| Distributive justice does not imply that everyone should | | | | are denied access because the procedures are out of |
| have equal access to everything all the time. This | | | | reach financially. Infertile couples in the middle and |
| would be an extreme position and lead to severe | | | | lower economic classes may be working two jobs |
| distortions in availability of medical services. Competing | | | | and contributing substantially to the welfare of their |
| needs must be balanced fairly and opportunities to | | | | communities, but still have no chance to flourish as a |
| access medical care must be equitable. In the | | | | family and raise children of their own. |
| American health care marketplace, however, the | | | | This is economic favoritism of the worst kind. The rich |
| bioethical principle of distributive justice receives lip | | | | get richer, literally. It's a simple calculus. If you're an |
| service only. In America, when it comes to health care, | | | | infertile couple with plenty of discretionary capital, you |
| minimal attention is paid to matters of fairness. | | | | can undergo IVF and have a child. Infertile couples who |
| For example, assisted reproductive technologies | | | | can't afford the price of admission are out of luck. |
| (ART) have been generally available since the early | | | | Fertility clinics accept cash, checks, and credit cards. |
| 1980s. In recent years more than 100,000 in vitro | | | | Their front desk people are happy to "discuss financing |
| fertilization (IVF) procedures are performed annually. | | | | options" with potential clients. But if you don't have |
| But IVF costs - typically ranging between $15,000 and | | | | sufficient funds you shouldn't even bother showing up |
| $25,000 - are rarely covered by insurance plans. | | | | for the first appointment. The fertility business is a |
| Infertile couples wishing to have children need to pay | | | | prime example of the transformation of American |
| for IVF out of their own pockets. National statistics | | | | medical priorities from patient care to financial |
| indicate that for women younger than age 35, 41% of | | | | transactions. |
| IVF procedures result in a live birth. For women | | | | Distributive justice doesn't mandate that all infertile |
| between ages 35 and 37, 31% of IVFs result in a live | | | | couples have equal access. But the principle does |
| birth. So it's likely that many couples will need to | | | | require that some couples without the financial |
| undergo at least two rounds of IVF, spending a | | | | wherewithal be able to undergo IVF. Fertility clinics |
| minimum of $30,000 and possibly more than $50,000 in | | | | should be required to provide a specific minimum of |
| attempts to have a family. | | | | annual pro bono procedures. Federal funds should be |
| As the median household income in the United States | | | | available to provide IVF services to additional couples. |
| was approximately $50,000 in 2008, it's obvious that | | | | Access to funding could be based on a national lottery. |
| very few families can afford what reproductive | | | | There are many solutions. What's needed is the will to |
| medicine has to offer. This harsh reality implies that the | | | | put some flesh on the bones of distributive justice. It's |
| vast majority of families that could benefit from ART | | | | the right thing to do. |