10/8/99
9:54 PM BST
Ann BradleySterile debateHealth ministers must have thought it was their birthday and Christmas come at once when mother-of-sextuplets Jean Gibbon was discovered to be a single mum.Two weeks earlier health ministers had been pilloried by every infertility specialist within reach of a TV studio. Support groups and campaigning organisations had used National Fertility Week to expose the diabolical provision of infertility services in the UK. In France women are entitled to four state-funded cycles of IVF (in vitro fertilisation) as a right, plus another two at the discretion of their con-sultant. Here, women across much of the nation (including London) have no access to NHS provision at all. The infertile have to shell out around £1800 a go for IVF with only a slim chance of it working. A national disgrace. Politicians said it. Doctors said it. Psychotherapists said it. Articulate women were paraded to explain the agonies of childlessness. One specialist got so carried away he declared that infertility provision was more important than cancer treatment. It takes all sorts.... But within two weeks the birth of the Leeds sextuplets had changed everything. The worm had turned, problems of getting infertility treatment were forgotten and everybody was attacking doctors for rashly providing IVF with no thought to the consequences. Why the change of heart? The plight of nicely spoken, educated, middle class but barren couples talking of their longing for a child tugs at the heart strings. After all they have so much to give. On the other hand, the birth of six infants to Jan Vince and Jean Gibbons, a working class, unmarried, pair of divorcees who don't even live together raises different issues entirely. When the media and political circus discussed the Leeds sextuplets the issue was not one of how much did the parents have to give - but how much were they trying to take. They were pilloried for having an agent with a brief to sell their story to a national newspaper and they were castigated for the amount that it would cost the state to raise their six children. The health correspondent of the Daily Telegraph calculated that Jean Gibbons would receive 'at least £45 000 in benefit over the next 16 years'. There was not just the cost to the nation to be considered, but the emotional cost to the children of being born to such inadequate and unconventional parents. Tom Sackville strutted on the stage to threaten new guidelines if there was widespread evidence that people 'without a stable family background' were receiving infertility treatment on the NHS. And the very consultants who two weeks earlier had pleaded for more resources now lined up to insist that they really did very, very little infertility work at all. And when they did it was only after vetting couples very closely. Health authorities competed to look the toughest at screening 'unsuitables'. The head of the IVF unit at St Mary's Hospital, Manchester bragged that his hospital only treated childless heterosexual couples who had been in a stable relationship for three years. West Essex Health Authority topped that with four years. The Leeds sextuplet case should have served as an example of what National Fertility Week had tried to illustrate earlier in the month: the inadequacy of the service. Champion of the infertile, Professor Robert Winston shone as the one light of common sense when he insisted that to use the Leeds case as an illustration of an abuse of the system was bizarre. Regardless of the parents' marital status, the very creation of sextuplets was a disaster for everybody concerned. You can bet your sweet life that given the choice Jean Gibbons would rather have conceived one child than half a dozen. It was adisaster which could only have happened because of the primitive way in which services are managed in many hospitals. With proper monitoring the treatment she was undergoing would have temporarily halted when it became clear she was at risk of a multiple pregnancy. But as Winston explained to a largely uncomprehending press, 'In the NHS doctors work with grossly limited and inadequate resources. Short cuts have to be taken'. Instead of being highlighted as an argument for a better health service, Jean Gibbons' case was widely used to reinforce the point that NHS resources should only be available to the 'deserving', defined as those who not only have an illness which by general consensus requires treatment, but also a way of life considered worthy of public support. When Tim Yeo MP declared that 'there are serious questions about why such treatment should be provided to a woman who is not married', the only objections were to his use of the adjective 'married'. Nobody seemed to question the fact that the medical profession and by proxy the government should have the right to impose moral criteria for assessing who should and should not have access to NHS resources. Game, set and match to the government. Once this principle is established all kinds of provision can be denied on the basis that the recipients are not deserving. There are already doctors who give smokers lower priority than non-smokers because they have contributed to their illness. How long before we have to lose weight, swim every day, and be married and monogamous for 10 years in order to sign on with a doctor? On what criteria will doctors decide who is deserving of Hormone Replacement Therapy, hip replacements or heart by-passes? The government's economic problems mean that public spending is being squeezed hard. By introducing a discussion about who does and doesn't deserve the limited resources available, the authorities pose the provision of care as a moral problem of who deserves it - rather than a discussion of why the resources are not available to all. We should have none of it. Jan Vince and Jean Gibbons should be entitled to infertility treatment without the humiliation of being vetted to make sure their lifestyle is suitable. Doctors should be doctors not vets. Reproduced from Living Marxism issue 57, July 1993
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