Six sail into a moral whirlwind: The furore over last week's birth of sextuplets has raised questions of medical practice and the ethics of fertility treatment, writes Mary Braid

WHEN six tiny babies were delivered to Jean Vince, of Grimsby, in seven minutes last week, the tabloid press uttered an immediate and loud collective 'aaah'. Every snippet about the progress of Vince Six - five girls and boy - born 11 weeks premature and weighing between 1lb 5oz and 2lb 12oz was faithfully reported. Katie, the smallest and most fragile, was causing the specially constituted medical team - and the public - most concern.

By Saturday it was predicted that the children, born after their mother received fertility treatment, had an 80 per cent chance of survival. Good news for Jean, 29, her husband Jan, 36, the great British public and the company handling publicity for the family and negotiating the sponsorship deals needed to generate the income necessary for their upbringing. To put it crudely, six survivors are far more marketable than five.

By yesterday the public relations dream had disintegrated into an exercise in damage limitation for Philip Ettinger, the PR consultant who has cornered the market in rare but lucrative sextuplet promotions. The Sunday newspapers dropped a Blitz of bombshells that appeared to rip the Vinces' wholesome family image apart.

Jean and Jan, it emerged, were not only not married, they lived apart. Both had been married before and the birth of the sextuplets brought Jan's total progeny to 10. His first wife and three children gave him an unflattering press. The most bizarre tabloid claim was that Jean's former father-in-law had murdered his wife with a crossbow.

Now the family is at the centre of a noisy, ill-tempered and ill-informed debate about who has the right to fertility treatment. In the judgement of some newspapers, politicians and churchmen, the Vinces' unconventional domestic arrangements should have barred them from any state-funded fertility treatment. And yesterday Virginia Bottomley, the Secretary of State for Health, in effect endorsed that view when she announced a tightening of the guidelines as to who may receive NHS fertility treatment.

The row lays bare contradictory medical practice and ethical inconsistencies in decisions about who should receive fertility treatment, and exposes widespread concern about the current status of the family.

According to Professor Robert Winston, of Hammersmith Hospital, London, who runs the NHS's largest comprehensive fertility clinic, Mrs Vince's predicament also exposes dangerous shortcomings in the NHS.

Professor Winston says: 'A lot of very stupid things have been said about this case and politicians have not been blameless. The main issue is not who should be treated for infertility on the NHS but the question of proper provision. Mrs Vince's treatment was obviously not monitored properly or she would never have had six babies.'

Jean Vince was born with a congenital condition, polycystic ovary syndrome, which means she is unable to ovulate unaided. Drugs and injections of hormones to encourage ovulation have been available since the early Sixties.

Women like her are commonly treated with injections of the hormone gonadotrophin, which stimulates the creation of eggs in the ovaries. Over-production of eggs is common and usually detected by ultrasound equipment and regular checks of hormone levels. If more than two or three eggs are created it is 'very simple' to abandon that month's treatment. The hormone hCG, which triggers the release of eggs, is withheld and the woman must try all over again.

In Mrs Vince's case, staff at Grimsby Hospital appear to have failed to detect some of the eggs, although the hospital has yet to give specific details. Once they were fertilised, she was faced with the hard choice of whether to have some of the foetuses she was carrying aborted. 'Mrs Vince made a brave decision in a disastrous situation and I applaud her. She was quite within her rights to refuse selective removal. It is hardly a satisfactory choice for a woman who has been trying to get pregnant for years. It is like shutting the stable door after the horse has bolted, and can cause all of the babies to be aborted.'

Professor Winston suspects that Grimsby Hospital may not have had the resources or equipment to monitor Mrs Vince's treatment properly. 'In the NHS doctors work with grossly limited and inadequate resources. Short cuts have to be taken which can cost a lot more in the long run.' He is angry about press claims that Mrs Vince had expensive test-tube baby treatment. The ovulation hormones are relatively inexpensive, he insists.

The row has also exposed vast differences in hospitals' criteria for deciding who should qualify for treatment. While the Hammersmith clinic will treat single women and lesbians alongside heterosexual couples, St Mary's Hospital in Manchester only treats childless couples in heterosexual relationships who have been co-habiting for at least three years.

Dr Brian Lieberman, head of the In-vitro Fertilisations Unit in Manchester, explains that the hospital's ethics committee decided that those criteria should apply for any sort of fertility treatment, from expensive test-tube baby technology through to cheaper drug treatments. The committee believes that is the surest way to safeguard the well-being of the child in compliance with legislation set down by the Government. Dr Lieberman does not entirely agree: 'I don't know of any evidence which proves a single woman is any less well equipped to bring up children than a couple. Single women face more difficulties, but that does not mean they cannot overcome them.'

Six years ago a Manchester prostitute failied in her bid to challenge the hospital's regulations. But Dr Lieberman claims she was turned down for fertility treatment because 'she did not understand the implications of parenting', not because of her profession.

Health professionals admit that stringent criteria are less about fairness than rationing limited resources. Despite its restrictions, St Mary's has a two-year waiting list. Professor Winston is astounded by the criteria applied there. 'The ethics committee at St Mary's seems to be behaving in an extremely unethical way. At Hammersmith anyone is given treatment as long as I am confident that any child will not be born into a disadvantaged situation. It seems stupid to stipulate you will only deal with couples when 40 per cent of marriages end in divorce. People are ignoring the reality of what a family is today. .'

He added that it was unfair for doctors to refuse to treat couples because they already have children. Having a brother or sister was crucial to a child's development

Mr Ettinger believes the weekend's press coverage was inaccurate and biased. He is considering legal action against a newspaper which wrongly claimed that Mr and Mrs Vince's six-year-old son was a test-tube baby. He is hopeful that the sponsorship will be unaffected.

Dr Michael Nicholson, editor of the Bulletin for Medical Ethics, says: 'You have to be very careful in formulating social criteria for fertility treatment. You could be open to accusations about eugenics. But there is reasonable evidence that children of single parents do not do as well as children of settled married couples. But then it may be that children of lesbian couples do better than children of single mothers.'

Mr Ettinger believes the Vinces have become unfairly embroiled in a wider debate. 'I have spent a lot of time with this family. Jan and Jean do intend to marry. They have been together for six years and have a strong bond. They are good parents to the son they already have.

'There has been a lot of adverse publicity, but I believe time will prove a great healer. A nappy manufacturer has offered a year's free supply of their product.'

(Photographs omitted)