Lea Ann Mawler: Final Project

Final Paper

Abstract

Multiple births continue to increase in the U.S., in some part as a result of Assisted Reproductive Technologies and advances in Reproductive Medicine. While twins and triplets are increasingly considered "normal," higher order multiples are frequently the result of reproductive medicine. For example the famous and highly covered McCaughey septuplets born in 1997 are the first known live septuplets and were the result of the efforts of reproductive medicine.

These extreme reproductive outcomes seem to raise a number of questions. Why did science evolve to extremes that have such associated medical risks (especially in the context of the fabled, "first do no harm")? Despite the difficulties and risks for mother and child, reproductive science had continued to develop "treatments" that are more and more extreme but by no medical definition imperative. What is the imperative that drives us to these extremes? Why, in the face of significant medical risks, do people continue to undertake higher order pregnancies and births? What societal and cultural forces impact these decisions?

I will look at the popular media coverage of the McCaughey septuplets and consider the rhetoric around reproductive medicine in light of a "successful" outcome. In addition, I will look at medical literature surrounding the trend in multiple births in Assisted Reproductive Technologies (ART) and Reproductive medicine. Finally, I will investigate the discussions of extremes and reproductive medicine in STS literature.

Annotated bibliography - Secondary Sources

Thompson, Charis. Making Parents: The Ontological Choreography of Reproductive Technologies. 2005, MIT Press, Cambridge, MA.

This book doesn't address multiple births directly, but it does discuss the reproductive medicine and technologies that assist in multiple births. In addition, it has a large section discussing the relationship of reproduction and reproductive medicine in the context of STS and Feminist literature. I can also use its bibliography to look for other good sources.

Sieck, William A. "In Vitro Fertilization and the Right to Procreate: The Right to No." University of Pennsylvania Law Review. Vol. 147, No. 2, Dec 1998 (pp. 435-485).

Did not end up using this one because it didn't fit the topic.

Haraway, Donna J. "The Virtual Speculum in the New World Order." Feminist Review. No. 55, Consuming Cultures, Spring 1997 (pp. 22-72).

Provides a feminist perspective in reproduction and the intersection of visualization of the body and reproduction with technology. (nearly inscrutable, but I got a few things from it.)

Cohen, Cynthia B. "Give Me Children or I Shall Die! New Reproductive Technologies and Harm to Children." The Hastings Center Report. Vol. 26, No. 2, March - April 1996 (pp. 19-27).

Ran out of time, but I thnk this would fit into my feminist section.

Goslinga-Roy, Gillian M. "Body Boundaries, Fiction of the Female Self: An Ethnographic Perspective on Power, Feminism, and the Reproductive Technologies." Feminist Studies. Vol. 26, No. 1, Spring 2000 (pp. 113-140).
First line:
"A common theme in the feminist literature on the reproductive technologies has been that their advent has disarticulated reproduction into its genetic, biological, and social aspects." (113)

Ran out of time, but this would fit into my feminist section.

Corea, Gena. The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs. New York, Harper and Row 1985.

Ran out of time, but I thnk this would fit into my feminist section.

Klotzko, Arlene Judith. "Medical Miracle or Medical Mischief? The Saga of the McCaughey Septuplets." The Hastings Center Report. Vol. 28, No. 3, May - June 1998 (pp. 5-8).
Quote:
"A failure of medical judgment — or at least medical management — seems to have occurred, but much of the media resolutely kept its eyes off this aspect of the story." (7)

Bloomfield, Brian P. and Theo Vurdubakis. "Disrupted Boundaries: New Reproductive Technologies and the Language of Anxiety and Expectation." Social Studies of Science. Vol. 25, No. 3, Aug. 1995 (pp. 533-551).

Decided to leave this article out.

Rapp, Rayna. "Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduction to the Center of Social Theory." Anthrosource. Nov. 4 2000. www.anthrosource.net.

Reinforces the evolution of feminist thought that Thompson describes and discusses the idea of "normal" that I also got from Waldschmidt.

