I'm extremely tempted to say that reproductive freedom is not a positive liberty at all. In other words, you only have the negative right not to be interfered with, you do not have a positive right to demand aid from others.
Stated this bluntly, it looks like the government shouldn't fund abortions, but there are other justifications for the government to provide this service. Unwanted children are a tremendous drain on state resources. Thus a woman who does not want to be pregnant can ask the state for help with an abortion, not because she has a right to assistance with reproductive matters, but because helping her is in the state's interest as well.
I have the impression that fertility clinics in some other countries are more heavily regulated, and won't implant multiple embryos per cycle -- it lowers the odds of success per cycle, but makes this sort of multiple pregnancy impossible.
Every country on earth does a better job of regulating fertility clinics than the US. Because of the pro-life lobby, any discussion of regulating fertility treatment here gets sidetracked into an attempt to ban abortion, or to really ban any attempt to medically intervene in pregnancy.
The country with the strictest laws on IVF is Germany, largely because of the Nazi experience. There you cannot implant more embryos than you are willing to raise to adulthood.
That said, most US clinics now refuse to implant more than three embryos, which is what was going on in this case. I should read TFA, but I bet the couple was told in advance that they should be ready for three babies if they implant three embryos.
Actually, this seems like a great time to "pontificate,"
Indeed, it does. Pulling a million clams out of Medicare for this is borderline criminal.
I think they were willing to raise 3 kids, but not pay the $1M hospital bill resulting from their likely premature birth.
How do you distinguish covering someone who has triplets naturally vs. through fertility treatments? As you say, it seems dangerous to start withholding treatment from one person due to their choices when someone else has the same condition by bad luck. Person A has high blood pressure because of genetics, person B because they drink a cup of soy sauce a day, so only A gets his medication covered?
4: Medicaid, I mean, which is what was referenced in the article and is supposed to be there to assist the poor.
The whole culture of wealthy, usually somewhat older people who desperately want their own babies has long struck me as selfish and somewhat disgusting. Why not adopt? What is so precious about your own sparkly genetic material that you can justify not just these kinds of financial risks but the medical risks to mother and (possible) babies, as well?
One gigantic difference between the United States and other countries's health care systems is that we're willing to go to far greater heroics to extend someone's life an extra month, or put the preemie on a ventilator, or risk the surgery with a supremely low success rate.
I can't condemn us for this without picturing one of my loved ones on the operating table.
Point being that this contributes to astronomical health care costs.
7: It's selfish, but I completely sympathize with it. Don't you have a strong, visceral relationship with your own family that's not just based on shared history but on similarity -- the physical and personality resemblances that come from being genetically related? My aunt and uncle adopted two kids after having had three biological kids, and the relationship is very different.
5: I think one set of considerations applies when the fertility treatments are being planned, and another one when the woman is actually pregnant.
When I wrote 1 and 3 I was imaging the decision to fund fertility treatments from the outset. "Ok, we will pay to implant three embryos, knowing that you wound use selective abortion, and that the whole pregnancy will eventually cost a million dollars."
Is that to say that Medicaid picks up the bill for such babies regardless of their parents' means, as a policy? Anyone who's spent thousands of dollars on fertility treatments is perishingly unlikely to qualify for Medicaid per se. For now, until we have universal single-payer, protecting the principle of means-testing should be enough to prevent this.
7,9: I kind of think it's one of those natural human tendencies that needs to be discouraged. Yes, people want their own kids, but when they don't have them they find other ways of making life work, and those other ways can be important to the health of the society. Broadening the range of people to whom you feel a deep and visceral connection is a powerful and valuable thing.
Feh. The privileging of genetic ties is a cultural thing, is it not? I remember, from one of Richard Lewontin's articles, the claim that in the Roman republic, adoption wasn't an esatz form of the "child-of" relation; it was full stop. Not that this proves anything, but it's the start of a larger argument.
Slightly OT, I'm incensed by people who use fertility treatments then have a moral objection to selective reduction. Oh, your moral theory allows you to risk harms to future dependent life, but it doesn't allow abortion? Gah.
With Rob here and everything, I'm sorry to miss the rest of this thread for teaching reasons.
If you're looking at expense, there's a balance between the cost of having to do multiple rounds of implants using fewer embryos vs. needing reduction vs. cost of multiple births. Maybe the solution is say we won't do more than 2 embryos per round, and you get x rounds, and that's all we'll cover.
Slightly OT, I'm incensed by people who use fertility treatments then have a moral objection to selective reduction. Oh, your moral theory allows you to risk harms to future dependent life, but it doesn't allow abortion?
This. Aren't you guaranteed to be destroying at least some embryos in the process? But because you implanted them first, it's different?
And
7,9: I kind of think it's one of those natural human tendencies that needs to be discouraged.
Sure. I probably should have said empathize with rather than sympathize with -- I don't really approve, I'm just saying that I understand the reaction and I have the same one. If I'd happened to be infertile, I probably wouldn't have adopted -- I didn't want to raise a child, I wanted to raise my child. (I might have talked myself into adopting for charitable reasons, and I'm sure I would have grown to love the kid, but the idea isn't immediately appealing to me.)
11: I think the coverage varies from state to state, but Medicaid has a classification of "categorically needy" that includes very premature babies.
As one who suffered from infertility, and who opted to adopt because the success rate for in vitro wasn't very good back then, and paying tens of thousands of dollars for procedures with questionable success rates seemed, well, pointless...
I understand the desire to have a child. I went through everything short of in vitro. It is no fun. But in terms of choice - well, your choice has, in effect, been taken away. It's emotionally devastating. Going through the adoption process is no picnic: Total strangers, on the basis of a couple of interviews, a questionnaire and some letters of recommendations decide whether you're as worthy of being a parent as some 15-year-old who got knocked up in the back of a Buick. Unless you're willing to swipe a baby from some random woman at the mall, "choice" is pretty much out of your hands.
So, I can understand why someone who has been told that three embryos 'took' and that weeding them down might cause a loss of all three, might hesitate - because it might just be the only chance, because another attempt might fail completely, because, because...
But...
Would I have gone for embryo reduction, had it been me? Yes, because I'm well aware of the problems early-term birth can cause and I would not want to inflict those problems on any child. There is a judgemental part of me that says taking that kind of risk just to have a baby is selfish, is not about the child at all, but about the parent. And, to be honest, I resent the la-di-da, Medicare takes care of the expense, when there are people in this country - much less around the world - dying for want of a couple of weeks of antibiotic. I'd favour a two-embryos-only policy, which would cut down on success rates, but would equally cut down on multiple births that endanger the resulting children. [And triplets are nothing - look at the number of quads and quints born whose health problems are not limited to a few months after birth, but which will last the rest of their lives.] But that's just me.
Question: What sorts of differences have you all witnessed between the experience of raising an adopted child versus a biological child?
Medicaid has a classification of "categorically needy" that includes very premature babies.
Yeah, the point is that it's actually covering the child>, not the parents. It's the same logic that gives a tax credit to everyone who's blind, regardless of means.
14: I think something like this is the situation in Italy. They won't freeze embryos either so you can only create enough for one round.
