The following is the full transcript of the May 24, 2009 episode of
Ethical Perspectives on the News. I am posting below without editing it
as posted here on their website on 5/28/2009.
I am posting this as a reference to my
5/28 post, which is based on comments recorded in the transcript, should the link later be used to host a transcript for a later show.
Here is information regarding this episode from their website:
Multiple births and fertility clinics
Producer: Cedric Lofdahl
Moderator: Peter Welch
Panel: - Ginny Ryan, MD, Associate, Reproductive Endocrinology and Infertility Dept., UI
- Janine Idziak, Professor of Philosophy, Director of Bioethics Center, Loras College
- Barbara Chadwick, Planned Parenthood of East Central Iowa, Director of Patient Services
Transcript:MULTIPLE BIRTHS AND FERTILITY CLINICS
ANNOUNCER: ETHICAL PERSPECTIVES ON THE NEWS IS PRODUCED BY THE INTER-RELIGIOUS COUNCIL OF LINN COUNTY, WHICH IS SOLELY RESPONSIBLE FOR ITS CONTENT. THE VIEWS AND OPINIONS EXPRESSED ON THIS PROGRAM DO NOT NECESSARILY REFLECT THOSE OF THE STAFF AND MANAGEMENT OF KCRG-TV9.
PETER: GOOD MORNING. WELCOME TO ETHICAL PERSPECTIVES ON THE NEWS. MY NAME IS PETE WELCH AND I’M THE MODERATOR FOR THIS MORNING’S SHOW. IN LINE FOR CURRENT TOPICS AND THINGS THAT HAVE BEEN IN THE NEWSPAPER, THIS MORNING WE WOULD LIKE TO DISCUSS THE ETHICS AND THE TOPIC OF MULTIPLE BIRTHS AND FERTILITY CLINICS. WITH US THIS MORNING FIRST IS PROFESSOR JANINE IDZIAK, WHO IS A PROFESSOR OF PHILOSOPHY AT LORAS COLLEGE IN DUBUQUE AND IS THE DIRECTOR OF THEIR BIOETHICS CENTER. ALSO WITH US IS DR. GINNY RYAN, WHO IS ASSOCIATE IN THE DIVISION OF REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY DEPARTMENT AT THE UNIVERSITY OF IOWA. AND LAST WE HAVE WITH US IS BARBARA CHADWICK WHO IS WITH PLANNED PARENTHOOD OF EAST CENTRAL IOWA. ONE OF THE MOST RECENT STORIES THAT’S BEEN IN THE NEWS IS ABOUT THE OCTOMOM IN CALIFORNIA, AND WHILE THAT PUTS A LOT OF THIS ISSUE INTO A SUSPECT LIGHT, ISN’T THIS ISSUE MORE THAN JUST THAT?
JANINE: WELL, IF YOU’RE DEALING WITH FERTILITY DRUGS ONE CAN ALSO EXPERIENCE THE PHENOMONEN OF MULTI-FETAL PREGNANCIES, SO IT ISN’T JUST LIMITED TO THE CASE OF THE OCTOMOM IN CALIFORNIA. WE CAN THINK OF THE MCCOY SEPTUPLETS SEVERAL YEARS AGO HERE IN IOWA. AND SOME OF THE SAME ETHICAL AND LEGAL QUESTIONS WERE RAISED THERE AS WITH THE OCTOMOM.
PETER: I SEE.
GINNY: I THINK THERE ARE SOME UNIQUE ISSUES WITH THE OCTOMOM IN CALIFORNIA THAT ARE A BIT DIFFERENT FROM THE PREVIOUS VERY HIGH ORDER MULTIPLES LIKE THE MCCOY SEPTUPLETS. THE ACTUAL MEDICAL TREATMENT FOR THE SEPTUPLETS IN THE PAST HAS BEEN HARD TO CONTROL FROM THE STANDPOINT OF THE PHYSICIAN AND SO TO SOME EXTENT THERE’S ONLY SO MUCH THEY COULD CONTROL ABOUT HOW MANY FETUSES ENDED UP BEING CONCEIVED. WHEREAS WITH MISS SULIMAN IN CALIFORNIA, I THINK THE THING THAT MAKES IT PARTICULARLY UPSETTING FOR MOST PEOPLE WHO KNOW ABOUT THE STORY THAT THERE WAS AN ACTUAL SPECIFIC TRANSFER OF MANY MORE EMBRYOS THAN ARE RECOMMENDED BY THE PHYSICIAN. SO A MUCH MORE CONTROLLED SITUATION. SO I THINK THAT MAKES IT EVEN MORE SUSPECT.
JANINE: ALTHOUGH EVEN WITH USING FERTILITY DRUGS IT’S MY UNDERSTANDING THAT THE NUMBER OF OVA THAT MATURE CAN BE MONITORED AND A DECISION CAN BE MADE NOT TO TRY TO ACHIEVE A PREGNANCY IF THERE ARE TOO MANY OVA THAT HAVE MATURED AT A GIVEN TIME PRECISELY TO TRY TO PREVENT THIS PHENOMENA OF MULTI-FETAL PREGNANCY.