Marx, Leo. The Machine in the Garden: Technology and the Pastoral Ideal in America. New York, Oxford University Press, 1964.

Waldschmidt, Anne. “Who is Normal? Who is Deviant? 'Normality' and 'Risk' in Genetic Diagnostics and Counseling.” Foucault and the Government of Disability. Shelley Tremain, editor. Ann Arbor: The University of Michigan Press. 2005, pp 191 – 207.

Discusses the motivation to be normal.

Primary sources

- Popular Media Treatment of the McCaugheys - Newspaper and Magazine articles about the septuplets around the time of their birth (and some after?)

"News" About the McCaughey Septuplets.
http://www.time.com/time/magazine/article/0,9171,987455-2,00.html

Brings up a point about the McCaugheys being "small town" Americans. Why is this part of the discussion? That points to other sources that might be pertinent, one STS-like, and the other current / op-ed-like:

Lemonick, Michael D., Wendy Cole, Kevin Fedarko, and James L. Graff. “It's a Miracle.” Time Monday, December 01, 1997.

Good popular media "overview" of the mccaughey septuplets conception and birth.

http://www.time.com/time/politics/article/0,8599,1840388,00.html
- article on the "mythology" of the small town

Goldstein, Avram. “Second-Guessing the Seven Births; Doctors Cite Fertility Drugs' Risks, Failure to Limit Number of Fetuses.” The Washington Post. July 22, 2001. A01.

Abigail Trafford. “Octuplets and Other Babies.” The Washington Post. January 12, 1999.

Weiss, Rick. “What's the Matter With Multiple Births?” The Washington Post. December 01, 2008.

Gudorf, Christine. "The McCaughey Septuplets: Gifts of God after All." The Park Ridge Center Bulletin. Issue 4, May 1998. The Park Ridge Center for Health, Faith, and Ethics. http://www.parkridgecenter.org/Page136.html.

provides an alterntive ethical view that the mccaugheys did nothing wrong.

- Medical journal articles on multiple pregnancy / multiple births / infertility / selective reduction

I am searching databases like PubMed (from NIH) to find articles from medical journals regarding multiple pregnancies / infertility / etc.

Béatrice Blondel,.Kogan, Michael D, Alexander, Greg R., Dattani, Nirupa, Kramer, Michael S., Macfarlane, Alison, Wen, Shi Wu. “The Impact of the Increasing Number of Multiple Births on the Rates of Preterm Birth and Low Birthweight: An International Study.” American Journal of Public Health. August 2002, Vol 92, No. 8. pp 1323 – 1330.

Statistics about risks fo multiple births and rates of multiple births.

Bernstein, Judith and Anne T. Fidler. “Infertility: From a Personal to a Public Health Problem.” PUBLIC HEALTH REPORTS. NOVEMBER/DECEMBER 1999 * VOLUME I 14 pp 495 – 511.
Van Voorhis, Bradley J. “Outcomes From Assisted Reproductive Technology.” Obstetrics and Gynecology. Volume 107(1), January 2006, pp 183-200.

Overview of infertility, including statistics and charts.

 
Selective single blastocyst transfer reduces the multiple pregnancy rate and increases pregnancy rates: a pre- and postintervention study
http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2253713&blobtype=pdf
 
Study of maternal age and muiltples on outcome
http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1955760&blobtype=pdf
 - shows increase in badness with multiples… (but too related to age?)
 
 
Assisted Reproductive Technology reports
http://www.cdc.gov/art/ARTReports.htm

- Statistics

Careful reading of the statistics sites may move some of these into the secondary source category.

