School of Population Health, The University of Adelaide, Adelaide, Australia 5005.
J Bioeth Inq. 2013 Mar;10(1):79-91. doi: 10.1007/s11673-012-9415-6. Epub 2013 Jan 4.
Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice-the capacity to benefit, personal responsibility, and need-to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice.
是否应对公共资金用于辅助生殖技术 (ART) 的女性年龄设限？这个问题具有重大的经济和社会政治影响，在许多国家都存在争议。我们将这个问题视为资源分配公正的问题，使用三个备受争议的公正实质性原则——受益能力、个人责任和需求——来构建和探讨一系列论点。受益能力论点不具有决定性：没有明确的成本效益依据将资金限制在那些仍然有一定能力从 ART 中受益的年长女性身上。个人责任论点受到晚育的结构性决定因素的挑战。需求论点也不具有决定性：它们可以支持或反对对女性年龄设限，具体取决于所使用的需求概念。我们展示了这些原则不仅在内容上而且在政府赋予它们的相对重要性上都可能存在差异。从这一角度出发，我们可以更好地理解辅助生殖技术公共资金政策的广泛差异。最后我们进行了一些国家间的比较。新西兰和瑞典的政策异常透明，因此特别清楚地展示了我们所探讨的论点是如何付诸实践的。
