German mom expecting quadruplets at 65

Excerpted from “German Mom Expecting Quads at 65 Is 'Irresponsible': Bioethicist,” NBC News. April 14, 2015 — Berlin school teacher Annegret Raunigk is proudly prolific and, at age 65, not done making babies — pregnant with quadruplets that would enlarge her family from 13 to 17 children. Raunigk said she became pregnant again because her 9-year-old daughter asked for a younger sibling. (Her first 12 children — by five men — are ages 22 to 44). She told German tabloid Bild that donated eggs were fertilized and implanted at a clinic in Ukraine. Multiple attempts were required to get the eggs to fertilize. She did not say whose sperm was used or if the egg donor was paid.

What she is doing is unethical. She doesn't think so. But she left her country to receive an infertility treatment that's illegal in Germany due to her age. And she sought that help on the sole grounds that her youngest daughter wants a sibling. Of course, given that logic, future requests by any of her newest kids apparently guarantee no end to her pregnancies.

The number of reasons why this very-late-in-life pregnancy is morally wrong nearly equates to the number of children Raunigk has conceived. But let's stick to the main issues. First, she likely will not live long enough to raise her current children, much less any new kids. It is not fair to children, as adoption agencies know when they limit adoption to those under 55, to intentionally create a family where mom and dad will enter a nursing home as the kids enter junior high.

Making four kids in a 65-year-old body also is irresponsible. The quadruplets are likely to be premature and, if they survive, may pay a steep price for this decision in terms of their health. Her older body makes the pregnancy extremely high risk all the way around. There will be a C-section, which is dangerous for her. And there certainly will be no breast-feeding by mom.

And what clinic would agree to accept as a patient a woman with 13 children — simply because her daughter wants a sibling? What clinic would not insist on a surrogate mom? What clinic would not demand she stay nearby during the pregnancy? What clinic would even let her try to deliver four fetuses?

The answer: One looking to gain fame and clients by engaging in a publicity stunt with nascent lives. Then again, this theoretically could have happened as well in the U.S. where there are no restrictions about who can use technology to have a baby — grandparents, mentally ill, very old single parents, even child molesters. Despite the headlines babbling about "miracles" and "gifts," and despite Annegret Raunigk's insistence that she should be free to reproduce however and whenever she wants, what's needed is a far more thoughtful, moral stance to govern reproductive technology.

Commentary

CMDA Member John Pierce, MD: “The case of Annegret Raunigk is another clear example of doing what is ‘…wise in your own eyes’ (Proverbs 3:7a, NIV 2011). In the world, there are arguments for age limits on IVF including the multiple health risks for the older mother and her infant, as well as arguments against age limits purporting reproductive freedom, equality for women (as older men can father a child) and social factors ‘to help fulfill lifelong dreams.’ Moral arguments might ask questions such as, ‘Is it right to have a child when the average life expectancy (about 80 years old for women in the developed world) means the child would be without a mother before driving a car?’ or ‘On what grounds do you deny the patient her rights?’

“Clear thinking using the principles of autonomy, beneficence, non-maleficence and justice has been supplanted with situational ethics incorporating intense emotions and cultural relativism. Why would we not have these struggles when there is no standard and a crumbling foundation? The law is silent on age in reproductive rights and most medical organizations provide weak recommendations,ⁱ leaving the decision up to individual clinics,ⁱⁱ or refute the need for practitioners to use their conscience.ⁱⁱⁱ

“Solomon sincerely asked the Lord, ‘So give your servant a discerning heart to govern your people and to distinguish between right and wrong...’ (1 Kings 3:9, NIV 2011). While we may argue vehemently, the loudest voice will be undeniable examples of healthy relationships, thriving marriages, happy families and renewed minds.”

ⁱEthics Committee of the ASRM. Oocyte or Embryo Donation to Women of Advanced Age: A Committee Opinion. Fertil Steril, 2013;100:337-40.
ⁱⁱ Fisseha S and NA Clark. Assisted Reproduction for Postmenopausal Women, AMA Journal of Ethics, Jan 2014, Vol 16, No 1:5-9.
ⁱⁱⁱCommittee on Ethics. ACOG Committee Opinion: The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol, 2007 (reaffirmed 2013);110:1203-8.

