public? Any answers? ..Maurice.
Saturday, December 23, 2006
PAIN
Today, I completed a 12 hour continuing medical education requirement set by the state of California for all licensed physicians. Why was this requirement necessary? Most physicians are poorly educated in the all the details of how to manage acute or persistent pain in their patients. In addition, there is unnecessary uncertainty both by the physicians and their patients about the legal and addiction consequences of pain treatments particularly with narcotics. And it turns out that patients are not being adequately treated for their pains. Because of this requirement, I learned many things that I never knew or only partially knew or understood about pain and pain management. For those who would like to read more about what your doctors should be learning, you can go to this American Medical Association link.
On my now inactive Bioethics Discussion Pages, I had an interesting topic a few years ago in which I wanted to read what my visitors there thought about pain in general or their own pain and how they looked at the relief of pain. I think that their comments were kind of interesting. I have posted a copy of that topic and the responses below. The more recent responses are at the top of the posting. I look forward for my current visitors to add their own views and comments to the question. Also I would like to know your own personal experiences with pain and pain management by your physicians—but no names please. ..Maurice.
________________________________________________________
Pain is one of the most common personal experiences that virtually all humans can have during their lifetime. It is a subjective occurrence that often cannot be easily quantitated and compared between individuals since it appears that each individual looks at his or her pain in their own way. Pain may be viewed by the affected individual in the context of the source of the pain, the intensity, the disability and the effect the individual's disability from the pain on others including his or her loved ones and the possibility for resolution of the pain either spontaneously or with help. In addition, religious or spiritual interpretations can be given to one's pains and how the individual responds may depend on how the individual looks at and accepts these interpretations. The medical profession in modern and post-modern times, with availability more and more tools or approaches to try to relieve pain, has looked at pain as a symptom needing to be treated by these tools and either substantially relieved or eliminated. Most patients look to their physicians to do just that. And many ethical issues have involved conflicts regarding pain and suffering and pain management. But do all patients find that relief of pain is a good action? And if not, why not? These are the questions I would like to pose for this page. I would like to know from my visitors what pain means to them and whether they consider that relief of pain is always a good.
Here is the question:
What Does Pain Mean to You? Is Relief of Pain Always a Good Thing?
The Discussions
Date: Tue, Jul 22, 2003 2:47 PM From: winstonjen@yahoo.com To: DoktorMo@aol.com
A bioethicist, Daniel Callahan, claimed that medicine should not be used to relieve suffering caused by despair. What an ignorant claim. Only those who have not experienced the pain that depression can cause. It is medicine's duty to work with psychiatrists and counsellors to relieve all suffering, regardless of how they are caused. Sincerely, Winston
Date: Mon, Jun 23, 2003 8:53 PM From: bizimom40@cox.net To: DoktorMo@aol.com
Pain to me is anything that makes me feel physically uncomfortable, a noticable difference from the way I would normally feel. I have to say that all pain is not bad. Pain serves as a wonderful radar system for our bodies to inform us of a problem. We must listen to our bodies and then tell our phsycians! Pain also is a great tool for instruction, from the toddler and the hot stove to the 40year old trying to work out and straining muscles, etc. The type of pain I have problems with is that in the terminally ill patient. I have had hospice patients who refuse to take medication for their pain and though it may bother me, I have to allow them to make that decision for themselves. The ones that really get to me are the ones when the patient is desperate for any help in getting relief from their pain and the family or the physician (ok, sometimes even a nurse) stand in the way of the patient getting relief. Folks worry about addiction, they worry about inadequacy of meds later down the road (like it will just stop working), family gets upset because if you make the patient comfortable they may sleep more and not be quite as responsive to the family then. Physicians aren't always informed well about pain management issues and all aren't comfortable with letting a nurse guide them through the nuances of good pain management. It is incredibly frustrating to have a patient in pain, who wants the pain relieved, you know what you need to have or give to alleviate the pain and the physician is not cooperative with it.
I usually think of all pain as bad but your comments on the good of pain were incredible!
Date: Wed, Jun 11, 2003 6:34 AM From: wibarth@attbi.com To: DoktorMo@aol.com
I agree with many of the comments regarding pain. Pain is an important warning mechanism that body has that something is wrong. I think it is one of the reasons that brings patients to seek medical care. It can also serve as a protection against danger in the case of skin burns. And as a nursing student I have learned that pain is subjective and that everyone's threshold is different. I think proper pain management is still either facilitated or constrained by the environment, including social and political factors. Some of the factors include emotions, behaviors, beliefs and attitudes.
Pain can also have a social impact this missed work due to persistent unrelieved chronic pain causing an economical impact. Insufficient pain relief is still a problem. Some patients are still willing to endure high levels of pain instead of asking for an analgesics. Some professionals still reluctant to give adequate levels of a medication out of concern that the patient may become dependent or addicted or they have been duped by a patient in the past. However, empowering the patient to be an active partner in reporting information about pain rather than being stoic is important and one must respect the patient's response to pain.
Rebecca, Salem State College Nursing Student
Date: Thu, Jun 5, 2003 6:02 AM From: wibarth@attbi.com To: DoktorMo@aol.com
I also agree and think that some pain is necessary. Pain in life can be behavioral, cognitive, sensory and physiologic. In life some pain is good as it can serve as a protector against danger or a possible opportunity to for the person to grow spiritually or intellectually after experiencing cognitive pain. Pain can serve as a protector; for example when exposed to a possible danger like fire when pain is felt the body's immediate response to pull way because of a pain trigger. I also feel that it is the body's way of warning that something is wrong internally or a signal that it is time to take better care and slow down in the case of headaches.
As a nursing student, I know that pain is subjective and pain thresholds vary from person to person. Pain can interfere with the things in life that bring joy and satisfaction. Unrelieved pain can cause emotional responses such as fear, depression, anxiety and anger that can be detrimental to recovery; and no one needs to suffer needlessly.
Rebecca, SSC
Date: Tue, Jun 3, 2003 3:31 PM From: Cutie42730@aol.com To: DoktorMo@aol.com
Pain mean that I will have some difficulty functiong on a daily basis. I would try alternative methods such as yoga and relaxation before I became dependent on a drug because the implications of using prescription drugs can be addictive and can cause other problems. I have to admit that my pain tolerence is low and I am the first one to pop an asprine when I have a headache. kim
Date: Fri, Apr 25, 2003 3:37 PM From: brandx@sbcglobal.net To: DoktorMo@aol.com
While I think that we agree that all pain is not bad, we must look on the impact of pain to the person. In western society, a person's function in society does play a role in ethics according to Garrett, Baillie, and Garrett's book Health Care Ethics: Principles and Problems (2000). If pain that is manageable is keeping a person from functioning in society or limiting his or her autonomy, then it is a tragic instance. In this situation, if the person requests, the pain should be managed. As in every topic, there is no black and white. In some instances pain is a good thing (in alerting someone that something is wrong with their bodies) and in some instances, a bad thing (when chronic pain that cannot be cured limits a persons activity, autonomy, and independence). Thanks.
Date: Tue, Apr 8, 2003 9:20 PM From: dnmricks@bellsouth.net To: DoktorMo@aol.com
This summer, I had a paradigm shift about pain. Throughout my first year of nursing school, I had been taught that pain is subjective and we must control it. I believe that patient comfort is one of a nurse's highest priorities.
However, my ideas and beliefs about pain were tweaked a bit this summer when I read a book called, The Gift of Pain by Dr. Paul Brand. Paul Brand grew up in India, the child of missionary parents. After many years back in England struggling with what to do with his life, he became a doctor (like his father) and returned to India. There he treated leprosy patients.
After several years of treating his patients and studying their disease, Dr. Brand created what are now the international standards of care for leprosy patients. You see, for hundreds of years almost no one had treated a leprosy patient or even been near one. It was assumed that leprosy patients were extremely contagious and that they lost fingers, toes, feet, noses, and various other parts of their anatomy due to the disease process itself. Dr. Brand found that this was not true. What was true was that leprosy patients lost not their body parts due to leprosy, but their ability to feel any pain at all. Leprosy patients can set their hand on a hot stove and never know anything is wrong until they smell the odor of burning flesh!
Now, you may be wondering where I am going with this. In his book, Dr. Brand presented a new perspective of pain--that of a precious gift to be appreciated, not a curse to be avoided. Dr. Brand very eloquently made his case for understanding that pain is a gift God gave when he created us. It serves to warn us that something is amiss in our bodies. Imagine how many patients would die from the infection of a ruptured organ if they did not feel the classic one-sided pain of appendicitis!
After reading The Gift of Pain, I have become truly grateful for sore feet and indigestion, for they tell me when I need to buy new shoes or eat less at the next meal! I truly believe that a patients pain needs to be controlled, but while I will do my best to keep my patients comfortable, I will be sure to investigate the cause of their pain in order to fix the problem that prompted it.
So what was my paradigm shift? To me, pain is no longer the enemy, but is one of my closest allies.
Date: Tue, Apr 8, 2003 2:13 PM From: laurabell732003@yahoo.com To: DoktorMo@aol.com
I believe that everyone is going to have pain at one time or another. I think that pain can be a good thing at times and that it should not always be treated. Pain is a way of our bodies letting us know that something is wrong. Instead of going straight for the pain pill or asking for an Rx, find out the real reason for the pain. Too many people are abusing pain meds these days. And I think that Rx's for pain meds are way overwritten also.I feel that a patient that is terminally ill should get as much pain med as needed to keep that person comfortable, and also a woman in labor as well. But just everyday aches and pains dont need narcotics or even a Tylenol every single time. Give your body a chance to tell you what's going on.
Date: Tue, Mar 18, 2003 8:06 AM From: CurtsT@leb.k12.in.us To: DoktorMo@aol.com
Pain is a part of life.It may not always be your favorite part but it is around for a reason. Pain is like a 6th sense a warning sign if you will. People need this sensation to comprehend how their body is feeling. Life without pain is like shoes without lases, it just dosen't fit. People have limitations and boundries and pain provides these boundries. Pain gives the limitations to people and is a must have even though it is unpleasant.
Date: Sun, Mar 9, 2003 10:04 PM From: byounger2@kc.rr.com To: DoktorMo@aol.com
What Does Pain Mean to You? Is Relief of Pain Always a Good Thing?
I think that before we ask this question we should consider different pain tolerances of different people and patients. To one person a needle prick might be a slight irritation and to someone else it might feel like someone had just stuck a knife into thier limb. I think that every patient should be asked what his or her tolerance is to pain by filling out a simple survey. This survey could tell how often medications could be given and by what route. This could be intertwined with costs of drugs and what route to give.
Now the real question is what is Pain to you and is Pain relief always a good thing. Pain to me means that something is wrong. Of course everyone knows that Pain is the body's way of saying "hey something bad is happening" But i believe after the intial pain it is felt it is ok to get rid of the pain. If one is in control of the patient and knows what is going on, I believe it is ok to make the patient comfortable. We must be careful of which drugs we are giving to make sure that patients do not become addicted. This can lead to a case of addiction which is a whole different topic.
Bryce
Date: Sat, Mar 8, 2003 7:42 AM From: jckskk1@swbell.net To: DoktorMo@aol.com
I define pain, in the physical sense, as noticeable discomfort during any waking activity of daily living. For example, if your ankle joints hurt when you walk, this is pain. If you are lying in bed and your neck and shoulders ache, this is pain. If you normally bound down stairs 2 or 3 at a time, but now you have to go one at a time and use the railing because your knees are sore and popping, that's pain. Like beauty, pain is in the eye of the beholder, or in this case, the one who feels it. I know from my experience in health care that different people would describe and qualify the same pains altogether differently than others...tolerance levels cover the gamut. And how people deal with and react to pain is very different as well. But ultimately, pain is defined by and quantified/qualified by the one who feels it.
Jeff Keener, Joplin, MO
Date: Tue, Jan 28, 2003 8:49 PM From: rosasharon1@juno.com To: DoktorMo@aol.com
Hi. Recently I had a myomectomy. A large fibroid mass was taken from my uterus. This happened because of pain and other complications. I know I made the right choice even though I know must deal for a time with post-operative pain. The doctors wanted me to be able to "manage" my pain. I don't think the idea was to completely mask it. Anyway, while I still have pain--I've got about four more weeks to go at least, it is much less than the first day after the operation. I look at it as a sign that my inside is not healed up. In fact, my sutures on the outside could heal before my uterus does. As far as drugs go, one day a couple weeks back, I inadvertantly took too much vicadin. I had to drink a lot of water and tea to wash it out of my system. I decided afterwards that I would rather feel as much pain as I can handle right now then be in the doped-up zombie-like state I was in. Yes, I think pain has its purpose, if for no other reason, to tell you when you are fine and not fine. It forces you to listen.
Sharon
Date: Thu, Nov 14, 2002 11:52 PM From: magichands@fastmail.fm To: DoktorMo@aol.com
I worked for 8 weeks in a Leprosy Research Centre in India on a clinical Physiotherapy placement.
And on of the main reasons people develop the deformities of leprosy is a "Lack of their ability to feel Pain". Because of this, they can't feel that little stone or pebble or thorn which has hurt their foot and is bleeding, and they carry on (pebble in shoe) and cause it to ulcerate and become infectious, granted this would not happen as often in a developed country BUT the example still illustrates the IMPORTANCE OF PAIN and as with anything it should not be in excess.
The right amount of pain in other words is very helpful as a a warning to something going wrong. Its in cases when it goes out of control or is not present,that we need to worry about.
Abrar 'MagicHands' Waliuddin, magichands@fastmail.fm
Date: Thu, Nov 7, 2002 9:51 PM From: garrett@rockisland.com To: DoktorMo@aol.com
What does pain mean to me? What it means to everyone! I hurt!!
Is relief of pain always good? Absolutely not! I know this is not going to be popular with the whiney ones out there, but pain is, by itself, not life threatening, unless it is so intense that it brings on shock, which can kill. It is also a way to monitor the recovery process. Less pain, more recovery. I know it sounds simplistic, but it is a necessary way to determine the seriousness of an injury or, less commonly, a disease.
If you have suffered a back injury, then the intensity of the pain you feel may be a way to judge the intelligence of the activities you engage in after the injury. If you mask this feedback with drugs, then you may cause yourself irreparable harm.
If you have a toothache, and you DON'T medicate to relieve the pain, you could suffer incredible pain for no reason. If you DO medicate for the pain, and continue to medicate without seeking professional relief through surgery to remove the cause of the pain, then you risk complications that could be very dangerous.
What level of pain shoud you accept? Whatever you can bear without damaging your physical or mental self. And whatever level of pain you chose to accept, be aware of the physical effects that non-treatment of the CAUSE might have.
Jim
Date: Mon, Oct 14, 2002 2:13 PM From: tchssh@msn.com To: DoktorMo@aol.com
Hi, Pain is a natural an important response that must not be ignored if we are to maintain maximum health. Whether it is physical or emotional, pain is necessary to help us respond to the changing needs of our minds and bodies. Although it is important, at times, to mask pain in order to begin the journey through the healing process, pain is good and should not be ignored. Pain allows us to acknowledge there is a problem, and later, to evaluate the progress of treatment. While we are learning how to manage pain and keep patients as comfortable as possible, we must not forget that it is an effective way for our mind and body to communicate to us.
Respectfully, Sue
On my now inactive Bioethics Discussion Pages, I had an interesting topic a few years ago in which I wanted to read what my visitors there thought about pain in general or their own pain and how they looked at the relief of pain. I think that their comments were kind of interesting. I have posted a copy of that topic and the responses below. The more recent responses are at the top of the posting. I look forward for my current visitors to add their own views and comments to the question. Also I would like to know your own personal experiences with pain and pain management by your physicians—but no names please. ..Maurice.
________________________________________________________
Pain is one of the most common personal experiences that virtually all humans can have during their lifetime. It is a subjective occurrence that often cannot be easily quantitated and compared between individuals since it appears that each individual looks at his or her pain in their own way. Pain may be viewed by the affected individual in the context of the source of the pain, the intensity, the disability and the effect the individual's disability from the pain on others including his or her loved ones and the possibility for resolution of the pain either spontaneously or with help. In addition, religious or spiritual interpretations can be given to one's pains and how the individual responds may depend on how the individual looks at and accepts these interpretations. The medical profession in modern and post-modern times, with availability more and more tools or approaches to try to relieve pain, has looked at pain as a symptom needing to be treated by these tools and either substantially relieved or eliminated. Most patients look to their physicians to do just that. And many ethical issues have involved conflicts regarding pain and suffering and pain management. But do all patients find that relief of pain is a good action? And if not, why not? These are the questions I would like to pose for this page. I would like to know from my visitors what pain means to them and whether they consider that relief of pain is always a good.
Here is the question:
What Does Pain Mean to You? Is Relief of Pain Always a Good Thing?
The Discussions
Date: Tue, Jul 22, 2003 2:47 PM From: winstonjen@yahoo.com To: DoktorMo@aol.com
A bioethicist, Daniel Callahan, claimed that medicine should not be used to relieve suffering caused by despair. What an ignorant claim. Only those who have not experienced the pain that depression can cause. It is medicine's duty to work with psychiatrists and counsellors to relieve all suffering, regardless of how they are caused. Sincerely, Winston
Date: Mon, Jun 23, 2003 8:53 PM From: bizimom40@cox.net To: DoktorMo@aol.com
Pain to me is anything that makes me feel physically uncomfortable, a noticable difference from the way I would normally feel. I have to say that all pain is not bad. Pain serves as a wonderful radar system for our bodies to inform us of a problem. We must listen to our bodies and then tell our phsycians! Pain also is a great tool for instruction, from the toddler and the hot stove to the 40year old trying to work out and straining muscles, etc. The type of pain I have problems with is that in the terminally ill patient. I have had hospice patients who refuse to take medication for their pain and though it may bother me, I have to allow them to make that decision for themselves. The ones that really get to me are the ones when the patient is desperate for any help in getting relief from their pain and the family or the physician (ok, sometimes even a nurse) stand in the way of the patient getting relief. Folks worry about addiction, they worry about inadequacy of meds later down the road (like it will just stop working), family gets upset because if you make the patient comfortable they may sleep more and not be quite as responsive to the family then. Physicians aren't always informed well about pain management issues and all aren't comfortable with letting a nurse guide them through the nuances of good pain management. It is incredibly frustrating to have a patient in pain, who wants the pain relieved, you know what you need to have or give to alleviate the pain and the physician is not cooperative with it.
I usually think of all pain as bad but your comments on the good of pain were incredible!
Date: Wed, Jun 11, 2003 6:34 AM From: wibarth@attbi.com To: DoktorMo@aol.com
I agree with many of the comments regarding pain. Pain is an important warning mechanism that body has that something is wrong. I think it is one of the reasons that brings patients to seek medical care. It can also serve as a protection against danger in the case of skin burns. And as a nursing student I have learned that pain is subjective and that everyone's threshold is different. I think proper pain management is still either facilitated or constrained by the environment, including social and political factors. Some of the factors include emotions, behaviors, beliefs and attitudes.
Pain can also have a social impact this missed work due to persistent unrelieved chronic pain causing an economical impact. Insufficient pain relief is still a problem. Some patients are still willing to endure high levels of pain instead of asking for an analgesics. Some professionals still reluctant to give adequate levels of a medication out of concern that the patient may become dependent or addicted or they have been duped by a patient in the past. However, empowering the patient to be an active partner in reporting information about pain rather than being stoic is important and one must respect the patient's response to pain.
Rebecca, Salem State College Nursing Student
Date: Thu, Jun 5, 2003 6:02 AM From: wibarth@attbi.com To: DoktorMo@aol.com
I also agree and think that some pain is necessary. Pain in life can be behavioral, cognitive, sensory and physiologic. In life some pain is good as it can serve as a protector against danger or a possible opportunity to for the person to grow spiritually or intellectually after experiencing cognitive pain. Pain can serve as a protector; for example when exposed to a possible danger like fire when pain is felt the body's immediate response to pull way because of a pain trigger. I also feel that it is the body's way of warning that something is wrong internally or a signal that it is time to take better care and slow down in the case of headaches.
As a nursing student, I know that pain is subjective and pain thresholds vary from person to person. Pain can interfere with the things in life that bring joy and satisfaction. Unrelieved pain can cause emotional responses such as fear, depression, anxiety and anger that can be detrimental to recovery; and no one needs to suffer needlessly.
Rebecca, SSC
Date: Tue, Jun 3, 2003 3:31 PM From: Cutie42730@aol.com To: DoktorMo@aol.com
Pain mean that I will have some difficulty functiong on a daily basis. I would try alternative methods such as yoga and relaxation before I became dependent on a drug because the implications of using prescription drugs can be addictive and can cause other problems. I have to admit that my pain tolerence is low and I am the first one to pop an asprine when I have a headache. kim
Date: Fri, Apr 25, 2003 3:37 PM From: brandx@sbcglobal.net To: DoktorMo@aol.com
While I think that we agree that all pain is not bad, we must look on the impact of pain to the person. In western society, a person's function in society does play a role in ethics according to Garrett, Baillie, and Garrett's book Health Care Ethics: Principles and Problems (2000). If pain that is manageable is keeping a person from functioning in society or limiting his or her autonomy, then it is a tragic instance. In this situation, if the person requests, the pain should be managed. As in every topic, there is no black and white. In some instances pain is a good thing (in alerting someone that something is wrong with their bodies) and in some instances, a bad thing (when chronic pain that cannot be cured limits a persons activity, autonomy, and independence). Thanks.
Date: Tue, Apr 8, 2003 9:20 PM From: dnmricks@bellsouth.net To: DoktorMo@aol.com
This summer, I had a paradigm shift about pain. Throughout my first year of nursing school, I had been taught that pain is subjective and we must control it. I believe that patient comfort is one of a nurse's highest priorities.
However, my ideas and beliefs about pain were tweaked a bit this summer when I read a book called, The Gift of Pain by Dr. Paul Brand. Paul Brand grew up in India, the child of missionary parents. After many years back in England struggling with what to do with his life, he became a doctor (like his father) and returned to India. There he treated leprosy patients.
After several years of treating his patients and studying their disease, Dr. Brand created what are now the international standards of care for leprosy patients. You see, for hundreds of years almost no one had treated a leprosy patient or even been near one. It was assumed that leprosy patients were extremely contagious and that they lost fingers, toes, feet, noses, and various other parts of their anatomy due to the disease process itself. Dr. Brand found that this was not true. What was true was that leprosy patients lost not their body parts due to leprosy, but their ability to feel any pain at all. Leprosy patients can set their hand on a hot stove and never know anything is wrong until they smell the odor of burning flesh!
Now, you may be wondering where I am going with this. In his book, Dr. Brand presented a new perspective of pain--that of a precious gift to be appreciated, not a curse to be avoided. Dr. Brand very eloquently made his case for understanding that pain is a gift God gave when he created us. It serves to warn us that something is amiss in our bodies. Imagine how many patients would die from the infection of a ruptured organ if they did not feel the classic one-sided pain of appendicitis!
After reading The Gift of Pain, I have become truly grateful for sore feet and indigestion, for they tell me when I need to buy new shoes or eat less at the next meal! I truly believe that a patients pain needs to be controlled, but while I will do my best to keep my patients comfortable, I will be sure to investigate the cause of their pain in order to fix the problem that prompted it.
So what was my paradigm shift? To me, pain is no longer the enemy, but is one of my closest allies.
Date: Tue, Apr 8, 2003 2:13 PM From: laurabell732003@yahoo.com To: DoktorMo@aol.com
I believe that everyone is going to have pain at one time or another. I think that pain can be a good thing at times and that it should not always be treated. Pain is a way of our bodies letting us know that something is wrong. Instead of going straight for the pain pill or asking for an Rx, find out the real reason for the pain. Too many people are abusing pain meds these days. And I think that Rx's for pain meds are way overwritten also.I feel that a patient that is terminally ill should get as much pain med as needed to keep that person comfortable, and also a woman in labor as well. But just everyday aches and pains dont need narcotics or even a Tylenol every single time. Give your body a chance to tell you what's going on.
Date: Tue, Mar 18, 2003 8:06 AM From: CurtsT@leb.k12.in.us To: DoktorMo@aol.com
Pain is a part of life.It may not always be your favorite part but it is around for a reason. Pain is like a 6th sense a warning sign if you will. People need this sensation to comprehend how their body is feeling. Life without pain is like shoes without lases, it just dosen't fit. People have limitations and boundries and pain provides these boundries. Pain gives the limitations to people and is a must have even though it is unpleasant.
Date: Sun, Mar 9, 2003 10:04 PM From: byounger2@kc.rr.com To: DoktorMo@aol.com
What Does Pain Mean to You? Is Relief of Pain Always a Good Thing?
I think that before we ask this question we should consider different pain tolerances of different people and patients. To one person a needle prick might be a slight irritation and to someone else it might feel like someone had just stuck a knife into thier limb. I think that every patient should be asked what his or her tolerance is to pain by filling out a simple survey. This survey could tell how often medications could be given and by what route. This could be intertwined with costs of drugs and what route to give.
Now the real question is what is Pain to you and is Pain relief always a good thing. Pain to me means that something is wrong. Of course everyone knows that Pain is the body's way of saying "hey something bad is happening" But i believe after the intial pain it is felt it is ok to get rid of the pain. If one is in control of the patient and knows what is going on, I believe it is ok to make the patient comfortable. We must be careful of which drugs we are giving to make sure that patients do not become addicted. This can lead to a case of addiction which is a whole different topic.
Bryce
Date: Sat, Mar 8, 2003 7:42 AM From: jckskk1@swbell.net To: DoktorMo@aol.com
I define pain, in the physical sense, as noticeable discomfort during any waking activity of daily living. For example, if your ankle joints hurt when you walk, this is pain. If you are lying in bed and your neck and shoulders ache, this is pain. If you normally bound down stairs 2 or 3 at a time, but now you have to go one at a time and use the railing because your knees are sore and popping, that's pain. Like beauty, pain is in the eye of the beholder, or in this case, the one who feels it. I know from my experience in health care that different people would describe and qualify the same pains altogether differently than others...tolerance levels cover the gamut. And how people deal with and react to pain is very different as well. But ultimately, pain is defined by and quantified/qualified by the one who feels it.
