Nadya Suleman, the Southern California woman who gave birth to octuplets nearly four weeks ago, continues to be a topic of discussion at water coolers and bus stops, and even in medical school classrooms.
Praised by the pro-family lobby, attacked by the media, Suleman has had her clarity of thinking questioned by the average person who is struggling to manage just a few young children. The 33-year-old single mother denies she is irresponsible and claims she can handle her family of 14 children – all under the age of 8.
At a recent seminar, medical students wondered about our society's priorities. One student recounted how she had recently seen several women who were having their second, third or fourth baby, all born with fetal alcohol syndrome. Another told of drug- addicted women who were unable to stop using drugs, even though they knew it would affect the outcome of their babies.
Another student raised her hand to ask if perhaps women should be required to have a license to reproduce. She wondered if the ability to have children should be a right or a privilege. She acknowledged that in our country, women have a right to prevent getting pregnant, but perhaps giving birth shouldn't be a right but a privilege.
Legal and ethical experts define a term "personal procreative liberty" as the freedom to decide whether to have and raise children without government interference unless there is a compelling reason to limit that freedom. The issue becomes: What constitutes a "compelling reason"? A drug addiction? Mental retardation? Immaturity?
There is another concept, "procreative liberty for society," which suggests that people should be able to decide what types of reproductive circumstances are in the best interest of a healthy society.
Assisted reproductive technologies have allowed a large percentage of infertile women to have children. But should there be limits as to the number of embryos a woman can have (as with Suleman)? And what about quality of the fetus? What if a woman is known to be carrying a fetus with a fatal or severe deformity? Should she alone have the right to make a reproductive decision? Does it matter if she is rich and can pay for the baby's care on her own, or poor?
At this point, many people are undoubtedly thinking about the horrors of eugenic selection (choosing the best and smartest babies), as occurred in Germany during World War II, and in the United States before that. What if a society determines that a certain race or a certain IQ is undesirable? Might that be a reason to limit a woman's right to bear that child?
Suleman's situation has rekindled a debate around fitness for motherhood, the abuse of reproductive technologies and the role of society in choosing to limit a woman's choice. Perhaps it is a time, not to attack the individual, but a time for society to ponder some important issues.
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Reach him at drwilkes@sacbee.com.
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