Irresponsibly Infertile? Obesity, Efficiency, and Exclusion from Treatment

Abstract

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation (IVF). One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable.

Access to infertility evaluation and treatment in two public fertility clinics and the reasons for withholding it: a prospective survey cohort study of healthcare professionals

“…Furthermore, the eligibility criteria imposed have often been chosen on the same grounds as in Sweden, that is, focusing on the welfare of future individuals (ie, preconception welfare principle ) 29. Lastly, the reasons for treatment refusal presented in the study have been previously reported in the literature and do not relate to conditions met exclusively in Sweden 1–7. These similarities increase the applicability of the findings even to public settings outside of Scandinavia.…”

“…29 Lastly, the reasons for treatment refusal presented in the study have been previously reported in the literature and do not relate to conditions met exclusively in Sweden. [1][2][3][4][5][6][7] These similarities increase the applicability of the findings even to public settings outside of Scandinavia.…”

“…Access to treatment with assisted reproductive technologies (ART) is most often restricted by the implementation of eligibility criteria imposed by national ART policies concerning the welfare of the individuals involved. Among the common reasons for withholding fertility treatment are reported prior medical and psychiatric conditions;1 inadequate financial resources;2 previous convictions3 4; child protection orders;4 drug or alcohol abuse;5 current tobacco use;6 and obesity 6 7. Many of these criteria are justified with reference to the health of the intended mother or the welfare of the child.…”

The Undeserving Sick? An Evaluation of Patients’ Responsibility for Their Health Condition

“…5 It may refer to some more 'deep relationship' between the actors and the disease, which makes them accountable for praise or blame. 6 For the purpose of our investigation, the latter notion seems to be the most appropriate, but unfortunately, the conditions of that 'deep relationship' are ill-or variously-defined in the literature. Here we clarify that issue by proposing a series of uncontroversial conditions that account for the most prototypical and widely shared cases of responsibility attribution (and exemption) in everyday life.…”

Personal responsibility for cardiac health: what are the ethical demands?

“…In some areas of healthcare, patients are deprioritised for treatment if they fail to make 'healthy' behavioural changes, which could be influenced by beliefs about responsibility [3,4]. Other possible responsibility-sensitive policies are given in But which model is correct?…”