Being fruitful, but responsible

Octuplets' birth sparks debate on ethics of child-bearing
April 13, 2009

"And God blessed them, and God said unto them, 'Be fruitful, and multiply, and replenish the earth.'" (Genesis 1:28)

Surely having children is a blessing and a joy. Yet this passage from Genesis tells us that we are to have them, not just for our own delight, but also to assist in the renewal of God's creation.

We are gifted with children, rather than entitled to them. Marrying and having children, the Book of Common Prayer declares in The Celebration and Blessing of a Marriage, are not to be entered into unadvisedly or lightly, but "reverently and deliberately."

A recent foray into the world of assisted reproduction by a single 33-year-old woman to have more children – octuplets, as it turned out – to add to six under the age of 8 already living, however, leaves us perplexed and concerned. Ought we to have as many children as our bodies will bear?

Is it possible for us to cherish and nurture children as creatures with their own uniqueness and integrity if we deliberately have more than a dozen of them who are very young? What are the limits to God's call to us to be fruitful and multiply?

The Christian tradition teaches that we are to refrain from using our children as mere instruments to fulfill our own desires. They are not our possessions, products or projects; they are our trusts.

We are to bring them into the world responsibly, according to the Anglican branch of the Christian tradition, which, at a 1930 Lambeth Conference, approved of the use of contraception to space the births of children so that they can receive appropriate nurture and care. The Episcopal Church recognizes that some among us face the agonizing realities of infertility and supports the use of in vitro fertilization (IVF) for the purpose of providing children in a marriage (a resolution of the 1982 General Convention).

It is a question of balance. We are to attempt to have and raise children in view of our own capabilities and circumstances, as well as the undoubtedly numerous needs of our offspring.

Many of those responding to the octuplets story worry that these considerations were set aside in this case and that the major focus of concern of the woman involved, according to reports, was to have more children, regardless of whether she could nurture and support them. Those children should be the central focus of our concern.

What role should society play in their upbringing and nurture? Should it keep them under the auspices of their biological mother and help fund their care? Or should it place them in foster or adoptive homes?

The latter choice would seem unfair considering that there are large families in which children have been brought into the world in the old fashioned way that do not have their "surplus" children confiscated. Why should those who learn that they have multiple embryos developing after an IVF transfer automatically be treated differently and subjected to loss of their children?

Whether multiple children are brought into the world as a result of a natural or medical act, the main consideration relevant to deciding whether parents should be allowed to keep their children is whether the children would be subject to injury, neglect or abuse if kept with their biological parents.

If that appears likely, there would be grounds to remove them from those who brought them into the world. In the case of the octuplets, the situation is unclear as of this writing.

The reproductive physician involved has raised the ire of those who have learned about this story. Physicians who specialize in reproduction medicine have the charge of aiding those who face physical and medical barriers to having children to try to do so safely. To enable a woman to have eight children at a time (six embryos were transferred to her, and two split) was to fail to meet this charge, in the eyes of many, and to place her life and health and that of the children at considerable risk.

The American Society of Reproductive Medicine (ASRM) has developed guidelines on the number of embryos to transfer in one IVF cycle to avoid such outcomes. These vary according to the age of the woman; the younger she is, the fewer the embryos the society recommends transferring.

Women younger than 35 are to receive no more than two embryos, according to these guidelines. Yet no regulations have been enacted to enforce this standard, and the ASRM has no means of doing so, other than to revoke the membership of those who violate its standards.

Some say that physicians eager to attract more paying patients by improving their record of producing children should not be allowed to put future children at risk of injury and disability through their selfishness and greed. They maintain that the ASRM guidelines, or even stricter ones, should be enacted into law and that physicians who do not follow them should be subject to financial penalties or even jail. Others argue, however, that this is a matter for those who seek to have children by means of IVF to decide.

Women younger than 35 who proceed with naturally induced pregnancies that involve triplets and quadruplets are applauded, no matter how many other children they have, some argue.

Those who must resort to IVF to have children should be allowed to do the same, they say. In either case, steps should be taken by social-services resources to enter into the situation if the welfare of the children is at risk.

Surely, having children to replenish the earth and bring us joy is a good and delightful end. Yet we have obligations as God's stewards to do so in ways that we believe are safe and in numbers that will allow us to care for them appropriately. Children are not mere instruments for the fulfillment of our desires, but ends in themselves whom we are to cherish and care for as God's creatures in light of our capabilities and circumstances.

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