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.