Abstract

The aim of this work is to argue that because of the inadequacies of in vitro fertilization assessments, policy makers have made decisions about fertility treatments that may not be in the public's best interests. I focus on four IVF reports produced by-institutional committees, respectively, in Australia, Spain, the United Kingdom, and the United States. Attempting to provide constructive criticism of the inadequacies of these evaluations, I suggest some possible ways to overcome or ameliorate them. First, I show that evaluations of IVF are inadequate because, in ignoring epistemological and ethical problems such as choosing criteria for decisions under uncertainty, assessors have overlooked the possibility of jeopardizing women's health. I argue that evaluators have erred in their analyses because, underestimating both the existing scientific evidence and the insufficiency of data on IVF safety and effectiveness, they have condoned the use of IVF. Thus, they have implicitly sanctioned questionable criteria for deciding in a situation of scientific uncertainty. They have preferred to minimize false positives over false negatives. As a consequence, many women may be exposed to needless risks. Likewise, I show that, in sanctioning the expansion of IVF to an increasing number of reproductive conditions, assessors also have implicitly condoned questionable criteria for making decisions under uncertainty. Second I argue that IVF assessments are problematic because they might have encouraged public policies that disregard the common good. I show that evaluators of IVF have erred in their analyses because, in presenting the problem of infertility as primarily an individual one, they have underestimated the role of social, ethical, and political solutions, such as prevention in solving reproductive problems. Undervaluing these kinds of solutions is, however, problematic because it may underemphasize social influences on, and the community's responsibility for, the well being of its members and may foster unfair discrimination against women. Furthermore, I argue that IVF assessors have failed in their analyses because, in assuming too broad a definition of 'infertility', they may encourage people to use IVF needlessly. Thus, assessors seem to have conceded more importance to individuals' desires to have children than to problems of the common good. However, unnecessary use of IVF may threaten the common good because it might influence governments to increase needlessly the amount of resources dedicated to this technique. Promoting excessive funding of IVF is problematic because IVF and related technologies are expensive procedures. Given that health resources are scarce, allocating money for IVF could prevent the funding of other health-care measures that might be equally or more important. Finally, I argue that assessors of IVF have failed because their evaluations might encourage public policies that jeopardize women's rights to free informed consent. I claim that because evaluators have underestimated problems with disclosure of information and with voluntariness their analyses may compromise women's opportunities to give free informed consent