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No IVF For You: Cutting Off Infertility Treatment Coverage for LGBT and Single Women

I am somewhat stunned when ethicists propose policies that discriminate against groups of people.  The job of an ethicist is to hold society to a standard; to ensure that we’re comporting ourselves in a way that is just and humane.  So I question when any ethicist, such as Cristina Richie, asks society to create policy that would target removing services from certain segments of the population.  Such as… oh… I don’t know… proposing that fertility treatment coverage be denied to those in the LGBT community or single mothers by choice.

Richie published a paper in the Journal of Medical Ethics this week and in the abstract stated, “Second, I will recommend that policymakers eliminate funded ARTs for those who are not biologically infertile.”  Why does she believe that only those who have a documented medical reason for not being able to conceive should receive the state mandated coverage (she lives in Massachusetts) of their infertility treatments?

Because she wants to create an incentive for those in the LGBT community and single women to adopt.

Since, you know, adoption is easy-peasy when you’re a lesbian or a single woman.  And it costs the same amount as insurance-covered fertility treatments.  And… oh… wait.  I guess it’s opposite day.

I’m not sure how ethical it is for ethicists to propose that the way to tackle environmental problems is to choose two historically oppressed groups and deny them the services that other people in their state are able to utilize.  Where does it stop?  Is the next step for Richie to propose that only those who are able to conceive without assistance be able to build their family?  And really, why should those who can have sex and create a child be allowed to have sex and create a child?  Wouldn’t the world be better and the overall carbon footprint reduced if humans stopped reproducing altogether and we allowed people to die off within the next hundred years or so?

And yes, I know that there is a whole movement of people proposing that brilliant idea.

But why stop at fertility treatments?  I mean, you have to allow non-smokers access to cancer treatments, but smokers?  Think of the dent we could make in our carbon footprint if we told smokers that their cancer treatments weren’t covered.  And why should obese men have their insurance shell out money when they have a heart attack?  I mean, it would be cruel to not treat lean vegetarians, but beer-drinking, meat-eaters?  They brought it upon themselves.  Maybe if they knew that we weren’t going to cover their medical treatment, it would encourage people to stop smoking — which contributes to the destruction of the environment — or eat meat — which certainly affects the earth.

But that isn’t how humans treat other humans.

I guess I’m just disappointed that Richie’s proposed solution to our environmental crisis is discrimination.  I expect a little more creativity and a little more humanity from those aiming to change the world.


1 Persnickety { 07.26.14 at 7:32 am }

I did take a quick look at the Australian situation. i currently get my cycles partially funded by Medicare (the national health care system). In order to get that i have to have a medical reason. in my case that means a referral from my GP to a specialist, renewed annually.
This appears to be the case for lesbian couples as well. So theoretically, if a couple tried artificial insemination over a given time period they would then be covered. It is definitely an issue that has been debated in Australia. That said, IVF is one of the very few things that is not covered by the medicare safety net, which the practice of funding 80% of the costs of any medical care after a certain amount of healthcare cost in a calendar year is reached. IVF is capped, regardless.
I can understand that caveat, to ask that people try to go the low tech, cheaper option first, but i wonder how it is defined. it seems harsh to deny one group of people so completely.

2 gwinne { 07.26.14 at 8:09 am }

I certainly agree with your analysis, but this really isn’t anything new. My own insurance co only covered IVF for married women. And many single & queer women need to undergo psych eval prior to IUI.

3 gwinne { 07.26.14 at 8:11 am }

And of course single women can be infertile in the medical sense, too…

4 Cristy { 07.26.14 at 8:30 am }

Yet another shining example of how people pass the blame for global issues off on infertiles. Can’t get pregnant? Just adopt! In this case, the whole idea of addressing climate change comes down to regulating which infertiles are allowed to undergo treatment. I’m willing to bet Ms. Richie knows a heterosexual couple who went through IVF, hence she’s instead picking on the LGBT community and single women. What she fails to understand is that, yet again, global issues should not be shouldered by a subset of the population. Most people undergoing fertility treatments are not Nadaya Suleman (shocker, I know).

What this is is adoption hate, fertility discrimination (notice she has said nothing about fertile single mothers who have multiple baby-daddies) and bigotry, all wrapped up in a nice little package.

5 Katherine A { 07.26.14 at 9:36 am }

*Sigh* This is ridiculous and infuriating.

I remember once reading a blog post about male writers engaging in theological/academic debates surrounding women’s roles in religious community. The (female) author pointed out that she can’t just debate these issues in an academic/theoretical sense because they directly affect her life in very real, every day sort of ways that the male debaters don’t experience. That academic distance is a sort of privileged position. That’s how I kind of see this article. Richie, as far as I can tell, is engaging in a sort of theoretical/academic exercise without empathy or understanding for the REAL people whose REAL lives she is attempting to impact.

Makes it even worse that she’s going after LGBT and single communities who, as you mention, are facing enormous discrimination both now and historically.

