Multifetal Pregnancy Reduction

Letters

References I. Abrams R: Eleclroconvulsive Therapy. Oxford. England. Oxford University Press. 1988 2. Dubovsky SL: Using ECT for palienls wilh neurological disorders. Hosp Communily Psychialry 1986; 37:819-825 3. Fraunfelder FT: Lymphoid IUmours. in Current Ocu· lar Therapy Vol 3. ediled by Fraunfelder FT. Hamplon R. Sydney. Auslralia. Saunders. 1990. pp. 297-299 4. Duchen LW: General Palhology of neurons and neuroglia. in Greenfield's Neuropathology. 51h Edition. ediled by Adams JH. Duchen LW. London. England. E. Arnold. 1992. pp. 1-ó5 5. Holland JC: Radiolherapy. in Handbook of Psychooncology. edited by Holi and JC. Rowland JH. Oxford. England. Oxford Universily Press. 1989. pp. 134--145

Mullifetal Pregnancy Reduclion SIR: I am saddened by your decision to publish the Ormonl and Shapiro articłe "Multifelal Pregnancy Reduction" in Ihe November-December 1995 issue of Psychosomatics. This is yel anolher article masking a morally repugnanI practice under Ihe guise of providing cłinical informalion wilh scientific neutralily. Ormonl and Shapiro's disingenuous lip service lo "highly emolionally charged consideralions" and "complicaled" elhical issues is belied by Iheir obvious bias for Ihis heinous practice, as evidenced by Iheir cold reference lo a "całculus of risk and benefit" and cali for Ihe usual valueless counseling lo facililale "decision making" and "coping skilIs." The blase references to "seleclive fetal reduction," "cardiac punclUre wilh exsanguinalion by aspiration of blood," elc., ad nauseam, lestify lo the macabre predilections of Ihe praclitioners of this "Iherapeulic service" (and Ihose who publicize il). The ethical issues surrounding "mullifelaI pregnancy reduclion" are not complicaled. bul elear: the end does not juslify Ihe means. Will they alIow Ihe women desperalely desiring children an opporlunily to "choose" which child will be sacrificed? If so, perhaps Ihe lilIe of Ihe artiele could be 398

revised to read "Multifelal Pregnancy Reduclion-Sophie's Choice." Thomas K. Nelson, M.D. ConsultanI in Psychialry Mayo Clinic Scottsdale Scottsdale. AZ

In Reply SIR: In response lo Dr. Nelson's leller about our paper "Multifetal Pregnancy Reduclion," which was published in the November-December 1995 issue of Psychosomatics. we offerthe following. We are aware Ihat many Ihoughtful people of good will view abortion as a morally repugnanI practice. If one begins with Ihe premise thal all abortions are wrong, then il follows thal seleclive aborlions for multifelal pregnancy reduclion musI also be wrong. Not everyone agrees with this initial premise, however. and Ihe facl is Ihat multifetal pregnancy reduclion is being performed in this country and elsewhere. Our purpose in writing our review was lo acquainl psychiatrists with the procedures and Ihe issues involved so that Ihey could beller respond to the needs of their palienls. An infertile couple considering whether lo engage in attempls to achieve pregnancy through assisted reproduction should know not only thal high-order multiple gestations may resuIt, but also that abortion of one or more of Ihe fetuses may be recommended for the survival of the others. They should have an opportunily, like any other patient, to receive counseling or psychiatric treatmenl as needed. Some patients opposed lo aborlion mighl accepl Ihe risks associaled wilh high-order multiple gestalion; those who cannot accepl the risks should Ihink about this before beginning allempts al assisted reproduction. Like some obstetricians, some psychiatrists. because of their objections to abortion, might choose not to participate in the care of a patient considering multifelal pregnancy reduclion. They can refer the palienls elsewhere and can express their opposition to abortion through public discourse and polilical action. Past research in the Uniled Stales has not demonstrated substantial long-term psychologiPSYCHOSOMAT1CS