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Primum non nocere is a Latin phrase that means "First, not to harm." The phrase is sometimes recorded as primum nil nocere.
The phrase expresses one of the principal precepts that all medical students are taught in medical school and that is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better to do nothing than to do something that risks causing more harm than good." It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit. Since at least 1860, the phrase has been for physicians a hallowed expression of hope, intention, humility, and recognition that human acts with good intentions may have unwanted consequences. A closely related phrase is "Sometimes the cure is worse than the ill."






This is in view of the Octumom. What sat ye all now?

The doc should have his med license pulled IMHO.

If it's true that the doctor always implanted six embryos before and only one ever took each time, I'm not altogether sure what he did wrong. He couldn't force selective abortion on her -- is it malpractice or unethical in and of itself to help a woman having a seventh child? Sixth? Fifth? Fourth? How you decide when the doctor needs to say, no more, I won't help you? Is it only numbers? Can s/he say "no, you have a history of hemophilia (or some other genetic disease), so I won't help you reproduce"? When you start saying the doctor gets to say yes or no, do we start down a slippery slope?

If the doctor that implanted Octomom is wrong, how about the doctor that helped Bobbi McCaughey (and I won't start my rant on that woman's hypocrisy, suffice to say I didn't think she was some fabulous star . . .)?

I'm not disagreeing that something is very wrong here, I'm just not sure how we decide who, beside Octomom herself, is.

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Reading is Fundamental.

I say we let it go. It's a done thing. No one can change it. No amout of rehashing is going to take back time.

Be outraged over ALL the unwed / unplanned / underage / unresponsible / (take your pick) pregnancies not having both biological parents intact. She is not the only questionable parent out there and yet we accept it now, it's cool to have a baby. I'm already seeing the results from all the kids who can't keep track of who their half siblings are / step siblings, and then they have former half siblings / step siblings because the adults can't conduct themselves accordingly.

dl

You said it!!!

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I agree. Mostly.

I, personally, would not find it in keeping with my own value system to purposely be involved in the creation of life outside of the scenario I think God created - and intended - to see new life come into the world. He could've made it an asexual event, such as is true with some plants and some lower forms of life. But for whatever reason, he created humankind in such a way that it takes a man and a woman, jointly, to initiate life. And for that reason, I have ethical issues with willy-nilly circumventing that family structure, on purpose, and denying a child the two parents that 'nature' deems it should have. I think that the importance of a mom AND a dad can't be under-estimated, and that the reasons for it transcend just the biology.

But given that this physician obviously doesn't share that position with me, from a medical standpoint, he had a number of things to consider, and none of them, apparently, were cause to deny her what she was seeking. She apparently had the money to pay for the procedure. WHERE anyone gets the money is none of his business or concern, so while we are outraged to think that she used money intended to help with her disabled children to fund her procedure, that is not something he necessarily knew about or about which he would have been able to make a judgment call.

Regarding the number of embryos that were implanted, given that it is unusual for all of the implanted eggs to attach, and that she herself had five other procedures that only resulted in multiples one time, the likelihood that they would all come to fruition - much less that two of them would divide -was extremely small. It's possible that the fertilized eggs were getting old and it was a 'now or never' situation. It was possible that given her history of only 1/6 of the eggs typically attaching, and the cost involved with the implantation procedure, that the only conscionable thing he could do was implant six yet again with the expectation that at most, she might get twins or triplets.

I find her motivations selfish and suspect and still think she is a fruitcake. I do not believe that what she did was right or sane or anything of the sort. But not knowing much about the physician... who knows?

Her website has now been shut down.

Gee, I wonder why?

How pathetically sad that someone brings forth 14 lives, then sticks out their grubby little paws for "gimme's". I'm sorry, I guess I missed the memo that she's supposed to pump out kids like a factory, while the rest of the country foots the bill.

I feel bad for those little ones. She's anything BUT a mother. I hope I hope I hope they get to good, stable homes. I wish nothing but good for the babies, but it's about darn time someone like this is made an example of.

