Against taxpayer funded access to IVF services

This weekend's column in the Kingston Whig-Standard, on IVF funding and adoption.

More than a few of my friends, colleagues and even family members think I am wrong on the issue of in vitro fertilization (IVF) funding for infertile couples.

For the life of me I cannot see what interest the state should have in paying significant amounts of money to satisfy some people’s interest in having their own genetically-linked children. I do understand that some people want to have a child that is biologically linked to them. I think the desire is irrational, but evolutionary pressures probably explain this drive to get hold of their ‘own’ child as opposed to opting for an adoptive kid.

My objection to IVF is not religiously motivated. Regular readers of this column will know that I am as secular in approaching ethical issues as they come. So I don’t care strongly about how babies are made, whether it’s by sexual intercourse, IVF, or any number of other means, including reproductive human cloning when that comes eventually about. My argument is not about prohibiting access to IVF. I am concerned about ongoing discussions – even court cases – aimed at getting taxpayers to pay for this sort of thing through our public health care system. In Canada, health care being a provincial matter, we see very different approaches. Wealthier provinces such as Quebec – just kidding – pay for IVF treatment cycles while poorer provinces such as Ontario have chosen not to. Well, who is right?

Given that the question is whether the public health care system ought to provide free-to-user IVF treatment cycles, it’s worth asking: is infertility a disease? I guess it depends on how you define disease. Some infertile people campaigning for taxpayer-funded access to IVF compare their infertility to cancer and other serious illnesses. You might want to ask someone struggling with life-threatening cancer what they make of that kind of comparison. Clearly, infertile people can live perfectly healthy lives very much like other people who choose not to reproduce. The latter choose not to reproduce, the former cannot, but both are able to live healthy lives. If you think that not being able to reproduce biologically is a sign of illness justifiably demanding tax monies to be thrown at it you will obviously disagree. At a minimum though it isn’t self-evident that infertility is an illness. It is also unclear whether we could find a sensible cut-off-point for IVF treatments that ought not to be funded. The oldest woman carrying an IVF caused pregnancy to term was a 74 years old. The sky is the limit and profit maximization is the name of the game for the fertility industry. Unsurprisingly the fertility industry is keen to see IVF treatment cycles paid for by taxpayers as that would increase its income.

Even if infertility was uncontroversially an illness it still wouldn’t follow that tax monies ought to be expended on it. We make resource allocation decisions in health care systems (public and private) all the time. More needs to be said to justify public expense than merely ‘I want my own genetically-linked child, so you pay for my IVF treatment cycles.’ Some cash-strapped parents-to-be argued that it truly is unfair of society to expect of them to pay the $15,000-$20,000 for IVF treatment cycles. I do think to describe this as unfortunate would be correct, that it is unfair is far from self-evident. Indeed, some went so far as to say that they would not have been able to have children if it hadn’t been for someone else paying the bill for the IVF treatment. Here’s my problem with this line of reasoning: The cost of raising a child to the age of 18 currently is in the average about $250,000 in Canada. You can’t tell me that a down payment of $15,000-$20,000 is beyond anyone considering that kind of overall expenditure. If it were, perhaps that would be a good reason to reconsider your spending priorities in life, or better even, your life-plan.

An expert panel working on behalf the last Liberal government in Ontario recommended that IVF treatment cycles be provided free of charge through the public health care system. It noted that some people who rely on their own funds to pay for the treatment, implant too many embryos to ensure a pregnancy. This leads to costly complications in some cases. My response to this argument would be that folks engaging in such risk-taking ought to be required to take out insurance to cover any health care cost their irresponsible behavior requires.

Be that as it may, my broader objection to IVF goes beyond merely bickering about scarce health care resources being wasted on people’s preferences for biologically linked children over – say – adoptive children. I think it’s actually a morally problematic choice to produce more children by costly artificial means while children in need of adoptive parents exist in the country. Yes, I’m not talking Madonna-style purchases of babies in the developing world, but needy children in our own backyard.

At the moment tens of thousands of children in Canada are in need of adoptive parents. They are still looking for a family to call their own. Most of these kids were biologically conceived by people unable to look after them. It remains true that it is for most of us a tad bit easier to make children than to look after them. To my mind it would be decadent of any public health care system to subsidize IVF procedures while in its jurisdiction large numbers of children are in need of permanent homes. It just does not make sense to me. I readily acknowledge that the non-commercial adoption system in this country is far from perfect, but I doubt – given what’s at stake – that there can be a perfect system.

Udo Schuklenk holds the Ontario Research Chair in Bioethics and Public Policy at Queen’s, he tweets @schuklenk

madonna's children

So it's 'amtlich', Madonna is trying to adopt a boy in Malawi. Should she be allowed to do so? A whole bunch of professional do-gooders believe she shouldn't. Mostly children's charities operating in Malawi and the perhaps inescapable church groups. They're currently going to court in Malawai to prevent the adoption from going ahead.

This leads to various interesting questions, chief among them whether Madonna's course of action was the best she could have taken under the circumstances. This question is being asked by lots of commentators and the opinion of most is that Madonna is doing something wrong. Their main rationale is that she could help more orphans in Malawai if she sponsored instead schools or sponsored a much larger number of children thru a charity.

The critics clearly have a point here. However, that taking legal action in order to prevent the adoption from going ahead is the right response is doubtful. Imagine if it became a universal rule that unless you undertook a particular course of altruistic action some charity or other would sue you and demand that you do what it believes is the best thing (usually probably sponsor the charity and its staff...). In Madonna's case, it seems somewhat clear that everyone is better off (the child will have a fairly comfortable upbringing together with Madonna's other pampered off-spring; Madonna got the additional child that she wanted, the kid's biological father is supportive because he doesn't have to worry anylonger abbout the child's welfare).

So, while we're probably entitled to snigger at Madonna's action, clearly the actual outcome is desireable. There certainly is no reason to take legal action to prevent the adoption from going ahead.

A second question that puzzles me a bit is this: If the charities are really so concerned about children in need, is it acceptable to put a lot of stress on a little child in order to pursue a legal (and, let's face it, political) case against Madonna. After all, while the kid is getting used to seeing Madonna and her other half as his parents, there are these children's charities trying to bring this process to an end. How would the kid feel if they succeeded? Surely it's not better off returning to an impoverished African orphanage. The point I am trying to make is that the legal case is surely not in the child's best interest, quite to the contrary.

This, again, makes me wonder about the charities' motives.

I can't help thinking that this adoption is also a fairly powerfulstatement against racism...