Bioethics

More Than Just a “Reduction”

Author Amy K. Hall Published on 05/23/2007

The article titled “Too Much to Carry posted on washingtonpost.com is a difficult read.  The author, Liza Mundy, spent time with a doctor who performs “selective reductions” for women who are pregnant with multiple fetuses.  To improve the chances of a successful birth of one or two of the children, the weakest one (or ones) is eliminated, or the one with a genetic abnormality, or the one most conveniently located, or the one who is not of the preferred sex. 

The article is heartbreaking in terms of the women who go through this, and even more disturbing in terms of the babies who are singled out to lose their lives. Here's how one decision went that day:

The test results for Jane and Emma stacked up like this: A: XX, B: not tested, C: XY, D: XX. Two girls, one boy, one unknown. The known ones all normal. And so, for this last reduction procedure of the day, one decision had been made. Evans would reduce B, which was most accessible. As for the other one, he told the women they could have two girls -- that is, he could keep A and D -- or they could have a boy and a girl, in which case he would keep C and one of the girls. “If you want one of each, I’ll keep one of each,” Evans told them. They wanted one of each....

He injected the potassium chloride, and B, the first fetus to go, went still. “There’s no activity there,” he said, scrutinizing the screen. B was lying lengthwise in its little honeycomb chamber, no longer there and yet still there. It was impossible not to find the sight affecting. Here was a life that one minute was going to happen and now, because of its location, wasn’t. One minute, B was a fetus with a future stretching out before it: childhood, college, children, grandchildren, maybe. The next minute, that future had been deleted.

What makes this all the more difficult to read is the fact that all the children were purposely implanted in the women by their choice and with their greatest hopes.  All of this heartache, the choosing of who would die, and the death itself could have been avoided if the women had only implanted what they would be willing to carry to term.  (The financial cost of failure is a small price to pay in light of these considerations.)  But reading the account of the women’s reactions throughout the article, I suspect that in their eagerness to be sure that at least one embryo implanted, they weren’t thinking carefully ahead of time about what “selective reduction” would mean when they had to face it in reality.

One woman described what I know would haunt me if I were ever to go through this:

“Now that I know my two daughters, looking at them, I think: It could have been you,” she continued. “You terminated an embryo that could have turned into a baby you would love as much as the ones that you have, and that”s hard....”  

“I could have ended up with one of these being gone, and the one that is gone could have been one of these.”