Ireland is actually more insane than the US as we have no real regulations on fertility treatment at all despite "the unborn" having special constitutional status. There is a case regarding frozen embryos wending its way to the Supreme Court. Anyway selective reduction couldn't happen here. Possibly they may get around this by suggesting women go to England for the procedure.
My html sucks. Only "child" should be italicized.
The government is just encouraging people to be born prematurely and poke their own eyes out.
I'm with the esteemed philosopher Tom Leykis on this one... the only thing that drives people to demand children of "their own" is ego.
The article says the odds of being born before 26 weeks is 14% for triplets. How high is it for twins?
Speaking as an adoptive mommy: I couldn't imagine feeling any different about a genetic child than I do about the Offspring. [And he does "look" like me, races and colouring aside: He has my expressions, my tone of voices, my gestures. People used to say I looked like my father - odd, because he was a dark haired, more olive-skinned sort and I was your basic Nordic blonde who burnt if exposed to sunlight - but I talk like him, have the same sense of humour, etc.]
When the social worker put him into my arms, I was hit with the almost-physical-blow realisation that, altho' I understood the Mommy Tiger phenomenon of fighting to defend one's child, I had no idea that I would understand, on some primitive gut level, that this was the only other being in the world that I would be willing to die for. Or, as the Biophysicist puts it, one's kids go into the lifeboat first.
19: OK, I suppose neonatal expenses can be very hard even on parents of significant means, and you can't let a baby die because their parents couldn't. So we're back to "where do you draw the line."
Wow, people. What's with the idea that having kids (or not) is (or should be) a purely rational decision? Or that kids are purely interchangeable?
Adoption's great, and should be encouraged. Along with other ways of raising kids without using the power of law to strip birth families of all legal rights or contact, but that's another issue. That said, having kids is a pretty fundamental desire, what with our being living creatures and all, and waving that away as selfishness or ego seems pretty blithe to me.
Obviously I'm far from objective on this, having been brainwashed from a young age that "there are two ways for a child to enter a family, one is to have been born into the family, another is to be adopted," etc. But the sentiment in the end of 15 is something I just can't get my head around at all. I mean, any child of yours is your child, no matter how they became your child. Why would you care? Of course, I guess I also can't quite grok why people want kids in the first place, so this should be taken with a grain of salt.
The one sensible interpretation of this that I share is that if I were to have kids I'd really want dorky ones. And the odds of that are a bit higher if they have my genes. But that's just a trade-off, not a totally different kind of experience.
23: I'm more inclined to believe that it's more of a couple-bonding thing or a tribal thing than strictly an ego thing -- creating babies that are "like us" rather than strictly "like me." Oh, he has your eyes and my nose, she must have gotten that temper from your side of the family, that sort of thing.
But the sentiment in the end of 15 is something I just can't get my head around at all. I mean, any child of yours is your child, no matter how they became your child. Why would you care?
I suspect that it makes me a bad person to feel this way. Part of it is reacting to my aunt and uncle's family, where the adopted kids have a very different relationship to the family than the bio kids do, and the difference isn't a happy one.
31: What age were they adopted at?
bitchphd, I was talking about people who put themselves at risk or spend thousands of dollars just to get pregnant.
18: From the outside, the families I know with adopted kids seem perfectly normal and happy (or no less so than the rest of us).
My own experience is a little different but I think related. We stopped at one in large part because of my sils' health issues and because it looked likely that we were going to need to care for a couple more kids in the relatively near future. Things have developed a little differently than anticipated, and the relationship we have with nieces and nephews is a bit different than the relationship we have with our son, but they're closer, richer, and more intense than they would have been in other circumstances, and that's enriched their lives and ours.
I confess that I also have a bit of the genetic narcissism thing going on.
32: Three-ish and one-and-a-half-ish? Something like that. Not infants.
So (some, not all) living creatures desire to have kids that come from their own gametes—so what? (FL's point about Roman adoption, if true, would come into play here too, since how our so-called fundamental desires are realized depends on what gets to count as realizing them, though we probably aren't in a position to just go back to the old way of doing things on a whim. (Probably.)) Similarly "so what" to whether it's a purely rational decision or not—that something's irrational or has irrational elements is not an excuse for your having done it.
Kids aren't fungible, but you're not exchanging Kid A for Kid B when you decide to forego making one to adopt one, because one of the kids, the one you'd have made, doesn't exist yet (and if you're just now deciding which strategy to pursue, there probably isn't a determinate other kid either).
30: I hear you. And it's still silly.
33: But think about it. Having kids is a fundamental instinct for all living things, more powerful even than survival. Why *wouldn't* you put yourself at risk or spend thousands, even hundreds of thousands of dollars to fulfill that desire? What better thing could you spend your money on?
I don't mean this to be prescriptive: obviously there are a lot of people for whom survival or self-realization or independence or whatever are far more important than having children. But surely that, not the desire to have kids at whatever cost, is the aberration. And surely the fact that adoptive parents can and do love their children as fiercely as birth parents is evidence that the desire for kids isn't purely rational and shouldn't be dismissed on those grounds.
That said, having kids is a pretty fundamental desire, what with our being living creatures and all, and waving that away as selfishness or ego seems pretty blithe to me.
Nobody is talking about prohibiting others from having kids. We're talking about how many resources should be devoted and how much risk should be tolerated to satisfy that urge when nature doesn't cooperate.
That said, having kids is a pretty fundamental desire, what with our being living creatures and all, and waving that away as selfishness or ego seems pretty blithe to me.
Just to be clear, long-standing understandings of fundamental desires are now to be taken as, if not fixed, then sufficiently important that they can't be dismissed as "irrational"?
I believe I know only one couple with both a biological and an adopted child; they seem to be pretty close with both of them. Obviously "the relationship is different" (I did not quite understand that, LB, were you euphemising a better/worse distinction?) because the two children are quite different and of different ages, but in my limited observation they seem equally close to both.
All of the parents I know with adopted children (a large number among which I include myself) seem happy with the choice and close to the children to varying degrees which are not, however, obviously different from the varying degrees to which my biological-parent acquaintances seem close to and happy with their children. [pause, deep breath]
I don't think I know anybody who has gone to extreme measures to have a biological child (successfully -- a couple of the parents of adopted children I know took that route after unsuccessful medical experimentation). It seems kind of common based on the amount of coverage I see -- is this a misperception? It could of course be true that some biological children I know are the result of in vitro fertilization but the parents don't mention that to casual acquaintances.
I should note that I don't see what the woman did that is objectionable. She wanted her own kids, and did what she had to do to get them.
40: There's this "culture" thing that we developed because letting the fundamental urges run wild wasn't working.
37: The "so what" is that waving basic instincts away as irrational is a silly way to construct an argument about what living creatures "should" do.
While there are many factors one could use to judge this woman, I think that chosing (or not) to go the selective reduction route is probably the shakiest of grounds. Check out this blog for some interesting discussions of the issue, but reducing a pregnancy from triplets to twins is a shaky prospect and not easily boiled down to statistics.
My dad had an aunt and uncle who adopted their two daughters, and their relationship to the rest of the family has always been different (much as LB describes in her family). The older daughter, who was adopted through the normal process, is very strange and quite different from everyone else in the family, but it's not clear how much of that is due to her being adopted (either through genetic factors or the circumstances). The younger one has had very big problems throughout her life, and in her case it's pretty clear that the circumstances of her adoption (though not necessarily the fact of it) have played a large role. Not sure what relevance these data points have for this discussion, but I figured I'd throw them out there.
