May 21, 2009
Pregnancy In 66 Year Old British Woman Starts Debate
66 year old British woman Elizabeth Adeney is pregnant with the help of assisted reproduction technologies (ART). This news come a few months after Octomom Nadya Suleman was roundly criticized for having 8 babies in a single pregnancy after already having 6 other babies (and I fully agree with that criticism). Now Elizabeth Adeney is coming under a similar round of criticism with commentator after commentator criticizing Adeney for her selfish disregard for the consequences of her choice to make a baby at age 66.
A woman who has everything but a baby and who decides, out of kilter with natural timing, that a baby is the one thing she must have, is certainly not thinking of the baby. Still less is she thinking of the school child, of the teenager, of the young person starting out in life in their twenties who has a parent in their late eighties to care for. I wonder if she sees herself at her child's wedding. I wonder if she has realised that her bargain does not include being a grandparent or supporting her child in having his or her own children.
Due to the age of the mother that baby is at far greater risk of birth defects and developmental problems that are life long in their effects.
I think we are seeing the beginning of a greater willingness of people to criticize the reproductive choices of others. Given the huge external costs (i.e. costs born by others) that come from poor reproductive choices I see this criticism as constructive and necessary. Some babies bring huge external costs to the rest of society. To the extent that we can reasonably know in advance when reproductive choices will create costs for the rest of us the criticism seems fully justified.
Technological advance increase the ease to start and keep high risk pregnancies going. We are going to also get far better means to test embryos and women to assess pregnancy risks. More powerful tools increase risks. We need a counterbalancing cultural pressure against abuse of these capabilities.
My question to you dear readers: Do you think there's a right to reproduce? Is there a right to reproduce even if one can know before the pregnancy begins that the choice of embryo or state of the prospective mother's womb will result in stunted and abnormal fetal development?
Suppose we reach a point where we know that certain genetic variations cause people to act more crimnally. Would it be an immoral violation of rights to prevent people from passing on such genetic variants?
Update: In the comments a few commenters question my assertion that older women using donated eggs are putting fetuses at greater risk of birth defects and developmental problems. Here's what happens over the age of 40 with pregnancies.
"First-time mothers who deliver at age 40 and beyond are twice as likely to have a Caesarean section than first-time mothers aged 20-29," says Gilbert. "The increase in C-sections is largely due to the increase in complications of labor and pregnancy."
For example, older first-time mothers had a tenfold increase in placenta previa, fourfold increase in gestational diabetes, 80 percent increase in pre-eclampsia (high blood pressure during pregnancy), 70 percent increase in malpresentation of the fetus (i.e., breech birth), 50 percent increase in fetal disproportion, 48 percent increase in abnormal forces of labor (i.e., inadequate contractions), and a 30 percent increase in prolonged labor. In addition, these older women were five times more likely to have chronic high blood pressure and three times as likely to have diabetes as an underlying health condition before pregnancy than their younger counterparts.
Older multiparous women showed similarly higher rates of complications as compared to younger multiparous women, including fetal disproportion (a 60 percent increase), prolonged labor (a 50 percent increase) and malpresentation of the fetus (a 40 percent increase). These older women also had a threefold increase in pre-eclampsia and in placenta previa. This population of women was also nine times more likely to have chronic high blood pressure and 6.4 times more likely to be diabetic than their younger counterparts.
There aren't enough data points for women over 60. But very likely the risks are far higher.
The incidence of Gestational Diabetes Mellitus (GDM) soars for women over the age of 40 reaching 31.9%. One can only guess how high it goes for women over the age of 50 and over the age of 60.
There was a significant difference and positive correlation in the prevalence of GDM, increasing from 1.3, 2.5, 6.2, 10.3, 21.7, and 31.9%, respectively, from the youngest to the oldest cohort (P < 0.001).
Diabetes causes many defects in fetal development including neural tube defects
I don't really accept the idea that rights somehow derive from natural law. To me, natural law is physics, and rights are most usefully thought of in a legal context. That said, I do know what I like: I like liberty. However, I'm not going to complain if the United States or any of its constituent states passes laws that prevent a person destined for a life of misery from being born.
As for "genetic variations cause people to act more criminally," we best be sure we aren't throwing away good traits that go along with criminal traits if we try to outlaw such genetic variations. For instance, perhaps the genes that make one more inclined to commit crimes are also the genes that make one more willing to take big chances. The world needs its entrepreneurs and explorers.
