“Who Pays? Mandated Insurance Coverage for Assisted Reproductive Technology,1” published by the American Medical Association Journal of Ethics, examines the arguments for mandating insurance coverage for assisted reproductive technology (ART) which includes in vitro fertilization (IVF). Overall, the researchers concluded, with almost palpable condescension, that while infertility is a hardship, it should not be mandated because the option of adoption is a good alternative.
Both authors, Dr. Rosoff and Katie Falloon, have carefully selected the research used to support the points they wish to emphasize. I fervently disagree with Dr. Rosoff and Katie Falloon on multiple points throughout their article and in fact, have information that would have provided a more balanced discussion to their article. Let me be bold and say, this article, as written, reads with bias, condescension, and half-truths, rather than a factual, ethical review. Being published by the American Medical Association only weakens this organization’s credibility.
Fertility Within Reach has written a five page response to this article. We are going to share our reaction this week in five separate blog posts.
Retort #1: Infertility and Adoption
Let me first acknowledge, adoption is an excellent family building option. I have close friends and family members who have built their families through adoption. For those who choose to adopt and are able to, it is a true gift of life. My appreciation for the option of adoption is where the commonalities between my viewpoints and those of the authors, Dr. Rosoff and Katie Falloon, end. As mentioned above, adoption can be a great option, but it is not for everyone. Adoption can also be costly, sometimes more than the expense of fertility treatment. According to the U.S. Department of Health and Human Services, Administration for Children and Families, the cost of adoption can range from $0 – $40,000 (including domestic and international adoptions)2. The variable expenses depend on the type of adoption (public agency vs. private), where you adopt from (foreign vs. domestic), what benefits are provided from an employer, and what legal support is required. The costs can be even more if the adoption process ends before the finalization and the intended parents must begin again.
Dr. Rosoff and Katie Falloon believe, “To make a convincing case for government mandated coverage, one would have to argue that medicine (through ART) offers a means to parenthood that is superior to the nonmedical means (through adoption). They go so far to say the surveyed results as to why couples do not want to adopt “are misguided”. Their judgment of the validity of the personal preferences expressed by couples in the survey is subjective. The authors naively describe adoption as merely filling out forms and yet, able to provide higher success rates than IVF. They do not address the fact that adoption can be more costly, involve home studies, probable travel and significant legal protocols. In addition, adoption possesses a lengthy time factor with unguaranteed results. For example, some states allow birthparents up to six months to change their minds, hardly a guarantee. A similar uncertainty may arise when children are adopted from foster care, since, according to the Department of Social Services3, the permanency plan for these children places the highest priority on reunification with natural parents. These authors characterize infertile couples who do not want to adopt as “misguided”, yet they do not present a complete picture of what can be involved in adoption within their article which serves to misguide their readers.
Retort #2 coming tomorrow
About the authors:
Davina Fankhauser, MA is the co-founder and President of Fertility Within Reach, a national non-profit organization which helps patients gain access to infertility health benefits to treat their medical condition in a timely and appropriate manner. She works collaboratively with medical professionals and organizations to bring accurate information to patients, employers, insurers and legislators. Davina lobbied at the Massachusetts State House and saw the successful passage of an update to the medical definition of infertility within the state. She also testified before the Massachusetts Division of Insurance to request Oocyte Cryopreservation be a required benefit of infertility. Working with medical directors, she presented recommended Oocyte Cryopreservation guidelines to insurers. These companies are now offering Oocyte Cryopreservation to infertility patients as well as patients facing medical treatments which will render them infertile.
Katie Falloon is a second-year medical student at Duke University School of Medicine in Durham, North Carolina. She graduated magna cum laude from Yale University with a degree in English.
Philip M. Rosoff, MD, MA, is a professor of pediatrics (oncology) and medicine at the Duke University School of Medicine and Duke University Medical Center in Durham, North Carolina. He is also chair of the center’s ethics committee and a member of the Trent Center for Bioethics, Humanities and History of Medicine. His research interests and scholarly work are in the area of medical resource allocation, especially rationing. His book Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare will be published in spring 2014 by MIT Press.
- Virtual Mentor. January 2014, Volume 16, Number 1: 63-69.
- Child Welfare Information Gateway. (2011). Costs of adopting. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau. Retrieved from https://www.childwelfare.gov/pubpdfs/s_costs.pdf
- Koller, Lillian B, Foster Care Services. (n.d.) South Carolina Department of Social Services, Retrieved from https://dss.sc.gov/content/customers/protection/fcs/index.aspx
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