The recent death of Maria del Carmen Bousada de Lara, the world's oldest confirmed mother, is likely to generate debate surrounding the ethics of offering in vitro fertilization to women in their sixties and seventies. The retired Spanish department-store employee gained international attention in 2006, when, at the age of sixty-six, she gave birth to premature twins, Christian and Pau, via caesarian section. At that time, questioned about the moral and practical implications of raising her young sons as a senior citizen, Bousada said, "My mum lived to be 101 and there's no reason I couldn't do the same." The unfortunate reality is that Bousada died before her sons' third birthdays, likely of cancer diagnosed shortly after their delivery. Another woman, Omkari Panwar, a seventy year-old grandmother from the Indian state of Uttar Pradesh, gave birth in 2008--but her age cannot be formally documented. Meanwhile, seventy-two year-old Londoner Jenny Brown has reportedly spent £30,000 on IVF in the hope of becoming the world's oldest mother. Births to women in their late fifties and early sixties, while not yet commonplace, are no longer international news. Whether these births are empowering or irresponsible has been a matter of ongoing debate.
Many American fertility clinics refuse to inseminate women beyond a set age. In Bousada's case, she had to lie to the Pacific Fertility Center in Los Angeles, claiming she was actually fifty-five, in order to qualify for treatment. At that time, the clinic's director, Vicken Sahakian, expressed indignation at Brousada's deceit and promised "to be more careful" in the future. Other hospitals set limits as young as fifty. What is not so clear is why these clinics impose such age restrictions. Are they concerned for the physical health of the mother during pregnancy? Or do they merely have ethical qualms about women embarking on child-rearing beyond a certain age?
During an off-the-record conversation with the head of one leading IVF program, the director candidly told me that social, rather than medical, factors were the primary determinant in his clinic's age limit. "You have to draw a line somewhere," he said. I followed up by asking whether his program sets any age limit for the male partners of these women. It does not. Nor does any other American fertility clinic, as far as I can tell. So while a sixty year-old woman with a twenty-five year-old husband will have difficulty obtaining IVF in the United States, a forty-nine year-old woman with an eighty-five year-old husband will face no age limits--even though the child of the twenty-five year-old is far more likely to have at least one parent survive into adulthood. If these cutoffs are imposed for purely social reasons, rather than medical ones, then they appear to be both illogical and discriminatory. It is not even clear to me that they should be legal. The right to IVF is only meaningful if physicians will actually provide it. Unless clinics can do a better job of justifying their policies on medical grounds, state legislatures should seriously consider rules banning such arbitrary age limits--particularly in hospitals and clinics paid for with public or publicly-mandated funds.
Those ethicists and social critics who oppose motherhood beyond a certain age risk adopting a troublesome double standard. Our society has long accepted, even acclaimed, fatherhood in later mid-life. An occasional eyebrow may rise when Tony Randall fathers children in his upper seventies, or Saul Bellow sires a daughter at eighty-four, but a man who becomes a dad at fifty-five or even sixty usually receives a proverbial cigar--not a lecture on social responsibility. The only difference between fatherhood at that age and motherhood at that age, assuming there are no excessive health risks during pregnancy, is that nature allows men to have children beyond fifty-five, but technological assistance is required for women to enjoy the same opportunities. One might question any use of IVF technology at all--and a small minority of conservative bioethicists have done so. However, if one believes--as I do--that IVF is a highly-valuable tool for empowering women, and that its benefits far outweigh any drawbacks, then one has already rejected the "naturalist" argument. Or what may be thought of as the natural fallacy: that the natural way is inherently preferable. (If that were so, we would also reject antibiotics for infectious disease and allow the myopic to stumble around without eye-glasses.) Once one rejects such an approach, relying upon nature to oppose IVF, only in cases where much older woman are concerned, strikes me as unreasonably arbitrary.
Critics of later-life mothering often argue that bringing a baby into the world, when one is unlikely to accompany that infant into adulthood, does such a child a disservice. However, one thing is nearly certain about women who spend upwards of $50,000 attempting to bear children: Those babies are wanted. That places these kids well ahead of the many children born to indifferent or mildly-enthusiastic parents. IVF mothers are also carefully screened--a process that should filter out women likely to abuse or mistreat their offspring. Moreover, such older mothers might have fewer years with their children, but they likely possess a great deal of age-acquired wisdom. Emphasizing life expectancy over the many other factors that define successful parent-child relationships oversimplifies a deeply complex--even mystical--equation. Needless to say, in the nineteenth century, long before IVF, far more children lost their parents prior to reaching majority. (This phenomenon explains why the twenty-something heroes of Jane Austen and George Eliot novels have already inherited their fortunes.) Our own concerns about later-life mothering may reflect our heightened expectation that children know their parents, and even grandparents, into adulthood, rather than any universal or socially-essential norm.
Parenting is among the most personal choices anyone ever makes. At the same time, no other individual decision has as significant a societal impact. Finding a careful balance between personal autonomy and the public welfare is often a considerable challenge. Fortunately, in the cases of sexagenarian and septuagenarian mothers, the private benefit is obvious--and the social harm, if any, is rather hazy. In some cases, women like Ms. Bousada will live to be 101. In others, tragedy may strike--much as tragedies also strike twenty-five year-old moms. If women choose to have children into their sixties and seventies, we should make sure that they are informed of any potential health risks entailed. And then we should do what we always do when devoted parents give birth: We should offer them our congratulations and our best wishes. In this regard, the ethics of parenting are surprisingly simple. Mothers should be judged on their love and commitment, not their chronological ages.
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