On BioScience and Life and Such

Should public health care pay for IVF-treatment ?

In Uncategorized on March 18, 2008 at 9:34 am

Some developed countries with public health care will offer in-vitro fertilization (IVF) to aid couples with their reproductive problems. Having trouble conceiving is thus regarded as a medical problem and treatment although expensive, is paid for through public health services. Now, nature news reports on a drive to extend such IVF-treatment to developing countries as well.

Why ?

Because:

“The inability to have children can create enormous problems, particularly for the woman,”

…………problems like……………….

“She might be disinherited, ostracized, accused of witchcraft, abused by local healers, separated from her spouse or abandoned to a second-class life in a polygamous marriage.”

I know perfectly well that I myself, am fortunate to have my own children. I thus, may not be able to understand the suffering that infertility can lead to (especially in the developing world).

Nevertheless, trying to be objective on this issue, isn’t it obvious that this is a misuse of health resources ?

In the developed world I find it immoral to spend public resources and money, on IVF. Adoption can help children who would otherwise suffer and in my mind, should be the alternative for infertile couples. Of course one cannot and should not, stop people if they would like to pay for assisted reproduction themselves. But, treating infertility is not a public responsibility.

In the developing world where resources are scarce, I find it even more immoral. The problem for infertile women in these countries is so clearly, a social problem, not a medical one. Put the money towards making them treat their women better, instead of giving credibility to prejudice and discrimination by treating this condition.

Also, in a world soon to be overpopulated, isn’t this just another step towards doom ?

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  1. “…is thus -regarded- as a medical problem” ???

    Reproductive problems -are- valid medical problems like any other medical problem. Why on earth is it a “obvious misuse” of funds to treat a medical problem? Let alone be “immoral”!!???

    Why should other people’s medical problems be covered, but not those with problems with their reproductive systems? What makes it “less” a public health responsibility than any other medical problem that is covered?

    And as for “adoption”… adoption is not a cure for infertility.

    Adoption is a wonderful option to grow a family, but is not right for everyone. And infertile couples are not more responsible that fertile people to adopt children in need (why don’t you suggest that adoption should be an alternative to anyone wanting a child? Why did you have children when you could have adopted?). Who is anyone to determine what family building choices anyone -should -make (let alone what medical treatment is valid and what isn’t for a medical problem). I can’t fathom why having a medical problem with one’s reproductive system should mean that the “appropriate” alternative should be adoption.

    “I thus, may not be able to understand the suffering that infertility can lead to…”

    I would say most definitely not.

  2. It is proven then, that I am unable to understand this.

    I am still going to try to answer your questions.

    1) I have called publicly funded IVF immoral because it takes focus and resources away from other ailments in a health care system with limited resources.
    2) Assisted reproduction is less a public responsibility because you can live a perfectly normal life with this condition left untreated, and, even though you say it isn’t, adoption is the (moral) cure for infertility, a cure found outside of the health care system.
    3) I am not saying that infertile couples have a responsibility to adopt, that choice is of course theirs to take. What I am saying is that if their problem is wanting to care for a child, adoption is a solution. Another solution is spending their own money to get medical help.
    4) You argument that everyone should adopt is just silly.

    I am sorry that you suffer over your infertility. This issue has so many feelings connected to it and why should it not, it is a fundamental biological need to create offspring. I nevertheless, fear we are loosing the big picture because we are afraid to say that everyones needs cannot always be met. Having children is not one of the human rights. Parenting is a possibility given to most and missed by some.

    Lastly, I strongly need to emphasize that I do not find assisted reproduction immoral in itself. It is the spending of public money in a health care system that has so many, in my mind more important, issues to deal with. This is especially true for the developing world.

  3. In response to your comments…

    1) Why are other ailments more ‘worthy’ than infertility? What criteria is being used to decide?

    What about prenatal care? After all pregnancy is NOT an illness (and infertility is). And since “Parenting is a possibility given to most and missed by some.” and you don’t feel that pregnancy is a “human right”…surely you support it also NOT being covered by a public health system? And well, now that you bring this up, I see no reason that public health it should cover such an ‘optional’ thing as pregnancy and all that prenatal care and delivery.

    Would you say the same thing about any other normal biological bodily function? “Walking is a possibility given to most and missed by some.” People in wheelchairs need to understand that “everyone’s needs can’t always be met” so, if there is a treatment that could help them walk, they are free to pay for it themselves, but it should not be covered over other conditions as it “takes focus and resources from other ailments in a health care system with limited resources.”