Resources

CMDA’s Assisted Reproductive Technology Ethics Statement
Standards4Life – Infertility and Reproductive Technology

Woman gives birth from a transplanted womb

Excerpted from “World first: baby born after womb transplantation,” Medical News Today. October 6, 2014 — In September, a 36-year-old Swedish woman became the first ever to give birth from a transplanted womb. A new paper published in The Lancet provides a "proof of concept" report on the case. The woman received her womb from a 61-year-old family friend. As the recipient had intact ovaries, she was able to produce eggs, which were then fertilized using IVF prior to the transplant.

"Absolute uterine factor infertility" is the only type of female infertility still considered to be untreatable. Adoption and surrogacy have so far been the only options for women with absolute uterine factor infertility to acquire motherhood. However, the news of the first baby to be born from a woman who received a womb transplant brings hope to women with forms of absolute uterine factor infertility.

The researchers who performed the transplant - from the University of Gothenburg, Sweden - have been investigating the viability of womb transplantation for over 10 years. In 2013, the researchers initiated transplants in nine women with absolute uterine factor infertility who had received wombs from live donors. The Swedish woman who recently gave birth was one of these women. Although two of the women in the trial had to have hysterectomies during the initial months - because of severe infections and thrombosis - the team reported success in the other seven women.

According to Prof. Brännström, who led the team of researchers, "Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility. What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a postmenopausal donor."

Commentary

CMDA National Director of Campus & Community Ministries J. Scott Ries, MD: “At first glance, it seems like a heartwarming tale of the newest medical ‘miracle’ and a triumph of life. But one doesn’t need to squeeze hard to deliver a very sour and sobering insight of what lies ahead. Though it is at its surface a sweet story of an otherwise impossible birth, deeply thinking and conscientious physicians must pause and ask, ‘At what cost?’

“Three things should deeply concern us in the pushing of these ethical boundaries:

1. How many developing babies will we immolate on the altar of innovation? This patient on three separate occasions nearly rejected her uterine transplant. How many babies will be sacrificed in future trials of uterine transplantation?
2. At what age do we stop? If it works for a 36-year-old woman, why not a 56-year-old woman? Or perhaps a 76-year-old woman? Where does the ‘right’ to bear a child end?
3. Why limit a uterine transplantation to only women? In this day of gay and transgender rights, why not allow a male partner to receive a uterine transplantation? If the barrier is simply vascular anastomosis and hormone infusion, why not permit gestation within the abdomen of a man?

“The story is both a wonder and a worry. That a uterus dormant for years can suddenly spring to life with mere influx of blood and hormone is wondrous testimony to its divine design.

“Yet if we abandon moral standards given by that same Designer, on what basis shall we then make these decisions? We have so quickly progressed from challenging the boundaries of moral standards to repudiating their existence altogether. As followers of the Way, we must infuse in our culture the distinction between what could be and what should be.”

Resources

CMDA Resources on Reproductive Technology
CMDA Ethics Statement – Assisted Reproductive Technology

Brain-dead patient taken off life-support

Excerpted from “Brain-dead Texas woman taken off ventilator,” CNN Health. January 27, 2014 — A wrenching court fight—about who is alive, who is dead and how the presence of a fetus changes the equation—came to an end Sunday, January 26 when a brain-dead, pregnant Texas woman was taken off a ventilator. The devices that had kept Marlise Munoz's heart and lungs working for two months were switched off about 11:30 a.m. Sunday, her family's attorneys announced.

Munoz was 14 weeks pregnant with the couple's second child when her husband found her unconscious on their kitchen floor November 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth had said state law required them to maintain life-sustaining treatment for a pregnant patient.

Sunday's announcement came two days after a judge in Fort Worth ordered the hospital to remove any artificial means of life support from Munoz by 5 p.m. Monday. The hospital acknowledged Friday that Munoz, 33, had been brain dead since November 28 and that the fetus she carried was not viable. Her husband, Erick Munoz, had argued that sustaining her body artificially amounted to "the cruel and obscene mutilation of a deceased body" against her wishes and those of her family. Marlise Munoz didn't leave any written directives regarding end-of-life care, but her husband and other family members said she had told them she didn't want machines to keep her blood pumping.

