NHS Trusts are cutting funding for IVF, inspiring protest. But there are many reasons to be sceptical of providing IVF on the NHS. It’s not just that it’s not really a treatment for an illness – there is a range of moral problems it raises.
The revelation that a number of NHS Trusts were reducing or halting altogether funding for in vitro fertilisation, or IVF, has lead to some controversy. Some people argue that “Everyone should be allowed a chance to have a baby”, as if we face a dichotomy between the government funding something, or that same thing being banned. Others argue that funds are best allocated elsewhere. There was a debate about this recently on Newsnight.
Overall, our culture seems to be very pro IVF. Even traditionally conservative outlets applaud it. I think there’s a range of arguments against IVF as it’s currently practised and regulated. I don’t endorse them all, but they show that the moral and practical situation is complicated. We should consider more carefully whether it’s the sort of medical procedure which taxpayers should be forced to spend money on.
Destruction of spare embryos
Although it does not necessarily have to be done this way, for each ‘cycle’ of IVF, intended to give a mother one child, a batch of embryos are fertilized, and only the most likely to survive the process is implanted in the mother’s womb. The other embryos are then frozen or destroyed. If one thinks that the embryo has some moral status (this does not need to be the same moral status as a newborn child) then this is very hard to justify. A typical response to that is that if abortion is justifiable then so should the destruction of embryos. But as the pro-choice philosopher Elizabeth Harman argues, this inference is mistaken. The continuation of a pregnancy involves substantial burdens on a woman, this might make it justifiable to abort even if the foetus has some moral status. But that is not so in the case of IVF. It is perfectly possible to realise the goals of IVF without destroying extra embryos (just fertilise the eggs one or two at a time rather than all in one go). So, unlike with abortion, the killing of the embryo is not necessary to realise another important good. Hence, unlike abortion, it is not justifiable.
Sometimes, IVF will involve the gametes of a third party who has donated them. Bioethicist Melissa Moschella argues that this is wrong because it involves an abdication of parental duties by the donor. If I have a child as a result of an unintended pregnancy, I will have both moral and legal duties towards that child. So parental responsibilities are not generated by consent (we did not want a pregnancy to result, and took precautions to avoid it).
Rather, it seems that parental responsibilities are generated either due to genetic ties or to the fact that one caused a new being to come into existence. But both conditions are satisfied in the case of a gamete donor, so they owe parental duties to the child. Now, it might be thought that such duties are transferable; suppose that the gamete donor has transferred their responsibility to the third party; and so the donor is off the hook. But such parental duties are only transferable in a weak sense. If some parents can no longer care for a child and give it up to adoption, it is true that the adoptive parents now owe those duties. But that does not mean that such transfer is always justifiable. Suppose a man has sex with a woman intending for her to conceive but also intending to have no role to play in the child’s life (not even financially). He intends to transfer his duties to her; but we don’t think he can legitimately do that. So, rather, it would seem that it is wrong to attempt to transfer parental duties unless one has a strong reason to do so, such as when one gives up a child for adoption because one is unable to care for it. But there is no such strong reason in the donation case.
There are many children in the UK and in the world who do not have parents to care for them. They need help and families. That need creates moral reasons for us to help them. So, bioethicist Tina Rulli argues that it would be better to adopt rather than to conceive another child.
She considers the objection that people prefer to have children that are biologically connected to them and argues that it is not strong enough. Perhaps Rulli makes the case rather too strongly, as it could imply that one should adopt rather than conceive naturally. But, even if it fails in such cases, the argument is quite strong against IVF. Perhaps, while in the abstract it would be best to adopt, it might be costly enough for the adopters that people are not obliged to do so if they could instead simply conceive naturally. But if they have put in the effort to use IVF, in terms of time and money, they will no longer have that ‘excuse’ not to go the extra mile and adopt.
This was the argument which was made on Newsnight. The NHS has limited funds. Difficult decisions must be made about where to allocate its funds. (Even if we raised taxes so as to successfully increase those funds, there might be better things to spend the new money on.) The total IVF bill for the NHS is about £400 million. Is it necessarily the best use of that money?
This raises a wider question about what the NHS should be about. It is about keeping people healthy, but IVF does not actually cure infertility. It simply bypasses the problem. Now, of course, there are many things that do that which should be funded on the NHS (prosthetic limbs, for example, do not make limbs grow back but they give some quality of life to people who lost theirs). But there are alternative ways of solving that problem, such as adoption, or couples choosing to have children when they are younger and more fertile. Is £400 million best spent on giving people a genetic connection to their child rather than adopting? Is it best spent removing the consequences of people’s decisions to start families later? Or is it best spent on other parts of the NHS – or other places of serious need?
When conception is done the natural way there is a natural process of selection at play. It is the best sperm which reaches the egg and fertilises it. Couples with genetic predispositions to infertility which are linked to other unfortunate traits would otherwise have those traits (including the infertility) naturally taken out of the gene pool when they do not conceive naturally. But IVF frustrates selection both at the level of nature’s screening for the best gametes, and at the level of nature’s screening for fertile couples. Professor Jonathan Aitken warns of the consequences this might have for IVF babies. He cites evidence that they have lower levels of fertility and health than those naturally conceived. You can listen to his talk here:
Other concerns about IVF
There are wider issues about IVF. One is that arguments in favour of it come from a premise that everyone has the right to a child, but maybe this leads to seeing children as property (or pets) and fails to respect their humanity. Instead, the better attitude to have is that “A child is not something owed to one, but is a gift.”
A related concern comes from the possibility of having designer babies, which IVF makes possible. Finally, there are concerns that the perceived availability of IVF, especially when encouraged by companies offering to freeze the eggs of their employees, is leading couples to overly delay parenthood to a point where IVF may not even be able to ‘solve’ the ‘problem’.
Rajiv Shah is a PhD candidate in Law at the University of Cambridge. Read Rajiv’s last article here.