Moral, Ethical, and Medical Considerations in Multifetal Pregnancies

Opponents of selective reduction compare the procedure to abortion. However, the issue of intent makes the two legally distinct.[1] Abortion is “the knowing destruction of the life of an unborn child or the intentional expulsion or removal of an unborn child from the womb other than for the principal purpose of producing a live fetus.”[2] Plainly stated, the principal intent is to completely terminate the pregnancy or pregnancies. In contrast, selective reduction is the knowing destruction of a fetus for the principal intent of preserving the pregnancy and the health of the mother and developing child.[3] [4]

Carrying a multiple pregnancy to term subjects the mother to health risks that increase with the number of fetuses carried, including gestational diabetes, hypertension, hemorrhage, miscarriage, and maternal death. Fetal risks include prematurity, developmental delay, cerebral palsy, and death. Selective reduction critics argue that hemorrhage and/or spontaneous abortion can occur during or after the procedure. They also reference data that says selective reduction does not significantly decrease fetal loss(es). However, their claims are not entirely correct, as much of this data is obsolete, having been collected over 25 years.[5] Advances in medicine, including better physician training in selective reduction procedures, improved ultrasound technique, and genetic testing to ensure complete removal of abnormal fetal tissue have vastly improved maternal and fetal outcomes in recent years.[6] The American College of Obstetrics and Gynecology is clear in its recommendation that both maternal and fetal health should be considered in selective reduction decision-making. However, the organization does not weigh in on the morality argument with regard to the “rightness” of those who agree with selective reduction versus those who do not.[7] [8] [9] [10]

One argument against selective reduction is that physicians can employ a variety of medical techniques to prevent the creation and implantation of a high number of embryos during IVF. Doing so eliminates the additionally problematic issue of how to handle “left-over” embryos. Should they be destroyed? Donated? Frozen for later use? Physician guidelines recommend a limit of implanting 2-3 embryos.[11] Some governments have weighed in on the issue, as well, with British law limiting the number of implanted embryos to three.[12] [13] Providers can also screen for the embryos that have the highest likelihood to implant. However, despite best efforts of prevention, circumstances that result in difficult decisions in the context of multifetal pregnancies continue to occur.[14]

 

Dorkina Myrick, MD, PhD, MPP, is a physician-scientist and pathologist trained at the National Institutes of Health. Dr. Myrick also previously served as a Senior Health Policy Advisor on the United States Senate. She obtained her Master of Public Policy degree at the University of Oxford in Oxford, England. Dr. Myrick is currently a JD candidate at the Boston University School of Law.

 

References:

[1] Daar, Judith F. “Selective Reducion of Multiple Pregnancy. Lifeboat Ethics in the Womb.” U.C. Davis Law Review. Volume 25. Number 4. Summer 1992.

[2] “Abortion.” Black’s Law Dictionary

[3] Meyers, David W. “Promises and Pitfalls of the New Reproductive Technology.” The Human Body and the Law. 2nd Edition. Stanford University Press. 1990. p. 70.

[4] Dickenson D, Huxtable R. Parker M. “Chapter 2: Reproductive Decisions at the Start of Life.” The Cambridge Medical Ethics Workbook. 2nd Edition. Cambridge University Press. 2010. p. 45.

[5] Evans, Mark et al. “Fetal Reduction: 25 Years’ Experience.” Fetal Diagnosis and Therapy. 35: 69-82. 2014. Data from Table 5. Online: https://www.karger.com/Article/Pdf/357974

[6] Id.

[7] “Multiple gestation pregnancy.” The ESHRE Capri Workshop Group. Hum Reprod 2000;15:1856–64. [PubMed] [Full Text]

[8] “Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy.” ACOG Practice Bulletin No. 56. American College of Obstetricians and Gynecologists. Obstet Gynecol 2004;104:869–83. [PubMed] [Obstetrics & Gynecology]

[9] “Perinatal risks associated with assisted reproductive technology.” ACOG Committee Opinion No. 324. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106:1143–6. [PubMed] [Obstetrics & Gynecology]

[10] Id. at “Multiple gestation: complicated twin, triplet, and high-order multifetal pregnancy.”

[11] “Multifetal Pregnancy Reduction.” American College of Obstetricians and Gynecologists. Committee opinion Number 553. February 2013. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Ethics/Multifetal-Pregnancy-Reduction

[12] Pinchuk, Stacey. “A difficult choice in a different voice: multiple births, selective reduction and abortion.” Duke Journal of Gender Law & Policy. Volume 7:29. Online: http://scholarship.law.duke.edu/cgi/viewcontent.cgi?article=1033&context=djglp

[13] Id. at “Multifetal Pregnancy Reduction.”

[14] Id.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s