Commentary

Since there are a variety of opinions on this difficult ethical issue, we have included 2 commentaries.

CMDA CEO David Stevens, MD, MA (Ethics):"While the medical technology being applied to Mrs. Munoz’s body might be considered “organ support” for her, it was “life support” for her unborn child. At the time of her death the baby was a few days from reaching 24-weeks gestation when survival rates approach 50%. Every day of continued life support improved the odds of the baby’s survival.

"A few days ago, on February 9th, Robyn Benson had a premature baby boy. Just after Christmas she suffered a cerebral hemorrhage resulting in her own brain death. She was maintained on life support until her baby was delivered. The ventilator was disconnected the day after her child was born. According to reports, the baby is doing well in the NICU.

"I don’t have access to the medical records in either of these cases, but a CNN article on the Benson case makes an inadequate effort to ethically differentiate between her baby’s situation and Mrs. Munoz’s. First, they let you know that one child was wanted by its father but the other was not. The worth of a human being does not depend on whether it is wanted or not. Secondly, the Munoz lawyer’s reported that an incomplete ultrasound had shown the baby had hydrocephalus and possibly other malformations. We should recognize that disposing of the disabled is unethical and simply eugenics. Who decides when a person is disabled enough for elimination?

"CMDA does not have an official ethics statement dealing with this complex issue. Maybe we should. You can contribute to the discussion of what it should say by clicking on the comment link below."

Clinical Ethicist and CMDA Trustee Robert D. Orr, MD, CM:“Marlise Munoz was dead, but her 14-week old fetus was alive. If Mom’s organs could be successfully perfused for another 12-14 weeks, her unborn baby could survive and be delivered by C-section. It is possible, though clinically very challenging. But should it be done?

“Marlise’s family did not want artificial support continued, and they were convinced she would not want it. The hospital believed Texas law prohibited removing life support from a pregnant woman. The legal issue was straightforward: Marlise was dead, therefore the support was not ‘life support’ for her, but ‘organ support’ for the benefit of the fetus. Continued support was legally optional.

“But what about the ethical dilemma? Who should decide? What factors should be considered? Some believe it is morally obligatory to do everything possible to prevent fetal death. Others believe that ‘doing everything’ is not always obligatory, making this comparable to high risk, high burden prenatal fetal surgery, i.e., optional, decided by her family based on their understanding of her wishes and values.

“Not all believers will agree. We will agree that we are stewards of our lives, our bodies and our resources. And we will likely agree it is immoral to intentionally end prenatal life for trivial reasons. The intention in continuation was to possibly benefit a second life. The intention in stopping was to discontinue ineffective and unwanted treatment. I personally believe continued support in this case was discretionary. And I believe we should not harshly judge the Munoz family’s decision.”

Resources

CMDA Ethics Statement on Vegetative State
Resources on End of Life Care

Why a feminist changed her mind on abortion

Excerpted from "How I Changed My Mind about Abortion," by Julia Herrington, Patheos, accessed on January 20, 2014 - Abortion was not an issue that I had ever imagined I’d become remotely passionate about. I am a bona-fide feminist with extreme ideas and boisterous opinions. Secretly, I’ve always felt that abortion wasn’t ideal and maybe not even right. But it’s complicated to believe that when you’re a feminist, and it’s certainly not something you profess publicly.

Working at a Pregnancy Resource Center changed all of this. This organization exists to offer women alternatives to abortion. I was pleasantly surprised to find that my co-workers were kind, compassionate and thoughtful.

My perspective changed dramatically because I determined that abortion does not actually benefit women. In so much as this is a women’s issue, it seems that abortion actually oppresses women. Procedurally what abortion requires is the silencing of a woman’s body and the unmitigated dismissing of her gender. What’s more, the reason a woman finds herself seeking out an abortion is that society holds her solely liable for pregnancy. Why are we letting men off the hook?

Abortion has a lot more to do with sex than we might have thought. Pornography, sexual crimes and abuses against women cannot be disconnected from the issue of abortion. Sexual liberation has made slaves out of women; it has only perpetuated and glorified their objectification. Sex that is void of relationship, honor and respect is why we’re here, be it the woman who is raped or the teenager who gets pregnant.