She's got a couple of majorly big brass ones!

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never been through IVF but do they always use 6-7 eggs even if it's for one child?


Octuplets doctor has another patient expecting quadruplets
The patient, who is in her late 40s, wanted one baby. Dr. Michael Kamrava transferred at least seven embryos to her. She is now hospitalized without insurance.
By Kimi Yoshino, Jessica Garrison and Alan Zarembo
February 13, 2009
A few months after Dr. Michael Kamrava helped Nadya Suleman become pregnant with octuplets, he transferred at least seven embryos to another patient.

She was in her late 40s and wanted just one baby.
Now she's five months pregnant with quadruplets and hospitalized at Los Angeles County-USC Medical Center, according to several sources familiar with the situation.

The new case could add to concerns about Kamrava's practice and about whether the fertility industry needs more regulation.

In fertility medicine, any pregnancy greater than twins is considered a poor outcome because of the danger it poses to the mother and the babies. Quadruplet births are rare, with an average of 14 sets born in California each year, according to state records.


"Historically, we have been very hesitant to regulate anything close to procreation from parents making judgments about how many children they will have and when," said Kirk O. Hanson, ethics professor and executive director of the Markkula Center for Applied Ethics at Santa Clara University.

"However, that worked under a natural process of fertilization and incubation. There are serious questions about whether it works in an era of scientifically enhanced procreation."

The woman in the latest case arrived recently at Good Samaritan Hospital in Los Angeles for unspecified treatment but was transferred last week to County-USC Medical Center because she lacks insurance. Doctors placed her on bed rest until the birth of the babies, which could be two or three months from now.

The California Medical Board has said it is looking into the octuplets' case to determine whether a doctor may have violated any standards of care.

The American Society for Reproductive Medicine, which has guidelines limiting the number of embryos that can be transferred depending on the woman's age and other circumstances, said it is also examining the doctor's practice. No laws govern this issue.

The guidelines allow for the transfer of more embryos in older women. But in this case, the woman was using embryos made from eggs donated by a woman in her late 20s -- which fertility specialists said increased the possibility of a multiple birth.

"I do think it is concerning, and dangerous, especially to the mother. She is close to 50. When women get to be that age, our fear is the cardiovascular complications, such as stroke or heart attack. That's how serious this is," said Dr. John Jain, a fertility specialist with knowledge of the case.

Reached by telephone, the woman did not confirm that Kamrava is her doctor. However, The Times has verified the information through several independent sources.

She said her doctors urged her not to talk to the media because she is already dealing with a high-risk pregnancy and doesn't need more stress.

"Please respect my privacy," she said, adding that her circumstances are much different from Suleman's.

The woman has three grown children from a previous marriage but wanted another child with her second husband, who is in his early 30s and doesn't have any children, sources said. She works as an apartment manager; her husband is a contractor.

She started fertility treatments seeking one baby, but after becoming pregnant with quadruplets, declined medical advice to reduce the number of fetuses, the sources said.

Kamrava could not be reached for comment and has declined previous interview requests. A woman who answered the phone at his West Coast IVF Clinic said: "If [a] mother wants to bring four kids, so what?"

Doctors at County-USC and Good Samaritan Hospital also declined to comment, citing patient confidentiality.

Suleman said in an interview with NBC that her doctor transferred six embryos. She gave birth Jan. 26, and although the births were initially celebrated as a medical miracle, public opinion quickly turned when it was discovered that Suleman had six other children, was a single mother and was relying on some public assistance, including food stamps and Social Security benefits.

Los Angeles police said Thursday that they are investigating death threats made against Suleman and her publicist.

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So do I. I saw on tv that Governor Schwarzenegger is getting involved in the decision about whether the children should be removed from the mother.

I wonder what the kids will think of all the hoopla over this when they are old enough to read about it. I wonder if they'll feel the world didn't want them, that is was bad or wrong they were even born.
If they are given to others to raise. I wonder if they'll be disappointed to not have been a chance to be with their birth mother.
I think the kids should only be taken away if their is abuse or SERIOUS neglect in the home.
Having to share a bed, or wearing hand me downs or living in a small house is no reason for them to be taken away from their natural mother.
Maybe they'll grow up less spoiled than other kids who have anything their hearts desire.

