One of the best-kept secrets of IVF is selective reduction — killing one or more foetuses in the womb of a woman who is carrying twins, triplets or quadruplets. In a new book, "Everything Conceivable", Washington Post writer Liza Mundy describes how it works. She conducted an in-depth interview with Manhattan obstetrician Mark Evans, one of the few American doctors who is willing not only to do reductions, but to discuss them and rationalise them.
Little is known about how widespread the practice is. Because of the growing number of pregnancies achieved with assisted reproduction techniques, including IVF and artificial insemination, there has been an explosion of high-risk multiple pregnancies. But no one keeps statistics on how many of these are "reduced". The US Centers for Disease Control and Prevention publishes an annual report on fertility clinic outcomes, but not on this procedure. The fertility industry does not keep statistics either. "This is a very sensitive topic," says David Grainger, president of the Society for Assisted Reproductive Technology.
Ms Mundy sat in on several interviews which Dr Evans had with his patients: a couple with IVF triplets (reduced from three to two), a lesbian couple with quads (four to two), and a young and immature Puerto Rican woman with triplets who had flown in from San Juan with her mother, her grandmother and another older woman (three to two).
Dr Evans has constructed his own bioethics on the fly, as the demand for various services fluctuated over the past 20 years. When he began work, 40 to 45% of his patients had quads. Now it is only 20%. At first he regarded it as unethical to reduce a normal twin pregnancy. Nowadays, he is willing to reduce from two to one. He argues that if it is OK to reduce from one to none (if one accepts abortion as ethical), then it must be OK to reduce from two to one.
The effects of reduction upon the mother and her relationship with the surviving children are not well understood either. The immediate feeling is relief, but later on women may feel depressed. An authority in multifoetal pregnancies, Isaac Blickstein says, "psychoanalytic interviews with women who underwent [selective reduction] describe severe bereavement reactions including ambivalence, guilt, and a sense of narcissistic injury, all of which increased the complexity of their attachment to the remaining babies."
PRESENTING HOLLAND’S ORGAN DONOR CIRCUS
Do you think that TV can’t get any worse? Think again. Prepare for the Big Donor Show, a one-off 80-minute Dutch reality TV program in which a dying woman decides which of three sick patients will get her kidneys. It is "degrading and heartless" in the opinion of some Dutch parliamentarians, but the production company, Endemol, insists that it is in the public interest. "It’s to boost public awareness about a shortage of organs for transplant," explained a spokesman.
It is also in memory of the memory of the founder of the network on which the show will be broadcast, Bart de Graaff, who died five years ago at the age of 35 from kidney failure.
A 37-year-old woman named Lisa with an inoperable brain tumour will interview candidates. Viewers will be cast their votes for the one they like best by sending an SMS text message. "We know that this program is super-controversial and some people will think it’s tasteless, but we think the reality is even more shocking and tasteless. Waiting for an organ is just like playing the lottery," explained the chairman of the BNN network.
Despite the hoopla surrounding the donation, it may not happen anyway. According to Dutch law, only living donors can direct donations. Organs from deceased donors go to the neediest candidate on a national waiting list.
Education minister Ronald Plasterk said that the program was "unfitting and unethical" but it would be censorship to ban it.
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