Just because a child is born into tragedy does not mean that his or her life is destined for a tragic ending. Regardless of circumstance, we as Christ followers must possess hope that any situation is redeemable. That’s what Jesus does, He redeems things. To be honest, I’m a fledgling where this conversation is concerned. I have really only just opened the door on this issue.

We cannot disregard this issue. We can no longer allow for the continued unquestioned oppression of women to persist. We need to reclaim healthy sexuality for ourselves, our children, our communities and our culture. And we must defend the weak, the defenseless; the children who might not be born.

Commentary

CMDA Member and Care Net Medical Advisor Sandy Christiansen, MD, FACOG– As an ‘older’ pro-life woman, it does my heart much good to see the next generation taking the standard and running with it. Kudos to Julia Herrington! Right you are that pregnancy centers are all about dispensing the compassion of Jesus to women—and men—at their point of need. Women facing an unplanned pregnancy come to our centers with a jumble of emotions and find a safe place to be heard, to gain valuable information about their bodies and their baby and to explore life-affirming alternatives to abortion.

“Abortion is not healthy for women. In fact, there are no scientific studies demonstrating how abortion improves women's mental health.¹ On the contrary, there is a lot data supporting induced abortion's harmful effect on women's wellbeing and mounting evidence of its negative impact on men.

“Not to burst Miss Herrington's feminist bubble, but pregnancy centers actually are responding to this new research and are customizing services for both women and men. Women are more likely to choose abortion because of lack of support and because they don't want to become single mothers.² Men who have experienced a partner's abortion can struggle with anger, anxiety and depression.³ No matter how you cut it, men are involved and need support, too. To find a pregnancy center near you or to talk to someone who cares, visit www.pregnancydecisionline.org.”

¹Fergusson DM, Horwood LJ, Boden JM. Does abortion reduce the mental health risks of unwanted or unintended pregnancy? A re-appraisal of the evidence. Aust N Z J Psychiatry. 2013 Sep;47(9):819-27. doi: 10.1177/0004867413484597. Epub 2013 Apr 3
²Finer, L. (2005). Reasons U.S. women have abortions: Quantitative and qualitative perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110–18.
Coleman, P.K., Maxey, C., Spence, M., Nixon, C. (2009). Predictors and correlates of abortion in the fragile families and well-being study: Paternal behavior, substance use, and partner violence. Int J Ment Health Addict., 7(3), 405–22.
³Rue, V. (1996). His abortion experience: The effects of abortion on men. Ethics and Medics, 21(4), 3–4.
Coyle, C. (2007). Men and abortion: A review of empirical reports. Internet J of Mental Health, 3(2).

President of Heartbeat International Dr. Peggy Hartshorn– “What a breath of fresh air it was to read this clear and articulate, first-hand account of a woman whose eyes were opened to the fact that abortion, far from advancing women's rights—or human rights for that matter—instead contributes to the increased and continued oppression of women.

“How fitting to come to grips with this truth in a Pregnancy Help Center, which for over 40 years have offered women in the United States and around the world the type of emotional support and practical resources needed in the midst of an unexpected or difficult pregnancy. Out of a sea of statistics showing that the pro-life movement is gaining ground in recent years, stories like Ms. Herrington's burst forth in vivid light and color, screaming, ‘Pregnancy Help Centers are good for America!’

“Today more than ever, physicians and everyone in the medical field have a critical role to play in the protection and cherishing of all life—born and preborn. Pregnancy Help Centers across the nation are adding and enhancing existing medical services, and they are in need of life-minded professionals from all corners of the medical field to lend their expertise to everything from medical advisory boards to staff physicians. What a joy it would be for the director of a local Pregnancy Help Center to receive a call from a pro-life medical professional in its community, asking what he or she can do to help save lives from the violence of abortion.”