Jeff Keener, Joplin, MO
Date: Tue, Jan 28, 2003 8:49 PM From: rosasharon1@juno.com To: DoktorMo@aol.com
Hi. Recently I had a myomectomy. A large fibroid mass was taken from my uterus. This happened because of pain and other complications. I know I made the right choice even though I know must deal for a time with post-operative pain. The doctors wanted me to be able to "manage" my pain. I don't think the idea was to completely mask it. Anyway, while I still have pain--I've got about four more weeks to go at least, it is much less than the first day after the operation. I look at it as a sign that my inside is not healed up. In fact, my sutures on the outside could heal before my uterus does. As far as drugs go, one day a couple weeks back, I inadvertantly took too much vicadin. I had to drink a lot of water and tea to wash it out of my system. I decided afterwards that I would rather feel as much pain as I can handle right now then be in the doped-up zombie-like state I was in. Yes, I think pain has its purpose, if for no other reason, to tell you when you are fine and not fine. It forces you to listen.
Sharon
Date: Thu, Nov 14, 2002 11:52 PM From: magichands@fastmail.fm To: DoktorMo@aol.com
I worked for 8 weeks in a Leprosy Research Centre in India on a clinical Physiotherapy placement.
And on of the main reasons people develop the deformities of leprosy is a "Lack of their ability to feel Pain". Because of this, they can't feel that little stone or pebble or thorn which has hurt their foot and is bleeding, and they carry on (pebble in shoe) and cause it to ulcerate and become infectious, granted this would not happen as often in a developed country BUT the example still illustrates the IMPORTANCE OF PAIN and as with anything it should not be in excess.
The right amount of pain in other words is very helpful as a a warning to something going wrong. Its in cases when it goes out of control or is not present,that we need to worry about.
Abrar 'MagicHands' Waliuddin, magichands@fastmail.fm
Date: Thu, Nov 7, 2002 9:51 PM From: garrett@rockisland.com To: DoktorMo@aol.com
What does pain mean to me? What it means to everyone! I hurt!!
Is relief of pain always good? Absolutely not! I know this is not going to be popular with the whiney ones out there, but pain is, by itself, not life threatening, unless it is so intense that it brings on shock, which can kill. It is also a way to monitor the recovery process. Less pain, more recovery. I know it sounds simplistic, but it is a necessary way to determine the seriousness of an injury or, less commonly, a disease.
If you have suffered a back injury, then the intensity of the pain you feel may be a way to judge the intelligence of the activities you engage in after the injury. If you mask this feedback with drugs, then you may cause yourself irreparable harm.
If you have a toothache, and you DON'T medicate to relieve the pain, you could suffer incredible pain for no reason. If you DO medicate for the pain, and continue to medicate without seeking professional relief through surgery to remove the cause of the pain, then you risk complications that could be very dangerous.
What level of pain shoud you accept? Whatever you can bear without damaging your physical or mental self. And whatever level of pain you chose to accept, be aware of the physical effects that non-treatment of the CAUSE might have.
Jim
Date: Mon, Oct 14, 2002 2:13 PM From: tchssh@msn.com To: DoktorMo@aol.com
Hi, Pain is a natural an important response that must not be ignored if we are to maintain maximum health. Whether it is physical or emotional, pain is necessary to help us respond to the changing needs of our minds and bodies. Although it is important, at times, to mask pain in order to begin the journey through the healing process, pain is good and should not be ignored. Pain allows us to acknowledge there is a problem, and later, to evaluate the progress of treatment. While we are learning how to manage pain and keep patients as comfortable as possible, we must not forget that it is an effective way for our mind and body to communicate to us.
Respectfully, Sue
Wednesday, December 20, 2006
The Authentic Right to Health Care: Treating Yourself as You Desire
There is a philosophy of healthcare in this country and elsewhere that there should be total freedom for people to select how they want to be treated for their illnesses. If that happened, it is believed that medical costs would drop and everyone could obtain healthcare. The freedom would include treating themselves with whatever medications they understand will be helpful without any prescriptions and/or go to any person they want for medical attention who need not have gone to a medical school or be licensed to practice medicine. Those persons who offered themselves as practitioners and didn’t practice effective medicine would be eliminated by attrition. What do you think about this right and whether, in the end, it would take the politics and laws out of medicine and make medical care more affordable to everyone? Is there any merit to this philosophy?
The following article is from the self-described “raw data for raw nerves” website totse.com by Sheldon Richman, representing the libertarian organization The Future of Freedom Foundation, who presents a discussion about this “authentic right”. ..Maurice.
The
Right to Self-Treatment
by Sheldon Richman, January 1995
_________________________________________________________________
Over the last year or so, much has been said about the right to health care. The advocates of government management of the health-care system believe that everyone should be able to obtain the services of doctors and related practitioners regardless of ability to pay. That is what has fueled the push by the Clinton Administration and others for so-called universal coverage.
Truth be told, there is no right to health care as the advocates of socialized medicine conceive it. In their view, anyone who needs medical attention ought to be able to count on the government to force others to provide or pay for it. But no one can have a right to the services or money of unwilling providers. One has a right to buy services from willing providers. One has a right to request free services or financial donations. But one has no right to use the threat of physical force--directly or indirectly (i.e., through the state)--to obtain those things. The right to health care in that sense is a counterfeit right.
There is, however, an authentic right to health care, which was recognized in the United States until 1914. It is typical of our age that while nearly everyone embraces the counterfeit right, almost no one accepts the authentic right. Even worse, few realize they are denied an important freedom. That authentic right may be called, as the noted psychiatrist Thomas S. Szasz has called it, the right to self-medication. It is the right to care for one's own health without prior permission from the state.
At first glance, many people will believe we already have that right. They are wrong. For example, one may not seek treatment from a practitioner who is not licensed by the state. Although one may be perfectly content with the treatment provided by an unlicensed practitioner, the state will prohibit that therapeutic relationship; it will even jail the practitioner if it wishes. True, it will not jail the patient. It will merely prevent a consenting adult from engaging in the medical acts of his choice.
Another way that the government interferes with the authentic right to health care is through the system of prescription medicines. Citizens of this theoretically free country may not use certain medicines without the written permission of an officer of the state. Yes, doctors are officers of the state by virtue of their having been
deputized by the state to grant, or withhold, such permission. That was not true before 1914. Until then, adult citizens could enter a pharmacy and buy any drug they wished, from headache powders to opium. They needed no one's permission. They were, in a phrase, pharmacologically free.
That freedom was abolished as the paternalist ethic gained currency. People had to be protected from their own unwise choices. For their own good, they could not be allowed to prescribe medicines for themselves. At least, that is what they were told. In fact, we know otherwise. When Americans were pharmacologically free, they managed not to kill themselves with overdoses or inappropriate medicines. When they felt it necessary, they sought advice from physicians or others who had greater experience than themselves. Americans somehow knew not to swallow purported medicines without wondering about the consequences. (We know this because population and life expectancy grew all during the period.)
Then they lost this right. They were told they were no longer able to make those kinds of decisions. For some unfathomable reason, they surrendered their authentic right to health care without a bloody struggle.
They were lied to, of course. The doctors and the politicians did not really believe that Americans had suddenly become too benighted to medicate themselves. No, the doctors and politicians wanted power. The prescription law was just one piece of a larger conspiracy against the public. At about this time, the United States got its first laws to license doctors and accredit medical schools. The same paternalistic rationalizations were fed to the public. But the minutes of the medical societies' meetings tell another story. Historian Ronald Hamowy has documented what was really on the minds of the doctors: income. They were concerned that free entry, and hence unrestricted competition, into the medical profession was driving down fees. Only government regulation could keep the doctors living in the manner to which they had become accustomed.
That regulation took several forms. Accreditation of medical schools regulated how many doctors would graduate each year. Licensing similarly metered the number of practitioners and prohibited competitors,such as nurses and paramedics, from performing services they were perfectly capable of performing. Finally, prescription laws guaranteed that people would have to see a doctor to obtain medicines they had previously been able to get on their own. The doctors and politicians succeeded in supporting the medical profession's income; they also contributed to the infantilization of the American people. We have never recovered.
The same laws have also subverted the medical profession, since doctors can be--and have been--prosecuted for prescribing drugs "in amounts that exceed a legitimate medical purpose." In some states, doctors must send a copy of prescriptions for certain drugs to a government bureaucracy. Government thus reserves the power to decide what is legitimate.
Some will say, things were simpler before 1914. Surely in our complex age, people cannot be expected to make those decisions for themselves. This is fallacious. Despite all the purported protection against self-treatment, the one thing that is supposed to activate the system for the individual is left entirely to his own discretion: the visit to the doctor. What protects a person against his decision not to see a doctor? Even the most extreme proponents of socialized medicine donot advocate compelling people to see a doctor against their will. The freedom to do without medical care, at least, is respected. If the paternalists were truly consistent, they would call for protecting us from that dangerous freedom by requiring periodic visits to the doctor. But perhaps that would bare their totalitarian talons a little too much.
However, if we can be trusted to make such a basic decision, why can't we be trusted with other decision-making related to health care? The reason cannot be that people are ignorant in these matters. We are ignorant in lots of matters in which the consequences of unwise decisions can be great. Most of us know little about automobiles. An improperly serviced auto can be dangerous to others. Yet, there is no law against my servicing my own auto. The law does not stop me from working on my own furnace, though a mistake could kill me and others. If I am spiritually distressed, I am free to console myself or seek comfort from a bartender, friend, or anyone else. If I can work on my car, my furnace, and my mind, why can't I work on my own body?
But surely no medicine should be allowed on the market before it is approved by the government, right? Wrong. The right to self-treatment means just that--the right to choose and administer (or have administered) any treatment. Each individual should be free to determine his own level of confidence about a medicine. A desperately sick person quite reasonably may be willing to seize on a new, untested drug. He may not survive the years of testing required by the Food and Drug Administration. (That systemic delay kills thousands of people each year.) Someone less ill or more risk averse may be more selective. A third person may only want medicines that have stood the test of time. The key question is, who should decide one's level of confidence? Should the government impose one level on everyone? Or should each decide for himself? In a free society, there can be only one answer.
It is certainly wise to know what one is doing before treating oneself. And that is why the free market provides an abundance of medical information to the layman. It would provide even more in a free medical marketplace. Sources of information would include doctors, medical societies, insurance companies, Prevention magazine, Consumer Reports, newspapers, and more. Competition and the civil law against fraud and malpractice are the best assurances of quality in both information and services. But in the end, people must have the right to enter into any mutually agreed-on contracts for medical services that they choose. Anything less makes a mockery of the idea that we are free.
Permission is granted to reprint this article, provided appropriate
credit is given. Please send two copies of the reprint to The Future
of Freedom Foundation
_________________________________________________________________
Sheldon Richman is senior editor at the Cato Institute in Washington,
D.C., and the author of The Future of Freedom Foundation.
The following article is from the self-described “raw data for raw nerves” website totse.com by Sheldon Richman, representing the libertarian organization The Future of Freedom Foundation, who presents a discussion about this “authentic right”. ..Maurice.
The
Right to Self-Treatment
by Sheldon Richman, January 1995
_________________________________________________________________
Over the last year or so, much has been said about the right to health care. The advocates of government management of the health-care system believe that everyone should be able to obtain the services of doctors and related practitioners regardless of ability to pay. That is what has fueled the push by the Clinton Administration and others for so-called universal coverage.
Truth be told, there is no right to health care as the advocates of socialized medicine conceive it. In their view, anyone who needs medical attention ought to be able to count on the government to force others to provide or pay for it. But no one can have a right to the services or money of unwilling providers. One has a right to buy services from willing providers. One has a right to request free services or financial donations. But one has no right to use the threat of physical force--directly or indirectly (i.e., through the state)--to obtain those things. The right to health care in that sense is a counterfeit right.
There is, however, an authentic right to health care, which was recognized in the United States until 1914. It is typical of our age that while nearly everyone embraces the counterfeit right, almost no one accepts the authentic right. Even worse, few realize they are denied an important freedom. That authentic right may be called, as the noted psychiatrist Thomas S. Szasz has called it, the right to self-medication. It is the right to care for one's own health without prior permission from the state.
At first glance, many people will believe we already have that right. They are wrong. For example, one may not seek treatment from a practitioner who is not licensed by the state. Although one may be perfectly content with the treatment provided by an unlicensed practitioner, the state will prohibit that therapeutic relationship; it will even jail the practitioner if it wishes. True, it will not jail the patient. It will merely prevent a consenting adult from engaging in the medical acts of his choice.
Another way that the government interferes with the authentic right to health care is through the system of prescription medicines. Citizens of this theoretically free country may not use certain medicines without the written permission of an officer of the state. Yes, doctors are officers of the state by virtue of their having been
deputized by the state to grant, or withhold, such permission. That was not true before 1914. Until then, adult citizens could enter a pharmacy and buy any drug they wished, from headache powders to opium. They needed no one's permission. They were, in a phrase, pharmacologically free.
That freedom was abolished as the paternalist ethic gained currency. People had to be protected from their own unwise choices. For their own good, they could not be allowed to prescribe medicines for themselves. At least, that is what they were told. In fact, we know otherwise. When Americans were pharmacologically free, they managed not to kill themselves with overdoses or inappropriate medicines. When they felt it necessary, they sought advice from physicians or others who had greater experience than themselves. Americans somehow knew not to swallow purported medicines without wondering about the consequences. (We know this because population and life expectancy grew all during the period.)
Then they lost this right. They were told they were no longer able to make those kinds of decisions. For some unfathomable reason, they surrendered their authentic right to health care without a bloody struggle.
They were lied to, of course. The doctors and the politicians did not really believe that Americans had suddenly become too benighted to medicate themselves. No, the doctors and politicians wanted power. The prescription law was just one piece of a larger conspiracy against the public. At about this time, the United States got its first laws to license doctors and accredit medical schools. The same paternalistic rationalizations were fed to the public. But the minutes of the medical societies' meetings tell another story. Historian Ronald Hamowy has documented what was really on the minds of the doctors: income. They were concerned that free entry, and hence unrestricted competition, into the medical profession was driving down fees. Only government regulation could keep the doctors living in the manner to which they had become accustomed.
That regulation took several forms. Accreditation of medical schools regulated how many doctors would graduate each year. Licensing similarly metered the number of practitioners and prohibited competitors,such as nurses and paramedics, from performing services they were perfectly capable of performing. Finally, prescription laws guaranteed that people would have to see a doctor to obtain medicines they had previously been able to get on their own. The doctors and politicians succeeded in supporting the medical profession's income; they also contributed to the infantilization of the American people. We have never recovered.
The same laws have also subverted the medical profession, since doctors can be--and have been--prosecuted for prescribing drugs "in amounts that exceed a legitimate medical purpose." In some states, doctors must send a copy of prescriptions for certain drugs to a government bureaucracy. Government thus reserves the power to decide what is legitimate.
Some will say, things were simpler before 1914. Surely in our complex age, people cannot be expected to make those decisions for themselves. This is fallacious. Despite all the purported protection against self-treatment, the one thing that is supposed to activate the system for the individual is left entirely to his own discretion: the visit to the doctor. What protects a person against his decision not to see a doctor? Even the most extreme proponents of socialized medicine donot advocate compelling people to see a doctor against their will. The freedom to do without medical care, at least, is respected. If the paternalists were truly consistent, they would call for protecting us from that dangerous freedom by requiring periodic visits to the doctor. But perhaps that would bare their totalitarian talons a little too much.
However, if we can be trusted to make such a basic decision, why can't we be trusted with other decision-making related to health care? The reason cannot be that people are ignorant in these matters. We are ignorant in lots of matters in which the consequences of unwise decisions can be great. Most of us know little about automobiles. An improperly serviced auto can be dangerous to others. Yet, there is no law against my servicing my own auto. The law does not stop me from working on my own furnace, though a mistake could kill me and others. If I am spiritually distressed, I am free to console myself or seek comfort from a bartender, friend, or anyone else. If I can work on my car, my furnace, and my mind, why can't I work on my own body?
But surely no medicine should be allowed on the market before it is approved by the government, right? Wrong. The right to self-treatment means just that--the right to choose and administer (or have administered) any treatment. Each individual should be free to determine his own level of confidence about a medicine. A desperately sick person quite reasonably may be willing to seize on a new, untested drug. He may not survive the years of testing required by the Food and Drug Administration. (That systemic delay kills thousands of people each year.) Someone less ill or more risk averse may be more selective. A third person may only want medicines that have stood the test of time. The key question is, who should decide one's level of confidence? Should the government impose one level on everyone? Or should each decide for himself? In a free society, there can be only one answer.
It is certainly wise to know what one is doing before treating oneself. And that is why the free market provides an abundance of medical information to the layman. It would provide even more in a free medical marketplace. Sources of information would include doctors, medical societies, insurance companies, Prevention magazine, Consumer Reports, newspapers, and more. Competition and the civil law against fraud and malpractice are the best assurances of quality in both information and services. But in the end, people must have the right to enter into any mutually agreed-on contracts for medical services that they choose. Anything less makes a mockery of the idea that we are free.
Permission is granted to reprint this article, provided appropriate
credit is given. Please send two copies of the reprint to The Future
of Freedom Foundation
_________________________________________________________________
Sheldon Richman is senior editor at the Cato Institute in Washington,
D.C., and the author of The Future of Freedom Foundation.
Friday, December 15, 2006
The Mentally Disabled Women: Sterilization at the Request of Others
On December 13, 2006, the United Nations General Assembly,as reported in the
International Herald Tribune approved the “first convention protecting rights of world’s 600 million disabled people.” According to the article,the convention “guarantees that the disabled have the inherent right to life on an equal basis with the able-bodied and requires countries to prohibit discrimination on the basis of disability and guarantee equal legal protection. Countries must also ensure the equal right of the disabled to own and inherit property, to control their financial affairs, and to privacy over their personal lives.” The convention will enter into force when it is ratified by 20 countries. One of the issues that concern disability activists is the “forced sterilization of girls and women because of their disability, forced institutionalization and substitute decision making.”
It is my understanding that governmental ordered (forced) permanent sterilization of mentally disabled women in the United States has been abolished in the past several decades. Sterilization, to prevent pregnancy, of a woman who is mentally unable to provide informed consent varies in the different states but can be performed only on the direct request of a legal guardian with physician recommendation and/or court approval. The obvious medical rationale for performing such a procedure would be to prevent harm if further pregnancy or delivery would endanger the life or health of the mother. However, if this is not the case, the social rationale would be to prevent harm to the child if the mother is mentally unable to provide appropriate care or as a consequence of the pregnancy an unnecessary burden placed on society or the guardian with regard to the financial or other responsibilities to care for the child. Another social argument would be to prevent any genetic basis for the mental handicap to be passed on to future generations—eugenics. The latter argument for mandatory sterilization, as originally approved by the Supreme Court in 1927, was overturned in 1942 by the Court.
Here is the ethical issue to my visitors: Do you find any excuse for the permanent sterilization of a mentally disabled woman ethical on the basis of a decision by others without the woman’s own personal and informed consent? How about non-surgical, non-permanent contraceptive medication use without consent? ..Maurice.
International Herald Tribune approved the “first convention protecting rights of world’s 600 million disabled people.” According to the article,the convention “guarantees that the disabled have the inherent right to life on an equal basis with the able-bodied and requires countries to prohibit discrimination on the basis of disability and guarantee equal legal protection. Countries must also ensure the equal right of the disabled to own and inherit property, to control their financial affairs, and to privacy over their personal lives.” The convention will enter into force when it is ratified by 20 countries. One of the issues that concern disability activists is the “forced sterilization of girls and women because of their disability, forced institutionalization and substitute decision making.”
It is my understanding that governmental ordered (forced) permanent sterilization of mentally disabled women in the United States has been abolished in the past several decades. Sterilization, to prevent pregnancy, of a woman who is mentally unable to provide informed consent varies in the different states but can be performed only on the direct request of a legal guardian with physician recommendation and/or court approval. The obvious medical rationale for performing such a procedure would be to prevent harm if further pregnancy or delivery would endanger the life or health of the mother. However, if this is not the case, the social rationale would be to prevent harm to the child if the mother is mentally unable to provide appropriate care or as a consequence of the pregnancy an unnecessary burden placed on society or the guardian with regard to the financial or other responsibilities to care for the child. Another social argument would be to prevent any genetic basis for the mental handicap to be passed on to future generations—eugenics. The latter argument for mandatory sterilization, as originally approved by the Supreme Court in 1927, was overturned in 1942 by the Court.
Here is the ethical issue to my visitors: Do you find any excuse for the permanent sterilization of a mentally disabled woman ethical on the basis of a decision by others without the woman’s own personal and informed consent? How about non-surgical, non-permanent contraceptive medication use without consent? ..Maurice.
Saturday, December 9, 2006
“Grains of Truth” vs Evidence-Based Medicine”
For the layman, “old wifes’ tales” (“a wisdom much like an urban legend, supposedly passed down by old wives to a younger generation. It is so named for the alleged lack of sophistication of old wives.”) often deal with sex, pregnancy, puberty, nutrition and health issues. Most of the tales have no basis in fact but occasionally a few have, as quoted from the Wikipedia article, “... grains of truth, the veracity is likely coincidental.”
In medicine, physicians have carried along the professional version of “old wives’ tales” through the years, the veracity of which was mainly based on a physician’s own personal experiences in practice, the reports of other physicians experiences or just theories. Some of these tales dealt with issues of diagnosis or illness outcomes and others dealt with therapeutic benefit of drugs or procedures.
In the last decade or so, out of concern for providing the best in medical care but also because of concerns relating to the financing of medical care that the medical profession and others have looked to providing physicians and their patients the results of “evidence-based medicine” which defined by the Centre for Evidence Based Medicine as quoted in the Wikipedia article “is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." And continuing from the Wikipedia article “Using techniques from science, engineering and statistics, such as meta-analysis of scientific literature, risk-benefit analysis, and randomized controlled trials, it aims for the ideal that healthcare professionals should make ‘conscientious, explicit, and judicious use of current best evidence’ in their everyday practice.”
What has all of this to do with medical ethics? It has to do with the physician’s duty to be trustworthy to the patient and to aim to do good and not produce harm to the patient. Informing the patient, unless some patient rejects being informed, is also duty of the physician and is part of the consent to treatment process. It should be a standard of medical practice that the patient understand what portions of the physician’s decisions regarding diagnosis, prognosis or treatment is based on reliable evidence and which is based on hearsay or simply statistically not verified experience. But do most physicians have the time or skill to explain to the patient on what basis their decisions were made? Further, do most physicians even know which of the “facts” they are using have not been rigorously proven? Unfortunately, even with the best of physician attention to educate themselves on the evidence and to explain this to the patients, there is much in medical care that will remain “old tales” either because there is not sufficient interest to provide the time and expense to do scientific studies or realistically because some studies just can’t be accomplished because of technical or ethical issues. Fortunately,for both the patient and the physician, many decisions the physician makes do have incidentally those “grains of truth” and are luckily followed by successful outcomes. ..Maurice.
In medicine, physicians have carried along the professional version of “old wives’ tales” through the years, the veracity of which was mainly based on a physician’s own personal experiences in practice, the reports of other physicians experiences or just theories. Some of these tales dealt with issues of diagnosis or illness outcomes and others dealt with therapeutic benefit of drugs or procedures.
In the last decade or so, out of concern for providing the best in medical care but also because of concerns relating to the financing of medical care that the medical profession and others have looked to providing physicians and their patients the results of “evidence-based medicine” which defined by the Centre for Evidence Based Medicine as quoted in the Wikipedia article “is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." And continuing from the Wikipedia article “Using techniques from science, engineering and statistics, such as meta-analysis of scientific literature, risk-benefit analysis, and randomized controlled trials, it aims for the ideal that healthcare professionals should make ‘conscientious, explicit, and judicious use of current best evidence’ in their everyday practice.”
What has all of this to do with medical ethics? It has to do with the physician’s duty to be trustworthy to the patient and to aim to do good and not produce harm to the patient. Informing the patient, unless some patient rejects being informed, is also duty of the physician and is part of the consent to treatment process. It should be a standard of medical practice that the patient understand what portions of the physician’s decisions regarding diagnosis, prognosis or treatment is based on reliable evidence and which is based on hearsay or simply statistically not verified experience. But do most physicians have the time or skill to explain to the patient on what basis their decisions were made? Further, do most physicians even know which of the “facts” they are using have not been rigorously proven? Unfortunately, even with the best of physician attention to educate themselves on the evidence and to explain this to the patients, there is much in medical care that will remain “old tales” either because there is not sufficient interest to provide the time and expense to do scientific studies or realistically because some studies just can’t be accomplished because of technical or ethical issues. Fortunately,for both the patient and the physician, many decisions the physician makes do have incidentally those “grains of truth” and are luckily followed by successful outcomes. ..Maurice.
Monday, December 4, 2006
Being “Culturally Competent” vs Caring for a Patient’s Concerns
“A medical anthropologist is asked by a pediatrician in California to consult in the care of a Mexican man who is HIV positive. The man's wife had died of AIDS one year ago. He has a four-year-old son who is HIV positive, but he has not been bringing the child in regularly for care. The explanation given by the clinicians assumed that the problem turned on a radically different cultural understanding. What the anthropologist found, though, was to the contrary. This man had a near complete understanding of HIV/AIDS and its treatment—largely through the support of a local nonprofit organization aimed at supporting Mexican-American patients with HIV. However, he was a very-low-paid bus driver, often working late-night shifts, and he had no time to take his son to the clinic to receive care for him as regularly as his doctors requested. His failure to attend was not because of cultural differences, but rather his practical, socioeconomic situation.”
The medical profession is being encouraged to engage in becoming culturally competent. That is, for the medical profession to be able to understand and behave constructively towards patients’ cultural backgrounds in hopes of providing more compassionate and effective care. But as the above story from the article “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It” by Arthur Kleinman and Peter Benson in PloS Medicine, an online open-access journal, suggest and the authors explain, making cultural assumptions may not be valid in a particular case and actually hinder practical understanding. In their story they conclude, in place of stereotyping the patient,“talking with him and taking into account his ‘local world’ were more useful than positing radically different Mexican health beliefs.”
The authors give another example story where therapy didn’t fully work, the example emphasizing the importance of using “culturally appropriate terms to explain people’s life stories” rather than terms usual in medical culture..
The authors give healthcare workers six steps in dealing with a patient of another culture, however they conclude by writing that “If we were to reduce the six steps of culturally informed care to one activity that even the busiest clinician should be able to find time to do, it would be to routinely ask patients (and where appropriate family members) what matters most to them in the experience of illness and treatment. The clinicians can then use that crucial information in thinking through treatment decisions and negotiating with patients.”
