Talking whether or not to have children in contemporary American society seems as fraught with danger as talking about religion, politics, or sex itself. First of all, the act of reproduction is now largely perceived as a matter of choice rather than an accident, a chance occurrence, or a reflection of the will of God.
For this reason we tend to view reproduction almost exclusively as an activity within the individual's control, You want to have a child; check when the female partner is ovulating and have fun. You don't want to have children: have fun but don't forget the birth control. This reductive either/or thinking makes it all to easy to forget how vulnerable we humans still are to flawed genes, the curve ball of disease, and the threat of infertility that increases as we defer parenting to our late thirties or forties.
New reproductive technologies have offered one form of reassurance to those who have trouble conceiving, especially those who have deferred the choice to have children until infertility presents a serious impediment. They also make it possible for lesbian couples to conceive and for gay male couples to have children as well if they can find a female surrogate.
But while new technologies like in-vitro fertilization offer solve a number of problems for these couples, they also raise serious ethical questions that medical practitioners and those seeking such treatment are often ill-equipped to answer.
For example, the ability for infertile couples to use in-vitro techniques as an alternative to adoption has fostered a situation in the United States in which large numbers of children remain locked into the foster care system, often seen as “unadoptable” by the very families who might once have taken a closer look at them. Moreover, infertile couples are not simply choosing to conceive one or two embryos that might be born as their biological children but are choosing a technology so costly that many choose to risk multiple births rather than lose the opportunity of becoming pregnant at all.
The case of Nadya Suleman, the single mother who chose to have so many embryos implanted in her womb that she gave birth to octuplets, merely writes large the ethical dilemmas that such unregulated reproductive technologies have generated.
The cost of in-vitro fertilization is high, and since few have health insurance to cover the cost, the incentive is even greater to try to get the most “bang for your buck” by having as many embryos implanted in the womb as possible.
The problem is that the human womb is not designed for more than one or two occupants at best, and the situation of multiple births automatically presents high risks and higher medical costs for both mother and babies, some of which may persist for the life of the children who survive. In fact, the ugly underside of potential multiple births is the real possibility of multiple deaths as the survival rate lessens dramatically for twins, triplets, quadruplets, and higher multiples. (For an excellent overview of these issues,read Liza Mundy, Everything Conceivable: How Assisted Reproduction Is Changing Our World).
The other side of this reproductive superabundance is also reflected in the dilemma of what to do with the embryos that are not implanted. In almost every in-vitro situation, there are “left over” embryos that a couple may want to use for future births. By one estimate, there may be half a million of these potential babies.
Unfortunately, once a couple has the number of children they desire, many cannot face the ethical dilemma of what to do with the embryos they no longer need. Do they donate them to other infertile couples? Do they allow them to “expire”? Do they offer them for scientific research? A growing number of people, unable to decide, simply stop paying the fees to keep their embryos frozen, but doctors are often too afraid of legal problems not to continue keeping them in this reproductive limbo.
Which brings me back to Nadya Suleman. The public is quick to condemn her for choosing to give birth to children she cannot afford to raise and has not the means to care for, but the same public says little about the many couples who abandon their unused embryos, leaving them in a legal and physical limbo, a financial charge to the labs that helped create them.
Indeed, the amount of vitriol directed at this woman rivals that provoked by Ronald Reagan's mythical Welfare Queen, and reflects the resentment of an American public that can barely afford to feed, house, educated and provide health care for its own children, much less subsidize a woman who appears to have her children at “taxpayer expense.”
But we don't see nearly the same amount of outrage directed at the doctors and hospital that agreed to provide this infertility treatment to Ms. Suleman, even knowing full well that she already had six children from previous treatments. The real scandal that Ms. Suleman's multiple births has revealed is that of a medical profession operating under “wild west” conditions guidelines but no clear rules that might have immediately rendered Ms. Suleman an inadmissible candidate for further in-vitro fertilization treatments.
The medical profession that practices these techniques needs to take a hard look at itself and ask some pressing questions such as: What role does the profit motive play in decisions to offer in-vitro fertilization services? Under what conditions, if any, should a doctor refuse to provide in-vitro fertilization? Rich or poor, there may well be an ethical limit to the number of children that any medical professional should help a couple conceive by these means.
Certainly, as a society, there is a public interest in determining to what degree tax payers should subsidize the infertile when we already underfund housing, education, and services for children who do not have families to care for them.