    2) No, actually most people do not live a “perfectly normal life” with this condition left untreated. Infertility is a serious condition, not unlike many other medical problem. Just because you can’t see it, doesn’t mean it isn’t affecting the lives of those dealing with it in very significant and detrimental ways. The impact of infertility has been studied and those dealing with it can be as distressed and depressed as cancer patients. Emotional well being is not any less significant than physical well being.

    3) Nope. Adoption is not the “moral cure” for infertility. That is your -opinion-. And you are entitled to feel that way, but that does not make it true for anyone but you. Adoption and infertility are two very different issues.

    4) Adoption is a way to experience parenting. Indeed that is true. However, that does not address all the issues of infertility. Too many people who have -no experience- with infertility (or adoption) connect them as being a problem=solution. That simply is a false assumption.

    4) So it is silly for me to suggest that you, and everyone else who wants children should adopt instead of getting pregnant, but it makes sense and is the “moral cure” to you for someone with a medical reproductive problem to adopt regardless of the reality of what infertile losses are, and that adoption does not “cure” them, and that adoption might not be right for many people. Oh, and by the way, adoption itself is not an easy process, it is invasive, complex, and at times very expensive.

    I agree, that it is silly to suggest that everyone should adopt, but it is just as silly when you suggest that infertile couples should adopt and that it is a “moral cure”, you just can’t see that.

    Since when is ANY normal biological function broken down into them being a “human right” or a luxury only for some people? But the reality is that it IS a fundamental human activity. And in fact, the United Nations does actually consider “founding a family” to be a human right.

    “The United Nations Declaration of Human Rights

    recognizes that, “Men and women of full age, without

    any limitation due to race, nationality or religion, have

    the right to marry and found a family”

  4. Again, I need to emphasize, I am not arguing against IVF in itself, only spending public money on it. Second I admit that adoption is not the cure, not even the moral cure. You are right, adoption is not the solution to infertility.

    But, there are other things in your comments that I feel I need to respond to:
    1) Prenatal care is disease prevention which is most certainly an important task for public health care. And, loss of walking ability takes away your ability to function normally in a very different manner to infertility.
    2) You say that “the impact of infertility has been studied and those dealing with it can be as distressed and depressed as cancer patients”. Granted, emotional distress is significant for infertility sufferers. But, as with walking abilities, your comparison is unfair. Cancer can kill you, infertility does not.
    3) The Human Rights Declaration refers to prohibiting couples their right to bear children based on race, nationality and religion. These rights do not (and should not) mention infertility.

  5. 1) Prenatal care is “disease prevention”? So, pregnancy is a “possibility” and not a “right”, yet “prenatal care” for a healthy normal condition IN CASE something might go wrong -should- be publicly funded….
    …yet an ACTUAL disease affecting the reproductive system’s functioing is not worthy of public funding. I truly can’t see the justification and logic of this position.

    “And, loss of walking ability takes away your ability to function normally in a very different manner to infertility.”

    What is different about one over the other? Both are normal biological functioning that is impaired by disease/defect, both affect quality of life in various ways. How is not being able to use one bodily function over another different to the point that one is worthy to be funded and the other is not? Seriously, what is “different”?

    2) I wasn’t “comparing” infertility -to- cancer. I was saying that infertility can have JUST AS MUCH of an impact in terms of depression and emotional distress as Cancer on those dealing with it, to express the significant impact of infertility on those who are dealing with it. Since it is quite easily dismissed as “no big deal”.

    3) “These rights do not (and should not) mention infertility.”

    So, you are suggesting what the UN should/should not be saying?! LOL.

    This is a quote from a WORLD HEALTH ORGANIZATION report.

    “”The United Nations Declaration of Human Rights
    recognizes that, “Men and women of full age, without
    any limitation due to race, nationality or religion, have
    the right to marry and found a family” (4). This is
    supported by the European Convention on Human
    Rights which guarantees respect for family life and the
    right to found a family (5).

    It can be argued that these provisions create a
    positive right to access ART to achieve this goal, one
    taken for granted by fertile people in the community.
    For those who need medical assistance to form their
    families, infertility causes immense suffering. For
    those who finally remain without a child, infertility can
    be a lifelong disability.”

    “Infertile people, as citizens and taxpayers of our respective
    countries, seek rather to claim our right to equity of
    access, with fellow citizens, to affordable quality
    health care and appropriate recognition of ART as a
    standard, proven treatment for infertility.”

