Infertility and the NHSBMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7020.1586 (Published 16 December 1995) Cite this as: BMJ 1995;311:1586
- Donald Evans
- Director Centre for Philosophy and Health Care, University of Wales Swansea, Swansea SA2 8PP
Purchasers should avoid the moral high ground
New medical technologies have dramatically changed the prospects for infertile couples. A couple attempting in vitro fertilisation has nearly a 40% chance of achieving a live birth over three treatment cycles in 12 months.1 Yet relatively few people who could be helped by medicine to achieve their own biological families can obtain this help from the NHS. The latest figures from the College of Health, a patient interest group, show that in 1994 almost a quarter of health authorities in Britain refused to purchase in vitro fertilisation services and over a third refused to purchase gamete intrafallopian transfer services.2 There are three related issues pertaining to this startling shortfall in provision.
Firstly, the type of treatment that most health authorities provide reflects the underlying assumptions about infertility. Only one treatment--tubal surgery--seeks to cure infertility. Others (artificial insemination by husband, donor insemination, in vitro fertilisation, and gamete intrafallopian transfer) aim to produce a pregnancy but leave the couple as infertile afterwards as they were before. These interventions treat not infertility …