This, the authors feel “is much different than cultural competency. Finding out what matters most to another person is not a technical skill. It is an elective affinity to the patient. This orientation becomes part of the practitioner's sense of self, and interpersonal skills become an important part of the practitioner's clinical resources. It is what Franz Kafka said 'a born doctor' has: 'a hunger for people'. And its main thrust is to focus on the patient as an individual, not a stereotype; as a human being facing danger and uncertainty, not merely a case; as an opportunity for the doctor to engage in an essential moral task, not an issue in cost-accounting.”
Please click on the link above and read the entire article with the references (not included in the extracts above) and let me know what you think. Have you and your physician come from different cultures (besides the obvious medical culture) and how was your relationship with the physician handled? ..Maurice.
The medical profession is being encouraged to engage in becoming culturally competent. That is, for the medical profession to be able to understand and behave constructively towards patients’ cultural backgrounds in hopes of providing more compassionate and effective care. But as the above story from the article “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It” by Arthur Kleinman and Peter Benson in PloS Medicine, an online open-access journal, suggest and the authors explain, making cultural assumptions may not be valid in a particular case and actually hinder practical understanding. In their story they conclude, in place of stereotyping the patient,“talking with him and taking into account his ‘local world’ were more useful than positing radically different Mexican health beliefs.”
The authors give another example story where therapy didn’t fully work, the example emphasizing the importance of using “culturally appropriate terms to explain people’s life stories” rather than terms usual in medical culture..
The authors give healthcare workers six steps in dealing with a patient of another culture, however they conclude by writing that “If we were to reduce the six steps of culturally informed care to one activity that even the busiest clinician should be able to find time to do, it would be to routinely ask patients (and where appropriate family members) what matters most to them in the experience of illness and treatment. The clinicians can then use that crucial information in thinking through treatment decisions and negotiating with patients.”
This, the authors feel “is much different than cultural competency. Finding out what matters most to another person is not a technical skill. It is an elective affinity to the patient. This orientation becomes part of the practitioner's sense of self, and interpersonal skills become an important part of the practitioner's clinical resources. It is what Franz Kafka said 'a born doctor' has: 'a hunger for people'. And its main thrust is to focus on the patient as an individual, not a stereotype; as a human being facing danger and uncertainty, not merely a case; as an opportunity for the doctor to engage in an essential moral task, not an issue in cost-accounting.”
Please click on the link above and read the entire article with the references (not included in the extracts above) and let me know what you think. Have you and your physician come from different cultures (besides the obvious medical culture) and how was your relationship with the physician handled? ..Maurice.
Wednesday, November 29, 2006
"The Doctor's Office"
I found this story "The Doctor's Office" written by a medical student and it struck me that this story was very appropriate for my blog. I wonder if any of my visitors here find the experience of Ms. Clemens in the story familiar.
Thanks to Synaesthesia Literary Magazine, University of Southern California Keck School of Medicine for allowing me to post this story here. ..Maurice.
"Synaesthsia was created in the Spring of 2004 by a group of students and faculty at the Keck School of Medicine with the hope of providing USC's health sciences community with a forum for creative expression."
The Doctor's Office
by Soames Boyle
(Soames is a member of the Class of 2007)
I was reading an article entitled "The twelve secrets to making this Thanksgiving the best ever" when a woman called my name. I got up and walked into the Nurses' Station. It was April, but that article was the finest offered in the waiting room.
An overweight woman in red, white, and blue scrubs verified my name.
"Maureen Clemens?"
"That's me."
"OK dear. Take off your shoes and get on the scale." I was here to ask the doctor about the problems I was having with my high blood pressure medication. My weight as changed from two months ago didn't seem germane to my current medical concerns. And I didn't like being called "dear" by a woman twenty years younger than myself in coral hued lipliner.
"Really? Do I have to?" I heard myself whining. She nodded by way of answer and turned away to write something. Her body language indicated she too believed me to be whining. I dutifully got on the scale. I had gained 10lbs since my last visit. Braced for a reprimand or advice such as 'you should try drinking more water', I was a little surprised the nurse said nothing at all. She ushered me into a room and told me to undress below the waist. For high blood pressure medication? Again, for what earthly purpose? The nurse left.
Someone rapped quickly and a young girl walked in. A couple of pimples, a stethoscope around her neck, a little food in the corner of her mouth. Please God, don't let this be the doctor.
"Hi My name is Student Dr. Steamed I am a medical student working with Dr. Kares I am going to ask you some questions and then he is going to come in." This was said in one fluid seamless sentence without pause or room for interruption. She had either rehearsed her introduction or had anticipated my surprise and wanted to head off any concern that she was the doctor I would be consulting.
"Can you tell me why you are here?"
"My blood pressure medication is making me sick. And I am having problems sleeping at night. I lay in bed for -"
"What do you mean 'sick'?" She interrupted. "have you been vomiting? Nauseated? Changes in bowel habits? Fever, chills, abdominal pain, sinusitis? Orthostatic hypotension? Or do you mean the hypertensive medication is preventing you from falling asleep?" she inhaled "or do you mean you wake up at night and your heart is beating really fast?" She shook her left hand over her left chest quickly, gesticulating a palpating heart I imagine. "No." I paused and she opened her mouth to continue, but I cut her off - "I have two independent problems. My medication and sleeping problems."
"OK. Tell me what's going on." Now we were getting somewhere.
"My blood pressure medication is giving me a cold. I have a sore throat and a cough that hasn't gone away since I started the medication two months ago. And I can't sleep at night, which has been going on since my husband died last year."
"I am sorry to hear that." She pursed her lips and gave a little nod in condolence. "Do you live alone? Or with someone? What have you been doing to get yourself through this time?" The concern seemed genuine, but the questions forced and obligatory. I didn't want to overwhelm the poor girl. She wasn't old enough to have experienced the loss, abandonment, disappointment that haunts old age. She didn't want to hear about our martial problems, the fights, the frustration of cancer and his constant needs, my guilt now that he was gone.
"I live alone. My children are grown. I have tried the mild sleeping pills, some herbal medications, a glass of wine with dinner. Nothing helps."
"How much wine are you drinking?"
"A glass or two" I repeated myself.
"So like 15 drinks a week would you say?" Quick mental arithmetic indicated she was grossly overestimating my intake.
"No. Not that much."
"Have you tried to cut back?"
"Haven't seen the need."
"Have you ever been annoyed by criticism of your drinking?"
"Huh?
"Have you ever felt guilty about your drinking?"
"I just said I don't drink that much."
She looked apologetic. "Sorry, I have to ask those questions of everybody. Please don't be offended. Have you ever needed a drink in the morning to get you going?" The last question seemed reflexive and she didn't wait for an answer before asking "What can you tell me about your cough?" At least we weren't talking about alcohol anymore.
"It hurts. It's dry and-"
"That could be caused by your anti-hypertensive medication, the ACE inhibitor."
"The what?" Was she insane? Was I insane? "But I feel sick."
"This is very common side effect of this medication. I am going to talk to Dr. Kares and we will return in a few minutes." She left.
I sat there and waited. I studied a framed poster of four little girls in sundresses eating ice cream cones.
Dr. Kares and the medical student returned. "Hello." He looked down at his paper and added "Mrs. Clemens. Can you tell me why you are here today?" Again? I looked to the medical student, but she was looking at her paper.
"I am here because my medication is making me sick and I am having problems sleeping." And in anticipation of similar confusion I added "I don't think they are related."
"Have you been exercising?" What? Given the succession of unrelated and unprompted questions, I wouldn't be surprised if he next asked me was who I thought would win the Superbowl this year.
"No." Did I want to tell him my knees had been hurting lately? Not if it would set off another three ring circus of free-for-all Q and A sessions.
"Well you should. It would be highly beneficial in the management of your blood pressure and surely efficacious towards your insomnia. I am changing your medication to another similar drug in this class. I want you to start a walking routine three times a week. Do you have someone to walk with?" I didn't. I nodded a confirmation.
"But I don't want the drug. It made me sick. I have had a cold since I started it."
"You have had a cough, which is caused by the medication." He took my silence to be agreement. But I was just confused. He looked at me again and reconsidered my understanding. "Does that make sense? You shouldn't have the same problem with this new medication." He was trying and I appreciated it.
He wrote me a prescription. Get it filled. Something about the pharmacy.
"Is there anything else I can do for you today?"
"I am having problems sleeping. I just can't fall asleep at night."
"Do you want some medication for that?" Not really, but again, he was trying to help.And that is what I was here for. Some help.
"Sure, that would be fine."
Thanks to Synaesthesia Literary Magazine, University of Southern California Keck School of Medicine for allowing me to post this story here. ..Maurice.
"Synaesthsia was created in the Spring of 2004 by a group of students and faculty at the Keck School of Medicine with the hope of providing USC's health sciences community with a forum for creative expression."
The Doctor's Office
by Soames Boyle
(Soames is a member of the Class of 2007)
I was reading an article entitled "The twelve secrets to making this Thanksgiving the best ever" when a woman called my name. I got up and walked into the Nurses' Station. It was April, but that article was the finest offered in the waiting room.
An overweight woman in red, white, and blue scrubs verified my name.
"Maureen Clemens?"
"That's me."
"OK dear. Take off your shoes and get on the scale." I was here to ask the doctor about the problems I was having with my high blood pressure medication. My weight as changed from two months ago didn't seem germane to my current medical concerns. And I didn't like being called "dear" by a woman twenty years younger than myself in coral hued lipliner.
"Really? Do I have to?" I heard myself whining. She nodded by way of answer and turned away to write something. Her body language indicated she too believed me to be whining. I dutifully got on the scale. I had gained 10lbs since my last visit. Braced for a reprimand or advice such as 'you should try drinking more water', I was a little surprised the nurse said nothing at all. She ushered me into a room and told me to undress below the waist. For high blood pressure medication? Again, for what earthly purpose? The nurse left.
Someone rapped quickly and a young girl walked in. A couple of pimples, a stethoscope around her neck, a little food in the corner of her mouth. Please God, don't let this be the doctor.
"Hi My name is Student Dr. Steamed I am a medical student working with Dr. Kares I am going to ask you some questions and then he is going to come in." This was said in one fluid seamless sentence without pause or room for interruption. She had either rehearsed her introduction or had anticipated my surprise and wanted to head off any concern that she was the doctor I would be consulting.
"Can you tell me why you are here?"
"My blood pressure medication is making me sick. And I am having problems sleeping at night. I lay in bed for -"
"What do you mean 'sick'?" She interrupted. "have you been vomiting? Nauseated? Changes in bowel habits? Fever, chills, abdominal pain, sinusitis? Orthostatic hypotension? Or do you mean the hypertensive medication is preventing you from falling asleep?" she inhaled "or do you mean you wake up at night and your heart is beating really fast?" She shook her left hand over her left chest quickly, gesticulating a palpating heart I imagine. "No." I paused and she opened her mouth to continue, but I cut her off - "I have two independent problems. My medication and sleeping problems."
"OK. Tell me what's going on." Now we were getting somewhere.
"My blood pressure medication is giving me a cold. I have a sore throat and a cough that hasn't gone away since I started the medication two months ago. And I can't sleep at night, which has been going on since my husband died last year."
"I am sorry to hear that." She pursed her lips and gave a little nod in condolence. "Do you live alone? Or with someone? What have you been doing to get yourself through this time?" The concern seemed genuine, but the questions forced and obligatory. I didn't want to overwhelm the poor girl. She wasn't old enough to have experienced the loss, abandonment, disappointment that haunts old age. She didn't want to hear about our martial problems, the fights, the frustration of cancer and his constant needs, my guilt now that he was gone.
"I live alone. My children are grown. I have tried the mild sleeping pills, some herbal medications, a glass of wine with dinner. Nothing helps."
"How much wine are you drinking?"
"A glass or two" I repeated myself.
"So like 15 drinks a week would you say?" Quick mental arithmetic indicated she was grossly overestimating my intake.
"No. Not that much."
"Have you tried to cut back?"
"Haven't seen the need."
"Have you ever been annoyed by criticism of your drinking?"
"Huh?
"Have you ever felt guilty about your drinking?"
"I just said I don't drink that much."
She looked apologetic. "Sorry, I have to ask those questions of everybody. Please don't be offended. Have you ever needed a drink in the morning to get you going?" The last question seemed reflexive and she didn't wait for an answer before asking "What can you tell me about your cough?" At least we weren't talking about alcohol anymore.
"It hurts. It's dry and-"
"That could be caused by your anti-hypertensive medication, the ACE inhibitor."
"The what?" Was she insane? Was I insane? "But I feel sick."
"This is very common side effect of this medication. I am going to talk to Dr. Kares and we will return in a few minutes." She left.
I sat there and waited. I studied a framed poster of four little girls in sundresses eating ice cream cones.
Dr. Kares and the medical student returned. "Hello." He looked down at his paper and added "Mrs. Clemens. Can you tell me why you are here today?" Again? I looked to the medical student, but she was looking at her paper.
"I am here because my medication is making me sick and I am having problems sleeping." And in anticipation of similar confusion I added "I don't think they are related."
"Have you been exercising?" What? Given the succession of unrelated and unprompted questions, I wouldn't be surprised if he next asked me was who I thought would win the Superbowl this year.
"No." Did I want to tell him my knees had been hurting lately? Not if it would set off another three ring circus of free-for-all Q and A sessions.
"Well you should. It would be highly beneficial in the management of your blood pressure and surely efficacious towards your insomnia. I am changing your medication to another similar drug in this class. I want you to start a walking routine three times a week. Do you have someone to walk with?" I didn't. I nodded a confirmation.
"But I don't want the drug. It made me sick. I have had a cold since I started it."
"You have had a cough, which is caused by the medication." He took my silence to be agreement. But I was just confused. He looked at me again and reconsidered my understanding. "Does that make sense? You shouldn't have the same problem with this new medication." He was trying and I appreciated it.
He wrote me a prescription. Get it filled. Something about the pharmacy.
"Is there anything else I can do for you today?"
"I am having problems sleeping. I just can't fall asleep at night."
"Do you want some medication for that?" Not really, but again, he was trying to help.And that is what I was here for. Some help.
"Sure, that would be fine."
Culture and Organ Donation
With no means at present to replace or adequately repair vital organs when they fail except through transplantation, it is clear that organ donation to provide the organs for procurement is at present the best and most ethical means for saving lives. Since the need for organs to be used for transplantation is greater than what is currently made available, there is pressure on those who facilitate the procurement of organs to do a better job. To do a better job though can be a challenge. It depends so much on the willingness of the public to want to donate their organs after their death for transplant. For those who provide an advance directive of their wishes to donate, their directive is hopefully followed. Hopefully, because though there is in the United States laws requiring such a directive to be followed, there are stories of families, after the death of their loved one, rejecting the directive and the organ procurement organization following the family’s wishes. The organs that are obtained after death of a member who had no directive are obtained because the families have agreed to the donation. The challenge to those requesting that the family agrees to donation is that the request is made at a very difficult time, at a time of expected or often unexpected loss that has not yet been fully emotionally accepted. In addition families may be confused about what the procurement process is all about, particularly when matters of “brain death” and death after life-support has been removed is discussed.
How a family might react to a request for donation is also related to the culture of the family and the associated beliefs both through cultural background and religion. It is apparent that in some cultures, it is the family that first receives the bad news of their member’s illness and the family makes all the decisions. In some cultures, invasion of the body of the deceased would be considered desecration and in other cultures there is attention to the matter of what is called “death”.
The request is made more delicate by the way the request is made and the degree of skill, understanding of the family’s views despite a different cultural background of the person making the request.
I bring up this topic of the role of culture and beliefs in the process of organ donation because in most hospitals within the United States, the patients and families are multi-cultural and so it is not at all unusual for cultural factors to be involved in whether organs can be obtained. For more details of the effect of culture on organ donations and the considerations that those who request donations from patients or families must take into account,go to this
link.
Since, I see from my Sitemeter that I am getting visitors to my blog, not only from the United States but from around the world, I wonder how someone from Nigeria or South America or Japan or Saudi Arabia or other countries looks at organ donation after death and how their culture could affect their decisions either for themselves or as a family member. Any comments? ..Maurice.
How a family might react to a request for donation is also related to the culture of the family and the associated beliefs both through cultural background and religion. It is apparent that in some cultures, it is the family that first receives the bad news of their member’s illness and the family makes all the decisions. In some cultures, invasion of the body of the deceased would be considered desecration and in other cultures there is attention to the matter of what is called “death”.
The request is made more delicate by the way the request is made and the degree of skill, understanding of the family’s views despite a different cultural background of the person making the request.
I bring up this topic of the role of culture and beliefs in the process of organ donation because in most hospitals within the United States, the patients and families are multi-cultural and so it is not at all unusual for cultural factors to be involved in whether organs can be obtained. For more details of the effect of culture on organ donations and the considerations that those who request donations from patients or families must take into account,go to this
link.
Since, I see from my Sitemeter that I am getting visitors to my blog, not only from the United States but from around the world, I wonder how someone from Nigeria or South America or Japan or Saudi Arabia or other countries looks at organ donation after death and how their culture could affect their decisions either for themselves or as a family member. Any comments? ..Maurice.
Friday, November 24, 2006
Publicizing the Illnesses of Celebrities: Is it Ethical?
Barron H. Lerner, MD, PhD,who is Associate Professor of Medicine and Public Health at Columbia University Medical Center and is the author of “When Illness Goes Public: Celebrity Patients and How We Look at Medicine,” just published by Johns Hopkins University Press sent me today the following commentary. He raises some interesting ethical concerns regarding the consequences of such publicity. Read his thoughts on this subject below and you may also wish to read his book. Let me know what you think about the ethics of this not uncommon social experience. ..Maurice.
Celebrity illnesses have alerted the public to a series of diseases—think of Lou Gehrig’s amytrophic lateral sclerosis, Betty Ford’s breast cancer, Arthur Ashe’s AIDS and Michael J. Fox’s Parkinson’s disease. But these cases have also raised a series of challenging ethical issues.
For example, celebrities have often “pushed the envelope” as far as experimental treatments go. Few realize that Gehrig participated in a clinical trial of Vitamin E injections for his disease beginning in 1939. The civil rights lawyer Morris Abram received two types of experimental immunotherapy for treatment of his acute myelogenous leukemia beginning in 1973. And actor Christopher Reeve advocated aggressively for embryonic stem cell research, which he believed would lead to remarkable breakthroughs in the treatment of his quadriplegia.
However, undergoing, publicizing and advocating for such therapies can create ethical problems. Members of the public with the same diseases, feeling desperate and assuming that celebrities necessarily get the best care, may assume that they should also enroll in experiments. As one woman with Parkinson’s said of Michael J. Fox, ““I just tried to follow right behind him and step in the footprints.” In addition, because society lionizes its celebrities, their illnesses are almost always remembered in a positive light. Thus, readers of The New York Times were told, incorrectly in retrospect, that Gehrig’s and Abram’s experimental therapies had been highly effective. In Reeve’s case, the potential value of stem cell research remains highly remains controversial.
Another ethical issue raised by celebrities concerns the allocation of research funding. These days, it seems that having a big name celebrity spokesperson is the best way to ensure funding support for a given disease. Such individuals are able to attract the attention of both the media and members of Congress. For example, Yasmin Aga Khan, the daughter of actress Rita Hayworth, who died of Alzheimer’s, has made several successful fundraising appearances for the disease on Capitol Hill. Fox has done the same for Parkinson’s and Lance Armstrong has been a tireless advocate for new cancer breakthroughs. While it is logical to think that scarce research dollars should instead be allocated based on need and chance of success, the current situation is unlikely to change.
And famous patients may not be purely altruistic in their advocacy efforts. In 2002 a scandal emerged when it was learned that a series of celebrities—including Kathleen Turner, Olympia Dukakis and Rob Lowe—had booked themselves onto talk shows to tout the supposed virtues of various pharmaceutical products. The fact that they were being paid to do so was unsaid until the media outed this practice.
In sum, celebrities can perform a great service in publicizing diseases and informing others about possible advances. But by dint of their great popularity, celebrity patients can also wield too much power, potentially misleading sick people at a most vulnerable time.
Celebrity illnesses have alerted the public to a series of diseases—think of Lou Gehrig’s amytrophic lateral sclerosis, Betty Ford’s breast cancer, Arthur Ashe’s AIDS and Michael J. Fox’s Parkinson’s disease. But these cases have also raised a series of challenging ethical issues.
For example, celebrities have often “pushed the envelope” as far as experimental treatments go. Few realize that Gehrig participated in a clinical trial of Vitamin E injections for his disease beginning in 1939. The civil rights lawyer Morris Abram received two types of experimental immunotherapy for treatment of his acute myelogenous leukemia beginning in 1973. And actor Christopher Reeve advocated aggressively for embryonic stem cell research, which he believed would lead to remarkable breakthroughs in the treatment of his quadriplegia.
However, undergoing, publicizing and advocating for such therapies can create ethical problems. Members of the public with the same diseases, feeling desperate and assuming that celebrities necessarily get the best care, may assume that they should also enroll in experiments. As one woman with Parkinson’s said of Michael J. Fox, ““I just tried to follow right behind him and step in the footprints.” In addition, because society lionizes its celebrities, their illnesses are almost always remembered in a positive light. Thus, readers of The New York Times were told, incorrectly in retrospect, that Gehrig’s and Abram’s experimental therapies had been highly effective. In Reeve’s case, the potential value of stem cell research remains highly remains controversial.
Another ethical issue raised by celebrities concerns the allocation of research funding. These days, it seems that having a big name celebrity spokesperson is the best way to ensure funding support for a given disease. Such individuals are able to attract the attention of both the media and members of Congress. For example, Yasmin Aga Khan, the daughter of actress Rita Hayworth, who died of Alzheimer’s, has made several successful fundraising appearances for the disease on Capitol Hill. Fox has done the same for Parkinson’s and Lance Armstrong has been a tireless advocate for new cancer breakthroughs. While it is logical to think that scarce research dollars should instead be allocated based on need and chance of success, the current situation is unlikely to change.
And famous patients may not be purely altruistic in their advocacy efforts. In 2002 a scandal emerged when it was learned that a series of celebrities—including Kathleen Turner, Olympia Dukakis and Rob Lowe—had booked themselves onto talk shows to tout the supposed virtues of various pharmaceutical products. The fact that they were being paid to do so was unsaid until the media outed this practice.
In sum, celebrities can perform a great service in publicizing diseases and informing others about possible advances. But by dint of their great popularity, celebrity patients can also wield too much power, potentially misleading sick people at a most vulnerable time.
Wednesday, November 15, 2006
You Failed to Screen for Cancer? You Got Cancer? There's a Penalty for That
An article in the British Medical Journal for October 28, 2006 relates that the German government as part of a package of health reform legislation, yet to be passed, has a law that would penalize cancer patients who did not undergo screening for the cancer before the cancer was diagnosed. Patients with chronic illness currently pay up to a 1% maximum of their gross income for their health care, whereas the cancer patients who did not screen would have to pay up to a 2% maximum.. The screening tests advised for adult Germans include fecal occult blood testing and colonoscopy for colon cancer, cervical smear tests for cervical cancer and breast exams and mammography for breast cancer detection in women and rectal exams for prostate cancer. My reading of the age to begin testing and the frequency of the testing appears similar to criteria in the United States. But the ethical issue is whether patients who are suffering the emotional and physical pains of cancer should have another burden, a penalty of not having been screened for their disease. The ethical principles involved here, in my opinion, would be that of justice vs beneficence. Presumably, the rationale for this law is to have the patients be responsible, and not society, for the presumed added costs for treatments which is felt they brought on themselves because of their failure to be screened. The other rationale would be, through this penalty, to encourage people to participate in cancer screening for their own personal benefit. Both of these rationales would have to be based on the assumption that all cancer screenings would be sensitive and specific enough to detect the cancer in every patient who was later to become symptomatic of the cancer. How about penalizing patients with other diseases which are related to personal poor health habits: alcohol, tobacco, illicit drugs, overeating and ??? riding motorcycles. What is your take on this issue? ..Maurice.
Friday, November 10, 2006
"Why Can’t A Woman Be [ treated ] More Like A Man?"
"Why Can't a Woman Be More Like A Man?"The question posed by the “My Fair Lady” lyrics might be revised by some to “why can’t a woman be treated more like a man?” The consequences of the issue of gender inequality is analogized as like cancer detection in an article “Early Detection of Differential Treatment” by Alison Jost in the November 3, 2006 issue of Bioethics Forum. The article describes the author’s experience with her new dermatologist (a male dermatologist) and her suspicions that she received differential treatment (in a negative sense) with respect to what a man might have received. Although she reminds us of other areas of differential treatment of women's health and life,she is worried that this unequal treatment by physicians may be, at times, to the detriment of the woman’s health. The author seems to be concerned that some women would not early recognize the inequality and therefore not act on it, thus leading, like the need for early cancer detection, to their medical harm.
There are some questions that arise from this article. One is: is the concern about differential treatment realistic? There has been published commentary about the missed diagnosis and therefore missed treatment of women who have significant coronary artery disease. This might support the concern. Another question is whether women physicians also provide differential treatment to women patients and, if so, what is the difference regarding their behavior or their attention to the needs of woman vs men? If the differential treatment is real,what is the motivation of the physician? Any help on these questions? ..Maurice.
There are some questions that arise from this article. One is: is the concern about differential treatment realistic? There has been published commentary about the missed diagnosis and therefore missed treatment of women who have significant coronary artery disease. This might support the concern. Another question is whether women physicians also provide differential treatment to women patients and, if so, what is the difference regarding their behavior or their attention to the needs of woman vs men? If the differential treatment is real,what is the motivation of the physician? Any help on these questions? ..Maurice.
Wednesday, November 8, 2006
The Dying Patient: Some Questions
It would be unusual for the patient's personal physician to be attending and witnessing the imminent death of his or her patient. Usually, that physician is somewhere else at the time and it usually is the family, attending nurses, pastor, hospitalists or paramedics who actually are present and attending to the patient. However, often, it is in the day or days before death that the personal physician has the opportunity to be present and therefore be able to professionally interact with the dying patient. But what should be that interaction?
