Carolyn McLeod and Andrew Botterell question the Ontario government’s commitment to equal access to fertility treatments and adoption.
Recently, the Ontario government announced a plan to increase access to both in vitro fertilization and adoption services. It proposes to fund one cycle of IVF per patient with single embryo transfer. It also intends to implement measures that will make it easier for people wanting to adopt children to find relevant information, and to provide “new subsidies to eligible families” wishing to pursue a public domestic adoption of a child 10 years of age or older.
Unfortunately, this plan will not ensure that there will be equal access in the province to fertility treatments and adoption (whether private or public, domestic or international). An expectation that access to these services be equal is morally justified, in our opinion. It is also central among the expectations laid out in Raising Expectations: the 2009 report of Ontario’s Expert Panel on Infertility and Adoption.
At a minimum, equal access to these services is determined by two factors: funding and eligibility requirements. If the government funds IVF and other fertility treatments more than it funds adoption, then access will be unequal. Similarly, if the government imposes very few eligibility requirements for fertility treatments (e.g., there need only be evidence of medical or social infertility) but continues to impose arduous requirements for adoption, then access will be unequal.
While there are certainly questions about whether the Ontario government’s recent announcement reflects a commitment to equality of economic access to fertility treatment and adoption, we focus here on equality of access based on eligibility.
At the moment, to be eligible for an adoption in Ontario, one must complete a home study and participate in 28-32 hours of mandatory parenting classes. The home study involves various background checks (criminal, medical, financial, etc.) and must be updated every two years (and for each new adoption). The process is time consuming, expensive, and emotionally draining.
By contrast, currently there are no mandatory background checks or parenting classes for people who pursue IVF or other forms of fertility treatment. This situation, in our opinion, is unjustified. While some will say that parental vetting is inappropriate in the context of reproduction, arguably that is true only when the state would be interfering in “the bedrooms of the nation” (to quote former Prime Minister Trudeau) or would be denying people’s entitlement not to undergo forced sterilizations, or the like. Parental vetting in the context of assisted reproduction would require neither of these things. At most, it would involve state interference in the fertility clinics of the nation (or province), which are soon to receive substantial public funding.
Moreover, dispensing with a requirement of parental vetting for assisted reproduction is especially problematic when the government underwrites these services. The reason for this is that such assistance directly implicates the government in any improper use of these services. Consider, for example, a patient who has psychiatric issues significant enough to compromise her ability to parent a child, or who has a criminal record of child or domestic abuse. If the government indirectly assists her in creating a new life by subsidizing fertility treatments, then it also acquires an obligation to ensure that any child(ren) thereby created is/are likely to have good—or good enough—parents. And this is precisely what parental vetting is designed to achieve (which is not to say that it always does so successfully or in a way that is fair).
These are not mere academic quibbles. Consider, for example, the case of a Quebec woman who underwent successful IVF treatment at the McGill Reproductive Centre only to have her child removed from her care when it was later determined that she was unfit to parent the child.
Or, consider an Ontario case from 1982. There, a couple’s application to adopt was rejected by their local Children’s Aid Society on the grounds that the male partner was of advanced paternal age and had a physical disability. Denied the opportunity to adopt, this couple pursued contract pregnancy (or ‘surrogacy’) instead. Notwithstanding the fact that their local Children’s Aid Society had determined they were not suitable parents for the purposes of adoption, they succeeded in hiring a woman to gestate a child and became that child’s parents.
To be fair, in the Ontario case, we might question the validity of the reasons given for rejecting the couple’s original application to adopt. But this does not affect the underlying ethical issue. This and similar cases indicate that individuals seeking to become parents via IVF or other forms of assisted reproduction should be subject to justified forms of parental vetting, especially where the state subsidizes the means by which these individuals become parents.
The Ontario government’s announcement makes no mention of eligibility requirements for IVF, although it does refer to the establishment of an advisory body that will “review program implementation details.” In our view, this body should recommend parental vetting requirements similar to those currently in place for adoption (or at the very least, it should require medical and criminal background checks for people who receive publicly-funded fertility treatments). If the government fails to impose such requirements on patients of fertility clinics, then equal access in Ontario to the opportunity to build a family via fertility treatment or adoption will be illusory.
Carolyn McLeod is Associate Professor of Philosophy at Western University. In 2013-14, she is Visiting Professor at the Centre for Ethics at the University of Toronto.
Andrew Botterell is Associate Professor of Law and Philosophy at Western University. In 2013-14, he is Visiting Professor at the Centre for Ethics at the University of Toronto.