This story from England strikes a familiar chord: a doctor has assisted a woman well beyond the typical age of fertility to undergo an IVF pregnancy; critics claim he should not have done so because it smacks of “selfishness” and because “it would be extremely difficult for a child to have a mother who is as old as a grandmother”. Art Caplan said much the same thing in a column about a year ago: “it was wrong because there was a terrible price to pay for using reproductive technology [in the case he discusses].”

I’m uneasy about this, in a lot of ways.

The problems with pregnancy in older women are well-known. The burdens of pregnancy on older women are greater; the likelihood of spontaneous abortion is greater in an older mother; premature deliveries and low-birthweight babies are more common in older mothes; delivery of an older mother must often be by C-section which imposes greater risk; babies born from older men’s sperm are now known to carry increased risk of genetic disorders; and there are the obvious complications for family life, childrearing, and parent/child relations when the age difference between them is much more than a standard generation’s gap. The policy question, however, is whether such pregnancies should be allowed when they are requested, which devolves to the familiar question of “who decides?”

Of the various objections, the seemingly-strongest ones are those having to do with the infant’s welfare:

[A] spokesman for the Human Fertilisation and Embryology Authority said clinics must take into account the welfare of the child, including the [mother's] health, age and ability to provide for the needs of the child or children.

and, Caplan again:

Consider that when her daughter enters high school, [a 66-year-old mother] will be 80. Eighty! That should be the end of the argument. If you are 66 and single — man or woman — you should not be having a baby.

The time-worn “think of the children!” argument here arises in full force – and naturally enough. There is no question that the unavoidable circumstances of very old parents create real issues for children. These issues may carry greater weight even than the matter of the health burdens on the mother: those risks, presumably, she may choose to run on her own autonomous choice. But to bring a child into the world against such odds! That may be going too far, yes?

What, exactly, is “too far”, though? The risks noted above are real, but they are not greater in the case of older mothers (or fathers) than in many other cases that seem much less questionable. For instance, there have been a couple of cases recently, widely touted on “pro-life” blogs, of women with serious illnesses insisting on continuing pregnancies where abortion had been recommended, even at risk to their own lives; one such woman died delivering a premature infant by C-section, and was hailed as a hero for her devotion to her fetus. But this “devotion” meant bringing a baby into the world under precisely the circumstances critics now say are immoral: at grave risk to the mother’s health, and to a mother who may well die in childbirth and has limited life expectancy thereafter. The children of these terminally-ill women, it was known, were fated to lose their mothers at birth or at a young age, and have to spend the rest of their lives without a mother to rely on. Yet no one suggested that the drawbacks to such a scenario were a reason not to have children at all, even in the face of an important health benefit to the mother from terminating those pregnancies. The issue of actually creating a pregnancy under hazardous conditions may be slightly different, but not much. If we are not willing to criticize terminally ill women for bearing children who will grow up without mothers – and if we are not to attempt to dissuade or prohibit terminally ill women from becoming pregnant in the first place - it is not obvious why we should prevent older women – who may actually have lower health risks and longer life expectancies than a young woman with advanced cancer or severe heart disease – from also becoming pregnant if they choose.

There is always a danger in policy advocacy – and it seems particularly overpowering where children are concerned – to assume that a sub-optimum course of action is an immoral course. But we accept second-best courses all the time, without thinking twice. In fact, it is rare that every competing interest and relevant factor combine such that the resultant best course of action is also the optimum course – the one that satisfies every interest without compromise. Almost all our decisions are compromises in which we accept some fraction of a loaf in respect of all our desires, to avoid being completely thwarted in any of them. The same is true in childbirth and childrearing, though we don’t like to think so. And so, the immediate impulse to ban any policy that might put a child into a situation that is not best should be resisted; for one thing, it is not immoral to give a child what is acceptable even if it is not best, and for another, insisting on a no-compromise policy would ensure that only the very, very lucky few were allowed to have children at all.

