Bioethics in Faith and Practice, Volume 4, Number 1

21 Bioethics in Faith and Practice ⦁ 2019 ⦁ Volume 4 ⦁ Number 1 against a 70% increased risk of leukemia a medical treatment? What about 20%? What about genetic predispositions to mental illness such as depression? What about genetic factors that may be linked to violent behavior? What about superficial factors, such as height, that could lead to increased likelihood of bullying, which could result in anxiety? While this level of specificity is currently in the future, it is not so far off as many suppose. In November 2018, Chinese researcher He Jiankui announced the birth of twin girls edited by CRISPR and implanted by IVF. This crossed the line of selection into the realm of engineering. While almost universally condemned by the scientific community, Jiankui’s work opened the door to an inevitable future. CRISPR kits can be purchased on Amazon for less than $200, and self-proclaimed ‘biohackers’ are already exploring its potential. This is no longer new and state-of-the-art technology. The question is only when it becomes acceptable in the professional as well as clandestine laboratory; it may be a matter of just a few years. While CRISPR and other gene therapies bring their own set of ethical conundrums beyond the scope of this paper, it is crucial to consider where the technology is headed in order to clarify our thinking on what we have now. Concerns over modifications to the germ line, the line between medicine and preference, just distribution of resources, and the slippery slope into eugenics are all real, significant questions that should be answered before scientists like Jiankui answer them for us. Ethics of economy: IVF and insurance incentives IVF is not only a complex and involved procedure, but an expensive one as well. Each cycle typically costs between $10,000-$15,000 out of pocket, 63 but the average couple has only a 29.5% chance of conceiving on the first cycle. 64 For hundreds of thousands of couples every year, it seems, the mere hope of conceiving a child is priceless -- or at least close enough to justify the cost. However, for many couples experiencing infertility, financial realities close the door to this possible treatment. Others have bankrupted themselves pursuing fruitless treatment, falling victim to the sunk-costs mentality that surely the next cycle would bring results. The pain of real financial barriers to conceiving children has led some to advocate for insurance coverage of advanced reproductive technologies (ART), including IVF. Insurance coverage of ART is controversial -- not only because of the ethical issues involved, but also the complex policy decisions and compromises required in application. Infertility coverage isn’t skimmed off the top of insurance company profits; it comes from either raising the cost of insurance for all participants or from reducing the coverage of other conditions. It’s worth considering where the money comes from. Despite the very real emotional pain of infertility, is it a significant enough health condition to justify diverting funds from other medical treatments? On the other hand, is it just to restrict ART to those who can afford its steep price tag? Nine U.S. states have mandated insurance coverage for IVF, reducing out-of-pocket costs to only about $2,000-$3,000 per cycle. 65 However, infertility coverage brings with it a knot of policy issues that have to 63 Barton Hamilton et al., "Health Care Access, Costs, and Treatment Dynamics: Evidence from in Vitro Fertilization," American Economic Review , no. 108 (2018), 3725-3777 . https://doi.org/10.1257/aer.20161014 . 64 Smith, "Live-Birth Rate Associated with Repeat in Vitro Fertilisation Treatment Cycles," , 2654-2662 65 Hamilton, "Health Care Access, Costs, and Treatment Dynamics: Evidence from in Vitro Fertilization," , 3725- 3777