GINNY: THAT’S TRUE. TO SOME EXTENT IT’S HARDER TO CONTROL. I BELIEVE IN THE MCCOY SEPTUPLETS SITUATION THEY HAD ONLY FELT LIKE ONLY FOUR MIGHT, DEPENDING ON THE SIZE OF THE FOLLICLE WHEN THEY WERE MONITORING, THEY WERE ACTUALLY FOUR AT THE MOST MAY OVULATE WHERE SEVEN DID, SO I THINK TO SOME EXTENT WHILE SOME CLINICS MAY HAVE STILL CANCELLED HER CYCLE, IT’S A LITTLE BIT HARDER TO CONTROL VERSUS THE ACTUAL IVF AND THE EMBRYO TRANSFER OF SIX EMBRYOS.
PETER: BARBARA, YOUR THOUGHTS?
BARBARA: WELL, THE THOUGHTS THAT COME TO MY MIND ARE CERTAINLY THE TECHNOLOGY OF THIS SCIENCE AS WE MOVE FORWARD WITH THIS ABILITY TO MEET FERTILITY DESIRES OF A FAMILY, OF A WOMAN. BUT WHAT CONCERNS ME IS THE MONITORING OF THIS PRACTICE AND THE STANDARDS OF CARE AND AS A PROFESSION, THE MEDICAL PROFESSION, PHYSICIANS, NURSES AND SO FORTH, AND THE DEFINITION OF A PROFESSION IS MONITORING YOUR OWN PROFESSIONAL STANDARDS AND PRACTICES AND IS THAT IN PLACE? NOT REGULATION OF THE CARE, BUT MONITORING OUR OWN BEST PRACTICES, AND ARE WE DOING THAT IN AN APPROPRIATE, ENFORCEABLE MANNER?
PETER: ONE OF MY THOUGHTS OR QUESTIONS IS, IS ANYBODY AWARE OF, IS THERE AN ACTUAL ETHICAL CONSIDERATION FOR A FERTILITY DOCTOR IN THIS FIELD OR, THAT WOULD SAY IF A MOTHER HAS HAD MULTIPLE BEFORE, OR MANY BIRTHS, IS THERE A STANDARD OUT THERE THAT ANYBODY’S AWARE OF?
JANINE: WELL, THERE ARE DEFINITELY GUIDELINES THAT THE PROFESSIONAL SOCIETY, WHICH IS CALLED THE AMERICAN SOCIETY OF REPRODUCTIVE MEDICINE, THERE’S GUIDELINES OUT THERE. IN THIS SITUATION THERE SHOULD HAVE BEEN A MAXIMUM OF TWO EMBRYOS TRANSFERRED. THOSE GUIDELINES EXIST. MOST CLINICS ARE MEMBERS OF THAT SOCIETY AND AN AFFILIATED MONITORING GROUP CALLED THE SOCIETY FOR ASSISTIVE REPRODUCTIVE TECHNOLOGIES. MEMBERS OF THAT GROUP ARE EXPECTED TO REPORT BACK TO THAT ORGANIZATION WITH THEIR NUMBERS AND THEIR PRACTICES, BUT THEY DON’T HAVE A WHOLE LOT OF PUNITIVE FORCE BEHIND THAT. AS FAR AS FAMILIES THAT HAVE CHILDREN ALREADY VERSUS FAMILIES WHO ARE CHILDLESS, THAT DOESN’T IN GENERAL COME INTO THE MEDICAL CONSIDERATION OF TREATING A FAMILY OR NOT. BECAUSE AT LEAST GENERALLY NOBODY CAN REALLY DETERMINE WHAT THE OPTIMAL SIZE OF A FAMILY IS. FOR SOME PEOPLE THAT MAY BE ONE CHILD, FOR SOME THAT MAY BE MANY MORE.
GINNY: THERE’S A CHAPLAIN WHO’S A WELL-KNOWN BIOETHICIST AT THE UNIVERSITY OF PENNSYLVANIA, PROPOSED THAT WE HAVE LEGAL REGULATION OF FERTILITY CLINICS SOLVING THE SITUATION OF THE OCTAMOM. NOW, AGAIN, I DON’T KNOW HOW PRACTICAL THAT WOULD BE. MY OWN INTUITIONS WOULD BE TO PROVIDE COUNSELING FOR THE WOMEN BEFORE THEY UNDERTAKE REPRODUCTIVE TECHNOLOGIES TO MAKE THEM THINK ABOUT THE IMPLICATIONS OF WHAT THEY ARE GOING TO DO OR HOW MANY CHILDREN THEY ARE GOING TO HAVE AND THE LIKE. PERHAPS THAT WOULD BE MORE WORKABLE THAT TRYING TO INSTITUTE SOME SORT OF LEGAL REGULATION OF THESE CLINICS.
PETER: WOULD WE AGREE THAT WE THINK MAYBE THE OBLIGATION TO ASSIST A FAMILY OR A COUPLE FOR A CHILDLESS COUPLE WOULD BE MORE THAN A FAMILY OR A MOTHER THAT’S HAD ALREADY A NUMBER OF CHILDREN? BECAUSE THE BETTER OR MORE NEEDY PARENT WOULD BE THE MOTHER THAT HASN’T HAD A CHILD.