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If Vegetarians eat Vegetables. Do Humanitarians eat Humans?

'Vegetarian' is an old Native American word for bad hunter.

But the mom prefers to buy toys instead of food from what the family has said. Since the birth there's been pictures of her getting her nails done and buying video games not really the "Oh my Sometime I'm going to be having eight babies in the house do i have enough diapers, clothes...."

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No, it is practically unheard of to implant more than 4, and that would only be done in an older mother (40+). And 4 is also pretty unusual.

I don't think Bobbi McCaughey had IVF.

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Raising my baby RIGHT!!!!!!

All the cool babies are wearing cloth!

Oh Susie you are too nice and your heart is too big. That being said I don't think people saying that this was irresponsible is the same as saying these kids shouldn't have been born. I think on the contrary there are lots of loving sane responsible people out there who would be so happy to have one of these precious bundles of joy.
I think what most of us are feeling is how could she be so irresponsible? It's one thing to have more than one child sleeping in a bed or sharing clothes it's more about not seeing to their care herself. I think we can all agree that two children or more sleeping in a bed when their parent(s) are working hard to provide for them is not the same as being on welfare and cramming eight more children into an already overcrowded overburdened situation.

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The political system is broke and it's a joke.

What about the fact that she already had six kids at home? Did she 'need' all those embryos implanted? Doesn't a doctor have to take all of that into account? I know doctors won't usually tie the tubes of a young woman (I know two women in their early 20's who already had two kids and the docs wouldn't do it-said they were too young and to wait) so if they can make that judgment they should be able to use common sense in these situations also. The whole thing is a mess and I hold the doctor as much or more accountable than the nut case woman!

Kathy, I believe there is a shelf life for frozen embryos. It may have been a 'now or never' situation.

If he doesn't care that she doesn't have a spouse, then I guess she falls under the same umbrella as any woman trying to get pregnant the old fashioned way. Doctors can't control a woman getting pregnant six times over a seven year period - it's up to individuals to decide how they want to space out their kids, if they want them all close together or with 12 years in between. That's really not his call to make.

Personally, I wouldn't have signed on to be her MD in the first place, though, given that she is not in a marital relationship. It's not about her wants - it's about the needs of humans to have the best chance possible at having two committed parents. From the get-go, these kids had no chance of that.

If a woman, without any means of support, with 6 very young children, some of who have problems, wants to get pregnant again, then "Do no harm" should apply. Her ability to care and nurture the children she has, is stretched beyond thin, and adding more, even if only one had implanted, is harmful to all the babies. The doctor did a lot of harm, probably more than he even suspected. Frankly, I think he should be paying for their support. I'm also beginning to think that the "father" should be paying support. If he wants to go around "sharing" his sperm, then maybe he should help pay for the outcome.

It's past time for some laws to prevent all this. Sperm donors should have to think twice about what they are selling. Doctors should have to think twice about what they are doing. And the women should think more than twice about adopting. And most of all, insurance should step out of the picture and let all of those involved pay the bills.

There is a far cry from this scenario you describe and a person who has been completely and totally irresponsible with her body and 14 little lives.

She has no job, she's on or was on disability, no husband to help and it sounds like HER Mom was to wash her hands of the whole situation.

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Amen!

I always thought most sperm donors were anonymous and had no clue when/with who their sperm was even used - if it was used at all.

Wasn't it also stated somewhere else, that this sperm donor wanted her to stop, but she did what she wanted anyway? If that's truly the case, then that's her issue.

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"First do no harm"

That applies to mental issues as well as physical issues. Now, I don't know about IVF treatments, but some medical treatments require psych counseling or psych eval prior to the procedure taking place. Goodness, some of my work comp claimants have to undergo psych eval prior to BACK SURGERY! It should stand to reason that women (regardless of marital status or sexual preference) should have to undergo a psych eval to determine if they are good candidates for the procedure. *shrugs*

I hope that the children grow up to be healthy and happy.....

