Aleta St. James is the latest celebrity to enter the "Are you ever too old to have a baby?" sweepstakes. St. James is a singer and self-described "healer" with lots of Hollywood clients. She is also the sister of Curtis Sliwa, the New York radio personality who founded the crime-fighting group the Guardian Angels.
Tuesday morning, three days shy of her 57th birthday, she gave birth to twins — a boy and a girl — at Mount Sinai Medical Center in New York City. The babies were delivered by Caesarean section. Born three weeks premature, they were taken to the neonatal nursery where both were reported to be doing well.
St. James is not married. She used an egg made available by a stranger and sperm reportedly donated by a former boyfriend to achieve the pregnancy. In response to media questions about why she had decided to have children at age 57 she responded, "It is never too late. You are never too old. It is just in your mind."
The doctors to whom she paid more than $25,000 for the treatments that resulted in her pregnancy apparently did not think she was too old. And her family, as well as a gaggle of reporters, deemed her upbeat answer (in addition to her healing work, St. James is a motivational speaker) a more-than-sufficient response. Her father, who is well into his '80s, said that he now has two big reasons to want to keep on living.
What it means to be an older parent
But is it really the case that it's never too late and that you are never too old to parent?
It is hard to even raise this question without seeming like a moral busybody. What right does anyone have to challenge the reproductive decisions of another person? But, that line of argument is simply wrong-headed. If decisions as important as when to have children are not open to ethical comment and discussion, then what is worthy of ethical analysis — decisions about what color to paint the living room?
I have a lot of doubts about St. James’ decision. I also have a lot of doubts about the wisdom of the doctors who decided to help a 57-year-old woman have twins.
Let's think for a minute about what it means to have twins at 57. What it means is that when your twins are about to enter high school, say at the age of 14, you are 71. Now I know that there are many grandparents who have successfully raised kids when the children's own parents could not. But it is one thing for two older people to deal with a difficult situation and make the best of it. It is quite different to deliberately create a situation where a single, 71-year-old parent who has been eligible for Medicare for seven years must deal with twins entering both puberty and high school.
If you talk to children of older parents, most will tell you that they worried quite a bit about whether their parents would live to see them graduate from high school. Others will tell you that as much as they loved their parents they missed having someone who could do all the physically demanding things that younger parents can do. Putting aside the proven risks to babies and mothers when women over 40 attempt childbirth, is it really all that nuts to suggest that 57 is just too old to start raising two children by yourself?
The doctors who agreed to help St. James become pregnant dismissed such worries about her age. They said no one complains when an older man, say a Tony Randall or a Clint Eastwood or a Strom Thurmond, has a baby. Notice, however, that two of these men have died since creating a baby very late in life. Is that good for the child?
Sending the wrong message
In addition, there is a special problem created when an older, single woman has twins. When old men have babies they usually do so with much younger wives, so at least one parent will be present if the father dies. There may be no one around to be the parent if an older woman gets sick, becomes disabled or worse, dies.
This is why most nations, which have laws governing the use of reproductive technology, would not have allowed a 57-year-old single mom to become pregnant. This is why adoption agencies view requests from people who are single and much older with wariness. And this is why the ethics guidelines of the American Society for Reproductive Medicine discourage what the doctors in this case have done.
St. James said that it is never too late to have a child. And the miracles of reproductive technology do appear to support her statement. The parade of fifty-something celebrity moms who proclaim their pregnancies on the morning talk shows could give any young woman the impression that there is no rush to reproduce because medical technology can bail them out if need be.
But this is simply not true. St. James had to use donor sperm and an egg, which was "donated" but more accurately bought from an anonymous stranger. The doctors could not create a baby biologically related to her but instead used reproductive technology to achieve what is in effect a new form of adoption. Adoption is a wonderful thing but many people want to have a genetic relationship with their children if possible and that is not something that today’s reproductive technology can do for women in their fifties and older.
It is not true that it is never too late to have your own biological baby and younger women need to understand that fact.
A legal minefield
Keep in mind, too, that when donor sperm and eggs are used a potential legal minefield is created. If either the source of the sperm or the eggs decides to assert parental rights over St. James’ twins they will likely be successful. A court in Erie, Pa., has just ruled that a woman hired by a single man as a surrogate mother has just such a right. At any time in the lives of the children the person who supplied the sperm may try to enter into St. James life. And despite the anonymity of the person who supplied the egg, she might be able to litigate her way to an answer should she ever decide to find out who has "her" baby.
Or, St. James’ children may decide at some point that they want to know, just as more and more adopted children do, who their biological parents are. Courts traditionally show little respect for anonymity in the face of such requests.
Watching a new family come into being is a wonderful thing, but let’s not kid ourselves. The new reproductive technologies raise a lot of difficult ethical questions for patients and doctors about who should use them, why and when. Society needs to be sure that as we stand in amazement watching medicine circumvent nature’s reproductive limits, nothing is done to put the best interests of the children that are created at risk.
Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania.