Who should pay for the test-tube babies?
Childless couples have been pressing insurance companies to pay the costs of high-tech measures like test-tube fertilization. Some of the companies pay. But the rest argue it costs too much, helps only a few and increases the premiums for all the rest.It's the latest wrinkle in a debate that began 20 years ago in England when Cambridge researcher R.G. Edwards learned how to fertilize women's ova, or eggs, with men's sperm in a laboratory dish.
"When I began I had no idea just how much trouble I was stirring up," he once told me. "When I started getting hate mail from all over the world, I began looking around for an ethics committee."
A year or so before the first successful in-vitro fertilization (IVF), he and a visiting ethicist were able to predict some of the problems.
He sympathized with the couples who ached for a child. Helping them was the reason Edwards had started the research. But there were still ethical questions:
- Many would consider this form of reproduction unnatural. Did he have any right to proceed?
- Is infertility a disease? Should it be healed at any cost? Is there a right to have children?
- Can we justify the effort in a world already bulging at the seams?
- If he were successful, who should have access? Only those who can afford it? Or did justice require that it be available to all who need it, regardless of bank account?
- If IVF were used to make a "surrogate mother" pregnant, what would be the legal ties between the participants? What if the birth mother refuses to give up the child?
- If six ova are fertilized, and only two used, is it OK to discard the leftovers? Or are these human beings, and is that murder?
- If it is all right for a woman to be a surrogate mother as a favor for a sister, would it be all right for another woman to do it for money?
Most of the problems we didn't foresee in those discussions in Cambridge involved the foundation of U.S. health care: money. We didn't foresee the scandal in which a doctor is charged with selling the leftover fertilized ova. We didn't imagine the divorced couple suing each other for custody of frozen embryos the size of a pinhead.
Who would have guessed that the technology would spawn a gaggle of go-betweens who matched up childless couples with surrogates - and pocketed a fee as big as the surrogate's nine-month compensation?
Who would have guessed so many expensive fertility clinics would spring up so early, or that so many would fail because the technology wasn't ready?
Now the technology has matured and most of the surviving clinics are top-notch places. But who could have guessed they would be caught in a trade war, competing for clients the way Macy's used to fight Gimbel's?
On the Internet, even.
Dial up http://www.pfmc.com, and you'll see how today's market forces make it necessary for even the best clinics to go out and push their wares.
"If you are struggling with infertility, you want more than hope," Pacific Fertility Center's web page begins. "... You want what everyone else seems to have ... a baby to love."
You can click to pages about the reasons for infertility, from antibodies to blocked tubes. Click again for "How Testicular Biopsy Helps Men Become Fathers." Or "Breakthroughs in IVF Surrogacy."
The competitive edge begins to show when you click on "success rates" and read about "the difference between care at PFC and other centers, and understand PFC's commitment to honest reporting of success rates." (Their rates, we are informed, are audited by the firm of Arthur Anderson LLP.)
Another click: "How to Save Money on Your Treatment" tells of "package pricing options" and "outcome-based cost containment."
An example of ingenuity in cost-cutting: a "shared donor option." One donor, in one procedure, can provide enough ova to implant in two or three infertile women. PFC gets them all ready and in the same building at the same time.
PFC makes the procedures available to more people by offering discounts to low-income couples, and "hardship grants for couples in extreme financial need." And, at the end, "a 90 percent refund if you don't get pregnant."
It isn't PFC's fault that its public face is that of a sales representative. No matter how severe the need, or how compassionate the staff, the first question a U.S. health-care institution has to ask is:
"Who pays?"