Should There Be a Female Age Limit on Public Funding for Assisted Reproductive Technology?
Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice—the capacity to benefit, personal responsibility, and need—to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice.
KeywordsReproductive techniques, assisted Ethical analysis Distributive justice Health care rationing Health policy Need Capacity to benefit Disinvestment
In memory of Konrad Jamrozik. We thank: Dale Halliday and Stephanie Krawczyk for research assistance; Jason Gordon and Lisa Smithers for their help; Cindy Farquhar, Wayne Gillett, and Gavin Mooney for private correspondence on particular points; Tony Milligan and Jan Deckers, in addition to anonymous reviewers; and those who made suggestions at the Feminist Approaches to Bioethics 2010 Congress.
This paper was initiated as part of Changing Policy and Practice in Health Care, also known as The ASTUTE Health Study (Assessing Service and Technology Use to Enhance Health) (National Health and Medical Research Council of Australia Project, Grant ID 565327). Its chief investigators are Janet Hiller, Adam Elshaug, Annette Braunack-Mayer, John Moss, Janet Wale, and Heather Buchan. Drew Carter is a research fellow on the “Health Care in the Round” Capacity Building Grant in Population Health (NHMRC, Grant ID 565501). The NHMRC played no role in: study design; data collection, analysis, and interpretation; the writing of this article; or the decision to submit this article for publication.
Statement of Competing Interests
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