The issue of the dying patient is an important topic that is discussed with medical students as they begin their medical education and their careers. At the medical school in which I participate, we talk about the dying patient in the first semester of the first year. The students are given the opportunity to sit with and talk to an actor (standardized patient) playing the role of a dying patient and then later are given feedback regarding their behavior by both the “patient” and the physician facilitator. Further, I give my students a series of questions to answer and which becomes the basis for a small group discussion regarding the role and responsibilities of the physician dealing with the dying patient. The students may each have different answers to some of the questions, perhaps based on their own personal experiences and these differences are discussed.
The public’s view of the role of the physician attending the dying patient may be different than any consensus arrived at by a group of students learning to become doctors. I would like to present these questions to my blog visitors and then read and learn how they would answer them. As I have noted in previous posts, a physician's role in medicine is often set by society and my visitors represent that society. ..Maurice.
1. What do you think is the physician’s role in dealing with the dying patient?
2. Do you think there is a time when the physician should back away and let the nurses, family and pastor deal with the patient?
3. What do you think a physician feels when he/she stands at the bedside of his/her dying patient? Is there any “right: or appropriate feeling?
4. Should a physician tell his/her patient that he/she is dying? Why or why not?
5. What should the physician be talking about to his/her dying patient?
6. What is the role of a bedside physician when his/her patient has just died?
The issue of the dying patient is an important topic that is discussed with medical students as they begin their medical education and their careers. At the medical school in which I participate, we talk about the dying patient in the first semester of the first year. The students are given the opportunity to sit with and talk to an actor (standardized patient) playing the role of a dying patient and then later are given feedback regarding their behavior by both the “patient” and the physician facilitator. Further, I give my students a series of questions to answer and which becomes the basis for a small group discussion regarding the role and responsibilities of the physician dealing with the dying patient. The students may each have different answers to some of the questions, perhaps based on their own personal experiences and these differences are discussed.
The public’s view of the role of the physician attending the dying patient may be different than any consensus arrived at by a group of students learning to become doctors. I would like to present these questions to my blog visitors and then read and learn how they would answer them. As I have noted in previous posts, a physician's role in medicine is often set by society and my visitors represent that society. ..Maurice.
1. What do you think is the physician’s role in dealing with the dying patient?
2. Do you think there is a time when the physician should back away and let the nurses, family and pastor deal with the patient?
3. What do you think a physician feels when he/she stands at the bedside of his/her dying patient? Is there any “right: or appropriate feeling?
4. Should a physician tell his/her patient that he/she is dying? Why or why not?
5. What should the physician be talking about to his/her dying patient?
6. What is the role of a bedside physician when his/her patient has just died?
Wednesday, November 1, 2006
Spirituality and Medical Practice
If it is true as reviewed in the article “Spirituality and Medical Preactice” published in the journal ”American Family Physician” January 1 2001 that “95 percent of the Americans believe in God” and that “94 percent of the patients admitted to hospitals believe that spiritual health is as important as physical health” and that “77 percent believe that physicians should consider their spiritual needs as part of their medical care” and that “37 percent want their physician to discuss their religious beliefs more” then there is a mismatch between patient desires and physician behavior when “80 percent of patients reported that physicians never or rarely discuss spiritual or religious issues with them.”
“Spirituality is a complex and multidimensional part of the human experience. It has cognitive, experiential and behavioral aspects. … Many people find spirituality through religion or through a personal relationship with the divine. However, others may find it through a connection with nature, though music and the arts, through a set of values and principles or through a quest for the scientific truth.” Whichever way they find it, it can brighten one’s life and provide an extra support during trying times. It also has been suggested that there might even be therapeutic value toward emotional or physical illness.
What is important, I think, is that the way patients may look at their physical illnesses is not necessarily the way physicians are taught to describe the pathophysiology and the clinical implication of the patient’s illness on the patient. Patients may have an entirely different way of looking at their sickness, why they are sick and what the effect the sickness will have on their life. This is especially true when patients are faced with a life ending illness. I think that when patients are considering factors that are “beyond their body” dealing with emotions, beliefs or religion, it is important that physician recognize these considerations as they evaluate the patient. This is done by communicating with the patient and gaining an understanding regarding to what extent spirituality is playing in their life and how it is being used. Medical school education programs are now stressing that the knowledge of patient’s spirituality and religious thoughts and feelings are as worthy considerations as the patient’s physical exam and laboratory findings. Perhaps in the future more physicians will do what many patients seem to desire, consider spirituality as part of medical care.
Do you have any thoughts about this? Has your physician ever asked you about your spirituality or religious beliefs? Do you think they should? ..Maurice.
“Spirituality is a complex and multidimensional part of the human experience. It has cognitive, experiential and behavioral aspects. … Many people find spirituality through religion or through a personal relationship with the divine. However, others may find it through a connection with nature, though music and the arts, through a set of values and principles or through a quest for the scientific truth.” Whichever way they find it, it can brighten one’s life and provide an extra support during trying times. It also has been suggested that there might even be therapeutic value toward emotional or physical illness.
What is important, I think, is that the way patients may look at their physical illnesses is not necessarily the way physicians are taught to describe the pathophysiology and the clinical implication of the patient’s illness on the patient. Patients may have an entirely different way of looking at their sickness, why they are sick and what the effect the sickness will have on their life. This is especially true when patients are faced with a life ending illness. I think that when patients are considering factors that are “beyond their body” dealing with emotions, beliefs or religion, it is important that physician recognize these considerations as they evaluate the patient. This is done by communicating with the patient and gaining an understanding regarding to what extent spirituality is playing in their life and how it is being used. Medical school education programs are now stressing that the knowledge of patient’s spirituality and religious thoughts and feelings are as worthy considerations as the patient’s physical exam and laboratory findings. Perhaps in the future more physicians will do what many patients seem to desire, consider spirituality as part of medical care.
Do you have any thoughts about this? Has your physician ever asked you about your spirituality or religious beliefs? Do you think they should? ..Maurice.
Sunday, October 29, 2006
Growing Old
Apple Boxes
By Maurice Bernstein, M.D.
A stack of old wooden apple boxes
Each waiting to hold another peck
Mackintosh, Braeburn and maybe even Spitzenburg
Hoping their wooden ribs
Hold, not break and spill the contents
And be considered useful for another season.
A group of old men and women
Each waiting to hold the child
Their own great grandchild or maybe even a neighbor’s child
Hoping their arthritic hands
Grip, not let go and drop their precious contents
And be considered useful for another season.
[Photographed by me yesterday at an apple farm in San Luis Obispo County, California.]
Examples of Healthy Advice or Unhealthy Intrusions
From the Bioethics Forum October 27 2006 comes this article about frank pharmaceutical companies’ intrusions into the doctor-patient relationship all under the banner of health advice to the patient. Intrusions consist of video drug commercials on company supplied screens in the doctor’s office to company supplied laptops in the doctor’s office for the patients to enter their medical history and then the company provides specific health information to the patient. And if that isn’t enough, how about a pharmaceutical company supplying physicians with what the patients may think is their physicians own personal website but actually is a device, as described in the article, “designed to gather information about patients and to lure them to other web sites designed to trigger demands for specific drugs.” Read the article and let me know what you think. It seems that direct-to-consumer advertising in magazines and TV is not sufficient for pharmaceutical companies. Now they are inserting themselves right into the doctor-patient relationship. What better way to twist that relationship toward the direction of the drug company?
However,what I didn't get from the article was the motivation of the physicians who let the pharmaceutical companies into their offices and allow them to manipulate their patients and in effect interpose themselves into the doctor-patient relationship. Do the doctors get any financial benefit from the companies? What is the payback, if any? And does the health information provided to the patient by these various services sufficient to trump the possible unethical advertising? ..Maurice.
However,what I didn't get from the article was the motivation of the physicians who let the pharmaceutical companies into their offices and allow them to manipulate their patients and in effect interpose themselves into the doctor-patient relationship. Do the doctors get any financial benefit from the companies? What is the payback, if any? And does the health information provided to the patient by these various services sufficient to trump the possible unethical advertising? ..Maurice.
Saturday, October 21, 2006
Two Way Street and Compassion in Medical Care
Many of the views expressed on my blog thread ”I Hate Doctors” show little, if any, compassion for the plight or burdens that physicians must carry in their general professional life or with regard to specific patients. And yet, as I have mentioned previously, the doctor-patient relationship is not a “one-way street”. To accomplish the goal of the best medical care, both patient and physician have information and responsibilities to relate to each other, which will help to attain that goal. The physician can’t accomplish the task of diagnosis and therapy alone. The participation of the patient is also required. As part of the professional relationship with the patient, the physician must behave in a manner to engender trust with an attentive, thoughtful, considerate and particularly express compassion for the patient. But, my view, which I would like to put up for discussion here, is that the patient should not expect the best out of the doctor, if the patient is belligerent, uncooperative, angry and shows no compassion toward their physician. There are patients out in the world who present to their physicians that very way and expect that the doctor will ignore the patient’s non-productive behavior and be able,nevertheless, to do a good job. Well, doctors are human beings too and despite their education, they have weaknesses as all humans have. A good doctor will try to investigate and understand the basis for anger in an angry patient and attempt to mitigate the patient's concerns. A good patient must, however, remember that he or she is part of the treating team and their own behavior can affect outcomes. Patients should try to avoid behaviors that clearly create roadblocks toward effective treatment of their illness. The two-way street toward a satisfactory therapeutic ending should not be dead-ended by disruption of the doctor-patient relationship by either party. ..Maurice.
Saturday, October 14, 2006
Role Playing Exercise: A Case of Killing vs Letting Die
What does one do when a patient who has the mental capacity to make medical decision requests a physician to turn off a life-supportive treatment knowing that the act will lead to the patient’s death. One of the ethical issues is whether that act represents intentional killing of the patient or not killing but simply allowing the patient to die from the underlying illness. In this case example of the issue, you will be role-playing the physician. ..Maurice.
Mr. G. is a 34 year old unmarried man who has been a quadriplegic (unable to breathe without the respirator and unable to move his arms or legs) for the past 4 years since he was injured in a motorcycle accident. You, as the newly appointed physical therapy physician in a neurologic rehabilitation hospital have met and examined Mr. G. for the first time. He can talk during the respirator phase when he is exhaling and tells you his history. For most of the 4 years, the patient lives alone at home except for a full-time male aide who attends to his comfort, nursing care and feeding. During this time he was hospitalized about 5 times, twice for pneumonia and a few times for severe urinary tract infections which led to infection in the blood stream and required intensive intravenous antibiotics. This admission was a few days before you arrived and was for another urinary tract infection, now being treated and his fever is abated.
Mr. G. states that he was a city motorcycle officer for 8 years prior to his accident and had a girl friend whom he was hoping to marry living with him for the year before the accident. He speaks sadly about the fact that his girl friend left him shortly after he became quadriplegic and has not returned. Though at first he had understood he had a slim chance for some recovery, he states after additional tests that doctors told him that his spinal cord was completely severed and there can be no return of function. He says he has been evaluated by physical therapists numerous times in the past and has had whatever support and encouragement that they could provide but he has continued in an immobile state, spending most of his life of a quadriplegic in bed. The few hours the aide gets him up in a chair causes him to be exhausted easily. He finds his quality of life so poor that in the past year, he has decided that he no longer wants to live. He knows that if he could turn off the respirator, he would die fairly quickly but he is physically unable to perform the act himself. He has asked his aide to turn off the respirator so he could die. The aide refused. On two previous hospital admissions, he had asked the physicians in the hospital to turn off the respirator, but they too refused. He has been given anti-depressants in the past but they have not changed his demands to end his life.
Mr. G. now turns to you, as his new physician, and after relating his life story, he requests that you turn off the respirator and let his underlying illness cause him to die. As you talk to Mr. G., you evaluate his mental state you find that he is mentally clear and his understanding of the medical facts of his illness and the consequences of his request is excellent. You understand that every patient has the autonomous right to refuse unwanted treatment and to force treatment on a patient who has capacity to make medical decisions may even represent legal battery.
Mr. G. says to you “Doctor, I no longer want to live the way I have been living these past 4 years so now I want you to turn off the ventilator and allow me to die a natural death.” OK.. now you as Mr. G.’s physician must decide what to do next. …. Well, Mr. G. is waiting for your response. You can write the response in the Comment section of this posting.
(For your information, this has been a altered description of a real case. Some of the facts may be a bit different but the issue and ethical challenge is the same as the original case.)
Mr. G. is a 34 year old unmarried man who has been a quadriplegic (unable to breathe without the respirator and unable to move his arms or legs) for the past 4 years since he was injured in a motorcycle accident. You, as the newly appointed physical therapy physician in a neurologic rehabilitation hospital have met and examined Mr. G. for the first time. He can talk during the respirator phase when he is exhaling and tells you his history. For most of the 4 years, the patient lives alone at home except for a full-time male aide who attends to his comfort, nursing care and feeding. During this time he was hospitalized about 5 times, twice for pneumonia and a few times for severe urinary tract infections which led to infection in the blood stream and required intensive intravenous antibiotics. This admission was a few days before you arrived and was for another urinary tract infection, now being treated and his fever is abated.
Mr. G. states that he was a city motorcycle officer for 8 years prior to his accident and had a girl friend whom he was hoping to marry living with him for the year before the accident. He speaks sadly about the fact that his girl friend left him shortly after he became quadriplegic and has not returned. Though at first he had understood he had a slim chance for some recovery, he states after additional tests that doctors told him that his spinal cord was completely severed and there can be no return of function. He says he has been evaluated by physical therapists numerous times in the past and has had whatever support and encouragement that they could provide but he has continued in an immobile state, spending most of his life of a quadriplegic in bed. The few hours the aide gets him up in a chair causes him to be exhausted easily. He finds his quality of life so poor that in the past year, he has decided that he no longer wants to live. He knows that if he could turn off the respirator, he would die fairly quickly but he is physically unable to perform the act himself. He has asked his aide to turn off the respirator so he could die. The aide refused. On two previous hospital admissions, he had asked the physicians in the hospital to turn off the respirator, but they too refused. He has been given anti-depressants in the past but they have not changed his demands to end his life.
Mr. G. now turns to you, as his new physician, and after relating his life story, he requests that you turn off the respirator and let his underlying illness cause him to die. As you talk to Mr. G., you evaluate his mental state you find that he is mentally clear and his understanding of the medical facts of his illness and the consequences of his request is excellent. You understand that every patient has the autonomous right to refuse unwanted treatment and to force treatment on a patient who has capacity to make medical decisions may even represent legal battery.
Mr. G. says to you “Doctor, I no longer want to live the way I have been living these past 4 years so now I want you to turn off the ventilator and allow me to die a natural death.” OK.. now you as Mr. G.’s physician must decide what to do next. …. Well, Mr. G. is waiting for your response. You can write the response in the Comment section of this posting.
(For your information, this has been a altered description of a real case. Some of the facts may be a bit different but the issue and ethical challenge is the same as the original case.)
Thursday, October 12, 2006
Multiple Fetal Births: Should Society Regulate?
In November 1997, Bobbi and Kenny McCaughey became parents of fraternal sextuplets in Des Moines Iowa with the help of fertility drugs. Do you remember that news item and the associated publicity? The use of fertility drugs to induce pregnancies with more than one fetus and that noted delivery led me in 1997 to put a topic on my now inactive “Bioethics Discussion Pages” regarding the ethics of society playing a role in the regulation of multiple fetal births.
Recently I got three responses from visitors to the “Pages”. I will post them here and then follow those responses below with the earlier numerous responses to the topic. How do my current visitors feel about the issue? ..Maurice.
10/8/2006 Ordinarily, I do not believe that society should interfere with family matters
like birth or multiple births. However I can also see how the multiple birth and
selective abortion issue could get out of hand if common sense is not used.
People are not puppies, and really should not be trying to put babies in jeapardy
for selfish reasons if better techniques can be utilized.
Thank You
kjm55@drexel.edu
_____________________________________
10/7/2006 I don't think that society should have any role in this. Society, at least in most places, does not have a role in other types of birth, so why should it have one in multiple fetal births? I believe that allowing a physician or society to be able to make this type of decision for a couple would be very unfair. WKMayfieldCo@aol.com
_____________________________________
10/5/2006
I feel it is none of society's business how many children a couple has.
Whether these children come from individual pregnancies or one
pregnancy, that is their right. As long as they realize the risk for
birth defects and are willing to accept a child or multiple children
with this defect, I do not think we as a society should have any say.
Thanks
Melissa Pitts
Drexel University
mp375@drexel.edu
+++++++++++++++++++++++++++++++++++++++
Should Society have a Role in Regulating Multiple Fetal Births?
The recent birth of the Bobbi and Kenny McCaughey's septuplets has stimulated discussion regarding ethical issues involved in multiple fetal births. The issues have included whether doctors should, in fact, provide assisted reproduction so that litters of babies are created and delivered or if created, should there be selective reduction (abortion) of some of the babies so that the others have a better chance to survive in a healthy state. Other issues involve the burden multiple fetal births may have immediately and in the long term on society. A controversial point would be whether assisted reproduction where multiple fetal births are possible should be a procedure to be carried out in privacy between the parents and the physician or should society enter the relationship and have a role in regulating the outcomes of such a procedure.
Here is the question:
Should society have a role in regulating multiple fetal births?
Date: Sun, Jun 6, 2004 5:59 PM From: justin.roberts1@us.army.mil To: DoktorMo@aol.com
If a couple has gone through everything it takes to get to the step of infertility treatment that may or may not cause multiple births, what right does society have in regulating how many they have???? As part of an infertile couple I have had bloodwork, transvaginal ultrasounds, taken hormones, been given injections by my husband, helped produce multiple semen samples, had surgery and have been poked and prodded in ways that the average person in society can't even imagine. For those women out there who dread their annual pap smear...it's nothing compared to having 2-3 doctors, a nurse and your husband in the room while you lay in the stirrups so they can inject your husband's washed sperm into your uterus. Talk about your romantic conception!!! And after all that.still no baby. So the next step is in vitro fertilization which has an extremely small percentage of multiple births (granted, more of a percentage for average, normal, fertile couples, but still very small). And you want me to pick and choose which babies to have if by some miracle I get pregnant with more than one???? My answer would be " Go to H*$$ !!!"
Date: Thu, Apr 1, 2004 4:49 PM From: middletonearth1@earthlink.net To: DoktorMo@aol.com
How absolutely ridiculous that anyone would think society should have a hand in telling parents with muliples how many they should or should not keep and/or if they should be ALLOWED to take fertility drugs in the first place. Spoken by someone who a.) has had no difficulty having children b.)has no children of their own or c.)may live in China.
I am a mother of quadruplets. After trying for 3 years to have babies, we were finally pregnant. I knew the risk of carrying that many babies. I was in the hospital for 2 months prior to their birth. They were in the NICU for 4 months. I lost one of my children at 3 weeks from a blood clot in his heart. I buried my child. (The most painful experience that I have ever been a part of.)
I love my children very much. I am 10 credit hours from having my masters degree in counseling. My husband has an MBA. We live on a modest budget, but make due. We could be anybody off of the street. How dare you, tell me, that you know better about how many children I should have.
Further more. Who is to say I would not have had 4 babies as singletons? Who is to say that they would not have been multiples....at least twins...had I not taken fertility drugs. My mother did not take fertility drugs, and I have a fraternal twin brother...and sisters that are identical twins. Oh yes, it happens! Also, any single baby can be born a preemie...it happens all of the time. Any child can be born with medical problems. Any child can die.
I am sick and tired of the people who believe they are in the know, telling me how I should raise my family. Read the newspaper...take a walk...distribute flyers to help someone actually in need of your services...but do not have the arrogance to think that you are in any position to dictate to society if they should have children, and how many they should have...Many third world countries do that...and that is why they have to have mail order brides to reproduce.
--- Brett Middleton
Date: Tue, Mar 23, 2004 8:28 AM From: LamborghiniGurl1@aol.com To: DoktorMo@aol.com
No, people do not give these children up for adoption because they love their babies-every one of them. But they also have to understand that society has to pick up the slack of paying for the babies in one form or another. The society of the United States is already in chaos. Do we really need women to start having abnormal births to six, seven, or even eight babies at a time? I don't think so. The United States as a whole cannot put out the money that would be necessary, nor the space needed! If every family had that many children, then we would have to make artificial islands for people to live on--a very costly program--and then find out ways to keep the children healthy. No, is my overall opinion because we, the next generation, already have enough of a mess to clean up, and I don't think we need anything else to hinder it.
Date: Sat, Sep 27, 2003 8:15 AM From: Dakker@webtv.net To: DoktorMo@aol.com
Yes they should! It is very unnatural. Animals have litters. The babies are not full term.That can/could cause all kinds of health problems.
Date: Tue, Aug 5, 2003 4:45 AM From: Klb524@aol.com To: DoktorMo@aol.com
No, physicians and society should not have a role in regulating multiple fetal births. They don't have a role in regulating any other births. So why this kind ? Yes, physicians should offer their strong recommendations, but society should offer the same care for these babies as for any singleton. Twins are novel and cute to everyone. They are socially acceptable. People seem to be horrified by multiple fetal births. This is not fair. They are people too. A woman knows the risk that she is taking when consuming fertility drugs by now. This is the woman's choice as is abortion. We never hear of couples with multiple fetal births giving some of their children up for adoption. This is because they want their babies - all of them. In this day and age, stillbirths and preemies happen all the time in singletons. So lets stop pretending that these situations are so rare. Perhaps technology will catch up with itself soon and multiple fetal births will meet with better medical equipment and techniques.
Date: Thu, Jun 26, 2003 10:07 AM From: Rginagail@aol.com To: DoktorMo@aol.com
I believe these families need a little more screening. There needs to be some kind of criteria put in place. Yes everyone deserves to have children, even if you are poor. But I think there needs to be more counselling to these families. I dont think they realize how much it is going to cost to raise these children. And: Do they have the support system to take care of this many children?
DoktorMo@aol.com 03 10:07 AM
Date: Tue, Jun 3, 2003 4:35 PM From: Meganterryhansen@aol.com To: DoktorMo@aol.com
In my opinion, society should not have a say in this very personal and private matter. Multiple's can occur naturally, as well. The bottom line here is that this is a private matter which demands confidentiality.
Date: Mon, Jun 2, 2003 7:03 PM From: Desibilt@aol.com To: DoktorMo@aol.com
Hello Doctor Mo, Im currently taking a medical ethics course with Priscilla Richardson from Boston and was introduced to this very interesting site! I believe the society in which we live in (USA), we do not have a right to intervene in regulating multiple births. This type of procedure is a consentual agreement between a doctor and a consenting adult. Furthermore if the decision is made for selective reduction painful of a decision as it may be, the family has the right of patient autonomy. A woman who feels comfortable with this type of decision and feels shes made the right moral choice shouldn't be expected to live up to societys idea of right and wrong when reproduction and abortion are legal in this country.
Date: Tue, Apr 8, 2003 8:06 AM From: mjestes@tds.net To: DoktorMo@aol.com
Personally, I do not believe that 5+ babies born at the same time are a miracle. Miracles do not occur from a mother taking fertilization drugs to enhance her egg production. If a mother naturally becomes pregnant with 2+ babies, that is the will of the world. However, when medicine interferes and multiple fetuses are formed, the lives of the fetuses must be considered. Medical interventions to prevent disease and sustain life is totally different that this type of medical treatment. The area is very gray. Do you deny a mother the right to bear children, just so fertility treaments are not given? Hopefully, in future years fertility treatments will become more of a science than a guestimate. Multiple births have a higher mortality rate than do twin and single birhs, which only proves that selective reduction should occur in SOME cases. However, I don't feel that society should have a role in choosing for the parents whether selective reduction should occur. I feel this should be a private decision between the mother, father and medical team. If society becomes involved in these decisions, strides that have been made in other women's health issues such as the right to choose (Roe v. Wade) could also be argued that society should be involved in deciding for women whether to have an abortion.
Date: Wed, Jan 29, 2003 1:47 PM From: boline1@email.msn.com To: DoktorMo@aol.com
The Pro-life folks would be the ones who would want society to choose whether or not a family is allowed to have multiple fetal births. Many times I believe that the Pro-lifers are more interested in taking choices away from individuals, than preserving life. Whether or not a multiple fetal birth is come by naturally or through infertility treatments, I believe the humans involved in the pregnancy should discuss the birth with their doctor, then choose what is right for them. Their decision is between them and their God. It has no bearing on the rest of society. Their decision is not designed to hurt or help society. This is a PERSONAL decision and choice. The McCaughey septuplets have turned into a beautiful bunch of children. The parents never appeared to have any intention of sponging off of society. They never thought they would be rich with money, but now they are a family rich with love. That family's life is completely different now than it was before the septuplets, and that family has adjusted and struggled with health issues. When you have a child, the challenges and the rewards are woven together to create a bonding and unconditional love. It is no different with single or multiple fetal births. At least when infertility treatments cause multiple fetal births, the parents are usually desperate to have children to love. If an individual feels overwhelmed at the prospect of seven children, it is up to them to "pick and choose", and consider aborting some of the fetuses or putting some up for adoption. I have my own problems and challenges. I don't want to be someone else's conscience. Society should not be the conscience of someone in this difficult position. Jakki B.
Date: Thu, Sep 12, 2002 11:59 AM From: LJButler6CO@aol.com To: DoktorMo@aol.com
After reading the article about society and their potential role in regulating fetal births, I had to ask myself why society would even be considered in this process. Since when does society have a say in a family's decision to start a family. Whose business is it to tell a person that they are limited to so many children? As for the McCaughey's, each child has brought something special into their lives. Each of these children was placed in this family for a reason; God knew that this family could handle the trials and disabilities. God is the Creator of all living beings and His Will ultimately decides the future!
