Ethical and Medical Issues: Nadya Suleman Octuplets Case Study

This case study examines the controversial Nadya Suleman octuplets case, born after in-vitro fertilization (IVF) treatment involving multiple embryo transfers. The assignment explores the ethical and medical challenges, including the risks associated with multiple births, the doctor's actions, and the patient's autonomy. The case highlights the professional problem of exceeding recommended embryo transfer numbers and the ethical dilemma of balancing patient wishes with potential health risks. Stakeholders include Nadya Suleman, Dr. Kamrava, Suleman's mother, the babies, the health system, and the California Medical Board. The study proposes a solution that emphasizes practitioner adherence to guidelines, limiting patient choices when health is at risk, and promoting public awareness. The analysis references ethical principles like non-maleficence, beneficence, and justice, while also acknowledging potential criticisms related to patient autonomy. Ultimately, the case underscores the need for a balance between patient rights and the responsibility of healthcare providers to ensure patient safety and well-being, providing a comprehensive understanding of the ethical complexities in reproductive medicine.

Running Head: NADYA SULEMAN’S OCTUPLETS CASE STUDY 1
Nadya Suleman’s Octuplets Case Study
Name
Institution

NADYA SULEMAN’S OCTUPLETS CASE STUDY 2
Nadya Suleman’s Octuplets Case Study
In this case study, a woman named Nadya Suleman gave birth to octuplets following In-
vitro fertilization(IVF) treatment. Earlier on, Suleman had conceived six babies. Thus, now she
was a mother of 14. However, Suleman was in a precarious economic state. She was
unemployed, lived with her mom, and was unable to meet her necessary expenses. However,
despite this condition, it was Suleman’s wish to have more babies. Therefore, her doctor, Dr.
Kamrava, transferred 12 embryos which resulted in octuplets. Notably, this multiple embryo
transfer was double the recommended number as per the guidelines, but it was Suleman’s wish to
have the transfer done. Multiple embryo transfers and numerous births have significant health
risks such as miscarriages, chronic disabilities for the baby, low birth weights, deaths, and many
more. Also, such deliveries carry huge financial burdens since they are expensive. Thus, it
becomes vital for practitioners to inform their patients about these risks. In the case of multiple
conceptions, a therapeutic abortion regarded as fetal reduction is done. However, in this case,
Suleman declined the therapy. Dr. Kamrava argues that her refusal of the fetal reduction
procedure was within Suleman’s reproduction rights. In the end, the Medical Board of California
revoked Dr. Kamrava’s license.
There are several stakeholders in this case. The first stakeholder is Suleman, who is the
patient for this controversial IVF treatment. The second stakeholder is Dr. Kamarava, the doctor
who conducted the procedure. Third, is Suleman's mother because Suleman was dependent on
her economically. The fourth stakeholder was Suleman's babies. The situation places them at
significant health risks, and additionally, their mother's financial status significantly impacts their
quality of life. The fifth stakeholder is the overall health system. The expensive nature of
Suleman's birth procedure and its accompanying risks places a significant strain on the system's

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resources. The sixth stakeholder is the California Medical Board, the board necessary for
controlling health practitioner's conduct.
A critical professional problem exists whereby Dr. Kamarava contravened his
professional integrity by transferring 12 embryos. This is double the recommended number.
Also, another technical problem arose upon Dr. Kamarava’s failure to conduct the fetal reduction
procedure. This placed the health of Suleman and the born babies at significant risk (Brezina &
Zhao, 2012). On the other hand, a critical ethical challenge arises on the fact that Dr. Kamarava’s
actions were based on the patient’s wishes. Patient’s have a right to autonomy in regards to
decision making. Thus, it can be argued that the doctor was only respecting the patient’s
autonomy and reproductive rights. However, in the process of preserving the patient’s
independence, Dr. Kamrava put their health at risk.
The arising question, in this case, is what would be the appropriate solution for situations
whereby a patient’s wishes places their health at risk. In such an instance, the best solution would
be for the practitioner to uphold their professional integrity by only acting according to the
knowledge and existing guidelines. The patient’s choices should be limited according to these
guidelines. For example, in Dr. Kamrava’s case, he should have declined to transfer more than
six embryos, since that is the recommended number. Also, he should inform her of the reason as
to why he could only transfer a maximum of six embryos. Then, after this explanation, he should
then give Suleman a choice to select whether she wants to go ahead with the procedure as per the
six embryo transfer framework. Three essential perspectives can support this solution. First is
from a health perspective, whereby the solution prevents any health risks for the patient. Thus,
this is in line with the ethical principle of Nonmaleficence which requires that practitioners
conduct no harm to the patient (Londra, Wallach & Zhao, 2014). The second perspective is the

NADYA SULEMAN’S OCTUPLETS CASE STUDY 4
economic perspective. The recommended solution reduces the financial burden of the patient in
regards to the medical costs and also the costs involving raising multiple babies. Thus, it upholds
the principle of beneficence which requires practitioners to act for the good of the patient. The
third perspective is based on the principle of justice. The principle of justice requires that
practitioners should equitably distribute resources regarding care (Londra, Wallach & Zhao,
2014). However, for Suleman’s case, in case of any arising complications, she and her babies
would have used up many health resources. The solution acts as a prevention of such difficulties,
thus enhancing efficiency. Therefore, by doing so, it upholds the principle of justice by ensuring
the effective use of scarce health resources.
Notably, the recommended solution of limiting the patient’s choices would not withstand
criticism from the proponents of the principle of the patient’s autonomy and freedom to choose.
They would argue that by limiting their options, the patient’s full rights to independence would
not have been respected. Therefore, it is my recommendation that extensive public awareness
should be conducted. The primary reason for the awareness campaign will be to inform the
public that in some cases, a practitioner’s decision supersedes the patient’s choice. This is in the
case where the patient’s life is at risk. Thus this compels the practitioner to act in the best
interests of the patient. It is in this way that the patient’s best interests can be preserved.

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References
Brezina, P., & Zhao, Y. (2012). The Ethical, Legal, and Social Issues Impacted by Modern
Assisted Reproductive Technologies. Obstetrics And Gynecology International, 2012, 1-
7. doi: 10.1155/2012/686253
Londra, L., Wallach, E., & Zhao, Y. (2014). Assisted reproduction: Ethical and legal
issues. Seminars In Fetal And Neonatal Medicine, 19(5), 264-271. doi:
10.1016/j.siny.2014.07.003