Hazel McHaffie


Justice, rights, entitlement

The latest casualty of the coronavirus lockdown in this country is fertility care. As of Wednesday of this week, no new patients will be accepted, and even those in mid-treatment, those for whom this is their last hope, those who will be too old to qualify or stand a chance of success by the end of lockdown, will not now receive the necessary procedures towards which they’ve been working for so long. Yet another tragedy. More heartbreak. More hopelessness.

Which brings my thoughts to the ethical issues around assisted conception …

It’s now fifteen years since I wrote Double Trouble, a book about surrogate pregnancy. Fifteen years! Yoiks. But as with so many ethical dilemmas in medicine, the issues are still relevant today.

I was fascinated then, to watch the serialised BBC1 drama, The Nest, which finished this week, about a very wealthy but childless couple, Glasgow property tycoon Dan and his beautiful pampered wife Emily, who decide to go down this route. Click on the picture for the official trailer.

All attempts at IVF have proved unsuccessful. Dan’s sister has already tried to carry a baby for them but miscarried. They have one precious embryo left. One. Only one more chance. Emily meets the troubled teenage Kaya when she accidentally knocks into her in her car. Kaya sees an opportunity to get out of her impoverished life, and offers to be a surrogate for them in return for £50K. But as the story unravels we find that Kaya has secrets in her past and a very dubious pedigree indeed …; the would-be father Dan is something of a rough diamond too, dealing with a lot of shady characters and skullduggery …; Emily is single-minded about motherhood and what she wants, but privately troubled by the morality of what they are doing – always setting herself up as ‘the principled one‘ according to her sister-in-law. No-one in the UK will implant the last embryo. However, the Dochertys can well afford to go abroad for the simple procedure, and they do so.

On the face of it everyone stands to win. Kaya will be set on her dreamed-of pathway to becoming a successful business woman, able to ‘go on a plane, have one of these pull-along cases‘. The wealthy couple get their hearts’ desire. Better yet, surrogate and intended parents establish a relationship, even friendship. Kaya moves in with the Dochertys and gets a taste of a life of privilege. The baby will not only be much wanted, but will have every advantage money can buy.

Naturally – this is, after all, fiction, drama, a series requiring cliff hangers – things go pear-shaped. Relationships get confused. Loyalties are divided. Dubious and unsavoury motives emerge. But the underlying questions and challenges remain pertinent.

Is parenthood a right?
Is ‘want’ the same as ‘need’ in childbirth terms?
Payment for this service in the UK is forbidden. Should it be?
How binding should a contract between intending parents and surrogate be?
Should private arrangements for surrogacy be permitted?
Does a woman have the right to do whatever she likes with her own body?
What constitutes ‘reasonable expenses’?
Should those with the wherewithal be allowed to circumvent ethical and medical guidelines?
Does using someone far less powerful in this way constitute exploitation?
In the event of a dispute about whose baby it is, whose rights should take precedence, and who should decide?
What if the child is damaged/imperfect/not what was expected? Should the contract still stand? Who should accept responsibility for him/her?
What of the baby’s rights?
How much of its origins should a child be told?

Back to the drama … enter Kaya’s long-estranged mother, who encourages her to renege on the contract, hang on to the baby, become a mother herself, a better mother than she has been. But Dan already loves this child. Even when he finds out she is not his genetically, she’s still his daughter in his heart. The Dochertys call in their lawyer; the case goes to court. It’s left to the judge in the Family Court to put things into perspective – severely castigating their self-serving recklessness, the complete imbalance of power, the undesirable qualities on both sides. But, she says, at the end of the day it’s not a question of how she would judge them; it’s about what is in the baby’s best interests.

Contrary to expectation, there is a happy ending to this story, and both sides demonstrate they’ve learned important lessons about what matters in life. But the drama perfectly illustrates the power of fiction to challenge us to think about what society today should endorse, and how far the law can go in dealing with the fine nuances of moral questions in assisted reproduction. Well done, screenwriter Nicole Taylor.


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The Stone Angel

Given the horrific and haunting events in the wake of the Japanese earthquake and tsunami, it seems somehow frivolous to be thinking about books, or quibbling about words, or debating the niceties of modern medicine. If you aren’t already saturated by the images, have a look at these pictures. Unimaginable. Where would anyone begin to rebuild lives and cities?

But there’s little I can add to the unfolding catastrophe; every conceivable angle has been expanded and exploited in the media. And life here does go on. People aren’t all killed in natural disasters; they do grow old. So let’s talk about that instead. And perhaps even manage a wry smile in this week of escalating suffering.

If you’ve visited my website you’ll know that I work in a voluntary capacity with elderly people – have done for more years than I care to tot up. I also co-ordinate a befriending scheme, which basically provides one-to-one friendship for every individual in a residential home. So I do know something of what advancing age is like, and the dilemmas of deciding when the time has come to relinquish independence.

But in addition to that, two days before the earthquake I became the mother of a forty-year old son. Forty! Ho hum. It seems impossible. JP as a babeAnd a miracle in itself given that this baby wasn’t supposed to live beyond three weeks.

Forty years of parenthood. All very grown up stuff. Yes, elderliness is just around the corner.

With all this reality and experience bearing down on me, the novel The Stone Angel resonated strongly.

