Rationing Health Care/Rationing Parenthood

There’s a discussion current in the UK just now about access to IVF under the UK’s National Health System.  This little commentary is a reflection of that larger discussion, and I’ll use it as my taking-off point. 

The question currently raised in the UK is whether the NHS should cover IVF.   IVF, like a lot of assisted reproductive technology, is fairly expensive.   Health care resources are limited.   Given these circumstances, perhaps it is reasonable to discuss whether IVF should be covered as necessary medical care, or perhaps doled out on some discretionary basis. 

In the view of the commentator, the problem is that some (many?) people need to resort to IVF because they chose to wait to have kids.  In other words, need for IVF is the logical consequence of free choice.   The implication is that a woman who wants to use IVF because she chose to wait is less deserving (and hence, should be further back in the line) than a woman whose need for IVF is unrelated to her choices in life.    Perhaps he’d go even further and say that having a child is not something one is entitled to. 

Of course, in the US, IVF is generally not covered by insurance.   Thus, access to IVF is already limited by income.   In a sense, this is a form of rationing–it’s only available to those who can pay market rates.   Whether this is the best way to allocate IVF is a topic one might well consider.   Indeed, we are currently engaged in a much broader debate on the topic of access to healthcare generally.   

I’ve written a little about this before.    Assessing eligiblity for IVF (or for IVF subsidies) by judging each person’s need leads to so many difficult questions.   A single woman who wants a child may require IVF.   Is she as worthy as a married women with a similar need?   (I can imagine you might contend that in the case of the married woman, it is actually the need of two people–the woman and her spouse.) 

For the moment, though, I just want to sketch out where these questions might lead.  It seems that in the field of ART we are willing to have decisions about who gets to be a parent made by someone other than the person or people who want to be parents.   Maybe it is a doctor who decides whether to accept a patient or maybe it is an insurance company that decides whether or not to pay for a procedure or maybe it is the blind force of the market.  Somehow, someone is controlling access to parenthood.   (Okay, only to this form of parenthood–I’ve momentarily moved adoption to the side.) 

Why is it acceptable to do this for folks who need to use ART and not for those who will conceive a child without resort to medical intervention.   (I don’t want to say without the assistance of a third-party, because private in-home insemination is assisted but is not really medical intervention.)  In other words, why don’t we regulate who becomes a parent generally? 

One answer–an obvious one that I don’t see much way around right now–is that it isn’t practial to do so.   But I have an inkling it is more than just pragmatics that lead us to be comfortable with regulating access to parenthood via ART but not for all people.   I suspect this goes back to what’s natural.  If you can conceive naturally, then it is your right to do so.   Who could interfere with that?

I do see the dystopian potential of a world where each person would have to be licensed to parent.  I just know there’s some grim sci-fi movie out there with that very plot line.   But it seems to me that it still worth considering:  If we are going to restrict who becomes a parent for those who need to use ART (and for those who adopt) why leave this liberty untouched for those who pursue parenthood via other avenues?

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2 responses to “Rationing Health Care/Rationing Parenthood

  1. If healthcare is socialized in the US then I absolutely think that IVF should be covered. We pay our taxes and there’s no reason it shouldn’t be.

    • I’m not sure it is so simple. I imagine even if we provide health care for all, it will be limited to care that is reasonably necessary, or something like that. (I’m not wanting to pay for cosmetic surgery to make people’s toes look nice, for example.)

      The question I think this raises is whether IVF is within the bounds of what we’ll call reasonably medically necessary. Is it necessary for a person or for people to have a child? Is it a sufficient alternative to say that she/they can adopt? Does it depend on whether you can document that you are in psychological distress because you cannot conceive without IVF?

      Similar questions can be raises with regard to assisted insemination (I’ve got a post back there somewhere on this, the question being whether just not being involved with a man qualifies you for needing insemination) and surrogacy. Underneath all of them is a question about the extent to which we consider there is some right on entitlement to have a child that carries your genetic material, I think.

      I don’t mean to suggest I have an answer to these questions right at the moment, only that I see the questions.

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