The Problem With Single Mothers…..

I am about to spend some time reading and responding to comments but before I do that I thought I’d put up a short post about a long story from yesterday’s NYT.   It’s a story–like many others about single mothers–that I found particularly frustrating.

The story is built around a contrast between two women who have much in common.    Here’s the second paragraph which is written to emphasize the commonality:

They are both friendly white women from modest Midwestern backgrounds who left for college with conventional hopes of marriage, motherhood and career. They both have children in elementary school. They pass their days in similar ways: juggling toddlers, coaching teachers and swapping small secrets that mark them as friends. They even got tattoos together. Though Ms. Faulkner, as the boss, earns more money, the difference is a gap, not a chasm.

The story then pivots to a signal difference between the women:  

Rationing Health Care/Rationing Parenthood

There’s a discussion current in the UK just now about access to IVF under the UK’s National Health System.  This little commentary is a reflection of that larger discussion, and I’ll use it as my taking-off point. 

The question currently raised in the UK is whether the NHS should cover IVF.   IVF, like a lot of assisted reproductive technology, is fairly expensive.   Health care resources are limited.   Given these circumstances, perhaps it is reasonable to discuss whether IVF should be covered as necessary medical care, or perhaps doled out on some discretionary basis. 

In the view of the commentator, the problem is that some (many?) people need to resort to IVF because they chose to wait to have kids.  In other words, need for IVF is the logical consequence of free choice.   The implication is that a woman who wants to use IVF because she chose to wait is less deserving (and hence, should be further back in the line) than a woman whose need for IVF is unrelated to her choices in life.   

Lesbian and Gay Parents and the Luck of the Draw

Not long ago, I wrote about the ways in which lesbian and gay families live on patchwork quilt when it comes to legal recognition of their families.   If you look over last few posts you can see what I meant:  The legal entitlements of lesbian and gay parents vary enormously depending on the location of the family in question.  

But of course, on several levels, where a lesbian or gay parent lives is the result of chance.    First there is the chance of where you were born or grow up or where your home turns out to be.   You could read the cases about lesbians mothers living in Louisiana and you can wonder what they are doing there–couldn’t they guess Louisiana would be rather inhospitable?  

Gay Fathers/Lesbian Mothers, III

I’m not sure where or how far I want to take this thread for now.   The last couple of posts seem unsatisfying to me–they aren’t clear enough and they lack direction.  Perhaps all I am ready to do at this moment is not that there are both commonalities and differences between lesbian mothers and gay fathers.

I’ve a bunch of other topics queued up for now anyway, so let me just add one more thought here before I move off for now.  This is really the thought that triggered me to write about this topic now, so I might as well at least flag it.

A few posts back you’ll find an entry about some good news from New York state.  It’s a note about a case in which one woman donated an egg which was then combined with donor sperm. The resulting embryo was then transferred to the other woman who brought the pregnancy to term and gave birth.  As is discussed in that post, under the relevant law (there New York law) the second woman is a mother by virtue of having given birth.  The first women has a number of theories under which she might claim motherhood, but in the case is allowed to adopt her the child (a second parent adoption) in order to ensure portable parental rights.

What the women did here is a fairly elaborate procedure, and it bears some resemblance to several different forms of ART discussed.   So, for example, you could look at the first woman as an egg donor and/or you could look at the second woman as a gestational surrogate (a woman pregnant with and giving birth to a child she is not genetically related to).   But that’s not what the women involved intend to be, for neither egg donors nor gestational surrogates generally intend to be mothers.    (Indeed, there’s a well known CA case, KM v. EG, where the lower courts treated the first woman as an egg donor who therefore had no parental rights.  This result was reversed on appeal.)

The Flip Side of Regulation is Access

I seem to have wandered into a discussion on the regulation of ART. Or perhaps it is a discussion of the regulation of reproduction generally.  Or maybe it’s parental status.  Look back at some of those posts and you’ll see a lot of different ideas floating around.

By regulation I think I’ve generally meant restricting access to ART.   A regulation might say that one or another group of people cannot use ART, or perhaps can only use it under certain conditions.  This worries me, as I’ve discussed.   (The helpful comments included with that post don’t allay my fears, but instead multiply them as I realize there are a number of groups that could be disfavored if we move to regulate ART.   To be clear, this doesn’t mean I think ART needs to be unregulated.  I just think we’d need to move very carefully if we were to go in that direction.)

Anyway, here I want to look briefly at what I think is the flip side of regulation–that would be access.   As regulation restricts the ability of people to use ART (or to become parents more generally), access would ensure the ability to use ART (or to become parents more generally.)

Now I think the primary regulation of ART in place at the moment is economic.    It’s very expensive.  If you cannot pay for it, you cannot have it.   It is rarely covered by insurance.  

Who pays for the octuplets?

Since I am still (or back) on the topic of the octuplets, I thought I’d throw out one more idea.

