“Because we want 'a baby,' we'll do whatever it takes to have that baby. And if we happen to overdo it, and wind up with more than one baby, we'll just kill it.”
Caruso was involved with five cases in which individuals considered selective reduction to increase their odds of a healthy pregnancy. “Four of them went for selective reduction,” he recalled. “All four of them against my advice. But four of the five did.”
The fifth kept all of her artificially-conceived children, “because I convinced her that it was okay to have triplets.”
Most of Caruso's patients, over the course of 10 years, never faced a situation in which they might have considered a selective abortion. But all of them, he noted, were told that artificial reproduction might lead to a situation in which a physician could recommend reduction.
“It is discussed every single time the patient gives consent for in vitro fertilization – whether was done by myself as a practitioner, or by a nurse, or by a psychological professional, or by a social worker. They have to, as a means of fulfilling informed consent. They must discuss this substantively, including the risks to the pregnancy.”
In Caruso's experience, couples often wanted twins, considering it a bargain of sorts. “As a matter of fact, the euphemistic joke – that's only a half joke – is that maybe they'll get two for the price of one.”
But those who only wanted one child often got more than they bargained for. “In those cases, when they have twins … that changes their world terrifically,” Caruso said. “You see marriages break down, relationships break down, people have all kinds of problems – because they didn't plan on having more than one child.”
For some couples, the status quo that's threatened by a second child becomes more precious than that child's life.
In one case documented by the Times, two women in a same-sex partnership both underwent IVF, and both became pregnant with twins. They were already caring for a 14-month-old child, and found the stresses overwhelming. Just before one of the women lost both her children in a miscarriage, the other chose to abort one of her twins selectively.
That woman told the Times she was “very grateful that we had this option at our disposal, that it can be done safely and in a legal way, but it was very difficult for both of us. I still wonder, did we choose the right one? That idea, that one's gone and one's here, it's almost like playing God.”
“There are those people out there who will do everything in their power to only have one child,” Caruso reflected.
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“Pregnancy is a commodity for them – and when you think about it from that perspective, all the other possibilities that come through, on what you might call the 'slippery slope' – why wouldn't they happen? Why wouldn't you have a situation where a person gets pregnant with triplets and has an abortion to a singleton because they only wanted one baby?”