Chapter 13 : Reproduction: Assistance and Control Issues
|Section 4. Readings|
Author: Arlene Judith Klotzko
Title: Medical Miracle or Medical Mischief? The Saga of the McCaughey Septuplets
Publication Information: Hastings Center Report, Vol. 28, No. 3, 1998, pp. 5-8.
Summary by Nancy Weitzman (QCC, 2004)
The McCaughey family has eight children – their first one, two years old, then septuplets, that is, seven babies – all born alive and healthy. This event, however, is not a wondrous American family tale, it is a story of medical risk and a failure of medical judgment and medical management. The mother, Bobbi McCaughey, was born with a malfunctioning pituitary gland and did not produce enough FSH, a follicle stimulating hormone, to release mature eggs each month. After a year of fertility treatment and no pregnancy, her doctors tried Metrodin, a drug rich in FSH. Mikayla, their first child, was born resulting from this drug therapy. Two years later, they decided to have another child and requested Metrodin immediately. There is some conflict about what followed, but it seems that Bobbi was given a shot of human chorionic gonadatropin, HCG, which helped release her eggs and enable fertilization with her husband’s sperm. Bobbi became pregnant right away and six weeks later an ultrasound revealed she was carrying seven fetuses. This is where a failure of medical judgment, or at least, medical management, seems to have occurred. What are the circumstances where we should allow or even recommend selective reduction? Should this be a recommendation limited to situations of great risk to mother or baby or can its use be discretionary?
The American public and the media focused on “the magnificent seven”, all born within six minutes. Their weight ranged from two pounds, five ounces to three pounds, four ounces. All were placed on ventilators but within two weeks they were breathing on their own.
This birth captured and held the attention of America. The McCaughey’s friends and neighbors in Carlisle, Iowa, showered them with all sorts of gifts, including university scholarships for all the children, years of Pampers, portrait photographs, cable television and the Governor of Iowa actually promised to build them a new and much larger house.
Most Americans believe the McCaugheys faced an inevitable choice between the risks of this multiple pregnancy and what was for this family, as fundamentalist Christians, the morally untenable option of selective abortion.
Here was a very dangerous situation and this multiple pregnancy did not have to happen, and it should not have happened. Good medical practice mandates ultrasound scans for women who have taken fertility drugs in order to monitor the number of eggs they produce. When the scan shows a large number of eggs, in vitro fertilization can be used to fertilize the eggs outside of the mother’s body and then implant a maximum of three embryos in her womb. Had Bobbi McCaughey’s progress and use of fertility drugs been medically managed and monitored, the tests would have revealed her ovaries must have been grossly overstimulated by the Metrodin. Ovarian overstimulation carries dangers of swelling and bleeding of the ovaries and severe fluid retention. In rare cases this can lead to heart failure. In some cases of multiple births, more than three, the children can suffer from strokes, chronic lung disease, mental retardation and blindness.
Shortly after the multiple birth, critical voices on major Sunday news programs discussed the overzealous use of fertility drugs. This medical technology must be carefully monitored and if the medical management has failed, then selective reduction should be used.
Human IVF mostly operates in the private sector and these clinics operate without government regulation. There are guidelines in place, but compliance is voluntary. There are also ethical considerations published by The American Society for Reproductive Medicine in 1994. These clinics, however, have an entrepreneurial atmosphere and a woman wanting to become pregnant will choose the clinic that has the highest pregnancy rate. One way of securing a competitive advantage is to overuse fertility drugs and produce as many pregnancies and as many babies as is feasible. A septuplet birth is viewed by the secular public as the medical state of the art – a miraculous accomplishment orchestrated by unique and talented medical professionals. There are dangers to the mother and the fetuses in a multiple birth, and who is paying for the huge expense of it all? The controversial issues are compelling and should not be overlooked by all the “hype” surrounding the “miracle” of a multiple birth.
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© Copyright Philip A. Pecorino 2002. All Rights reserved.
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