Wrongful life, wrongful birth, and moms over 40

I mentioned in the comments thread on a previous post that I might want to discuss the ethics of moms over 40 having babies. I have no idea how prevalent is the view that it might be immoral. Several friends in their 40s, however, have worried about it to me. So here goes!

Full disclosure: I do have a kid with a Ridiculously Rare chromosomal abnormality. His particular disorder is not correlated with the parents’ age. I am under 40.

There are two things I’m not discussing in this post. One is the ethics of abortion, which I’ve inconclusively touched on elsewhere. The other is the prudence of having a child when the mom is over 40. Is it a good idea for a woman to wait until her fertility drops and risk of genetic disorders increases? I myself decided that it wasn’t a good idea for me. There are pluses and minuses, and each will weigh on each family differently. So that’s not what I want to talk about here. I by no means dispute the facts that fertility drops and genetic disorders increase with maternal age.

What I want to talk about is whether the increased risk of genetic disorders makes it immoral (not imprudential) to have a child if you’re a woman over 40.

Women in general have a 97-98% chance of having a child without a birth defect. About chromosomal abnormalities: a 40 year old woman has a 98.5% chance of having a baby with no chromosomal abnormalities. A 45 year old has a 95.2% chance of having a baby with no chromosomal abnormalities.

There are three possible parties that might be harmed by the decision to have a baby over 40: the baby, the parents and other family members, and society in general.

First, the baby. Is it a wrong to him to bring him into existence with disabilities? I think there’s a pretty low bar for a life so awful it had better not had been lived at all. Certainly not in most cases of Down syndrome, where people can often walk, talk, read, laugh, and socialize. My own child is more severely disabled than the majority of people with Down syndrome. We’re not sure if he will walk unassisted, if he will ever speak. But here’s what I see (I may be biased, but on the other hand, I observe disability much more closely than most people): I see a boy who has far more pleasure than pain. Who enjoys socializing, playing, splashing bathwater everywhere, laughing, trying to talk. Who recognizes friends and family. I also see a boy who has a lot of annoying health problems and who will never marry, live independently, hold a job without a minder, live as full a life as his brothers do. But I do not see a life that is not worth living. There are many different ways in which people don’t live independently (people on dialysis, for example) and yet their lives are worth living. I think most of us share the instinct that there is actually a fairly low bar for a life worth living. Experiences are themselves valuable. Most of us who favor euthanasia favor it under pretty strict circumstances. Wrongful life lawsuits are not allowed in a majority of states precisely because it seems wrong to say the child is harmed merely by being brought into existence. There is a chance a woman over 40 will have a child so severely disabled that his life is not worth living, I suppose. I have no idea how to characterize that in terms of percentages, but I think that would be extremely unlikely.

Then, the family. Is the higher risk of chromosomal abnormalities a way of committing wrongful birth against oneself? The majority of families with Down syndrome tend to do very well. One study showed that in families with kids with severer syndromes, like my kid’s, there is an increased risk of depression and anxiety, especially in the mother. There is also a higher rate of divorce. There are ways to mitigate it (counseling, having more children, respite care). But I think if that’s a risk the family is aware of, then they’ve done themselves no wrong by taking it on. Again, it may not be the best idea prudentially, but I don’t think they’ve committed a moral wrong against themselves. If anything, parents tend to overrate how unhappy they will be with a disabled child. Every parent I know talks about how the first year after diagnosis is the worst. There is a possible harm done to siblings. But siblings of disabled kids show both harms and benefits.

Then, there is society. Society will bear the cost of a child with a disability. Disabled kids are expensive. My kid has cost our private insurance into the seven figures. He will not be productive. I think this is the most persuasive possible reason that it might be immoral for a woman in her 40s to have a child. But I still think it doesn’t add up. Having a baby at all adds to society’s health care costs. There is no guarantee that any of them will be productive enough to put that money back in. 2-3% of all babies have birth defects. The percentage of babies of 45 year old moms with chromosomal abnormalities is actually not all that much higher than that. If it’s okay for any mother, I don’t see how a relatively small increase in likelihood of needing medical care is much worse for older parents. There are many activities that people do that have a much greater likelihood of increasing all our health costs, and sucking out more money from the health care system than is paid in: smoking, alcoholism, eating junk food, etc.

In the previous comment thread, it was mentioned that people over 40 could just adopt. Perhaps that is the morally best thing to do, but that doesn’t mean it’s immoral to have one’s own child.