It seems to me that a good deal of the hostility directed at Nadya Suleman arises from the expense of the octuplets and her inability to pay for them.   I suspect if she were sufficiently wealthy to be able to afford to raise the kids without public support, we’d be much more inclined to let her go her own way.

So perhaps there is someone else who could pay apart from us?   One obvious place to look is to the father of the children.   That turns out to be less than satisfying.   I’m not convinced that there is actually a legal father here.   There’s the sperm donor.   But under California law I don’t think he’s legal father, which does seem to make sense.  He was well gone before the oldest of the kids was conceived (if I’m doing my math right.)   That makes it hard for me to argue that he is somehow morally responsible in a way that makes it right to burden him with the costs.

Now it also seems that Suleman was married when a bunch of the children were born, but it hardly makes sense to look to her (now ex-) husband and call him the father.   As far as we know, he has nothing to do with the operation.

There is, however, someone I would consider obligating to help pay for the kids.  That would be Michael Kamrava.   He’s the fertility doctor who is apparently responsible for all fourteen children. 

What worries me…..

I’ve been thinking about regulating reproduction.  Some of this has been spurred by the octuplets–the product of unregulated ART–but I’m trying to think about it in a broader frame.

So far I’ve focused on the one form of regulation we in the United States seem to firmly believe in–pricing.   If you cannot pay for ART you cannot have it.   The reverse is also largely true–if you can pay for it, you can buy it.   And then there is a lesser (but more broadly applicable) corollary:  if you cannot pay to raise your children you should not have them.    This one is more  moral/social judgment.

I haven’t finished thinking this through, but it is hard to watch the whole octuplets thing and not feel that some other form of regulation is needed.    But here is what makes me nervous about this.

I’ve just gotten an e-mail from the Family Research Council.   They are all for regulating ART, because they would surely like to withhold it from various categories of unworthy people–lesbians, gay men, single people.   At the very minimum, in their view, doctors should be gatekeepers, entitled to bar the door when, in their judgment, that’s a good idea.   In the e-mail I got, the FRC ties the octuplets case back to the recent California Supreme Court opinion holding that denying lesbians ART services constituted unlawful discrimination.    FRC portrays the court’s decision and octuplet affair  as two sides of the same coin.

It’s obviously possible to advocate for some forms of regulation and still not agree to every proposed regulation.   But it can be a bit tricky.   Who, after all, will get to say which regulations are okay and which are not?

Regulating Reproduction, Artificial or Otherwise?

I want to pick up on yesterday’s thought, but also try to open up the field of consideration.     Part of the point of yesterday’s post was that it seems that you can indulge yourself in whatever reproductive technology you care to if you have the money.

This is true in two senses.   One is that if you have the money, you can afford to purchase whatever materials and services you might want and, given the robust and unregulated US ART market, that practically means you can buy anything short of an actual living child.  (Note that while you technically cannot buy pre-embryos, you can buy all the constituent parts and the services to create them, so it’s pretty much a technical bar, I think.)  Indeed, given commercial surrogacy, I’m sure there are some who would say that you can indeed purchase a child, so long as you go about it the right way.

The second is that if you have money it is far more likely that your choices will be deemed private, and hence, your business only and hence, socially acceptable.   A huge brood of children is fine if the public doesn’t have to pay for them.   People may look at you like your are slightly crazy, but it’s still your choice.   (The recent NYT article about large families essentially walks this line.)

The Unregulated Industry of ART

It’s the octuplets again, of course.   It’s been a bit since I’ve written about them, but the story carries on (and on and on.)

A good deal of the recent discussion has focused on Suleman’s ability to support the children.    To many it seems that it would be fine to have octuplets or fourteen children under the age of eight if you could pay for them yourself.   That’s a question worth returning to, and I think in the end it will tie in here.

But I want to start with a second theme that has been quite prominent recently, including a front page story in today’s New York Times.    The octuplets have brought sudden scrutiny to the largely unregulated fertility industry in the United States.    Rather unsurprisingly, in the absence of regulation, a vigorous and competitive market for fertility services have developed.        

Back to the Octuplets

The stories about the octuplets are really everywhere now–I hardly know what to link to, so I will link back to my own first post first.  But of course, tenor of the coverage has shifted significantly.  Compare the things I linked to in my first post with something like this or this.  Increasingly the focus is on the media circus itself, the ethics of the medical professionals involved (not the doctors who delivered the babies, but the fertility specialists involved) and the mother.

It’s particularly interesting to track the depiction of the woman herself.   I think the most charitable present characterizations are that she is addicted to babies, or perhaps slightly crazy.   It’s rare to read an article that doesn’t support this characterization with reference to the fact that she is 1) single and 2) not rich.   I’m not altogether sure I’d think it a better choice if she were partnered and/or wealthy, but I think it clear that the media would consider the choice to be more legitimate or, perhaps, private.   I think it is her single-motherness and the prospect that she (and her children) will come to be a burden on the public fisc that frees up people to be harshly judgmental.