Hagar Shipley is now in her nineties, incontinent, confused, wilful. Her son, Marvin, and his wife, Doris, have been caring for her, but the burden is now too great. They are no spring chickens themselves.

By stealth and subterfuge they get her to visit the Silverthreads Nursing Home. But Hagar is nobody’s fool. She makes her own shrewd assessments.

The matron is a stoutish woman, pressing sixty, I’d say, clad in a blue uniform and a professional benevolence. She has that look of overpowering competence that one always dreads, but I perceive that some small black hairs sprout like slivers from her chin, so she’s doubtless had her own troubles – jilted, probably, long ago by some rabbity man who feared she’d devour him. Having thus snubbed the creature in my head, I feel quite kindly disposed towards her, in a distant way, until she grips my arm and steers me along as one would a drunk or a poodle.

Hagar finds an opportunity to speak to one of the residents:

‘Do you –‘ I hesitate. ‘Do you ever get used to such a place?’
She laughs then, a short bitter laugh I recognize and comprehend at once.
‘Do you get used to life?’ she says. ‘Can you answer me that? It all comes as a surprise. You get your first period, and you’re amazed – I can have babies now – such a thing! When the children come, you think – Is it mine? Did it come out of me? Who could believe it? When you can’t have them any more, what a shock – It’s finished – so soon?’

She has serious health problems requiring investigation but she has her own take on those experiences too. Here she is struggling with a barium meal:

I sip again and force myself to swallow. Again and again until I start to retch.
‘I can’t – I can’t –‘
‘Stop, then. Perhaps that’ll do for now.’
‘I’m going to be sick. Oh –‘
‘Try to keep it down,’ the X-ray says, calm as Lucifer. ‘If you don’t, you’ll have it all to take again. You wouldn’t like that, would you?’
My eyes stop watering and my constricted throat is eased by my fury.
‘Would you?’ I snap.
‘No. No, I wouldn’t.’
‘Well, why ask me if I would, then, for pity’s sake?’
From the infinite gloom comes, unexpectedly, a sigh.
‘We’re only doing our best, Mrs Shipley,’ the doctor says.
And I see it’s true, and he’s a human, and overworked no doubt, and I’m difficult, and who’s to blame for any of it?
‘I only wish my stomach or whatever it is could be left alone,’ I say, more to myself than him. ‘I can’t see that it matters much what’s wrong with it. It’s been digesting for getting on for a century. Maybe it’s tired – who’d wonder at it?’
‘I know,’ he says. ‘Sometimes one feels that way.’
So sudden is his gentleness that it accomplishes the opposite of what he intended and now I’m robbed even of endurance and can only lean here mutely, waiting for whatever they’ll perform on me.

As she battles with all the indignities and uncertainties of her present situation Hagar reminisces – her thoughts muddling past with present, youth with old age, courage with weakness. Beautifully conveying her ambivalence and conflict in so many areas of her life.

In desperation she runs away from the threat of residential care – actually physically absconds – and lives on her wits. Listen to this masterly description of life in her hideaway:

‘I have everything I need. An overturned box is my table, and another is my chair. I spread my supper and eat. When I’ve done, the light still holds and in one shell lying on the floor at my feet I see that half a dozen June bugs have been caught. I prod them with a fingernail. They’re not alive. Death hasn’t tarnished them, however. Their backs are green and luminous, with a sharp metallic line down the centre, and their bellies shimmer with pure copper. If I’ve unearthed jewels, the least I can do is wear them. Why not, since no-one’s here to inform me I’m a fool? I take off my hat – it’s hardly suitable for here anyway, a prim domestic hat sprouting cultivated flowers. Then with considerable care I arrange the jade and copper pieces in my hair. I glance into my purse mirror. The effect is pleasing. They liven my grey, transform me. I sit quite still and straight, my hands spread languidly on my knees, queen of moth-millers, empress of earwigs.’

It’s a penetrating insight into the mind of a person who’s losing her independence and her grasp on reality; whose physical health is failing, and yet who’s hanging on for dear life. As she says: ‘How you see a thing – it depends which side of the fence you’re on.’ And later: ‘Things never look the same from the outside as they do from the inside.’

How true.

The author of The Stone Angel is Margaret Laurence, a Canadian. She doesn’t shy away from the nastiness of a thwarted old woman – and they can indeed be difficult, even mean and vindictive at times. I always try to file such experiences away in my personal memory-bank … against the day it might be me in danger of losing my inhibitions.

Laurence conveys a depth of perception and honesty that I found quite scary. I suspect I should not have been comfortable in the presence of such a shrewd observer; I’d have felt she was penetrating my outward polite façade, and X-raying all the intolerance and impatience I’ve struggled to suppress.

Hagar is every inch her own person – ‘a holy terror’, to quote her son, Marvin. Sobering then to find I can identify with many of her sentiments and actions. Tongues do betray us. Kindly feelings are too often left unsaid. And I don’t want to be patronised by nurses, or betrayed by strangers, or pitied by relatives, either. Hmmm. Lessons have been learned! (I hope.)

As Sarah Maitland said in her afterword to the book: ‘I do not know, anywhere in literature, a more convincing or more moving account of old age, of the anger and the fear and the humiliation, coupled with a completely unsentimental recognition of the manipulation and the craziness and the meanness of a dangerous old woman.’ High praise indeed.

Oh, and the ending is fabulous.

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