h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

My inclination is that it shouldn't in general be available at all on the NHS and yet...

I wouldn't like to see it only available to the wealthy, who are no more qualified to be good parents than anyone else.

If someone is rendered infertile as a result of a medical condition/procedure cared for under the NHS, should IVF be considered an adjunct to their treatment?

Infertility is not an illness & bearing children is a privilege rather than a right. However, I am aware of the potential psychological problems that can occur when conventional attempts at achieving pregnancy fail. Should these considered a condition that is eligible for NHS treatment?

On the other hand, the NHS has finite resources and decisions have to be made. I certainly think that eligibility for NHS IVF should be very strict, as it should be for certian other treatments which could be viewed as elective rather than necessary.

Hmm, contemptuous?

Now I'm a bit confused about it too, but seems to me its a choice. One of those choices where there never could be any rhyme or reason: at some point you have to just accept there is no further justification behind what's important to you, make a decision and just go with it.

So I think its a bit rude to pick on someone else's irrational urge when we all plan our lives around such sillyness. I must say I think it would be a bit dumb to base your decisions on whether or not evolution would approve.

Moreover, shouldn't we be fighting against evolutionary pressure, so we have a more diverse species, more likely to survive when some sort of crisis does come? And since when did you care about the future of the human gene pool anyway?

On the other hand, I do think that IVF is a lot to put yourself through when there are lots of kids up for adoption (granted, generally not babies), and, as Blicky has pointed out, lots of jobs where you get to look after kids without having to take them home at the end of the day. Is it really so necessary for the child to be 'yours'?

"I am aware of the potential psychological problems that can occur when conventional attempts at achieving pregnancy fail."

I'm aware of the psychological problems that can occur to women who have small breasts. Do we therefore fund breast augmentation on the NHS?

(Answer: yes, we do. Surprised?)

And yes, contemptuous, and as for planning your life around irrational silliness, speak for yourself. I don't talk to the weather, believe in fairies or Santa, Jesus or Allah. I don't mind if anyone else does, as long as I don't have to pay for it and the funding to treat my congenital heart disease isn't cut to satisfy the selfish need for a child of some middle class bint who'd be better off with a cat.

SoRB

I'm not entirely sure whether we're supposed to take that post at face value, SoRB, but I'll bite in any case.

"1. Darwinism in action. If you can't have kids, you shouldn't be having kids. That's the universe giving you a hint - take it."

This kind of argument can be used against any kind of medical treatment, surely? Premature babies, people with major allergic reactions (anaphlaxia), or anyone who's got any illness whatsoever. Can't it be argued that much of modern medicine is dedicated to keeping people alive who nature wants dead?

But what strikes me most about your post is the sheer illiberal nature of your views on this. You may not have parental urges (and to my surprise, neither do I), but I'm not sure why that leads you to hold people who have those urges in contempt. Why the intolerance on this issue, but not on other issues where others have different needs and drives to your own?

So you can find a reason for what you value most in life? And a justification for why those reasons matter? How do you avoid it becoming an infinite cause and effect chain?

I'm pretty sure that for everyone at some point it degenerates into 'I just feel that way'.

Hmm. Well SoRB is a naughty boy as we all know Otto.

I have to say I'm in two minds about this. I understand that psychological damage *can* result from infertility, but is IVF the best way to treat those problems. It's a hit and miss treatment anyway, and it costs a great deal.

On the other hand, there are plenty of kids out there that don't have a loving household who are deperate for the love and stability that adoption might bring them. I know for a fact that it can be just as fulfilling - I work with a chap who adopted after many years of failing to have kids and he is the proudest and happiest father I know, and his kids are amongst the most loved and cherished I've ever seen.

I think it's like any new science the leaders will push as far and as fast as they can. Obviously the long term trends cannot be seen, they emerge over time. Multiple births, quods etc. and now evidence is building of increased risk of premature births and genetic disorders. Hence unforseen ammounts of cash are needed to cope with the consequences.

Darwinism has got us a long way without scientific intervention. And before anybody jumps all over me I am from the Jedi rather than the intelligent design school of thought.

SoRB, yes I am aware that some cosmetic surgery is NHS funded. I'm sure there are some doctors who are more liberal than others in justifying this.

Good point Blues, as to whether or not IVF is necessarily the most appropriate action. Certainly, there is no guarantee that those who are most desparate to become parents will be 'good' parents. There could be an argument that they are less emotionally stable to cope with the stress of parenting.
Patients do have some sort of counselling don't they, to ensure that they understand the odds of success etc.?

This a huge question at any time, but more so if you know someone desperate to have a child and desperate for the NHS to fund the treatment.

But sadly , as WA just pointed out it doesn't end with the IVF (or other treatments). If it doesn't succeed, and most don't, the individual pain and self blame can mar the prospective parents for years. There are also the potential additional problems if the child is born with 'difficulties'.

I am only five foot six. I am balding. I have a curved spine. Could I expect the NHS to striaghten my back , stick 2" of leg length in ? No. And I wouldn't expect it if it were possible. There are times when we just have to accept what we are given, and get on with life - not spend large sums attempting to defeat nature, whilst taking valuable resources awway from the money pot.

Novo

"Can't it be argued that much of modern medicine is dedicated to keeping people alive who nature wants dead?"