Date: Tue, Aug 13, 2002 4:01 PM From: panther@stis.net To: DoktorMo@aol.com
Those who say society should have a role in deciding what to do with the "problem" of multiple births are suggesting that a mother has a bigger obligation to society then to her own flesh and blood. Those multiples will be taxpayers too someday and are members of society from the day they are born. How can you make judgements about who should be born or not in your own society? Multifetal selectve reduction is not the magical cure for multiple pregnancies it is made out to be. Women who go through the procedure have an up to 40% chance of miscarrying the rest of the babies. 55-60% of reduced pregnancies don't make it to term anyway. Many of those don't go past the # of weeks gestation they would have gone to if all the babies had been allowed to live and in many cases it's best to leave things alone and carry all of them. What exactly do these people think they are reducing anyway? How is reducing a pregnancy going to improve the health for the babies that die? If they are dead there is a 100% chance they are not healthy. It is not at all clear how deliberately killing a child is better then giving him a chance at life and him dying of natural causes. It is true that multiple pregnancies are risky and can be dangerous, but carrying multiple babies does not automatically mean a disasterous outcome. As for the people who say that a woman who cannot concieve on her own should not try fertility drugs, they have obviously not been through it themselves. While I do not agree with some forms of IVF because of they way the fertilized embryo's are disposed of, I do not think trying to find help when something goes wrong with your body is going against God's will. If a couple is truly meant not to have children, they will not have any, no matter what they try. To think that man and science can bypass the absolute will of God is ridiculous. Telling a woman who is infertile that God "meant" for her to be infertile so therefore she should not try fertility drugs is like telling a diabetic that God meant for their pancreas not to work and therefore should not take insulin. The consequences of being infertle and being diabetic are vastly different, but they are caused by the same thing. Something went wrong with their body. Selective reduction forces parents to to play russian roulette with their children and, by choosing which children will live and die, allows a doctor to play God. Seeing the way some doctors behave that is not a position I'm comfortable with. Which one of the septuplets should Bobbi and Kenny have allowed to been killed? That is exactly what needs to be asked, because if the pregnancy had been reduced, four to six those beautiful children would not be here. To parents, which of your children can you imagine not being here? It is TRAGIC when parents choose to carry all of the children they concieve only to have some die, but how is it better to for them to have NO CHANCE to live? Is it better to let these children at least have a chance at living then to give them no chance at all.It is also important to remember that ALL children are gifts from God no matter if they come one at a time or seven at a time.
Date: Sat, Jul 27, 2002 5:22 PM From: EdandEvyG@aol.com To: DoktorMo@aol.com
I think it should be up to the parents to decide what to do......as for fetal abortions, can you honestly look at your children, and pick you & you, and you......that's God's business, so let Him intervene
Date: Wed, Jul 10, 2002 7:09 PM From: Planetsoul24@aol.com To: DoktorMo@aol.com
To whom it may concern:
I read the topic and frankly am appalled. Why is there always something? We as a "society" can NEVER let well enough alone. Let these people have ten children if they wish. However, now if we were talking of a single parent who was a welfare respondent or something of the sort, then its the welfare of the child/children at stake. For now, Its a couple who wanted children and after a long struggle and finally blessed. There are couples who have 6-7 children one at a time, hence, what's the big deal if they are born at the same time. GOD BLESS those babies. Leave that family be, stop starting these posts about them and let them live their lives happily.
Thank for your time, Ryann L, Upstate New York
Date: Wed, Jun 12, 2002 10:35 PM From: als@salmoninternet.com To: DoktorMo@aol.com
I have a sister in law who wanted to have a baby and couldn't . So she looked into fertility help. She did receive the fertility help and has had not one but 2 separate pregnancy's. 2 little girls. I thought that was such a wonderful gift she had received. Now she has decided to have another baby. Her and her husband cannot conceive naturally, like I said earlier so they had to have fertility help. Now she is pregnant with quads! When will the selfishness stop? I thought It was wonderful for her to have a couple of children with help. But to selfishly risk her life ,and the four babies she is caring is foolish, not to mention if she dies she is also putting her 2 little girls at risk of not having their mommy .Not to mention the fact that her husband could be left to raise all these children alone! Its insane! I will say this. If people would sit back and realize what they have and be appreciative of what they have and not be so selfish then I would say leave it to the parents and Doctors. But if society continues on its materialistic "I have more then you" rollercoaster then the government should be involved. We as a society cause our own problems.
Date: Sun, Apr 7, 2002 2:44 PM From: MSBGP@cs.com To: DoktorMo@aol.com
To all those who say leave it to God to decide how many babies a person should have, I agree. If God lets you get pregnant then go ahead and have it. If God decides you should not have a baby then don't intervene with drugs. Accept God's will or leave God out of it, you can't have it both ways. I believe that all babies should be wanted and the parents should be able to provide for them or aborted.
Date: Sat, Feb 23, 2002 1:38 PM From: Moocows132@aol.com To: DoktorMo@aol.com
I think that every child is a blessing. Who is the government to decide who many children we can have at one time? China does that not America the land of the free. I believe that everything happens for a reason. The good Lord decides when children are born and when they are not. Who does the government think they are? They have no right to tell women if they can carry multiple fetuses or not. I understand there are a lot of risk with carrying more the one baby at a time but there are also risk carrying just one baby as well. The decision of reduction should be made by the parents and no one else because it is the parents who are going to have to deal with the lost of that child, not the government. Besides what do they care. Its not like they are footing the bill when these babies are born. If the government is allowed to tell us how many children to have at one time what is to say they are not going to tell us how many children to have in all. Uncle Sam does not have to raise these children the parents do. The parents are the ones that are going to have to do the late night feedings and changing the diapers and kissing boo-boos away. If they think they are up for it then I say let them do it. The government is getting to nosey these days and it seems like they are trying to put a leash on us. That is not what America is all about. Let the parents and God decide. They are the only ones who will be taking care of these little miracles.
Christina Cordier
Date: Fri, Jan 25, 2002 1:24 PM From: kristy_millage@csgsystems.com To: DoktorMo@aol.com
Reading some of the answers from those who think society should have a roll in regulating this is ludicrus. Most multiple birth children grow to be tax payers just like those who write their comments. It's no different than those non-tax payers having several single-birth children. The couples that are going through the fertility treatments are doing well financially and aren't the ones living on "tax-payers" money, and are tax payers themselves. I don't have any multiple birth children, but have had 4 single birth babies, 2 which we've lost, and trying one more time for a healthy baby. I am now on a "ovulation stimulator" fertility drug, and I (probably like most other women on fertility treatments) just want a healthy baby, and if God happens to bless us with more than one, so be it. ALL babies are Gods work. Some women are just fortunate to be fertile. How many of the people that have written that think society should have a roll in this, have infertility problems--probably very few!! To all of the multiples...God Bless you, what a miracle. It's sad to know that some day, most of these "miracles" will be paying the taxes and social security on these "simple minded" people that are complaning about paying for them now.
Signed: Hoping to soon be mom of any amount of babies God will bless me with!
Date: Tue, Jul 10, 2001 1:11 PM From: jennifer@mplaw.org To: DoktorMo@aol.com
I had to laugh at the person who ranted about tax payers paying for the children that result from multiple birth pregnancies. I thought it was common knowledge that in almost every case, multiple births of triplets or more are a result of fertility treatments. Having just completed a round of in vitro fertilization and (joyfully) expecting twins in December, I KNOW how much those treatments cost and I am fairly certain that people who are too poor to support their children certainly could NOT afford these kinds of infertility treatments.
This is my body, not the rest of the world's, and if we had found that we had a litter of children rather than just two, it would be no one's business but mine and my husband's what we decided to do about it, if anything.
Date: Sat, Jul 7, 2001 1:24 PM From: caroline.cooke@btinternet.com To: DoktorMo@aol.com
I live in the UK and after a perfectly normal conceived pregnancy in 1988 had my first child.However after trying for a second for several months I was put on a daily fertility injection called METRODIN which produced Quadruplets.Although this came as a bit of a shock after being told I would only have one child, I carried on with the pregnancy well and in 1993 gave birth to healthy babies.I would also like to take the opportunity to reply to one of your recent replies which is that I have never received any financial help what so ever, and even though my Quads are celebrities in my area we have never been offered any help and we wouldnt accept it anyway. We were given the choice to have all four and we have to live with the financial difficulties, we are blessed to have such healthy children however we conceive.
Date: Sun, Jun 17, 2001 5:55 PM From: JulieWinslow@msn.com To: DoktorMo@aol.com
I have to assume that if a couple has made the decision to have a child and received help to conceive one ( or more), they are willing to accept the challenge of multiple children. I feel decisions on the number of children a person can have at one time will vary from person to person. That decision needs to be made between the family and the doctor. I couldn't imagine a law telling me how many children I could carry in my body or how many I could take home from the hospital after completing 40 weeks of gestation. This article discuses a family having trouble conceiving children and getting help. If they wind up with 4 fetuses growing well and will accept the challenge, they should be supported by society.
Date: Tue, Apr 3, 2001 6:29 PM From: tcbfry@charlo.net To: DoktorMo@aol.com
My question is what if I WANT multiples? I want more than 1 child but after my first pregnancy I don't think I could do it again. I was hospitalized 13 times and had morning sickness 24 hours a day including migraines that required high powered drugs to control from my 4th month on so my question is, what do you use that has a high percentage for birthing multiples. We have the money, love and room for 2-3 more but cant do it that many times.
Christy
Date: Tue, Feb 6, 2001 8:03 PM From: Kccountryrose@aol.com To: DoktorMo@aol.com
I believe that there should be a regulation on multiple births. Many people can not even have one child and yet here we have people going out and having so many that most times the children are in some way neglected. It is a fact of life that if you can't have a child on your own then you simply find a way o have it created for you. I don't think it is right to add more stress on everyone by trying to increase the number of births in one pregnancy. Thisaffects everyone in society so therefor I think society should have a say in what goes on. It's our tax money that pays for those who can't afford it so we should have SOME say in how it is spent. You can't always get what you want in life so people should learn they need to distinguish between what they want and what they need.
Date: Thu, Feb 1, 2001 5:04 PM From: tmoeckel@usd239.org To: DoktorMo@aol.com
When the issue is with someone far away it seems like the a miracle. But, if the person was in a group insurance plan that I belonged to my attitude may change. Society, at this point, seems to come to the rescue for these births with donations of physical item and money. Limiting the number of children by aborting some of the fetus would be something that I would not agree with. This is the risk that is being taken for the chance to have a child with out adopting. I think the decisions has already been made, if we are allowing the use of these fertility drugs, then to be fully responsible, allowing the multiple births must continue.
Terry Moeckel
Date: Sun, Jan 28, 2001 11:46 PM From: MMUGNA@DADA.IT To: DoktorMo@aol.com
We are Italian students and we think that our society should not have a relevant role in regulating multiple fetal births because men and women (parents) should not decide the destiny of another person who is not able to defend himself. Only God should decide what it is best for us.
Date: Mon, Dec 4, 2000 4:05 PM From: chickn@email.msn.com To: DoktorMo@aol.com
I feel that society should not have a role in regulating multiple fetal births. It is a personal decision. For those who feel it is Gods right to decide ( and I am a Christian) let me say this, who do you think made all of this possible, all of the fertility medication and methods? God, that's who. If one decides to selectively abort, that is that persons decision, and should be no one else's. NO one should be called a sinner, for we are all sinners and no one sin is greater than the other. Also, the bible says that we should not judge one another, only God should judge. Society should let a person judge for themselves what is right for them and what they feel is right. This is America, we have the freedom of speech and the freedom of choice, and no one should take that away.
Date: Wed, Nov 15, 2000 2:10 PM From: emilydiamond@avenew.com To: DoktorMo@aol.com
Absolutely. America becomes so busy raising money and collecting toys for those babies but they don't even think about the other mothers out there that have that many children if not more. Some people adopt or just have the children in a natural way. Yet they get no recognition for their wonderful commitment to parenting. The government also sees this birth as a miracle while they call a mother who had seven children, one every year for seven years irresponsible! All that Bobbi did was put herself and each of her seven babies in incredible danger for their lives. They were lucky enough not to loose any of their babies, but most people are not so lucky. Society should not waste their time trying to help the careless. They should spend their time on someone more thoughtful.
Date" Sat, Oct 28, 2000 1:48 PM From: Kristinz4@cs.com To: DoktorMo@aol.com
I realize you were merely wanting to discuss the ethical issues regarding high order multiples, but I thought you might be interested in the article below, this is exactly what I was trying to say in my post to you a few months ago, I'm glad that someone is finally looking into this! Maybe the question should be "Who should be paying for these infertility procedures?". Is it a person's "right" to receive medical coverage for these procedures? I believe so, but I doubt that a person who can conceive "naturally" would feel this way. I would think that there could be a sort of happy compromise, like a limitation in the number of procedures that would be covered. Hopefully this will become a national priority considering the increasing rate of high order multiples.
Sincerely, Kristin Smith
Friday 27 October 2000 'Outdated' fertility drugs not worth the risk: expert Sharon Kirkey, with files from Joanne Laucius The Ottawa Citizen SAN DIEGO -- The most common form of fertility treatment in the world should be all but abandoned because of the risk of multiple births, a leading infertility expert says. Super-ovulation drugs that force a woman's ovaries to churn out far more eggs than her body ever could produce naturally are the most common cause of "high-order" multiple births -- triplets, quadruplets and more -- Dr. Norbert Gleicher, of Chicago's Center for Human Reproduction, said yesterday at a gathering of reproductive experts. Yet the standard tests used to determine how a woman is responding to the drugs are "basically worthless" at predicting whether she's at risk of giving birth to three or more babies, he said. "It's probably time to say good-bye (to the fertility drugs) and move those patients over to IVF," Dr. Gleicher told reporters after a panel discussion on ways to reduce multiple births. His comments shocked other physicians. "It's a radical departure" from standard fertility practice, said Dr. Steve Ory, chair of the American Society of Reproductive Medicine's practice committee. "It's going to come as a surprise to most of the medical community." Fertility doctors around the world are grappling with the consequence of assisted conception -- a dramatic rise in the number of multiple birth babies. In Canada, there were approximately 8,700 multiple births in 1997. That's up from 6,200 births in 1977. In the U.S., the number of multiple births involving triplets or more soared 400 per cent between 1980 and 1997. The increase is a huge concern because of the risk to the mother and child. Babies born in multiple deliveries are born earlier and smaller than single-birth babies, they're less likely to survive their first year of life and are far more likely to suffer long-term disability when they do survive, says a recent report by the U.S. department of Health and Human Services. The Parents of Multiple Births Association of Canada has urged doctors to warn fertility patients of the potential problems associated with premature and multiple births before the patient undergoes fertility treatment. "There should be a full expose of what could go wrong if you have quadruplets," said Lynda Haddon, a past president of the association and mother of twins who offers bereavement support to parents who lose one or more children of a multiple birth. "Success does not mean pregnancy. It means the baby grows to be a healthy adult person," she said. Women undergoing fertility treatment are often starry-eyed at the possibility of two, three or more babies, said Ms. Haddon. But 90 per cent of triplets, quadruplets and quintuplets are born early, leading to a greater chance of disabilities including vision, hearing and respiratory problems. "People who really want a child have a fantasy," said Ms. Haddon. "They don't realize that the children could be premature, and they could have anomalies." Critics have pegged the blame on sophisticated new baby-making technologies such as in vitro fertilization, which involves collecting eggs from a woman, mixing them with her partner's sperm and transferring the resulting embryos into her uterus. Until recently, doctors have routinely put in three, four or more embryos to increase the odds that at least one would implant and a baby would result. Experts heard yesterday how a relatively new technique that allows embryos to be incubated in the lab for five days instead of the usual three before being transferred into the woman can dramatically lower the multiple birth rate while actually increasing a woman's shot at getting pregnant. Growing embryos to "blastocyst" stage gives doctors more time to determine which embryos are the healthiest and more likely to implant. Blastocyst transfer could one day lead to doctors transferring no more than two, and even one embryo, during every attempt at in vitro fertilization. But Dr. Gleicher, of Chicago, says in vitro fertilization isn't driving the explosion in multiple births. "Old-fashioned" fertility treatments are. In fact, 80 per cent of multiple births are due to the powerful drugs that stimulate ovulation induction. Two years ago, a Houston woman gave birth to the world's first octuplets after taking fertility drugs. At one point in her pregnancy, she had to be suspended nearly upside down in a hospital bed to relieve the pressure on her expanding belly. Seven of the babies survived. Just this month, the fourth of eight babies born to an Italian woman in September after she took fertility drugs died. And in 1996, a British woman who took fertility drugs attempted to carry all eight of the resulting fetuses to term despite warnings from her doctor. None of the babies survived. In Ottawa, the Forgie quintuplets were born after their mother took even a low dose of fertility drugs. The most common fertility drugs are gonadotropins, naturally occurring hormones that the brain produces to stimulate the ovaries to produce hormones and prepare eggs for release. The drugs bypass a woman's normal process of egg development and release and induces ovulation in women who don't ovulate on their own. The problem, Dr. Gleicher said, is that doctors and patients have no control over how many eggs end up being fertilized after insemination. With in vitro fertilization, "we can decide how many embryos to transfer," he said. "We exert some control" over the process. His team reviewed more than 4,000 cycles of treatment using fertility drugs followed in most cases by artificial insemination. They found that blood tests and ultrasound examinations used to monitor the development of egg follicles weren't reliable at predicting the risk of a multiple pregnancy, he said. Lowering the drug levels could reduce the risk of multiple births, but it would also significantly lower overall pregnancy rates as well, he said. "The whole treatment then becomes very inefficient." "The treatment we use most today is probably outdated considering where we are" with in vitro fertilization, Dr. Gleicher concluded. Although he said doctors shouldn't "completely throw out" super-ovulating drugs, the number of patients who should get them "is very, very small." He said younger women, those under 30 who tend to produce lots of eggs after fertility treatment, should instead use in vitro fertilization. So too should older women "who have very little time left" to get pregnant, he said. "It's logical to use the most efficient treatment, and IVF gives us two-and-a- half to three times the pregnant rate of ovulation induction" per attempt in these women. But Dr. Ory, of the American Society of Reproductive Medicine, said the sheer cost of IVF makes it an option many couples can't simply afford. IVF can cost four to six times what it costs a woman to take fertility drugs alone, he said. And many doctors believe more research needs to be done before they can completely rule out ultrasound in predicting risk for multiple pregnancies, he said.
Date: Sat, Oct 14, 2000 10:22 PM From: latonia28@juno.com To: DoktorMo@aol.com
I do not belive that society has the right to make a decision about the actually aspect of multiple fetal births. This is a decision that is so private and personal, and only a couple and there doctor should be involved in that decision. But I feel that what is bothering society the most is that these couple seem to get more support then other couples who have single or double births. I feel that if that couple has the money to participate in a fertility program , and know that multiple births are a possibility,and that they can't make a decision to eliminate any of the fetuses,then they should be responsible for the care of those newborns. It is not fair that these couples receive so much support from various companies to assist their every need. There are so many mothers and fathers who need that same support and do no get it ,worst it is not even offered. I believe that children are a blessing, one blessing is still as special as multiple blessings. And this is what I feel seems to make the public outraged. I know that it is not possible for these companies to contribute to everyone who needs there assistance but they could do a better job. And what is more upsetting these companies are just doing it for the media and public attention,what every it takes to get their name out there and it's probably tax deductible. No business is going to do anything that is really FREE, it is all about the money.
Date: Sun, Oct 8, 20000 9:46 AM From: rennia.bybee@home.com To: DoktorMo@aol.com
I am so tired of hearing that " If God wanted you to be able to have children then he would of made it possible for you to do it naturally with out the help of fertility drugs" I've have noticed though that the people saying these things are the people who don't have a clue about what it feels like to not be able to have children. So who are they to tell people like me that we are going against God because we want to be able to love a child of our own. Unless you have been in our place then you really have no idea what you are talking about.
As far as multiple births go. If you people did would look at the research you would see that most fertility drugs and invitro fertilizations end up in singleton births. With the occasional twins or triplets. Very rarely do pregnancies of four or more result from these procedures. ( If they happened all the time the the media wouldn't make a big deal out of it when it happens now would they. )
My husband and I are just looking to have a healthy baby of our own. We know about the slim chance of a multiple birth and all of the risks and decisions me may end up facing. But those are our risks and our desisions no one has the right to make them for us. We thank God every day for giving us the strength ( And our doctor the skills and knowledge) to see us through this.
Date: Sun, Jul 30, 2000 1:45 PM From: Kristinz4@cs.com To: DoktorMo@aol.com
First of all, it is a ridiculous argument to say that people who seek infertility treatments are going against God's will. If that is true then that means that any medical intervention from treating diabetes to immunizations is going against God's plan to control population. Don't you think that God gives us (at least some of us) the intelligence needed to improve health and living conditions of mankind? This ridiculous argument concludes that all doctors and scientists must be working for Satan.
Secondly, as a mother of triplets I do admit that having higher order multiples has been a financial and physical strain, but I would do it again in a heartbeat! The vast majority of triplets, even when premature, grow into healthy children!
Lastly, I would like to comment that the majority of pregnancies that result from infertility treatments consist of only ONE baby. The pregnancies that result in most of these very large multiple pregnancies (quintuplets, sextuplets, septuplets, etc) are usually conceived by using highly powerful ovulation inducing drugs which are extremely difficult to control. Most infertility specialists have much better control with assisted reproductive technology which includes invitro fertilization (IVF). However, most insurance companies do not cover IVF which can run around $10,000, so couples are faced with the much more affordable option of doing a cycle of the ovulation inducing drugs which runs about $2000, thus increasing the risk of higher order multiple births. If only insurance companies would weigh the cost of an IVF cycle (even several IVF cycles) compared to the millions of dollars required for a very high multiple pregnancy which they do have to cover.
In conclusion, my suggestion is more insurance coverage for less risky and better controlled infertility procedures. Prevention of these terribly high risk pregnancies should be our biggest priority. No mother should have to face the extraorindarily difficult decision of selective reduction.
Date: Tue, Jun 13, 2000 10:02 AM From: smrnlv@gateway.net To: DoktorMo@aol.com
Society should definitely have a role in regards to multiple births! We pay for these kids, we build the family houses and supply them with life long diaper services and basically reward these folks for their selfishness! I can see these kids being supplied with any toy, computer, etc. for the rest of their lives due to their 'celebrity'. I think I have even heard that they are guaranteed college funds by some business.
I think of the struggles of raising my own 2 kids. We were never assisted by society. We were limited to 2 children, as that was all we could feed and clothe! My son will be going to college next year, and we will be either working another job or assuming more debt for a loan in order to send him. He is a good kid, has never been in trouble and that is the best that he can get. Sure, he can get partial scholarships; wish he could have gotten a full one! But he will not be rewarded because his parents could only have kids one at a time and pay for them themselves.
There is also something to be said about the ability to have children. Some people cannot. Perhaps it is a built in population control by nature. There are plenty of children that need families! So, science has enabled people to conceive when their bodies physically cannot by normal means. Will science now make me a champion figure skater, because I demand it? Will society pay for my ice time and world famous skating coaches? Will they supply me with sequin encrusted tutus for my skating career? Will they pay for the operation on my brain, bestowing me with the talent and the reorganization of my muscles, so that I may tolerate skating? Yes, the above sounds crazy, but that is what multiple births are. I am a pediatric nurse and I see these kids when they are older with their g-tubes and their weak lungs, suseptible to any bug that comes down the pike. When we intubate these kids and put them at further risk of illness, doesn't anyone feel responsible for this? We pay for this. We make these children suffer and suffer, all because their parents had a right to have children. Thanks for listening.
Date: Sun, Apr 30, 2000 2:48 PM From: xqz@hotmail.com To: DoktorMo@aol.com
New technological advances constantly bring forward new ethical dilemmas such as what is the case in the assisted reproduction field. The role of the medical profession and the society in general is of course not to interfere with or to regulate individual decision-making; it is to highly publicize the pros and cons of the new technology so that better informed and more cautiously meditated decisions could ensue. It is inappropriate for the society to dictate what is right and what is wrong, but it sure should not keep its mouth shut in terms of what is better and what is worse. Most people outside the medical profession derive their knowledge and understanding through advocacy and education. If they are totally left on their own to make blindfolded decisions, it is then not the freedom of choice but the irresponsibility out of ignorance. In the case of multiple births, it defies the mode endorsed by natural selection and will potentially pose high stress and various disadvantages to both parents and offspring biologically, financially and functionally. So it should not really be promoted as a standard or even preferred method in assisted reproduction. If the prospective parents choose to pursue this option, no one can and should prevent them, however, it has to be made clear to them that it may not be a wise choice, given current conditions.
Date: Fri, Mar 24, 2000 1:38 PM From: mkbledsoe@hotmail.com To: DoktorMo@aol.com
In regulating multiple fetal births, it seems that society is attempting to play the role of God in deciding who has the right to live and who does not. God intended for diversity in the human race. Genetic defects as a result of multiple fetal births are a part of this diversity. In fact, there have been many noted instances where there was a multiple fetal birth, and all children survived and were healthy. This is even supported by the previous response of the registered nurse. I also work in the birthplace of a hospital as a volunteer and seen a case of multiple births turn out very well. I therefore believe no one, including the court or society as a whole, should have the right to allow certain children in multiple fetal births to be aborted.
Date: Fri, Mar 24, 2000 9:15 AM From: Mrscfromsta@netscape.net To: DoktorMo@aol.com
I do not believe so, each child should have an equal chance for survival and should not be chosen by mother or doctor.
Date: Tue, Mar 21, 2000 11:13 PM From: cinefacta@hotmail.com To: DoktorMo@aol.com
As a means of population control, regulating multiple births would be a logical place to start. It would be so easy-- when a doctor diagnosed more than one fetus developing in the womb, he could perform a short easy elimination of the fetus (or plural) he chose. It could be standard procedure. However this is unthinkable in the modern US, land of the free and the American dream--which includes children and a lot of room to lay down roots-- and is morally repugnant as well. Plus, the US is not exactly at the point where it needs to implement population control programs. Even in China, where couples are encouraged and bribed by government benefits to only have one child, the choice is left to the parents. I'm not sure how 'society' is being defined on this website, but government regulation of multiple births, unless it were a regulation which provided a mortgage and diaper service for the overwhelmed parents, has absolutely no place in American democracy. I am staunchly pro-choice, and would support a mother's decision to selectively eliminate fetuses to provide a chance for better health for the remaining fetuses, but neither should it be the mother's obligation to do so. What is growing in a woman's womb is the responsibility of the mother, not society (and I am speaking in the cases of typical, healthy women, not child-beaters/molesters/drug addicts or the like).
Date: Tue, Mar 21, 2000 4:49 PM From: jkbyrd13@hotmail.com To: DoktorMo@aol.com
I believe that it is a wonderful thing that we can now help the infertile have children. However, it is a sad thing that it has become a circus lately when a couple has an abnormal number of children. I believe that we should possibly impose restrictions on the amount of fertility drugs that can be given to a couple (if it is possible to do so and still improve chances of conceiving) so that these great numbers of babies are not born at once. Because we as humans were not meant to give birth to large numbers at a single time, the chance for survival for these babies is lowered when such a thing happens. Also, it is probably very difficult for the parents to take care of so many children of the same age. However, I do not believe that we have the right to selectively abort children in cases of multiple births. We should do all that we can to help them survive outside the mother, and those that are meant to live will live.