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

I feel he does have some responsiblity in this. This is not a couple who has a large family the natural way. This is a single woman, with 6 kids already and obvious mental issues. Doctors do have responsiblity for their actions. I can't go into a doctors office and demand some valium for my nerves for example. Why should this doctor do what the patient tells him to do when there are obvious conditions presented that says he shouldn't? He should have at least sent the woman for a mental evaluation at that point.
As far as "now or never" for the embryos-what if there were 12 left? Would that legitimize putting all 12 in when that is not the standard protocol? I think I read somewhere that 4 is usually the limit to implant. She had six born children already-who says you have to use them all?

I don't disagree with you, Kathy, and hope it doesn't sound like I am defending the Dr.. I'm really not. I saw some talking heads discussing this issue last week, and the one who seemed to speak from a legal standpoint was explaining what 'family decisions' were within a doctor's purview and which would typically be the patient's business and not the doctor's to dictate. The span of time between having kids was one thing they indicated was not something the doctor was supposed to dictate, absent a medical reason the woman's life (or a baby's life) would be in danger.

I think the idea of a mental evaluation is a good one and is probably practiced by more ethical doctors than this one. Heavy duty counseling is certainly required for adoptions.

Playing devil's advocate: Yes, you can go into the Dr's office and demand valium. The Dr.has no obligation to give you valium. They do have an obligation to stabilize you if you are in need of treatment. Furthermore, you do not own the valium you demand....
Embryos are the possession of the donor(s). And if the female owner is a private pay patient, then the physician is not obligated by anything by his own moral and ethics.
Now, that's not to say I disagree with you in the grand scheme of things---there are just some flaws in your argument.
Physicians generally operate on a usual and customary standard of care. I don't think this doctor did.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

Agreed. But doesn't the doctor have an ethical obligation in this particular instance since it has been reported that this woman had mental issues, is unemployed and already has six children? I don't see how he could be obligated to implant all six under those particular circumstances. My point was that doctors don't have to do whatever the patient wants-ie tie my tubes, give me valium, implant a dozen embryos or whatever. (Obviously not counting life threatening situations, etc....)

Be careful what you wish for. Wishing for Government intercept could have negative connotations and set a precedence that I am not sure would be in the best interest of our civil liberties.
I am concerned, if this is true that the Gov of California is getting involved, with movements to take away the children simply because she has more than she can "afford".

I don't know if that is the only reason, (although it's not entirely a bad one), but I do know that they are more than she can handle. I can't even begin to think of the logistics of feeding, clothing, laundry, diapers, and just plain snuggling. If her parents quit helping, and even if they don't, this is more than two people can handle. Most large families have the ages staggered so that there are not too many babies in the house at one time. She has no husband or older kids to help out with the younger. They are all younger. If her mother gives up or can't continue, that leaves her alone. She obviously expects her mom to take care of all 14 while she goes to school, studies, shops, etc. That poor woman must be beside herself. For her mom I feel sympathy. For the babies I feel sympathy. For her dad I feel sympathy. But for her I feel disgust. Her consummate selfishness, her complete egotism, her extreme lack of judgment, and her total disregard for the well-being of her existing children and her own parents, add up to one very unstable and unfit mother.

Very well stated!

While common sense would lead most to this assumption, you do not know this to be fact. So far, everything you are basing this on is based on public opinion.

The point I am trying to make is, that you do not want government coming in, or really anyone for that matter, and telling you what you can do/can't do in your life-having children, for example-just because they might think you are not capable.

It is wrong to judge her in this way, and it is even more wrong to wish that the government step in when as of right now, it is not warranted.

Being poor a bad parent does not make.

On my gosh. There are so many things wrong with this situation and it has nothing to do with public opinion or judging, etc... there are enough facts out there to form a knowledgable opinion on this situation.

