Medicare Won’t Be Swamped With Pregnancy Claims

The story sounds like something from a supermarket tabloid: a woman of nearly 64 gives birth to a healthy baby girl, thus becoming the oldest woman to have delivered a baby since God made Sarah fertile at age 90. For many people, the true story revealed this week in a fertility journal may inspire discomfort or even revulsion. That’s a far cry from the story’s seemingly innocuous beginnings.

As Dr. Richard Paulson, a USC fertility specialist, and his colleagues explain in the article, they believed the woman, who had never been pregnant, was 50 years old when she first sought their aid. Neither her medical records nor medical work-up revealed she was lying. After several years of treatment, the medical team succeeded in establishing a pregnancy with a thawed frozen embryo. The doctors thought they were dealing with just one of 100 pregnancies produced since 1990 when their team established that treating women past menopause with estrogen and progesterone enables them to carry to term babies created from donated eggs. Only when this patient began prenatal care did she admit to being 63 years old.

If past experiences with these medically produced cases of the “oldest mother ever” are any indication, we soon will witness ethical hand-wringing and calls for action. But it would be a mistake to translate our instinctive sense that it’s “unnatural” for women this old to become pregnant into legislative prohibitions of the type called for when earlier cases were publicized.

Any medical innovation inspires the cry that the doctors are “playing God,” which seems particularly apt here because of the biblical parallels with Isaac’s birth to the elderly Sarah. But that does not mean that medicine has exceeded its boundaries. True, one can question whether, if medicine’s central objective is to restore normal human functioning, altering the normal condition of menopause can qualify as medical treatment. The answer lies in the relativity inherent in the goals of medicine.

Few questions would be raised about this technology if the patient were in her early 40s and had experienced menopause well before 50, the average age in this country. Menopause may be a natural condition, but for a woman of 60 who has been trying to become pregnant for years, it still has come prematurely. From that vantage point, her hormonal treatments would be aimed at restoring a natural human function, albeit one rarely found in others her age.

Another criticism is that it is unfair to a child that her mother be so old. Putting aside the fact that men much older than 63 become fathers without anyone making a fuss, attacking geriatric motherhood calls into question the rights of too many other mothers.

What’s the problem? That a 63-year-old won’t live long enough to see her child graduate from college? In an earlier era, many women didn’t live past menopause, but today most can expect to live roughly 30 years beyond. More important, if life expectancy were the essential criterion, then we ought to prevent all women with potentially fatal health problems from having babies. If we’re really concerned with protecting children, we ought to address the known risks posed by inadequate pre- and postnatal medical services for thousands of children rather than the hypothetical problems in rare cases like this one.

Is the objection that older mothers will have difficulties with the rigors of midnight feedings or playtime? But, again, that objection would apply to women with other handicaps, including the demands of a busy career. Certainly we’re not prepared to say that all these women should be barred from motherhood.

Thus, proposals of the sort that greeted prior reports of induced post-menopausal pregnancies--to forbid physicians from assisting older women with becoming pregnant--have worrisome implications for the more general right of women to control their reproduction. Of course, individual physicians are not precluded from setting their own limits. But we should not rush to turn an informal standard, such as the limit of 55 years that Paulson established for his practice, into a binding law.

Many aspects of the fertility business, including numerous social and ethical issues, urgently need public examination. Polarized positions on abortion have posed a barrier to a public ethics debate about those issues, which instead get talked about behind closed professional doors or in the ivory tower and occasionally pop up in the media.

Once the National Bioethics Advisory Commission finishes the very public and very intense deliberations it is conducting on the potential for human cloning, it might turn its attention to the broader questions raised by the range of artificial reproductive technologies that have grown over the 20 years since Louise Brown, the first “test tube baby,” was born.

In the meantime, let’s hope, as will probably be the case, that few women in their 60s will try to evade physicians’ age limitations on assisted reproduction. We don’t need governmentally imposed restrictions or criminal penalties for women who lie about their age to protect the Medicare program from being swamped by claims for induced pregnancy.