I'm thinking now about how often genetic ideas were casually thrown around in my childhood. Discussions about where a particular eyelid configuration came from (my eyes are from my Danish great-grandfather!). My mother would respond to my teenaged whining about breast-size (or a million physical or personality traits) with "Well, you come by it honestly!"---seriously, she uses that phrase all the time. Debates about inherited hearing-loss, discussions about the recessive missing-tooth that's popped up in some branches of the family, arguments between my siblings about who got the best skull phenotype.
If I were to decide to have kids and discover I couldn't, I would have to do a lot of thinking and a LOT of vocabulary shifting. I'd probably also have to police my extended family's language and assumptions.
HG: I remind him occasionally that he's damn lucky he doesn't have my genes.
Seriously, given that, as I don't have any experience with a genetic child, I can only tell by observation: It doesn't seem that different. Frankly, I'm closer to my kid than my sister is to her [genetic] three; if the kid's observations are correct, his father is just as inept with his subsequent genetic child as he was with the Offspring, and her mother is completely befuddled as to why, when she wanted a Britney [the early years] princess, she got a geekgirrl who'd rather read than go to auditions. [As an aside: wife #2 used to refer to her daughter as my ex's "real child". I suspect he never mentioned to her that he's also adopted.]
My mother and stepfather love him to bits, as did his [late] paternal grandfather, and there is a history of adoptions and intermarriage in my family, so an Asian face isn't an isolated instance.
From his standpoint - well, he went through a short period of time when he was little when a nasty little brat who shall burn in hell kindergarten classmate told him I wasn't his "real" mom and he could be sent back to Korea, which scared him. Fortunately, he had a great respect for judges - there were days when I had to bring him to the courthouse and he had to sit silently whilst I got an order signed - and the picture of the judge finalising the adoption made him feel secure. He's never gone through a "my real parents would understand" phase, tho' he's certainly gone through a "yuck - paaarents!" phase.
But love him any more than I do? Not possible. Ever feel "not my real child"? Only when he was teething and I was convinced that the faeries had stolen my real child and left the Devil Brat from Hell.
[Warning: If one uses that as a term of endearment, be prepared for one's four-year-old to declare same proudly to nice old ladies in the grocery store. I swooped him off before she could call Child Services.]
I'm sure that fundamental instincts *are* irrational. After all, it's irrational for me to prefer my own life to the lives of, say, any of you. Nonetheless, I do; and we take that kind of thing into account when we talk about policy and morality, do we not? Isn't that kind of the basis of why most of us agree that Peter Singer is a nutcase?
37: The "so what" is that waving basic instincts away as irrational is a silly way to construct an argument about what living creatures "should" do.
That would be a better point if "so what" was the argument, rather than the response to the counterargument of "basic instincts."
Obviously "the relationship is different" (I did not quite understand that, LB, were you euphemising a better/worse distinction?) because the two children are quite different and of different ages, but in my limited observation they seem equally close to both.
Partially I just meant different, but partially I meant worse. The adopted kids just don't fit smoothly into the family unit -- it's five people who are very much like one another (placid, smart people with cutting wits and personally conservative instincts) and two who don't fit the mold at all.
Three and a half is pretty old. My brothers were adopted at around one and a half, which is still a long time. Though, that year and a half had a lot more impact on the one who spent that time in a third-world orphanage with no language than it did on the one who had one stable loving foster family. But at some age it's not really a child you raised either, which probably changes the dynamics a lot. And the older they are the more likely it is that there will be attachment issues (which happened with one of my brothers, but not the other), which also changes everything.
If I were to adopt, I think I'd want to go pretty young. No more than a year old. And only from a stable situation. Though apparently that's harder if you're not a christian, as it limits what sort of adoption agencies you can work with.
An aunt and uncle adopted an eleven year old foster child (after having six of their own). It's nearly destroyed them. Personally, I can't help thinking there was a fair amount of hubris involved: they are very righteous...
53: And I should say that my aunt and uncle love all of their kids, and my cousins are better off having been adopted by them then they would be under any other circumstances I can imagine. It's just not a totally happy situation.
I should do a post expanding on 48. It's an interesting story (though, like most stories about my family, very sad).
The adopted kids just don't fit smoothly into the family unit
I can see that this might be a problem, particularly for children not adopted as young infants, but it is similar to the issue of step-children and half-siblings etc. Sometimes things never gel. In other families, everyone is one big happy family. I would imagine that it is harder in families, such as LizardBreath described, where there is a divide between the "real" kids and the adopted ones. But i imagine that there are also lots of such families that are cohesive and happy. And as someone who has gone through (and is going through) the stage of parenting teenagers, I can testify that even when they are you own kids, the relationship is not always harmonious.
If I were to adopt, I think I'd want to go pretty young. No more than a year old. And only from a stable situation.
Surely all of those desires are as irrational and/or selfish as the desire to have biological children.
Look, the condemnation of people who use tons of money to get pregnant is basically an extreme form of mommy-bashing. What would you rather spend the money on? Keeping poor people alive? But rationally the children of parents who are rich enough to afford IVF and committed enough to having kids to go through all that work are probably going to be healthier, richer, and more productive than poor people with (say) chronic health conditions. And surely it's more rational to prefer someone who'll be paying into social security for fifty years than it is to prefer someone who only has twenty left.
Yes, we could (and should) improve the world for the people who are in it; but realistically, those people not only want to live, they also, many of them, want to get pregnant and have children. I don't see any grounds on which to pass judgment on individuals over this kind of thing, or really even to base an argument over public costs: my IVF pregnancy vs. your lifelong insulin use. Surely the only reasonable solution is to figure out how to cover basic needs (food, shelter, reproduction, health care) for everyone, rather than to start arguing about which basic needs really matter.
Look, the condemnation of people who use tons of money to get pregnant is basically an extreme form of mommy-bashing.
Mommy bashing is a tradition of longstanding, even if irrational.
A therapist I know, who is heavy into attachment parenting theories, claims all adoptive families need to undergo therapy to deal with the abandonment issues that the child will face. Not that adoption isn't an excellent solution - but that it is never perfectly clean.
I don't know why claims about adopted kids versus biological kids are given a standing that we're reluctant to give claims about single-parent/parents both working/etc. kids. As Healey said at CT at the time (IIRC): we just don't know. We're all aware of situations where adoption worked out, and some where it didn't. Most of us probably aware of situations where having biological kids didn't work out all that well, either.
59: Um, no, not at all irrational. I don't want fucked up kids. And I want children who bond with me. I think those are objectively rational wants. The older you adopt the less the chances of that is.
What standing? I've made stronger claims, I think, than anyone else, and all I've claimed is that I found the idea of having bio-kids more attractive than adopting kids (I wanted to do the first, wouldn't have wanted to do the second) and that I was probably a bad person for it.
I don't see any grounds on which to pass judgment on individuals over this kind of thing, or really even to base an argument over public costs
You think it's morally neutral to reinforce the idea that it's appropriate to favor biological kin over all others?