Action

Medical pregnancy centers need physicians willing to volunteer as little as an hour per week to write orders, read ultrasounds and provide oversight to the nurse administering the medical services. To find a pregnancy center near you through a national pro-life organization:

• Care-Net centers: Go HERE to see centers in your region or call 703-554-8753 or email.
• Heartbeat International centers: email Heartbeat's Medical Specialist - SDammann@HeartbeatInternational.org

Resources

• Women’s Protection Project - state legislation
• CMDA Abortion Resources

Many women physicians regret delaying reproduction

Excerpted from “Many women physicians regret delaying reproduction,”OB.Gyn.News. October 21, 2013 – Many female physicians say that if they had to do it over again, they might have tried to have children sooner, chosen a different specialty or elected to have embryos frozen "just in case" they had later fertility problems, an investigator said at the conjoint meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine.

Dr. Natalie A. Clark and her colleagues surveyed a random sample of female physicians in the United States to ask about their choices for timing of conception, their basic knowledge of reproductive limitations, and how reproductive choices factor into their professional and personal decision making. The investigators randomly selected 600 women who graduated from medical school from 1995 through 2000, and a total of 333 (55.5%) responded.

Asked whether they would in retrospect have changed anything about their reproductive choices, 27.9% said they would have attempted to conceive earlier, 17.7% would have opted for a different specialty, 7.2% would have used cryopreservation of embryos or oocytes, 5.3% would have started medical training earlier, and 4.3% would have taken a leave from training. The survey highlights the unique challenges women of childbearing age face when trying to balance the demands of education, training and career advancement, said Dr. Clark, a third year resident at the University of Michigan department of obstetrics and gynecology in Ann Arbor. "We have a number of highly educated patients who come into our clinic who have finished their MDs or PhDs, and have done a great amount of postgraduate work, and they present at very late reproductive ages. They say, ‘I’m ready to start reproducing, and I don’t want to be too aggressive, but what can I do?’ – not fully realizing that they’ve missed their ideal reproductive window," Dr. Clark said in an interview.

One-fourth (25%) of all respondents had been diagnosed with infertility. "Despite having a medical background, 44% of infertile respondents were surprised about their diagnosis of infertility," Dr. Clark said.

Commentary

CMDA Member and Care Net Pregnancy Center Medical Director Sandy Christiansen, MD, FACOG: “Dr. Clark’s survey of 333 U.S. female physicians highlights an important pitfall to the pursuit of a career in medicine for women: the impact of delayed childbearing. As the reproductive clock ticks, female medical students and residents are spending their fertile prime time pouring over textbooks, taking night call and honing their skills as physicians. A significant portion of women physicians surveyed wished they’d tried having children sooner, but that choice brings an entire new set of challenges. One thing seems clear: women in medicine are rethinking their priorities and more are seeking ways to balance the needs of family and career during training years.

“Changing mores within medical education are reflective of increasing numbers of women in the profession. Shared training slots, extended family leave, shortened work days and reduced night call have all helped make room for living life, instead of putting it on hold during training years. The rate of childbearing among surgical residents at one program increased from 7 percent to 35 percent from 1976 to 2009, leading the authors to conclude programs should make accommodations or lose out on well qualified applicants.¹ Sometimes, it isn’t the institution that needs to adjust, but one’s own expectations and goals.

“As a Christian physician, when I married and began having babies, my priorities completely shifted. It was scary making changes, at first, but I’ve never regretted subordinating career for my family. Romans 12:2 provides a great counterpoint to society’s ‘you can have it all’ message: ‘Do not conform any longer to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will’ (NIV 1984). In God’s economy, sometimes less is more.”

¹Caitlin Smith, Joseph M. Galante, Jonathan L. Pierce, and Lynette A. Scherer (2013) “The Surgical Residency Baby Boom: Changing Patterns of Childbearing During Residency Over a 30-Year Span.” Journal of Graduate Medical Education In-Press. doi: http://dx.doi.org/10.4300/JGME-D-12-00334.1

Dr. Sandy Christiansen is a Fellow of the American College of OB/GYN, is the medical director of the Care Net Pregnancy Center of Frederick and national medical consultant for corporate Care Net, whose mission is to promote a culture of life within our society in order to serve people facing unplanned pregnancies and related sexual issues and whose vision is a culture where lives are transformed by the Gospel of Jesus Christ and every woman chooses life for herself and her unborn child.

Resources
Women In Medicine & Dentistry
Wait ‘til Your Mother Gets Home