“National Center for Health Statistics Multiple Births Multiply During Past Two Decades.” November 13, 1997. http://www.cdc.gov/nchs/pressroom/97facts/triple2.htm

The Changing Epidemiology of Multiple Births in the United States; By R. B. Russell, J. R. Petrini, K. Damus K, D. R. Mattison and R. H. Schwarz, Perinatal Data Center, March of Dimes Birth Defects Foundation
http://www.marchofdimes.com/professionals/681_9209.asp

Trends in Multiple Births Conceived Using Assisted Reproductive Technology, United States, 1997–2000. The Journal Pediatrics.
http://pediatrics.aappublications.org/cgi/content/abstract/111/5/S1/1159

CDC Vital Statistics online
http://www.cdc.gov/nchs/about/major/dvs/Vitalstatsonline.htm

Iatrogenic multiple births: a 2003 checkup. Fertility and Sterility , Volume 87 , Issue 3 , Pages 453 - 455 H . Jones Jr.
http://linkinghub.elsevier.com/retrieve/pii/S0015028206045596

Live-birth rates and multiple-birth risk of assisted reproductive technology pregnancies conceived using thawed embryos, USA 1999–2000. Human Reproduction, Vol. 18, No. 7, 1442-1448, July 2003
http://humrep.oxfordjournals.org/cgi/content/abstract/18/7/1442

http://allcountries.org/uscensus/79_births_and_birth_rates_by_race.html

http://www.infoplease.com/ipa/A0922289.html

Twin and Multiple Births are on the Rise  by: Nancy Wurtzel
http://www.streetdirectory.com/travel_guide/7351/parenting/twin_and_multiple_births_are_on_the_rise.html

Redfearn, Suz. “A Reality Check on Assisted Reproduction: New Center to Publish Objective Data on IVF, Other Birth Technologies.” The Washington Post. November 4, 2003.

Longo, Dan L. and Edward A. Sausville. “Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy.” Harrison's Principles of Internal Medicine. 16th ed. Dennis L. Kasper and Tinsley Randolph Harrison Editors. New York: McGraw Hill Medical Publication Division. 2005. pp 464 – 482.

Mann, Judy. “Getting a better handle on a miracle.” The Washington Post. December 10, 1999: C12.

Redfearn, Suz. “Pursuing a Baby to the Ends of the Earth; After $70,000 worth of unsuccessful fertility treatments, a Virginia couple resorts to 'reproductive tourism' for one last shot at pregnancy.” The Washington Post Magazine. January 14, 2007: W16.

Trafford, Abigail. “Miracle Birth is Nothing Worth Celebrating.” The Washington Post. July 24, 2001: T09.

Waldschmidt, Anne. “Who is Normal? Who is Deviant? 'Normality' and 'Risk' in Genetic Diagnostics and Counseling.” Foucault and the Government of Disability. Shelley Tremain, editor. Ann Arbor: The University of Michigan Press. 2005, pp 191 – 207.

Weiss, Rick. “Fertility Innovation or Exploitation? Regulatory Void Allows for Trial — and Error — Without Patient Disclosure Rules.” The Washington Post. February 9, 1998: A01.

Weiss, Rick. “Studies of Test Tube Babies Disagree About Mental Lag.” The Washington Post. May 22, 1998: A03.

Weiss, Rick. “What's the Matter With Multiple Births?” The Washington Post. December 1, 2008: Z10 (Health).

Yardley, Jonathan. “Mystery And Maternity.” The Washington Post. September 14, 1998: B02.

Edwards, Robert G. and Bart C. Fauser. “The Early Days of IVF.” Human Reproduction Update. Accessed online at http://humupd.oxfordjournals.org/cgi/content/full/11/5/437. Print reference: Volume 11, Number 5, August 2, 2005: pp 437 – 438.

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “2005 Assisted Reproductive Technology (ART) Report: Home” Accessed online at http://www.cdc.gov/ART/index.htm.

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “2005 Assisted Reproductive Technology (ART) Report: Section 5 – ART Trends, 1996 - 2005” Accessed online at http://www.cdc.gov/ART/ART2005/section5.htm.

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “2005 Assisted Reproductive Technology (ART) Report: Appendix B: Glossary of Terms Used in This Report.” Accessed online at http://www.cdc.gov/ART/ART2005/appixb.htm.