Due to the age of the mother that baby is at far greater risk of birth defects and developmental problems that are life long in their effects.
I doubt that the egg donor was older than 25.
"Is there a right to reproduce?" Obviously not. Not everybody is fertile and they have no real redress from the government on that problem. I don't really think that the question as phrased is what you meant to ask. What I think you meant to ask was whether or not people should be forcibly prevented from reproducing under certain, to be debated, circumstances. The criteria for this forcible prevention seems to be implied as placing a burden of some sort on other people or society in general. So, the question is "Should society through the agency of government coercion have the ability to prevent certain people, under certain circumstances, from reproducing?"
If people are perceived as having value by means of their net production for society, then the answer is determined by some sort of projection of cost / benefit. (Whose benefit or cost will probably be determined by power distribution in the society.)
If people are always valuable, sacred even, simply because they are human, then the answer is that government should NEVER be given the coercive power over the beginning of lives.
"I think we are seeing the beginning of a greater willingness of people to criticize the reproductive choices of others."
Beginning? Palin was demonized for not murdering her downs-syndrome baby.
Xenophon Hendrix said "I'm not going to complain if the United States or any of its constituent states passes laws that prevent a person destined for a life of misery from being born."
First, it must be understood that once a government has the power to prevent a person from being born for one reason, then they have the power to prevent a person from being born for ANY reason they deem appropriate.
Second, my opinion, or yours for that matter, as to the 'misery' of a person's life is irrelevant. What really matters is that person's opinion. Many people who are fully healthy and whose lives are full of choices can't imagine that a person of less than full health with constrained choices can be happy, loving, productive, and meaningful. But they can be and are. Yet, if the government makes that choice for them, then their lives, joys, and loves will never occur. I certainly would not claim to be so wise and prescient as to make that judgment on their behalf prior to their being born. I certainly wouldn't want a bored bureaucrat to make that judgment for anyone either.
While my initial reaction is "ew," I do think this woman had every right. Her age bothers me less than the fact that she apparently has no other family. But, this is something that, to me, is impossible to legislate. Does anyone tell a 14-year-old that she legally can't keep her baby if she gets pregnant? Nope. And I feel better about a 66-year-old of some wealth raising a child than I do about a little girl raising one. A kid who is desperately wanted, loved and can be financially provided for is starting off life better than one whose parents are living in a refugee camp in Sudan or something. And, again, nobody tells those people they can't reproduce. I assume she has made arrangements for a guardian for the baby, should something happen to her. Bottom line, I don't suppose it's anyone's business but Elizabeth Adeney's.
"I doubt that the egg donor was older than 25."
Not all birth defects are genetic. A 66-year-old mother is probably far more likely to give birth to a premature infant, with all the attendant problems. Probably also more prone to gestational diabetes, gestational hypertension, you name it.
mabirch, we no longer live in a state of nature where a person needing massive support dies. We don't live in a society where the hubris and stupidity of parents is punished by making them pay for the folly of purposefully bringing into the world a person that is going to need lifetime care. We do live in a society where money taken by the threat of force (taxes) will be used to provide lifetime care for those who cannot care for themselves.
You might think you are are the side of the angels when you say that you don't want bureaucrats making such decisions, but bureaucrats will be involved in caring for such heavily damaged persons for the rest of their lives. Our legal system and ethical systems have not been keeping up with out technology.
These situations involving moral judgments aren't easy, but these questions involving reproduction are no longer hypothetical. Should persons who are significantly damaged be purposefully created? Do the rights of the parents (whatever those are) trump the soon-to-be rights of their hypothetical offspring? Do they trump the rights of the people who are going to have to pay for this child?
Interesting that Roe v. Wade is starting to go all the way in the other direction. Roe was a lawsuit based on the premise that the government couldn't legally stop someone from ending a pregnancy. When Roe was reaffirmed in Planned Parenthood v. Casey, some key language struck me: "the decision whether or not to beget or bear a child" lies at "the very heart of this cluster of constitutionally protected choices" (quoting the earlier case of Carey v. Population Services International).
I disagree fundamentally with Roe and Casey, but I don't see how someone could be supportive of Roe and its progeny and be in FAVOR of reproductive restrictions under any circumstances. It seems to strike at the heart of choice: if a woman can choose to end a pregnancy under any circumstances, she can also choose to HAVE one. We may not like the social or financial implications of either Octumom or Octugenarian-mom, but if choice is the standard to be upheld, then it has to cut both ways (or conversely, if pregnancy can be restricted, than so can abortion).