What facts would lead you to believe that something is illegal or she has done wrong to these children?
Because she is on forms of welfare? Because she is not married? Because she has a small home? Because she made the stupid choice to get nails?

I do not find anything in this case that warrants government action to take away her children; especially if it is based on the assumption of what might happen in the future.

We are America and not communist controlled. If this did happen to her, it would open up the door for many of our freedoms, as Americans, to be placed in jeopardy.

It was brought up that her children should be taken away. I do not disagree with you that making an inference about this situation would be illogical. What I am stating is, if the government got involved (it was stated that the Gov of California was considering action), it would be completely and totally a violation of.her basic rights as an American citizen. In my opinion, there is no basis for this type of severe intervention.
You also admitted this is just an opinion of her situation. It is not based on reports containing factual evidence of neglect. What is floating around is all just the court of public opinion, and they have damned her completely.

Let's see, she was on disability, has no job that I know of, no husband, her disability papers stated she has mental issues among other things, etc.... It would be reasonable for DHS to check her and their living situation. If she's going to mess with nature so much that she has 14 children and no means of support , etc...then please let them make sure those kids are ok. If it takes the Governor to step in and check it out-GOOD!!!

there remains the question of just how she funded the IVF treatments. There also is the question of how the govt. assistance she did receive was used.

And for all those who have brought up the Work Comp payout: California's work comp laws are some of the most "injured worker" friendly. California also has one of the most generous benefits policies. That being said, a lot also depends on what the claims adjuster did and how the claim was handled. I think she got far too much money for her injury--but that's based on what I deal with in my state. For that amount of money, here, a person would have to be permanent disabled and sustained a significant injury.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

So it's ok with you if the government checks on everyone they think MIGHT have a problem, even without any report of one? OK if Arnold just stops by and inspects your house anytime he wants?

I'm all for taking these kids away from her, but I think there needs to be cause first. I don't see it. Yet.

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Reading is Fundamental.

Sure, I don't have anything to hide!!! If I had 14 kids, no husband, no job, etc... I would HOPE someone would check on the kids to make sure all is well.

I may not have attended school, studied, nurtured, fed, diapered, bathed, transported, shopped for, laundried for, 14 kids at once, several of whom are special needs, but I have the "opinion" based on first hand knowledge of raising a small amount of children, that this is probably physically and mentally near to impossible.

Being poor is just a part of the problem. Grandma is talking about leaving and going back to her country of birth for a visit, grandpa, (if he's smart), is off to make a living. There is no support system if grandma leaves and not much of one if she stays, because grandma is worn out with the original six.

Fourteen who all need to be fed at the same time, diapering for at least a few besides the new ones and cuddled, That is a full time job right there. How does she get food into the house? What happens if she has to go to the doctor with one of them? How about a fire? Who takes care of them while she is in class and how does she get them there? The information I heard, and it may be wrong, there will be 16 or 17 people in a two bedroom apartment. It makes me cringe to think about it.

I'm sure she will get some help and guess who is paying for it? I figure if my taxes are paying for these children then I should have some say in things. And another scary thought is that there is absolutely nothing to keep her from doing this again.

One could say that her rich uncle gave her the money for the IVF treatments and those pretty new nails. He also might be providing for the children, as well.
Speculation. That is all that has come out of this.
Nadya did say that she worked and saved for the IVF treatments. Could be true, may not be true. She was not sworn under oath at the time of the interview, so this statement alone can not be held up at this point. She could be protecting this wealthy uncle from public scrutiny, for all we know.

Everything is speculation at this point. There is nothing that has proven to me she is an unfit, or neglectful, parent to the point of needing to have the children removed from the home. Even an investigation of alleged abuse and/or neglect would be ridiculous under the current circumstances.
Services can be offered to help her with how to be a better parent to these children, but in no way should she be obligated, legally, to have to accept such services under the circumstances that have been presented thus far.

