IVF Treatments are less available than you think

The Slades are an unusual family. Their daughter Beatrix, born last year, has four parents. When her mother Katy couldn’t conceive, her sister Lucy donated her eggs which were then fertilised in vitro by Katy’s husband’s sperm. The fertilised egg was then implanted in the womb of her sister-in-law, who carried the child as a surrogate mother to full term and then gave the baby quite willingly to the Slades. “Carrying the baby was something I was happy to do for them”, she said.

The delight of the Slade family is partly offset by the disappointment that 75% of couples suffer after fertility treatment, which has only a 25% chance of succeeding (and only around 5% for the over 40s). Moreover the cost can be great, at £8,000 a cycle if you go privately. As far as the NHS is concerned, it matters greatly where you live. Live in Warrington and you get no cycles of treatment; live in Oldham and you get up to three. The Government recommends, but does not insist, that every infertile woman under 42 should have the chance of at least one state-funded cycle of treatment.

The issue of IVF treatments and the supposed “right to a child” raises some complex ethical issues. Compare these two comments: “Being denied appropriate fertility treatment can have a devastating consequence on patients’ lives, effectively denying them the right to a family.” (Dr Sue Avery of British Fertility Society). Dr Andrew Davies, chair of Warrington Health Consortium, said: “While we fully understand infertility is a condition that causes great distress to couples, it does not affect general physical health or life expectancy.” Here are the main points to consider: (click read more below)

1. Issues of what a “right to a family” actually means. Arguably you cannot have a “right” unless someone else has an obligation to protect and uphold that right. There is no right to free speech if you never allow me to speak, so in the case of IVF treatments, who is obliged to provide that treatment? If it is the taxpayer who pays for it, then should the taxpayer be required to pay for every woman below a certain age to have this treatment?

2. Issues of which family unit qualifies. At present every woman applying for NHS treatment is screened by the ethics committee of the local hospital trust. Occasionally women are denied treatment as “unsuitable”. But what of gay couples? Should they have the absolute right to a surrogate child? Should they have exactly parallel rights to heterosexual couples?

3. Issues of justice. It depends where you live how many treatments, if any, you can have funded by the taxpayer. Of course, those rich enough can have any number of treatments, with an age restriction that depends on the country where you have the treatment. 60% of IVF treatment is privately funded. In the UK that age limit is currently 42. Is this fair?

4. Issues of need. Infertility isn’t an illness as the Doctor from Warrington points out above. If I spend £8,000 on an IVF treatment, this money cannot be spent screening 55 year olds for prostate cancer, which kills 11,000 men every year. How many lives could be saved if the £60m spent last year on IVF treatments was directed elsewhere?

5. Issues of wastage. We know that the money spent on IVF cycles will be wasted in 75% of cases, with the utilitarian disadvantage that any woman experiencing IVF treatment and failing to succeed is likely to suffer acute disappointment. In a perverse way, it may be that aggregate happiness might be higher if no-one had treatment at all. But there again, what of the joy of the 25% and their very wanted child? It’s always hard to balance utility and disutility on the scales of social happiness.

But there again, if we universalise infertility, it is highly likely that I would want treatment should I be unfortunate to have problems conceiving. For this reason a Kantian might well argue strongly for IVF treatment. But is the child then born a means to an end – the end being the sense of happiness and fulfilment of the parents?

Embryo wastage occurs because many eggs are fertilised and the healthiest are then implanted. Sometimes two or more are implanted, and one may then later be removed. Those who argue for the sanctity of embryonic life find this wastage of live embryos ethically unacceptable. We are back at the base point we encountered with abortion: what exactly is the moral status of an embryo or foetus, and in the end, is this a metaphysical question about beliefs rather than something resolvable by science?

http://www.nhs.uk/conditions/IVF/Pages/Introduction.aspx

http://www.telegraph.co.uk/health/healthnews/9007268/Thousands-being-denied-IVF-on-the-NHS.html