JANINE: I WOULDN’T SUPPORT THAT APPROACH AT ALL BECAUSE WHO ARE WE TO SIT HERE AND DECIDE THESE ARBITRARY CRITERIA WHO CAN HAVE CHILDREN AND WHO CAN’T? THE MARRIED STATUS, NUMBER OF CHILDREN AT HOME, WHETHER THEY’RE CHILDLESS, HOW MUCH MONEY THEY MAKE, HOW MUCH EDUCATION YOU HAVE. THAT’S NOT MY PLACE OR ANY OF OUR PLACE TO DO THAT. THAT REALLY BELONGS WITH THE PHYSICIAN AND THAT WOMAN TO DETERMINE, AND GO THROUGH THE COUNSELING, I THINK DOCTOR, YOU HIT IT RIGHT ON THE HEAD THAT THERE NEEDS TO BE SOME COUNSELING. AND THAT’S WHAT INFORMED CONSENT IS ALL ABOUT – THE PROS, THE CONS, THE POSITIVE, THE NEGATIVE, HAVE YOU THOUGHT ABOUT. NOT DECIDING, BUT FACILITATING THAT DECISION-MAKING PROCESS THAT THAT WOMAN HAS TO GO THROUGH. THE PHYSICIAN’S OBLIGATION, AGAIN, THIS IS … SPEAKING, IS TO PRESENT ALL OF THE KNOWN INFORMATION AT THE TIME, WITH OUR TECHNOLOGY, THERE ARE NO GUARANTEES, OR WE KNOW THIS IS GOING TO HAPPEN, TO MAKE SURE THAT ALL OF THE INFORMATION NEEDED FOR THE DOCTOR IS MEDICALLY APPROPRIATE AND CONTRAINDICATIONS, THAT KIND OF THING, AND THE TWO OF THEM MAKE THAT DECISION. PRIMARY CONCERN OF THE PHYSICIAN NEEDS TO BE THE HEALTH OF THAT FETUS AND THE BABY, AND THE HEALTH OF THAT MOTHER. AND THE BEST STANDARD OF CARE THAT CAN BE PROVIDED IS BEING PROVIDED. AND IF NOT, THEN YOU DON’T GO THERE. YOU MAKE REFERRALS, ET CETERA, THAT NEED TO BE DONE.
PETER: I WOULD GUESS IT’S A GOOD THING YOU WEREN’T IN CHINA FOR THE LAST 25 YEARS WHERE THEY’VE HAD THE RULE OF ONE CHILD, AND THAT WAS A GOVERNMENTAL DECISION, NOT ETHICAL OR MORAL OR ANYTHING ELSE. I’M SORRY. DOCTOR?
JANINE: THAT’S QUITE RIGHT. NO, YOU CONTINUE.
PETER: NO, I JUST WANTED TO BRING IT UP.
JANINE: WELL, I WAS JUST GOING TO MENTION THAT IN MY BIOETHICS CLASS THIS SEMESTER, SOME OF MY STUDENTS DID A PROJECT WHERE THEY LOOKED AT THE WEBSITES OF FERTILITY CLINICS AND THEY LOOKED SPECIFICALLY AT THE EXTENT TO WHICH ETHICAL CONCERNS WERE ADDRESSED ON THE WEBSITES OF THE FERTILITY CLINICS. THEY FOUND VERY LITTLE ETHICAL INFORMATION. AND THE SUGGESTION THEY CAME UP WITH WAS TO DEVELOP OF BROCHURE THAT COULD BE GIVEN TO POTENTIAL CLIENTS IN WHICH THE FACTUAL INFORMATION COULD BE PRESENTED RATHER THAN ANSWERING THE ETHICAL QUESTION. NOW, OBVIOUSLY, THE FERTILITY CLINICS DEAL WITH CLIENTS FROM A WIDE VARIETY OF ETHICAL AND RELIGIOUS BACKGROUNDS, BUT AT LEAST THEY COULD PRESENT THE FACTUAL INFORMATION THAT WOULD ALLOW PEOPLE TO MAKE INFORMED ETHICAL CHOICES. FOR EXAMPLE, WHAT IS DONE WITH SPARE FROZEN EMBRYOS? OKAY. HOW MANY EMBRYOS WOULD BE IMPLANTED AT A GIVEN TIME, HOW MANY WOULD BE FROZEN AND THE LIKE. OKAY? ARE THERE EMBRYO ADOPTION PROGRAMS AVAILABLE? AGAIN, IF PEOPLE HAVE THE INFORMATION THEN THEY COULD BE THE ONES TO MAKE THE ETHICAL CHOICES ABOUT WHETHER THEY WANTED TO PROCEED WITH A PARTICULAR REPRODUCTIVE TECHNOLOGY.
BARBARA: AND THAT SEEMS LIKE THERE IS, WHO HAS THE CHOICE TO MAKE THOSE DECISIONS?
PETER: DOES IT MAKE SENSE TO ALLOW A MOTHER THAT WANTS TO ADD EIGHT MORE BABIES TO THE SIX THAT SHE’S ALREADY HAD THAT SHE CAN’T POSSIBLY SUPPORT, TO ALLOW THAT DECISION TO GO FORWARD JUST BECAUSE SHE THINGS IT’S ETHICAL.
