Almost all discussions about reproductive ethics are invariably deformed by analogizing to abortion. The train of thought goes something like this: the conclusion of an ethics discussion must result in confirming the right to abortion; anything that limits a woman’s reproductive choices could potentially impact the right to abortion; therefore, there can never be any limits to women’s reproductive choices.
That argument is weak, wrong and does not consider what the “choice” in pro-choice actually means. The “choice” is the decision to have an abortion, and it does not extend to any possible choice in reproductive ethics. That’s why Nadya Suleman had a right to get pregnant, a right to terminate the pregnancy and a right to carry it to term. She had no right to deliberately conceive octuplets, however, and it is a misunderstanding of reproductive rights to claim that she did.
Ultimately the protection for the choice of abortion is rooted in the right to bodily autonomy. No one can interfere with a person’s right to control his or her own body. No one can force an individual to donate a kidney, to accept a particular medical treatment, or even to accept lifesaving care. The individual has no obligation to do any of those things, and always has a right to say “no.” But that does not mean that the converse is true. Bodily autonomy is the right to refuse various measures, but there is no concomitant right to undergo whatever medical procedures one might wish.
Similarly, the right to an abortion is rooted in the right to refuse to continue a pregnancy, particularly because pregnancy has a small but real risk of death. No woman can be forced to remain pregnant against her will.
Bodily autonomy allows the individual to refuse to donate a kidney. It does not allow the individual to have a doctor remove his kidney to sell to someone else. It also does not confer the right to have a leg amputated or an eye put out, simply because the patient might desire it.
Bodily autonomy means that patients have the right to refuse cancer care even if that might lead to death from cancer. It does not mean that they have the right to receive chemotherapy when they don’t have cancer, because they want to see what chemotherapy is like. Nor does it mean that they have the right to demand unapproved medical treatments or inappropriate medical treatments, no matter how much they believe that they might work, or how desperately they want them.
The right to an abortion implies a concomitant right to get pregnant spontaneously and to carry a pregnancy to term. Yet women who cannot get pregnant have no “right” to infertility care. Moreover, even if they are paying for infertility care, they have no right to dictate inappropriate fertility treatment or unapproved fertility treatment. That means that there is no right to demand an excessive number of embryos to be transferred even if that’s what the patient might want. The current medico-ethical recommendation for women under the age of 35 is two embryos. There is no “right” to demand more, and the right to control one’s own body does not confer the right to demand more.
Nadya Suleman had no “right” to conceive octuplets. She had no “right” to demand that 8 embryos be returned to her uterus, and the doctor had no “right” to put them there. If, as seems more plausible, she conceived octuplets using fertility medication, she had no “right” to take excessive doses of medication, and certainly no “right” to take fertility medication if she did not meet the medical definition of infertility.
In the rush to protect abortion rights, people should not ignore the rest of medical ethics. The right to end a pregnancy does not confer the right to begin one using artificial means. The right to selectively reduce a multiple pregnancy does not confer the right to create a multiple pregnancy of any number of embryos. In fact, the right to control one’s body does not confer the right to demand medical treatment of any kind if it is not medically indicated.
The “right to choose” is the right to choose to terminate a pregnancy; it does not confer a right to choose anything, even if it is a reproductive choice.
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Comments
I don't come down on either side of this issue, because I don't know. I am interested in arguments on both sides, though.
"do we say that teenagers who cut themselves, by analogy, are violating their own rights?"
No, we say that teenagers have no "right" to cut themselves.
Not having the right to do something does not mean that you are violating your own rights when you do it. For example, you have no "right" to use cocaine. If you use cocaine, you are not violating your own rights. Of: You have the right to vote, but you are not violating your own rights if you don't vote.
You know nothing AT ALL about her reasons for doing this and, even if you DID, you'd still have no right to get on her case. It is just one more example of people trying to mess around with other people's lives.
