August 15, 2011 | Posted By David Lemberg, M.S., D.C.

Distributive justice does not imply that everyone should have equal access to everything all the time. This would be an extreme position and lead to severe distortions in availability of medical services. Competing needs must be balanced fairly and opportunities to access medical care must be equitable. In the American health care marketplace, however, the bioethical principle of distributive justice receives lip service only. In America, when it comes to health care, minimal attention is paid to matters of fairness.

For example, assisted reproductive technologies (ART) have been generally available since the early 1980s. In recent years more than 100,000 in vitro fertilization (IVF) procedures are performed annually. But IVF costs — typically ranging between $15,000 and $25,000 — are rarely covered by insurance plans. Infertile couples wishing to have children need to pay for IVF out of their own pockets. National statistics indicate that for women younger than age 35, 41% of IVF procedures result in a live birth. For women between ages 35 and 37, 31% of IVFs result in a live birth. So it’s likely that many couples will need to undergo at least two rounds of IVF, spending a minimum of $30,000 and possibly more than $50,000 in attempts to have a family.

As the median household income in the United States was approximately $50,000 in 2008, it’s obvious that very few families can afford what reproductive medicine has to offer. This harsh reality implies that the vast majority of families that could benefit from ART are denied access because the procedures are out of reach financially. Infertile couples in the middle and lower economic classes may be working two jobs and contributing substantially to the welfare of their communities, but still have no chance to flourish as a family and raise children of their own.

This is economic favoritism of the worst kind. The rich get richer, literally. It’s a simple calculus. If you’re an infertile couple with plenty of discretionary capital, you can undergo IVF and have a child. Infertile couples who can’t afford the price of admission are out of luck. Fertility clinics accept cash, checks, and credit cards. Their front desk people are happy to “discuss financing options” with potential clients. But if you don’t have sufficient funds you shouldn’t even bother showing up for the first appointment. The fertility business is a prime example of the transformation of American medical priorities from patient care to financial transactions.

Distributive justice doesn’t mandate that all infertile couples have equal access. But the principle does require that some couples without the financial wherewithal be able to undergo IVF. Fertility clinics should be required to provide a specific minimum of annual pro bono procedures. Federal funds should be available to provide IVF services to additional couples. Access to funding could be based on a national lottery. There are many solutions. What’s needed is the will to put some flesh on the bones of distributive justice. It’s the right thing to do.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.