GINNY: I THINK IT’S TOUGH BECAUSE I AGREE WITH IT MAKES ME NERVOUS TO TRY TO GIVE ANY VALUE TO CERTAIN SOCIAL SITUATIONS BECAUSE WE DON’T KNOW TRULY WHAT MAKES, WEALTH CERTAINLY DOESN’T GUARANTEE A GOOD PARENT. AND SO THIS SEEMS LIKE AN EXTREME EXAMPLE. SO OF COURSE YOU CAN POINT TO THAT BUT I THINK THEN YOU CAN GET IN TROUBLE BY SAYING, WELL, YOU NEED X NUMBER OF DOLLARS PER CHILD TO BE ABLE TO. SO I THINK THAT’S DIFFICULT. AND I GET UNCOMFORTABLE IN THE SITUATION OF LIMITED RESOURCES WITH REALLY TRYING TO TRIAGE YOUR PATIENTS THAT YOU HELP. WE DO HAVE, SO, IN, SO I’M INTERESTED IN WHAT YOUR STUDENTS THOUGHT OF OUR INFERTILITY WEBSITE. WE DO HAVE A PROGRAM WHERE WE OFFER EGG, DONATED EGGS, SO, FROM ANONYMOUS AND KNOWN EGG DONORS. AND IN THAT SITUATION WE DO HAVE A LIMITED NUMBER OF DONORS SO WE DO TRIAGE TO SOME EXTENT THAT PROGRAM, WHERE WE OFFER FIRST OUR EGG DONORS TO COUPLES WHO ARE CHILDLESS AND THEN SO WE HAVE LISTS IN THAT SENSE. BUT IN GENERAL WITHOUT A LIMITED RESOURCE I FEEL UNCOMFORTABLE TRIAGING THEM TO GIVE SOCIAL VALUE TO, OR MEDICAL VALUE TO SOME SOCIAL…
PETER: WOULD YOU SCREEN YOUR DONORS?
GINNY: SCREEN FOR WHICH?
PETER: STABILITY AND LIKE THAT?
GINNY: WE DO, AND.
PETER: WHAT ABOUT YOUR RECIPIENTS?
GINNY: THAT BRINGS UP THIS ISSUE AGAIN TO MY MIND WHERE WE WERE TALKING ABOUT FULLY COUNSELING. I THINK THAT ONE OF THE UNFORTUNATE THINGS IS PAYMENT FOR SERVICE THINGS. WE USED TO YEARS AGO, ANYBODY GOING THROUGH INFERTILITY TREATMENT, ESPECIALLY INVITRO FERTILIZATION, WE HAD A HEALTH PSYCHOLOGIST IN OUR CLINIC WHO SAW ALL OF THESE PATIENTS. UNFORTUNATELY, PAYMENT FOR THAT HAS BEEN REALLY CUT, I’M SURE EVERYBODY’S AWARE OF IN GENERAL, MENTAL HEALTH SERVICES AND LIKE THAT. SO NOW WE ONLY MANDATE THAT EGG DONORS OR RECIPIENTS OF DONATED EGGS OR EMBRYOS DO STILL GO THROUGH THE HEALTH PSYCHOLOGY PROCESS, AND THAT’S OFTEN PAID FOR OUT OF POCKET BY THE RECIPIENT, COUPLES OR SINGLE PARENTS. BUT NO LONGER, WE ALWAYS OFFER THE SERVICES, BUT WE NO LONGER MANDATE BECAUSE IT’S FAIRLY EXPENSIVE AND COUPLES ARE PAYING A LOT OUT OF POCKET. SO UNFORTUNATELY THAT WOULD OFFER EXTENSIVE COUNSELING AND SUPPORT FOR ALL OF THESE ISSUES. AND ALSO MIGHT BRING UP SOME CONCERNING ISSUES FOR US AS PHYSICIANS THAT WE MIGHT FEEL ARE TOO MUCH FOR US TO BE ABLE TO OFFER THESE SERVICES TO THESE POTENTIAL PARENTS.
BARBARA: I APPRECIATE YOUR CONCERN ABOUT SOCIETAL RESOURCES BEING USED TO SUPPORT 14 CHILDREN FROM ONE MOM, BUT I THINK BEYOND THE ISSUE OF THE NUMBER OF CHILDREN A FAMILY HAS IS THE ISSUE OF THE HARM THAT CAN COME BOTH TO THE FETUS AND THE MOTHER IN A MULTI-FETAL PREGNANCY. THAT IS BAD FOR THE DEVELOPING FETUSES IS THAT THEY WILL LIKELY BE BORN PREMATURE, THEY SUFFER DEVELOPMENTAL DISABILITIES. A MULTI-FETAL PREGNANCY CAN ALSO BE HARMFUL TO THE MOTHER IN TERMS OF DEVELOPING HIGH BLOOD PRESSURE AND OTHER PHYSIOLOGICAL CONDITIONS. SO FROM AN ETHICAL POINT OF VIEW I THINK THERE ARE TWO PRINCIPLES THAT ARE RELEVANT HERE: FIRST OF ALL, ON AUTONOMY. THE RIGHT OF THE WOMAN OR THE COUPLE TO DETERMINE THE SIZE OF THEIR FAMILY. BUT BALANCE THAT AGAINST NON-MALEFFECENT, OUR DUTY NOT TO ENGAGE IN ACTIONS WHICH CARRY A SUBSTANTIAL HARM TO OTHER PEOPLE. AND I WOULD ARGUE IN THIS CASE THAT NON-MALEFFECENCE TRUMPS THE AUTONOMY. THAT FIRST AND FOREMOST IS THE CONSIDERATION NOT TO ENGAGE IN MEDICAL, IN ACTIONS, WHICH CARRY SERIOUSNESS OF HARMFUL FOR THE MOTHER AND THE DEVELOPING FETUSUS.
