Multifetal pregnancy reduction

Sir. I n ;i recsiit paper ( I ) the results of embryo technique reduction in ten Swedish clinics are assessed. Apart from the technical results obtained, in this article the ethical legitimacy of these procedures is questioned. I n my opinion. embryo elimination, that is the elimination of alive human beings, always deserves the strongest ethical condemnation. Multiple gestations may occur spontaneously or after assisted conception techniques. Multiple pregnancies of more t h a n four embryos are very uncommon in a natural way. since the most numerous, if they occur. would be lost spontaneously. Anyway, if there were a spontaneous pregnancy of more than four embryos it would not be ethically legitimate to suppress any of them in order to allow the survival of the others. The suppression of the life of a human being is an act intrinsically lacking of ethics. We would be admitting the ethical principle that the aims justify the means. This is unacceptable. Recent historq has shown us how this principle has led to the most dreadful moral outrages. Furthermore. which are the criteria to determine who will live . and. why is this embryo and not another one is t o be eliminated? What is quite certain is that the solution is to allow all the embryos to live so a s t o save the largest number of them. But in the case of ' i f 7 vitro ' fertilization, ethical legitimacy is absolutely untenable. It must be taken into account that since the amount of embryos implanted is the desired. there is no ethical reason to authorize the iinplantation of more embryos than those ~ , h o have life expectancy and it is even less acceptable to implant a number of embryos knowing that some of them are to be eliminated. Due to this ethical criterion, in some countries the maximum number of embryos implanted by 'ill vif ro ' fertilization has legitimately been stated and this number can never be more than three embryox. because modern management of triplet