Albert Schweitzer once stated, "A man is truly ethical only when he obeys the compulsion to help all life which he is able to assist, and shrinks from injuring anything that lives" (n.d.). A pronouncement that in 1952 - when he won the Nobel Peace Prize for his philosophy of "Reverence for Life" -- may have had a different meaning than it does today. Nowadays, one lives in a world where artificial insemination is a normal practice, where in vitro fertilization is a common practice, where life has the potential to begin outside the womb in a test tube, where the very definition of "life" has become increasingly complex. Consequently, the issue of what is considered "ethical" and what is considered "unethical" with regards to human reproduction methods has also become more complicated. To understand the ethical minefield that is modern human reproduction, one should consider the situation of Nadya Suleman, the "Octomom" and her presiding physician, Dr. Michael M. Kamrava. It is the purpose of this paper to examine whether or not Dr. Michael M. Kamrava acted in an ethical fashion when he implanted 12 embryos into the then, 33-year-old, Suleman (Mohajer, 2011). Michael M. Kamrava, Beverly Hills physician, and presiding doctor for Nadya Suleman, aka "Octomom," during her octuplet pregnancy, will lose his California State medical license on July 1, 2011. After being found guilty of gross negligence, repeated negligent acts, and inadequate medical records in the charges steaming from the Suleman case, the California State Medial Board decided to revoke his license. He was also found guilty of several charges steaming from other cases in which he acted unprofessionally (Lin). One of those charges, repeated negligent acts, is related to his compliance with Suleman's wishes to forgo selective reduction. The Medical Board stated this in their decision whe Dr. Kamrava's lawyer attempted to justify his willingness to forgo selective reduction, "To assign even a scintilla of responsibility to a patient who becomes pregnant and then elects not to follow through with a procedure that may jeopardize her (and possibly her family's) prized objective is troubling and telling." In short, the Medical Board beleived selective reduction was the ethical action in this case.
Is ethics a relative term? Yes, to some extent it is. If one were to use the aforementioned quote by Albert Schwietzer as a rubric for analyzing the Octomom scenario, he/she could make a convincing case that Dr. Kamrava acted ethically when he implanted the "living" embryos into Sulerman's womb. Were he not to implant them, they would have been destroyed -- "murdered" as some might suggest. In this particular context, Dr. Kamrava did everything he could to allow those embryos to develop and gestate in Suleman's uterus. Additionally, he acquiesced to Suleman's request to forgo selective reduction, a process "in which a drug is injected into the heart of one or more embryos to stop its beating and give the others a better chance of growing nearer to full term" (Komaroff, 1999, p. 910). So in obliging this request, Dr. Kamrava did "shrink from injuring anything that lives" and could be said to have acted ethically according to Schwietzer's definition.
But does anyone really believe this? Aside from religious fanatics who are staunchly pro-life, the answer is no. By in large most people contend that Kamrava acted unethically when he implanted those 12 embryos in Sulerman. One must briefly point out that "ethics" is not tied to public opinion or consensus or even prevailing law. There are wise minorities (i.e. think back to the civil rights era), there are "ethical" dissenters who have cogent reasons for their non-conformity. Moreover, the tension that is created between the (wise) minority viewpoint(s) and the majority viewpoint(s) is an important dynamic of any ethical debate. In ideal circumstances, this tension allows for a dialectical resolution (a thesis, antithesis, synthesis response) and sparks critical and self-reflective discourse. The point is what is ethical and what isn't ethical is not a settled subject and one should resist the temptation to frame ethics in terms of populism or popularity. In short, just because a large faction (really the majority) of individuals believes Kamrava acted unethically does not mean he did so.
Instead of relying on public opinion to answer this question about whether or not Dr. Kamrava acted ethically, one needs to again consult some moral framework or system of ethics (like the Schwietzer quote). It's only when one has an ethical framework can one begin to address this question and construct an argument one way or the other. Part 2 of this paper will examine in thorough detail Kamrava's behavior in terms of professional standards as set by the California State Medical Board.