PETER: NOW, ISN’T THERE, IN MY RESEARCH, ISN’T THERE A VERY STRONG CORRELATION BETWEEN MULTI-FETUS BIRTHS AND PROBLEMS WITH THE NEWBORNS GOING ON, AND IT’S A, DO YOU HAVE SOME OF THOSE?
GINNY: WELL, IT’S ACTUALLY, I THINK, THIS HAS BEEN FOCUSED ON A LOT IN THIS CASE, WE’RE REFFERING TO, IT’S TRULY A MEDICAL MIRACLE AND QUITE AN AMAZING ACCOMPLISHMENT FROM THE NEONATOLOGIST STANDPOINT AND THE HIGH RISK OBSTETRICIAN STANDPOINT THAT TOOK CARE OF THIS PREGNANCY, THAT ALL EIGHT FETUSES LIVED AND WERE DELIVERED. AND I, IT’S AN INCREDIBLY TRAGIC SITUATION IN GENERAL, BUT IT’S A MEDICAL MIRACLE BECAUSE, AS YOU POINTED OUT, EVEN TWINS ARE REMARKABLY RISKIER THAN A SINGLE PREGNANCY. WE, OUR CLINIC HAS BEEN QUITE LUCKY IN THAT WE HAVE NICE, HIGH PREGNANCY RATES AND SO WE’RE ABLE TO VERY MUCH CUT DOWN ON THE NUMBER OF EMBRYOS WE TRANSFER. SO WE REALLY THINK OF IT AS A REAL FAILURE IF WE HAVE TRIPLETS AT ALL. WE TRY TO ABSOLUTELY STOP ANY CHANCE OF TRIPLETS. WE, AND WE’VE EVEN BEEN CUTTING DOWN ON OUR TWIN RATES, TRULY A HIGH ORDER MULTIPLE, ANYTHING OVER TWINS WE REALLY FEEL LIKE IS SOMETHING THAT WE REALLY, TRULY SHOULD HAVE PREVENTED AND HOPEFULLY THAT’S THE WAY THE CLINICS AROUND THE COUNTRY ARE. AND IT HAS SHOWN, ACTUALLY, THOSE ARSM GUIDELINES I MENTIONED EARLIER, HAVE REALLY CUT DOWN ON THE NUMBER OF TRIPLETS NATIONWIDE THAT HAVE BEEN CONCEIVED. BUT EVEN TWINS, AS I SAID, ARE, INCREASE IN RISK OF PREMATURITY AND PROBLEMS LATER.
PETER: NOW, ARE, I SEE THAT A LOT OF THEM WILL TRANSFER LIKE TWO OR THREE EGGS AT A MAXIMUM, IS THAT WHAT YOU WOULD DO?
GINNY: WE TRY TO, WE ACTUALLY HAVE A FAIRLY UNIQUE PROGRAM WHERE WE HAVE A MANDATORY SINGLE EMBRYO TRANSFER POLICY FOR COUPLES THAT WILL HAVE A GOOD PROGNOSIS. SO FOR WOMEN UNDER 37 WHO HAVE A GOOD QUALITY EMBRYO, WE ACTUALLY TRANSFER ONE. AND THAT’S VERY UNIQUE. I THINK WE REALIZE THAT WE MIGHT BE ONE OF A HANDFUL OF CENTERS ACROSS THE WHOLE COUNTRY THAT DOES THAT. BUT IN GENERAL, IT DEPENDS ON THE DAY OF EMBRYO DEVELOPMENT AND VARIOUS OTHER THINGS, BUT, MOST AGE. BUT WOMEN UNDER 35 AS IN THE SITUATION WE’RE REFERRING SHOULD TRULY NEVER HAVE MORE THAN TWO EMBRYOS TRANSFERRED. AND THEN AS WOMEN GET OLDER, THEIR PREGNANCY RATES PER EMBRYO TRANSFER GO DOWN AND SO WE CAN USUALLY GET AWAY WITH TRANSFERRING MORE EMBRYOS AND NOT END UP WITH THE HIGHER ORDER MULTIPLES. BUT WE NEVER TRANSFER MORE THAN FOUR, EVEN IN 42-YEAR-OLD WOMEN, FOR EXAMPLE. SO, BUT AGAIN, I THINK THE PROBLEM WITH LEGALLY GOING AFTER THIS IS THAT IT GETS AWAY FROM THAT DECISION-MAKING PROCESS BETWEEN THE PHYSICIAN AND PATIENT WHICH, AND I THINK CERTAIN GUIDELINES CAN BE PUSHED A LITTLE BIT IN CERTAIN SITUATIONS THAT HAVE HAD MULTIPLE CYCLES THAT HAVE FAILED, FOR EXAMPLE, OR SO ANYTIME YOU LEGISLATE YOU TAKE AWAY FROM THAT FLEXIBILITY, FLEXIBILITY TO BE ABLE TO WORK WITH THAT PATIENT AND THAT’S UNFORTUNATE. AND ALL CLINICS ARE DIFFERENT IN HOW THEIR PREGNANCY RATES ARE.