Kastor, Elizabeth. “People Find Multiple Meanings in The Birth of Iowa Septuplets.” The Washington Post. November 27, 1997

Rapp, Rayna. “Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduction to the Center of Social Theory.” Medical Anthropology Quarterly. 15(4):466-477.

Haraway, Donna J. “The Virtual Speculum in the New World Order.” Feminist Review. No. 55, Consuming Cultures (Spring, 1997), pp. 22-72.

Glusker, Anne. “Misconceptions; A writer recounts the ordeals she went through to have a child.” The Washington Post. March 11, 2007. (Book review.)

Whitaker, Barbara. “Overshadowed Texas Sextuplets Are Receiving Belated Help.” The Washington Post. A9.

Research obstacles

I'm having some difficulty deciding how to frame this paper.

I had originally decided to specifically focus on 1981 (the year of the first successful test tube baby) to 1997 (the year the McCaughey septuplets were born). However, I'm having difficulty deciding if that is too narrow, or perhaps too broad, and I've found a couple of perfect articles that are outside of that scope.

In addition, mutiple pregnancies are sometimes (as in the case of the McCaugheys) the result of fertility drugs, while a great deal of the literature is on IVF and other ARTs (in which fertility drugs aren't included).

So… Drugs only leaves out good stuff on IVF and ARTs; IVF only leaves out my focus people; 1981 - 1998 leaves out good discussion that follows, and also seems like it frames the problem of high risk fertility treatments, but not how the problem has developed in the last decade (which has seen quite a difference in treatments and also in attitudes.)

Situating The Topic In American Culture

NOTE: I couldn't figure out how to indent the block quotes (and the quote function just made them disappear) so I made them monotype so they'd stick out. Hopefully that will be understandable. Also, sorry for the excessive length…

Multiple Births in American Culture

In some ways, reproductive medicine doesn't have any home outside of culture in the ways that it could be argued other areas of science do. There are certainly parallels to be drawn between cutting-edge laboratory science that advances a science “agenda” and cutting-edge medical laboratory science which (in theory) is aimed at solving individual medical problems.

For example, while many people know of the CERN super-collider, it seems that few could explain the science, and even fewer know someone who has worked on or been directly affected by the science involved. With reproductive medicine, almost everyone knows about someone working in or using the science involved, and in fact, facilities for the research and application of reproductive medicine are in many neighborhoods. Additionally, reproductive medicine is not funded federally and so the research is distributed (at the clinics) and the clinics are distributed so that most large towns and cities have a physical, local presence.

Fertility doctors… argue, since the federal government has decided not to fund fertility research, it is up to the private sector to conduct that work. (Weiss, 02/09/1998)

The focus of my paper is on extremes in reproductive medicine with a special focus on multiple births resulting from reproductive medical treatments. Part of the question is why has the science of reproductive medicine gone in the directions that it has? Infertility is a medical problem, but it is certainly not life-threatening. But, reproductive medicine has gone down a path that introduces considerable risk to the mother and the potential offspring, in a way that seems different from other medical protocols.

There are some themes that can be identified for what drives patients and doctors to such extremes that derive specifically from reproductive medicine being situated so squarely in culture, and in this case, American culture. Two of these are desperation and economics.

In numerous articles in popular and journalistic media, authors, patients, and doctors all attest to the “desperation” of patients to get pregnant and have a child. In an article discussing “Normality” and “Risk” in Genetic Testing, Anne Waldschmidt discusses a possible driver of this desperation – seeking to be “Normal.”

Normality— that seems to be the central buzz word of our time. Don't all of us want to be as normal as possible? Is there anyone who wants to be ostracized or considered deviant? Like ideals of health, the concept of normality has gained such great suggestive power, especially in the course of the last century, that one can hardly avoid its influence. In the government of deviance, normality has become the decisive point of orientation. Professional discourses and social policies, rehabilitation programs and therapeutic practices, all with the aim of making normality possible for their clients and recipients, revolve around this central notion. (Waldschmidt, 191)

Examples abound from patients and doctors relaying their patients' desperation. A Washington Post article which discusses the lack of regulation over testing and research of new reproductive medical protocols quotes an NIH official regarding the population of patients seeking fertility treatment.

