Uncertain comforts: The justification for treating infertility

Abstract

Some infertility treatments are expensive and they have unknown benefits, partly because theic effectiveness is not clear. These disadvantages have led to their being given a low priority in some health services budgets. This low priority has been further justified by an argument that infertility treatments do not constitute the treatment of ill people, and hence do not improve health. The argument put forward here is that infertility treatments generally do constitute the treatment of ill people, or at any rate the amelioration of an impairment. I argue further that even where they do not they can still reasonably be held to form part of the legitimate work of a health service. If they are to be of low priority, the justification for the low priority has to be the need to save resources so that they can be used for more beneficial purposes. Difficulty in evaluating the relative benefits of infertility treatment is not resolved by calculating QALYs, as their calculation depends on a qualitative decision as to what counts as an ‘allowable’ benefit, and it is this that causes the difficulty in the first place. An appropriate evaluation of the benefits of fertility treatment would be principally concerned neither with avoiding the distress of infertility nor with the years of life gained by die child, but with the positive if uncertain benefits of parenthood to the parents. These are highly valued, which justifies the widespread provision of infertility services.