PETER: BARB, DOES YOUR CLINIC DO SOME OF THE SAME SCREENING FROM A PSYCHOLOGICAL STANDPOINT OF, ARE THESE PEOPLE PREPARED FOR WHAT THEY’RE DOING AND THAT TYPE OF WORK, OR DO YOUR COUNSELORS ALREADY HAVE A LITTLE BIT OF THAT AS A…
BARBARA: NO, WE DON’T COUNSEL SPECIFIC ON THIS. BUT AND REALLY NOT AT ALL. IF WE HAVE A YOUNG LADY OR A WOMAN THAT COMES IN FOR, WHETHER IT’S INFERTILITY OR FERTILITY PREVENTION OR CONTROL OR MANAGEMENT, FAMILY PLANNING, WE DO COUNSELING. BUT IF IT IS SOMEONE WHO WE’VE TRIED DIFFERENT CONTRACEPTIVE MEASURES AND HORMONAL THERAPIES AND SO FORTH AND TALKING ABOUT HER CYCLES AND OVULATION AND THAT SORT OF THING, THEN WE MAKE A REFERRAL TO A CLINIC LIKE AT THE UNIVERSITY. BUT IN TERMS OF THE COUNSELING AND APPROPRIATENESS OF FERTILITY IMPLANTATION AND SO FORTH, WE DON’T GO THERE, A LITTLE BEYOND OUR SCOPE. BUT WE DO TRY TO GET THE REFERRALS IN PLACE THEY NEED TO BE.
PETER: PROFESSOR, YOU’RE IN A UNIQUE PLACE WHERE WE AS ADULTS ARE READING ABOUT WHAT HAPPENED IN CALIFORNIA. WHAT KIND OF FEEDBACK DID YOU GET FROM YOUR STUDENTS? WERE THEY OUTRAGED, OFFENDED, WHAT WAS THEIR PERCEPTION?
JANINE: WELL, I DID NOT GET THAT MUCH FEEDBACK FROM MY STUDENTS ABOUT THIS. BUT AGAIN, I THINK THIS IS AN EXTREME CASE THAT WE ARE LOOKING AT. I THINK IT NEEDS TO BE KEPT IN MIND, FIRST OF ALL, THAT SOME PEOPLE DO HAVE ETHICAL RESERVATIONS ABOUT THE BASIC PROCEDURE OF INVITRO FERTILIZATION BECAUSE OF THE EMBRYONIC LOSS THAT IS INVOLVED THERE, BOTH IN TERMS OF SPARE FROZEN EMBRYOS AND IN TERMS OF TRANSFERRING EMBRYOS WHICH DO NOT IMPLANT TO ACHIEVE A PREGNANCY. IN DEALING WITH ASSISTIVE REPRODUCTIVE TECHNOLOGIES I THINK IT’S IMPORTANT TO DISTINGUISH AMONG DIFFERENT TYPES THAT YOU MIGHT CONSIDER SOME OF THEM TO BE ETHICALLY PERMISSIBLE BUT NOT ALL OF THEM.
PETER: WHERE WOULD PEOPLE DRAW SOME OF THOSE LINES?
JANINE: ONE PRINCIPLE IS THE TECHNOLOGY INVOLVES EMBRYONIC LOSS, AND AGAIN, IF YOU BELIEVE THAT THE EMBRYO IS A HUMAN BEING FROM THE TIME OF FERTILIZATION, YOU WOULD NOT BE INCLINED TO ENGAGE IN ANY KIND OF TECHNOLOGY THAT INVOLVED LOSS OF EMBRYOS THROUGH DELIBERATE HUMAN FORESIGHT OR HUMAN ACTION VERSUS, SAY, OTHER KINDS OF SURGICAL TECENCESHNIQUES WHICH MIGHT CORRECT DEFICIENCIES, RENDER A COUPLE FERTILE. OR AN APPROPRIATE USE OF FERTILITY DRUGS. IT WOULD BE IN A DIFFERENT CATEGORY.
PETER: BUT IT’S WHEN YOU TAKE SOMETHING OUT OF THE BODY AND PUT IT IN A DISH THAT THEY MIGHT DRAW THE LINE?
JANINE: YES, OKAY. THERE IS CONCERN, TOO, ABOUT THE RAMIFICATIONS OF SEPARATING THE CONCEPTION OF A CHILD FROM THE INTERPERSONAL RELATIONSHIP OF SEXUAL INTERCOURSE BETWEEN THE COUPLE. I THINK OF THE BRAVE NEW WORLD AND THE VERY FIRST CHAPTER OF THAT, WHERE SOCIETY HAS EVOLVED TO THE POINT THAT CHILDREN ARE CREATED ON AN ASSEMBLY LINE IN THE LABORATORY AND THEY ARE PROGRAMMED TO PERFORM CERTAIN TYPES OF JOBS WITHIN SOCIETY. NOW, AGAIN, THAT MAY BE AN EXTREME CASE, BUT IS SOMETHING IMPORTANT BEING LOST WHEN YOU TURN SO MUCH TO CREATING CHILDREN IN A LABORATORY VERSUS TRYING TO DEVELOP METHODS OF ADDRESSING INFERTILITY PROBLEMS WHICH STILL MAINTAIN THE CONCEPTION OF THE CHILD WITHIN THE FRAMEWORK OF THE CONJUGAL ACT BETWEEN HUSBAND AND WIFE. FOR EXAMPLE, THERE IS A CLINIC CONNECTED WITH CREIGHTON UNIVERSITY THAT DOES NOT PRACTICE INVITRO FERTILIZATION, BUT LOOKS AT OTHER METHODS OF TRYING TO ADDRESS INFERTILITY PROBLEMS ON THE PART OF COUPLES.
