Is it wrong to bring children who will have serious diseases and disabilities into the world? In particular, is it unfair to them? The notion that existence itself can be an injury is the basis for a recent new tort known as "wrongful life" (Steinbock, 1986). This paper considers Feinberg's theory of harm as the basis for a claim of wrongful life, and concludes that rarely can the stringent conditions imposed by his analysis be met. Another basis for maintaining that it is morally wrong to have children under extremely adverse conditions is suggested: a principle of parental responsibility. We also argue that having children under such conditions may be unfair to the children, even if they have not been (in Feinberg's sense) harmed. Finally, we consider when conditions are sufficiently awful that having children might be viewed as incompatible with being a good parent and unfair to the child.
On one very plausible conception of rights, the function of rights is to protect interests. To understand the claim that there can be a right not to be born, we must explain how someone can have an interest in not being born. Born children clearly have all kinds of interests, including an interest in healthy existence. A child who was injured in utero, and is subsequently born, has been harmed even if it is maintained that, at the time of the injury, there was no being with any interests at all. In fact, it is possible for a child to be harmed by negligence that occurs prior to that child's conception, when no being, not even an embryo, existed (although it must be admitted that courts have been extremely reluctant to acknowledge preconception torts).
By contrast, wrongful life suits do not claim merely that the infant plaintiff was harmed before birth. They claim that the child was harmed by being born, implying an interest in not having been brought into existence. Someone can be said to have an interest in not being born if his or her existence is inexorably and irreparably such that life is not worth living. Joel Feinberg explains the right not to be born this way:
Talk of a "right not to be born" is a compendious way of referring to the plausible moral requirement that no child be brought into the world unless certain very minimal conditions of wellbeing are assured. When a child is brought into existence even though those requirements have not been observed, he has been wronged thereby...(Feinberg, 1984, p. 101).
Feinberg goes on to suggest that these "minimal conditions of wellbeing" amount to a requirement that we not doom the child's future interests to total defeat. The advance dooming of a child's most basic interests -- those essential to the existence and advancement of any ulterior interests -- deprives the child of what might be called his birthrights. And if you cannot have that to which you have a birthright, you are wronged if you are brought to birth.
Is the infant plaintiff in a wrongful life suit also harmed by being born? In Harm to Others (Feinberg, 1984), Feinberg offers an analysis of harming as "the thwarting, setting back, or defeating of an interest." To have an interest in something is to have a "stake" in it: "In general, a person has a stake in X... when he stands to gain or lose depending on the nature or conditions of X":
One's interests, then, taken as a miscellaneous collection, consists of all those things in which one has a stake... [these] are distinguishable components of a person's well-being: he flourishes or languishes as they flourish or languish. What promotes them is to his advantage or in his interest; what thwarts them is to his detriment or against his interest (Feinberg, 1984, p. 34).
Applying this analysis to the case of prenatal harms, Feinberg concludes that harm can be caused to a person before his birth "in virtue of the later interests of the child that can already be anticipated" (Feinberg, 1984 p. 96). The pre-conscious, pre-sentient fetus has no actual interests, and therefore cannot be harmed (or benefited). But on the assumption that the fetus will be born, we can ascribe to it certain "future interests" which can be set back, thwarted, or defeated by actions done before the potential person becomes an actual person. For example, a negligent motorist who runs over a pregnant woman may cause damage to the fetus that causes it later to be born crippled. Sometime after birth the infant will have an actual welfare interest in self-locomotion. Feinberg writes:
The child comes into existence in a harmed state caused by the earlier negligence of a motorist whose act initiated the causal sequence, at a point before actual personhood, that later resulted in the harm. The motorist's negligent driving made the actual person who came into existence months later worse off than she would otherwise have been. If the motorist had not been negligent, the child would have been born undamaged (Feinberg, 1984, p. 96).
Prenatal -- and even preconception -- torts can be explained and justified on Feinberg's analysis. But is it possible to explain how someone can be harmed or wronged by being born? The challenge is to explain what it means to say that someone is "worse off" for coming into existence, or "better off unborn."