I definitely agree that the couples taking the fertility drugs would be among the most loving parents, and I believe that society has no business telling them that they can only have a set number of children.
Ken Byrd
Date: Sun, Mar 19, 2000 8:49 PM From: Jdtaylor20@aol.com To: DoktorMo@aol.com
I see this as being an issue that should be handled by the family and physician after the particular situation is discussed. These situations vary from one family to the next. Under these circumstances, it is impossible to allow society to form a general regulation on whether multiple fetal births should be allowed. I have heard of numerous instances where multiple fetal births occurred, and all newborns survived and were healthy. It is a fact that newborn survival rates decrease with multiple births. Yet, it must be left to the family, not society or the court, to decide whether their moral feeling about abortion should take priority over the health and survival of their children.
-Jon Taylor, Univ. of South Carolina
Date: Sun, Mar 19, 2000 4:47 PM From: amhames@hotmail.com To: DoktorMo@aol.com
We are very fortunate to life in a society that allows for breakthrough medical technology as amazing as assisted reproductions. However, progress is almost always complicated by problems such as this. It is wonderful that couples hoping to start a family can do so even if nature dictates otherwise. At the same time, it poses some significany societal risks. The "burden" of multiple births on the families which receive them are nonexistent. They may suffer a bit financially or make several sacrifices in daily life. However, these are the same people who desperately sought after life after nature told them it was not possible to create it. In the context of society, multiple births could lead to long term problems. Genetically, there will obviously be problems according to Darwin's "Survival of the Fittest" theory. Also, the threat of overpopulation is a major concern today. However, the actual occurence of these multiple fetal births is relatively small, comparitively speaking, and will not have an overwhelming effect on either of these societal concerns in time in the near future. I think doctors should be able to guide their patients in ways that will be most conducive to their health. They must council them on the possiblilities and risks involved in assisted reproduction. However, I feel that it is wrong to destroy a life, intentionally created, in order to help its siblings. What if your parents, during hard times, decided that though they wanted you at one time in their lives you were now a "burden"? Would you want them to blatantly diregard the life they had created to make life a little more convenient and comfortable for them?
Date: Sat, Mar 18, 2000 9:39 AM From: MayDay913@aol.com To: DoktorMo@aol.com
I don't believe that society should be involved in the personal matter of births within any family. Multiple fetal births should be no exception, in acquired naturally. When the multiple births are engineered in the laboratory, society should still not be involved, but there is more room for ethical dilemmas when this doesn occur. In the case of Bobbi and Kenny McCaughey's septuplets, it happened naturally, and things are working out well. There are serious complications, as I am sure we are all aware, that can arise when there is more than one fetus attempting to survive within the mother's womb. However, this too is a concern for doctor and patient, not society. Decisions of selective abortion for the sake of other fetuses or for the sake of the mother are very important. Doctors are expected to acknowledge any dilemma that arises, and they are to offer their expertise in determining what the patient's should do. In no way should society be in charge of regulating these happy births. It is a personal/family matter. When the discussion of engineered multiple births arises, there is an enormous gray area in which complication is evident. I believe, as long as in-vitro, etc. continues that parents should be able to decide how many attempts are made. With this occurring, it might be helpful to have a pre-set number within the couple as to how many fetuses they will attempt to keep alive after successful fertilization. But again it is an intimate decision-not spanning society's realms. In the large spectrum of birth/pregnancy (I do not know the exact figures), multiple septuplet births are rare. So as for the societal strain this might cause, I see none. The McCaughey's situation brought smiles and happiness to so many faces and families. It also produced unity throughout the nation in many aspects. Healthy for a society, if you ask me.
Date: Fri, Feb 11, 2000 10:49 AM From: dcmay@junct.com To: DoktorMo@aol.com
What an interesting question. I also read many interesting answers. I humbly offer my own opinion. The multiple births I have witnessed as a labor and delivery nurse, whether artificially induced or not, have been joyous occasions for loving, caring families. These babies survived despite the odds, this can be said of single births also, and so why should society or anyone say who should live and who should die. Despite the politically correct term 'selective reduction' it still adds up to murder. So, enough said, we have no right to kill any of these babies. Thanks,
C. J.
Date: Wed, Feb 2, 2000 5:40 PM From: pyunb@csv.warwick.ac.uk To: DoktorMo@aol.com
If these multiple births are the result of medical assisstance to naturally infertile couples, or couples having genetic complications with conventional reproduction, then we are producing such evolutionary pressures that we face the exitinction of the naturally reproducing homo sapien. It is survival of those most effective at reproducing as the proportion of organism possessing their genes will become highest in a population.
Date: Wed, Jun 2, 1999 7:55 PM From: Nanie3690@aol.com To: DoktorMo@aol.com
Society as a whole should not have a role in regulating multiple births. If the multiples occur thru a natural process (i.e no fertility drugs or other such methods used), than total autonamy should be given to the mother and/or father whether there will be any selective abortions. Dangers to the fetus' and the mother alike should be well conveyed to the parties involved; any and all decisions should be made by the mother and/or father in conjunction with the doctor. Nature is still an ever-present force, if an egg should spontaneously divide and " multiple " situation arise, decisions should be made by only parties involved, not society.
However, I'm assuming you are talking about fertility/biomedically engineered multiple's. In this case, still society should not be involved. Who should be involved?...the doctors who are aiding in the process. Be it the doctor who is dosing the fertility drugs, or the fertility clinic who is preforming the egg inplantations. During inplantations generally many many eggs are used with the hope that one or two will " make it ", as we've seen lately such is not the case. In using fertility drugs, on the first sign of multiple's it should be made clear to the parties involved that human beings are not meant to, and never have birthed liters.
The controls for regulating multiple births has nothing to do with society. Studies have shown that children born as multiples tend to do much better in socialization, and self-gratification; these children tend to go the extra mile to stave off immeadiate self-gratification. That type of behavior does not pose a threat to society, rather it would be welcome. The problem lies in that most multiples, a hand full, develop correctly in respects to health and mental apptitude. There in lies the reason for some sort of control of " engineered " multiple births. Possibly implementing some type of contractual aggrement between parties involved that should multiple births of X number or more be detected, this number X will have to be selectively aborted. And so many of us tend to forget that between black and white there is an enormous gray area. In that I mean that specific parameters could be used to decide upon safety of mother and children alike; i.e first pregnancy, age of mother, health of mother, etc.
Date: Wed, Mar 24, 1999 5:42 PM From: h1073@hopi.dtcc.edu To: DoktorMo@aol.com
I think that the parents should not implant so many eggs because their is that chance of all of the babies to be a success. They should start out with two to four eggs. I believe that it's the parents right to choose if they want to abort any of the embroys. I'm not certain how i feel on the situation where they are given the right to choose which sex should live.Since some parents are implanting such a large number in at a time the should at least understand that if they do not abort some of the embros that all of the babies could die.This is the reason i believe a small number should be implanted at a time.
Date: Wed. Feb 24, 1999 2:26 PM From: grkas@webtv.net To: DoktorMo@aol.com
I DO NOT believe society should have any say so what so ever in the choice of selective reduction. This is obviously a choice that is clearly a hard one to make and should only be between the family and the Dr. I am the proud mother of very Healthy and Happy 11 month old quadruplet girls that are loved very much by their entire family, they are also cherished very much by their older brothers 11, and 13, We couldnt be happier, however selective reduction was not a choice for us, yes we were told about this option but we never considered it.
Date: Wed, Feb 10, 1999 3:28 PM From: hammonsdc@socket.net To: DoktorMo@aol.com
I do not feel that society should play any type of role in regulating multiple births. I feel as though that is between the doctor and the patient. I am currently undergoing intensive treatment for IVF and my husband and I know the risks that go along with the procedure. I don't think anyone could possibly understand the frustrations of not being able to conceive naturally unless they have experienced it first hand. I personally feel that God will be using my doctor as tool when I go in for the IVF procedure and no one could make me ever think otherwise.
Part of the problem with couples having multiples is the insurance companies. They are the reason that people are so desperate that they want several embryos transferred. Insurance companies don't want to cover infertility procedures, especially assisted reproductive procedures. The assisted procedures are their only chance for conceiving and if most people are like myself, can only afford one procedure therefore taking a risk of having more than one baby. So if you want someone to blame for multiple births, blame it on the insurance companies who squirm when they hear the word "infertility". Don't blame the infertile couples who just want to have a family and have to mortgage their homes or take out high loans for a one time procedure that makes them so desperate that it doesn't matter how many babies they have. The babies that are born to infertile couples are the most wanted children in the world.
If you want to worry about the well being of children, worry about the children who are born to the people who don't want them, the children who are beaten and neglected everyday.
Cherie M.
Date: Sat, Jan 2, 1999 5:16 PM From: patbob@elkhart.net To:DoktorMo@aol.com
To September 1st.
I am a person who doesn't say alot or reply to articles on the internet. But after reading your response, I couldn't pass up a chance to put my two cents worth in. First, I understand that handling multiple births is a big responsibility. Second, I understand that there are people who do use fertility drugs sometimes( I do mean sometimes) abuse this privilidge to have more than two or three births. Where I have the rub, is the saying about GOD not wanting loving parents to bring his children to earth. I am a father who is going through fertility drugs to have a child that my wife and I have wanted for some time. We feel that the Lord himself has brought us through this process. We understand the complications that go with using fertility drugs and we are prepared to take responsibilty. You can't even experience the feeling of wanting a child and going through the process to concieve one. We feel that the Lord has blessed us with the opportunity. Unil you have walked a mile in our footsteps, please reconsider what you have written.
Date: Tue, Dec 15, 1998 9:36 PM From: katebehm@yahoo.com To: DoktorMo@aol.com
I don't believe that society should have any say over multiple births. I am 24 years old and am infertile. After trying to have a baby for two years I was told that I had a disease called Polycystic Ovarian Syndrome. Because of this I will never be able to have children through natural means. After I was diagnosed my husband and I had many disuddions about fertility drungs and multiple births. Three years ago we decided to risk it and I am very happy to say that I now have a beautiful 2 1/2 year old son that I love and adore. But, we would still like to have one more child. I am currently on my thrid month of Clomid and have not gotten pregnant. I am now faced with the option of higher doage of drugs or to try new drugs. This is a decision that only my family can make. It would not be fair to have the government or the general population to tell me that I can not go on. Infertility is something that is very hard to cope with. Even with drugs it is still a miracle to actually conceive a child. Unless you have walk a mile in my shoes and know what it is like to see your friends with babies and know that you can never have this, you can judge those of us who are infertile for wanting to take the risk of being blessed with children.
Date: Sat, Nov 21, 1998 12:33 PM From: jmeichtr@popmail.lmu.edu To: DoktorMo@aol.com
Hi,
I just wanted to respond that no one can make a human. It is God that creats us. Even if people do use fertility drugs to help the process there is no way they 'create' a person. They cannot construct the intricucies of the eye and how it sees, the brain and how it works, blood and how it brings nutrients to the body, etc. Only God can create these things. A human is a human because God made them. They are made in the image of God. God knew them before God knit them in their mothers womb. God predestined us before we were conceived and knows every day of our life - and has given life to us. I personally think it is great that couples can use the assistance of medicine to have babies. One point I would like to make is that if there are multiple fetus the couple has a responsiblity to these little humans [babies] to birth them so they can have life. Removing them before birth is killing them.
Sincerely, jan
Date: Fri, Nov 20, 1998 5:23 PM From: jkruse@inetdirect.net To: DoktorMo@aol.com
I think that there is no need to regulate the presence of multiple births. While they are fascinating to some, they tend to also create a strong bond between the multiples, their parents, and those who are close to them. Every baby should be given a chance, even if they were no naturally created!
Date: Tue, Sep 1, 1998 9:11 AM From: KRomas555@aol.com To: DoktorMo@aol.com
I would like to voice my opinion on the multiple birth issue.
I have triplets. They are identical girls and were concieved naturally, without the use of fertility drugs or treatments. I am a fraternal twin. I also have two boys who are seven and nine.
I know firsthand how hard it is to raise just one baby at a time, let alone three. We are coping, all my children are happy and healthy, with no disabilities.
However, this can not be said for many multiples, and therein lies the rub. I do not believe that a woman should use artificial means to have children. These women who use the drugs and doctors to have twins or higher are just playing God, and the children often pay the price. Many multiples suffer from things such as hearing loss, eye problems, cerebral palsy, mental retardation, the list goes on.
I know that some might say that any child can be afflicted with these problems, but multiples have a much higher chance of suffering from life-long medical problems than singletons.
I also think that women who use the drugs and treatments should not say that God gave them their children. They made them in the lab themselves. If God had chosen to give them children, they would already have had them. Many women who resort to medically-assisted gestations SEEM to be deeply religious, but in truth, if they were, they would not have done what they did. It seems to me that by using artificial means to get pregnant, you are telling God that He made a mistake, and you will correct it, therefore, you are mightier than God.
Date: Wed, Aug 5, 1998 11:31 PM From: pjwhite@telusplanet.net To: DoktorMo@aol.com
I don't think anyone except God has a right to regulate multiple births. Even though fertility drugs and other fertility aids (such as IVF) raises the chance of multiple births, it is still a miracle. I know it can be dangerous to both mother and babies, but families that end up with many babies at one time need support.
Patricia White
Date: Sat, May 30, 1998 11:22 AM From: "fleurant@cybertours.com"@cybertours.com To: DoktorMo@aol.com
In my personal opinion I do not feel that society has the right to intervene in any couple's personal decisions, especially those that involve important matters, such as children.
Date: Wed, Mar 18, 1998 11:29 AM From: samiller@ehc.edu To: DoktorMo@aol.com
Assisted reproduction has definately raised new ethical questions which must be addressed. I do not feel that society should play a role in making decisions about multiple fetal births. The decision to reduce a multiple pregnancy or to continue the full pregnancy should be that of the parents and the doctors, not society. Although multiple fetal births do pose difficult dilemmas, it is the responsibilty of the parents and the doctors to discuss the situation and make an educated decision that will be best for the infants and the parents. With advanced technology, parents and doctors are increasingly being placed in the position to "play" God. Now that the technology is available, there is no turning back. Technology marches on, leaving pending ethical dilemmas. Technology has made life and death decisions mighty tricky!
Sarah Alice Miller, E&H Box 159, P.O. Box 9001, Emory, VA 24327-9001, Phone:(540)944-6526
Date: Thu, Feb 26, 1998 4:04 PM From: rachael25@hotmail.com To: DoktorMo@aol.com
My thoughts on this subject are simple. Multiple births are not to be desired. They leave most babies premature, making birth defects or disabilities much more likely. They put the parents in the unhappy position of having to choose between reduction and the possible loss of all the babies. And when they are born, multiple birth babies place an enormous strain on the mothers and fathers...of course, it does depend on how many babies you have at once, but the fact remains that to have more than one baby is much harder. However, I do not feel it is society's right to intervene. Too many parents want babies desperately. It is not fair to stop all fertility treatments for everyone just because some people have multiple births. If you did that you could argue that every person in one room should be punished because one of the people did something bad. Therefore, my solution is to make fertility counseling much more thorough. This means that parents should know all the problems with multiple births. Also, doctors should not be allowed to give so much of a fertility drug that it makes the woman release seven eggs. And finally, it should be that only three eggs can be implanted during the In-vitro Fertilization process. Such restrictions, while not completely stopping the problem, would at least stop the growth of multiple births and perhaps make them become more rare.
-Rachel
Date: Thu, Jan 8, 1998 11:54 AM From: kellyc99@hotmail.com To: DoktorMo@aol.com
No, I don't think society should, in any way, have a say in the regulations of multiple births. If the parents feel they can successfully raise a family of more than three children then they should be allowed to. Society doesn't comment on any other couples pregnancies, then why should they have something to say against couples who have, for so long, been trying to have a child and now have finallyl become successful? The fact that there will be three or more babies born doesn't have anything to do with them and so why should they have a say in the regulations of multiple births? Again, if the couple feels that they are ready for a family and believe that they can do a good job then they should be allowed to, without others determing the outcome of their children's lives.
Date: Wed, Jan 7, 1998 6:40 PM From: Asis45@aol.com To: DoktorMo@aol.comj
I am studying about reproductive technologies in my bioethics class now. I do not think that people should have sooo many options for having children. I think that if the person was meant to have children, that God would have made it that way. I am sure that it is a very sad and stressful situation to be in, but that is the way it happened. Doctors should not provide assisted reproduction to people that would cause them to have "litters" of children. Only animals are meant to have litters of children. Humans are not built for it. Take any person who has had more than three children at one time for an example. The mother can become very sick and unable to do things during her pregnancy. If the mother gets too sick, selective reduction may be recommended by the physician. Is that really the right thing to do? the mother took the chance in having more than one embryos with the possibility of growing implanted. An innocent life should not have to suffer the consequences. If the mother does decide to go through with selective reduction, how will it effect her? If I was in her situation, I would always wonder what the child would look like and what it would act like. On the other hand, if the mother does go full term without selective reduction, one or more of the children, when born, can become very sick and die. A lot of multiple births will have a long term effect on the society. There are already hardly enough jobs available to todays socity. HOw will there be enough jobs for double or triple the amount of people. Will there be enough housing, food, jobs, and enough room in schools for all the children? I don't think that society will be able to handle it. It is something that is very hard to decide what is right and what is wrong. That is why i believe that nature should never have been messed with. People should not play God. Although i do not agree with this, i do believe that it should stay between the parents and the doctor. I do not think that the pregnancy of the mother should be spread all over the news and the babies born shouldnt be filmed from the second they are born and watched over like eagles. So, no i do not believe that society should be involved in regulating multiple births.
Date: Wed, Dec 31, 1997 12:26 AM From: robinsnest6kids@webtv.net To: DoktorMo@aol.com
I'm not a physician but I do encounter women in this position almost on a daily basis. I'm a counselor for expectant/new mothers (parents) of multiples. I really don't think that society, in general, should or could have a choice in this matter. Yes, these children could end up being supported by the "tax-payers" but these chances aren't really higher than any other large family. If interested parties wish to voluntarily take part in the financial, emotional or physical support of these families then they should be encouraged to do so but no one is forcing people to "help" if they choose not to. The families who seek out specialist in the field of infertility are usually quite "desperate" people. People looking for that, perhaps, last chance at a biological family. They should be counseled in great length and explained of the realistic risks involved and the true chances of having "more than one". However, the vast majority of these families ignore these words of caution and are often willing to accept anything providing they indeed get pregnant. Some go into the process realizing they may conceive twins but very few of them think much beyond that. (And the truth of the matter still remains that actually very FEW really even conceive, much less, carry through to viable birth, two or more babies at once. What makes the news and what gets public reaction is only the very rare exception to the rule.) I know several infertility specialist and I don't think any of them have ever had a case of more than 4 fetuses and all of them counsel their patients about selective reduction even with only triplets - which, in my opinion is too extreme. Once a pregnancy is "in tact" I personnally feel the choice should NO longer be that of the physician much less that of the public but only should remain and remain alone with the parents. They should be offered (even strongly advised) to receive counseling to help them make the right choice for them as a family and the health of the mother. It takes courage like no other to be able to make a choice like the McCaughey family made and luckily so very few families are in such an extreme position to have to make such a choice. I look up to these people and encourage them however I can. They love their children and that should be admired. No one can predict the future and what might be in store for these seven babies or any family of children (I have 6 myself - including twins). And... What about the chances that nature itself played a significant role in the McCaughey pregnancy and other "higher-order multiple" pregnancies?? If a woman's body is not capable of being pregnant with multiples then her body will not allow it to continue. The female body was made for only one - what does that fact do to the odds of a body able to accept successfully a multi-fetal pregnancy?? Does anyone know for sure that two or more of the McCaughey babies aren't monozygotic?? That possibility would then have NOTHING to do with the assisted pregnancy!! That is nature pure. I have encountered many of these pregnancies (whether IVF, Clomid or Pergonal - or similar drugs - induced) that result in all or partially monozygotic siblings! I hope I've made a reasonable point.
Thank You, Robin Rabenschlag San Antonio, TX.
Date: Tue, Dec 16, 1997 7:48 PM From: EAKR07F@prodigy.com To: DoktorMo@aol.com
I don't think that the individualistic society in which we live is in any position to take a consistent position on multiple births. If it frowned on them, with the physician as its "operative" tool, consistency would demand that it have similiar positions on births that were ordinally separate, on parental responsibility, on a host of "Brave New World " issues, etc. But the key, and thankfully that for now, is that we live in an individualistic society and I see little evidence that society has some collective notion, conscience, or will, in this regard.
Recently I got three responses from visitors to the “Pages”. I will post them here and then follow those responses below with the earlier numerous responses to the topic. How do my current visitors feel about the issue? ..Maurice.
10/8/2006 Ordinarily, I do not believe that society should interfere with family matters
like birth or multiple births. However I can also see how the multiple birth and
selective abortion issue could get out of hand if common sense is not used.
People are not puppies, and really should not be trying to put babies in jeapardy
for selfish reasons if better techniques can be utilized.
Thank You
kjm55@drexel.edu
_____________________________________
10/7/2006 I don't think that society should have any role in this. Society, at least in most places, does not have a role in other types of birth, so why should it have one in multiple fetal births? I believe that allowing a physician or society to be able to make this type of decision for a couple would be very unfair. WKMayfieldCo@aol.com
_____________________________________
10/5/2006
I feel it is none of society's business how many children a couple has.
Whether these children come from individual pregnancies or one
pregnancy, that is their right. As long as they realize the risk for
birth defects and are willing to accept a child or multiple children
with this defect, I do not think we as a society should have any say.
Thanks
Melissa Pitts
Drexel University
mp375@drexel.edu
+++++++++++++++++++++++++++++++++++++++
Should Society have a Role in Regulating Multiple Fetal Births?
The recent birth of the Bobbi and Kenny McCaughey's septuplets has stimulated discussion regarding ethical issues involved in multiple fetal births. The issues have included whether doctors should, in fact, provide assisted reproduction so that litters of babies are created and delivered or if created, should there be selective reduction (abortion) of some of the babies so that the others have a better chance to survive in a healthy state. Other issues involve the burden multiple fetal births may have immediately and in the long term on society. A controversial point would be whether assisted reproduction where multiple fetal births are possible should be a procedure to be carried out in privacy between the parents and the physician or should society enter the relationship and have a role in regulating the outcomes of such a procedure.
Here is the question:
Should society have a role in regulating multiple fetal births?
Date: Sun, Jun 6, 2004 5:59 PM From: justin.roberts1@us.army.mil To: DoktorMo@aol.com
If a couple has gone through everything it takes to get to the step of infertility treatment that may or may not cause multiple births, what right does society have in regulating how many they have???? As part of an infertile couple I have had bloodwork, transvaginal ultrasounds, taken hormones, been given injections by my husband, helped produce multiple semen samples, had surgery and have been poked and prodded in ways that the average person in society can't even imagine. For those women out there who dread their annual pap smear...it's nothing compared to having 2-3 doctors, a nurse and your husband in the room while you lay in the stirrups so they can inject your husband's washed sperm into your uterus. Talk about your romantic conception!!! And after all that.still no baby. So the next step is in vitro fertilization which has an extremely small percentage of multiple births (granted, more of a percentage for average, normal, fertile couples, but still very small). And you want me to pick and choose which babies to have if by some miracle I get pregnant with more than one???? My answer would be " Go to H*$$ !!!"
Date: Thu, Apr 1, 2004 4:49 PM From: middletonearth1@earthlink.net To: DoktorMo@aol.com
How absolutely ridiculous that anyone would think society should have a hand in telling parents with muliples how many they should or should not keep and/or if they should be ALLOWED to take fertility drugs in the first place. Spoken by someone who a.) has had no difficulty having children b.)has no children of their own or c.)may live in China.
I am a mother of quadruplets. After trying for 3 years to have babies, we were finally pregnant. I knew the risk of carrying that many babies. I was in the hospital for 2 months prior to their birth. They were in the NICU for 4 months. I lost one of my children at 3 weeks from a blood clot in his heart. I buried my child. (The most painful experience that I have ever been a part of.)
I love my children very much. I am 10 credit hours from having my masters degree in counseling. My husband has an MBA. We live on a modest budget, but make due. We could be anybody off of the street. How dare you, tell me, that you know better about how many children I should have.
Further more. Who is to say I would not have had 4 babies as singletons? Who is to say that they would not have been multiples....at least twins...had I not taken fertility drugs. My mother did not take fertility drugs, and I have a fraternal twin brother...and sisters that are identical twins. Oh yes, it happens! Also, any single baby can be born a preemie...it happens all of the time. Any child can be born with medical problems. Any child can die.
I am sick and tired of the people who believe they are in the know, telling me how I should raise my family. Read the newspaper...take a walk...distribute flyers to help someone actually in need of your services...but do not have the arrogance to think that you are in any position to dictate to society if they should have children, and how many they should have...Many third world countries do that...and that is why they have to have mail order brides to reproduce.
--- Brett Middleton
Date: Tue, Mar 23, 2004 8:28 AM From: LamborghiniGurl1@aol.com To: DoktorMo@aol.com
No, people do not give these children up for adoption because they love their babies-every one of them. But they also have to understand that society has to pick up the slack of paying for the babies in one form or another. The society of the United States is already in chaos. Do we really need women to start having abnormal births to six, seven, or even eight babies at a time? I don't think so. The United States as a whole cannot put out the money that would be necessary, nor the space needed! If every family had that many children, then we would have to make artificial islands for people to live on--a very costly program--and then find out ways to keep the children healthy. No, is my overall opinion because we, the next generation, already have enough of a mess to clean up, and I don't think we need anything else to hinder it.
Date: Sat, Sep 27, 2003 8:15 AM From: Dakker@webtv.net To: DoktorMo@aol.com
Yes they should! It is very unnatural. Animals have litters. The babies are not full term.That can/could cause all kinds of health problems.
