title: Assisted reproduction and distributive justice.
abstract: The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization (IVF). The province of Ontario recently de-insured IVF. Both provinces cited cost-effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights-based and needs-based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance-based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means-tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy-makers alike.
authors.forename: Vida
authors.initials: V
authors.lastname: Panitch
mesh_terms: D002170:Canada; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics / Q000941:ethics; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D009864:Ontario; D011792:Quebec; D046269:Reproductive Rights / Q000191:economics / Q000941:ethics / Q000592:standards; D027724:Reproductive Techniques, Assisted / Q000191:economics* / Q000941:ethics*
keywords: assisted reproduction; basic needs; contractarianism; distributive justice; health policy; in vitro fertilization; right to reproduce