Sadly, I wasn't entirely surprised to hear that Nadya Suleman, America's famous "Octomom," has claimed in an interview this week to hate her babies. The transfer of 12 embryos simultaneously to a woman who was already the mother of 6 children was a recipe for disaster from the beginning. The resulting birth of eight babies would have been enough to enormously raise the stress level of any parent, let alone this particular single mother. This begs the question, whether fertility clinics should require a psychological profile of patients in certain "at risk" categories.
Thankfully, the Octomom case is pretty much a one-off. Perez Hilton, the gossip 
columnist, has labelled her a "tabloid magnet" for her attention-grabbing antics of the past 2 years. Now describing her 6 older children as animals, Suleman's excuse for their behavioural problems is stretched resources; she simply doesn't have the time to teach them good discipline. What did she think raising 14 children on her own was going to be like? Her brood of eight two-year olds "disgust" her, presumably because they do what all two-year old children do: soil their pants, dribble, play with their food, have fun making mess and vie for attention. The difference here seems to be the absence of unconditional love, which goes a long way toward offsetting the more exhausting and patience-testing aspects of parenting.
Dr Michael Kamrava, Suleman's fertility specialist, also has reason to regret his role in the Octomom saga. Kamrava's medical license was revoked this week by the California State medical board, which decided that Kamrava "did not exercise sound judgment" and "committed gross negligence, repeated negligent acts and incompetence," in this and two other cases. Having already helped Suleman conceive her previous six children, he must have known her fairly well. It's difficult, therefore, not to wonder whether his actions were more motivated by an interest in fame than in appropriate medical care. I marvel that those who worked with him professionally didn't put a stop to it by refusing to be involved in Suleman's treatment, before it got so out of hand.
In the normal course of events, medical clinics take patient histories before agreeing treatment. You sit in the waiting room and fill out pages on a clipboard even when going to have a check-up these days, let alone assisted reproduction. In theory, some further scrutiny of an unusual medical and personal background history should take place. At the very least, it should prompt a discussion among all the responsible parties as to whether the patient is suitable for treatment.
Clinics turn down prospective patients all the time for unsuitability based upon subjective criteria. The question "Is she a good candidate for the proposed procedure?" gives them a lot of scope. "Am I doing more good than harm by treating her as requested?" is another. Obviously, this will apply differently for each patient and procedure...after all, assisted reproduction, while elective, isn't cosmetic surgery, where a person is only doing damage to themselves (though I might argue that some plastic surgeons should say "no" more often too). Clinics must institute their own system of checks and balances to guard not only against runaway egos like Suleman and Kamrava doing whatever they like, but also against misguided and risky procedures for the sake of convenience or cost-cutting. It is the medical professional's responsibility to limit treatment to what is both medically advisable and socially responsible under the circumstances. The first is more easily defined, the latter more controversial because there is no set standard, but that doesn't mean it should be overlooked entirely.
In the wake of the Octomom debacle, the American Society of Reproductive Medicine asked that doctors who exceed the recommendation transfer only one additional embryo, note the decision in the medical record and caution patients about the risks of multifetal pregnancies. This leaves room for patients with a very poor prognosis being given more leeway regarding embryo transfer, but would leave patients with dubious intentions nowhere to go. I have no doubt that the better clinics already do this.
Balancing our personal freedoms - I commiserate when hearing of the way well-intentioned adoptive parents are scrutinized by social workers, their relationship, lifestyle and personal philosophy poked and prodded enough to make anyone look unbalanced. I don't believe that everyone who is infertile needs counselling. It isn't fair that anyone who is able to conceive naturally can have as many children as they like, without anyone's intervention, but those who need assisted reproduction techniques or adoption to become parents might need to jump through hoops. Ultimately, however, fairness to the adults involved is less important than the protection of children's health and welfare. When third parties get involved in creating families, it presents an opportunity to make sure that decisions are based upon the best interests of the child. Far better than Social Services having to go in and remove children from their parent's care once born into a dysfunctional situation.
It's clear that Nadya Suleman was in over her head, with unrealistic expectations, insufficient support and insufficient finances. Her doctor(s) should have been able to discern this and make a more responsible decision at an early stage in the process. Now, she and her children are faced with the consequences. I have no doubt she is going through challenging times. Does she hate her children? Despite it being an unforgivably horrible thing to say, I hope she was just mouthing off and didn't mean it. I hope this woman gets some help, and fast. But in the end, my concern is for all 14 of her children, who don't deserve to be subject to her resentment, erratic behaviour and inadequate parenting skills.