Date: Tue, Aug 5, 2003 4:45 AM From: Klb524@aol.com To: DoktorMo@aol.com
No, physicians and society should not have a role in regulating multiple fetal births. They don't have a role in regulating any other births. So why this kind ? Yes, physicians should offer their strong recommendations, but society should offer the same care for these babies as for any singleton. Twins are novel and cute to everyone. They are socially acceptable. People seem to be horrified by multiple fetal births. This is not fair. They are people too. A woman knows the risk that she is taking when consuming fertility drugs by now. This is the woman's choice as is abortion. We never hear of couples with multiple fetal births giving some of their children up for adoption. This is because they want their babies - all of them. In this day and age, stillbirths and preemies happen all the time in singletons. So lets stop pretending that these situations are so rare. Perhaps technology will catch up with itself soon and multiple fetal births will meet with better medical equipment and techniques.
Date: Thu, Jun 26, 2003 10:07 AM From: Rginagail@aol.com To: DoktorMo@aol.com
I believe these families need a little more screening. There needs to be some kind of criteria put in place. Yes everyone deserves to have children, even if you are poor. But I think there needs to be more counselling to these families. I dont think they realize how much it is going to cost to raise these children. And: Do they have the support system to take care of this many children?
DoktorMo@aol.com 03 10:07 AM
Date: Tue, Jun 3, 2003 4:35 PM From: Meganterryhansen@aol.com To: DoktorMo@aol.com
In my opinion, society should not have a say in this very personal and private matter. Multiple's can occur naturally, as well. The bottom line here is that this is a private matter which demands confidentiality.
Date: Mon, Jun 2, 2003 7:03 PM From: Desibilt@aol.com To: DoktorMo@aol.com
Hello Doctor Mo, Im currently taking a medical ethics course with Priscilla Richardson from Boston and was introduced to this very interesting site! I believe the society in which we live in (USA), we do not have a right to intervene in regulating multiple births. This type of procedure is a consentual agreement between a doctor and a consenting adult. Furthermore if the decision is made for selective reduction painful of a decision as it may be, the family has the right of patient autonomy. A woman who feels comfortable with this type of decision and feels shes made the right moral choice shouldn't be expected to live up to societys idea of right and wrong when reproduction and abortion are legal in this country.
Date: Tue, Apr 8, 2003 8:06 AM From: mjestes@tds.net To: DoktorMo@aol.com
Personally, I do not believe that 5+ babies born at the same time are a miracle. Miracles do not occur from a mother taking fertilization drugs to enhance her egg production. If a mother naturally becomes pregnant with 2+ babies, that is the will of the world. However, when medicine interferes and multiple fetuses are formed, the lives of the fetuses must be considered. Medical interventions to prevent disease and sustain life is totally different that this type of medical treatment. The area is very gray. Do you deny a mother the right to bear children, just so fertility treaments are not given? Hopefully, in future years fertility treatments will become more of a science than a guestimate. Multiple births have a higher mortality rate than do twin and single birhs, which only proves that selective reduction should occur in SOME cases. However, I don't feel that society should have a role in choosing for the parents whether selective reduction should occur. I feel this should be a private decision between the mother, father and medical team. If society becomes involved in these decisions, strides that have been made in other women's health issues such as the right to choose (Roe v. Wade) could also be argued that society should be involved in deciding for women whether to have an abortion.
Date: Wed, Jan 29, 2003 1:47 PM From: boline1@email.msn.com To: DoktorMo@aol.com
The Pro-life folks would be the ones who would want society to choose whether or not a family is allowed to have multiple fetal births. Many times I believe that the Pro-lifers are more interested in taking choices away from individuals, than preserving life. Whether or not a multiple fetal birth is come by naturally or through infertility treatments, I believe the humans involved in the pregnancy should discuss the birth with their doctor, then choose what is right for them. Their decision is between them and their God. It has no bearing on the rest of society. Their decision is not designed to hurt or help society. This is a PERSONAL decision and choice. The McCaughey septuplets have turned into a beautiful bunch of children. The parents never appeared to have any intention of sponging off of society. They never thought they would be rich with money, but now they are a family rich with love. That family's life is completely different now than it was before the septuplets, and that family has adjusted and struggled with health issues. When you have a child, the challenges and the rewards are woven together to create a bonding and unconditional love. It is no different with single or multiple fetal births. At least when infertility treatments cause multiple fetal births, the parents are usually desperate to have children to love. If an individual feels overwhelmed at the prospect of seven children, it is up to them to "pick and choose", and consider aborting some of the fetuses or putting some up for adoption. I have my own problems and challenges. I don't want to be someone else's conscience. Society should not be the conscience of someone in this difficult position. Jakki B.
Date: Thu, Sep 12, 2002 11:59 AM From: LJButler6CO@aol.com To: DoktorMo@aol.com
After reading the article about society and their potential role in regulating fetal births, I had to ask myself why society would even be considered in this process. Since when does society have a say in a family's decision to start a family. Whose business is it to tell a person that they are limited to so many children? As for the McCaughey's, each child has brought something special into their lives. Each of these children was placed in this family for a reason; God knew that this family could handle the trials and disabilities. God is the Creator of all living beings and His Will ultimately decides the future!
Date: Tue, Aug 13, 2002 4:01 PM From: panther@stis.net To: DoktorMo@aol.com
Those who say society should have a role in deciding what to do with the "problem" of multiple births are suggesting that a mother has a bigger obligation to society then to her own flesh and blood. Those multiples will be taxpayers too someday and are members of society from the day they are born. How can you make judgements about who should be born or not in your own society? Multifetal selectve reduction is not the magical cure for multiple pregnancies it is made out to be. Women who go through the procedure have an up to 40% chance of miscarrying the rest of the babies. 55-60% of reduced pregnancies don't make it to term anyway. Many of those don't go past the # of weeks gestation they would have gone to if all the babies had been allowed to live and in many cases it's best to leave things alone and carry all of them. What exactly do these people think they are reducing anyway? How is reducing a pregnancy going to improve the health for the babies that die? If they are dead there is a 100% chance they are not healthy. It is not at all clear how deliberately killing a child is better then giving him a chance at life and him dying of natural causes. It is true that multiple pregnancies are risky and can be dangerous, but carrying multiple babies does not automatically mean a disasterous outcome. As for the people who say that a woman who cannot concieve on her own should not try fertility drugs, they have obviously not been through it themselves. While I do not agree with some forms of IVF because of they way the fertilized embryo's are disposed of, I do not think trying to find help when something goes wrong with your body is going against God's will. If a couple is truly meant not to have children, they will not have any, no matter what they try. To think that man and science can bypass the absolute will of God is ridiculous. Telling a woman who is infertile that God "meant" for her to be infertile so therefore she should not try fertility drugs is like telling a diabetic that God meant for their pancreas not to work and therefore should not take insulin. The consequences of being infertle and being diabetic are vastly different, but they are caused by the same thing. Something went wrong with their body. Selective reduction forces parents to to play russian roulette with their children and, by choosing which children will live and die, allows a doctor to play God. Seeing the way some doctors behave that is not a position I'm comfortable with. Which one of the septuplets should Bobbi and Kenny have allowed to been killed? That is exactly what needs to be asked, because if the pregnancy had been reduced, four to six those beautiful children would not be here. To parents, which of your children can you imagine not being here? It is TRAGIC when parents choose to carry all of the children they concieve only to have some die, but how is it better to for them to have NO CHANCE to live? Is it better to let these children at least have a chance at living then to give them no chance at all.It is also important to remember that ALL children are gifts from God no matter if they come one at a time or seven at a time.
Date: Sat, Jul 27, 2002 5:22 PM From: EdandEvyG@aol.com To: DoktorMo@aol.com
I think it should be up to the parents to decide what to do......as for fetal abortions, can you honestly look at your children, and pick you & you, and you......that's God's business, so let Him intervene
Date: Wed, Jul 10, 2002 7:09 PM From: Planetsoul24@aol.com To: DoktorMo@aol.com
To whom it may concern:
I read the topic and frankly am appalled. Why is there always something? We as a "society" can NEVER let well enough alone. Let these people have ten children if they wish. However, now if we were talking of a single parent who was a welfare respondent or something of the sort, then its the welfare of the child/children at stake. For now, Its a couple who wanted children and after a long struggle and finally blessed. There are couples who have 6-7 children one at a time, hence, what's the big deal if they are born at the same time. GOD BLESS those babies. Leave that family be, stop starting these posts about them and let them live their lives happily.
Thank for your time, Ryann L, Upstate New York
Date: Wed, Jun 12, 2002 10:35 PM From: als@salmoninternet.com To: DoktorMo@aol.com
I have a sister in law who wanted to have a baby and couldn't . So she looked into fertility help. She did receive the fertility help and has had not one but 2 separate pregnancy's. 2 little girls. I thought that was such a wonderful gift she had received. Now she has decided to have another baby. Her and her husband cannot conceive naturally, like I said earlier so they had to have fertility help. Now she is pregnant with quads! When will the selfishness stop? I thought It was wonderful for her to have a couple of children with help. But to selfishly risk her life ,and the four babies she is caring is foolish, not to mention if she dies she is also putting her 2 little girls at risk of not having their mommy .Not to mention the fact that her husband could be left to raise all these children alone! Its insane! I will say this. If people would sit back and realize what they have and be appreciative of what they have and not be so selfish then I would say leave it to the parents and Doctors. But if society continues on its materialistic "I have more then you" rollercoaster then the government should be involved. We as a society cause our own problems.
Date: Sun, Apr 7, 2002 2:44 PM From: MSBGP@cs.com To: DoktorMo@aol.com
To all those who say leave it to God to decide how many babies a person should have, I agree. If God lets you get pregnant then go ahead and have it. If God decides you should not have a baby then don't intervene with drugs. Accept God's will or leave God out of it, you can't have it both ways. I believe that all babies should be wanted and the parents should be able to provide for them or aborted.
Date: Sat, Feb 23, 2002 1:38 PM From: Moocows132@aol.com To: DoktorMo@aol.com
I think that every child is a blessing. Who is the government to decide who many children we can have at one time? China does that not America the land of the free. I believe that everything happens for a reason. The good Lord decides when children are born and when they are not. Who does the government think they are? They have no right to tell women if they can carry multiple fetuses or not. I understand there are a lot of risk with carrying more the one baby at a time but there are also risk carrying just one baby as well. The decision of reduction should be made by the parents and no one else because it is the parents who are going to have to deal with the lost of that child, not the government. Besides what do they care. Its not like they are footing the bill when these babies are born. If the government is allowed to tell us how many children to have at one time what is to say they are not going to tell us how many children to have in all. Uncle Sam does not have to raise these children the parents do. The parents are the ones that are going to have to do the late night feedings and changing the diapers and kissing boo-boos away. If they think they are up for it then I say let them do it. The government is getting to nosey these days and it seems like they are trying to put a leash on us. That is not what America is all about. Let the parents and God decide. They are the only ones who will be taking care of these little miracles.
Christina Cordier
Date: Fri, Jan 25, 2002 1:24 PM From: kristy_millage@csgsystems.com To: DoktorMo@aol.com
Reading some of the answers from those who think society should have a roll in regulating this is ludicrus. Most multiple birth children grow to be tax payers just like those who write their comments. It's no different than those non-tax payers having several single-birth children. The couples that are going through the fertility treatments are doing well financially and aren't the ones living on "tax-payers" money, and are tax payers themselves. I don't have any multiple birth children, but have had 4 single birth babies, 2 which we've lost, and trying one more time for a healthy baby. I am now on a "ovulation stimulator" fertility drug, and I (probably like most other women on fertility treatments) just want a healthy baby, and if God happens to bless us with more than one, so be it. ALL babies are Gods work. Some women are just fortunate to be fertile. How many of the people that have written that think society should have a roll in this, have infertility problems--probably very few!! To all of the multiples...God Bless you, what a miracle. It's sad to know that some day, most of these "miracles" will be paying the taxes and social security on these "simple minded" people that are complaning about paying for them now.
Signed: Hoping to soon be mom of any amount of babies God will bless me with!
Date: Tue, Jul 10, 2001 1:11 PM From: jennifer@mplaw.org To: DoktorMo@aol.com
I had to laugh at the person who ranted about tax payers paying for the children that result from multiple birth pregnancies. I thought it was common knowledge that in almost every case, multiple births of triplets or more are a result of fertility treatments. Having just completed a round of in vitro fertilization and (joyfully) expecting twins in December, I KNOW how much those treatments cost and I am fairly certain that people who are too poor to support their children certainly could NOT afford these kinds of infertility treatments.
This is my body, not the rest of the world's, and if we had found that we had a litter of children rather than just two, it would be no one's business but mine and my husband's what we decided to do about it, if anything.
Date: Sat, Jul 7, 2001 1:24 PM From: caroline.cooke@btinternet.com To: DoktorMo@aol.com
I live in the UK and after a perfectly normal conceived pregnancy in 1988 had my first child.However after trying for a second for several months I was put on a daily fertility injection called METRODIN which produced Quadruplets.Although this came as a bit of a shock after being told I would only have one child, I carried on with the pregnancy well and in 1993 gave birth to healthy babies.I would also like to take the opportunity to reply to one of your recent replies which is that I have never received any financial help what so ever, and even though my Quads are celebrities in my area we have never been offered any help and we wouldnt accept it anyway. We were given the choice to have all four and we have to live with the financial difficulties, we are blessed to have such healthy children however we conceive.
Date: Sun, Jun 17, 2001 5:55 PM From: JulieWinslow@msn.com To: DoktorMo@aol.com
I have to assume that if a couple has made the decision to have a child and received help to conceive one ( or more), they are willing to accept the challenge of multiple children. I feel decisions on the number of children a person can have at one time will vary from person to person. That decision needs to be made between the family and the doctor. I couldn't imagine a law telling me how many children I could carry in my body or how many I could take home from the hospital after completing 40 weeks of gestation. This article discuses a family having trouble conceiving children and getting help. If they wind up with 4 fetuses growing well and will accept the challenge, they should be supported by society.
Date: Tue, Apr 3, 2001 6:29 PM From: tcbfry@charlo.net To: DoktorMo@aol.com
My question is what if I WANT multiples? I want more than 1 child but after my first pregnancy I don't think I could do it again. I was hospitalized 13 times and had morning sickness 24 hours a day including migraines that required high powered drugs to control from my 4th month on so my question is, what do you use that has a high percentage for birthing multiples. We have the money, love and room for 2-3 more but cant do it that many times.
Christy
Date: Tue, Feb 6, 2001 8:03 PM From: Kccountryrose@aol.com To: DoktorMo@aol.com
I believe that there should be a regulation on multiple births. Many people can not even have one child and yet here we have people going out and having so many that most times the children are in some way neglected. It is a fact of life that if you can't have a child on your own then you simply find a way o have it created for you. I don't think it is right to add more stress on everyone by trying to increase the number of births in one pregnancy. Thisaffects everyone in society so therefor I think society should have a say in what goes on. It's our tax money that pays for those who can't afford it so we should have SOME say in how it is spent. You can't always get what you want in life so people should learn they need to distinguish between what they want and what they need.
Date: Thu, Feb 1, 2001 5:04 PM From: tmoeckel@usd239.org To: DoktorMo@aol.com
When the issue is with someone far away it seems like the a miracle. But, if the person was in a group insurance plan that I belonged to my attitude may change. Society, at this point, seems to come to the rescue for these births with donations of physical item and money. Limiting the number of children by aborting some of the fetus would be something that I would not agree with. This is the risk that is being taken for the chance to have a child with out adopting. I think the decisions has already been made, if we are allowing the use of these fertility drugs, then to be fully responsible, allowing the multiple births must continue.
Terry Moeckel
Date: Sun, Jan 28, 2001 11:46 PM From: MMUGNA@DADA.IT To: DoktorMo@aol.com
We are Italian students and we think that our society should not have a relevant role in regulating multiple fetal births because men and women (parents) should not decide the destiny of another person who is not able to defend himself. Only God should decide what it is best for us.
Date: Mon, Dec 4, 2000 4:05 PM From: chickn@email.msn.com To: DoktorMo@aol.com
I feel that society should not have a role in regulating multiple fetal births. It is a personal decision. For those who feel it is Gods right to decide ( and I am a Christian) let me say this, who do you think made all of this possible, all of the fertility medication and methods? God, that's who. If one decides to selectively abort, that is that persons decision, and should be no one else's. NO one should be called a sinner, for we are all sinners and no one sin is greater than the other. Also, the bible says that we should not judge one another, only God should judge. Society should let a person judge for themselves what is right for them and what they feel is right. This is America, we have the freedom of speech and the freedom of choice, and no one should take that away.
Date: Wed, Nov 15, 2000 2:10 PM From: emilydiamond@avenew.com To: DoktorMo@aol.com
Absolutely. America becomes so busy raising money and collecting toys for those babies but they don't even think about the other mothers out there that have that many children if not more. Some people adopt or just have the children in a natural way. Yet they get no recognition for their wonderful commitment to parenting. The government also sees this birth as a miracle while they call a mother who had seven children, one every year for seven years irresponsible! All that Bobbi did was put herself and each of her seven babies in incredible danger for their lives. They were lucky enough not to loose any of their babies, but most people are not so lucky. Society should not waste their time trying to help the careless. They should spend their time on someone more thoughtful.
Date" Sat, Oct 28, 2000 1:48 PM From: Kristinz4@cs.com To: DoktorMo@aol.com
I realize you were merely wanting to discuss the ethical issues regarding high order multiples, but I thought you might be interested in the article below, this is exactly what I was trying to say in my post to you a few months ago, I'm glad that someone is finally looking into this! Maybe the question should be "Who should be paying for these infertility procedures?". Is it a person's "right" to receive medical coverage for these procedures? I believe so, but I doubt that a person who can conceive "naturally" would feel this way. I would think that there could be a sort of happy compromise, like a limitation in the number of procedures that would be covered. Hopefully this will become a national priority considering the increasing rate of high order multiples.
Sincerely, Kristin Smith
Friday 27 October 2000 'Outdated' fertility drugs not worth the risk: expert Sharon Kirkey, with files from Joanne Laucius The Ottawa Citizen SAN DIEGO -- The most common form of fertility treatment in the world should be all but abandoned because of the risk of multiple births, a leading infertility expert says. Super-ovulation drugs that force a woman's ovaries to churn out far more eggs than her body ever could produce naturally are the most common cause of "high-order" multiple births -- triplets, quadruplets and more -- Dr. Norbert Gleicher, of Chicago's Center for Human Reproduction, said yesterday at a gathering of reproductive experts. Yet the standard tests used to determine how a woman is responding to the drugs are "basically worthless" at predicting whether she's at risk of giving birth to three or more babies, he said. "It's probably time to say good-bye (to the fertility drugs) and move those patients over to IVF," Dr. Gleicher told reporters after a panel discussion on ways to reduce multiple births. His comments shocked other physicians. "It's a radical departure" from standard fertility practice, said Dr. Steve Ory, chair of the American Society of Reproductive Medicine's practice committee. "It's going to come as a surprise to most of the medical community." Fertility doctors around the world are grappling with the consequence of assisted conception -- a dramatic rise in the number of multiple birth babies. In Canada, there were approximately 8,700 multiple births in 1997. That's up from 6,200 births in 1977. In the U.S., the number of multiple births involving triplets or more soared 400 per cent between 1980 and 1997. The increase is a huge concern because of the risk to the mother and child. Babies born in multiple deliveries are born earlier and smaller than single-birth babies, they're less likely to survive their first year of life and are far more likely to suffer long-term disability when they do survive, says a recent report by the U.S. department of Health and Human Services. The Parents of Multiple Births Association of Canada has urged doctors to warn fertility patients of the potential problems associated with premature and multiple births before the patient undergoes fertility treatment. "There should be a full expose of what could go wrong if you have quadruplets," said Lynda Haddon, a past president of the association and mother of twins who offers bereavement support to parents who lose one or more children of a multiple birth. "Success does not mean pregnancy. It means the baby grows to be a healthy adult person," she said. Women undergoing fertility treatment are often starry-eyed at the possibility of two, three or more babies, said Ms. Haddon. But 90 per cent of triplets, quadruplets and quintuplets are born early, leading to a greater chance of disabilities including vision, hearing and respiratory problems. "People who really want a child have a fantasy," said Ms. Haddon. "They don't realize that the children could be premature, and they could have anomalies." Critics have pegged the blame on sophisticated new baby-making technologies such as in vitro fertilization, which involves collecting eggs from a woman, mixing them with her partner's sperm and transferring the resulting embryos into her uterus. Until recently, doctors have routinely put in three, four or more embryos to increase the odds that at least one would implant and a baby would result. Experts heard yesterday how a relatively new technique that allows embryos to be incubated in the lab for five days instead of the usual three before being transferred into the woman can dramatically lower the multiple birth rate while actually increasing a woman's shot at getting pregnant. Growing embryos to "blastocyst" stage gives doctors more time to determine which embryos are the healthiest and more likely to implant. Blastocyst transfer could one day lead to doctors transferring no more than two, and even one embryo, during every attempt at in vitro fertilization. But Dr. Gleicher, of Chicago, says in vitro fertilization isn't driving the explosion in multiple births. "Old-fashioned" fertility treatments are. In fact, 80 per cent of multiple births are due to the powerful drugs that stimulate ovulation induction. Two years ago, a Houston woman gave birth to the world's first octuplets after taking fertility drugs. At one point in her pregnancy, she had to be suspended nearly upside down in a hospital bed to relieve the pressure on her expanding belly. Seven of the babies survived. Just this month, the fourth of eight babies born to an Italian woman in September after she took fertility drugs died. And in 1996, a British woman who took fertility drugs attempted to carry all eight of the resulting fetuses to term despite warnings from her doctor. None of the babies survived. In Ottawa, the Forgie quintuplets were born after their mother took even a low dose of fertility drugs. The most common fertility drugs are gonadotropins, naturally occurring hormones that the brain produces to stimulate the ovaries to produce hormones and prepare eggs for release. The drugs bypass a woman's normal process of egg development and release and induces ovulation in women who don't ovulate on their own. The problem, Dr. Gleicher said, is that doctors and patients have no control over how many eggs end up being fertilized after insemination. With in vitro fertilization, "we can decide how many embryos to transfer," he said. "We exert some control" over the process. His team reviewed more than 4,000 cycles of treatment using fertility drugs followed in most cases by artificial insemination. They found that blood tests and ultrasound examinations used to monitor the development of egg follicles weren't reliable at predicting the risk of a multiple pregnancy, he said. Lowering the drug levels could reduce the risk of multiple births, but it would also significantly lower overall pregnancy rates as well, he said. "The whole treatment then becomes very inefficient." "The treatment we use most today is probably outdated considering where we are" with in vitro fertilization, Dr. Gleicher concluded. Although he said doctors shouldn't "completely throw out" super-ovulating drugs, the number of patients who should get them "is very, very small." He said younger women, those under 30 who tend to produce lots of eggs after fertility treatment, should instead use in vitro fertilization. So too should older women "who have very little time left" to get pregnant, he said. "It's logical to use the most efficient treatment, and IVF gives us two-and-a- half to three times the pregnant rate of ovulation induction" per attempt in these women. But Dr. Ory, of the American Society of Reproductive Medicine, said the sheer cost of IVF makes it an option many couples can't simply afford. IVF can cost four to six times what it costs a woman to take fertility drugs alone, he said. And many doctors believe more research needs to be done before they can completely rule out ultrasound in predicting risk for multiple pregnancies, he said.
Date: Sat, Oct 14, 2000 10:22 PM From: latonia28@juno.com To: DoktorMo@aol.com
I do not belive that society has the right to make a decision about the actually aspect of multiple fetal births. This is a decision that is so private and personal, and only a couple and there doctor should be involved in that decision. But I feel that what is bothering society the most is that these couple seem to get more support then other couples who have single or double births. I feel that if that couple has the money to participate in a fertility program , and know that multiple births are a possibility,and that they can't make a decision to eliminate any of the fetuses,then they should be responsible for the care of those newborns. It is not fair that these couples receive so much support from various companies to assist their every need. There are so many mothers and fathers who need that same support and do no get it ,worst it is not even offered. I believe that children are a blessing, one blessing is still as special as multiple blessings. And this is what I feel seems to make the public outraged. I know that it is not possible for these companies to contribute to everyone who needs there assistance but they could do a better job. And what is more upsetting these companies are just doing it for the media and public attention,what every it takes to get their name out there and it's probably tax deductible. No business is going to do anything that is really FREE, it is all about the money.
Date: Sun, Oct 8, 20000 9:46 AM From: rennia.bybee@home.com To: DoktorMo@aol.com
I am so tired of hearing that " If God wanted you to be able to have children then he would of made it possible for you to do it naturally with out the help of fertility drugs" I've have noticed though that the people saying these things are the people who don't have a clue about what it feels like to not be able to have children. So who are they to tell people like me that we are going against God because we want to be able to love a child of our own. Unless you have been in our place then you really have no idea what you are talking about.
As far as multiple births go. If you people did would look at the research you would see that most fertility drugs and invitro fertilizations end up in singleton births. With the occasional twins or triplets. Very rarely do pregnancies of four or more result from these procedures. ( If they happened all the time the the media wouldn't make a big deal out of it when it happens now would they. )
My husband and I are just looking to have a healthy baby of our own. We know about the slim chance of a multiple birth and all of the risks and decisions me may end up facing. But those are our risks and our desisions no one has the right to make them for us. We thank God every day for giving us the strength ( And our doctor the skills and knowledge) to see us through this.
Date: Sun, Jul 30, 2000 1:45 PM From: Kristinz4@cs.com To: DoktorMo@aol.com
First of all, it is a ridiculous argument to say that people who seek infertility treatments are going against God's will. If that is true then that means that any medical intervention from treating diabetes to immunizations is going against God's plan to control population. Don't you think that God gives us (at least some of us) the intelligence needed to improve health and living conditions of mankind? This ridiculous argument concludes that all doctors and scientists must be working for Satan.
Secondly, as a mother of triplets I do admit that having higher order multiples has been a financial and physical strain, but I would do it again in a heartbeat! The vast majority of triplets, even when premature, grow into healthy children!
Lastly, I would like to comment that the majority of pregnancies that result from infertility treatments consist of only ONE baby. The pregnancies that result in most of these very large multiple pregnancies (quintuplets, sextuplets, septuplets, etc) are usually conceived by using highly powerful ovulation inducing drugs which are extremely difficult to control. Most infertility specialists have much better control with assisted reproductive technology which includes invitro fertilization (IVF). However, most insurance companies do not cover IVF which can run around $10,000, so couples are faced with the much more affordable option of doing a cycle of the ovulation inducing drugs which runs about $2000, thus increasing the risk of higher order multiple births. If only insurance companies would weigh the cost of an IVF cycle (even several IVF cycles) compared to the millions of dollars required for a very high multiple pregnancy which they do have to cover.
