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| What is society's problem with elderly mothers? | What is society's problem with elderly mothers? |
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| 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. | 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. | 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. |
| FIND OUT MORE... Too Old to Be a Mum? is on Tuesday 26 January at 2235 GMT on BBC OneOr catch up using the iPlayer | FIND OUT MORE... Too Old to Be a Mum? is on Tuesday 26 January at 2235 GMT on BBC OneOr catch up using the iPlayer |
| 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? | 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 | |
| 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. | |
| CHLOROFORM CONTROVERSY In the 1840s, the use of anaesthesia in childbirth was strongly opposed by clergy in the Church of EnglandEven some clinicians believed it was going against God's will that women should "in sorrow, bring forth children" as punishment for Eve's sinAnd some thought it caused women to become sexually aroused during labour | CHLOROFORM CONTROVERSY In the 1840s, the use of anaesthesia in childbirth was strongly opposed by clergy in the Church of EnglandEven some clinicians believed it was going against God's will that women should "in sorrow, bring forth children" as punishment for Eve's sinAnd some thought it caused women to become sexually aroused during labour |
| 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. | 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 Steptoe, the gynaecologist involved in the creation of Louise Brown. | 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 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. | These examples show that what society considers morally permissible evolves with time. They also point to the need to dissect our gut reactions. |
| It's unnatural | It's unnatural |
| 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. | 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. |
| Rajo Devi had a baby at the age of 70 | Rajo Devi had a baby at the age of 70 |
| 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? | 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. | 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. |
| Welfare of mother and child | Welfare of mother and child |
| 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. | 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. |
| RASHBROOK REACTION Dr Patricia Rashbrook had a child by IVF at the age of 62, prompting controversy Jon Gaunt, in the Sun, wrote: "The news that the selfish 62-year-old, Patricia Rashbrook, has 'given birth' to a baby boy makes me sick to the pit of my stomach."Karren Brady, in the Birmingham Mail, wrote: "I know that there are wrinkly old rockers like Michael Douglas, Rod Stewart and Mick Jagger who are fathers to young children, but they are because they can be. Women of the same age aren't because they can't be. Or shouldn't."AN Wilson, in the London Evening Standard, wrote: "Women in their 60s these days are usually fit, and often make ideal carers for children. Why the uproar about supposed selfishness? Is it because the sight of a competent, pretty woman being happy fills other people with envy?" | RASHBROOK REACTION Dr Patricia Rashbrook had a child by IVF at the age of 62, prompting controversy Jon Gaunt, in the Sun, wrote: "The news that the selfish 62-year-old, Patricia Rashbrook, has 'given birth' to a baby boy makes me sick to the pit of my stomach."Karren Brady, in the Birmingham Mail, wrote: "I know that there are wrinkly old rockers like Michael Douglas, Rod Stewart and Mick Jagger who are fathers to young children, but they are because they can be. Women of the same age aren't because they can't be. Or shouldn't."AN Wilson, in the London Evening Standard, wrote: "Women in their 60s these days are usually fit, and often make ideal carers for children. Why the uproar about supposed selfishness? Is it because the sight of a competent, pretty woman being happy fills other people with envy?" |
| 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. | 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. | "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? | 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. | 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. | 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. |
| The good mother | The good mother |
| 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? | 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? |
| Is there an ideal age for a family? | Is there an ideal age for a family? |
| 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. | 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". | 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. | 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 Daniel Sokol is honorary senior lecturer in medical ethics at Imperial College London. | Dr Daniel Sokol is honorary senior lecturer in medical ethics at Imperial College London. |
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