"Rule by public opinion" is abominable. If your yapping leads to a law interfering with other people's choices on this matter, soon you, or others, will be trying to have laws passed to tell folks how to make other personal choices.
There are already far too many "interference with other folks" laws on the books.
Not one of you lives such an exemplary life that you can even claim to always know what to do about things which concern YOU. Where do you get off trying to tell others what they may or may not do.
Keep your doggone nose in your own affairs and out of other peoples business. Until the day comes when you are perfect, you need all your concern directed toward your own life.
Jeeze, I hate busibodies!!!!
"Not one of you lives such an exemplary life that you can even claim to always know what to do about things which concern YOU. Where do you get off trying to tell others what they may or may not do."
Did you even read what I wrote? This is about ethics, not about this woman's particular choices.
I wrote about whether there is a philosophical right to demand medically unindicated or medically inappropriate treatment. There is no such right. Do you think there is a right to demand medically unindicated or inappropriate treatment?
Seriously, what is the motivation here? Guiness Records? Lifetime TV movie? Who is paying for litter-babies? ...It can't be the Gaia-wombed mother, who already has several pups to feed from earlier...
"Where does this definition come from and why is it restricted in this particular way?"
Good question.
It reflects the difference between negative and positive rights. A negative right is the right to be left alone. That's the basis of many of our rights. A positive right, on the other hand, is an affirmative right to something.
So, for example, the First Amendment guarantees the right to free speech, which means that no one can interfere with your ability to speak your mind. It does not mean that a newspaper or TV station is required to give you a forum to express your views.
On the other hand, the right to a trial by jury is a positive right. The government must provide each individual accused of a crime with a trial by jury and everything that entails regardless of the cost. You even have a positive right to a lawyer, whether or not you can pay.
"Does your understanding of bodily autonomy say that I don't have the right to get a tattoo or a body piercing?"
I think that the problem here is that you are using "right" in a colloquial sense, meaning that no one can stop you. So when you say the "right" to get a tattoo, what you mean is that no one can stop you from getting a tattoo.
I am using "right" in the philosophical sense. A right is something that society is legally or morally obligated to provide for the individual. In that sense, there is no "right" to get a tattoo.
No, that's not the the problem here.
Right you are, AT. But to go even further, a positive right inevitably involves a concommitant duty on the part of someone else and that's the rub. That's where we lost our way as a society.
The right of free speech doesn't involve anyone's duty to listen. The right to education, however, is totally different; it involves the duty of taxpayers to provide it at the point of a gun through taxation.
I would, however, quarrel with your notion that a woman has an unlimited right to terminate a pregnancy. Once another life is involved, that right must be severely limited. Not being a scientist, I don't know exactly when that "once" occurs. I'm reasonably sure it doesn't occur at conception, but I'm totally sure it does occur after five months when our little mother-to-be should have made up her bloody mind, if any.
I think this latest pathological incident is more challenging to the media and the public than to the mother and her family. If the family can, without public or media support, live with the consequences of this insane act, no problem. But any media who pays this woman or her family one penny for the "story" is performing an unbelievably venal act. And anyone who watches any such program or otherwise supports in any financial way this obscenity is equally culpable.
- she has 6 children, all the result of prior implantation
- her own mother has reported that her daughter was forced into mental therapy due to her unusual, obsessive "need" to have children
- she is unemployed and on welfare without a means to cover the costs of raising these children. A 2008 federal government report estimated the cost of raising a child from birth to age 18 in a normal home environment runs to $206,000; so this family now faces a total cost of at least $2.8MM. That does not account for the need for additional help just to physically attend to this many children. Absent a movie of the week deal, the California taxpayer will bear most if not all the cost of raising this brood
- with each additional child, this mother robs time and attention from her current children, virtually assuring that each child will have their prospect for success reduced to some degree.
This episode was the result of a woman with an obsession for having children being enabled by a physician willing to ignore ethical guidelines depending on others (taxpayers without a say in this) to pay the price.
"I would, however, quarrel with your notion that a woman has an unlimited right to terminate a pregnancy."
