Friday, July 29, 2005

Who Gets to be a Parent? Who Decides?

I heard this story on All Things Considered tonight which addressed the ethics of providing in vitro fertilization to post-menopausal women who want to have a child. I was somewhat distrubed by some of the comments, so I thought I'd post and see what others think. I was surprised that at one institution, it went through two ethics committees to decide whether a couple could receive treatment. Some of the arguments bothered me, such as the assumption that an older mother (the debate is not about fathers, which is another issue) would necessarily die earlier or be unfit. I couldn't help thinking how many children lose parents through tragic events early in life - terrible, yes, but would they have been better off not being born? What about 2000 Census data showing that 2.4 million children are already being raised by their grandparents? Other arguments involve health risks to older women in pregnancy; I wonder why this is not simply an issue where the woman is informed, decides, and consents knowing the risks, rather than having the clinic make the decision on her behalf.

This made me think about what criteria fertility clinics are using to determine whether to assist individuals in conceiving children. A January 2005 article in Fertility and Sterility attempted to count just this type of information, asking assisted reproduction facilities about the information they gather and asking them to state whether they would care for certain types of hypothetical patients. Among the findings: more programs collect information on religion (34%) than criminal history (17%); 20% would be very or extremely likely to turn away an unmarried woman, 53% for an unmarried man; 18% would turn away a couple in which both partners were 43 years old. Big shockers to me: 5% would turn away a biracial couple, and 81% would turn away a couple in which the husband has been physically abusive to an existing child (why not all?).

This is a long post already, but here are a couple of links on the topic:
American Society of Reproductive Medicine's statement on oocyte donation to postmenopausal women
Debate on fertility treatment for older women from BMJ.
Commentary piece on bioethics.net
Another commentary

I'd love to hear what others think on this topic.
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