The Hearing of Octomom's Doctor and the Medical Ethics Debate
She's the news story that will never end -- Nadya Sulemnan, otherwise known as Octomum, is back on CNN. Well, more accurately, her doctor, Michael Kamrava, is in the news, though it's impossible to discuss one without the other. Currently, he is taking part in a hearing that will determine whether or not he should lose his medical license. He has already lost his membership to the non-profit group, ASRM (American Society for Reproductive Medicine).
On one hand, it seems like a no-brainer. Beyond the Suleman case, there are other reasons Kamrava is having this hearing. With Suleman, guidelines state that doctors should transfer "no more than two embryos for women under 35 years old and no more than five for women over 40." He clearly violated the guidelines, and in doing so, put a patient's life in grave danger as well as the lives of her unborn children. Just because the story has a happy ending (is it a happy ending?) doesn't mean that the medical board should forget the statistically much more likely ending which could have included maternal death or neonatal death due to premature birth.
An expert witness inadvertently stated the heart of the matter. Dr. Victor Fujimoto was asked by the deputy attorney about Suleman's request to transfer 12 embryos.
When Alvarado asked him if it is not a doctor's responsibility to protect a patient from themselves, he answered "Sometimes."
There are clearly times when we'd fight just as hard for the right to not accept a doctor's protection. We can point to plenty of cases where we want the patient's voice to be heard, even when they are taking a risk with their life. Can we have it both ways?
For instance, VBAC (vaginal birth after cesarean) is a popular hot topic. The decision for a VBAC should be solely between the patient and doctor since only these two individuals have the woman's medical information. Yet what about women who rest in that grey zone for VBAC, neither clearly safe to attempt it, nor high risk for a uterine rupture? Is it the doctor's responsibility to protect the patient from herself and make the call, or is it the patient's right to decide once they've weighed the risks?
Moving up to an even greyer area, the case of Virginia v. Cherrix. Abraham Starchild Cherrix (also called Wolf) refused to continue chemotherapy in order to combat Hodgkin's disease. In refusing treatment, is the doctor allowing a patient to put themselves in harm's way, and is it that doctor's job to protect that patient from themselves?
Clearly, doing something to the body is quite different than withholding something from the body, though the end result may be the same. Still, this is a discussion we need to have because the meeting of religion and medicine could lead to more Suleman-like situations down the road (and for the record, Suleman is not the first person to have 12 embryos transferred. She is simply the first person who had 8 embryos implant and carried and delivered all 8 babies. People never hear about other cases because either none or a lower amount of the embryos implant).
Some religions have made clear statements against the freezing of embryos. But in a medical procedure that is just as much art as science, it is impossible to control how many viable embryos are created in the end. Doctors need to encourage the production of multiple embryos in order to give patients a chance of having one or two viable embryos for transfer. But what about the lucky few who create many viable embryos in a cycle? If they are against freezing embryos or destroying embryos, are religious organizations encouraging them to transfer too many embryos (legally sharing the embryos in this situation becomes almost impossible without freezing the remaining embryos)?
Please remember in thinking about this case, while Dr. Kamvara was negligent, he is not the first doctor to transfer more embryos than the human body can safely carry. While some people who have multiple embryo transfers (MET) end up with twins or higher order multiples, many patients who have a MET end up with a singleton. And while single embryo transfers (SET) would obviously be the ideal, what stops most people from electively opting for a SET is the high cost of IVF, which is often not covered by insurance. Medical ethical dilemmas may seem to have a clear solution until you consider the other pieces of the puzzle.
Fertility procedures have been keeping medical ethicists busy, but the question of whether a doctor should follow the request of a patient isn't unique to the fertility world. Do you believe a doctor should follow the wishes of his patient if that wish has the potential to harm them?
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