Eight is enough to make us take another look

Maybe we owe an apology to the doctors who made the birth announcement with such pride. The delivery of eight babies in five minutes was, they exhaled, "amazing." The mom was "incredibly courageous." All in all it was a "very exciting day," a feat for which the 46-member medical team at the California hospital expected kudos and high-fives.

But instead of smiles, they saw jaws drop. Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.

It turned out that Nadya Suleman already had six kids at home. The Suleman Fourteen don't have a father, they have a sperm donor. They were apparently all conceived by in vitro fertilization with the last eight presumably implanted en masse. For good measure, their mother doesn't have a job. And her family recently filed for bankruptcy.

Before she left the hospital, before the babies left intensive care, the whole country had gone from "gee whiz" to "are you kidding?" Everything that we don't really want to talk about in terms of pregnancy and child rearing - marital status, money, individual choice, responsibility and technology - had converged in the shouting and blogging over Nadya Suleman's womb mates.

Does anyone have a right to tell anyone else how many kids to have? Can only people who can afford them bear children? Do you need a husband to have a baby? These are questions that make us feel queasy when we talk about old-fashioned families but take on a new flavor in the unregulated wild west of fertility technology.

Fertility doctors don't say no - nor should they - to single or gay patients or those who already have children. Doctors do not do home visits or psychological evaluations or socioeconomic profiles on patients who want children. At most, doctors do what bioethicist Arthur Caplan calls "a wallet biopsy" to see if they can pay the bill. We are far more rigorous about accepting people for adoption or foster care than for fertility treatments. But shouldn't there be limits?

The reason why we haven't seen Nadya's fertility doctor on "Larry King Live" (yet) is that it's against all guidelines to implant more than two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies, anyone who endangers patients ought to lose their license. This is more than an individual decision. Suleman's babies weighed between 1 pound 8 ounces and 3 pounds 4 ounces. They will cost at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies. The meter is running at the neonatal unit.

I wish these eight little people well. I tip my hat to the delivery team for dealing with an octuplet of problems they didn't create. If Suleman's brand new publicist succeeds in selling her as a "smart," "joyful" mother with a "wonderful sense of humor" who is grateful "for the miracle of life," maybe this mother will be able to roll her degree in child development into a reality program that supports them all.

But right now, a reproductive business that generates so much controversy has produced a remarkable consensus. Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is "nuts."

© 2009, Washington Post Writers Group