You're right. I was not clear about that. A woman does not have an unlimited amount of time to terminate a pregnancy. She only has an unlimited right to terminate within the time frame allowed (usually the first 24 weeks of pregnancy).
"I think that some pertinent facts here argue that she did not have a moral "right" to the implantation of 8 embryos:"
Although I agree absolutely with your reasons as to why this was a very bad, if not outright pathological choice, the actual reasons don't matter. No one has the "right" to choose or receive medical care that violates accepted guidelines for safe, appropriate care, regardless of how good or bad their reasons might be.
That's why this situation is completely unrelated to abortion rights. There is no affirmative right to fertility treatment of any kind.
Women have a legal right to choose to get pregnant, to pursue ivf, to get contraception, and to get abortion. Fundamental rights.
Doctors may self-regulate, as private individuals, and as a profession. There's no obligation to YOU or to any other doctor to assist women with IVF, and no obligation to the profession, as a whole, to condone it.
The right to an abortion IS the same right as the right to bear children. While my support for abortion does come from my strong belief in bodily autonomy, the right itself is grounded in the right to have decisions regarding pregnancy, family, intimate relationships, and child-rearing free of government influence.
It's a fundamental right, Dr.
The government may only legislate against the exercise of a fundamental right when they have a compelling reason, when the legislation is narrowly tailored, and when the legislation is the least restrictive possible.
You don't have to perform IVF on anyone you don't want to, just as other doctors don't have to perform abortions on demand - but the Government may NOT pass laws regulating either without compelling reasons.
"Women have a legal right to choose to get pregnant, to pursue ivf, to get contraception, and to get abortion. Fundamental rights."
And nowhere in there is the legal right to have more embryos than medically indicated implanted in your uterus. You also don't have the right to be treated with fertility medications if you are not infertile.
Treatment for infertility is a medical service. No one has the right to demand any medical services that are unsafe, unindicated or inappropriate.
And Doctors have a right to refuse.
"And they have a right to demand them."
No, they don't. Where are the legal cases that support your claims? To my knowledge, there are no legal cases that assert a right to receive inappropriate medical care.
A person doesn't have a right to any kind of medical care on demand, but they have a right to seek, and a right to ask, and a right to ask vehemently.
I, personally, think that doctors have far too much power in our society. The way that doctors' purported 'professional judgment' infringes on the way that people are able to live - bothers me. A lot.
But doctors have a right to refuse to perform any medical procedure, for a good or a bad reason, just as a lawyer may refuse any client.
Of course, a firm can always fire a lawyer for refusing to work on a case, because that's within their rights. And a hospital, or practice, or clinic - can always fire a doctor for refusing to perform a procedure - because that's within their rights.
You see how it all balances out?
"You see how it all balances out?"
No, I don't.
You have a asserted the claim that there is a legal (and presumably philosophical) right to have 8 embryos implanted into your uterus. I am saying that no such right exists.
This is not an opinion issue. Either there is a legal right, enunciated by a legislature or court, or there isn't. I'm not aware of any laws or cases that assert such a right. Do you know of any?
In the absence of law or case law, there cannot be a "right."
She asserted no such thing and you know it. She asserted that patients have the unqualified right to ASK FOR any and all treatments.
They do not necessarily have the right to RECEIVE these treatments.
We all know you know the difference.
"She asserted no such thing and you know it. "
Of course she did, and on her own blog she tied it to a right to abortion.
Obviously she isn't asserting a "right" to ask for 8 embryos to be implanted, since we all know that anyone has the right "to ask" for anything. It is commonly understood that if someone says, "I have a right to all your money" he doesn't mean that he has a right to ask you for all your money; he means that you have an obligation to give him your money.
Dr. Tuteur is correct--there is likely no case law on the issue of the right to be impregnated with multiple embryos, but the principle of privacy established in Griswold suggests the possibility that a court would say you have the right to get just as pregnant as you want to. However, the legal question here is not, to me, as interesting as the question of medical ethics. Whether a woman has a right to have multiple embryos implanted, should medical regulatory agencies say that it is unprofessional and unethical to do so.
