This not Burger King! On California embryos and veterinary medicine
What does the case of the California woman whose womb carried eight implanted embryos have to do with veterinary medicine? Only that the ethical slippery slope is steeper in our sister profession when it begins to approximate ours.
Implanting eight embryos into a woman following in vitro fertilization is not even remotely defensible if you ask most bioethicists. Where does the woman’s psych profile fit into this case? What was the doctor who implanted the eight embryos thinking? And where’s the Board of Medicine? What does the Department of Health have to say?
Sure, we don’t know all the details of this case (and I’m not sure I really need to based on the superficial details), but someone clearly let this woman have at least eight chances to add to her brood of six children with a litter of babies that will almost certainly never lead normal healthy lives.
I’m not saying we should place limits on the number of children a woman can have. I’m not even decrying any woman's unwillingness to terminate some of her offspring once they were existent in utero. But granting the possibility of survival of more than three embryos in a human is a nasty thing to do to anyone--mother or child(ren). And a medical provider is responsible for this outcome?
Primum non nocere
First do no harm. That means that no medical provider should knowingly contribute to the cruel fate of shockingly premature birth and a lifetime of healthcare concerns (should the infants survive).
Even if a woman (and her family) understands every detail of what may come, there’s no excuse for a physician to allow her to assume this risk on behalf of others. After all, she’s not the one who will have to live in an incubator, undergo multiple surgeries and suffer a lifetime of developmental difficulties. And yet we too often treat infertility medicine from the standpoint of a woman’s right to choose whatever she likes on behalf of her unborn...even before they’re conceived.
Don’t get me wrong, I believe in a woman’s right to terminate her pregnancy under certain circumstances, but I do not subscribe to the belief that medicine should be offered up Burger King-style to anyone willing to pay, much less to a human version of a “collector” (one who hoards pets addictively).
Have it your way?
The physician gatekeeper in this case was obviously asleep at the switch...or worse, this person gave in to the concept of medical care as a “have-it-your-way” commodity:
- She wants a tubal ligation at age 15?
- He wants his stomach stapled but his diabetes isn’t under control and he can’t quit smoking long enough to make him a decent surgical candidate?
- She wants to buy her way up a liver transplant list but she can’t stop drinking and drugging?
- He’s overweight and he won’t take his meds but he still wants that eye lift?
- She swears her kid’s sick and she begs for the exploratory surgery, but her doc suspects Munchausen’s by proxy.
Sad to say but you can always find a doc to do these procedures, though not always in the country of your choice. In the US, satisfying these consumer elections is typically not doable according to our physicians’ code of ethics. There are channels for the mentally ill who seek unreasonable measures. But if you want to foist your will on your children when it comes to "infertility," it seems you can always find a doc willing to take advantage of your desperation.
The veterinary connection
And how is this in any way related to veterinary medicine? In many ways, though the connection might not be immediately apparent. Consider that we can do almost anything we like on behalf of our animals as long as it’s not considered cruel and inhumane by prevailing standards...and that’s a long list of do’s relative to the don’ts:
- We can cut their tails, remove their claws, cut out their canines, slice their vocal cords, do-up their ears and force them to have as many babies as we like.
- We can allow pet owners to take home pets with broken bones, fluid in their chest, ruptured bladders and paralyzed hind limbs...with no treatment or pain control measures.
- We must often treat suffering patients with a minimum of care because our clients can’t or won’t pay...it’s always their choice.
- When we know our clients are “collectors” we can nonetheless continue to allow our clients to take on more and more animals we know are living under increasingly desperate conditions.
- Should we suspect animal cruelty in any guise, few channels exist for any option save an unsavory co-dependency.
It’s clear we veterinarians serve at the pleasure of our paying clients in ways the human medical profession would never tolerate...at least not in most of the world.
Yet the good news is that veterinary medicine has been approximating the human medical profession for decades. We’re ever so gradually catching up. Specialists, standardized protocols, licensed para-professionals, pet health insurance, doc-in-a-boxes.
OK, so they’re not all great changes and we still have a long way to go (please no lengthy discussions on how far we haven't come), but we are making progress. Maybe that’s why it pains me to see physicians take a page out of the veterinary playbook when it comes to offering Burger King medicine.
Could it be that our professions are not so ethically disparate? That as veterinary medicine begins to resemble human medicine the line between the two will continue to blur? I certainly hope not...not if it means human care will succumb to our staggering inequities and ethical insufficiencies...not for the sake of humaneness as much as for our humanity.