But honestly, reading her argument, I can see it being applied to all IVF and people who use IVF. I mean, her whole point appears to be the environmental impact of freezing, hormones, etc, which are intrinsic to IVF. I remember another fairly recent article from the AMA by Philip Rosoff and Katie Falloon (http://virtualmentor.ama-assn.org/2014/01/msoc1-1401.html) that also basically promoted the premise that IVF (for anyone) should not be paid for because people could adopt.

This stuff drives me nuts. Part of me genuinely wants to talk to all of these authors and ask them if they’ve ever been in these situations. Because I can tell you, none of these decisions are easy ones. Not for infertile people, not for LGBT people trying to build families, not for singles. These authors may be debating stuff in an academic sense. But their words and articles have real impacts on real people and real lives.

6 Katherine A { 07.26.14 at 9:43 am }

Sorry, accidentally posted before proofreading. Top should have read that *Richie’s article* is ridiculous and infuriating.

Your analysis is spot on and excellent.

7 Mrs T { 07.26.14 at 10:06 am }

Well argued, Mel. Interesting that an ethicist seems to be completely blind to the many ethical issues surrounding adoption too.

8 ANDMom { 07.26.14 at 2:44 pm }

I don’t agree with what she’s saying in regards to carbon footprint, adoption, etc, but I’m also not sure I would classify it as discrimination for a medical insurance company to only cover treatments for biological infertility. It’s not a case of “they did it to themselves” like with the smoking example you gave – it is a distinction between a medical condition and a non-medical condition, which is a perfectly appropriate distinction for a *medical* insurance policy to make as long as they provide adequate guidelines to establish criteria to determine biological infertility among people who are not in a heterosexual relationship.

I’m not actually sure how it works in regards to medical insurance as it stands now, but as part of a heterosexual couple we had to submit a lot of proof via our RE that I was, really, biologically infertile before they would cover infertility treatments. I can’t imagine how it would be fair for a single mother by choice to walk in and get coverage purely based on her circumstance without the myriad of tests, procedures, and affidavits that we had to submit. Or do you think no one should have to submit any proof and it should just be covered for everyone regardless of medical necessity?

9 loribeth { 07.26.14 at 2:47 pm }

Right after I read this, I found this article in the New York Times:


This also reminds me that I’ve read about several states in the U.S. that have limited medical benefits for childless adults. Which would include me, if I lived there. Yikes. One more way those of us without children are made to feel “lesser than” in the current parent-and-child obsessed culture. :p

10 Queenie { 07.26.14 at 5:04 pm }

Super ignorant and obnoxiously so. SHE should “just adopt.” And sit down and shut up.

11 Pepper { 07.26.14 at 7:47 pm }

This is so disappointing and sad to me. As someone who did IVF (successfully) and is now in the midst of an adoption, neither was easy and I had the best possible outcomes. To force a person to choose adoption without benefit of other alternatives is ridiculous. Adoption is not easy, nor is it a guarantee. And I’ll be honest – I am a caucasian woman in a heterosexual marriage, living in a midwest suburb – if it was a rough path for me, let’s get real about what it is like for the LGBT and single mother community. This just stinks all around. It is simply an illogical expansion of the “just adopt” mentality and it makes me sick.

12 Mali { 07.26.14 at 9:20 pm }

This infuriates me. How can she make a distinction between children born of fertility treatments and unwanted children born of a drunken fumble in the backseat? One a conscious, well thought out decision – whether from hetero couples, singles, or LGBT couples or individuals – and the other … well … not. But she wants to arbitrarily treat the first group differently. I guess ethicists don’t have “being ethical” in their job description.

I find the”concept of a “green bioethics movement” to reduce the carbon footprint caused by elective medical procedures” to be utterly terrifying. How about making contraception cheaper and more widely (and globally) available, so that unwanted pregnancies are reduced, allowing those people who need fertility treatment to have much-wanted pregnancies (and children) without being accused of increasing carbon emissions.

13 Prairie { 07.26.14 at 10:09 pm }

More IVF discrimination in the news here: http://ww2.nationalpost.com/m/wp/blog.html?b=news.nationalpost.com%2F2014%2F07%2F25%2Fno-prerogative-to-create-rainbow-families-calgarys-only-fertility-centre-restricts-donations-that-dont-match-ethnicity
Clinic in Calgary, Alberta, Canada requires patients pick donor eggs/sperm from donor of same ethnicity.

14 Andy { 07.27.14 at 5:29 pm }

sigh…. I’ve got nothing……

15 Tiara { 07.28.14 at 7:46 am }

Wow…just wow. Well said Mel.

16 A. { 07.28.14 at 5:12 pm }

ANDMom took the words out of my mouth. The fight to get insurance companies to treat infertility like a legitimate disease and not an elective procedure driven my social motives akin to plastic surgery is already challenging enough. I don’t think it helps that case when we lump in women who are, medically speaking, perfectly healthy and, for lack of an accepted term, socially infertile. However, if one tries for a year via artificial insemination without success, then at that point it becomes an issue of reproductive ‘health’ and it’s discriminatory for your ‘health’ insurance not to cover testing/treatment same as they would a heterosexual couple.

(c) 2006 Melissa S. Ford
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