GINNY: I WOULD RESPOND TO THAT BY SAYING THAT I DON’T THINK ANY COUPLE COMES TO US WITH A DESIRE TO GO THROUGH THESE IN ORDER TO THEY ABSOLUTELY NEED TO. I THINK EVERYBODY WOULD PREFER TO BE ABLE TO CONCEIVE IN A LOVING RELATIONSHIP IN THE MORE NATURAL WAY, SO IT’S ONLY KIND OF AS A LAST DITCH THAT THESE TECHNOLOGIES ARE USUALLY REQUIRED. NOT, I THINK A LOT OF PEOPLE IN GENERAL SOCIETY THINK ABOUT DESIGNER BABIES, PEOPLE ARE JUST GOING TO START SHOPPING FOR THEIR EGG DONOR AND SPERM DONOR AND PUT THIS BEAUTIFUL CHILD TOGETHER AND IT’S GOING TO BE. BUT THE REALITY IS THAT MOST COUPLES WHEN THEY COME TO NEEDING ASSISTIVE REPRODUCTIVE TECHNOLOGIES AFTER MANY YEARS OF DIFFICULTIES, AND SO IT’S USUALLY MORE OF AN UN…
JANINE: WELL, THIS MAY NOT BE TRUE OF THE UNIVERSITY OF IOWA, BUT FOR EXAMPLE, IF YOU LOOK AT THE GENETICS AND IVF INSTITUTE IN FAIRFAX, VIRGINIA, THEY HAVE AN OVUM DONOR PROGRAM WHERE THEY GIVE EXTENSIVE DESCRIPTIONS OF THE BACKGROUNDS OF THE WOMEN WHO HAVE DONATED OVA AND THEY HAVE A SPECIAL CATEGORY OF DOCTORATES, MDS, PHDS, JDS AND THE LIKE, AND COUPLES HAVE TO PAY EXTRA TO GET OVA DONATED BY THESE PEOPLE WITH DOCTORAL DEGREES. TO ME, THAT SEEMS TO BE GOING SHOPPING FOR YOUR BABY.
PETER: ALSO, IN ONE ASPECT, AND THE MONEY THAT IT WOULD COST TO GO THROUGH THIS PROCEDURE, IS THAT YOU’RE MAKING IT NOT SOMETHING THAT ALL OF THE POPULATION COULD ENJOY BUT IN PLACES LIKE HOLLYWOOD OR HIGH-INCOME PLACES PEOPLE ARE ALLOWED TO DO THIS TYPE OF SHOPPING BECAUSE THEY CAN AFFORD TO USE THE SERVICES OF A CLINIC LIKE YOURS. AND THAT KIND OF MAKES, WHEN I WAS A CHILD I ALWAYS HEARD THAT THE RICH GOT RICHER AND THE POOR GOT CHILDREN, BUT THAT WOULD TEND TO FLY IN THE FACE OF THAT.
GINNY: I THINK THAT’S UNFORTUNATELY TRUE IS THAT IT’S VERY EXPENSIVE BUT I’M ALWAYS AMAZED AT THE MOTIVATION OF MANY FAMILIES IN REALLY WANTING TO GROW AND FAMILY AND WHAT THEY’RE ABLE TO, THE RESOURCES THEY’RE ABLE TO BRING TOGETHER TO ACHIEVE THAT. AND ALSO, IT SHOULD BE KNOWN THERE ARE 10 STATES IN THE COUNTRY THAT MANDATE INFERTILITY COVERAGE IN INSURANCE POLICIES AND WE’RE HOPING THAT CONTINUES TO GROW AS WELL.
PETER: IS IOWA ONE OF THOSE?
GINNY: NO, ILLINOIS IS AND WE HAVE A NUMBER OF PATIENTS FROM ILLINOIS WHO HAVE GOOD COVERAGE. BUT WE HAVE COVERAGE WITHIN THE UNIVERSITY SYSTEM, FOR EXAMPLE, SO THERE’S STILL SOME GOOD COMPANIES THAT PROVIDE THAT COVERAGE WHETHER IT’S MANDATED OR NOT. SO IT’S AMAZING THE NUMBER OF PATIENTS THAT CAN AFFORD THAT. WE ALSO HAVE A WARRANTY PROGRAM THAT HELPS TO SHARE THE RISK WITH COUPLES. IT ISN’T EXPENSIVE.
PETER: A WARRANTY PROGRAM?
GINNY: IN EFFECT.
PETER: COULD YOU QUICKLY EXPLAIN WHAT A WARRANTY PROGRAM…
GINNY: WELL, IT’S BASICALLY, IT BASICALLY MEANS THAT IF A COUPLE HAVE A GOOD PROGNOSIS, THEY HAVE A RELATIVELY NORMAL SPERM COUNT, THEIR NUMBER OF EGGS A CERTAIN AGE, THAT THEY’LL PAY A LITTLE EXTRA OUT OF POCKET AND IF WE’RE UNABLE TO HELP THEM GET PREGNANT THEN WE GIVE THEM, THEY GET MOST OF THE MONEY BACK. SO IT’S A SHARED RISK TYPE OF PROGRAM. AND WE ALSO WORK WITH BANKS TO HELP WITH FINANCING AND THINGS LIKE THAT TO TRY TO MAKE IT ACHIEVABLE FOR MANY FAMILIES. BUT IT IS EXPENSIVE. BUT WHEN IT COMES TO EGG DONATION, I WOULD SAY AGAIN, THAT MOST WOMEN, ALL WOMEN, WOULD MUCH RATHER HAVE A BIOLOGICALLY-RELATED CHILD THAT THEY CARRY AND ONLY COME TO EGG DONATION AS A VERY LAST RESORT. AND WHEN IT COMES TO THAT POINT, THEN, IT IS DIFFICULT TO KNOW HOW MUCH INFORMATION YOU WANT TO GIVE THE PERSON WHEN THEY’RE LOOKING FOR THEIR EGG DONOR. IT DOES BECOME A BIT SILLY WHAT PEOPLE ARE LOOKING FOR AND WHAT THEY MIGHT CHOOSE AS IN THEIR EGG DONOR. BUT THAT’S A WHOLE OTHER TOPIC, I THINK, TOO.