This seems like an area where rational regulation by the experts makes the most sense. Without impinging on a woman's right to choose umpteen babies, they could say that certain procedures, likely to result in multiple implantations should not be performed by licensed physicians or certified fertility specialists.
Benton Williams, J.D., Ph.D.
In which she only asserts that people have the right to request any and all treatments. And even request them vehemently. Even if the doctors keep refusing. As is their right.
And yes, if a person says "I have a right to your money," they are incorrect. On the other hand, a person has every right to ask you, "May I have your money?" Just as you have every right to say,
"no."
This woman had the right to request 27 embryos be implanted in her uterus. She has the right to ask that 27 embryos and a plasma TV be implanted in her uterus. That doesn't mean she has the right to have it done.
It's clearly unethical to help a mentally ill person harm herself.
The term "reproductive rights" would seem to signify that one may have, or not have , as many children as one wishes. "Abortion rights" would seem to indicate the right to have abortions. There is a difference implicit in the two terms. Don't you agree ?
The right to do something, is not the right to have something done to you. Doctors are private individuals. They cannot be forced to perform procedures. They cannot be, even, forced to practice medicine at all. (Citation - 13th amendment. Forced labor is not ok.)
Therefore, although the right to privacy in decisions relating to childrearing, pregnancy, intimate marital relations, etc (Citation - Griswold v. Connecticutt, Eisenstadt v. Baird, Loving v. Virginia, Lawrence v. Texas, Roe v. Wade, and on, and on, and on) is a fundamental one, and cannot be interfered with by the state without a compelling reason.
The right to be free from state interference and regulation of family life - the right which makes abortion legal, interracial marriage legal, and forced sterilization illegal - IS NOT the right to force any person to perform personal services of any kind, whether it be performing an abortion, or solemnizing an interracial marriage.
Therefore, your argument that either there's a right to force doctors to perform IVF - or there's no right at all - is all twisted up and ridiculous.
And there ARE differences between legal rights and moral rights. It's only a very shallow thinker who believes that advocating for liberty itself, is advocating for its abuse, unchecked.
The right to choice is the right to make your own decision about what is moral.
"The term "reproductive rights" would seem to signify that one may have, or not have , as many children as one wishes. "Abortion rights" would seem to indicate the right to have abortions. There is a difference implicit in the two terms. Don't you agree ?"
"Reproductive rights" is an umbrella term that encompasses abortion rights. Although there are some philosophers who argue for total freedom in any aspect of reproduction, reproductive rights do not extend to the right to have infertility treatment. In fact, unfortunately, there is no recognized legal right to healthcare of any kind, let alone infertility treatment.
No one has the right to demand any healthcare that is unindicated, harmful or inappropriate, and that includes reproductive healthcare as well as non-reproductive healthcare.
"Therefore, your argument that either there's a right to force doctors to perform IVF - or there's no right at all - is all twisted up and ridiculous."
That is not my argument. There is no right to have an excessive number of embryos implanted, period. It doesn't matter if you want it. It doesn't matter that it is a reproductive choice. It doesn't matter whether you think it is or is not the business of other people. The "right" that you are articulating does not exist.
You could not possibly sue a doctor for refusing to implant eight embryos because you don't have a right to have eight embryos implanted. If you did, you could find law or case law that confers that right, and to my knowledge, there is no law or case law that does so.
You raise slipperiness to a High Art.
One moment you are stating that you are making a moral/ethical argument - the next you are falling back on 'case law' or lack thereof.
Let's face it; you are one of those people who just can't resist poking your nose into other people's affairs. Being a doctor gives you an excuse for doing so in some cases. You extend that 'right' way too far.
Again you know nothing of this woman's motives. I don't either but perhaps she fully realized the financial implications and what might be expected to come her way from contracts with movie makers, and others who climb all over things like this.
