A Spanish woman who only 21/2 years ago became the oldest mother on record to give birth has died, leaving the fate of her twin sons in limbo and reopening a fierce debate over who can and should be permitted to undergo infertility treatments.
"It is an open and fair ethical question as to what maternal age we should be drawing the line at," says Kerry Bowman, a medical ethicist at the University of Toronto.
Maria Carmen del Bousada was 66 when she gave birth to twin boys in December, 2006. She had lied to a California fertility clinic, saying she was 55, its maximum age for single women receiving in-vitro fertilization.
Ms. Bousada died on Saturday. What caused her death is not yet known, but she was reported to have been diagnosed with cancer. She has a brother in his 70s. It is not known what will happen to her children.
Delivering the twins earned Ms. Bousada a spot in Guinness World Records and put her at the centre of a worldwide debate over who should have access to infertility treatments.
It is far from settled.
"It's an extremely hard call," Dr. Bowman says. "The argument can be, you're too old, you don't have the energy, vitality, it's not fair to the children and you may die. Having said that, we see patients [who are younger]that have had one, two and even three rounds of cancer who are choosing to go forward and have children. Would we refuse those patients?"
While there is no legal prohibition in Canada on providing fertility treatment to older women, "the vast majority of doctors won't do IVF on a woman over 50," says Margaret Somerville, founding director of the McGill Centre for Medicine, Ethics and Law.
Some clinics, however, will provide IVF to women well beyond 50.
"What happens in the private clinics is quite unregulated," Dr. Bowman says.
Although the Assisted Human Reproduction Act was implemented five years ago, Health Canada has yet to put in place regulations that would allow the agency it created, Assisted Human Reproduction Canada, to license fertility clinics.
Indeed, regulatory oversight is lacking in Canada, Dr. Bowman says, adding that 45 may be a more reasonable cut-off age.
Still, even if a stringent regulatory framework existed, people would find a way to have children, some experts argue. "People just go to another place and get things done, whether it's India or somewhere outside the country or whatever," Dr. Bowman says.
Earlier this year, for example, a 60-year-old Calgary woman who was refused treatment at Canadian fertility clinics because of her age delivered twins after travelling to India for donor eggs.
Last year, a 70-year-old woman in India became the world's oldest new mother after giving birth to twins after IVF treatments. In 2006, a 63-year-old woman in Britain became pregnant after undergoing fertility treatments.
What makes people uneasy about such cases, ethicists say, is the belief that women in their 60s and beyond are too old to raise children.
Ms. Bousada had told an interviewer that she stood a good chance of raising her children because her mother had lived to 101.
Still, not enough of the debate has focused on what the repercussions are for the children of people in their 50s and 60s who undergo IVF, Dr. Somerville says.
Just as a 66-year-old single woman would not be allowed to adopt a child, regardless of whether she was expected to live long enough to raise the kids, Dr. Somerville argues that we should be wary of allowing a 66-year-old single woman to give birth through fertility treatments.
"We've made a serious mistake in putting the adults who want a child at the centre of the decision-making," she says.
Diane Allen, executive director of the Infertility Network, says the wish to have children can often override more fundamental questions. "The desire to have a child is a very deep, very profound desire that can become all-consuming," she says. "But you always have to ask the question, just because we can do something, should we?"
Still, some ethicists don't believe that age should be the only factor, suggesting that overall health indicators, such as blood pressure and medical history, should also be taken into account.
"This had a whole lot to do with age, but people can die at any point in their life. Obviously, statistically, your chances of dying at 65 or 70 are much higher than 30. But there's no guarantees there either," Dr. Bowman says.