Should Anyone get IVF?

Cast your mind back to this summer, and Christina Richie’s paper about the provision of ARTs.  It attracted a fair bit of controversy because of the way it talked about gay people’s rights to access ARTs, and their “voluntary” infertility.  For my money, that was the weakest part of the paper, and it should have been left out of the argument; the majority of the paper, and the more ethically interesting part, had to do with the environmental impact of striving to have more and more kids, irrespective of their parentage.  But I can see why the part about gay people struck many people as worth commenting on.

Why mention all that now?  Well, there’s a nice paper by Emily McTernan currently on pre-pub in the Journal of Applied Philosophy asking whether any fertility treatment should be state-funded.  In it, she asks whether IVF should be state-funded at all.  In a nutshell, her claim is that many of the arguments about the good of parenthood are either weak in their own right, or else could apply equally well to any number of other goods that a person might pursue.  Those that are weak are obviously less likely to sustain a claim that iVF should be provided; those that apply equally well to other goods obviously suggest either that governments should fund the pursuit of those other goods as well, or that if pursuit of those other goods is not funded, then neither should IVF be.  Thus

it is unjustifiable for a state to provide fertility treatment more generously than it funds other valuable like projects, both in the quantity of funding and the lack of means testing.

What I really like about the paper is that McTernan sets out the main arguments for funding in a simple but never simplistic manner, and calmly knocks them down one by one.  I’m already inclined to be suspicious of, if not hostile to, public funding of IVF (there being things with a more pressing need for public money, and genetic relatedness being not all that important), but she puts the arguments more neatly than I ever could.  She’s very good at pointing out that a particular argumentative strategy might be tempting, but that we would probably fight shy of adopting it because it would commit us to moral conclusions we wouldn’t normally want to embrace.  So, for example, if you’re inclined to agree with the Daniels line that adverse departures from normal species functioning could count as disease, you might be tempted to say that infertility is a disease – and therefore ought to be treated, or at least ameliorated, by IVF.  But

lack of reproductive success cannot itself suffice to make for an adverse departure [from the norm]: we would not want to conclude that those preferring same-sex partners have a disease, given the reproductive failure resulting from their statistically unusual sexual preference, let alone that it should be treated.


Elsewhere, she attacks the idea of parenting as a unique good as a ground for providing IVF, and the idea that we ought to support and enable reproduction as a social good.  McTernan recognises that there is arguably a social injustice in that a woman’s most fertile years tend to coincide with the years most crucial for her career.  This means that a woman who wants kids is likely to defer pregnancy, thereby reducing her chance of getting pregnant.  IVF might correct for that.  However, McTernan contends, this isn’t compelling, not least because the argument transforms a social phenomenon – which she thinks constitutes an injustice – into a problem with the individual; providing IVF (which isn’t all that reliable anyway) might provide an interim solution to the social problem, but it does nothing to address it fundamentally.  So, she claims, the argument probably isn’t all that strong.

But she then makes a fascinating exception – and this is where her paper is in interesting contrast to Richie’s: it’s that we do have more of a reason to provide IVF to gay couples.

Here’s why.  One of the things that makes infertility a harm rather than just another characteristic is that there is a social norm associated with the conventional nuclear, heterosexual family.  People who don’t fit that norm are therefore put under a social pressure that does not accrue from at least some other characteristics that they may have: there isn’t a social pressure to be dark-haired, for example.  This, for McTernan, indicates a structural injustice.  And in respect of that,

fertility treatment might act to undermine the structural injustice.  Fertility treatment might challenge the normal construction of the family through creating new forms of family.  Further, fertility treatment in this case may become a social good, in supporting a diversity of ways of life with these varied forms of the family.  In contrast, infertility treatment for heterosexual couples further reinforces the very same ideal of the traditional, heterosexual, nuclear family.


I’m not wholly sold on this part of the argument, I have to admit.  I think that there’s too much crammed into a couple of paragraphs.  I’m not sure that the nuclear family really is as toxic as McTernan’s argument hints – while presenting it as the only plausible family model is, that’s a problem with how it’s presented, not the institution itself.  As such, I’m not sure that it’s the nuclear family that needs to be challenged so much as some of its proponents.

Finally, McTernan suggests that it’s possible that states are required to respond to injustice, and that providing IVF to gay couples might be a part of that.  Well, maybe.  But this itself seems to lend itself to an unacceptable conclusion.  After all, it could be taken to be treating gay couples as the means to achieve a moral end.  Note how their desire to have children isn’t emphasised: it’s the possible spinoff of their having children that carries the weight here.  We’d get the same challenge to the perceived injustice if they had children without actually wanting them.  More: if there is some social injustice, it doesn’t fall wholly on the state to remedy it – each of us does.  So suppose that a gay person is persuaded that there is an injustice implicit in the nuclear ideal, and that injustices ought to be remedied, and that each of us has a part to play.  Does that mean that there’s a corresponding duty to reproduce for the sake of this end?

Maybe this is a touch hyperbolic – like I said, McTernan crams a lot into a few paragraphs at the end of the paper.  Maybe, with more space, the argument’d be more persuasive.

But even as it stands, the paper’s definitely worth reading, and merits being taken seriously.