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IVF on the NHS? Juliet Tizzard Progress Educational Trust 13 August 2003

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[BioNews, London] This weekend, the Daily Mail newspaper broke a story that a British government agency is considering a proposal to offer six IVF cycles to women under 40 years of age on the National Health Service (NHS). If NICE, the National Institute for Clinical Excellence, ends up publishing what are at present draft proposals, it could spell the end of the 'postcode lottery' in IVF provision, in which access to service depends upon where you live, rather than whether you need treatment. It could also mean an end to the dominance of the private sector which currently provides treatment to 80 percent of couples undergoing IVF.

Not everyone thinks this proposal is a good one. Stephen Pollard, writing in the Independent, suggests that if the NHS were to start funding IVF in this way, it would undermine its policy of funding only essential services. This, according to Pollard, is 'redefining the purpose of the NHS to include the provision of all treatments, rather than just those that are clinically necessary.' However, the NHS already provides non-essential services which are not clinically necessary to patients. One such service is family planning. Pregnancy is not a disease (though, in fact, infertility often is a result of disease) and having a baby is not life threatening, yet contraceptive advice and services are provided free of charge - and so they should be.

That is not to say that NHS provision of family planning services is guided by an enlightened view of women controlling their fertility. Early adoption of such services was probably motivated at least in part by a desire to limit the number of babies born to single women or to families on low incomes. But regardless of the reason for the introduction of family planning services, they are now part of our health system and few would argue that they ought to be removed. The point remains that whilst preventing conception is seen as a legitimate service for the NHS to provide, assisting conception is regarded by some as unworthy of government funding.

Pollard argues that the crux of the issue is whether 'there is any "right" to children, the absence of which is something that the state, through the NHS, has a duty to rectify'. He goes on to say that IVF treatment is provided largely by the private sector 'because the existing consensus is that there is no such right, and thus no such NHS duty'. Does such a consensus exist and, if it does, how was it arrived at? Until now, there has been no real public or political debate about NHS provision of fertility services. In truth, the current poor provision of IVF on the NHS is based not upon rational decision-making, but upon ethical reactions to IVF which are 25 years out of date. IVF grew up as a private service because the state was unwilling to fund what was regarded at the time by many influential people as an ethically dubious treatment. Times have changed and public attitudes have changed with them. Perhaps it's time that the health service's view caught up with the times.

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© Copyright Progress Educational Trust

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