Abstract
In this paper, I suggest that ethical constraints may have a role to play in the provision of some medical interventions. If there are sound ethical reasons for preventing the use of some treatments, these will be valid, whether treatment is provided in the state or private sector. If such restrictions prove unfounded or are unsuccessful in preventing unethical practices, they may be challenged and abolished or amended, that is, they stand or fall on their own merits. However, socioethical criteria incorporated in many primary care trusts’ guidelines for IVF provision have come to be used as a means of restricting the pool of potential patients, rather than preventing unethical practice per se. I will argue that this is contrary to the ideology of the National Health Service, is unjustly discriminatory and constitutes the biggest problem for IVF provision in the UK. Economic criteria are an essential consideration for the distribution of resources in a publicly funded health system. The least problematic way of approaching this is to primarily ration according to medical need. However, I argue that this is peculiarly difficult in the context of IVF, and that this is why socioethical criteria of dubious validity have found their way into IVF provision at a number of levels. Since clinical factors alone are not sufficient to draw up eligibility criteria, IVF cannot be provided on the National Health Service without diverging from the National Health Service principles. I suggest that further developments in reproductive technology will place untenable strain on the current system and that IVF and other fertility treatments may ultimately be relegated to the private sector, thus circumventing the need for additional discriminatory rationing criteria employed by primary care trusts.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.