The appeal to nature implicit in certain restrictions on public funding for assisted reproductive technology

Bioethics

Volumn 25, Issue 8, 2011, Pages 463-471

  Carter, Drew ^a   Braunack Mayer, Annette ^a  

^a UNIVERSITY OF ADELAIDE   (Australia)

Author keywords

Appeal to nature; Assisted reproductive technology; Equity of access; Medical infertility; Philosophy of medicine; Social infertility; Wittgenstein

Indexed keywords

ADULT; ARTICLE; ECONOMICS; ETHICS; FEMALE; HEALTH CARE DELIVERY; HUMAN; HUMAN CHARACTERISTIC; INFERTILITY; INFERTILITY THERAPY; MALE; MEDICAL CARE; ORGANIZATION AND MANAGEMENT; PHILOSOPHY;

ADULT; ELIGIBILITY DETERMINATION; FEMALE; HEALTH SERVICES ACCESSIBILITY; HUMAN CHARACTERISTICS; HUMANS; INFERTILITY; MALE; MEDICAL ASSISTANCE; PHILOSOPHY, MEDICAL; REPRODUCTIVE TECHNIQUES, ASSISTED;

EID: 80053012497     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2011.01925.x     Document Type: Article

References (31)

1. South Australia's 'infertile' has been interpreted to mean this while Western Australia specifies 'medical reasons'. SA, ASSISTED REPRODUCTIVE TREATMENT ACT 1988 - SECT 9(1)(c)(i-ii); WA, HUMAN REPRODUCTIVE TECHNOLOGY ACT 1991 - SECT 23
2. Vic, ASSISTED REPRODUCTIVE TREATMENT ACT 2008 (NO. 76 OF 2008) - SECT 10(2)(a)(i-ii).
3. Carol Nader. 2007. No Medicare for Lesbians' IVF. The Age 19 Dec.
4. Assisted Reproductive Technologies Review Committee. Report of the Independent Review of Assisted Reproductive Technologies. Australia: Commonwealth Department of Health and Ageing: 43.2006
5. Håkan Lindström & Susanne Waldau. Ethically Acceptable Prioritisation of Childless Couples and Treatment Rationing: 'Accountability for Reasonableness'. Eur J Obstet Gynecol Reprod Biol 2008; 139: 176-186
6. O. Rauprich, E. Berns & J. Vollmann. Who Should Pay for Assisted Reproductive Techniques? Answers from Patients, Professionals and the General Public in Germany. Hum Reprod 2010; 25(5 1225-1233
7. Philipa Mladovsky and Corinna Sorenson review observed rationales: ART should be publicly funded because: (1) infertility is a disease or medical condition; (2) ART meets a 'medical need'; (3) ART fulfils a human right; (4) health inequalities are inequitable; and (5) publicly funded ART will increase a country's Total Fertility Rate and reduce population ageing. In our view, the first four rationales conceptually reduce to questions concerning the second, while the fifth, Mladovsky and Sorenson stress, 'needs to be treated with caution, not least because there is very little experience with it and minimal supporting evidence'. Philipa Mladovsky & Corinna Sorenson. Public Financing of IVF: A Review of Policy Rationales. Health Care Anal 201018: 113-128.
8. M.M. Peterson. Assisted Reproductive Technologies and Equity of Access Issues. J Med Ethics 2005; 31: 280-285
9. Maurice Rickard. 2001. Is It Medically Legitimate to Provide Assisted Reproductive Treatments to Fertile Lesbians and Single Women? Australia: The Department of the Parliamentary Library. Available at: [Accessed 1 Nov 2010
10. A Closer Look at Reproductive Technology and Postmenopausal Motherhood. CMAJ 1996; 154(8): 353-355.
11. For such a list, see Mladovsky & Sorensen, The last phrase borrows from Norman Daniels. 1985. Just Health Care. Cambridge: Cambridge University Press.117-119.
12. Andrew Dutney. 2001. Playing God: Ethics and Faith. East Melbourne, Vic: HarperCollinsReligious.
13. We do not see that a retreat from the 'natural' to the 'normal' is much of one at all. The same connotations or morally normative dimensions can exist in both talk of the natural and talk of the normal.
14. Eleni Hale. 2009. AMA President Dr Andrew Pesce Says Gay People Should Not Have IVF. News.com.au 2 Aug. Available at: [Accessed 1 Nov 2010].