And we should also be asking those who provide the technology for the infertile to conceive to make sure that these same couples fully comprehend the implications they face in making the decision to create multiple embryos or undertake multiple births. We cannot allow those who make the choice to create multiple embryos simply to walk away from those choices when they become inconvenient or superfluous.
Nor should we sweep under the table the negative effects of reproductive technologies' effects on women's health, on the ability of families to cope with the economic, emotional, and physical stresses of raising multiple babies at once, and the many costs to society of providing care to these children, who are often more vulnerable to disease and disability than their singleton counterparts.
In-vitro fertilization has offered many couples the opportunity to turn the dream of having a child into a reality, and I fully support the efforts of any couple, straight or gay, to have a child who shares at least some of their own unique genetic makeup.
But as Nadya Suleman's tragic situation demonstrates, an unregulated and unquestioning field of reproductive technology also poses the nightmare scenario of a society subsidizing one woman's unrealistic obsession that has turned into the grim reality of fourteen very young and very vulnerable children, who are dependent on one mother and an increasingly fragile safety net for their very survival.
That fact alone should have the medical community and the public large asking the question: Can in-vitro fertilization be too much of a good thing?
Thursday, February 26, 2009
Friday, February 20, 2009
A Melancholy Month
T.S. Eliot wrote that April was the cruelest month, but for me it's always been February that is the most difficult time of year to get through.
When I was growing up in Detroit, it seemed that February was the time when winter settled in with grey clouds, biting cold, and not even a glimpse of blue sky for weeks on end. It was when the snow either settled into a permanent crust with snow tires creating deep grooves that remained permanently frozen, or fell from the sky in a perpetual icy drizzle that was not quite rain, or else simply melted into black slush, an ugly combination of salt, snow, and mud.
They hadn't invented the term “SAD" (seasonal affect disorder), but I knew that if I ever had the choice, I would definitely spend those twenty-some days in a place far warmer and sunnier than Michigan.
Now that I live in northern California, I no longer feel saddened by the winter weather. Instead, I feel anxious if we have too many stretches of sunshine between the rainstorms that roll in from the Pacific, and I enjoy afternoons where the temperature reaches 70 degrees in January with more than a tinge of guilt, knowing that the warmth doesn't bode well for the Sierra snow pack.
My February blues these days don't come with the weather but with my own inevitable sense of disappointment and failure to live up to my own expectations. I always look to January, the month when I was born, as a turning point in the year; a time to take stock and start over. As anyone in my family will tell you, I am not a laissez-faire sort of personality. I want to take life by the shoulders and shake some sense into it. Like my hero, Captain Jean-Luc Picard, I want my “Earl Grey hot” as soon as I finish saying the words, and my dream is to arrange real life so that “Make it so” could be more than a line in a sci-fi script.
Unfortunately, none of my other family members ever conform to this fantasy, and February has had more than its share of small domestic dramas that have kept me awake at the wee hours of the morning worrying about how my teen is ever going to make it to college and how my little one can find a school that values rather than tries to suppress his energy and enthusiasm.
I worry about how we're going to find the funding to sustain the great ideas my husband has for his new company and whether or not I'm ever going to find a job I love again. I worry and worry some more, joining the company of thousands of Americans who lie awake at 3:00 a.m. wondering if they can keep a roof over their heads or pay their medical bills or avoid the pink slips that seem to be sprouting like the buds in my garden.
Each day seems to set a new low for the stock market, and a new dip in consumer confidence. I know I am not alone in my February melancholy and my heart goes out to those who have far more reason for a heavy heart than I do.
But knowing that your misery is shared does not necessarily make the sufferer any happier. So a couple of days ago, after getting the kids off to school, I went back to bed with an escapist novel and spent as much of the day as I could in my pajamas before heading off to the airport to pick up my husband.
If I were the bubble bath sort, it would definitely have been a “Calgon, take me away!” sort of moment, but for me, just a couple of hours in self-indulgent sloth is enough for me to gird my loins and return to the grey skies of February and a reality that we could all stand to be a little less grim.
When I was growing up in Detroit, it seemed that February was the time when winter settled in with grey clouds, biting cold, and not even a glimpse of blue sky for weeks on end. It was when the snow either settled into a permanent crust with snow tires creating deep grooves that remained permanently frozen, or fell from the sky in a perpetual icy drizzle that was not quite rain, or else simply melted into black slush, an ugly combination of salt, snow, and mud.
They hadn't invented the term “SAD" (seasonal affect disorder), but I knew that if I ever had the choice, I would definitely spend those twenty-some days in a place far warmer and sunnier than Michigan.