I would have a real resistance to adopting an older dog, let alone an older child.
But I have no problem with selfishness. I was just saying I don't grok the basis for why people want biological kids.
rather than to start arguing about which basic needs really matter
We could argue about whether implanting three embryos qualifies as a basic need, though.
"A therapist I know, who is heavy into attachment parenting theories, claims all adoptive families need to undergo therapy to deal with the abandonment issues that the child will face. Not that adoption isn't an excellent solution - but that it is never perfectly clean."
As opposed to other families??!?!? Are there really families out there who do not have issues?
Doesnt everyone else look at families who allegedly do not have problems and wonder when the murder/suicide will take place? Am I the only one?
65: I don't think that's what I'm arguing. I can see where you get it, but what I'm saying is that I think it's morally *admirable* to favor one's *children*--adopted or birthed--over all others. And that I don't see any grounds to make the argument that reproducing is any less important than staying alive, when talking about groups and societies (which is what we're talking about when we talk about setting rules for health care expenses). Reproducing *is* staying alive, for groups and societies.
69: Sure, and we can argue about whether open-heart surgery qualifies as a basic need on the same grounds.
Reproducing *is* staying alive, for groups and societies.
We don't have any shortage of fully reproductive adults. We managed to get to 4 or 5 billion people prior to the advent of IVF methods.
68: For many of the same reasons that if you were to adopt, you'd want to adopt an infant, one assumes.
73: Yep, and since we don't have a shortage of adults, there's no real reason not to just let some of 'em die, right?
64: See 61. I seem to recall there was a therapist or marriage therapist who had a best-selling book out that arguing that marriages would be better if wives would just submit to their husbands; yet, even though a therapist said it, I don't think it needs much thoughtful ventilation.
72: Yes, and some folks don't get their open heart surgeries covered because they are poor candidates for success and we have a finite amount of health care resources.
there's no real reason not to just let some of 'em die, right?
We do.
77, 78: Okay. Then the argument is not about whether or not parents who pursue IVF are selfish or ego-driven. Then the argument is about whether public funding of X treatment in Y circumstances is a public good or not. For instance, I'd argue that we should cover any and all birth costs, regardless of the circumstances of conception.
Then the argument is not about whether or not parents who pursue IVF are selfish or ego-driven.
That may be the argument other people are making, but it certainly isn't mine.
71: Again, we're not talking about reproduction per se, but about taking heroic measures to enable reproduction when nature won't cooperate. We have this strong cultural tendency to see life's curveballs as obstacles to be overcome by whatever means necessary. That's a harmful thing. It validates the idea that there is a right way to organize your life and that departures from right living are matters of personal failure.
72, 77: One of the major ways a single-payer system would save money is that it would allow us to better ration health care, with more $$ going to prevention and a lot less going to dramatic treatments with slim chances of success.
Look, everyone feels that their own medical needs are the most important thing ever, but the money has to go for the procedures that will do the most to benefit those who actually exist right now or who are guaranteed to exist in the future. A hell of a lot of crap we do right now-- IVF, long-shot surgery, MRI scans for healthy people--just isn't worth it.
I think 74 is wrong but I don't have the time or intellectual resources to explain why right now.
61: Believe me, abandonment issues aren't confined to adopted children - and any therapist who claims "all" for any class of people is an idiot.
59: If a child is born brain damaged, suffering from cerebral palsy, blind and deaf, unable to eat or any of the other ailments that are, unfortunately, common in high-multiple births, all the money in the world isn't going to change that.
You're also drawing a false parallel: It isn't the cost of IVF pregnancy v. lifelong insulin use; it's the cost of keeping the multiple products of that pregnancy alive + possible lifelong care that should be the comparison.
If you can afford them, have 'em - but when you voluntarily enter into a procedure that you know full well can end in enormous health care expenses that will be borne by other people - and to the detriment of still others who didn't choose to suffer injury or illness - you aren't the one paying. That's not mommy bashing; that's reality.
With freedom comes responsibility, something that our "entitled" populace cannot seem to grasp.
I think (and heaven knows I haven't thought about this enough to have firm, well-considered opinions; I'm just thinking aloud) that implanting more than two embryos at a time creates a sufficiently high risk for severely premature births that it's a bad idea. For the same reasons that we don't cover liver transplants for hard-core alcoholics.
80: Then I wasn't arguing with you, though I've answered your arguments with me, no?
81: And arguing that parents who use IVF to get pregnant are selfish doesn't validate the idea of personal failure?
74: That doesn't seem to be the case with any of the people on this thread who have expressed a strong preference (LB, JM). I think I understand LB's point of view now. It's perfectly rational to avoid bad situations that you've seen up close, even if you don't have a strong rational basis for thinking that situation generalizes. JM's reason of having a family that would make things harder is also sensible (if a little more morally questionable). But neither of them is what B's saying in 74. I was asking because clearly people have some reasons that I can understand by hearing their answers.
82: That's not at all clear. HMOs more or less rationed health care by cost effectiveness, and people hate them. Americans (at least those moderately wealthy and up) are very used to getting the medical care they think they want rather than what some faceless bureaucrat thinks they "need". Attempts at changing this will be met with fierce political resistance.
85: There is some very interesting research on liver transplants and alcoholics. Turns out that a transplant can be a very sobering experience. You don't see alcoholics simply destroying the new liver you gave them. At least from a financial perspective, withholding transplants from alcoholics *doesn't* make sense.
49: My family was and still is the same way. A few months back a friend of my mom's complimented me on my haircolor; she asked me where I got it and at the same time I said, "the salon," my mother said, "her great-grandfather."
Re: adoption: I knew a couple of adoptees in college who had a whole lot of anger towards women, a lot of which was clearly due to their feelings towards their birth mothers about having been put up for adoption. On the other side, my aunt had a baby in high school and put her up for adoption; both her childhood and her establishing a relationship with her birth mother in adulthood seemed relatively smooth and drama-free. But society wants to act as if these things are always neat and tidy, that the birth mother can go on as if she never had a child and that the child will never be troubled by not being raised by someone else, and that's just not true.
These are not judgments on other people's decisions, just the thoughts that I kick around as I face the put-up-or-shut-up stage of my (presumptive) fertility. I can't judge because I just have no idea what I'd do under similar circumstances.
A hell of a lot of crap we do right now-- IVF, long-shot surgery, MRI scans for healthy people--just isn't worth it.
Okay, in theory. But of course you don't know that the MRI patient is healthy until after you do the scan. And attempts to disallow "long-shot surgery" fall apart every time you have a news story where some dying kid's insurance plan won't pay for their chemo, or whatever.
I'm willing to agree that okay, public funds shouldn't pay for elective procedures like IVF until and unless we figure out how to cover chemo and heart surgery for everyone who needs it first. But that's an argument that can certainly be made empathetically rather than judgmentally.
If you can afford them, have 'em - but when you voluntarily enter into a procedure that you know full well can end in enormous health care expenses that will be borne by other people - and to the detriment of still others who didn't choose to suffer injury or illness - you aren't the one paying. That's not mommy bashing; that's reality.
On those grounds, one could argue that adoptive parents shouldn't get parental leave or other kinds of parental benefits, which presuambly you don't want to do.