Xenophon Hendrix said: "You might think you are are the side of the angels when you say that you don't want bureaucrats making such decisions, but bureaucrats will be involved in caring for such heavily damaged persons for the rest of their lives."
That's only true if everyone is willing to cede control over their lives to the government. I am one of the millions who are not.
And by the way, the only decisions I want bureaucrats to be making are either 1) "When will I go stand in the unemployment line today?" after they've lost their jobs, or 2) "What will I study in college in order to start a career that actually does something. It's time to get rid of the massive federal waste that's been going on for way too long, and making devastating cuts to the unproductive class--i.e. bureaucrats--is a great place to start. It's time to grow the productive class in this country, no matter what the (mostly unproductive) fat cats in Washington might think.
Do we have a right to reproduce? My first thought is that we have a natural right to natural reproduction -- i.e., a human right to use our bodies to procreate naturally. Thus it's a grave violation of that natural right for governments to coerce individuals into, say, sterilization, for any reason.
But I'm inclined to say that people in a community are also within their rights to collectively decide to ban technologies that manipulate the human reproductive process, either because risks outweigh benefits to the population as a whole, or simply because those people wish their law to express their values about human reproduction.
I am astounded how ready some people are to cede life and death decisions to the government. I suppose you also think that people aged over 90 shouldn't be allowed to have medical care because they are too old and defective. I know you think that "defective" children should be aborted from your remarks. Do you know how much you sound like a Nazi - you know a real one from the 30's and 40's.
For many purposes it seems to be a temporary problem.
It's only a matter of time before reproduction becomes less arbitrary and random and more intelligently controllable, in which case even old parents will be able to freely have healthy children.
Er...excuse me? The reproductive choices of others have costs for the rest of us, and that gives us the right to interfere? Christ, what next, eugenics? The choice of people with "undesirable" characteristics (a genetic tendency to alcoholism, or early heart disease, or breast cancer, or low IQ, or -- ha ha, only joking you understand! -- a tendency to vote the wrong way) to reproduce should be criticized, perhaps legislated on, because these choices have "costs" to the rest of us?
This is disgusting. Let's step away from the 1930s, okay? When you are smart enough to predict all the way out a full lifespan what the costs and benefits of a particular life are, then you can get back to us with your wonderful social theories of how the decisions of others should be vetted by your most excellent self.
Sure, the 66-year-old woman's baby may end up being a burden to us all, when he turns out to be a Down's child and mom tubes it when he is only 4, leaving no estate. But, on the other hand, maybe mom will be hale and hearty up to age 90, and furthermore this child will, at age 21, discover the cheap and easy way to build a nuclear fusion plant. You don't know. You don't know squat, really. And yet here you are pretending you do, and you're wise enough to make decisions -- to criticize the decisions of others -- based on some fatuous not to say stunningly arrogant fantasy of being able to predict ALL the future consequences of the present complex decisiosn of others. Feh. Use your damn head. Or at the least, use your common everyday experience about how often you are actually wrong in predicting what happens tomorrow, or next week, let alone four or five decades from now.
"Due to the age of the mother that baby is at far greater risk of birth defects and developmental problems that are life long in their effects."
This is false, and I bet a lot of people have this wrong notion of the consequences of pregnancy in an older woman. It would be true if the baby were conceived from her own 66 yo egg, but it isn't when a young donor egg is used.
IT"S THE QUALITY OF THE FERTILIZED EGG that matters, and ART babies from donated eggs do as well as ART babies in younger women, so long as the women gestating the pregnancy is in general good health. The baby is not likely to have age-related birth defects or genetic difficulties.
Let's not forget that this woman is said to be quite wealthy. No financial responsibility is going to fall on the taxpayers or society.
The 66-year-old woman's forward life expectancy is no worse than the average mother's forward life expectance for most of human existence. Cut her off from welfare benefits for her kid? OK -- if you cut every other mother's benefits off. The baby's chances are probably better than a crack mother's baby's.
Otherwise, it's none of your business.
The age of the womb matters too. Old wombs cause more developmental defects.
You are simply wrong. Womb age matters greatly in fetal development.
Accidental birth defects are a temporary (though at least for 2 more decades) problem. But that's only true to the extent that people are willing to use the tech to avoid the defects once the tech becomes available.