It may help to start with the expression "better off dead." To say that someone is better off dead is not to compare his condition while alive with his condition after he is dead. That would be absurd, since after someone ceases to exist, he is in no condition at all. Instead, the phrase "better off dead" simply means that life is so terrible that it is no longer a benefit or a good to the one who lives. In the case of a competent adult, a normal requirement for judging that a person is better off dead is typically whether the person himself considers life not worth living.
This test, however, cannot be applied in the case of infants. It isn't just that infants cannot express their preferences; they do not yet have the intellectual equipment necessary for having the relevant preferences. Infants cannot understand the choice between severely handicapped existence and no existence at all. They cannot weigh up benefits and harms to reach a decision as to whether life is, on balance, worth living. Therefore, it doesn't make any sense to ask what the infant would want, if he could only tell us. The test of "substituted judgment" is simply inapplicable in the case of never-competent individuals (Buchanan, 1981).
What sense, then, can be given to the judgment that the infant would be better off not existing? It might be thought that if we cannot consult the infant's own preferences, then life is necessarily a benefit and a good to the child. The implausibility of this is seen if we consider the example of an infant who is severely physically and mentally handicapped, and who suffers from chronic and unrelievable pain. The child's physical handicaps prevent him from the ordinary pleasures of infancy and childhood, while his mental handicaps prevent him from acquiring compensating interests. At the same time, he suffers without comprehension. Even if we cannot ascribe a preference for nonexistence to the child, surely we can say that this is a life so awful that whatever interests or preferences the child might come to acquire, they would be completely frustrated.
We do not then substitute a judgment based on some view about the child's particular interests. Instead, we offer the judgment of a "proxy chooser," who acts as the infant's advocate, concerned to promote his or her general welfare. Feinberg explains:
[The proxy chooser] ... exercises his judgment that whatever interests the impaired party might have, or come to have, they would already be doomed to defeat by his present incurable condition. Thus, it would be irrational -- contrary to what reason decrees -- for a representative and protector of those interests to prefer the continuance of that condition to nonexistence (Feinberg, 1992, p. 22).
There are two important features of the proxy's choice. First, the choice of nonexistence is not merely rational in the weak sense of being in accordance with reason, but in the strong sense of being required by reason. Second, his nonexistence is rationally preferable in the strong sense if all of his interests, present and future, whatever they might be, are "doomed to defeat."
Although Feinberg's analysis may well give the correct answer in cases so dismal that all possible interests are completely "doomed to defeat", this will only cover a small fraction of the cases in which questions of wrongful life might seem to have at least some plausibility. The "doomed-to-defeat" test seems to apply only in cases so awful that the child faces chronic pain, combined with such severe mental retardation that developing any compensating interests is impossible. Such cases are (fortunately) quite rare. Relatively few impaired newborns, even those with the severest anomalies, have lives filled with severe, chronic, and intractable pain. Far more common are cases where the infant's condition precludes the ability to develop or to do any of the things that human beings characteristically develop (Arras, 1987). John Robertson considers the case of a profoundly retarded, nonambulatory, blind, and deaf infant who will spend his few years in a crib in the back wards of a state institution.
One who has never known the pleasures of mental operation, ambulation, and social interaction surely does not suffer from the loss as much as one who has. While one who has known these capacities may prefer death to a life without them, we have no assurance that the handicapped person, with no point of comparison, would agree. Life and life alone, whatever its limitations, might be of sufficient worth to him (Robertson, 1974-75, p. 254).
If we confine ourselves to the infant's own perspective, it does not seem that we can say with confidence that the child is "better off dead" or "better off unborn." It is not clear that even the most radically impaired infant suffers from, or has interests of his own that are defeated by, his impaired condition.
Such examples emphasize the highly limited applicability of Feinberg's analysis. Very few lives meet the stringent conditions imposed by the wrongful life analysis outlined above. On this account, and strictly from the standpoint of the future child, it seems that we can very rarely say that it would be wrong to bring a child into existence. Even the most dismal sorts of circumstances of opportunity (including, for example, slavery, an extremely high chance of facing an agonizing death from starvation in the early years of life, severe retardation plus complete quadriplegia, etc.) are all cases which fail to be covered by this analysis.