When did she work and save? If my understanding is correct she was on Work Comp disability from about 2006 forward. And one thing that is pretty universal in work comp is: if you are completely off of work from the time of injury employer, you can't work somewhere else and draw full TTD benefits (temporary total disability). You may be able to draw TPD (temporary partial disability), but the income you are receiving from another job, cannot exceed your average weekly wage. If it does exceed the average weekly wage, you are not eligible for TPD.
So, tell me again, when did she work and save for IVF?
Furthermore if she doesn't have a home to bring the new 8 to, and doesn't have a home for the older 6 to live in (since she hasn't paid the mortgage in 10 months by report--oh gee did she use the rent money for IVF??), then you are mistaken. That is reason enough to place all 14 of the children in a protective and safe enviroment, until such time as their mother can get and keep a job, and pay the bills and provide for the children.

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Mental that one, I'm telling you. ---Ron Weasley, "Harry Potter and the Chamber of Secrets"

Based on the interview with Curry, she said during the time she gave birth to her first six children she went to college and graduate school and stayed home from work and collected disability payments that totaled about $165,000. This was over a period of around 8-9 years, spread out. She did not receive a lump sum, according to reports. She lived on this for her day to day living expenses.

"I had so many reproductive problems from fibroids. I have also had lesions in my fallopian tubes. It turned out that my tubes were scarred.

So the only option left over was IVF, a procedure where they remove your eggs, and then they take the sperm, culture it in a dish and then transfer it back."

But in vitro fertilization is very expensive, and rarely covered by insurance. At that time - the late 1990's - Nadya was working as a technician at a psychiatric hospital, doing basic nursing, assessing patients, administering medication.

"And I was able to work double-shifts, constantly working double-shifts, 'cause I was hoarding my money, and I was saving it and nonstop working. I was so driven, so determine, I wouldn't give up. There's no way I would have ever allowed any obstacle, impediment to get in my way of my dream"
Then she was hurt on the job. With the money she had saved, she went in for her first IVF. Then continued on each year after that, entering college at the same time.

Nadya says she and her children lived on her disability checks and student loan money. She says she paid for in vitro with money she saved while working, along with a small inheritance.

She was 31 years old. There were embryos left over from the batch that produced the twins. They were frozen. Waiting.

The point is, she saved the money before she was injured for the first IVF treatments after she divorced her husband.

Concerning her living situation: she paid rent to her mother. The home belongs to her mother.

Cantering1-I did a quick google search and it looks like at least $10,000.00 per try plus egg storage, etc....for in vitro. So if there were 7 times and it took each time that's $70,000.00+ just for 7 times. Since the success rate is not 100% I would venture to guess it was closer to $100k. So she saved $100k in those few years she was working before her back injury? Her disability payments-over 8 years that would be $20,625.00 a year or $1,740.00 a month. She was supporting the kids she had, going to school, etc... on that plus student loans? If that's the case maybe she should be hired to solve the national financial crisis. Even with her mom watching the kids she did have and even if she was living with her mom for free that's still not much to live on. And living in California? I think a trip to the grocery costs about that much out there! Just kidding, but CA has a pretty high cost of living. Not to mention that fact that she seems to have expensive tastes. Something just doesn't seem to add up here.

I think she's a fruit loop, but have to agree with the posters that say it's not the government's right to take them away or oversee her parenting. I would say that if she is living on government aid that she probably has / will have a social worker assigned to her, and that person would have their nose in her business. I have a friend whose kids are on a government-run health care plan and she has to submit all sorts of records each month and the social worker checks in on them - it's part of an accountability thing they do to ensure people aren't totally mooching and that the government's 'investment' in the health of the kids isn't for naught.

Generally, though, I'm not for the government intervening unless there is clear and present danger and evidence of a crime. What we have right now is evidence that she is weird and that she is a mooch. Lots of people are weird moochers and they don't have their parenting overseen by Big Brother.

I can't see how on earth she is going to manage. Hopefully there will be people in her life who will maintain awareness and if there is neglect, step in.

seems she may have a offer for full time care for all the kids, the eight kids have angel for a middle name so sounds like she had talks closer to the birth Video - Breaking News Videos from CNN.com

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