A 59-year-old plans to have a baby through IVF and dissenting voices can be heard everywhere from the newspapers to the office watercooler. But is there really any reason why we should have a problem with the idea, asks medical ethicist Daniel Sokol.
Imagine walking past a poster on the street. It shows a mother and baby. The mother, however, is old enough to be the baby’s grandmother.
The initial reaction of many passers-by, upon being told that this grey-haired and wrinkled woman is the mother, would be one of revulsion. There is something deeply unnatural about the image.
These are the thoughts that many have had in response to the news that Susan Tollefsen, who became a mother at 57, is now considering IVF treatment again at the age of 59.
But is there a rational basis for concern?
The “yuck” response is not uncommon in the face of new things. It is an internal red flag, telling us in an indistinct way that something is amiss. At times, that something is perfectly reasonable.
The disgust we feel at the recent torture of two young boys by brothers aged only 11 and 12 is underpinned by solid reasons. Yet, often, our “yuck” response is nothing but the external manifestation of ignorance or prejudice.
This is apparent by looking at history. Pain-relieving chloroform in the 19th Century, heart transplantation (involving a donor and recipient of different races), homosexuality, and in vitro fertilisation in the 20th Century, were all met with initial cries of disgust.
The birth of the first “test tube” baby, Louise Brown, in 1978 was deemed immoral by, among others, the Vatican and Nobel laureate James Watson. “I am not a wizard or a Frankenstein,” said Dr Patrick Steptoe, the gynaecologist involved in the creation of Louise Brown.
These examples show that what society considers morally permissible evolves with time. They also point to the need to dissect our gut reactions.
In one sense, the computer screen in front of you is unnatural. It is the product of man’s ingenuity. So too is an umbrella. Distinguishing the natural from the unnatural is not an easy task.
Can we say that keeping people alive on life support or resuscitating them when they would otherwise have died is natural, but that enabling an older woman to conceive a child is not?
Both are trying to “remedy” the natural ravages of ageing. If we accept that both can be viewed as unnatural, we must appeal to something else to justify treating them differently.
Assisted reproduction, like virtually all medical procedures, carries a risk of harm. The treatment, usually requiring several cycles of IVF, is hard on women emotionally and physically. At 60, the impact is likely to be greater than at 30.
Yet, in a liberal democracy, individuals are to a large extent allowed to incur even significant risk as long as this does not harm others.
“Over himself, over his own body and mind, the individual is sovereign,” wrote the 19th Century philosopher John Stuart Mill.The problem is that assisted reproduction involves a third party - -the potential child. He or she cannot consent to the risk of harm. Neither, of course, can any baby.
There is evidence, however, that IVF babies are at greater risk of birth defects than naturally conceived babies. A study published in the New England Journal of Medicine in 2002 suggested that IVF babies have double the risk of major birth defects compared with naturally conceived babies.
“How much more at risk with potential mothers in their 60s?” is a key question in determining the morality of assisted reproduction in that age group.
Another concern is the child’s welfare in childhood and beyond. Last July, the single woman who had become the oldest mother in the world at 66 died after having cancer, less than three years after the birth of her twins. What awaits them now?
They may grow up to live a fulfilled life, as many orphans do, but their odds are not as favourable as their parented counterparts. But what about a young mother in a country where civil war, disease or other factors mean she may not see the child to adulthood? Yet we are not comparing like with like.
It is always possible to point to a worse situation and say “see, it’s not as bad as this”. Maybe so, but that is not a cogent reason for allowing the practice.
An argument popular among philosophers is that, as long as the child’s life is of acceptable quality, it is irrational to use arguments based on the child’s welfare. The alternative for that particular child is non-existence.
The twins would not be alive without their elderly mother’s decision to undergo IVF.
Is their life really so bad that they themselves would have preferred non-existence? Philosophers are still not agreed on how to solve this apparent puzzle.
There has been much talk in recent years of reproductive autonomy, the idea that people should be able to make their own reproductive choices. Yet what are the limits of such autonomy? Did the lesbian couple who in 2002 sought a deaf sperm donor to create a deaf child overstep the mark? Can people choose to have a baby girl because they prefer girls?
And what about our 60-year-old mothers? While these questions have no easy answer, it is clear that the limits must in part be set by the risk and severity of harm to the potential child. Who determines the cut-off point is another matter.
There are many other arguments both in favour and against allowing older women to use assisted reproduction techniques (including issues of resource allocation, age discrimination, adoption and other alternatives, feminist critiques, and slippery slope arguments), but one that appears repeatedly in everyday conversation is the feeling that there is something “not quite right” with a 60-year-old woman who wants a baby: “What kind of selfish woman would dream of such a thing? She won’t be a very good mother at that age. Poor child”.
This is where prejudice and societal values colour our judgement in ways that may be imperceptible to ourselves. Many passers-by will look at the woman in the poster like a jury eyeing up the defendant at the start of a trial. They will deliver an immediate verdict. Justice requires a more considered approach.
Dr Sokol is a honorary senior lecturer in medical ethics at Imperial College, London.