Should we then conclude that it's acceptable to bring children into the world even when they are destined to have terrible lives? We find this implausible, and in this section we'll suggest how the decision to have children when a decent minimum cannot be provided can be criticized on moral grounds. Then in the following section, we'll turn to responding to what we see as the most important line of criticism against the general position we're taking -- that is, a criticism coming from Feinberg and Parfit which claims that decisions to have children destined to terrible lives cannot be criticized on moral grounds if the children them selves are glad, on balance, that they were born.
Consider the case of a teenager who wants a baby (Parfit, 1984, pp. 357-361). Most people would agree that teenagers should not have babies. Teenagers who become mothers severely limit their own educational and job opportunities. They are more likely to be poor, and to raise families in poverty. In addition, teenage mothers tend to have babies who are low birthweight, a condition associated both with a significantly higher mortality rate than that of normal-sized babies, and with learning disabilities in the future. Children of teenagers are also unlikely to get adequate mothering, as their mothers are still children themselves. While there are no doubt exceptions, in general, young teenagers lack the maturity and stability necessary to be good parents. For all these reasons, it would be better if teenagers did not have babies.
Notice that many of these reasons appeal to the harmful physical and psychological effects on the future children. A young girl who waits until she is older will give her child a better start in life. Therefore, even if she herself does not mind having fewer opportunities and living in poverty, she ought to wait, we might say, for the sake of her child. However, this claim bears closer examination. Derek Parfit points out that a young girl who is contemplating having a child cannot make that child better off by waiting. If she delays childbirth, she will give birth, not to that child, but to a different child, who will develop from a different egg and sperm. The child she will have if she becomes pregnant now cannot be born at a later time. It is either birth to a teenage mother, or no life at all.
This simple fact has provocative implications. If we maintain that it is for the sake of the child she would bear that she should avoid pregnancy, we seem to be committed to the view that it would be better never to be born at all than to be born to a very young mother. But this is surely implausible. Being born to a teenage mother isn't ideal, but neither can it be said to be so bad as to make nonexistence preferable. Despite the hardships they undergo, despite the fact that they might have preferred having an older mother, most children of very young mothers are probably glad they were born. If they were asked, "Would you prefer to have the life you have now, with a fourteen year old mother, or not to have been born at all?" they would choose this life.
What conclusions should we draw from this? We might conclude -- implausibly -- that it is not wrong for fourteen-year-olds to decide to have children. Or we might conclude that the reasons why it is wrong all have to do with the deleterious effects on the young girls themselves, on their parents, and on society in general. But to say this is to leave out the idea that having children under very adverse conditions is unfair to them. Can we make clear and coherent the prima facie plausible idea that it is unfair for parents to bring children into being without some reasonable prospects at a non-miserable life?
The very particular and detailed ways such a principle of parental responsibility might be filled out will of course be very different given more globally differing meta-ethical perspectives. But the outlines of such a defense are not hard to see for the obvious mainstream possibilities. Whether utilitarian, virtue-based, deontological, or contractarian, it's not hard to see how the the parents' special relationship to and control over the life and well-being of the child should be seen as giving them a special responsibility. So rather than spending time trying to fill that out in detail (and by so doing, making the appeal of the idea less rather than more general), we'll content ourselves here with spelling out some the most general features such a principle might involve, and then in the next section turn to a very general criticism that any such principle must face.
A principle of parental responsibility should require of individuals that they attempt to refrain from having children, unless certain minimum conditions can be satisfied. This principle maintains that in deciding whether to have children, people should not be concerned only with their own interests in reproducing. They must think also, and perhaps primarily, of the welfare of the children they will bear. They should ask themselves, "What kind of life is my child likely to have?" Individuals who will make good parents -- that is, loving, concerned parents -- will want their children to have lives well worth living, and will strive to give them such lives. But what if the parents cannot give their children even a decent chance at a good life? The principle of parental responsibility maintains that under such conditions, it is better not to have children, and that it is in fact unfair to children to bring them into the world with "the deck stacked against them."
Although a principle of parental responsibility requires individuals to refrain (when possible) from having children if they cannot give them a decent chance of a happy life, this of course does not imply that responsible parents of born children should be willing to kill them if their lives fall below a certain standard. Given a child with severe handicaps and a very limited and considerably painful life (but still a life which the child finds worth living), parents should choose treatment that will allow their child to go on living, as he or she wants ( ceterus paribus, of course; we're not assuming that issues about availability and cost of treatment or the like couldn't bear on the decision as well). Given a preference for life, it is not in general the parents' place to decide that the child would be better off dead.
