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Critical Care ethics series – the ethics of maxiple pregnancies

by Dominic Wilkinson

Quads, Quins, Sexts, Septs, even Octs!

High order multiple pregnancies such as the Suleman octuplets in California generate enormous media attention. However, they also raise some unique ethical questions. In the second of a series of seminars on critical care ethics, the neonatal grand round today looked at ethical questions arising from 'maxiple' pregnancies. These include questions about the normativity of conception decisions, the moral status of fetuses, selective feticide and lifeboat-type dilemmas. Around the time of delivery these pregnancies generate enormous practical and ethical questions for neonatal intensive care relating to their impact on capacity and the potential need to balance claims on intensive care beds between different infants and families.

Here is a copy of today's 
presentation (pdf 4.6MB).

Further reading…

The Suleman Octuplet Case: An Analysis of Multiple Ethical Issues. Women's Health Issues (2010) vol. 20 pp. 260-5

Evans et al. Update on selective reduction. Prenat Diagn (2005) vol. 25 (9) pp. 807-13

Daar. Selective reduction of multiple pregnancy: lifeboat ethics in the womb. Univ Calif Davis Law Rev (1992) vol. 25 (4) pp. 773-843

Pector. Ethical Issues of High-order Multiple Births. Newborn and Infant Nursing Reviews (2005) pp. 8

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1 Comment on this post

  1. What does one taken into account (one can’t really consider all things) when making a decision about whether to have a child or n children; or taking fertility drugs, which often produce many children? Ethics depends, I think, on what we should expect of people who make decisions under particular circumstances. The decision to have a child is probably made without taking much into account, including the happiness of the potential parents. Cf. All Joy and No Fun
    Why parents hate parenting,

    When it comes to decisions about whether to have a child or n children, I doubt anyone considers anything more than (in too few cases) the ultimate caretaker’s ability to support the children. What answers the question “what should I do?” when it comes to making babies? The effects of a single birth of quintuplets on the world is minuscule. The effects on the children to be born is large. Does ethics cover the to-be-born? I think so; indeed, it includes future generations (hence, the ethical content of environmentalism).

    One source for the ethics of child-making is the community in which the parent lives, but the norms accepted generally play no role in the decision to make babies — including using fertility drugs. People who take such drugs are in a highly self-absorbed mode (not too different from the woman conscious of her “biological clock’s ticking”). The can’t be relied upon to take these norms seriously as applicable to herself. One could simply jell the birth norm into a statute but the result would be awful, especially in a free individualistic society.

    In short, this is a situation that no practical ethics can cover except in a totalitarian state — and even then, with difficulty.

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