In conclusion, my suggestion is more insurance coverage for less risky and better controlled infertility procedures. Prevention of these terribly high risk pregnancies should be our biggest priority. No mother should have to face the extraorindarily difficult decision of selective reduction.
Date: Tue, Jun 13, 2000 10:02 AM From: smrnlv@gateway.net To: DoktorMo@aol.com
Society should definitely have a role in regards to multiple births! We pay for these kids, we build the family houses and supply them with life long diaper services and basically reward these folks for their selfishness! I can see these kids being supplied with any toy, computer, etc. for the rest of their lives due to their 'celebrity'. I think I have even heard that they are guaranteed college funds by some business.
I think of the struggles of raising my own 2 kids. We were never assisted by society. We were limited to 2 children, as that was all we could feed and clothe! My son will be going to college next year, and we will be either working another job or assuming more debt for a loan in order to send him. He is a good kid, has never been in trouble and that is the best that he can get. Sure, he can get partial scholarships; wish he could have gotten a full one! But he will not be rewarded because his parents could only have kids one at a time and pay for them themselves.
There is also something to be said about the ability to have children. Some people cannot. Perhaps it is a built in population control by nature. There are plenty of children that need families! So, science has enabled people to conceive when their bodies physically cannot by normal means. Will science now make me a champion figure skater, because I demand it? Will society pay for my ice time and world famous skating coaches? Will they supply me with sequin encrusted tutus for my skating career? Will they pay for the operation on my brain, bestowing me with the talent and the reorganization of my muscles, so that I may tolerate skating? Yes, the above sounds crazy, but that is what multiple births are. I am a pediatric nurse and I see these kids when they are older with their g-tubes and their weak lungs, suseptible to any bug that comes down the pike. When we intubate these kids and put them at further risk of illness, doesn't anyone feel responsible for this? We pay for this. We make these children suffer and suffer, all because their parents had a right to have children. Thanks for listening.
Date: Sun, Apr 30, 2000 2:48 PM From: xqz@hotmail.com To: DoktorMo@aol.com
New technological advances constantly bring forward new ethical dilemmas such as what is the case in the assisted reproduction field. The role of the medical profession and the society in general is of course not to interfere with or to regulate individual decision-making; it is to highly publicize the pros and cons of the new technology so that better informed and more cautiously meditated decisions could ensue. It is inappropriate for the society to dictate what is right and what is wrong, but it sure should not keep its mouth shut in terms of what is better and what is worse. Most people outside the medical profession derive their knowledge and understanding through advocacy and education. If they are totally left on their own to make blindfolded decisions, it is then not the freedom of choice but the irresponsibility out of ignorance. In the case of multiple births, it defies the mode endorsed by natural selection and will potentially pose high stress and various disadvantages to both parents and offspring biologically, financially and functionally. So it should not really be promoted as a standard or even preferred method in assisted reproduction. If the prospective parents choose to pursue this option, no one can and should prevent them, however, it has to be made clear to them that it may not be a wise choice, given current conditions.
Date: Fri, Mar 24, 2000 1:38 PM From: mkbledsoe@hotmail.com To: DoktorMo@aol.com
In regulating multiple fetal births, it seems that society is attempting to play the role of God in deciding who has the right to live and who does not. God intended for diversity in the human race. Genetic defects as a result of multiple fetal births are a part of this diversity. In fact, there have been many noted instances where there was a multiple fetal birth, and all children survived and were healthy. This is even supported by the previous response of the registered nurse. I also work in the birthplace of a hospital as a volunteer and seen a case of multiple births turn out very well. I therefore believe no one, including the court or society as a whole, should have the right to allow certain children in multiple fetal births to be aborted.
Date: Fri, Mar 24, 2000 9:15 AM From: Mrscfromsta@netscape.net To: DoktorMo@aol.com
I do not believe so, each child should have an equal chance for survival and should not be chosen by mother or doctor.
Date: Tue, Mar 21, 2000 11:13 PM From: cinefacta@hotmail.com To: DoktorMo@aol.com
As a means of population control, regulating multiple births would be a logical place to start. It would be so easy-- when a doctor diagnosed more than one fetus developing in the womb, he could perform a short easy elimination of the fetus (or plural) he chose. It could be standard procedure. However this is unthinkable in the modern US, land of the free and the American dream--which includes children and a lot of room to lay down roots-- and is morally repugnant as well. Plus, the US is not exactly at the point where it needs to implement population control programs. Even in China, where couples are encouraged and bribed by government benefits to only have one child, the choice is left to the parents. I'm not sure how 'society' is being defined on this website, but government regulation of multiple births, unless it were a regulation which provided a mortgage and diaper service for the overwhelmed parents, has absolutely no place in American democracy. I am staunchly pro-choice, and would support a mother's decision to selectively eliminate fetuses to provide a chance for better health for the remaining fetuses, but neither should it be the mother's obligation to do so. What is growing in a woman's womb is the responsibility of the mother, not society (and I am speaking in the cases of typical, healthy women, not child-beaters/molesters/drug addicts or the like).
Date: Tue, Mar 21, 2000 4:49 PM From: jkbyrd13@hotmail.com To: DoktorMo@aol.com
I believe that it is a wonderful thing that we can now help the infertile have children. However, it is a sad thing that it has become a circus lately when a couple has an abnormal number of children. I believe that we should possibly impose restrictions on the amount of fertility drugs that can be given to a couple (if it is possible to do so and still improve chances of conceiving) so that these great numbers of babies are not born at once. Because we as humans were not meant to give birth to large numbers at a single time, the chance for survival for these babies is lowered when such a thing happens. Also, it is probably very difficult for the parents to take care of so many children of the same age. However, I do not believe that we have the right to selectively abort children in cases of multiple births. We should do all that we can to help them survive outside the mother, and those that are meant to live will live.
I definitely agree that the couples taking the fertility drugs would be among the most loving parents, and I believe that society has no business telling them that they can only have a set number of children.
Ken Byrd
Date: Sun, Mar 19, 2000 8:49 PM From: Jdtaylor20@aol.com To: DoktorMo@aol.com
I see this as being an issue that should be handled by the family and physician after the particular situation is discussed. These situations vary from one family to the next. Under these circumstances, it is impossible to allow society to form a general regulation on whether multiple fetal births should be allowed. I have heard of numerous instances where multiple fetal births occurred, and all newborns survived and were healthy. It is a fact that newborn survival rates decrease with multiple births. Yet, it must be left to the family, not society or the court, to decide whether their moral feeling about abortion should take priority over the health and survival of their children.
-Jon Taylor, Univ. of South Carolina
Date: Sun, Mar 19, 2000 4:47 PM From: amhames@hotmail.com To: DoktorMo@aol.com
We are very fortunate to life in a society that allows for breakthrough medical technology as amazing as assisted reproductions. However, progress is almost always complicated by problems such as this. It is wonderful that couples hoping to start a family can do so even if nature dictates otherwise. At the same time, it poses some significany societal risks. The "burden" of multiple births on the families which receive them are nonexistent. They may suffer a bit financially or make several sacrifices in daily life. However, these are the same people who desperately sought after life after nature told them it was not possible to create it. In the context of society, multiple births could lead to long term problems. Genetically, there will obviously be problems according to Darwin's "Survival of the Fittest" theory. Also, the threat of overpopulation is a major concern today. However, the actual occurence of these multiple fetal births is relatively small, comparitively speaking, and will not have an overwhelming effect on either of these societal concerns in time in the near future. I think doctors should be able to guide their patients in ways that will be most conducive to their health. They must council them on the possiblilities and risks involved in assisted reproduction. However, I feel that it is wrong to destroy a life, intentionally created, in order to help its siblings. What if your parents, during hard times, decided that though they wanted you at one time in their lives you were now a "burden"? Would you want them to blatantly diregard the life they had created to make life a little more convenient and comfortable for them?
Date: Sat, Mar 18, 2000 9:39 AM From: MayDay913@aol.com To: DoktorMo@aol.com
I don't believe that society should be involved in the personal matter of births within any family. Multiple fetal births should be no exception, in acquired naturally. When the multiple births are engineered in the laboratory, society should still not be involved, but there is more room for ethical dilemmas when this doesn occur. In the case of Bobbi and Kenny McCaughey's septuplets, it happened naturally, and things are working out well. There are serious complications, as I am sure we are all aware, that can arise when there is more than one fetus attempting to survive within the mother's womb. However, this too is a concern for doctor and patient, not society. Decisions of selective abortion for the sake of other fetuses or for the sake of the mother are very important. Doctors are expected to acknowledge any dilemma that arises, and they are to offer their expertise in determining what the patient's should do. In no way should society be in charge of regulating these happy births. It is a personal/family matter. When the discussion of engineered multiple births arises, there is an enormous gray area in which complication is evident. I believe, as long as in-vitro, etc. continues that parents should be able to decide how many attempts are made. With this occurring, it might be helpful to have a pre-set number within the couple as to how many fetuses they will attempt to keep alive after successful fertilization. But again it is an intimate decision-not spanning society's realms. In the large spectrum of birth/pregnancy (I do not know the exact figures), multiple septuplet births are rare. So as for the societal strain this might cause, I see none. The McCaughey's situation brought smiles and happiness to so many faces and families. It also produced unity throughout the nation in many aspects. Healthy for a society, if you ask me.
Date: Fri, Feb 11, 2000 10:49 AM From: dcmay@junct.com To: DoktorMo@aol.com
What an interesting question. I also read many interesting answers. I humbly offer my own opinion. The multiple births I have witnessed as a labor and delivery nurse, whether artificially induced or not, have been joyous occasions for loving, caring families. These babies survived despite the odds, this can be said of single births also, and so why should society or anyone say who should live and who should die. Despite the politically correct term 'selective reduction' it still adds up to murder. So, enough said, we have no right to kill any of these babies. Thanks,
C. J.
Date: Wed, Feb 2, 2000 5:40 PM From: pyunb@csv.warwick.ac.uk To: DoktorMo@aol.com
If these multiple births are the result of medical assisstance to naturally infertile couples, or couples having genetic complications with conventional reproduction, then we are producing such evolutionary pressures that we face the exitinction of the naturally reproducing homo sapien. It is survival of those most effective at reproducing as the proportion of organism possessing their genes will become highest in a population.
Date: Wed, Jun 2, 1999 7:55 PM From: Nanie3690@aol.com To: DoktorMo@aol.com
Society as a whole should not have a role in regulating multiple births. If the multiples occur thru a natural process (i.e no fertility drugs or other such methods used), than total autonamy should be given to the mother and/or father whether there will be any selective abortions. Dangers to the fetus' and the mother alike should be well conveyed to the parties involved; any and all decisions should be made by the mother and/or father in conjunction with the doctor. Nature is still an ever-present force, if an egg should spontaneously divide and " multiple " situation arise, decisions should be made by only parties involved, not society.
However, I'm assuming you are talking about fertility/biomedically engineered multiple's. In this case, still society should not be involved. Who should be involved?...the doctors who are aiding in the process. Be it the doctor who is dosing the fertility drugs, or the fertility clinic who is preforming the egg inplantations. During inplantations generally many many eggs are used with the hope that one or two will " make it ", as we've seen lately such is not the case. In using fertility drugs, on the first sign of multiple's it should be made clear to the parties involved that human beings are not meant to, and never have birthed liters.
The controls for regulating multiple births has nothing to do with society. Studies have shown that children born as multiples tend to do much better in socialization, and self-gratification; these children tend to go the extra mile to stave off immeadiate self-gratification. That type of behavior does not pose a threat to society, rather it would be welcome. The problem lies in that most multiples, a hand full, develop correctly in respects to health and mental apptitude. There in lies the reason for some sort of control of " engineered " multiple births. Possibly implementing some type of contractual aggrement between parties involved that should multiple births of X number or more be detected, this number X will have to be selectively aborted. And so many of us tend to forget that between black and white there is an enormous gray area. In that I mean that specific parameters could be used to decide upon safety of mother and children alike; i.e first pregnancy, age of mother, health of mother, etc.
Date: Wed, Mar 24, 1999 5:42 PM From: h1073@hopi.dtcc.edu To: DoktorMo@aol.com
I think that the parents should not implant so many eggs because their is that chance of all of the babies to be a success. They should start out with two to four eggs. I believe that it's the parents right to choose if they want to abort any of the embroys. I'm not certain how i feel on the situation where they are given the right to choose which sex should live.Since some parents are implanting such a large number in at a time the should at least understand that if they do not abort some of the embros that all of the babies could die.This is the reason i believe a small number should be implanted at a time.
Date: Wed. Feb 24, 1999 2:26 PM From: grkas@webtv.net To: DoktorMo@aol.com
I DO NOT believe society should have any say so what so ever in the choice of selective reduction. This is obviously a choice that is clearly a hard one to make and should only be between the family and the Dr. I am the proud mother of very Healthy and Happy 11 month old quadruplet girls that are loved very much by their entire family, they are also cherished very much by their older brothers 11, and 13, We couldnt be happier, however selective reduction was not a choice for us, yes we were told about this option but we never considered it.
Date: Wed, Feb 10, 1999 3:28 PM From: hammonsdc@socket.net To: DoktorMo@aol.com
I do not feel that society should play any type of role in regulating multiple births. I feel as though that is between the doctor and the patient. I am currently undergoing intensive treatment for IVF and my husband and I know the risks that go along with the procedure. I don't think anyone could possibly understand the frustrations of not being able to conceive naturally unless they have experienced it first hand. I personally feel that God will be using my doctor as tool when I go in for the IVF procedure and no one could make me ever think otherwise.
Part of the problem with couples having multiples is the insurance companies. They are the reason that people are so desperate that they want several embryos transferred. Insurance companies don't want to cover infertility procedures, especially assisted reproductive procedures. The assisted procedures are their only chance for conceiving and if most people are like myself, can only afford one procedure therefore taking a risk of having more than one baby. So if you want someone to blame for multiple births, blame it on the insurance companies who squirm when they hear the word "infertility". Don't blame the infertile couples who just want to have a family and have to mortgage their homes or take out high loans for a one time procedure that makes them so desperate that it doesn't matter how many babies they have. The babies that are born to infertile couples are the most wanted children in the world.
If you want to worry about the well being of children, worry about the children who are born to the people who don't want them, the children who are beaten and neglected everyday.
Cherie M.
Date: Sat, Jan 2, 1999 5:16 PM From: patbob@elkhart.net To:DoktorMo@aol.com
To September 1st.
I am a person who doesn't say alot or reply to articles on the internet. But after reading your response, I couldn't pass up a chance to put my two cents worth in. First, I understand that handling multiple births is a big responsibility. Second, I understand that there are people who do use fertility drugs sometimes( I do mean sometimes) abuse this privilidge to have more than two or three births. Where I have the rub, is the saying about GOD not wanting loving parents to bring his children to earth. I am a father who is going through fertility drugs to have a child that my wife and I have wanted for some time. We feel that the Lord himself has brought us through this process. We understand the complications that go with using fertility drugs and we are prepared to take responsibilty. You can't even experience the feeling of wanting a child and going through the process to concieve one. We feel that the Lord has blessed us with the opportunity. Unil you have walked a mile in our footsteps, please reconsider what you have written.
Date: Tue, Dec 15, 1998 9:36 PM From: katebehm@yahoo.com To: DoktorMo@aol.com
I don't believe that society should have any say over multiple births. I am 24 years old and am infertile. After trying to have a baby for two years I was told that I had a disease called Polycystic Ovarian Syndrome. Because of this I will never be able to have children through natural means. After I was diagnosed my husband and I had many disuddions about fertility drungs and multiple births. Three years ago we decided to risk it and I am very happy to say that I now have a beautiful 2 1/2 year old son that I love and adore. But, we would still like to have one more child. I am currently on my thrid month of Clomid and have not gotten pregnant. I am now faced with the option of higher doage of drugs or to try new drugs. This is a decision that only my family can make. It would not be fair to have the government or the general population to tell me that I can not go on. Infertility is something that is very hard to cope with. Even with drugs it is still a miracle to actually conceive a child. Unless you have walk a mile in my shoes and know what it is like to see your friends with babies and know that you can never have this, you can judge those of us who are infertile for wanting to take the risk of being blessed with children.
Date: Sat, Nov 21, 1998 12:33 PM From: jmeichtr@popmail.lmu.edu To: DoktorMo@aol.com
Hi,
I just wanted to respond that no one can make a human. It is God that creats us. Even if people do use fertility drugs to help the process there is no way they 'create' a person. They cannot construct the intricucies of the eye and how it sees, the brain and how it works, blood and how it brings nutrients to the body, etc. Only God can create these things. A human is a human because God made them. They are made in the image of God. God knew them before God knit them in their mothers womb. God predestined us before we were conceived and knows every day of our life - and has given life to us. I personally think it is great that couples can use the assistance of medicine to have babies. One point I would like to make is that if there are multiple fetus the couple has a responsiblity to these little humans [babies] to birth them so they can have life. Removing them before birth is killing them.
Sincerely, jan
Date: Fri, Nov 20, 1998 5:23 PM From: jkruse@inetdirect.net To: DoktorMo@aol.com
I think that there is no need to regulate the presence of multiple births. While they are fascinating to some, they tend to also create a strong bond between the multiples, their parents, and those who are close to them. Every baby should be given a chance, even if they were no naturally created!
Date: Tue, Sep 1, 1998 9:11 AM From: KRomas555@aol.com To: DoktorMo@aol.com
I would like to voice my opinion on the multiple birth issue.
I have triplets. They are identical girls and were concieved naturally, without the use of fertility drugs or treatments. I am a fraternal twin. I also have two boys who are seven and nine.
I know firsthand how hard it is to raise just one baby at a time, let alone three. We are coping, all my children are happy and healthy, with no disabilities.
However, this can not be said for many multiples, and therein lies the rub. I do not believe that a woman should use artificial means to have children. These women who use the drugs and doctors to have twins or higher are just playing God, and the children often pay the price. Many multiples suffer from things such as hearing loss, eye problems, cerebral palsy, mental retardation, the list goes on.
I know that some might say that any child can be afflicted with these problems, but multiples have a much higher chance of suffering from life-long medical problems than singletons.
I also think that women who use the drugs and treatments should not say that God gave them their children. They made them in the lab themselves. If God had chosen to give them children, they would already have had them. Many women who resort to medically-assisted gestations SEEM to be deeply religious, but in truth, if they were, they would not have done what they did. It seems to me that by using artificial means to get pregnant, you are telling God that He made a mistake, and you will correct it, therefore, you are mightier than God.
Date: Wed, Aug 5, 1998 11:31 PM From: pjwhite@telusplanet.net To: DoktorMo@aol.com
I don't think anyone except God has a right to regulate multiple births. Even though fertility drugs and other fertility aids (such as IVF) raises the chance of multiple births, it is still a miracle. I know it can be dangerous to both mother and babies, but families that end up with many babies at one time need support.
Patricia White
Date: Sat, May 30, 1998 11:22 AM From: "fleurant@cybertours.com"@cybertours.com To: DoktorMo@aol.com
In my personal opinion I do not feel that society has the right to intervene in any couple's personal decisions, especially those that involve important matters, such as children.
Date: Wed, Mar 18, 1998 11:29 AM From: samiller@ehc.edu To: DoktorMo@aol.com
Assisted reproduction has definately raised new ethical questions which must be addressed. I do not feel that society should play a role in making decisions about multiple fetal births. The decision to reduce a multiple pregnancy or to continue the full pregnancy should be that of the parents and the doctors, not society. Although multiple fetal births do pose difficult dilemmas, it is the responsibilty of the parents and the doctors to discuss the situation and make an educated decision that will be best for the infants and the parents. With advanced technology, parents and doctors are increasingly being placed in the position to "play" God. Now that the technology is available, there is no turning back. Technology marches on, leaving pending ethical dilemmas. Technology has made life and death decisions mighty tricky!
Sarah Alice Miller, E&H Box 159, P.O. Box 9001, Emory, VA 24327-9001, Phone:(540)944-6526
Date: Thu, Feb 26, 1998 4:04 PM From: rachael25@hotmail.com To: DoktorMo@aol.com
My thoughts on this subject are simple. Multiple births are not to be desired. They leave most babies premature, making birth defects or disabilities much more likely. They put the parents in the unhappy position of having to choose between reduction and the possible loss of all the babies. And when they are born, multiple birth babies place an enormous strain on the mothers and fathers...of course, it does depend on how many babies you have at once, but the fact remains that to have more than one baby is much harder. However, I do not feel it is society's right to intervene. Too many parents want babies desperately. It is not fair to stop all fertility treatments for everyone just because some people have multiple births. If you did that you could argue that every person in one room should be punished because one of the people did something bad. Therefore, my solution is to make fertility counseling much more thorough. This means that parents should know all the problems with multiple births. Also, doctors should not be allowed to give so much of a fertility drug that it makes the woman release seven eggs. And finally, it should be that only three eggs can be implanted during the In-vitro Fertilization process. Such restrictions, while not completely stopping the problem, would at least stop the growth of multiple births and perhaps make them become more rare.
-Rachel
Date: Thu, Jan 8, 1998 11:54 AM From: kellyc99@hotmail.com To: DoktorMo@aol.com
No, I don't think society should, in any way, have a say in the regulations of multiple births. If the parents feel they can successfully raise a family of more than three children then they should be allowed to. Society doesn't comment on any other couples pregnancies, then why should they have something to say against couples who have, for so long, been trying to have a child and now have finallyl become successful? The fact that there will be three or more babies born doesn't have anything to do with them and so why should they have a say in the regulations of multiple births? Again, if the couple feels that they are ready for a family and believe that they can do a good job then they should be allowed to, without others determing the outcome of their children's lives.
Date: Wed, Jan 7, 1998 6:40 PM From: Asis45@aol.com To: DoktorMo@aol.comj
I am studying about reproductive technologies in my bioethics class now. I do not think that people should have sooo many options for having children. I think that if the person was meant to have children, that God would have made it that way. I am sure that it is a very sad and stressful situation to be in, but that is the way it happened. Doctors should not provide assisted reproduction to people that would cause them to have "litters" of children. Only animals are meant to have litters of children. Humans are not built for it. Take any person who has had more than three children at one time for an example. The mother can become very sick and unable to do things during her pregnancy. If the mother gets too sick, selective reduction may be recommended by the physician. Is that really the right thing to do? the mother took the chance in having more than one embryos with the possibility of growing implanted. An innocent life should not have to suffer the consequences. If the mother does decide to go through with selective reduction, how will it effect her? If I was in her situation, I would always wonder what the child would look like and what it would act like. On the other hand, if the mother does go full term without selective reduction, one or more of the children, when born, can become very sick and die. A lot of multiple births will have a long term effect on the society. There are already hardly enough jobs available to todays socity. HOw will there be enough jobs for double or triple the amount of people. Will there be enough housing, food, jobs, and enough room in schools for all the children? I don't think that society will be able to handle it. It is something that is very hard to decide what is right and what is wrong. That is why i believe that nature should never have been messed with. People should not play God. Although i do not agree with this, i do believe that it should stay between the parents and the doctor. I do not think that the pregnancy of the mother should be spread all over the news and the babies born shouldnt be filmed from the second they are born and watched over like eagles. So, no i do not believe that society should be involved in regulating multiple births.
Date: Wed, Dec 31, 1997 12:26 AM From: robinsnest6kids@webtv.net To: DoktorMo@aol.com
I'm not a physician but I do encounter women in this position almost on a daily basis. I'm a counselor for expectant/new mothers (parents) of multiples. I really don't think that society, in general, should or could have a choice in this matter. Yes, these children could end up being supported by the "tax-payers" but these chances aren't really higher than any other large family. If interested parties wish to voluntarily take part in the financial, emotional or physical support of these families then they should be encouraged to do so but no one is forcing people to "help" if they choose not to. The families who seek out specialist in the field of infertility are usually quite "desperate" people. People looking for that, perhaps, last chance at a biological family. They should be counseled in great length and explained of the realistic risks involved and the true chances of having "more than one". However, the vast majority of these families ignore these words of caution and are often willing to accept anything providing they indeed get pregnant. Some go into the process realizing they may conceive twins but very few of them think much beyond that. (And the truth of the matter still remains that actually very FEW really even conceive, much less, carry through to viable birth, two or more babies at once. What makes the news and what gets public reaction is only the very rare exception to the rule.) I know several infertility specialist and I don't think any of them have ever had a case of more than 4 fetuses and all of them counsel their patients about selective reduction even with only triplets - which, in my opinion is too extreme. Once a pregnancy is "in tact" I personnally feel the choice should NO longer be that of the physician much less that of the public but only should remain and remain alone with the parents. They should be offered (even strongly advised) to receive counseling to help them make the right choice for them as a family and the health of the mother. It takes courage like no other to be able to make a choice like the McCaughey family made and luckily so very few families are in such an extreme position to have to make such a choice. I look up to these people and encourage them however I can. They love their children and that should be admired. No one can predict the future and what might be in store for these seven babies or any family of children (I have 6 myself - including twins). And... What about the chances that nature itself played a significant role in the McCaughey pregnancy and other "higher-order multiple" pregnancies?? If a woman's body is not capable of being pregnant with multiples then her body will not allow it to continue. The female body was made for only one - what does that fact do to the odds of a body able to accept successfully a multi-fetal pregnancy?? Does anyone know for sure that two or more of the McCaughey babies aren't monozygotic?? That possibility would then have NOTHING to do with the assisted pregnancy!! That is nature pure. I have encountered many of these pregnancies (whether IVF, Clomid or Pergonal - or similar drugs - induced) that result in all or partially monozygotic siblings! I hope I've made a reasonable point.
Thank You, Robin Rabenschlag San Antonio, TX.
Date: Tue, Dec 16, 1997 7:48 PM From: EAKR07F@prodigy.com To: DoktorMo@aol.com
I don't think that the individualistic society in which we live is in any position to take a consistent position on multiple births. If it frowned on them, with the physician as its "operative" tool, consistency would demand that it have similiar positions on births that were ordinally separate, on parental responsibility, on a host of "Brave New World " issues, etc. But the key, and thankfully that for now, is that we live in an individualistic society and I see little evidence that society has some collective notion, conscience, or will, in this regard.
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