When the child is too young to have preferences, the parents will have to judge whether continued life is in the child's best interest. Depending on the prognosis, a reasonable judgment might be made either way (Steinbock, 1984). A decision to stop life-prolonging treatment could be consistent with, or possibly even required by, the special responsibility the parents have to the child.
But where there is no child at all, the question facing the prospective parents is not "what does my child want?" nor "what is best for my child?". It's rather a question of whether to create a child who is likely to have a life marked by pain and severe limitations. It seems to us that the answer to this question must be no. What reason could be offered in justification of an affirmative answer? That the child's life, while miserable, is not so awful that he or she will long for death? That is not the kind of answer that a loving parent could give. Anyone willing to subject a child to a miserable life when this could be avoided, would seem to fail to live up to a minimal ideal of parenting.
We've claimed that a child's being destined to a miserable life may well count strongly against having it. However, the fact that a child would have a happy life if brought into existence does not obligate its putative parents to having a child. If one decides not to have a child, one harms no one. It is not as if there are people in the wings, so to speak, hoping to get the gift of life. No one is injured or made unhappy or deprived by non-birth (Brandt, 1974, p. 163). By contrast, if one decides to have a child, then there will exist a real person, with needs and interests that must be considered. Mary Anne Warren expresses the point this way:
... failing to have a child, even when you could have had a happy one, is neither right nor wrong... But the same cannot be said of having a child, since in this case the action results in the existence of a new person whose interests must be taken into account. Having a child under conditions which should enable one to predict that it will be very unhappy is morally objectionable, not because it violates the rights of a presently existing potential person, but because it results in the frustration of the interests of an actual person in the future (Warren, 1978, p. 25).
In this section, we've suggested some reasons for expanding the notion of parental responsibility for starting lives beyond the kind of minimal conditions suggested by Feinberg earlier. Any such expansion of this notion of parental responsibility must face a serious challenge: Is there any way to make a principle plausibly account for a kind of unfairness to the child from being born in very adverse conditions, even if the child itself prefers the dismal life it's been given to no life at all. In the next section, we'll consider an argument against any such expansions of parental responsibilities, and show why the argument fails.
Feinberg suggests a fundamental limitation on what sorts of unpromising births might reasonably be counted as bleak enough so as to be unfair to the child. This limitation comes out in the consideration of an example of Derek Parfit's: A woman is warned that if she becomes pregnant while she suffers from some temporary illness, the baby will be born in a defective condition. Whether through deliberate perversity or recklessness, the woman fails to take precautions and becomes pregnant during the dangerous period. She gives birth to a baby with a withered arm, a defect which is serious, but not totally incapacitating.
Has this child been harmed by his mother's act? We may suppose that while the child wishes he didn't have a withered arm, he does not regret being born. Given the choice between life with a withered arm and no life at all, he is glad to be alive. But if the child is glad to be alive, despite his or her suffering, then it would seem that the bad aspects have been outweighed by the good. He cannot therefore wish that his mother had followed her doctor's advice, for if she had, he would not have been born at all, which, as Feinberg says, "even the child acknowledges was the worse fate. Hence, she picked the option that had the best total consequences for the child that eventually emerged" (Feinberg, 1992, p. 27).
Feinberg concludes that the child's mother cannot be said to have harmed him, although she is responsible for his having come into existence in a harmed condition. And -- importantly for our purposes -- he further maintains that the mother has not wronged her child or been unfair to him by causing him to come into existence in a harmed (handicapped) existence. The reason:
... if he were to claim that she wronged him by doing what she did, that would commit him to the judgment that her duty to him had been to refrain from doing what she did; but if she had refrained, that would have led to his never having been born, an even worse result from his point of view. There is no doubt that the mother did act wrongly, but it does not follow that her wrongdoing wronged any particular person, or had any particular victim. She must be blamed for wantonly introducing a certain evil into the world, not for harming, or for violating the rights of, a person. (Feinberg, 1992, p. 27)
Feinberg thus holds that when a child's existence is so miserable that he would have been better off unborn, he has been both wronged and harmed; but when his condition is impaired, but not so seriously that nonexistence is preferable, he is neither wronged nor harmed. Of course, the person responsible for his harmed condition may still have acted wrongly. It might still be seen as wrong to have children under extremely adverse circumstances, as long as we reinterpret the wrongdoing so that it does not involve being unfair to anyone -- and in particular, not to the child, so long as the child prefers existence to nonexistence.
