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

>>The daily mail reader in me would prefer a system based on the relative health of your lifestyle. The self preservationist in me wouldn't. Plus, It's not as logistically neat as your idea - working out the degrees of damage you'd done to yourself and the level of seriousness and so on would be a bureaucratic nightmare, although since this is the NHS we are talking about.... Mind you, isn't that the situation in the States. I assume that insurance is based on some kind of health assessment.

Yeah...its a non-starter on many levels. When this idea is raised, everyone immediately thinks of fags, booze, burgers, drugs. But then you look at all the young men receiving extremely expensive i/c care following head injuries. Maybe we need a debate about bikers paying more, but I don't feel its a particularly productive route to go down.

Of course, poverty is also correlated with negative health factors. Fags, booze, burgers, drugs. Also mental ill health. And pedestrian road traffic accidents (a *big* correlation that one!). I suppose we *could* start rationing by wealth, but we partly stopped that in 1945 and I kinda hope we don't go back to it.

Etc. etc.

Still, though, old people vs women vs vs stupid people. Shouldn't really be a contest, should it?

Actually, the problem with the stupid people one is that once you get that the next on the list could well be genetic issues - which I assume is definitely similar to the US, as surely you are harder or more expensive to insure with inheritable disorders in the family. In fact, dear god, I am arguing for the Staside healthcare system aren't I? Right, I'll shut up now.

Count Zero, I believe that you're referring to the outcome measure the Quality Adjusted Life year, aka the QALY

http://www.nice.org.uk/newsroom/features/measuringeffectivenessandcosteffectivenesstheqaly.jsp

In general £30 000 per QALY is the upper limit.

But if infertility treatment creates life:

Each IVF cycle has a 1 in 4 chance of success, and costs £2000, therefore each IVF pregnancy costs £8000. But that gives you a baby, and a baby will hopefully have 70 years of life, so that only £114 per QALY.

But then there's the benefit to the mother and father, assuming that the baby will bring an extra 20% of joy to their lives for 20 years, you get an extra 8 years of QALY for that. Which means that it's only £102 per QALY. Which is a bargain.

What I'm still not getting is why this "illness", which I may well suffer from but am never likely to find out, is something we should spend money on "curing" for people who've already had kids.

Seriously - fully half the people I've known who've had IVF have been people who already had at least one child, and wanted another. I can think of no justification for this AT ALL.

I'd be prepared to entertain the idea that a woman would become irretrievably mentally scarred if she was unable to perform the one thing she believes society thinks she's any good for. I'm not sure we should pander to that, but people who already have kids???

yes I do sort of agree twiggster,
if a couple already has a child or children should they be given ivf on the nhs
I think I would answer no, you already have a child the treatment should be saved for those who have no children
but equally I would prioritise married couples to single parents and healthy parents to disabled ones,
so my feelings on this are probably wrong

You *may* be right that more than half of IVF candidates already have children - but in the interests of science I'd prefer to see a survey based on a wider sample than your acquaintances.

I'm prepared to accept, though, that those who already have children should have lower priority than those who haven't. (and I'd be surprised if that isn't the general NHS assumption anyway. in which case why restate the obvious?). This isn't to say that successful parents are fundamentally batty to expect their IVF to be funded - they may have their emotional reasons - but I'd have to decide whether to sympathise on a case-by-case basis.

Still, I'm glad you've moved on to this Special Case from your original, blanket IVF Is For Losers stance. It's a tacit admission, perhaps, that you started to get the point that at least *some* might legitimately feel entitled?

But then...

>>I'd be prepared to entertain the idea that a woman would become irretrievably mentally scarred if she was unable to perform the one thing she believes society thinks she's any good for.

You do love your parodic distortions, don't you?

Dunno. Maybe that sentence was written by someone who's never discussed the issue with a woman who's been unable to have children. Let's just call it....unsympathetic. Now that's fine - you're entitled to your lack of sympathy. But if its based on an unwillingness or inability to empathise with another's position it may mean that you're lacking the data you need to be taken seriously.

Dr A:

Leaving aside Married Couples vs Unmarried Couples vs Civil Partnerships...

Disasbled? How are you defining that?

My starting point on Fertility Issues is that if someone with working reproductive organs can do it, then someone with faulty reproductive organs should get help if they want to do it.

We don't police the bedroom activities of disabled people. We should not limit their access to IVF.

Ah, some may be thinking, but are the disabled people capable of looking after a child? Well...we don't stop disabled people having children unassisted. Instead we provide them with whatever help they need to ensure their child's wellbeing.

No IVF was required to create this (wonderful!) statue:

http://www.toptenz.net/top-10-most-controversial-statues.php/alison-lapper-pregnant

I'm not saying that a disability should prevent you from being able to have children, or that disabled people don't make as good a parent
but if someone's argument is that ivf should only be for the rich then why not only for the able bodied and minded among us too

Eh?

Only the rich should get it on the NHS? Or only the rich will get it because it won't be on the NHS? But being disabled doesn't automatically mean you can't be rich and... I don;t follow the connection.

I think I've slightly confused myself,

the rich certainly shouldn't get it on the nhs but you can't very well deny them and create a tiered system with private health care and the nhs only for the impoverished it wouldn't work we would end up like america, well perhaps not quite that bad


I wasn't saying disabled people can't be rich,
my point was meant to be along the lines of if we are going to discriminate against one group of people why not all groups of people, you can't simply say you can't have this treatment because you've got a child, or your not wealthy enough, or you and your children are unlikely to give enough back to society for it to be worth our while
the nhs already discriminates in some cases with a sort of postcode lottery, isn't that bad enough?

No way can the whole of any society have what it is they assume to be their rights. In any event the whole issue of rights, politically, morally or emotionally becomes an attempt to hit a moving target. What's right for the goose will never be right for the gander.
The compromise has to be that no individual has the right to have any more than another.
It's needs that have to be resolved before rights are even considered.

>>No way can the whole of any society have what it is they assume to be their rights. In any event the whole issue of rights, politically, morally or emotionally becomes an attempt to hit a moving target. What's right for the goose will never be right for the gander.<<

I disagree: not all rights are zero sum. Political participation, freedom of assembly, right to an education don't conflict with the rights of anybody else.

@HI (it is you with the Dylan Thomas, yeah?)

Agreed. There is a clear distinction between inalienable rights and contingent rights. This distinction is not only made by political philosophers but is made explicit in the stunningly practical document that is the Human Rights Act. Anyone who doesn't already get these things would benefit from some light reading. The HRA is not a difficult document.

Dr A:

>>the rich certainly shouldn't get it on the nhs


I somewhat disagree. The rich very much *should* get the same treatment as anyone on the NHS, free at point of provision. But they should pay proportionally more for it under a system of progressive taxation.

I'll stick my neck out further. I'm somewhat inclined to the view that the rich should *only* be able to receive treatment from the NHS, private medicine being a societal evil. I doubt I can get that one enforced, mind.

Now why doesn't that surprise me.

OK. If fertility treatment isn't available on the NHS, then I think that people should be able to pay for it.

Given that £2000 the cost of 1 cycle of IVF is around the amount that many people spend on a car, and considerably less than the average cost of a wedding, is it not a sum of money that is only available to the very rich, but is really within the reach of those on an average income.

>> but is really within the reach of those on an average income.


But less affordable for 50%, obviously.

OK - assuming that IVF were not available on the NHS, I concede that private provision would be the Best Awful. But that applies to any treatment currently available.

*waits for Eds post to appear*