What’s wrong with elderly women giving birth?

“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.

Poor child

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.