15. Our emphasis. Marcus Aurelius. Meditations. Translation and notes by Martin Hammond. London: Penguin23. 2006
16. P. Singer & D. Wells. In Vitro Fertilisation: The Major Issues. J Med Ethics 1983; 9: 192-199
17. Singer would later argue that people fundamentally aim at the satisfaction of their preferences. The views of Aurelius and Singer and Wells are reconcilable if our ends are conceived as natural.
18. Alternatively, we may wish to assert that they are more important than regard for whatever may be natural.
19. Michel Foucault opposed all conceptions of what is natural to human beings (all conceptions of human nature) precisely because he took them to 'straightjacket'. He took them to limit, via universalizing norms of behaviour, the full range and depth of potential belonging to human individuality. See Christopher Cordner. Foucault and Ethical Universality. Inquiry200447580-596.
20. Our emphasis. Tom Frame. Children on Demand: The Ethics of Defying Nature. Sydney: New South:2008
21. Victor Hugo. 1994. Les Misérables. Introduction and notes by Roger Clark. Hertfordshire: Wordsworth Editions Limited: 2: 606
22. Following Wittgenstein, Raimond Gaita has argued that remorse need not depend upon, or merely attend, some acknowledgement of wrong-doing: rather, remorse can be (or take the form of) precisely such acknowledgement. A great deal can be made of the difference between acknowledgement (or recognition) and ascription, but in this paper we do not enter into it. See Raimond Gaita. Good and Evil: An Absolute Conception. 2 edn. Abingdon: Routledge: ch. 4.2004
23. For instance, see Daniel Sokol. Sokol implies that all moral intuitions must be externally justified, 'underpinned by solid reasons'. This is contested by, among others, Raimond Gaita and Christopher Cordner. Daniel Sokol. 2010. What Is Society's Problem with Elderly Mothers? BBC News 26 Jan. Available at: [Accessed 1 Nov 2010].
24. The same charge might conceivably be made against any pair composed out of the beautiful, the true, the good, and the healthy.
25. Norman Malcolm. 1984. Ludwig Wittgenstein: A Memoir. 2nd edn. Oxford: Oxford University Press: 58.
26. Ludwig Wittgenstein. 2001. Philosophical Investigations. Translated by G.E.M. Anscombe. Oxford: Blackwell Publishing
27. Plato. 1969. The Last Days of Socrates. Translated by Hugh Tredennick. Harmondsworth: Penguin Books Ltd: 10.
28. To Wittgenstein, such overlapping in meaning appeared ongoing and open-ended as we continued to speak and live. Threads of meaning are not static but transforming to varying degrees as we live with language. To use a different simile, Wittgenstein principally likened a word's different meanings to family resemblances. No one trait appears to be common among all the members of a family: certain members share some traits while other members share different traits. Just as a family exhibits different traits, a word exhibits different meanings.
29. Our emphasis. Cora Diamond. Rules: Looking in the Right Place. In Wittgenstein: Attention to Particulars: Essays in Honour of Rush Rhees (1905-1989). D.Z. Phillips & Peter Winch, eds. Houndmills: Macmillan: 14-15.1989
30. 'un-natural, adj. (and n.)'. OED Online. June 2011. Oxford University Press. Available at: [Accessed 21 July 2011
31. Michael Bess expresses basic support for our position when he writes 'We need to. acknowledge that some distinctions [like "x is more natural than y"] will wind up relatively straightforward and satisfying, whereas others will leave us with a frown of nervous compromise and approximation.'Michael Bess. Enhanced Humans versus 'Normal People': Elusive Definitions. J Med Philos 2010; 35: 641-655