My views are illiberal because there's a priority thing at work here.

There's talk of a new generation of cancer drugs, ones that NHS patients will never see, because they cost £50,000 a year and they only extend a patient's life for a few months. This is not seen as "a priority".

Well excuse me, but I think the needs of the living MASSIVELY outweigh the needs of the not-yet-conceived, or the not-able-to-conceive. If I've got cancer, and I'm told I have six weeks to live, or six months if only Mrs. Selfish and her husband weren't so *desperate* to have a baby, I'd be round their house with a shotgun.

Of course, the NHS is a finite resource. But I strongly feel that the priority should be improving the lives the sick who are living, not the well who are merely unable to breed. I simply don't regard infertility as an illness.

SoRB

I would rather spend money are keeping someone existing than spend money on trying to make someone exist...especially when there are people who can make people exist without spending money.

What is the overall bigger emotional effect including how many people it could affect emotionally:

a) Losing someone who you have known and has existed. Will affect dozens of people.

b) 'Losing' someone who you have never known and has never existed. Will affect one maybe two depending on how much the potential father emotionally requires a child and how much it will affect him seeing his wife being affected.

The needs of the many out-weigh the needs of the few?

OK. If we're going to be straightforward about this.

We can spend X keeping someone alive. Why? Chances are that even with treatment, they're going to be sod all use for society. £50,000 to keep someone alive in a hospital bed? Why?

Or we can spend X bringing a future taxpayer into the world, who will spend 60 years more than amply paying for the cost of his/her production.

I'm a little puzzled why IVF and people who want it should incite such ire in you, SoRB. Not just not wanting it on the NHS, but wanting prices put up artificially out of the reach of nearly everyone. There's nothing innately illiberal about having a particular opinion on resource allocation, but there is in being so dismissive of the life goals of others.

True, it's a resource allocation issue, but there's far more to those kinds of questions than just IVF. If someone finds themselves denied heart treatment or cancer treatment, I'd say that the overall level of NHS funding is more to blame, along with (perhaps) excessive profiteering by the drug companies. In any case, the people who really miss out in the resource allocation lottery are those with "unsexy" or unfashionable diseases. Like anything mental health related, or lung cancer, for example.

I don't think this should be available on the NHS, though counselling should be.

Do you *have* to talk entirely in terms of numbers and priorities?
Doesn't an individual count at all? Every time I stumble upon a debate I feel sick.
Ag and anyone else in this predicament
- and , oh, SoRB, do you have to be so insensitive?

Unfortunately the NHS is all about numbers and priorities.

Surely any policy discussion has to be about numbers and priorities?

Of course, individuals count. But when you are a government looking after lots of individuals you have to make decisions which help the majority of those individuals rather than the minority of those individuals.

As Brain said: You are all individuals (even when in a crowd) but if the overall needs of that crowd of individuals can be better served than a smaller group of individuals...who may not even die from not being served then unfortunately its the larger amount of individuals (who might die) who count.

Life can be a bitch sometimes but we have not got a bottomless pit of money.

I don't think SoRB is being insensitive, I think he's being realistic. (And on the subject of insensitivity, how many would criticise someone for being oversensitive? Not many, I feel, yet it is two degrees of the same concept.)

IVF should not be funded by the NHS, nor should breast enlargement/reduction, tattoo removal &c. Any psychological impacts of these treatments being withheld should be treated with psychotherapy. To give an analogy, if someone supported Newcastle United FC, and was depressed because NUFC hadn't won a trophy since before he or she was born, the answer wouldn't be to try and make NUFC win a trophy, it would be to relieve the person's depression. Cognitive therapy could, perhaps, make him or her realise that his or her hapiness was not dependent on the trophies that NUFC won but his or her reaction to whether or not NUFC win trophies. (I have no wish to offend Newcastle fans but it was the best example I could think of.)

If physiological intervention is unnecessary, leave it to the psychologists.

See devil? See deep blue sea?

In some ethical arguments, there's no right and no wrong.

Do cancer patients have a right to the fullest of our medical (and therefore financial) resources? Yes. We are on this earth, if anything, to ease one another's suffering.

Should those wishing to breed but medically enable to do so be assisted? Yes. We are on this earth, if anything, to continue our society. (For purposes of clarification: non-breeders also provide essential contributions to society).

Both are right, then, yes? Cancer drugs *and* IVF

Now as it happens, we don't always have the resources to support both of these desirable outcomes, and so we have to ration. For example - too many kids per family and the planet will die. BUT: In a prosperous, low-birthrate, 1st-world society, is the ethical dilemma:
a) How to share out finite medical resources?
b) How to organise ourselves so that medicine is adequately resourced? (eg equitable distribution of wealth; separation of medical development from the profit imperative).
Paradigm shift: Should we be worrying about how to get the extra money needed to pay for expensive cancer drugs and IVF?

Supplementary question:
How far do we want to take an either/or stance on this issue?
a) No medicine at all, once an individual passes an economically productive age?
b) No medical asistance, pre-natal, obstetric or paediatric, once a woman has bred enough production units to keep society economically viable?

Please - let's not pretend that either side has the 'right' answer.

"Be just if you can, and if you can't, be arbitrary." William S Burroughs.