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What can European Principlism Teach about Public Funding of IVF? The Israeli Case

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Abstract

Fertility treatments, which are part of "assisted reproductive technologies" (ART), mainly undertaken through in vitro fertilization (IVF), offer the opportunity to infertile couples to conceive. IVF treatments are undertaken in Israel in significantly higher numbers than in the rest of the world. As such, Israel provides an important case-in-point for examining the validity of the actual claims used to justify the more generous public funding of IVF treatments at the policy level. In this article, we utilize an analytical philosophy approach to conduct this examination. First, we highlight two fundamental concepts that were used at the Israeli public policy level in order to justify the generous public funding of IVF treatments. These concepts are “emotional vulnerability” and the “worthlessness of the childless,” where the latter emphasizes the infinite value of children. Then, by applying the perspective of the European model of Bioethical Principlism, and focusing the attention to these two concepts we show that these justifications are invalid. Specifically, it is suggested that these concepts are on the one hand both relying on and expressing the principles of vulnerability, dignity, and integrity; yet on the other hand, these concepts are also undermining the very principles of bioethics they are supposed to express and rely on. Based on this suggested criticism, we offer two “take home” messages informed by our analysis of the Israeli case, but reaching beyond it.

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References

  • Almog, O. 2000. The Sabra: The creation of the new Jew. University of California Press.

  • Ashcroft, R.E., A. Dawson, H. Draper, and J. McMillan. 2007. Principles of health care ethics: Wiley.

    Google Scholar 

  • Beaney, M. 2016. Analysis. In The Stanford encyclopedia of philosophy: Metaphysics research lab, edited by E.N. Zalta. San Francisco: Stanford University.

    Google Scholar 

  • Beauchamp, T.L., and J. Childress. 2008. Principles of biomedical ethics, 5th ed. New York: Oxford University Press.

  • Birenbaum-Carmeli, D. 2004. “Cheaper than a newcomer”: On the social production of IVF policy in Israel. Sociology of health & illness 26 (7):897-924.

    Article  Google Scholar 

  • ———. 2007. "Contested surrogacy and the gender order: an Israeli case study." Journal of Middle East Women’s Studies 3(3): 21–44.

    Article  Google Scholar 

  • ———. 2009. The politics of ‘‘The Natural Family’’ in Israel: State policy and kinship ideologies. Social Science & Medicine 69(7): 1018–1024.

  • Birenbaum-Carmeli, D., and Y.S. Carmeli. 2002. "Physiognomy, familism and consumerism: preferences among Jewish-Israeli recipients of donor insemination." Social science & medicine 54 (3):363–376.

  • Boas, H., Y. Hashiloni-Dolev, S.J. Lavi, D. Filc, and N. Davidovitch. 2018. Bioethics and biopolitics in Israel. Cambridge University Press.

  • Boltanski, L., and L. Thévenot. 2000. The reality of moral expectations: A sociology of situated judgement. Philosophical explorations 3(3): 208–231.

    Article  Google Scholar 

  • ———. 2006. On justification: Economies of worth. Vol. 27: Princeton University Press.

  • Brock, D.W. 2002. Priority to the worse off in health-care resource prioritization. In Medicine and social justice, edited by R. Rhodes, M.P. Battin and A. Silvers, 362–372. New York: Oxford University Press.

    Google Scholar 

  • Bulger, J.W. 2007. Principlism. Teaching Ethics 8(1): 81–100.

    Article  Google Scholar 

  • Collins, J.A. 2002. An international survey of the health economics of IVF and ICSI. Human Reproduction Update 8(3): 265–277.

    Article  Google Scholar 

  • Daar, A.S., and Za. Merali. 2002. Infertility and social suffering: The case of ART in developing countries. Current Practices and Controversies in Assisted Reproduction 15: 15–21.

  • Donath, O. 2015. Regretting motherhood: A sociopolitical analysis. Signs: Journal of Women in Culture and Society 40(2): 343–367.

  • ———. 2017. Regretting motherhood: A study. North Atlantic Books.

  • Dunn, A.L., T. Stafinski, and D. Menon. 2014. An international survey of assisted reproductive technologies (ARTs) policies and the effects of these policies on costs, utilization, and health outcomes. Health Policy 116(2–3): 238–263. 

  • Eliraz, R. 2017. In-vitro fertilization in Israel: An increase of 42% within 2 years. YNET.

  • Franklin, S. 2002. Embodied progress: A cultural account of assisted conception. Routledge.

  • Gooldin, S. 2008. Technologies of happiness: Fertility management in a pro-natal context. In, Citizenship gaps: Migration, fertility, and identity in Israel, edited by A. Kemp and A. Yona, 265–302. Jerusalem: Van Leer/Hakibutz Hameuchad.

  • ———. 2013. ‘‘Emotional rights’’, moral reasoning, and Jewish–Arab alliances in the regulation of in-vitro-fertilization in Israel: Theorizing the unexpected consequences of assisted reproductive technologies. Social Science & Medicine 83: 90–98. 

  • Haelyon, Hila. 2005. "Bio-ethical discussion of IVF." Medicine and Law (32):86–92.

  • Hashiloni-Dolev, Yael. 2007. A life (un) worthy of living: Reproductive genetics in Israel and Germany.  Dordrecht: Springer Science & Business Media.

  • Hashiloni-Dolev, Y., and S. Shkedi. 2007. On new reproductive technologies and family ethics: Pre-implantation genetic diagnosis for sibling donor in Israel and Germany. Social Science & Medicine 65(10): 2081–2092.