PETER: BARBARA, FROM YOUR PERSPECTIVE WHAT DO YOU SEE FROM THE PLANNED PARENTHOOD? HAS BUSINESS BEEN GOING UP LATELY? ARE PEOPLE MORE CONSCIOUS ABOUT THESE THINGS OR IS IT ABOUT LEVEL?
BARBARA: I HAVEN’T SEEN OR HEARD FROM MY STAFF, AN INCREASE IN INFERTILITY AND THE NEEDING TO CONCEIVE. BUT I GUESS A COMMENT OR QUESTION I’D LIKE TO GO OUT TO THE GROUP, I DON’T WANT TO STEAL YOUR THUNDER, EITHER, BUT I’VE HEARD COUPLES MAKING THIS DECISION, COUPLES MAKING THIS DECISION, AND COMING FROM THE PERSPECTIVE THAT IT’S THE WOMAN WHO’S INVOLVED WITH THIS AND HER HEALTH AND SO FORTH AND HER FEELING, ARE SINGLE WOMEN OR WOMEN WHO CHOOSE NOT TO HAVE A MALE PARTNER COME TO YOUR CLINIC FOR ASSISTANCE WITH FERTILITY.
GINNY: ABSOLUTELY. AND WE TREAT SINGLE WOMEN, LESBIAN COUPLES, WE’RE NOW STARTING A GESTATIONAL CARRIER PROGRAM, WHICH IS POSSIBLY THE TOPIC OF A WHOLE OTHER ISSUE FOR THIS SHOW, BUT IN ORDER, THEN, WE CAN ALSO TREAT GAY MALE COUPLES, SINGLE MEN, SO…
PETER: WE’VE DONE ANOTHER SHOW THAT I DID, ONE-THIRD OF THE BIRTHS IN IOWA RIGHT NOW ARE SINGLE WOMEN, WHICH IS, THERE’S QUITE A NEED FOR THAT. WE’RE GETTING DOWN TO THE FINAL COUPLE OF MINUTES. CAN I ASK YOU ALL FOR ANY LAST COMMENTS OR WORDS TO PASS ALONG?
JANINE: I GUESS I WOULD HAVE FINAL COMMENTS THAT I AGREE WITH THE OTHER PANELISTS THAT THE OCTAMOM IS REALLY SENSATIONALISM, THE EXTREME, KEEPING IT INTROSPECTIVE THAT THAT’S NOT THE STANDARD OF CARE AND HOPEFULLY WON’T BE REPEATED AGAIN. BUT MONITORING OUR HEALTHCARE SYSTEM AND OUR PRACTICES, HOLDING OUR PROFESSIONALS ACCOUNTABLE IF THEY CAN’T DO IT THEMSELVES THEN AN EXTERNAL FUNCTIONING BODY. BUT ALSO KEEPING LEGISLATION AND REGULATION OUT OF THE SITUATIONS. BUT AGAIN, IT’S THE WOMAN’S CHOICE, WITH THE PHYSICIAN’S ASSISTANCE.
PETER: REALLY QUICKLY, GINNY. WE’RE DOWN TO LESS THAN A MINUTE.
GINNY: I COMPLETELY AGREE THAT, I FEEL LIKE THE RIGHT TO BUILD A FAMILY IS VERY FUNDAMENTAL IN THIS COUNTRY, IN MANY COUNTRIES, AND I WOULD ALSO SAY THAT ACTUALLY FROM A PLANNED PARENTHOOD TO SORT OF BACK IN YOUR COURT, IT’S IMPORTANT TO TRY TO AVOID INFERTILITY IN THE FIRST PLACE BY AVOIDING SEXUALLY TRANSMITTED…
PETER: YOU’VE GOT ABOUT 10 SECONDS BEFORE I WRAP THIS UP.
BARBARA: I’VE HEARD THAT THE MOTHER OF THE OCTAMOM SAY THAT SHE’S OBSESSED WITH HAVING CHILDREN AND AGAIN, I THINK THE ISSUE NEEDS TO BE EXPLORED WITH HER PSYCHOLOGICALLY AND WHY SHE WANTS SO MANY CHILDREN, WHICH AGAIN, POINTS TO THE NEED FOR PEOPLE TO GO THROUGH COUNSELING IN CONJUNCTION WITH GOING TO FERTILITY CLINICS.
PETER: GOOD. GOOD. ON BEHALF OF THE INTER-RELIGIOUS COUNCIL OF LINN COUNTY, MY NAME IS PETE WELCH AND I’D LIKE TO THANK YOU FOR YOUR TIME THIS MORNING. HELP MAKE OUR PLACE A BETTER PLACE TO LIVE.
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