"It's an extremely vulnerable patient group," said Gary Ellis, director of the office for Protection From Research Risks at the National Institutes of Health. "Desperation reigns." (Weiss, 02/09/1998)

Another Washington Post article quotes Gianpiero Palermo, who pioneered the reproductive technology of intracytoplasmic sperm injection (ICSI) in Brussels and is now at the Cornell University Medical School in New York, discussing the desperation in his patients. “These people come in and they beg you to help them have a baby.” (Weiss, 05/22/1998)

Specifically with respect to multiple births, one method of prevention of multiple births is to simply limit the number of embryos implanted during an IVF procedure. However, even here, patient “desperation” is cited as driving doctors to exceed recommendations for such limitations. One article discusses a conference held jointly by the Geneva-Based Bertarelli Foundation and the National Institutes of Health. The author discussed this issue with Geraldine Ferraro, a member of the Bertarelli Foundation's Board.

The anguish surrounding multiple births surfaced in a conversation she had with a young woman who'd had a failed implant. The young woman begged her doctor to implant four eggs the next time, instead of three. He agreed on the condition that if all four were successfully implanted, she would agree to a reduction of one. This is a far different situation than aborting an unwanted pregnancy, Ferraro notes. These babies were very much wanted. "In this instance, you've got women who've spent a lot of time and money," Ferraro says, "and there's a lot of emotion tied up in this pregnancy." (Mann)

Judy Mann, the author of the article, goes on to state in her conclusion: “Couples who have had children easily can't possibly understand the devastating sense of loss felt by couples diagnosed as infertile.” (Mann)

It seems that the desperation for children extends also to a desperation for pregnancy. Even though egg and sperm donation are common parts of IVF, depending on the medical issues at hand, many parents see this as preferable to adoption. In an article in the Washington Post Magazine, Suz Redfearn discusses her own struggles to have a child, including egg donation and IVF, and as she considers adoption, she expresses the desire to be pregnant.

Adoption was not something I'd wanted to do. In fact, for years, I was wholly unable to picture it. One day, you are most decidedly not a parent, and then the next day you are? How was I supposed to wrap my head around that? Plus, something deep within me wanted to be pregnant — needed to be pregnant. Badly. Just once. I could see adopting later. But not now. (Redfearn)

While the desperation to have a child is not life-threatening, the impulse drives people to undertake extreme procedures and risks. There is a colloquial belief that physicians work under the tenet “First do no harm” primum non nocere. There are circumstances in which this tenet is violated, but these circumstances are typically life and death situations. Cancer treatments are a good example of a place where the tenet of first do no harm is not the central goal. An introductory overview of internal medicine, Harrison's Principles of Internal Medicine, states, “The goal of cancer treatment is first to eradicate the cancer… The dictum primum non nocere is not necessarily the guiding principle of cancer therapy. When cure of cancer is possible, cancer treatments may be undertaken despite the certainty of severe and perhaps life-threatening toxicities. Every cancer treatment has the potential to cause harm, and treatment may be given that produces toxicity with no benefit.” (Longo and Sausville, p. 464)

However, perhaps in the case of infertility, the circumstance in which the tenet is violated isn't life of death, but simply requires a level of desperation which patients display.

In addition, another squarely cultural reason for the extremes in reproductive medicine is economics. Infertility treatments are very expensive, and a survey, again, of the popular and journalistic media regarding what drives multiple births is economics.

