The case of a California woman who gave birth to octuplets continues to raise ethical questions about family size, in vitro fertilization and whether doctors should ask tough questions of their patients. Morning-show hosts, ethicists, family planners and physician groups are still talking about 33-year-old Nadya Suleman, the single mother who already had six children.

Suleman was implanted with eight embryos, six more than professional standards call for. News reports quote her mother as saying Suleman is obsessed with having babies. Her publicist said Suleman was not motivated by financial gain. So far, baby-supply companies are not showering her with freebies, as they have in other multiple-birth cases.

Some of the loudest debate, however, is occurring in the medical community. Based on her age, the American Society of Reproductive Medicine, which sets national standards, recommends that no more than two embryos be transferred. "I can't even imagine what would possess you to transfer those. We work really hard to minimize multiples," said Dr. Grant Schmidt, a reproductive endocrinologist at Ohio Reproductive Medicine. "You know she's fertile; you just don't do that. That exceeds any boundary of normal medicine."

Multiples can pose risks for the mother before birth and for the babies afterward. "The ideal outcome, in my mind, is one baby because even twins have higher incidence of risk," said Dr. James Goldfarb, director of infertility services at the Cleveland Clinic. "When we get to three, we really have concerns." He said if a mother demanded that eight embryos be transferred, he would refuse and send her and her embryos to another clinic.

What experts disagree on is whether it's a doctor's job to refuse in vitro fertilization based on how many children a woman already has. "A lot of people will say if you have six children, you already have enough," said Sean Tipton, spokesman for the American Society of Reproductive Medicine. "The problem is, who gets to make that determination? Some people say any children are too many."

Physicians counsel their patients about health risks of carrying multiple babies and the work involved in raising so many children, and they discuss how many children they already have. But they traditionally back away from telling a mother she shouldn't undergo fertility treatments to have more children. "I'm not their moral guidance," Schmidt said. "If they want a service performed and are paying for it, you're certainly going to have that discussion." But Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said it's "complete and utter nonsense" that physicians say they won't police their patients. "Medicine is not a restaurant, and doctors are not waiters," he said. "They need to have some professional responsibility when it comes to patients."

Kristen Watson, of the northwest side, had quintuplets in 2000. She was given fertility drugs. With one child already, she and her husband, Craig, enlisted the aid of family members, friends and co-workers to get through the quints' first year. "I hope she has a lot of help," Watson said. "It's hard raising kids; it doesn't matter if they come in bunches or come single."