The Ethical and Legal Implications of Octuplets

We all know about the old woman who lived in a shoe, the one with all those kids and who didn't know what to do. Well, one thing she didn't do was have eight more kids. And this wasn't because nothing rhymes with octuplets.

Having eight children at once — or seven, six, five or four, for that matter — is not healthy for the children. Such human litters rarely occur naturally because, the sad truth is, the children rarely survive to adulthood to mate and to pass along a genetic predisposition to multiple births.

It's a simple medical fact that the more babies in the brood, the lower their average birth weight. And the lower their birth weight, the more they are susceptible to a lifetime of health and social challenges.

The question is why would a medical doctor deliberately implant six embryos in a woman when this would guarantee a known medical condition called "very low birth weight" (VLBW) or quite possibly "extreme low birth weight" (ELBW). Among Nadya Suleman's eight new children, six were VLBW (below 3.3 pounds) and two were ELBW (below 2.2 pounds).

Implanting disease

The California Medical Board and the American Society for Reproductive Medicine are curious, too. Earlier this month they announced separately that they were investigating the Suleman case, stopping short of naming Michael Kamrava, the fertility doctor thought to have aided Suleman.

While much has been said about the social ramifications of the Suleman octuplets — such as issues about being a single mother, or the impact on the welfare system — these medical organizations need to investigate the case as they would any malpractice suit: Did the doctor deliberately put eight children at risk for serious medical conditions?

The science is rather conclusive that VLBW and particularly ELBW pose serious health risks. Many of these babies don't survive their first year, succumbing to hypothermia, respiratory problems, electrolyte imbalances, anemia, hemorrhaging, poor absorption of nutrients or infections.

Many babies survive and indeed thrive, but the odds are stacked against them.

Tough road

A study published in JAMA in 2005 followed over 200 ELBW babies until age 8 and found 14 percent to have cerebral palsy; 21 percent to have asthma; 10 percent to have vision worse than 20/200; nearly 40 percent to have an IQ lower than 85, which approaches a mental deficiency; and nearly 50 percent with poor motor skills.

Similarly, a study in Pediatrics in 2000 found that more than 50 percent of VLBW babies and up to 70 percent ELBW babies need special assistance at school.

Bad news often follows these kids through life.

Many studies of VLBW reveal higher rates of attention deficit disorders, brain abnormalities, hearing loss and chronic diseases. A 2007 study in the New England Journal of Medicine found that VLBW adults are at greater risk of developing diabetes and high blood pressure due to worsening glucose intolerance from birth.

A 2004 study in Pediatrics showed VLBW adults had on average a 17 percent reduction in the size of their posterior corpus callosum, that part of the brain that connects the left and right hemispheres. A 2008 Swedish study revealed half of VLBW adults had below-average IQs, with nearly 12 percent classified with extremely low intelligence.

Improving the odds

ELBW and VLBW are on the rise as a result in part of infertility treatments and multiple births. Yet other, poorly understood factors are at play, such as a mother's race, age and general health.

The health costs are staggering. A 2007 study in Pediatrics estimates that nearly $6 billion is spent annually on low-birth-weight deliveries, with an average ELBW birth costing $65,600.

The good news is that more and more ELBW and VLBW individuals are leading healthier lives with few if any cognitive delays as the result of medication and other interventions. Suleman children, if they are lucky, will grow up healthy. They are in fact off to a good start, born heavier than expected.

If these innocent kids survive and thrive, then the doctor, too, is lucky. His professional peers, however, might not view him any less guilty of placing eight children at risk for a hard life.

• The Future of Babymaking
• All About Pregnancy: News and Information
• Octuplets Reveal Limits to Human Empathy

Christopher Wanjek is the author of the books "Bad Medicine" and "Food At Work." His column, Bad Medicine, appears each Tuesday on LiveScience.