When I was in an HMO (Kaiser Permanente), I loved it. Easily the most convenient health care system I've ever used. But, I was the ideal HMO patient: totally healthy and fairly doctor-averse. I think I only used them myself to get stitches put in my head. Other than that, just picking up inhalers for my then-wife, her regular gyn visits, and the pre-natal/delivery/well-baby stuff for my first kid.
If I had had any real health needs, I might feel totally different.
88: I didn't say people will *like* medical rationing. It is quite clear that they won't. I'm saying
(1) that a single payer system will do it better than the HMO system. HMOs use all sorts of shitty, underhanded means to deny coverage and don't actually manage to keep costs down. Canada, Australia, etc. have the exact opposite experience.
(2) Rationing health care based on need rather than ability to pay would be a good thing.
You'd think that destroying your first liver would be a sobering experience, but that didn't stop my father from washing down his medications with Miller Genuine Draft the entire time he was on the transplant list. It's best that he didn't get a second liver; it would just have gone the way of the first.
some faceless bureaucrat
S/b "some faceless, moronic, and mule-like bureaucrat"
If it wasn't so easy to spot their goofs HMOs and their decisions wouldn't be so disliked.
I'm on board with 85.
87: It's not just avoidance of a bad situation, though. While it's bad, and egotistical, and I'm not saying I support it (I am embarrassed by what I'm about to say, just trying to be honest), part of what I enjoy about my family (not just my kids, but my parents and my sister) is our very strong resemblance -- we're all very much the same sort of person, and I take pleasure in that: one of the things I like so much about my sister is that she's very much a Breath. Something that I consciously thought of as a positive in having kids is that they'd be as much like me as my sister is -- the Breath family is made up of people I take great pleasure in, and I had the opportunity of taking a draw from that same genetic bag. And that's turned into part of the pleasure I do take in my kids.
On those grounds, one could argue that adoptive parents shouldn't get parental leave or other kinds of parental benefits, which presuambly you don't want to do.
Which would be fine. Then there would be fewer adoptions. On a bet, you'll find that most people believe that the benefits of extra adoptions outweigh the costs of parental leave and whatever other benefits you're thinking of. On another bet, you'll find that most people don't believe that the benefit of having parents with biological kids outweighs the cost of public payment for IVF-related healthcare costs. I'm less sure about the second, but that, I think, would be the argument.
93.2: Yes. 93.1: Agreed, but not convinced that Canada's the best example. Costs stay down, but access and wait periods are a pain in the butt and mean that people really do live in pain for months or even years before they can get treatment. Mental health care is really hard to get. Etc. Of course, these things may very well be functions of sparse populations and the US drawing doctors south, I don't know, but I have to admit that ime having private insurance has been better, for me, than being covered by OHIP.
A work acquaintance of mine just died from alcoholism last month. He consciously decided getting drunk was more important to him than getting a new liver and living longer. Very Leaving Las Vegas.
I'm also very curious about why people want children in the first place. I'm not particularly opposed to children, but I don't feel like I understand why people would want them. And I think whether or not I want to have children someday is something I should form an opinion on at some point. I don't quite understand why people whose interests (vocational or avocational) don't involve hanging out with small children suddenly want to have kids.
97: Nope, you're still coming at it from the perspective of judging other people's decisions. Adoptive parents should get leave because *their children have the same needs as every other child*. Same for prenatal care and birth costs for IVF babies.
101 continued: So fine, you don't want to cover IVF or the costs of adopting--that's cool. But if someone gets there, then the question of how they arrived should be moot.
86.2: No, not really. And I'm not out to shame anyone for IVF, etc., but only to view it as a luxury that's available only if you can pay full freight out of pocket (for the treatment; once conception happens, that's another story). I don't regard owning a Mercedes as particularly admirable, but I don't condemn it. I think the world would be a better place if we looked at IVF the same way.
97: Nope, you're still coming at it from the perspective of judging other people's decisions.
Wait, why is "judging other people's decision" a bar to...well, judging other people's decisions about what to do with public resources? If I say that I don't think a national healthcare plan should cover cosmetic plastic surgery, I'm doing the same thing, it seems to me.
87 is right, and moreover, fertility clinics need to be better regulated. As it stands, there's too much incentive on both sides for this sort of situation to be created in the first place: on the part of the prospective parents, because they want to do whatever they can to increase their chances of success, and on the part of the fertility clinics, because they want to keep their success rate numbers up so the patients and money keep coming in.
the perspective of judging other people's decisions
Unavoidable, and not necessarily a bad thing even if it could be avoided. People make bad decisions.
Not, however, a sound basis for setting public spending decisions.
65
"You think it's morally neutral to reinforce the idea that it's appropriate to favor biological kin over all others?"
Morality is just a set of rules to allow people to work together. Some sets of rules work better than other sets. Trying to prevent people from favoring their biological kin is not likely to work very well.
93: But if a lot of people really don't like a plan that is put in place by politicians, the plan will very likely be removed. You will note that we don't have private Social Security accounts.
109: There's a subtle but important difference between trying to ban something and spending money to further encourage it.
Responding to 65 particularly and more generally the comments criticizing IVF and other fertility treatments as selfish.
I'm late to the party here, but there seems to be a leap being made by some that wanting biological offspring enough to pursue all sorts of invasive treatments somehow means that these parents value (or would value) biological kin more than adopted kids. Nonsense.
There's alot more to biological reproduction than the end product. When I was pregnant eons ago, I loved (almost) every minute of those 40+ weeks. Yeah, even the nausea -- because it was very special nausea from my very special offspring. There's a certain sort of bonding that occurs when you've got a little person developing inside you and I think it's a very human thing to want that experience and connection that has very little to do with ego or "genetic narcissim."
I think society is moving a bit on this -- that reactions like LB's to the idea of adoption are more common among my parents' generation than they are in my own (to which LB belongs, but anyway), and that they will be less common still among my daughter's contemporaries. This is just a hunch though, not backed up by any data.
It doesn't have to do with bashing reproductive choices at all. No one's saying they're selfish for wanting their own kids. But if we've got a million dollars to go around (which is how insurance pools work), and three kids suck it all up because we a) don't believe we should restrict IVF implantations b) can't force women to abort and c) we believe that we should help out needy babies, something's gotta give. Medicaid wasn't designed for a high probability of these kinds of expenses. If it happens naturally, we deal with it, but when there's procedures that really increase the risk of it, we're going to have to deal with the funds somehow.
Enforcing b) would be immoral beyond belief. Enforcing a ban on c) for IVF kiddies seems to draw moral distinctions between preemies based on whether their parents conceived them naturally or not, and that seems flat-out wrong, too. So I'm leaning towards a): restrict it to two implantations/cycle.
112: Explain again how loving the nausea caused by your very special offspring isn't narcissistic.
No one's saying they're selfish for wanting their own kids.
See 7, 9, 17, and 27.
part of what I enjoy about my family (not just my kids, but my parents and my sister) is our very strong resemblance -- we're all very much the same sort of person, and I take pleasure in that
I think LB has finally identified why the idea of adoption has always appealed to me. I dislike most of the people in my family, and I really want little to do with their genetic material. If I have any children (that itself is a big IF), I wouldn't really want them to be anything like my parents or my siblings. I love my parents and siblings, but only in the "because they're family" way, because I have no choice about it. The idea of chosing a kid who comes with totally different weird genetic complications? Priceless.
