Question

Ms. Q. is a 30-year-old woman who is pregnant for the first time, having spent several years in a local infertility program. She has been treated previously with clomiphene citrate, a fertility drug that increases the incidence of multiple births among those who subsequently become pregnant from 1 percent to 8 percent. You, the physician who prescribed the drug, indicated to the patient that its use involved "some risk of multiple gestation."

At nine weeks gestation, ultrasound reveals the presence of triplets. After discussion, with her husband, Ms. Q. asks you to terminate two of the fetuses. She says she really wants to have a child and "be a good mother," but doesn’t feel capable of caring for more than one child at a time. Even though all three fetuses appear healthy, her preference is to abort two rather than have triplets.

A technique similar to amniocentesis (in which the uterine cavity is entered) has been used to selectively terminate a defective fetus, when a serious fetal anomaly, such as a trisomy disorder, occurs in multiple gestations. This technique could be used to terminate two of the triplets, but it entails an incremental risk of miscarriage. What do you do?

A. Obtain her written consent to the procedure and perform it.
B. Try to persuade her to change her mind.
C. Refuse to perform the procedure on ethical grounds.
D. Suggest that she adopt one or two of the triplets out after they are born.

Answer 1

Ms. Q. asks to terminate two of the three fetuses due to her inability to care for multiple children. The decision involves weighing the health risks, discussing options with the patient and her husband, and considering the emotional and ethical aspects.

Step-by-step explanation:

Ms. Q. is a 30-year-old woman who has been treated with clomiphene citrate, a fertility drug that increases the incidence of multiple births. At nine weeks gestation, ultrasound reveals the presence of triplets. Ms. Q. asks you to terminate two of the fetuses because she doesn't feel capable of caring for more than one child at a time. To selectively terminate the two fetuses, it would involve a technique similar to amniocentesis, which carries an incremental risk of miscarriage.

The decision on what to do in this situation is complex and should involve open communication with Ms. Q. and her husband. It is important to consider the health risks for both the mother and the fetuses, as well as the emotional and ethical aspects of the decision. The physician may try to persuade Ms. Q. to consider other options, such as adoption, that would allow all the fetuses to have a chance at life.