Now that I live in northern California, I no longer feel saddened by the winter weather. Instead, I feel anxious if we have too many stretches of sunshine between the rainstorms that roll in from the Pacific, and I enjoy afternoons where the temperature reaches 70 degrees in January with more than a tinge of guilt, knowing that the warmth doesn't bode well for the Sierra snow pack.
My February blues these days don't come with the weather but with my own inevitable sense of disappointment and failure to live up to my own expectations. I always look to January, the month when I was born, as a turning point in the year; a time to take stock and start over. As anyone in my family will tell you, I am not a laissez-faire sort of personality. I want to take life by the shoulders and shake some sense into it. Like my hero, Captain Jean-Luc Picard, I want my “Earl Grey hot” as soon as I finish saying the words, and my dream is to arrange real life so that “Make it so” could be more than a line in a sci-fi script.
Unfortunately, none of my other family members ever conform to this fantasy, and February has had more than its share of small domestic dramas that have kept me awake at the wee hours of the morning worrying about how my teen is ever going to make it to college and how my little one can find a school that values rather than tries to suppress his energy and enthusiasm.
I worry about how we're going to find the funding to sustain the great ideas my husband has for his new company and whether or not I'm ever going to find a job I love again. I worry and worry some more, joining the company of thousands of Americans who lie awake at 3:00 a.m. wondering if they can keep a roof over their heads or pay their medical bills or avoid the pink slips that seem to be sprouting like the buds in my garden.
Each day seems to set a new low for the stock market, and a new dip in consumer confidence. I know I am not alone in my February melancholy and my heart goes out to those who have far more reason for a heavy heart than I do.
But knowing that your misery is shared does not necessarily make the sufferer any happier. So a couple of days ago, after getting the kids off to school, I went back to bed with an escapist novel and spent as much of the day as I could in my pajamas before heading off to the airport to pick up my husband.
If I were the bubble bath sort, it would definitely have been a “Calgon, take me away!” sort of moment, but for me, just a couple of hours in self-indulgent sloth is enough for me to gird my loins and return to the grey skies of February and a reality that we could all stand to be a little less grim.
Tuesday, February 3, 2009
In Politics, the Poor are Expendable
It's a truism that politicians talk a lot about their concern for children and the poor, especially when they are in front of cameras. But when it comes to voting, too many politicians pay the most attention to their donors and to the constituents they believe are most likely to participate in the next election.
Unfortunately, the most recent compromise on the President's economic subsidy proposals proves this truism correct once again. With Republicans going on and on in front of TV news cameras about the inclusion of “millions of dollars for contraceptives,” President Obama caved in and jettisoned an important subsidy for poor women to gain access to contraception. Thus conservative hypocrisy won over common sense, and good public policy lost out to political expediency.
Hypocrisy is a strong term for describing conservative objections to this subsidy, but I cannot think of anything less accurate. With their emphasis on self-sufficiency, Republicans surely can not be said to be in favor of the poor having more children they cannot afford, and they are even more adamantly opposed to terminating an unintended pregnancy. Can you imagine the outrage they could have generated by showing up on Fox News and shouting, “This stimulus plan includes millions for publicly funded abortions”??
Yet what logical reason can they put forward for objecting to helping poor women control their family size and prevent the spread of sexually transmitted diseases? Is money spent helping pharmaceuticals offer contraceptives any better or worse than subsidizing an expensive drug plan for the elderly? According to most economists, it doesn't matter where you spend the money, as long as the government is pumping cash into the economy. So why are contraceptives any worse a product to subsidize than corn or wheat or any other commodity?
Do conservatives want poor women to stop having sex? Perhaps so. But given that poor women are disproportionately young and less educated, many of them may not have the power, real or perceived, of just saying “no” to a sexual partner. Moreover, since many conservatives are also libertarian in their thinking, they surely cannot favor the government either explicitly or implicitly getting into the business of dictating such choices.
And since Republicans always want the government to spend less, why wouldn't they want to spend a little on contraception in order to avoid spending a lot more subsidizing health care, education, and Aid to Dependent Children as well as the public spending on AIDS and sexually transmitted diseases that could be avoided by more women using contraceptives?
So why do poor women have to lose again? By courting conservative votes (which he didn't get), and avoiding any kind of controversy (especially around sex), President Obama chose to cede this issue to the conservative right. But that doesn't mean that voters have to go along with such political expediency. If those of us who take our ability to access contraceptives for granted don't speak up on behalf of poor women who don't enjoy that privilege, no one will.