    You might find this WHO report on Infertility/ART and the developing world interesting. (here are links to part of the report).

    http://www.who.int/reproductive-health/infertility/36.pdf
    http://www.who.int/reproductive-health/infertility/25.pdf

  6. It is probably not very fruitful to fight over which illness is the worst. Suffice it to say that we disagree.

    Also, even though one can argue that infertility treatment should be on the human rights list, – today it is not. You can laugh all you want, I am still entitled to my opinion even on the Human Rights declaration, so are you and everyone else, that’s actually a fundamental part of the human rights declaration as opposed to the right to ART/IVF.

    Lastly, the WHO report expresses the opinions of medical professionals. They report on the severity of suffering from infertility which I am sure is as real as both you and they, say it is. That view is also the reason some countries with public health care pay for ART/IVF. The Nature news piece that inspired my original post also came from opinions of medical professionals (European network of fertility specialists). They argue for increased use of ART/IVF also in developed countries. However, these people being medical professionals wherever they are employed, does not make them right. I am in medical research myself, I have done research that had potential benefits for assisted reproduction (sperm function) and I withdrew from those research projects because I did not believe in using research money and efforts on this topic. I believe that the above mentioned professionals are wrong. That is why I wrote the post in the first place.

  7. Seems you are a tad confused about what I have said and have twisted what I have said in a couple of instances.

    I was -never- “fighting over which illness is the worst”. My point was that infertility is just as valid as -any other- disease (and that prenatal care is NOT “treating a disease”).

    Yes, the “right to found a family” IS indeed on the list of “human rights”.

    I never said “infertility” or even fertility treatment is on the list of human rights!…
    no “disease” is a “right”.

    Nor did I say that it therefore meant there was a “right to ART/IVF”. Although, I think it is as worthy as any other disease to be covered by public health care, or medical insurance.

    I was countering -your- statement saying “Having children is not one of the human rights.”. To which I, and many others, disagree.

    The UN stated right “to found a family” is, by some experts, considered to mean that there IS a right to HAVE A CHILD (or children) – in other words to “found a family” (by everyone) not just avoiding prohibitions based on race, religion or nationality. That is what the WHO report was explaining about -regarding the UN declaration of human rights – (and see my blog for another set of opinions that having a child/parenthood is indeed a right based on the UN rights).

    So not only are you against public health care funding for medical fertility treatments for those who have a legitimate medical problem with a normal bodily function, you are also against funding research on infertility treatment?

    I am disappointed that you really haven’t answered my of my questions about what is truly different about infertility over any other disease/illness.

    I am truly surprised at how you completely invalidate infertility as a real medical problem worthy of treatment and research (unless it is all private). I hear you say that you agree that people dealing with infertility suffer like anyone else dealing with a medical problem, but yet you seem to dismiss the reality of it being the same as any other disease. Yet, you support prenatal care for the “optional” pregnancies healthy fertile people have being covered by everyone.

    You have really added to my understanding of undoubtedly many people’s perceptions on the reality (or unreality) of infertility being a significant and real medical problem.

    I am (honestly and seriously) reevaluating my views on public health care spending. If this is the attitude of many more people out there, I am willing to put my efforts into having regular prenatal/postnatal care -removed- from public coverage….if having a child is just a possibility for some (and only the “fertile” some, or the well to do “infertile”)…if people want to have children, why should **I** pay for their health care based on their -choice- to have children?

    Why should we use public funds or research money on prenatal/postnatal care?

    If people want to have children, they can pay for their prenatal/postnatal care themselves! I should not have to pay for anyone else’s “choice”, let alone one that is -not- a disease or illness. And most certainly if my actual medical problem is considered second rate to another’s optional prenatal care, I darn well won’t continue paying to support them. I have seen the light. Thanks.

  8. In direct response to… “In the developing world where resources are scarce, I find it even more immoral. The problem for infertile women in these countries is so clearly, a social problem, not a medical one. Put the money towards making them treat their women better, instead of giving credibility to prejudice and discrimination by treating this condition.

    Also, in a world soon to be overpopulated, isn’t this just another step towards doom ?”

    Try reading this…

    http://www.who.int/reproductive-health/infertility/5.pdf

    it addresses some of these very points.

  9. […] a previous post called “Should public health care pay for IVF-treatment ?” I argued that public health care, with its limited resources, should not prioritize ART/IVF, […]

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