Why shouldn't older women receive fertility treatment? asks Juliet Tizzard
The tainted conception
Elizabeth Buttle could have been the hero of the hour. At the age of 60, 41 years after the birth of her first child, she conceived and gave birth to her son Joe. Since nobody has ever had a child naturally at such an advanced age, the news of Mrs Buttle's remarkable feat caused great excitement in the press. But before the ink was dry on her £100 000 contract with the News of the World, Mrs Buttle was exposed as a fraud. Far from being a natural miracle, little Joe had been conceived in a test tube from a donated egg and a donated sperm - and his mother had lied about her age to the clinic providing in vitro fertilisation (IVF) treatment.
Immediately the media reaction changed. Excitement gave way to consternation and the talk of miracle births and wonders of nature turned into accusations that Mrs Buttle lacked consideration for the welfare of her child. Why?
When everybody believed that the conception was natural, it mattered little that the mother was a pensioner. Yet all agreed that 60 years of age was unacceptably late in life to have an IVF baby. Critics labelled Mrs Buttle selfish for paying £10 000 to have a child and irresponsible for having him so late in life that she might not live to see him into adulthood. Nobody raised concerns about an orphaned teenager-to-be when they believed the conception to be a natural one. That she had lied to the clinic about her age and was at the end of an affair with a married man only deepened the disapproval.
The only reason journalists could feel free to attack Mrs Buttle in this way was because anybody undergoing IVF technology has to satisfy those providing fertility treatment that they are 'suitable' as prospective parents. Unlike a natural conception, which nobody can vet in advance, clinicians often say that they have a moral responsibility to the children born as a result of the treatments they offer.
The law dictates that doctors must take account of the welfare of the future child before beginning IVF treatment. Since no child exists at the time of the first consultation with the doctor, assessing the 'welfare of the child' really amounts to scrutinising the would-be parents to see whether a child in their care would be properly looked after. The law's declared aim of looking out for the interests of children may appear an admirable one. But the consequence of the legislation is to legitimise the moral inspection of patients' lives.
You need only look at how the 'welfare of the child' is applied in clinical practice to see the real effects. Anybody who is single, homosexual, has a criminal record or, like Elizabeth Buttle, is over the age of 50 will not find it easy to get fertility treatment. One woman who requested IVF treatment was turned down because she had once been a prostitute.
Nobody who is able to conceive a child naturally is subjected to any moral scrutiny, and nor should they be. Such considerations should be equally irrelevant in the context of fertility treatment. The way in which the considerations are applied to IVF patients shows just how disingenuous the concern for the children really is. IVF patients, who want to conceive 'unnaturally', are automatically treated as people whose motives are suspicious. The stated concern with the welfare of the child simply becomes a means for doctors to scrutinise those motives. When things occur naturally and unexpectedly it is thought to be a happy accident, a force of Nature or even God's will. But when human planning or technology is involved, the decision to proceed is assumed to be one in need of inspection by a third party.
The criteria used to assess patients prior to fertility treatment show that the authorities' real concern is to distinguish between what is deemed 'natural' and what is not. People objected to Elizabeth Buttle's advanced age because she could not have conceived without assistance (although it is worth noting the speed with which they were prepared to believe that it was a natural conception). Lesbians and single women are frowned upon for exactly the same reason: that nature says that women who do not have sex with men do not get pregnant. It is their lifestyle choice which precludes them from having a baby and their inability to conceive is, therefore, brought upon themselves.
The bizarre idea that medical technology should only be used to restore natural processes flies in the face of reality. Particularly in reproductive technology, the trend in the second half of the twentieth century has been not to mirror nature, but to override it. New contraceptive devices and abortion techniques were welcomed by women as methods for avoiding precisely what nature would otherwise impose upon them. Here, nature was considered something to be conquered at all costs, not something to be respected. Now this positive attitude to technology is becoming less widespread, with worrying consequences for those at the giving and receiving end of fertility treatment.
In the wake of the Buttle case came calls for doctors to be much more vigilant about acquiring information on prospective patients. At the beginning of March, Professor Ian Craft of the London Gynaecology and Fertility Centre which treated Elizabeth Buttle, received an official reprimand from the Human Fertilisation and Embryology Authority (HFEA) because he was found to be treating older women, lesbians and single mothers. The HFEA demanded that he tighten controls at his centre in Harley Street. As Craft objected to the Sunday Times, 'Since when has a doctor's surgery become a court of law?' (1 March) - since those responsible for regulating fertility treatment decided that potential IVF patients should be treated as guilty until proven innocent, with the worst motives for wanting a child.
In the world of fertility treatment, it is fast becoming the case that patients have to convince their doctor that they will make good parents before receiving treatment. It shows an attitude which assumes the worst of patients and invites third party intrusion into decisions that should be private and personal, out of reach of government.
Juliet Tizzard is director of Progress Educational Trust
Reproduced from LM issue 109, April 1998