Even if all people become willing to use the tech that doesn't eliminate problematic offspring. There are deaf people who are trying to have deaf children. Others will make other problematic choices (e.g. higher aggressiveness).
For most of human existence we did not have a welfare state to take care of babies whose parents died. Now we do. That means we all pay. Unless you can get rid of the welfare state the decisions of others are my business when those decisions increase the burdens I pay for.
Should the state have the power to take children away from abusive and dangerous parents?
Does one have a right to procreate? Absolutely.
Does one have the right to force others in her community to provide for her child or children, were she to be unable to care for them herself, due to poor planning or accident? That's a different question.
RP: You've got a war of "I said so" going with SarahW. One of you needs to cite evidence.
Anonymous: Murder is "the unlawful killing of a human being with malice aforethought". Aborting a Down's Syndrome fetus is not malicious (it spares it a great deal of pain for matters like surgery to correct non-mental defects, among other things), not killing of a human being (legally, and by any non-religious measurement, morally until at least the gestational age of 30 weeks), and is lawful. You fail.
Regards pregnancy risks with age: There are plenty of examples. For example, the risk of eclampsia goes up with age. So does the risk of insulin-resistant diabetes. These conditions both cause problems for fetal development.
An old body has all the things wrong with it even if it is carrying a fetus. More chances of auto-immune response, less immune response to real pathogens, less ability to regulate internal physiology within desired operating limits under external environmental stresses, etc. These things matter for a fetus. A fetus is undergoing differentiation. It is far more sensitive to less than ideal biochemical environment than are fully differentiated tissue types.
Citations. All of this needs citations.
And after her she is orphaned, will this child be able to use her inheritance to purchase a mum and a dad?
It's called "advanced maternal age," and it's defined as pregnancy after age 35. Google it. THIRTY FIVE. Imagine a pregnancy at age 66. There's extensive medical literature about its risks. Other than Down Syndrome, none of these risks has been proven to have anything to do with the age of the egg. The rest are believed to be due to the age of the mother.
Randall- While agree it appears foolish, who are you and others to question her choice. Why stop at criticizing reproduction questions? How about other activities? Why not even thougts?
"believed to be" is the operative phrase here. What do we know?
One thing is for certain: this 66-yr-old will help us find out.
So then as a general rule you oppose criticising other people?
You are basically asking me to prove things that are so well known that I can't remember when I first learned them. But okay, here's an example: the incidence of rheumatoid arthritis (and other auto-immune diseases) rises with age and rheumatoid arthritis causes pregnancy complications that mess up fetal development.
Chakravarty was able to determine the incidence of lupus and rheumatoid arthritis pregnancies by sifting through records of pregnancies and deliveries using the Nationwide Inpatient Sample, a database of hospital discharge summaries from the entire country. In 2002, the latest year in which data was available, she found that at least 4,000 of the approximately 4 million total deliveries occurred in women with lupus or rheumatoid arthritis. By comparison, about 13,000 women who delivered in 2002 had diabetes.
"Women with rheumatoid arthritis are typically somewhat older when they become pregnant," said Chakravarty. "However, even after adjusting for maternal age, they run a higher risk for adverse outcomes and generally experience longer hospital stays than other women." On average, hospital stays increased from about two days for the general population to between three and four days for the rheumatoid group.
Chakravarty's findings also show that, compared with the general population, women with lupus or rheumatoid arthritis are three times as likely to develop hypertension and one-and-one-half times as likely to have cesarean deliveries or deliver prematurely.
The same is going to happen with insulin resistance. It rises with age. It hurts fetal development. Ditto obesity. Rises with age. Hurts fetal development. I'm not stating anything controversial.
The right to freely reproduce must not be abridged. This is a right to own and use our body [and wealth] as we wish.
Greater reproductive choices will put a strain on welfare; so there must be a rethinking on welfare costs and services.
Using taxpayer's funds for helping children in need was comprensible in the past, where pregancy was not a real choice or under the control of the mother. With abortion, contrapceptives, artificial reproduction and so on, the mother has much more freedom than before, so she must bear much more responsability than before.
The final solution to this problem is to let women to have as many children as they like and scrap welfare. The women must also provide for their children or find someone that will provide for them freely. They can not claim others must bear the burden of their reproduction.
Get back to me with your plan for how you intend to convince the majority to let mothers with babies to go hungry.
Reminds me of a joke in the 70's about two headlines being next to each other in the newspaper:
"60 year old woman pregnant."
"Carter blames Congress."