The question of Dr. Kamrava's behavior in the Octomom case can be examined through several ethical lenses or rubrics to determine whether or not he acted ethically or unethically. In the previous discussion, a quote by Albert Schwietzer was used to demonstrate how one can make an argument that Dr. Kamrava acted ethically in the Octomom case. It is the purpose of this paper to demonstrate how Dr. Kamrava acted unethically according to the professional standards set by the California State Medical Board and to consider when selective reduction (a form of abortion) is an appropriate option.
The board also had this to say about Dr. Kamrava in the 45-page ruling, "While the evidence did not establish him as a maverick or deviant physician, oblivious to standards of care in IVF practice, it certainly demonstrated that he did not exercise sound judgment in the transfer of twelve embryos to Suleman" (Medical Board). The question then becomes does not exercising sound judgment equate to unethical behavior?
One can assume the two are equivalent at least in terms of punishment. Unethical conduct and poor decision-making (negligence, repeated negligent acts, inadequate medical records) will both get one's medical license revoked by the California State Medical Board. And as one knows, Kamrava will now pay the costs of his poor decision making forfeiting his right to practice medicine in California.
There is another distinction that should be made with regards to Dr. Kamrava. That is, there is a difference between an unethical act and an unethical person. Dr. Kamrava, as evident by the statement from the California State Medical Board, is not an unethical person, rather he is a person who acted unethically. He is not a bad person, in fact, many people believe the ruling by the medical board was too harsh a sentence. His attorney for one, pleaded and said, "Nobody died here. This is a good doctor. I argue he really learned his lesson," and even endorsed a "recommendation by an administrative law judge for a lesser disciplinary action of five years' probation" (Dobuzinskis, 2011). The Medical Board's ruling ignored that recommendation.
One question that needs to be investigated is whether Dr. Kamrava should have used selective reduction to abort several of the embryos despite the pleas of Suleman to do otherwise. In a multifetal pregnancy selective reduction (a form of abortion) is considered and ethical procedure amongst physicians because it increases the chance of survival for the fetus (es) that exhibit the strongest characteristics. Plus it reduces the risk of complications that result from a multifetal pregnancy, including low birth rate and premature birth. Selective reduction is also used in other scenarios when a fetus is known to have a severe genetic disorder or a congenital defect (Komaroff, 1999).
As long as selective reduction is done in accordance to U.S. law, in particular the Supreme Court decision Roe V. Wade, then it is considered a legal act. Selective reduction typically occurs within the first trimester, which according to State and Federal law requires least amount of oversight and vetting (Komaroff, 1999).
With regards to Suleman, hindsight is 20/20. She, despite the odds, has had 8 relatively healthy babies. To the pro-life crowd, selective reproduction in the Suleman case would have been unconscionable. Even despite the factors surrounding Suleman's financial and mental instability. Consider this false equivocation used on Get Religion.org, "It's interesting that it's not morally acceptable to kill a girl if it's because Indian and Asian parents prefer boys, but it is morally acceptable to kill a girl if it's because she already has a sister" (Mollie, 2007). To the pro-life crowd those eight babies had a right to life and that the fact that they survived is the work of God. Yet, that doesn't change the fact that selective reproduction is a common practice and one that is used, typically, in the best interest of the child (ren) and of the mother.
At the end of the day, Dr. Kamrava acted unprofessionally and unethically. While he's not a bad man or an unethical man, he is suffering the consequences of his poor decision-making and unethical behavior. And even if one were to question the ruling from the Medical Board, he/she should consider this statement from Dr. Kamrava: "I'm sorry for what happened.…
Michael M. Kamrava, Beverly Hills physician, and presiding doctor for Nadya Suleman, aka "Octomom," during her octuplet pregnancy, will lose his California State medical license on July 1, 2011. After being found guilty of gross negligence, repeated negligent acts, and inadequate medical records in the charges steaming from the Suleman case, the California State Medial Board decided to revoke his license. He was also found guilty of several charges steaming from other cases in which he acted unprofessionally (Lin). One of those charges, repeated negligent acts, is related to his compliance with Suleman's wishes to forgo selective reduction. The Medical Board stated this in their decision whe Dr. Kamrava's lawyer attempted to justify his willingness to forgo selective reduction, "To assign even a scintilla of responsibility to a patient who becomes pregnant and then elects not to follow through with a procedure that may jeopardize her (and possibly her family's) prized objective is troubling and telling." In short, the Medical Board beleived selective reduction was the ethical action in this case.
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