Where end-of-life and beginning-of-life considerations collide

This month’s issue of Sexuality, Reproduction & Menopause, the journal of the American Society for Reproductive Medicine (ASRM), carries an article  entitled “’Last-chance kids’: A good deal for older parents – but what about the children?” The article discusses the growing number of older, post-menopausal women giving birth through assisted reproductive technology (ART), and gives a thoughtful analysis of the ethical points surrounding the use of assisted reproduction in women past childbearing age.

As my clinical ethics professor always said, good ethics begins with good facts. The authors of the article provide good, pertinent facts: data not just on life expectancy at various ages, but – just as important when considering the energy needed for parenting – actuarial data on how many of those years are likely to be spent in good or excellent health. (Should we use ART to give a child to a woman who statistically has very little chance of staying healthy enough to raise the child through high school?)

The article continues by asking, “Is reproduction a right?” Remarkably, instead of invoking the free-for-all autonomy that plagues attempts at ethical analysis of reproductive rights, the authors quote an ASRM Ethics Committee’s report that “Reproductive rights protected under the United States and state constitutions are rights against state interference, not rights to have physicians or the state provide requested services … It is also important to recognize that constitutional rights to reproduce are, like all rights, not absolute and they can be restricted or limited for good cause.” Refreshing, to say the least.

The authors continue with a surprisingly candid evaluation of the consequences for the children of these older parents. They conclude with strong cautions about the use of of ART in the elderly which, while falling short of prohibiting the practice, nonetheless give the overzealous practitioner of such techniques reason to pause and consider.

I can understand why a woman might desire to have a child in her older years. However, the inability to conceive a child in one’s 6th or 7th decade of life can hardly be regarded as a disease, and I cannot see any compelling reason why medical technology should be used to treat it. As Dr. R. Landau wrote, “Childlessness is a complex concept, and children are neither medicine nor therapy. They should not be used as means to other people’s ends.” (Quoted in the linked article.)

 

 

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