Yesterday’s Washington Post Magazine article Too Much to Carry? is astounding for its straightforward account of "selective reduction," where modern technology enables doctors to help women get pregnant with a monumental catch: if in vitro fertilization (IVF) produces more embryos than the mother wants, the doctor improves the chances of a successful delivery of the wanted babies "by sacrificing [the unwanted] fetus in utero." By showing the mother a sonogram of the 12-week-old fetuses, the doctor and mother determine which fetuses live and which are "sacrificed" so that the others have a greater chance of survival. Most telling is the reaction of the mothers who see and recognize exactly what is entailed in this procedure:
Greenbaum turned the screen toward the patient. "That’s the little heartbeat," she said, pointing to the area where a tiny organ was clearly pulsing. "And there are the little hands. There’s the head. The body."
"Oh, my God, I can really see it!" the patient cried. "Oh, my God! I can see the fingers!"
"Okay!" she said, abruptly, gesturing for the screen to be turned away. She began sobbing. There were no tissues in the room, so her husband gave her a paper towel, which she crumpled to her face. The patient spent the rest of the procedure with her hospital gown over her face, so she would not see any more of what was happening.
WHAT WAS HAPPENING WAS DAY ONE OF A TWO-DAY PROCESS, in which one of the woman’s three fetuses would be eliminated through an injection of potassium chloride, which stops the fetal heart.
Here’s what the article goes on to describe in the procedure:
Destroying a fetus requires three hands: one to hold the ultrasound transducer on the patient’s belly; one to inject the needle and maneuver it into a position near the fetal heart; another to draw out the metal rod at the core of the needle and replace it with the vial of potassium chloride. . . . [Dr.] Evans worked for a while trying to get the needle into the right spot.
"I’m not in," he said at one point, tensely. Then he pinned [Fetus] C with the needle, and pushed the plunger to release the chemical. The fetus, which had been undulating and waving, went still. It would remain in the womb, while the other fetuses grew and developed.
"Let’s check the other two," Evans said, and they moved the transducer to see the other two fetuses, still there, still waving, two hearts beating, unaware of what had just happened to the sibling they would never have. "Do you want to see your twins?" he asked the patient.
"I don’t want to see the other one," the woman said quickly.
Here’s what the doctor’s assistant said:
Still, she says: "It’s a very hard procedure, because the baby is moving, and you are chasing it. That is what is very emotional--when the baby is moving and you are chasing it.
"Do you still feel emotional?" she asked [Dr.] Evans.
"I’ve come to look at it as: The finished product has a much better chance of surviving," replied Evans, who had been following the conversation intently. "Look, you never want to dehumanize it, because then you get cavalier. You have to keep the big picture in mind. We’re not losing one. We’re saving some."
Dr. Evans justifies this procedure as follows:
Evans has written articles arguing that it is ethical to reduce a twin pregnancy. After all, he said, if it’s okay to reduce from one to none--that is, if you support abortion rights--then two to one should be okay, too. The idea is still controversial. "Twenty years ago, the ethical debate was with triplets. But now, as far as I’m concerned, there is no doubt about triplets, and the ethical debate has moved to twins."
Doctor Evans is no fool; he knows exactly what he is doing, consulting with a bioethicist early on to consider the moral ramifications of a procedure he originated. He basically considers selective reduction a form of triage: since he can help some of the embryos come to term better than getting all of them to term, he does not consider the act an abortion, as abortion terminates a pregnancy while what he does continues the pregnancy. As I say, Evans is no fool. Here’s what he calls the fetus they decide to kill:
Evans plunged the second needle into Emma’s belly. "See the tip?" he said, showing the women where the tip of the needle was visible on the ultrasound screen. Even I could see it: a white spot hovering near the heart. [Fetus] D was moving. Evans started injecting. He went very slowly. "If you inject too fast, you blow the kid off your needle," he explained.
After reading Hadley Arkes’s excellent letter to the Wall St. Journal editor (5/17/07) entitled "We See Real Human Beings Killed" (which commented inter alia on embryology and humanity), then reading this piece above on selective reductions(excepted from Liza Mundy’s new book, Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World), I thought it timely, more than timely, to bring this affecting, must-read essay to our attention.
UPDATE: Checkout this link, which provides the on-line discussion the author had with readers about her article on Monday.