This becomes an especially acute concern when you see the range of conditions people are willing to butt in on. Caplan surveyed IVF providers, and the results were shocking:

The naked social prejudice displayed here is breath-taking, but it is the arrogance that really boggles. Health status, income (not just the level of income, but its source), marital status, sexual preference, and age – not advanced age, mind you, but merely the edge of menopause – all trigger condemnation, but that is hardly surprising. The real concern is not that clinic staff have judgmental attitudes toward people in these categories – why should they be any different from the rest of society? – but that they are willing to use their technological monopoly to actively prevent those people from acting on their own reproductive desires. Whether or not they approve, few people, I think, would say it is actually immoral for a woman with AIDS, or a blind couple, of a single woman, to have a child; fewer still, no doubt, would think they themselves had a right to step in and prevent it. But these clinic staffers had no qualms about blocking access to the technology they control to do just that, in every one of the cases listed above. And these are merely factors related to the parents. When it comes to “saving the children!”, Caplan too jumps on the bandwagon: “Reproductive decisions now ‘are too driven by the desires of couples and not enough by the interests of children’”. He advocates legal regulation to impose his preferred age limits, so that clinics will not impose their preferred social restrictions. This qualifies as democratic high-mindedness among the save-the-children crowd.

But again, not even Caplan pretends to exert such control, or even offer such judgments, on parents (read: women) in all these categories who do not happen to need IVF to carry out their own choices. Caplan is happy to latch onto technology-driven inequality to impose his limits on a subset of women, just because he can, while keeping hands off others who are able to act outside his authority, without needing his permission. That is one of the things that makes me uneasy about these well-meaning restrictions on technology: that they take advantage of those in greatest medical need as a form of social engineering.

But there is a final argument to be offered, one that has wider implications. I have suggested above that it is not necessary or justified to impose greater “protections” on children born through assisted fertility than we are willing to impose on those born the old-fashioned way. I would go farther and say there is (virtually) no reason to impose any such pre-conception protections at all. The reason is the familiar “wrongful birth” argument. However strained, however risky, however deleterious the newborn’s circumstances may be, they cannot be (in all but the most extreme cases), actually worse for that infant than its never having been born at all. Whatever is done in bearing an infant into undesirable circumstances, that is still clearly a net benefit to the infant. And since the only alternative, and the one actively promoted by critics of certain women’s pregnancies, is that those infants should not be born at all, they can hardly claim to be doing the infants a favor by taking such a stance. In other words, the anti-pregnancy argument, predicated upon the infant’s welfare, is self-defeating. Another way of putting this is that there are no circumstances so bad that they would make having a baby a moral crime against that baby (other than those so extreme that baby would literally be better off dead) – so there is no argument that can be offered that having a baby under such-and-so circumstances should not be allowed out of fidelity to that baby’s interests. Sure it’s bad having your mother die in your infancy – but you’re better off existing with no mother than never having existed. Sure it’s bad to be born at low weight, with birth defects, with cognitive impairments, but . . . . (Repeat as necessary.)

This argument has wide application: not merely to the case of old-age pregnancies, but to pregnancies among poor women, unhealthy women, even, arguably, women at risk of transmitting congenital illnesses. Simply put, you cannot criticize a woman’s decision to have a child out of concern for the child. (I would have thought this was an argument that would have been obvious to “pro-lifers”, though they are often among those who criticize childbearing by the “wrong” women.) That being so, there is no good reason to put limitations on when women may have children, grounded on the eventual children’s interests; there is also no good reason to do so on the basis of the woman’s interests, since she may presumably make that decision for herself. What we need is less discussion of when it is “appropriate” for a given woman to have a child, and more on the topic of the many cases when it is inappropriate for others to presume to make that decision for her.

(A final, and hopefully (but not likely) obvious point: this argument in no way undermines the right to abortion, or creates an argument that any woman should undergo a pregnancy she does not want to. The argument from the infant’s interests presumes there will be such an infant; its interests given that it has been born are in question. But no fetal non-person, without interests early in pregnancy, has any claim to have its interests protected at that time. Still less is it necessary to create a fetus in order to protect its interests. The argument above says that you may do so and there is no consideration of that eventual infant’s interests that stands against your doing so – nothing about it says that you must do so.)