This account of the ethical failure of the parents in terms of the wanton introduction of an evil into the world seems unsatisfactory. It suggests that the only thing wrong with having children likely to have very unhappy lives is that the world is thereby made a worse place. But surely this is not the whole story. Such an explanation leaves out our sense that the children whose lives fall below a decent minimum are the victims of their parents' decision to procreate. It leaves out the plausible and intuitive idea that bringing children into existence under very adverse conditions is unfair to the children themselves.
If Feinberg's position here is correct, he has effectively ruled out any claim by or on behalf of a child that he or she him/herself has been wronged or harmed by the action of being born as long as he/she prefers the state of having been born -- as miserable as life is -- to no life at all. What reason has Feinberg given for this? In the passage quoted above, he infers that the mother is not to be blamed for "harming or for violating the rights of" the child from the fact that not being born would be a "worse outcome from the child's point of view." Stated simply, it seems that something like the following principle underlies the inference here:
If I prefer outcome A to outcome B, then I haven't been wronged or treated unfairly by your bringing about outcome A rather than outcome B.
But this principle is highly tendentious. If you act so as to utterly disregard my legitimate interests for your own (perhaps even minor) benefit, then you've wronged me by treating me unfairly, even if in the end (perhaps by some accident of chance) I end up in a situation preferable to the one I would have otherwise been in. Fairness of treatment is not necessarily determined by the end acceptance or approval of those receiving it with respect to the available alternatives.
Examples illustrating this are easy enough to produce. Suppose you, as District Attorney, frame me (just some random loser) for an unsolved crime to further your career. I then appeal my case and get my conviction overturned, and go on to write a book about the whole thing that makes me rich and famous. Or you hijack the plane I'm on and threaten to kill passengers until your demands are met. But I get the jump on you, save myself and the other passengers, become a big hero, write a book... (vamp till done). In each case, you wronged me and treated me unfairly by your disregard for my interests, even though the eventual outcome is one I'm delighted with.
Note that in such cases, it's not just that what was done overall was wrong, but that at least part of what was wrong was a matter of being unfair to me -- and even though the outcome is better in my view than the available alternatives. I may even be, in certain odd sense, glad that things worked out the way they did; but that does not entail that your actions weren't unfair to me. Similarly then, the simple fact that I prefer the outcome of having been born severely handicapped to the available alternative (non-existence) does not itself establish that I am not treated unfairly by my being born into dismal conditions of life.
These examples don't show that having a child destined for a bad (but not totally horrible) life must be wrong. Real and concrete questions about this will turn on the kinds of details of opportunity and limitation considered in the next section. What they do show is how, given some principle of parental responsibility like that offered and motivated in the previous section, the fact that a child prefers the outcome of being born to the alternative does not make the claim of unfair treatment in any way inconsistent.
Without an answer of this sort to Feinberg's principle, any further considerations of detail would be constrained by the fundamental limitation that unless the child deems the life so bad as to be not worth living, there can be no claim of unfair treatment. Now having avoided this objection, we'll turn in conclusion to some discussion of the more concrete particulars faced in these decisions.
The principle of parental responsibility maintains that prospective parents are morally obligated to consider the kinds of lives their offspring are likely to have, and to refrain from having children if their lives will be sufficiently awful. But what is sufficiently awful? Laura Purdy considers the example of Huntington's disease (HD), a lethal genetic disorder (Purdy, 1978). Symptoms, which usually appear between ages 35 and 50, include spasmodic, involuntary movements, as well as personality changes (moodiness, paranoia, violent behavior, manic activity), memory loss, and chronic depression. The disease lasts approximately 15-20 years. At the end, the patient has degenerated to the point of being totally physically disabled and unable to communicate (Becker, 1988-89). HD inflicts severe and prolonged suffering on its victims. It is a horrible way to die. Purdy maintains that individuals at high risk of transmitting a serious disease to their offspring are unable to provide them with "at least a normal opportunity for a good life" and therefore such individuals should not reproduce.