LB is always articulating things for me that I could never do myself. Thanks, LB! Maybe you could give up a baby so I could adopt it?
115: Because it was about my feelings for her, not about my feelings for me or my projection of her feelings for me or my desire to influence anyone else's feelings about me. (Though, perhaps "loving" was a bit strong...)
and 27
So you yourself are among those calling IVF selfish! J'accuse!
115: I hated being pregnant, but if you want to say that being impressed by--even loving--the physical ability to create life is narcissistic, then I'm going to think that you're morally damaged.
I wouldn't really want them to be anything like my parents or my siblings
My rampaging recessive genetic material overwhelmed my first wife's Greek genes (hair so black it's blue) to produce a redheaded son. So, y'know, call me.
114
How much money are we talking about overall? Is this really a major contributor to public health care expenses? I suspect poor mothers are costlier overall.
114, 116: It is selfish. So's spending that $5 a day on a latte rather than sending it to Sally Struthers. So what? You're allowed to be selfish. The question is whether taxpayers are allowed to object to funding you, and on what basis.
I hated being pregnant
Be fair, though. You hate everything.
118: I'll pencil you in for the next time I have a free nine months to sleep through.
123: Overall, probably not an overwhelming amount; but there's an easy remedy here -- limit an expensive voluntary procedure -- and not so much with "poor people need medicines."
I don't think it's selfish, SCMTim, but you're right that the problem isn't selfishness, it's the taxpayer burden, which is what I say in the rest of my comment.
126: I don't think Wrenae was saying she wants you to make a new one for her. She wants one of the ones you already have. They are quite cute.
mmmmmm....LizardBreath baaaaabies.... must make her commit a Sophie's Choice....
Nah, just give me the girl. Then I can stunt her emotional growth in the way only late-adopted mother-daughter relationships can.
127
But this expensive voluntary procedure is not publically financed is it?
128: I understood your argument. I referenced you b/c B referenced you. As to "selfish": it seems that the word is being used to mean "good for the individual" and contrasted to something like "good for the polity" or "good for the world." You could make an argument about why having biological kids (rather than adopted kids) is good for society, but, as a first approximation, it looks selfish under that definition. And, again, that's fine.
131: The argument is that the foreseeable heroic costs associated with it are.
132: Fair enough. I'm not sure that's what we usually mean by selfish, though, but that's really not all that important.
130: I'll get in touch the next time she's bad: "Clean your room, or I'll sell you to the blog-commenters!"
135: The level of threat there probably varies widely by commenter, yes?
I'm so glad this came up bc I also don't get the urge to have biological children. I'm not sure what the connection is, but these discussions of preferring to try for a bio child before turning to adoption make me think about general societal attitudes about children. So often I hear stuff like 'children are our future' and 'children are our greatest treasure' and 'think of the children'.... And yet tons of children continue to suffer and die daily. It seems like when it comes right down to it, it's not really any child that's precious, valuable, etc., it's only some children. And yet I can't figure out for the life of me why one child would be more valued than another, even if one of the children were my own.
Geez, B, where is your brain today?
On those grounds, one could argue that adoptive parents shouldn't get parental leave or other kinds of parental benefits, which presuambly you don't want to do.
Again, you're comparing apples and oranges. Choosing to bear a child/choosing to adopt are both choices with limited risk. Choosing to bear known multiples is high risk, both for infant deaths and astronomical medical cost. [I think Cala has articulated that best.]
If you want to go that A/O logic route, then let's ban maternal leave altogether - after all, nothing prevents anyone who becomes pregnant by accident from "choosing" not to have a child, right? Why should parents get special treatment at all? Why shouldn't there be a steel ceiling for women, they're just going to take time off and have babies and make excuses like "Junior fell in daycare and fractured his skull" in order to get out of doing work - hell, women should stay home, barefoot and...
FWIW, you should be aware that parental leave for adoptive parents is a very new concept; it didn't exist 21 years ago. I didn't get it; my husband didn't get it. Nor did we get the newer tax breaks for adoption expenses.
You also aren't paying attention to what I said in 17: I didn't say having IVF was selfish; I said that taking the risk that a multiple birth caused by a greater-than-two embryo implantation would result in harm to the children was selfish - that I understood the impulse, but that I thought it was more about wanting-a-baby than the baby itself.
Hell, fertility clinics have acknowledged, albeit reluctantly, that the five or six embryo implantations are how they keep their success rates up - it increases the odds of at least one implanting. That it is also irresponsible, in that it increases the chance of high multiple births with the inherent problems is, well, not what they care about. The stats are "pregnancies to term", not "number of infants born without significant birth defects who survive".
133
This argument can be applied to lots of other things like mountain climbing in winter which aren't banned.
Anyway it is the decision not to reduce that leads to the heroic costs. So why ban IVF for sensible people who would reduce?
And yet I can't figure out for the life of me why one child would be more valued than another, even if one of the children were my own.
Your own children are more likely to pay for your nursing home than little Jimmy from across the street.
why ban IVF for sensible people who would reduce?
Because that's effectively punishing people for not aborting, which is morally problematic.
139: I'm not sure anyone's talking about banning IVF. As for choices about what foreseeable costs should be covered and what shouldn't--those are political decisions, in the meanest sense, and if society as a whole wants to cover heroic costs for more or less anything, then we do it. I don't think there's a self-evident truth here to be found.
139: Who said anything about banning IVF? The suggestions have been pretty much to require a no-greater-than-two implantation, as twins have a much better chance of being carried to term without incident than do tripllets or beyond.
141
Only if you think reducing is morally problematic which I don't.
Good grief, the triplets bore twin L's when I wasn't looking. Must be the Clomid.
143
Ok, banning more than 2 IVF (making it less effective) because of the slight chance 3 will take, a problem which is easily fixed.
142: I think we're stuck with covering certain post-natal costs, just in the name of humanity. But - I don't think we should go to heroic measures for an infant who is not likely to survive, no matter what is done - there's a time when pandering to the parents' "hope" is just cruel all around. Short circuiting the problem by prohibiting three or more embryos per IVF procedure would be a good idea, as well as regulating/improving fertility drugs more carefully.
[In case anyone wonders, taking Clomid results in all of the symptoms of pregnancy and menopause at the same time, so you puke whilst having hot flashes, your back aches, your feet swell and you both crying at diaper commercials and praying that your uterus will fall out so that ALL OF THIS WILL STOP.]
142, etc.: I think two public policy changes are needed: regulate IVF, fertility drugs, etc. to minimize risk of multiple births, and neither provide public funding for high-cost fertility treatment nor require health insurers to cover it. The first change is needed to reduce the risk of birth outcomes that lead to high costs and low quality of life. The second would put fertility treatment in the same category of elective procedures as cosmetic surgery, LASIK, etc. I wouldn't go any further than that, and I very much would not support treating pregnancies or children created through fertility treatment any different than other pregnancies or children.
Hi there! I have twins conceived through IVF, and I'd like to clear up some apparent misconceptions.
