Saturday, August 22, 2009

Public Funded IVF?

There's a new issue finding its way into public discussion. Ana Ilha and Amir Attaran feel OHIP (Ontario's public health insurer) should cover their IVF treatments. As the National Post writes, they have spent $6300 on treatment, and think that it isn't fair that others receive this treatment on the public's dime:

At 37 years old, Ms. Ilha suffers from a medical condition that results in a low egg count. Her doctor advised in-vitro fertilization, a treatment that is funded in Ontario for some conditions, but not all - and not for Ms. Ilha.

One course of IVF and $6,300 later, Ms. Ilha and her husband have filed a complaint with the Human Rights Tribunal of Ontario, alleging that the provincial policy is discriminatory, and should be changed.

This couple has a point. We have created a monopoly in health insurance - a legally enforced monopoly. There seems to be little justice in forcing these people into a system that refuses to meet their needs (this isn't a failure of the system, per se, it's a decision). I have great sympathy for those trapped by our public health system.

However, we are not talking about a starightforward health care issue. IVF treatment is more complicated than that, no matter what experts say:
"Infertility is a medical condition," says Arthur Leader, a leading fertility expert at the Ottawa Fertility Centre. "You have to understand that, for example, there are more men who suffer from infertility than diabetes. So, you wouldn't say to somebody who has diabetes, which is a medical condition, we'll diagnose it, but you go and pay for it. It's a medical condition for which this is the appropriate treatment."
Put aside how shocking it is that a "leading fertility expert" would think IVF should be paid for by the government, Mr. Leader's statement is ridiculous and insulting. In 2005, about 8.8% of people in Ontario have diabetes. Is it Mr. Leader's assertion that anything that occurs at a rate higher than that constitutes a medical condition for which OHIP should be relied upon to correct? Rate of incidence has very little to do with any moral imperative of the government to intervene (and it could be argued that because infertility is such a grand problem, it cannot be addressed - if the demands were minimal, the cost of covering might be little more than a rounding error in OHIP's budget).

Further, to assume that IVF is little more than a medical concern demonstrates a complete ignorance about the moral implications of the procedure, and the ensuing controversy. Hell, I bet more than 8.8% of people have heard of Octomom or Jon & Kate

Just as we can say that it is wrong to force Ms. Ilha and Mr. Attaran into an insurance system that won't fit their needs, we can also note that it is wrong to force the rest of us to pay into a system that covers what can be considered morally dubious, elective procedures. I think it is fair to make the distinction between medical care and health care. I firmaly believe this case certainly falls into the former; I'm not so sure that it falls into the latter.

The Ottawa Citizen one-ups the National Post. They actually have an Op-Ed written by the couple, which includes:
But the minister believes, despite all medical evidence and the obvious parallels, that treatment is not necessary when ovaries, testes or anything else goes bad — so the second and third (or fourth and fifth) couples are left to pay for exactly the same treatment.

Discrimination? Obviously.

Certainly, it is discrimination, but where does that get us? Is it undue discrimination? Does it violate our principles as a liberal democratic nation? Or does it just make us feel bad for them because they are having so much trouble conceiving?

If we are to get into a discussion of all the treatments that OHIP does not cover, I cannot believe that we would begin with IVF. I would submit that the biggest hole in OHIP (if we are to approach discussions about OHIP with the philosophy that it is the government's duty to cover all health issues) is dental coverage. It seems ridiculous that we would have some sense of "social justice" that leads us to pay for this couple's IVF treatments, but ignores every child's need to visit the dentist. I mean, come on, gum disease has been linked to heart disease; it truly is a health issue.

Moving from dental care, wouldn't we then concern ourselves with drug payments? Is it "fair" that people who need drugs to live have to secure those drugs on their own (either paying out of pocket, or through a private insurance plan)? Is the argument that trying to get pregnant is more important than not dying? Colour me unpersuaded.

I'm not a huge fan of IVF, at least not the way it has often been used in North America. I know, personally, that it can help people who are struck by tragedy (cancer in his mid 20's, in a friend's case), but we have to draw lines. We cannot fund these things indescriminately and maintain any expectation of solvency within the system. Through private insurance, we have addressed (perhaps inadequately) the issues of dental coverage and drug coverage. If we were to allow more freedom in medical care and insurance, perhaps couples would have more options to address fertility issues - options that do not involve paying for costly procedures out of their own pockets.

In the meantime, though I can offer my best wishes to Ms. Ilha and Mr. Attaran, I cannot offer support for the larger goal of unlimited coverage of IVF.


  1. It's ignorance of the facts to say that it's morally wrong and cite the octomom. If IVF was funded couples would choose (or even be mandated) to transfer 1 embryo, and not several to get the best bang for their buck. Even worse are people forced into fertility meds instead of IVF because they can't afford it, who have multiples and have an outcome of low birthweight preemies that cost the province TONS of money, in maternal and infant care. Trying to get pregnant isn't more important than trying to stay alive, but it's a fundamental part of life (quite literally) and should not be withheld quite as it is now.

  2. Hi Heidi,

    Thanks for the comment and incorrect use of the word, 'ignorant'.

    I did not use Octomom as evidence that IVF is morally wrong. I cited Octomom to demonstrate that it is a controversial issue. I had a number of examples; Octomom was perhaps the most topical when I wrote this post, but it was not the basis for my argument.

    It's a stolen base to assume that IVF funding would end the birth of extreme multiples. We don't know that couples would be allowed to have an endless supply of IVF treatments funded by the government. If there is a limit to the number of times it will be funded, desperation will ensue.

    Are you arguing that IVF is a right? (That's an honest question - as that is what others are arguing, but I wouldn't want to attribute their opinions to you.) If you are, it is interested to suggest it is a right, but then to imply it would be ok for the government to limit treatment to the transfer of one embryo.

    I have never had to resort to IVF, but I would think it is a stressful and anxiety-ridden endeavour. If there is nothing wrong with IVF, it seems cruel to so limit the chances of successful treatment by limiting the number of embryos.

    Nonetheless, I am sympathetic to your argument. I wrote this series of posts, in part, to think through the issue, as I was pretty torn.

    In the end, the beef I really have is with our health care system, and I hope that came through. The very fact that this is an issue is wrong. I'm not advocating moving to a completely private system, but I would rather that we have a consumer-driven system. If we had something like PSAs, would free up people to use their allotted health care however they thought best.

    However, we have nothing like that, and, thus, are forced into these incredibly unfair situations.