Ms Sylvia Sherborne1, Dr Giuliana Fuscaldo1, Dr Rebecca Brown2, Dr Cesar Palacios-Gonzalez2, Dr Joanna Demaree-Cotton2
1Monash Bioethics Centre, Monash University, , , 2Uehiro Centre for Practical Ethics, Oxford University, ,
Biography:
Sylvia is a final year medical student at Monash University, having completed her Bachelor of Medical Science (Honours) in Bioethics under supervision from Monash Bioethics Centre and the Oxford Uehiro Centre for Practical Ethics in 2023. Her research interests broadly include reproductive and clinical ethics.
Abstract:
Assisted reproductive technology (ART) is increasingly sought by people experiencing medical or social involuntary childlessness. Many people view having children as a valuable life project, but ART is costly, and state funding is governed by strict eligibility criteria. Conventional health technology assessments (HTAs) use quality-adjusted life years (QALYs) to measure ART cost-effectiveness, used to make decisions about funding allocation. However, while QALYs appropriately measure health benefit, it is contended that they do not encapsulate the value ART provides beyond health-related quality of life.
This study explores public attitudes towards state funding of ART, and examines whether people view ARTs as valuable because of, or beyond their capacity for disease amelioration. We conducted a survey of UK participants using experimental vignettes to gauge willingness-to-fund in vitro fertilisation (IVF) through the National Health Service (NHS). Vignettes varied by medical or non-medical causes of involuntary childlessness and the impact of parenthood on wellbeing.
We found that IVF resulting in happiness-benefit or disease-amelioration independently increased willingness-to-fund. Most participants (83%) supported state funding IVF for both health- and happiness-benefit, while 48.8% supported funding for a happiness-benefit only and 40.9% for disease-amelioration only. Only 21.4% supported funding when neither variable benefited. Attitudes recognising the wellbeing impacts of involuntary childlessness significantly predicted willingness-to-fund.
We conclude that current funding models based solely on QALY-benefits may not fully capture the value people attribute to ART. Incorporating non-medical benefits into HTAs would align with ethical perspectives on the value of parenthood and state responsibilities to alleviate harm from involuntary childlessness.