Who deserves fertility treatment? In the UK, the State-run, taxpayer-funded National Health Service, doesn't answer that question, it merely says who will receive it and who won't. The government watches its bottom line like a hawk, so I'd venture a guess that deserving doesn't even come into the conversation; it's about statistics and where to put the money. In the United States issues arise based upon 1) insurance companies who don't want to fund fertility treatment and 2) States that have not enacted legislation that would require insurance companies to pay out on fertility claims. Is deserving a moral issue, a health issue or a financial issue?
The argument the NHS and the insurers use against treating an infertile person, is often that it's not necessary medical treatment for the health of the insured; it's a "lifestyle choice." The health sector also makes these decisions based upon who is most likely to benefit from treatment; women 23 - 39 years old; of healthy weight, not indulging in unhealthy habits like drink, drugs or alcohol. I'm not really interested in going into bureaucrats' decisions based upon statistical analysis. I am more interested in examining the social aspect of it:
- is it right or wrong to expect your treatment to be funded by another entity?
- Is parenthood a right or a privilege?
- is it in the public interest to support the institution of the family?
- What do we do about reconciling the "haves" and the "have-nots" in terms of family, in society now and in the future?
Many people have confused these two separate issues: who deserves parenthood and who deserves medically assisted conception. "Deserving" is such a subjective word in the context of procreation. Whether we deserve to have and parent a child, sounds like an edict passed down by Gd. In this world, who is qualified to make a Gd-like judgment like that?
It seems a fundamental right to follow one's human instinct to have children. However, we all voluntarily live within a social structure that regulates what we can or can't do, based upon our moral behaviour and our ability to care properly for children. Someone who wants children and fulfills their desire without compromising the children's physical and emotional safety and their quality of life, should, all being well, be deserving of parenthood. The more earthbound limitations come up when people want to have children, but find themselves unable to conceive.
In regard to deserving funded treatment, it's a different story. It's no longer about who you are, what kind of parent you would make or continuing your family lineage. It can be about your unique reproductive challenges, the chance you have of conceiving with or without assisted conception techniques, how long you have been trying and crucially, how much money is available. Medical treatment costs money. Who will pay for that medical treatment?
If the woman or couple want to pay out-of-pocket for IVF, they have many options for treatment, as there seem few corners of the world that aren't populated by a fertility clinic. If it's too expensive at home, you can take a 2-week vacation abroad and pay less. Older women or a woman with secondary infertility will fit this profile.
Under the NHS system you could be wealthy or destitute and the eligibility, care and cost (nothing to the patient) would be the same. If found not to fulfill the criteria for funded fertility treatment, the couple would be back to the decision-making above. Is it fair that someone who neither qualifies for NHS treatment, nor has the thousands of pounds to pay for it, may not have a chance to have a baby? *The concept of fairness is as subjective as who is deserving, which is unique to each person.
Under a strictly private medical scheme in the U.S., the financial aspect of fertility treatment is like a game of dodge-ball. No one wants to hold on to the ball, so they keep throwing it back at each other. Those who can't afford health insurance are in a bind. Those who have health insurance, believe that paying their premiums are enough reason to have their treatment for the medical condition "Infertility" covered.
The lines are blurred. There is public opinion. It's a given that in democracies, the public always wants a vote. The decision-makers are accountable to their constituency; the people who pay those taxes that sustain the NHS. If individuals have no need or desire to have fertility treatment, they question why and how much money should go to a non-essential treatment. The loudest naysayers may argue that they don't support any "free" treatment for people who are irresponsible with their health. For example, this would apply to obese people who won't take steps to lose weight through diet and exercise, but want funded gastric band surgery.
It's the same group that would call parenting a lifestyle choice. Is it a lifestyle choice? If there is a person who wants to parent, has patience to spare, is physically capable of raising children and wants to spend 20 years without enough sleep, privacy or expendable income, it's not a lifestyle choice, it's a life choice. Some see it as a primal need. Others may just want to have a family around them, for love, support and more love. There is also some natural programming going on to carry on your bloodline and to re-populate the earth.
Its more of a lifestyle choice to decide that you don't want to have children. This is a conscious choice to break free of traditional expectations of family. It's a statement that says you aren't interested in permanent attachments, dependence, noise, toys, broken sleep, inconvenience, expense and responsibility for another person's life and welfare. If a high-gear career, late nights, financial freedom, restaurant food, relaxing adult-only vacations and/or dancing until dawn still seem attractive to you, having a baby will undoubtedly cramp your (life)style.This is my personal message (plea?) to anyone who is interested; any law-maker, any insurance company, fertility clinic, individual doctor, educator, chemist and/or any philanthropist: Forget questions about who deserves what and do what you can to help build families. Defray the costs to the patient, and even to the NHS and insurers. One by one, you can make a difference to hundreds of thousands of infertile women and men who are dependent upon fertility treatment to conceive. I don't care whether you benefit from it in terms of your profits, your public profile, or self-satisfaction, as long as the infertile community does.
- If it's too costly for patients, do what you can to lower costs of treatment, medication and other paraphernalia like ovulation and pregnancy kits. (See what Asda did).
- Start with the generation of girls whose fertility begins now, teaching and checking reproductive health earlier. (See my proposal "A Shot in the Dark")
- Introduce more inclusive criteria for funded treatment that gives leeway for case-by-case analysis.
- Raise awareness of issues around infertility so it's understood by the general public, loses any stigma still in play, and is seen as a worthwhile expense.
- Make more opportunities available for non-profit fertility treatment to those infertile couples who can't afford either health insurance or to pay for treatment themselves.
- Donate to charities that fund research into reproductive health, provide educational programs, public seminars and emotional support to people affected by infertility.
- Talk about infertility so that someone coping with it in silence will feel able to come out of hiding and get the support they need.