So on the whole, I really don’t see a very strong moral reason for a woman in her 40s to refrain from having children.


Rose Woodhouse

Elizabeth Picciuto was born and reared on Long Island, and, as was the custom for the time and place, got a PhD in philosophy. She freelances, mainly about disability, but once in a while about yeti. Mother to three children, one of whom is disabled, two of whom have brown eyes, three of whom are reasonable cute, you do not want to get her started talking about gardening.


  1. Luv this post.
    Yeah, it might be the morally “best” thing to do to adopt, but that actively downgrades the connection that a woman feels with her Own Child. (the lack of which has contributed to “evil stepmother” mythos, even if it’s not a large contribution).

    I suppose in an Ideal World ™ one would choose the smartest/most likely to be successful kids to nurture — in General! Now if we could only figure out which ones those would be. teehee!

    Reality’s rarely so cut and dried that we can say “it’s immoral.” wish we had better terminology.

  2. Thanks!

    Too many metrics of success, I think, to systematize it 🙂

    Some of my best friends are adoptive parents (you know who you are) and they feel a connection with their child that I am sure is as potent as mine. That said, there are many reasons why we chose not to adopt.

    • to have considered it at all does you good credit. it is not a path for everyone…

      • Ha! So glad my husband is around to be sensible, otherwise I would end up adopting, like, six disabled children.

        It isn’t a path for everyone, and I admire those who do it – healthy, disabled, younger, older…

  3. Read and enjoyed, but I don’t have anything to add. Since I’m not a mom, nor am I going to be, nor am I going to have any significant dealings with one, my opinion matters not a whit.

    • Thanks! But it’s not necessarily true that your opinion doesn’t matter. I have no plans to be tortured, to torture anyone, nor am I likely to have any significant dealings with a torturer or torturee. Yet I think it’s legitimate for me to opine on the issue.

      • Not the same, really. having a child impacts the mother, the father, the family in that order. So they need to be the primary decision-makers.

        Torture impacts the tortured. They, or their advocates, should have SOME say in the morality/ethics of torture. (Considering that torture is always immoral, we could say the same about incarceration,)

        • I wonder about a case in which someone who was tortured argued that it wasn’t always immoral.

          Anyhow, some things are the kind of things that only the wronged party should have a say. Others are simply wrong.

  4. Couldn’t one argue that it is “more” moral in ALL cases to adopt first? To take care of children who already exist.

  5. As I’ve noted many times before, i work with a lot of organizations that work with people with different kinds of developmental disabilities – so I do have some emotional skin in this game. That being said, the problem I have with the argument of immorality is that it supposes that there is something inherently wrong or immoral about someone with a DD existing in the first place.

  6. “So on the whole, I really don’t see a very strong moral reason for a woman in her 40s to refrain from having children.”
    The increase chance of having a child with a chromosonal abnormality is so small. I also happen to agree that a life would have to be so severally impacted to say that it was not worth living at all. A decrease in overall quality of life does not necessarily dictate whether or not the life was worth living in the first place.

    Thanks for the super thoughtful post, Rose!

  7. Well considered, Rose. Framing the morality of having children in one’s 40s as a matter of prudence, rather than imperative, is the most sensible approach, I think. We’re not dealing with absolutes or settled principles, but risks and uncertainty. My mother gave birth to my sister at age 45. She’s very healthy. At 30, my wife gave birth to our daughter, who suffered from anencephaly, a fatal birth defect that took her life 15 hours later. Childbirth and raising children are never clear sailing. To my mind, a society that respects women ought to respect their choices to take costly risks, even if that means bearing some or most of the costs.

    • Kyle, I’m so sorry about your daughter. That is so so rough. You’re right, there are no guarantees at any age.

  8. I don’t really have anything of substance to add to the post, but I wanted to say that is a goshdarned cute picture.

  9. What a adorable child!
    As far as having children when you 40 and above or under, its always a risk no matter who you are. I have a friend who had her second child when she was 42. This child is healthy and a dream child.
    Sandy, My High School girlfriend, had hers at 18 and that child had many disabilities and is no longer here with us. Sandy feels that every day she had with her child was a blessing.

