Assigning Blame: IVF and the Twin Situation
I read the Newsweek article on twins this week. Of course I did. I have twins due to fertility treatments. Amy Klein is usually a smart writer, and I’m always interested in the rehashing of the single-embryo-transfer meets non-insurance-coverage debate. It isn’t financially feasible to go with single embryo transfers when there is no insurance coverage, though it also isn’t financially feasible to pay the health costs for premature multiples. Because of the lack of insurance coverage, we are asked to make impossible choices with our medical team. Every cycle is literally a gamble, and you just hope that you put your money on the right roulette number.
Still, medical science has gotten better and single embryo transfers are now less risky than they were 10 years ago. That is the point of the article: that we need to look at the facts in front of us and make choices based on science now vs. using methods that made sense years ago but no longer apply.
The only thing that bothered me about the article were the quotes from doctors that implied the decision to transfer more than one embryo rests solely with the patient. It’s not that they absolve themselves fully from the situation, but each doctor has a quote that places the blame for negative medical decisions with the patient. People are hedging their bets. Parents are making “conscious decision that would cause health risks for their kids.”
Even the description of the article points a finger:
“Fertility doctors want to curtail multiple births, but that’s a tough sell for women desperate to be mothers.”
Fertility doctors are the good guys. Desperate, hysterical women are the culprit.
Which begs the question: who is in charge? I’m under the impression that doctors are in charge of my medical treatment. I can shop around to find a doctor willing to do my bidding, but ultimately, they are the ones making the decision about my care. Certainly, when things go well, they are perfectly willing to accept the accolades for their high SART scores. Those scores, for instance, are assigned to the work of doctors, not the choices of their patients.
But when things go wrong — because a twin pregnancy technically counts as “things going wrong” if the goal is one baby — all blame rests with the patient. It’s a situation we see repeated by the media and the general public and doctors alike.
Yes, Nadya Suleman’s doctor lost his medical license. But who was blamed for reckless behaviour in that situation? Was it the doctor or Suleman? I’d argue that it was Suleman. And yes, that is an extreme example, but this article reflect that ideology.
When it goes well, we thank the doctor. And when it goes poorly, we blame the woman.
It is important to be an informed patient so you know the questions to ask and the information to provide, but I don’t have a medical degree. When I go to a fertility clinic, I am expecting the doctor to lead me to a best course of treatment. If that treatment conflicts with what I thought would be the suggested course of treatment, I’d ask for an explanation. But beyond that, I am paying a doctor for his or her expertise. Not just to be a warm set of hands feeling my cervix.
I think we need to be careful about assigning blame in general. Humans are way too trigger happy when it comes to raining bullets of words down on individuals. How many times do political pundits blame President Obama for situations outside the reach of the presidency? How many times do we blame individual teachers for the failure of students, or parents for their offspring? We like to behave as if all situations pop up in a vacuum without any external factors affecting the outcome.
So I’m not recommending that we assign blame to the proper individual, but more that we stop assigning blame. Period. That we look at all the factors that go into making a decision and work on fixing individual pieces. In other words, make things work better vs. snarling fault.
We have a situation: IVF protocols are still leading to multiple births, and multiple births are not the best outcome for mothers or children. So how can we fix this without assigning blame? Which cog in this wheel isn’t engaging the other teeth in order to make things turn smoothly? What needs to change so we can get a better outcome?
That’s the article I’d like to read. Not ones that paint fertility doctors like clueless Little Red Riding Hoods skipping through the woods to Grandma’s house, just wanting to deliver the muffins. While those desperate women, those big bad wolves, lurk behind the trees, ready to jump out and demand transfers of multiple embryos.