Recently, several claims have been made that free provision of in vitro fertilisation will boost our economy. This is premised on the assumption that people provide more in terms of tax and insurance than they consume in resources, leaving an overall gain. Even where these ‘replacement’ people are created by means of IVF, it is argued that the costs involved are easily offset by the financial contribution we can expect IVF-conceived adults to make to our economy. However, although it may (...) be true that the creation of a new person constitutes an overall financial gain to the state, I question the degree to which the arithmetic involved is as simple as the reports suggest.Research presented by a group of scientists at the annual conference of the European Society of Human Reproduction and Embryology in Prague, which has been widely reported in the media, has suggested that it is in our society’s economic interests to fund access to in vitro fertilisation treatments.1,2 The team, led by Professor William Ledger from the University of Sheffield, claims that for each IVF baby born, the economy makes a net gain. But can this possibly be true? IVF is an expensive procedure, which by its very nature creates more claimants on state funds and National Health Service resources. IVF also takes a financial and physical toll on all those involved: the women, their partners, and the children born as a result. It might be assumed that state funding of IVF would be a drain on public resources, rather than boosting them. However, the researchers have suggested otherwise. Their claim is that the average £13 000 that it costs to create a baby using IVF is far exceeded by the average of £160 000 in taxes and insurance that will …. (shrink)

On 10 December 1948, the General Assembly ofthe United Nations adopted and proclaimed the Universal Declaration of Human Rights, a truly historic document, the full text of which is reproduced here. Following this historic act, the Assembly called upon all Member countries to publicize the text of the Declaration and "to cause it to be disseminated, displayed, read and expounded principally in schools and other educational institutions, without distinction based on the political status of countries or territories." Jacques Maritain was (...) actively involved in the drafting of the Declaration, especially its clauses regarding freedom of conscience and religious expression. (shrink)

How should medical services be distributed within society? Who should pay for them? Is it right that large amounts should be spent on sophisticated technology and expensive operations, or would the resources be better employed in, for instance, less costly preventive measures? These and others are the questions addreses in this book. Norman Daniels examines some of the dilemmas thrown up by conflicting demands for medical attention, and goes on to advance a theory of justice in the distribution of health (...) care. The central argument is that health care, both preventive and acute, has a crucial effect on equality of opportunity, and that a principle guaranteeing equality of opportunity must underly the distribution of health-care services. Access to care, preventive measures, treatment of the elderly, and the obligations of doctors and medical administrations are fully discussed, and the theory is shown to underwrite various practical policies in the area. (shrink)

NICE, the draft fertility guideline and dodging the big question: should fertility treatment be provided by the NHS?In August of this year the National Institute for Clinical Excellence made its draft guideline on fertility treatment available for consultation.1 As has been widely reported in the media the draft guideline recommends that the National Health Service should provide publicly funded fertility treatment in a consistent way across England and Wales. The guideline recommends that three cycles of IVF should be available when (...) “The woman is within the optimal range for in vitro fertilisation and there is an appropriately diagnosed cause of infertility of any duration, or unexplained infertility of at least three years’ duration .Those who need fertility treatment will celebrate the guideline, as will many fertility clinics. The guideline does not, however, address key questions that will be obvious to many. Is fertility treatment the kind of thing that ought to be available on the NHS? Will the inevitable increase in demand mean that resources are directed away from other services? Is fertility treatment really the same kind of intervention as heart or hip replacement surgery?My view is that there are good reasons for doing what we can to help people access fertility services. Most of us will start a family and for those of us who do it is probably the most important of all of our life projects. Given that social status and wealth can be significant obstacles to many of the things that people would like to do with their lives, the fact that most of us are able to pursue this important life project is good from an egalitarian …. (shrink)

In its decision in ex parte Blood the Court of Appeal relied on European Community (EC) law to hold that the Human Fertilization and Embryology Authority had acted unlawfully in taking its decision to prevent Mrs Blood from exporting sperm taken from her dying husband without his written consent. The Blood case raises the issue of the extent to which EC law may affect the regulation of human reproduction in the Member States. Responding to fears that such national regulation might (...) be ‘swept away’ by the commodifying nature of EC law, this article considers the scope of the potential application of EC law to regulation of human reproduction. The cautious conclusion is that, while there may be some increase in deregulatory pressures, the ‘vertical relationship’ of supreme EC law to national law may turn out to be less significant than ‘horizontal relationships’ between policy makers within and between the EU and its Member States. (shrink)

This essay seeks to characterise the essential features of an equitable health care system in terms of the classical Aristotelian concepts of horizontal and vertical equity, the common language of “need” and the economic notion of cost-effectiveness as a prelude to identifying some of the more important issues of value that policy-makers will have to decide for themselves; the characteristics of health that can cause policy to be ineffective ; the information base that is required to support a policy directed (...) at securing greater equity, and the kinds of research that are needed to underpin such a policy. (shrink)

This book is a discourse analysis of a series of interviews with women and couples who have had IVF unsuccessfully and who have subsequently stopped treatment. Taking a feminist approach, the book argues that treatment failure produces an ongoing and profoundly gendered burden of discursive work that is oriented towards locating the self, and the engagement with IVF, as "normal".