    Article  Google Scholar 

  • Häyry, M. 2003. European values in bioethics: why, what, and how to be used? Theoretical Medicine 24: 199–214. 

  • Health-Ministry. 2014. IVF—In-Vitro Fertilization. https://www.health.gov.il/English/Topics/fertility/Pages/ivf.aspx. Accessed January 5, 2020.

  • Hibner-Harel, M. 2014. Letter regarding Circular 6/2014. https://www.health.gov.il/hozer/mr06_2014.pdf. Accessed February 10, 2020.

  • Hine, K. 2011. What is the outcome of applying principlism? Theoretical Medicine and Bioethics 32(6): 375–388.

  • Hursthouse, R. 1999. On virtue ethics. Oxford: Oxford University Press.

  • Inhorn, M.C. 2003. Global infertility and the globalization of new reproductive technologies: Illustrations from Egypt. Social Science & Medicine 56(9): 1837–1851. 

  • Israel Center for Disease Control, (ICDC) 2011. Health status in Israel for the year 2010.  Tel-Hashomer, Israel. https://www.health.gov.il/PublicationsFiles/Health_Status_in_Israel2010.pdf.

  • Ivry, T. 2010. Kosher medicine and medicalized halacha: An exploration of triadic relations among Israeli rabbis, doctors, and infertility patients. American Ethnologist 37(4): 662–680.

    Article  Google Scholar 

  • Kahn, S.M., J. Farquhar, and A. Appadurai. 2000. Reproducing Jews: A cultural account of assisted conception in Israel. Duke University Press.

  • Kemp, P., and J. Rendtorff. 2008. The Barcelona Declaration. Synthesis Phylosophica 46(2): 239–251. 

  • Knesset. 2003a. Knesset Committee on the Status of Women—Protocol # 7113,18/09/2003

  • ———. 2003b. Knesset Finance Committee—Protocol # 7558. 25/12/2003.

  • Kottow, M.H. 2004. Vulnerability: What kind of principle is it? Medicine, Health Care, and Philosophy 7: 281–287. 

  • Mackenzie, C., W. Rogers, and S. Dodds. 2014. Introduction: What is vulnerability and why does it matter for moral theory? In Vulnerability: New essays in ethics and feminist philosophy, edited by C. Mackenzie, W. Rogers and S. Dodds, 1–29. Oxford, UK and New York, USA: Oxford University Press.

  • Mitchell, J.C. 2006. Case and situation analysis. In The Manchester School: Practice and ethnographic praxis in anthropology, edited by T. M. S. (Terry) Evens and Don Handelman, 23–43. New York and Oxford: Bergham Books.

  • Mladovsky, P., and C. Sorenson. 2010. Public Financing of IVF: A review of policy rationales. Health Care Analysis 18(2): 113–128. 

  • Nahman, M. 2006. Materializing Israeliness: Difference and mixture in transnational ova donation. Science as Culture 15(3): 199–213.

  • Newman, J., and M.C. Inhorn. 2015. Medical anthropology in the Middle East and North Africa. A Companion to the Anthropology of the Middle East, 205–232.

  • Remennick, L. 2000. Childless in the land of imperative motherhood: Stigma and coping among infertile Israeli women. Sex Roles 43(11/12): 821–841. 

  • ———. 2008. Contested motherhood in the ethnic state: Voices from an Israeli postpartum ward. Ethnicities 8(2): 199–226.

    Article  Google Scholar 

  • Rendtorff, J.D. 2002. Basic ethical principles in European bioethics and biolaw: Autonomy, dignity, integrity and vulnerability—Towards a foundation of bioethics and biolaw. Medicine, Health Care, and Philosophy 5(3): 235–244. 

  • ———. 2014. Handbook of global bioethics. Dordrecht: Springer Netherlands.

  • Rogers, W., C. Mackenzie, and S. Dodds. 2012. Why bioethics needs a concept of vulnerability. IJFAB: International Journal of Feminist Approaches to Bioethics 5(2): 11–38.

    Google Scholar 

  • Schuz, R. 2013. The developing right to parenthood in Israeli law. The International Survey of Family Law 2013 Edition, 197–225.

  • Seidman, G.I. 2007. Regulating life and death : The case of Israel's  "health Basket" committee. Journal of Contemporary Health Law and Policy 23(1): 9–63.

  • Shalev, Carmel, and Sigal Gooldin. 2006. "The Uses and Misuses of In Vitro Fertilization in Israel: Some Sociological and Ethical Considerations." Nashim: A Journal of Jewish Women's Studies & Gender Issues 12 (Fall): 151–176

  • Simonstein, F. 2010. IVF policies with emphasis on Israeli practices. Health Policy 97(2–3): 202–208. 

  • Teman, E. 2010. Birthing a mother: The surrogate body and the pregnant self. California: University of California Press.

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Author notes

  1. Noa Harel and Miriam Ethel Bentwich contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University Baruch Padeh Medical Center, MPO Lower Galilee 15208, Poriya, Israel

    Noa Harel

  2. Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, P.O. Box 1589, Safed, Israel

    Miriam Ethel Bentwich

Authors
  1. Noa Harel
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  2. Miriam Ethel Bentwich
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Correspondence to Miriam Ethel Bentwich.

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Harel, N., Bentwich, M.E. What can European Principlism Teach about Public Funding of IVF? The Israeli Case. Bioethical Inquiry 18, 441–454 (2021). https://doi.org/10.1007/s11673-021-10104-4

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