Tuesday, February 10, 2009

Don't Look At Me, I Just Work Here

Like Kerry Howley, I believe that when it comes to government regulation of in-vitro fertilization gone wild, the bureaucratic cure could be worse than the infertility cure.

However, Kerry sees a doctor who performs IVF as a morally neutral agent, working like an employee at the One-Hour-Photo Shop, shrugging his shoulders as he develops mementos of adultery and scandal, separating his own duties from his clients' sins.

We ought to distinguish crusades of government, as well as the passive observation of moral indiscretions already committed, from the actions of clinicians who potentially cause significant harm. Carrying octuplets to term would almost certainly lead to low gestational birth ages and weights (the California woman's offspring averaged about 2.5 pounds), as well as a dramatically increased risk of abruptio placenta, congenital malformations, eclampsia, or other events that could lead to long-term adverse effects for the products of this Guinness Book adventure. Indeed, someone might find it precious to ensure the birth of a child with Huntington's Disease, so Junior could be "just like mom," but I would decline the request to preferentially pluck such favored follicles.

Of course, we risk committing "IVF refusal ad absurdam"; We begin with objections to embryos with HD, and end with the dismissal of embryos cursed with my characteristic attached earlobes. Additionally, dramatically increased risk does not equal a guarantee of harm. Thus, I understand why conscientious clinicians might not yet object to the implantation of eight embryos. However, I reject the overall notion that a doctor ought to shove fingers in her ears, ignoring the loud protestations of her ventromedial prefrontal cortex, as it shouts that something is not quite right.

Upon public outbursts, such as "How could doctors let her bring so many babies to term?," Kerry counters with
"If there is a problem here, I’m pretty sure it is not that doctors are insufficiently judgmental in matters of female reproduction. Fertility specialists are medical service providers, not religious counselors, not ethicists. I would no more ask a GP whether it is ethical to bring 8 babies to term than I would ask her to hold forth on the existence of souls."
The problem is, the critic does not necessarily esteem the doctor an expert on ethical matters, but merely objects to the doctor's violation of said critic's own ethical views. I'm not concerned with the accountant's opinions on the ethics of tax fraud. But I will denounce him when he unscrupulously helps people cheat.


Bill said...

In our Roe vs. Wade era, privacy trumps ethics. The accountant encouraging tax fraud is breaking the law, it is a public act. But I would guess that IVF falls in the "penumbras" and "emanations" of personal autonomy that made Roe vs. Wade possible.

I doubt if there is any way to put this genie back in the bottle.

themadengineer said...

The doctor is put into an unfortunate bind. If the doctor agrees to help this woman as she wishes, he or she will be yelled at by childhood advocates, as this will less good for her offspring than a pregnancy with one fetus, and by anti-population-growth activists. If the doctor refuses to help her, she and reproductive-rights-activists (and possibly parenting activists) will get on his or her case.
No-win scenarios are incredibly frustrating.

Heal Spieler said...

Hi Bill,
Yes, I suppose the privacy concerns distinguishes the two issues. It is difficult to tease out morality when there are issues involving the legitimacy of acquring knowledge about the action, in the first place. Not an easy question.

Hi Mad Engineer,
Yes, I agree it's very frustrating. It is difficult to make a decision about doing the right thing, when it is clear, even before the decisions is made, that you will be criticized. And I feel that the sting of censure is generally felt more strongly than the happiness from praise. The paradox is, you want input from other people before making a moral choice, to ensure that you're not "missing something." However, the more voices you hear, the more you will feel the burn of having made more people angry.
I know that this is a more mushy psychological, rather than legal look at the issue, but it is the one that I fear more, nonetheless.

themadengineer said...

Morality inherently involves "mushy" psychological issues -- more than one system of morality has emerged and people disagree on both basis and fact in moral issues.

"Not missing anything" sounds like the right approach. You can always do actions later, but you can't take back what you've already done.