IVF is not necessarily more expensive than adoption. This woman mentions "tens of thousands" spent on fertility treatments, but I suspect that represents more than just IVF. In our case (on doctor's advice, we didn't try other approaches), it was not quite $15K, and adoption here in Oregon would have been almost exactly the same. Was it irrational to spend that much? Is it irrational to spend that much on a car?
To what extent it's a rich person's procedure depends on what you consider rich, I suppose. Certainly, it's not for poor people; neither medicare nor (most) insurance plans cover it in this country. We got lucky: shortly after my wife learned that she was infertile, she received an inheritance from a great-aunt that just covered IVF. (The money came from an Enron pension fund, just before the implosion; when my daughters are old enough to understand, I'll tell them how close they were to not existing thanks to corporate corruption.)
Triplets don't necessarily come from triple implantation. Our next-door neighbors went through the same program we did, and like us had two fertilized eggs implanted; one of the eggs then split. I don't know how representative our experience was, but we were warned that that was a possibility, and strongly counseled against hedging our bets by implanting more than two.
Incidentally, we donated our leftovers snowflakes to infertile couples, which means I may have been successful beyond my wildest dreams in spreading my seed.
Studies like this and those described in this book have convinced me that a parent's genetic contributions to kids' life chances are greater than environmental contributions.
I left for work after I commented. I moderate a Socrates Cafe at the library where I work. This topic would've been great. But everyone's cancelling on me tonight. Bum. Plus, I've gotta eat all this stuff myself.
138: My brain's on vacation with everyone else's compassion and reading skills.
I'm not going to get all offended about 152, but I would be more than happy to distinguish, at length, between compassion and support for public or insurance funding of fertility treatment, particularly fertility treatment involve significant risk of multiple births.
149: I know a couple personally who spent $70,000 on IVF - the first five times didn't take. In lieu of a sixth attempt, they adopted. I take it you were successful the first time around; lots of people are not. And, of course, there are women like the former blogger Chez Miscarriage who had a deformed womb [DES daughter] for whom IVF couldn't work at all.
The Offspring's adoption cost us about $10,000. [We were offered a black market baby for $40,000; join an adoption support group and all sorts of people get your name...]
153: If I'm not mistaken, I have already said--twice--that I'm cool with not funding IVF. What I have said is that prenatal care, birth, and postnatal care damn well should be funded, regardless of what one thinks of how the baby got there--whether the mom's poor, a drug addict, a rich IVF mommy, or whatever. Just like things like parental leave and deducting dependents should apply to all parents, not just the ones who are raising their own genetic offspring.
155: In which case we're not disagreeing on anything policy-related, but only about the moral significance of the whole thing. That's also true of a bunch of other people who have been arguing with you. So where is it that we're showing our lack of compassion?
The problem with IVF is that most people have to pay per attempt and each attempt costs $10-15,000 so there's a big incentive to transfer multiple embryos and hope some of them take, resulting in multiple births. In order to prevent this, some of the fertility clinics near me in Virginia were offering packages where you hedged you instead paid the cost of two attempts up front and got up to three or four tries. It was only offered for women the clinics assumed to be good candidates and the gamble was that the clinic made money off of women who got pregnant on the first try, broke even if she got pregnant on the second, and the couple wasn't out money if it took 3 or 4 tries. The couples were more willing to try fewer embryos, resulting in more single child pregnancies and still good results for the couples and, financially, for the clinics. (The fertility clinic took out ads on the radio about this, which is how I know.)
Also, I think it would be hard to pass a law saying that clinics can't implant more than two embryos but that could probably be effectively accomplished by passing a law saying that Medicaid has the right to sue IVF clinics to recover medical costs caused by the birth of triplets or higher number multiples if more than two embryos were implanted. Most clinics probably wouldn't take the risk.
By insisting that there's any substantive difference between the judgment that "people who have IVF are just selfish" (or "people who have more than one or two IVF treatments are just selfish," or "people who implant more than two embryos are selfish," or whatever) and any other way that people have of passing judgment on "selfish" parents. I think it's assholish to pass judgment on people for having kids, or for how they get them, and in any case, "selfish" is a poor argument when it comes to talking about public policy.
Short of kidnapping or grave-robbing, that is. I don't condone kidnapping or the creation of reanimated monsters in underground laboratories as means to producing children.
159: Um, OK. I don't find selfish/not selfish to be a helpful way of drawing the line, but I think it's pretty hard to sort out what's fucked up about our culture and what we might do to change it without being willing to criticize some of the choices people make.
B: All of the suggestions of government intervention suggested occur at the stage prior to using IVF. Most people have followed Apo's suggestion that we limit implantation to two embryos through regulation. For the health risks associated specifically with IVF, you could require parents to fund IVF disease related insurance, if that's what society decided it wanted to do. None of this suggests barring the door to any existing kid for any services at all. I think you're badly misreading everyone.
and in any case, "selfish" is a poor argument when it comes to talking about public policy.
Why, for gawd's sake? We do it all of the time in reverse--we want more kids, so we give people deductions for them, or we want more homeowners, so we give a deduction for it. All because we think those choices benefit society (or so we claim).
And most people aren't condemning people for doing IVF. If having a genetic kid is a priority for someone and they want to spend their money on it, go right ahead. But deciding to risk millions of taxpayer dollars on it for a high-risk pregnancy and possibly lifetime disability care, that's another story. If analogies weren't banned, I might say that a precedent is motorcycle helmet laws -- the government outlaws a risky activity partly because of the high probability it will get stuck with expensive medical bills resulting from the consequences.
I might say that a precedent is motorcycle helmet laws -- the government outlaws a risky activity partly because of the high probability it will get stuck with expensive medical bills resulting from the consequences.
This overlooks what a good source of organs non helmet wearers can be. Bah to helmet laws. Give those organs to people smart enough to wear some protective gear.
"wear some protective gear" s/b "stay away from donorcycles"
162: Because it undermines the very concept of public policy. First, because the public is made up of people, and second because policy is about enabling or promoting what people want.
163: No one "decides to risk millions of taxpayer dollars." And no one wants a child who will suffer a lifetime of disabilities. Talking about IVF as if people make their decisions out of an indifference to cost or the probable well-being of their children is ridiculous; it's a strawman argument. People make decisions that they think will best help them have a healthy child. Sometimes that's not what happens, because pregnancy is tricky and risky. Talking about penalizing people for failing to perfectly control the outcomes of their pregnancies is absolutely monstrous.
On the other hand: if we accept (I'm willing to do so) that implanting more than two embryos at a time puts people at very high risk for multiples--which is itself high-risk--then it seems to me the issue is one of professional standards or best practices. You can't blame people who are desperate for a child, and who cannot afford a third round of IVF, for wanting to rig the odds in their favor. If doctors abdicate their professional standards to desperate people, then it's the doctors who are at fault.
A million dollars? How?
Hospitals are the most expensive hotels in the world. It's not as hard as you'd think.
Sometimes public policy is about protecting people from the unanticipated consequences of pursuing what they really want. And wants aren't written in the universe. Once you get beyond basic food, clothing, shelter, companionship, there's a whole lot of cultural stuff going on.
On the other hand: if we accept (I'm willing to do so) that implanting more than two embryos at a time puts people at very high risk for multiples--which is itself high-risk--then it seems to me the issue is one of professional standards or best practices.