Patients are partially responsible for the problem. Fertility treatments are difficult and expensive, so many women getting IVF-in which embryos are grown in laboratory dishes and then transferred to a woman's uterus-insist upon having four, five or more embryos transferred to increase the odds that at least one or two will survive. Too often, a greater than expected number of them become babies. (Weiss, 12/1/2008)

A separate, but equally compelling economic argument is that doctors want their success rates to be as high as possible. “Success rates” of IVF are required by Federal regulation from fertility clinics and published annually, so consumers can use these success rates to shop for a clinic.

Doctors are also to blame [for multiple births], experts said, because they want their success rates to remain competitive. A cautious doctor who places only two IVF embryos in a woman's womb or counsels a woman to cancel a cycle because of ovarian overstimulation risks coming up empty-handed. (Weiss, 12/1/2008)

However, the success rates are often misleading, because the consumers don't know what practices led to the success rates (such as riskier procedures or tighter screening – turning patients away who aren't likely to have success.) In addition, some clinics will direct all patients to IVF, despite the possibility of lower-tech solutions working, because this shortens time frames and increases success rates.

All of these factors lead to discussions of ethics. Most of the articles don't question the ethics of fertility treatments, but of the tangential practices and research. There are huge ethics debates over left-over embryos, which relates to the topic of this paper because if fewer embryos are transferred in an IVF cycle, then the remaining embryos are frozen and their disposition becomes an ethical debate. In addition, IVF brings up the questions of selective reduction, which involves reducing the number of fetuses from a multiple pregnancy, and genetic testing of embryos leading to selection on the basis of “traits” versus health.

One example of this debate is given in an article about a sex selection technology pioneered by a fertility clinic in Fairfax, Virginin, Genetics & IVF. The clinic charges prospective parents for use of a technology they call MicroSort, which claims to be able to allow the parents to choose the sex of the child. While there are those who argue that there are ethically acceptable reasons for making such a choice, Jonathan Yardley clearly does not believe so, according to his article in the Washington Post shortly after MicroSort was introduced.

As was pointed out by many readers after I sounded off last spring about Viagra, its uses for vanity and frivolity can be offset by its curative or regenerative powers. Viagra has restored potency not merely to men who lost it due to self-indulgence but also to those who were deprived of it by illness or surgery. It is exceedingly difficult, though, to see how MicroSort can be of similarly genuine medical use. Genetics & IVF is a for-profit fertility clinic, and MicroSort presumably offers it vast potential for same, which is fine; it's a free country. Just do everybody a favor and don't try to fob MicroSort off as anything except another way of making a buck off human foolishness. (Yardley)

Fertility Treatments in general, and the risks of multiple births, specifically raise all sorts of issues, not the least of which is “blame.” Many doctors are quoted as stating that multiple births are not acceptable, using commensurate language. For example, the following quotes are from an article discussing septuplets born in Washington, DC four years after the McCaughey septuplets.

"Another tragedy," said Robert W. Rebar, associate director of the American Society for Reproductive Medicine (ASRM), the organization of fertility specialists. "We all cringe when it happens.”
"A failure," echoed Robert J. Stillman, medical director of the Shady Grove Fertility Centers in Rockville. "It's a failure of medical therapy. That's really the way we look at it." (Trafford)

At the same time, regarding the McCaughey septuplets, there are those that claim that the parents, at least, did nothing wrong, according to our current standards for parenting and fertility treatments.

I will not deny the troubling aspects of this birth. But it is difficult to find a point at which the McCaugheys contravened a moral consensus. They had one child, and they wanted a second. Even in view of the world's — and the U.S.'s — overpopulation, there is currently no serious proposal by any group to limit American families to one child, though there may eventually be. Furthermore, there is no consensus against the use of fertility drugs. Fertility drugs have become standard treatment for infertile women. As for selective abortion, there remains a significant minority in the nation who think that all abortion should be legally banned as murder. There is certainly no consensus on abortion as morally obligatory in any circumstance. Unless the McCaugheys knew how many ova had been or were about to be released when they decided to have intercourse, they are no more morally culpable for the huge medical bills the septuplets and mother incurred than any couple who encounters complications in childbirth. The McCaugheys' insurer is paying all claims, and Bobbi had a tubal ligation immediately after the delivery of the last child. They seem to fulfill the ordinary requirements of responsible parenthood. (Gudorf)

There appears to be a push and pull between patients and doctors for what drives research on in newer and more cutting edge reproductive medical practices.