However, judgments about the value of life are inescapably subjective. They vary depending on the individual's experience, personality, and general approach to life. Purdy acknowledges that not everyone will concur with her conclusion that individuals at risk of transmitting HD should refrain from procreating, because not everyone will share her pessimistic assessment of life with HD. She writes:
Optimists argue that a child born into a family afflicted with Huntington's chorea has a reasonable chance of living a satisfactory life.... Even if it does have the illness, it will probably enjoy thirty years of healthy life before symptoms appear... Optimists can list diseased or handicapped persons who have lived fruitful lives. They can also find individuals who seem genuinely glad to be alive (Purdy, 1989, p. 313).
Arlo Guthrie seems to have taken the optimistic point of view. His father, Woody Guthrie, died of HD, which means that Arlo has a 50 percent risk of developing the disease. Despite this, Arlo decided to have children, thereby imposing on each child a 50 percent chance of inheriting the disease. Of course, if Arlo did not have the disease, as now seems likely, then his children would not be affected. But he could not have known this at the time he decided to procreate. Therefore, he was taking a 50 percent chance that he would be passing on HD to his children. How could he justify this risk? Perhaps he reasoned as follows: "I haven't had a tragic life. I've had a very good life. The goodness of my life will not be destroyed if it turns out that I have Huntington's. I won't regret having been born, or resent my parents for having had me. So why is it wrong for me to have kids? I can give them a decent chance for a good life -- as good a life as I had." If this is a good argument, then even if we accept Purdy's principle, that individuals who cannot give their potential offspring a reasonable chance at a satisfactory life should not reproduce, we might not accept HD as coming under Purdy's principle.
A stronger case for the moral obligation not to reproduce exists in the case of HIV-infected women, who run the risk of transmitting AIDS to their offspring. John Arras asks, "Ought such women to forgo childbearing for the sake of children who would have been born infected? If already pregnant, should they abort 'for the sake of the fetus'?" (Arras, 1990, p. 353.)
AIDS is a painful and, so far as we know, invariably fatal disease. The aggregate median survival time for infected children is about 38 months from the time of diagnosis. The baby who develops AIDS does not get thirty (much less forty or fifty) healthy years, like the person with HD. Symptoms show up fairly early on, and for most afflicted children, their lives will be filled with considerable suffering. How, it may be asked, could someone aware of these facts even consider deliberately having a child?
The moral obligation of HIV-infected women to avoid conception is complicated by two factors. First, there is a pretty good chance that such women will not pass the virus on to their babies. Current studies indicate that the risk of actual perinatal HIV infection through any given pregnancy is somewhere between 20 and 30 percent (Arras, 1990, p. 355). Second, the severity of the disease varies widely. The most severely afflicted children present with adult-style opportunistic infections, such as Pneumocystis carinii pneumonia (PCP), during the first year of life. These children face painful death within a month or two after diagnosis. Such children have lives that clearly qualify as "wrongful." However, other children develop far milder manifestations, are diagnosed at a later date, and live much longer. Arras says:
Only a relatively small percentage (say, 10 to 20 percent) of those born HIV infected actually fit the worst-case scenario of early infection, chronic hospitalization, and death before the age of two. The rest will develop different and often less lethal manifestations of AIDS later on and will live longer, perhaps to the age of ten or beyond. The longer these children live with a tolerable quality of life, the more their lives will be worth living. A child who lives at home, goes to school, and attends summer camp does not fall into the same category as a Tay-Sachs baby (Arras, 1990, p. 365).
Nevertheless, even the better-off AIDS babies have lives that are, in Arras's phrase, "decidedly grim." More than half will die before the age of seven, and the remainder must live under a cloud of impending death with progressively deteriorating immune systems. In addition, most HIV-infected babies are born to mothers (and fathers) who are themselves dying. Many of these parents are too sick to care for their own children, who are often abandoned in hospitals or put in foster care. When the medical and the social realities are considered, even an optimist should concede that it is very unlikely that an HIV-infected woman will be able to provide her baby with a reasonable (much less a normal) chance at a good life. Therefore, knowingly to conceive a child under such conditions is morally wrong.
