It started out as something simple, and then your comments took it in all these different directions. This is how the question arose: I was reading about QALYs - Quality Adjusted Life Years - and how they may be used in decisions about the distribution of scarce healthcare resources. The idea is that "if an extra year of healthy (ie. good quality) life is worth one [year], then an extra year of unhealthy... life must be worth less than one...[and] the value of the condition of death is zero.(1)" Healthcare is then distributed along utilitarian lines, so as to produce the greatest amount of quality-adjusted life years (as opposed to the greatest number of calendar years).

I asked Mr Bea how many years he would give up for the opportunity to have a child, and he refused to answer. "It's like you're asking me to put a value on having children," he protested.

"It's not like what I'm asking, it is what I'm asking."

"You might as well ask how much money a child is worth."

"I could do that, too(2). Apparently, for example, women place a price tag of three hundred thousand US dollars on male fertility. You're just lucky I have expensive taste. But the problem there is that a grand is worth a lot more to someone with one grand and ten, than to someone with ten grand and ten. Life is a more universal currency."

Until, that is, you post the question on your blog and the first thing everyone says is, "It depends how many years I have left..." I suppose I was assuming a "standard" life expectancy of, say, 80 years. Then again, there's got to be a twenty-year age spread amongst you readers. If I'd included this assumption in my question, would the answers have been skewed by age, with younger readers willing to give up more time? And would this have been because youth places less value on being old, or because age has more to lose? What if I'd asked you to assume you had another forty years, regardless of what age you are now? What if I'd said you were being asked this at twenty? What if I'd had you express your answer as a percentage of the time you have left?

But the complications go beyond concerns over accuracies of measurement. Most medical conditions affect the patient to a far greater extent than they affect the patient's family and friends. Infertility is different - there are the children to think of, and most of us also have partners. Some of you mentioned grandparents - the desire to become one before you die, or to give that gift to your mother and father - but I think it's fair to say these are lesser stakeholders. There will always be lesser stakeholders.

At the extremes, Pamela said she would not have children knowing she was going to die, as it wouldn't be fair to them, and Aurelia, also ignoring her concerns for herself and husband, said she'd be happy just to bring her kids into the world(4). That the same focus can lead to such opposing conclusions is interesting in itself.

The general trend, however, is that most of us would give up at least some of the years of our life in exchange for our parenting dream. Rachel chose to phrase it positively, instead of negatively, but it amounts to the same thing. Bascially, what most people agreed was this: life as a parent is more valuable than a childless life. Well, duh. I mean, we're all here blogging about infertility and how robbed it's made us feel.

Let's examine this result from a distribution of healthcare point of view. It leads us in two very different directions: on the one hand, we should be helping couples to overcome infertility (one way or another), since this will cheaply produce a lot of QALYs throughout society. In other words, if an involuntarily childless year is only worth 0.7 voluntary parenting years, and 12.5% of the population is infertile, the sooner they can get kids, the more QALYs can be produced in society as a whole. In other words, overcoming infertility will arguably, dollar for dollar, raise the general standard of welfare to a greater degree than, say, cadaverous organ transplants. Infertility vs organ transplants. Organ transplants? Infertility(4).

On the other hand, if a young, childless fertile woman and a young, childless infertile woman - with the same life expectancies, aspirations, health complaints and prognoses - both present at the door of an ICU with only one bed, does this mean we should choose to treat the fertile woman, simply because her future life is more valuable to herself? How many times have you heard it said, in the wake of a tragedy, "And the worst thing is she had three kids"? On the other hand, how many times do people also say, "If I go, at least I'll have had the chance to raise my family a bit"? What do these statements say about the value society places on parents vs other individuals?

More importantly, what does it say about you? Pamela explains herself from the point of view of her hypothetical children, but I wonder how much her answer reflects her gradual reconciliation with living childfree? Those willing to give up the most time, on the other hand, were Geohde, M, and Aurelia - 2ww, 2ww, and pregnant after recurrent loss. Invested? Fuck yes. I'd say so. Would their answers be the same if I'd asked them in a break between cycles? I don't know, but I wonder.

When I posed him the question, Mr Bea accused me of trying to put a value on having children. "How many years do you think a child is worth?" he said, in an attempt to turn the tables.

"I'm not sure" I answered, and I was tempted to say both all and none. "Maybe ten years? Fifteen?" I guess I think I'm worth 25-40% more as a parent. That's the thing, you see. In the end, are you really putting a value on your kids? On your desire to parent? Or are you placing a value on yourself?

I want to see what you think of this. I have some further thoughts of my own.