Unfortunately, the most recent compromise on the President's economic subsidy proposals proves this truism correct once again. With Republicans going on and on in front of TV news cameras about the inclusion of “millions of dollars for contraceptives,” President Obama caved in and jettisoned an important subsidy for poor women to gain access to contraception. Thus conservative hypocrisy won over common sense, and good public policy lost out to political expediency.
Hypocrisy is a strong term for describing conservative objections to this subsidy, but I cannot think of anything less accurate. With their emphasis on self-sufficiency, Republicans surely can not be said to be in favor of the poor having more children they cannot afford, and they are even more adamantly opposed to terminating an unintended pregnancy. Can you imagine the outrage they could have generated by showing up on Fox News and shouting, “This stimulus plan includes millions for publicly funded abortions”??
Yet what logical reason can they put forward for objecting to helping poor women control their family size and prevent the spread of sexually transmitted diseases? Is money spent helping pharmaceuticals offer contraceptives any better or worse than subsidizing an expensive drug plan for the elderly? According to most economists, it doesn't matter where you spend the money, as long as the government is pumping cash into the economy. So why are contraceptives any worse a product to subsidize than corn or wheat or any other commodity?
Do conservatives want poor women to stop having sex? Perhaps so. But given that poor women are disproportionately young and less educated, many of them may not have the power, real or perceived, of just saying “no” to a sexual partner. Moreover, since many conservatives are also libertarian in their thinking, they surely cannot favor the government either explicitly or implicitly getting into the business of dictating such choices.
And since Republicans always want the government to spend less, why wouldn't they want to spend a little on contraception in order to avoid spending a lot more subsidizing health care, education, and Aid to Dependent Children as well as the public spending on AIDS and sexually transmitted diseases that could be avoided by more women using contraceptives?
So why do poor women have to lose again? By courting conservative votes (which he didn't get), and avoiding any kind of controversy (especially around sex), President Obama chose to cede this issue to the conservative right. But that doesn't mean that voters have to go along with such political expediency. If those of us who take our ability to access contraceptives for granted don't speak up on behalf of poor women who don't enjoy that privilege, no one will.
Back to the Gym
Okay, I confess. I have made that most banal of all New Year's resolutions, namely to get myself in shape.
But this year I have an extra incentive. The thrifty part of me that hearkens back to my dad's love of a bargain and the motto – “Eat it up, wear it out, make it do, or go without” – has made me answer the call of the January coupons for “free trial memberships” that every local gym seems to be offering.
Thus far, I've had a week at the Y and I've just finished two weeks at a new gym, which I could probably follow by one more trial if I pushed it. Don't get me wrong. I really am looking for a gym, and I do intend to pay for it, but not until I've explored every cross-trainer, every weight machine, and every free 30-minute personal training session to get the best bang for my buck.
Trying out the Y was actually a return to familiar ground since I used to be a member there for years before I moved to Albuquerque. I took prenatal dance before my first son was born by C-section, and afterward returned to post-natal classes. By the time I was pregnant with my third son, I was no longer paying much attention to all the hype about not getting your heart rate up too high or worrying about lifting weights.
I was working out on my due date when one of the trainers came up to me and asked when the baby was expected to arrive (I looked like an advertisement for Omar the Tent-Maker at this point). “Oh the baby is due today, actually,” I replied nonchalantly. With a look of horror, the trainer took one more look at my belly and said, “What the hell are you doing here then?” as if he expected a Hollywood scene to ensue with water bursting, me screaming and panting, and the arrival of a baby on an exercise mat right there in front of him.
So I was rather sad when I returned during my trial period and didn't see him there. I wanted to tell him that my son had arrived a bare fifteen minutes after I arrived at Stanford Hospital, just to get a rise out of him.
It was a little eerie seeing the same cast of characters I'd grown so used to, still working out, no one either visibly thinner or fatter, but all with the little quirks I'd grown so fond of. There was the elderly man and his wife who always worked out together; he often wore a Tam o'shanter on his head and sported a tie-dye t-shirt. Or the guy who always biked to the gym but never took off his windbreaker while he worked out; I never understood how he didn't die of heat exhaustion keeping it on after a hard ride. Or the friendly woman who always used to come up to me and say, “Now I know I've seen you before, but I can't remember your name” as she proceeded to introduce herself for at least the fifth time. To be fair, I never remembered her name either, but I always felt like I was in some kind of Star Trek time distortion whenever we went through this ritual
You may wonder why I took such an interest in my fellows as I did my own exercise routine, but I learned long ago as a graduate student when I started a weight training class at a university gym: “The guys are going to look at you; lifting weights is really boring, so don't take it personally.” That was the advice of our female trainer who was there to make us feel comfortable in this relatively alien territory, and it certainly freed me from any inhibitions about letting my curiosity have free reign while I was resting between sets.