The basic idea is that before embarking on so serious an enterprise as parenthood, people should think about the consequences for their offspring. Some circumstances may be so awful that birth is unfair to the child. However, the principle of parental responsibility says only that it is wrong to bring children into the world when there is good reason to think that their lives will be terrible. It does not suggest that people should not have children unless conditions are ideal, still less that only conventional childrearing circumstances are morally permissible. Consider, for example, the enormous fuss raised recently by the story of a fifty-nine-year-old British woman who gave birth to twins on Christmas Day, 1993. The eggs, donated by a younger woman and fertilized in vitro by the older woman's husband, were implanted into her at a private fertility clinic in Rome. Doctors in London had earlier refused to perform the same procedure because they believed she was too old to face the emotional stress of being a mother. Virginia Bottomley, the British Secretary of Health, told the BBC, "Women do not have the right to have a child. The child has a right to a suitable home." But as The New York Times put it in an editorial:
What makes Ms. Bottomley believe the twins won't have a suitable home? Youth is no guarantee of parenting skills: all too often the contrary is the case. And how would Ms. Bottomley define the homes in which parentless children are raised by grandmothers? Are they, ipso facto, unsuitable?
Undoubtedly, pregnancy poses special risks for many postmenopausal women, but most IVF programs carefully screen out candidates who are not in excellent condition. If society is going to decide which women are physically unsuited for pregnancy, it might start with young teenagers, as pregnancy in children who are not yet full-grown is risky both for the mother and the baby. And young teens are probably less emotionally equipped to be good parents than women in their fifties or sixties.
Another worry is that postmenopausal women won't live long enough to rear their children. According to Gail Sheehy, author of Passages and The Silent Passage: Menopause, "It's not a very nice prospect for a child of 10 or 12 to go to sleep every night, praying that his or her mother will live as long as he needs her." However, many women live into their eighties and nineties these days. The Italian doctor who helped the 59-year-old British woman give birth accepts only patients who have a life expectancy of at least 20 more years, based on their age and family history. They must be non-smokers and pass psychological and physical tests. These are conditions we do not require of any other mothers. Nor are they conditions imposed on fathers. Telly Savalas, the television star of "Kojak," recently died at the age of 70. The fact that he left behind school-age children was not even a subject of comment, much less outrage. It seems likely that the opposition to older women having babies expresses a prejudice against what is new or unconventional, rather than a position that can be rationally justified. So long as a woman is emotionally and physically equipped to be a reasonably good mother, there is no reason why age should be an absolute barrier for women, any more than it is for men.
Life is always a mixture of good and bad, pleasure and pain. We know that our children will have their share of suffering and adversity; that is the price of the ticket. This fact should stop no one who wants children from having them. At the same time, the judgment that the child you will conceive is likely to have a life that falls below a decent minimum provides a strong reason to avoid procreation. In some cases, all that is necessary is to postpone parenthood, as in the example of the young teenager who wants to have a child. The principle of parental responsibility tells her to wait, because if she does, she will be a much better parent to the child she eventually has. In other cases, where the risk is transmitting a disease, whether a genetic disease, such as sickle-cell anemia or cystic fibrosis, or a viral illness, such as AIDS, postponing pregnancy will not help. Prospective parents will have to base their decision on such factors as the risk of transmission, the nature and seriousness of the disease, the availability of ameliorative therapies, the possibility of a cure, and their ability to provide the child with a good life, despite the handicap. The principle of parental responsibility does not provide a formula for deciding such cases. Reasonable people can differ on what a decent chance at a happy life is, and what risks are worth taking.
Throughout this paper, we have been assuming that parenthood is
deliberately chosen, something that is not always, perhaps not
even typically, true. In many parts of the world, fertility is
not so easily controlled, and becoming a parent is more of a
fait accompli than a deliberate choice. The principle of
parental responsibility is aimed only at those individuals who are
capable of controlling their fertility, and of making a conscious
decision whether to have children.
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