  10. Hello, and thanks for your article.

    My wife and I are planning to try to conceive as soon as she’s weaned off her prescription medication. She’ll be 42 in a couple months. We live in England, and so far both GPs at our family practice have tried to discourage us — all but insisting that we don’t do it, referring us to genetic counseling, and planning her medication reduction over months instead of weeks. I have a minor disability (brittle bones) that carries a 50% chance of inheritance, yet the doctors dismissed the importance of that compared to the <2% chance of Down Syndrome. In their eyes, having a baby with Down Syndrome is a complete disaster to be avoided — at all costs. We disagree; people with Down Syndrome can be very happy and live rewarding, fulfilling lives.

    While we are personally ready to accept whatever the outcome will be, I've been weighing the potential impact on our family and society; that's how I arrived at this article. A close relative (a doctor) seems generally opposed to the idea, but our children say they'd love to have another brother or sister, with or without Down Syndrome. (They lived next door to a lovely, very happy little boy with Down Syndrome, so they have some insight into the reality of that scenario.) I'm sure we'll continue to discuss it with family and friends over the next few months.

    I think my biggest concern is that my wife and I will eventually become unable to care for a dependent, so if we do end up having a child with a disability, we would eventually need someone else to care for our disabled son or daughter. I still haven't worked through all of the ramifications of that, but I would be interested to hear others' opinions and perspectives.

    It seems to me that many people operate on the premise that any disability is a complete disaster. Personally, I assume such people either haven't thought about it enough or haven't known anyone with a disability (or both!).

    Thanks again!

    • Hi Dave,

      First of all, I wish you the best of luck!

      I realize most people think disability is a complete disaster. I used to think so, too! But our own experience and empirical data simply don’t bear that out. I don’t mean to imply that it is not difficult in many ways. It is. But our lives are not totally over, and we have a happy home, and not only in spite of our disabled son, but because of him.

      I don’t have much advice regarding what to do regarding conservatorship. We have appointed guardians, and plan to appoint our other sons when they are old enough. But I’m pretty sure, if it ever came to that, either a disability lawyer or Mencap would have some answers.

  11. Sorry, Charles. Your comment was just a wee bit too spammy for my taste. If you’re a real person and your strangely stilted comment was a real expression of thought, my apologies. I’m not deleting it outright, so if you are a real person with real thoughts to express, feel free to comment again and tell me so. — RS

  12. Disclaimer: I’m in my early 30s, single, male, and as far as I can tell am not going to be married to be having children anytime soon in the foreseeable future. However, these things also change rather quickly.

    Applying morality to some aspects of biology is interesting especially in the light of the increased likelihood that a childhood would be born with disabilities. What percentage of women wait to have their first children in their 40s? How does morality come in when a pregnancy sometimes happen. I used to work for a couple that had their first two children in their 30s and then had a pleasant surprise of a third pregnancy when they were both in their late 40s. Would they have have been ethically or morally required to discuss getting an abortion because of their ages at the time of the last pregnancy? That seems rather stark to me. I have no idea whether they discussed it or not and I am pro-choice but the idea of saying that a couple is ethically or morally required to consider abortion is queasy to me and unethical and immoral for different reasons.

    Posts like this are why philosophy is great but also very complex, tricky, and possibly sometimes unworkable considering the state of the world. I come from the upper-middle class background where men and women are both told to get educated, work on your careers, and have kids later in life when you are more stable and financially secure. We were taught that this is better because hopefully wild oats will have been sewn and we will be more economically comfortable/secure and our kids will not know want or instability. However, now you add the wrinkle about the risk of disability. Most people I know seem to have their children in their early to mid 30s. Some were in their mid or late 20s for their first children.

    Modern careers (at least the type I was brought up to obtain) take a while to start and get established in because of educational requirements and then the long hours required in the trenches. What is the solution between the reality of building careers and the reality of increased chance of disability in births after 40?

  13. I’d argue that we are all handicapped by something.; some people’s afflictions are just more visible than others. So there is no guaranteed that being born “healthy” means you’ll have a higher quality of life. Otherwise, able-bodied people wouldn’t commit suicide.

    Morality is a choice. Biology isn’t. If a woman is 40+ and can become pregnant naturally, than its a matter of biology not morality. Well unless, she is abusing drugs while being pregnant. The use of fertility treatments, the buying/selling of human eggs and sperms, shaming a scared pregnant teen to give away her child to an overzealous adoptive agency, and monetary based surrogacy are far bigger moral issues than a woman in her 40s who becomes naturally pregnant.

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