But what I loved most about the Y was the fact that I never saw a woman arriving to work out in full make-up or with perfectly matched leotard or workout gear. The Y crowd was an unpretentious group, who came there to get a workout and not to make a fashion statement.
So it was with regret that I came back to find that although all my favorite cast of characters were still there, the gym had also been caught in a bit of a time warp so that the machines were rather out-of-date and that the place had grown even more crowded in the intervening years. It was difficult to get on the machine you liked or find a space to stretch afterward.
I will be moving on to one of the newer facilities in the area with their state-of-the-art exercise machines, and pristine facilities, but I hope that in trading the new for the familiar, I'll still find the people-watching part of my exercise routine as entertaining as ever and the folks I exercise with similarly unpretentious in their pursuit of good health. After all, it's much more fun to watch people when you work out than CNN.
But this year I have an extra incentive. The thrifty part of me that hearkens back to my dad's love of a bargain and the motto – “Eat it up, wear it out, make it do, or go without” – has made me answer the call of the January coupons for “free trial memberships” that every local gym seems to be offering.
Thus far, I've had a week at the Y and I've just finished two weeks at a new gym, which I could probably follow by one more trial if I pushed it. Don't get me wrong. I really am looking for a gym, and I do intend to pay for it, but not until I've explored every cross-trainer, every weight machine, and every free 30-minute personal training session to get the best bang for my buck.
Trying out the Y was actually a return to familiar ground since I used to be a member there for years before I moved to Albuquerque. I took prenatal dance before my first son was born by C-section, and afterward returned to post-natal classes. By the time I was pregnant with my third son, I was no longer paying much attention to all the hype about not getting your heart rate up too high or worrying about lifting weights.
I was working out on my due date when one of the trainers came up to me and asked when the baby was expected to arrive (I looked like an advertisement for Omar the Tent-Maker at this point). “Oh the baby is due today, actually,” I replied nonchalantly. With a look of horror, the trainer took one more look at my belly and said, “What the hell are you doing here then?” as if he expected a Hollywood scene to ensue with water bursting, me screaming and panting, and the arrival of a baby on an exercise mat right there in front of him.
So I was rather sad when I returned during my trial period and didn't see him there. I wanted to tell him that my son had arrived a bare fifteen minutes after I arrived at Stanford Hospital, just to get a rise out of him.
It was a little eerie seeing the same cast of characters I'd grown so used to, still working out, no one either visibly thinner or fatter, but all with the little quirks I'd grown so fond of. There was the elderly man and his wife who always worked out together; he often wore a Tam o'shanter on his head and sported a tie-dye t-shirt. Or the guy who always biked to the gym but never took off his windbreaker while he worked out; I never understood how he didn't die of heat exhaustion keeping it on after a hard ride. Or the friendly woman who always used to come up to me and say, “Now I know I've seen you before, but I can't remember your name” as she proceeded to introduce herself for at least the fifth time. To be fair, I never remembered her name either, but I always felt like I was in some kind of Star Trek time distortion whenever we went through this ritual
You may wonder why I took such an interest in my fellows as I did my own exercise routine, but I learned long ago as a graduate student when I started a weight training class at a university gym: “The guys are going to look at you; lifting weights is really boring, so don't take it personally.” That was the advice of our female trainer who was there to make us feel comfortable in this relatively alien territory, and it certainly freed me from any inhibitions about letting my curiosity have free reign while I was resting between sets.
But what I loved most about the Y was the fact that I never saw a woman arriving to work out in full make-up or with perfectly matched leotard or workout gear. The Y crowd was an unpretentious group, who came there to get a workout and not to make a fashion statement.
So it was with regret that I came back to find that although all my favorite cast of characters were still there, the gym had also been caught in a bit of a time warp so that the machines were rather out-of-date and that the place had grown even more crowded in the intervening years. It was difficult to get on the machine you liked or find a space to stretch afterward.
I will be moving on to one of the newer facilities in the area with their state-of-the-art exercise machines, and pristine facilities, but I hope that in trading the new for the familiar, I'll still find the people-watching part of my exercise routine as entertaining as ever and the folks I exercise with similarly unpretentious in their pursuit of good health. After all, it's much more fun to watch people when you work out than CNN.
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