It's an epidemic. Everywhere I look I find normally calm, compassionate friends and colleagues foaming at the mouth whenever the word "octuplets" is mentioned. "You have an illness," I say. "Own up to it- it's the first step towards recovery."

Alas, if it were only so easy. Anger, Hatred, Moral Outrage! The accusations and recriminations flow one after another, with pressured speech.

"That woman is so irresponsible!"

"How is she going to take care of all those babies?"

"Why should I have to pay for her crazy actions!"

"She's crazy! She's had plastic surgery to look like Angelina Jolie."

"The doctor who did this should go to jail!"

"Disgusting use of our health care dollars!"

For those of you unaware of this case because you are living in a cave in Afghanistan waiting for Osama bin Laden and his dialysis machine to return to select you for the glory of a suicide mission, here is what you need to know. An unmarried woman in California allegedly underwent in-vitro fertilization (IVF), had six embryos implanted, and somehow delivered eight babies, all of whom have so far survived (A scientific miracle!). She already had six children at home, all conceived via IVF. So, baby (ies) make 14. Everyone involved in the case has been interviewed by People, Dr. Phil, etc, except for the studly tail-wagging sperm that could create eight babies from six embryos (Another miracle).

It's hard to know why a particular story captures the imagination the way this one has. My opinion is that the reasons are deeper than those usually expressed.

I don't find the common arguments particularly compelling. To begin, no law was broken; none of my angry friends live in California, and will not be contributing one cent directly or indirectly to care for her children; and I have sympathy for a woman who actually loves and wants her children, even if the numbers are beyond anything I can imagine. As for wanting to look like Angelina Jolie, this seems an indicator of good mental health- I'd be worried if she strove to look like Renee Zellweger.

Let's not forget that there are millions of unwed mothers (often just kids themselves) on welfare with multiple children, unplanned and unwanted, who became pregnant the old-fashioned way. Is that somehow better? And what about the deadbeat dads who flit from woman to woman without taking any financial or parental responsibility for their offspring? Less objectionable? I don't think so. Not long ago a man in his early 40s came to my office. He proudly told me he had 12 children from seven different mothers. What did he want? A vasectomy(!). I have no idea whether or not he supports any or all of his children, so I'm not criticizing, but just pointing out that Octo-mom may not be so beyond the pale. If only one birth had resulted from the six implanted embryos (as apparently happened with an earlier IVF cycle), leaving her with a final tally of seven children, would her behavior have been any less crazy?

I believe the passion engendered by this case comes from being forced to confront the fact that reproductive science has brought us to a place where traditional notions and experience are inadequate to deal with some of the issues that arise. How do we apply a sense of what is right or wrong when we've never even considered the possibility before? Frankly, it is a testament to the integrity of the clinicians and scientists involved in IVF centers in this country that cases like this one are so rare, because the potential for crazy stuff is a daily hazard.

The ethical questions are really challenging. The woman had six of her embryos stored in a frozen state. If some of my froth-addled commentators had their way, she should never have been implanted with any of them. But to whom do they belong, if not the woman? Who is to say what should happen to the embryos, if not her? The doctors? The government? Her church or community?

Who decides how many children are enough- two, four, six? One, as in China? Does the calculus change for a single mom versus a married couple? A rich couple versus one on state assistance? And what if fertility treatment is required? Is having children a right? Does it change if a person pays with their own money for infertility treatment?

It's a brave new world, folks. Let's not be too quick to judge. And if you think these issues are tough to handle, just wait until cloning arrives!

About the Author

Abraham Morgentaler, MD

Abraham Morgentaler, M.D. specializes in male reproductive and sexual health, and is a professor of urology at Harvard Medical.

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