You can bet yer bippy that those who say now that they would not 'support' anything like this will be first in line to see it at the theaters or on TV. They will do so, IF ONLY to criticize that woman and the people who reward her handsomely.
And again....you don't have time enough in your life to deal with YOUR OWN affairs. Stay our of other peoples. It is JUST NOT any of your business.
As far as your nifty little term "medically indicated" is concerned, do you think we don't know that this is only a euphemism for "Only the doctors have a right to decide"?
I am fortunate indeed that Dictator Amy is NOT my doctor.
You seem to commit a typical mistake of confusing actions of the state with actions of individuals. A doctor can refuse a course of treatment proposed by a patient, however a state may often be forbidden from action or required to take action.
I know this is tangential to the original post, but as both a physician and unsuccessful IVF vet, I get so annoyed when people describe embryos as being implanted with IVF. I wish they could be implanted...but alas, they can only be transferred to the uterus with hope and prayer that they will chose to implant.
Humans simply were not meant to carry more than one or occasionally two babies at once. That is why, absent fertility treatments, anything over twins is exceedingly rare. (A history from my mother's hometown of about 4,000 people listed only two sets of triplets born between 1865 and 1965.)
Not wishing to regurgitate the arguments here of moral, economic or ethical issues but at the end of the day it will be reduced to a basic supply and demand issue. Another attempt of a government to enforce moral issues through economics. Why does China have a state enforced policy of birth control if it is a human right? Why do mothers in Africa continue to have 19 children all with aids? Have personal stories from both.
My assertion for years is that when the private and professional sector will not regulate itself…then the government will have to step in and do the job without recourse.
George: Look, mister, there's... two kinds of dumb, uh... guy that gets naked and runs out in the snow and barks at the moon, and, uh, guy who does the same thing in my living room. First one don't matter, the second one you're kinda forced to deal with. (From the movie: The Hoosiers)
You have personal freedom to fly airplanes anywhere you want…but when you fly two airplanes full of people into the twin towers…we’re kinda forced to deal with it.
So while she has the “right” to have as many kids as she wants…when she economically dips into my pocket for finances for the consequence of her decisions…then I’m kinda forced to deal with it.
Yes in the end all her expenses will be covered by the state of California. Who else can pay for this? Not Oprah…it is estimated far over 20 million not counting collage if they even get that far. Now Gov Arnold is asking the Feds for 17 Billion in aide…11 Billion of which has gone to social programs for indigents and illegals. Mostly medical, welfare, food stamps and ADC. Now she is on those programs and we as FEDERAL taxpayers get to support her. Now I become involved.
Eventually…and this is where my assertion comes in…is this. When you insert a program CD into your computer to install a program you have to type in the Serial # to activate the program.
As scientists are nearing to crack the entire DNA code…eventually…each baby will be born with that reproductive gene missing. After petitioning the govt for the exclusive right to reproduce, couples who are approved based upon family, finances, psychological profiles et al. are injected with the missing gene to unlock their specific DNA code. Each couple will have the “right” to have two children…zero population growth. The stuff movies have already been made from. End of argument.
World Population Growth:
1900: 2 billion
2000: 6 billion
2100: 18 billion (predicted)
After this prime example of abuse of rights…how many will be enough…before individual rights become privileges.
That would open the door to so much abuse, I do not know where to start. Have you read "1984?"
As I understand it, the idea is that you have the right to bodily autonomy, which may give you the right to abortion. But you don't have the right to have any procedure done for you that you want -- just as as person cannot (morally) require the state to pay for his ear piercing or whatever.
This does raise the question (suggested by others above) of what would happen if a woman were able to bring about this process on her own -- without the assistance of others. Would she have a "negative right" to be left alone to do so? I sort of think "no," but I'm not sure why.
I totally agree. All this clamor about "Rights" and nothing about "Responsibilities". And I don't see the connection with the right to abortion either.