So you agree with what everyone else has been advocating as long as it's the AMA rather than the government that enforces it?
After going through the bills following my father's death, I can assure you that reaching a million dollar hospital bill wouldn't even require that much time in the hospital.
If you implant 3 what are the odds that all 3 will take? And if they do, what are the risks of reducing to 2? I doubt that combined this is high risk at all.
Shearer, not everybody is as OK with reduction as you are.
B, if only you'd stop slinging around the term "selfish" we'd have comity.
160: Honestly, because I think that giving individuals the benefit of the doubt is the best way to bring about change or build workable solutions. Most people make the best choices they can given their circumstances (material, psychological, emotional, temporal, whatever): when they make "bad" choices it's usually because the way the choices are defined is bad, rather than because they're bad people.
170: If the problem is a medical one, then it should be treated as such. At least for the purposes of this discussion, we seem to be assuming that the cost issue is a function of the medical problem.
174: Right. So we push them to make good choices (or no choices) in certain cases through government policy. Largely because we have scarce resources that we have to allocate. We can't simply be "about enabling or promoting what people want" for all desires by all people. We just don't have the resources.
I'm probably about 100 comments late, but on the "wanting kids" thing: I don't think there's consensus that it's a natural desire. We don't naturally want kids; we naturally want to fuck. But fucking is how our bodies trick us into having kids that we didn't otherwise have an interest in. This ties in well with the tidbit about Roman adoption, in demonstrating that the desire to have a baby is socially constructed.
174: I'm not accusing anyone of being bad people. I just think that when we get to wanting something, whatever it is and whatever our reasons for wanting it, we tend to get a little nuts and to be way too slow to cut our losses and rethink things when we run into obstacles. That's not horrible, it's just human nature. And human beings make shitty decisions all the time. It's not impossible to question someone's thinking without denying their humanity or their freedom. It's not easy, and Lord knows there's no shortage of unpleasant people trying to tell others what to do, but shaping choices and behavior is just one of the things that culture does. We shouldn't feel bad about participating in that.
I agree with 178 entirely. My entire point is just that it's way too easy to say that people's decisions when it comes to kids are "selfish," and we ought to be able to come up with better arguments than that.
177: I'm going to go with the argument that human beings clearly value children, and that it's right we should do so.
(As a society, we don't clearly value children much beyond sentimentalizing them--but that's a separate issue.)
179: Comity!
Also, from the Modern Love piece:
She would prove to be the only one who fully understood our dilemma. Most everyone else burst out laughing and hollered in joy at the news. All they could say was, "Well, you got it all over with in one shot."My husband and I laughed along with them. We couldn't share what the doctor had advised. It felt like our dirty secret.
Over the next couple of weeks, we consulted various specialists, including one who told us the odds in plain terms: The chances of having severe complications in a triplet pregnancy, he explained, are only 2 percent greater than with twins once you pass the 26-week mark. Babies born earlier than 26 weeks, which happens in roughly 14 percent of triplet pregnancies, almost always suffer serious handicaps, and many die. Then again, the reduction procedure itself carries the risk, however small, of terminating the entire pregnancy.
Focusing on those cold numbers, we made our decision: we would not reduce.
Does anyone believe that the "focusing on those cold numbers" bit is anything other than pure rationalization of a decision that was effectively made the moment they started telling family and friends she was carrying triplets?
181: I actually read that excerpt as suggesting (or at least allowing the possibility) that they made the decision before they started telling people.
My question on the whole policy end of it is what, exactly or at least approximately, is the risk that implanting three eggs will result in a triplet pregnancy, and in what percentage of those cases do complications arise that result in million dollar Medicaid claims? Also, if it's a million dollar hospital bill, how much does Medicaid actually pay out? I know from my doctor friends that it's certainly not 100%.
It just strikes me as something of a leap from "this one couple in an article had this experience" to "every couple that attempts to implant more than two eggs is risking a dramatic drain on public resources."
The idea of a bunch of policy wonks deciding for every couple in America that two eggs is the limit creeps me out. It's a medical decision (as B said above) and should be made by the woman and her doctor, who are entitled to the presumption that they are perfectly capable of weighing the benefits and risks.
154, 157: True, I should have specified that multiple attempts are very expensive in the absence of a package such as Becks described.
I'm all for tight regulation of the infertility industry. The Royal College of Obstetricians and Gynaecologists has shown how big an impact the costs of multiples have on the system (and how many more people in Britain could take advantage of IVF if multiple births were reduced, since the National Health actually funds IVF).
We regulate medical interactions all of the time.
My entire point is just that it's way too easy to say that people's decisions when it comes to kids are "selfish," and we ought to be able to come up with better arguments than that.
But we have been coming up with better arguments. It's high risk; this isn't about demanding that people have perfect pregnancies and punishing them if they don't. It's a way of recognizing that if (and I'm willing to say this is a big if) IVF of three or more embryos leads to a very high likelihood of complications, the costs of which are going to be borne by the rest of society, then procedures that lead to those should be either regulated, or, more practically, the state should be able to recover those costs from the clinic that endorsed the risky practice (tying it to the practice, not the result). Lots and lots of medical decisions are made that way, and none of them entail that the person is selfish or punished. Transplant lists are a good parallel.
Di Kotimy has a very good point; this may be a mountain out of a molehill. But it isn't all that hard to run up a million dollar hospital bill, and Medicare isn't an unlimited resource.
181: I buy into your rationalization theory. She's rather precise about the probabilites except for the risk of losing everything by opting for the reduction. Those numbers are around somewhere.
To those who have asked how common triplets are in ivf, the answer depends a lot on the age of the mother. The cdc has statistics for ivf clinics (latest numbers are from 2004). For the clinic I used, women under 35 had: 47% of cycles resulted in pregnancies, (40.9% live births), and 4.8% of pregnancies were triplets or more. For women 41-42, only 23.7% of cycles resulted in pregancies (only 16.9% live births) and 2.6% of pregancies had triplets or more. (The cdc doesn't give a per embryo rate for pregnancy or multiples, though they give an average number of embryos transferred.) My clinic that has specific guidelines about how many embryos to transfer (it also makes a difference *when* they are transferred), and the guidelines differ by maternal age. Some clinics have looser guidelines, of course.
I noticed that the Modern Love column did not mention the age of the mother. Also, this discussion seems to be assuming she did ivf, but she does not even specify that. She also doesn't say how many embryos they transferred if it was ivf. As I understand it, higher order multiples are more common with some of the treatments people go through (such as Intra Uterine Injection of sperm and/or fertility drugs) before they move on to ivf, because it is harder to control the number of eggs.
Unfoggetarian @100: I'm also very curious about why people want children in the first place. I'm not particularly opposed to children, but I don't feel like I understand why people would want them.
Because they are animals which have evolved an altricial reproductive strategy, which endows most of them with strong instincts to care for their young. The strength of the instinct may vary from person to person and from time to time, but it exists, and it's an intrinsic part of the genetic inheritance that makes us different from squid.
That doesn't mean that you have to follow the instinct of course - that's part of the genetic inheritance that makes us different from chimpanzees. I have no children. For various good reasons it would have been irresponsible for me to have done so. But it doesn't mean I wouldn't have liked to.