Fertility doctors say they are just trying to give women the best odds of getting pregnant. Patients want nothing less than the latest technology, they say, even if it is still experimental… (Weiss, 02/09/1998)

And patient desperation seems to drive patients to be participants in research that pushes the cycle forward.

"When we started getting some [embryos from frozen eggs] that lived, we approached a patient… We told her, we don't know if this will work. We won't charge you, but if we make an embryo with one of these thawed eggs and your husband's sperm, would you take it?" The woman, who like many fertility patients could barely afford her treatments, said yes. Last year, she became the first in this country to give birth to a baby from a frozen egg. (Weiss, 02/09/1998)

From a cultural perspective, it seems to be the desperation to have a child that is driving medical research in the field of reproductive medicine. For some, that is the desperation to have a pregnancy; for some, it is the desperation to have a genetically related child (in the case of surrogacy). However, the increases in multiple births seem to be driven partly from an economic perspective, and partly because of the physical and emotional difficulty of some of the fertility treatments available. These aspects combine to push doctors and prospective parents into incredibly risky procedures in order to create a new life.

The Time Magazine article on the McCaughey septuplets seems to sum up the situation well:

Seven healthy babies born at once are clearly a testament to the marvelous workings of nature, or God, depending on your point of view. But they are also a powerful demonstration of human ingenuity. The septuplets graphically demonstrate both the promise of modern fertility treatments and their peril. (Cole)

Works Cited

Cole, Wendy, Kevin Fedarko, James L. Graff, and Michael D. Lemonick. “It's a Miracle.” Time. December 1, 1997. Accessed online: http://www.time.com/time/magazine/article/0,9171,987455-1,00.html November 2, 20008.

Gudorf, Christine. “The McCaughey Septuplets: Gifts of God after All” Bulletin (Faith and Sexuality). Issue 4. Chicago: Park Ridge Center. May 1998.

Longo, Dan L. and Edward A. Sausville. “Principles of Cancer Treatment: Surgery, Chemotherapy, and Biologic Therapy.” Harrison's Principles of Internal Medicine. 16th ed. Dennis L. Kasper and Tinsley Randolph Harrison Editors. New York: McGraw Hill Medical Publication Division. 2005. pp 464 – 482.

Mann, Judy. “Getting a better handle on a miracle.” The Washington Post. December 10, 1999: C12.

Redfearn, Suz. “Pursuing a Baby to the Ends of the Earth; After $70,000 worth of unsuccessful fertility treatments, a Virginia couple resorts to 'reproductive tourism' for one last shot at pregnancy.” The Washington Post Magazine. January 14, 2007: W16.

Trafford, Abigail. “Miracle Birth is Nothing Worth Celebrating.” The Washington Post. July 24, 2001: T09.

Waldschmidt, Anne. “Who is Normal? Who is Deviant? 'Normality' and 'Risk' in Genetic Diagnostics and Counseling.” Foucault and the Government of Disability. Shelley Tremain, editor. Ann Arbor: The University of Michigan Press. 2005, pp 191 – 207.

Weiss, Rick. “Fertility Innovation or Exploitation? Regulatory Void Allows for Trial — and Error — Without Patient Disclosure Rules.” The Washington Post. February 9, 1998: A01.

Weiss, Rick. “Studies of Test Tube Babies Disagree About Mental Lag.” The Washington Post. May 22, 1998: A03.

Weiss, Rick. “What's the Matter With Multiple Births?” The Washington Post. December 1, 2008: Z10 (Health).

Yardley, Jonathan. “Mystery And Maternity.” The Washington Post. September 14, 1998: B02.

Final Paper

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