1. Beauchamp and Childress, Principles of Biomedical Ethics, 5th Edition, p207. (Back)

2. Financial decisions in the real world of infertility are, of course, complicated by the gambling factor. And then the whole thing is complicated by all sorts of other factors. (Back)

3. Barb also said she wouldn't give any, but her answer revolved around a healthy mistrust of magical creatures instead of thoughts for her offspring. Similarly, there were others who would "give all", but Aurelia was the one who specifically centred her explanation around her children. (Back)

4. I am nakedly making up figures here, but I bet if you collect and crunch the numbers, that's true. Not saying it's right - bald utilitarianism makes me itch - but a lot of people use it to argue against funding for fertility treatment ("the money would be better used...") and I don't believe that's the correct utilitarian conclusion.
**Updated to add - on page two hundred and fifty something, B&C make exactly this point, but using arthritis vs organ transplants. I'm feeling pretty clever over here. (Back)


Geohde said...

You bet I'm invested, up to my little beady eyeballs. But do I mean it more out of regard for my partner than I do out of pure desire to spread my questionable genes :)


M said...

Yup, up to my beadies as well....

My head hurts after reading this - but I think if you'd asked me this question *before* infertility and loss, my answer my well have been different....

Drowned Girl said...

And how about secondary infertility - would my son give up time with me, for what is potentially a lot more time with a sibling?

serenity said...

I really like your QALY argument, but unfortunately there IS the not-so-small societal bias that having children is a choice, not a medical neccessity.

The 12.5% of us struggling with infertility would most likely trade some of years for a child, absolutely. But if asked of the remaining 87.5% of the population, would they do so as well?

Whether we like it or not, as infertiles, most of us are forced to place value on having a child. How much are we emotionally willing to put ourselves through for that goal? How about financially? We have to make the decisions about how best to spend our money on treatments and/or adoption.

I do feel uncomfortable suggesting that I am worth more as a person because I'm willing to trade some years for a child, but only because I've never thought of it that way before. I suppose it's easier for me to think that it's the value I'd place on my children. Not me.

But it's a good point, really. And something to think on.

Pamela Jeanne said...

I'm very protective of my hypothetical children. Having seen my best friend's mother die of ovarian cancer when we were just 14 and my husband being just 19 when his mother died in her sleep unexpectantly, I know the longing that lives on in children for their mothers...

The Town Criers said...

Seriously, you are blowing my mind so much right now that I had to get up and get more coffee in the middle of reading this :-)

You have hit on something where everyone can relate because everyone is someone's child--and some have experienced loss of a parent and can weigh this question differently know how they personally feel and others have not experienced a loss yet and they are weighing their answer with how they think they'll feel when it happens.

I would definitely give my life for my child, so I'm not sure why I can't flip the question and answer that I'd give up any amount of time to parent. But when you're comfortable, you get selfish. The fact is, regardless of whether I traded years for children, I will die anyway. But there is something that goes against the will to survive that keeps us from imagining years of our life away--even for a huge reward.

You are really blowing my mind today, dear.

Karaoke Diva said...

Basically, based on my age now (31) and a life expectancy of 80, I would give up approximately 30 years of my life to have my kids. I want to see them reach adulthood (hence the ~20 year difference). To me, I can't say any amount of years because the whole reason for my wanting kids is to be with them and see them grow. Just bringing them into the world would not be enough for me.

Vee said...

Hmm lots to think about and lots of woms. I am brain dead at the moment. Or maybe that is an excuse for I really don't want to think about it. Putting fingers in my ears blah blah blah. Because you know it wont happen to me attitude.

I am interested in others comments and what you have to add to this though.

GLouise said...

Ah, brilliant blog post, dear Bea. My poor little tired brain is too feeble to respond intelligently, but I did enjoy reading the post and I like your argument :-)

Aurelia said...

I'm trying to write post in reply to this, because my comment was becoming insanely long.

It is because I'm currently invested in this both with this pregnancy and my current children, but it's more than that.

I need to think about this.

Give me a minute, it's hard to be coherent.

cooler*doula said...

Now - I need to check this with my acupuncturist again (I'll see her tomorrow) but if I understood correctly, according to Chinese medicine bearing a child takes away from your kidney energy, which is largely responsible for your longevity... So. Those of us who do, are giving up some years...

LAS said...

Wow - this is so interesting. I came here through Aurelia over at No Matter How Small. I suppose if I had to answer the question before I was diagnosed with breast cancer at the age of 29, and before facing my mortality and possible infertility as a result of chemo drugs - I would have answered differently. I think I would have been willing to give up years of my life at that point in order to have children (not even knowing the status of my fertility). Now, I don't think I would be willing to. Now, I just desperately want to get to live myself, so much so, that I can't imagine giving up years to get to be a parent. I don't think my life is more valuable if I'm a parent. It's valuable just the way it is - equally valuable - it's just valuable in a different way - it just means something else. I just want to live the rest of my life and the thing is, I might get to, and I might not (that's true for any of us, right?). But every second, that I do get to be here, is valuable to me.

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