The Two-Minus-One Pregnancy | Modern Family of Choice & Its Ethical Dilemma

Ruth Padawer has written a fascinating article, “The Two-Minus-One Pregnancy,” recently published in the New York Times Magazine section. I have to say Padawer literally took my breath away. There are so many questions; the choices are so personal. The reduction of a multiple pregnancy involves ethical, religious, social, moral, emotional and personal dilemmas. Obviously, ultimately, the choice is made by the prospective parents.

The reduction of a pregnancy from twins to a singular child, however, is a procedure only recently available. Padawer writes of young and not-so-young mothers pregnant with twins each of whom chooses, for various reasons, to have reduction in the pregnancy so that she will bear only one child. Most often, this procedure is sought after fertility treatments.

A family seeking a two-to-one reduction often already has one or more children. Age, socio-economic status and the early development in the mid-1980s of pregnancy reductions that, in A.R.T., terminated all but two or three fetuses to lower the risks to women and the babies they took home are only some of the issues that factor into the decision. Another more controversial factor is just this: the couple’s idea of how they picture their ideal family life—in other words, what they see as their life style wrapped around their existing family and personal situation. Is this innovation any more controversial than selecting for sex? It depends upon one's point of view.

As Padawer discloses, what started as an intervention for extreme medical circumstances has now quietly become an option for women carrying twins. Padawer says: “With that, pregnancy reduction shifted from a medical decision to an ethical dilemma. As science allows us to intervene more than ever at the beginning and the end of life, it outruns our ability to reach a new moral equilibrium. We still have to work out just how far we’re willing to go to construct the lives we want. The dilemmas are so multi-faceted, that Padawer says that couples work out the moral calculation on their own, and never intend to tell their families, let alone even their closest friends about it, fearing that the responses would be judgmental.

Dr. Mark Evans, an obstetrician and geneticist, was among the first to reduce a pregnancy. According to Padawer, “Evans quickly became one of the procedure’s most visible and busiest practitioners, as well as one of the most prolific authors on the topic. Early on, Evans decided the industry needed guidelines, and in 1988, he and an ethicist with the National Institutes of Health issued them. One of their central tenets was that most reductions below twins violated ethical principles.”

Padawer later explains that by 2004, Evans had changed his stance. The ethical discourse among doctors in this field is explored and worth reviewing. The most powerful part of the article from my perspective, however, are the personal stories of women who chose to talk to Padawer about their decision to do a two-to-one reduction.

See Ruth Padawer, [email protected] “The Two-Minus-One Pregnancy,” The New York Times, http://www.nytimes.com/2011/08/14/magazine/the-two-minus-one-pregnancy.html (Accessed August 14, 2011)

Further Reading:

I am reminded of the case of Sean and Carolyn Savage, a couple living in Sylvania, Ohio who had struggled with infertility. They decided to use three of their remaining frozen embryos in an attempt to enlarge their family. They knew that if this IVF didn’t work, they would have to let go of their dreams for a larger family. At the time of implantation, Carolyn’s infertility doctor made it clear that they needed to be sure about how many embryos they chose to implant because he did not do pregnancy reductions.

The Savages’ joy at learning that one of the three embryos implanted had “taken,” and “they” were pregnant, was immediately blunted when they were then told the fertility clinic had made a mistake and implanted embryos belonging to another couple! Suddenly, Carolyn’s doctor wanted her to have an abortion!

Carolyn and Sean made the decision that Carolyn would carry the baby to term and upon birth they would relinquish the child to the genetic parents. The Savages’ struggle with the ethical, legal, religious, and personal dilemmas this posed for them is chronicled in their amazing book Inconceivable: A Medical Mistake, the Baby We Couldn't Keep, and Our Choice to Deliver the Ultimate Gift. I blogged that here on June 8, 2011. Inconceivable: A Medical Mistake . . . and Parents' Love

Ruth Padawer ([email protected]) is a writer and teacher. Her most recent article for the magazine was about how DNA testing is changing fatherhood, which I blogged here on November 22, 2009: Paternity fraud | "Duped Dads" | What's the answer?