Blake Valarie K
Bioethics. 2018 Oct;32(8):527-533. doi: 10.1111/bioe.12506. Epub 2018 Aug 31.
The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible.
美国首例子宫移植（UTx）婴儿已成功诞生，该手术正迅速成为子宫因素不孕症（UFI）患者可行的临床选择。这引发了一个实际的伦理问题：健康保险公司是否应为子宫移植提供资金，以及在做出这一决定时应考虑哪些问题？本文阐述了在美国决定是否为子宫移植提供资金时的一些影响因素，包括必须涵盖哪些手术、子宫移植更类似于器官移植还是不孕症治疗（在美国这两者的待遇不同）以及该手术的益处和替代方案。然后，本文探讨了关于为何应为子宫移植提供资金，或者至少应与其他重要医疗需求一并考虑的观点。本文认为，子宫移植应与其他对医疗服务的竞争性需求一并考虑。在那些慷慨覆盖其他不孕症服务的国家，当医疗保健系统涵盖受孕服务时，为实现妊娠的医疗服务提供保险可能在逻辑上是合理的。然而，在美国，许多群体长期以来在不孕症及更广泛的医疗保健方面面临着医疗服务获取不足的问题。在美国，在子宫移植被视为在财政或政治上可行之前，可能需要使医疗保健更加广泛地公平。
