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B.C. ethicist: Don’t cover infertility treatments for fertile gay or single women

Should insurance coverage be denied to fertile women who use infertility treatments to get pregnant because they’re single or gay? Sounds like an outlandish plan, except it was published in a well-respected medical journal and proposed by a doctoral student in theological ethics at Boston College.

Cristina Richie, author of the provocative paper published Thursday in the Journal of Medical Ethics, told me she has no religious objections to infertility treatments such as artificial insemination or in vitro fertilization. Her motivation is to start what she calls a “green bioethics movement” to reduce the carbon footprint caused by elective medical procedures.

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“Hormones used in these treatments have environmental side effects when they get into the water supply, and the retrieval of eggs and storage of embryos is a carbon intensive procedure,” Richie said. “Children conceived from these procedures also leave a carbon legacy.”

Thus, she reasoned, mandated insurance coverage for infertility treatments -- as in Massachusetts -- should not apply to fertile women. Excluding them from this coverage might encourage them to adopt instead.

She emphasized that her concern is not population growth, but consumption of resources that leads to carbon emissions.

So does this idea pass muster with medical ethicists?

Not by a long shot, said Arthur Caplan, head of the division of bioethics at New York University Langone Medical Center in New York City. “There’s an argument to be made that if you’re single or gay, it kind of renders you infertile due to practical circumstances, even if not for biological reasons,” he said.

Caplan applauds efforts that hospitals are making to reduce their carbon footprint -- such as switching to energy efficient heating and cooling systems and reducing medical waste. But he said encouraging people to forgo medical procedures for environmental reasons “just won’t fly,” nor does the argument that he said Richie resurrected from population control debates in the 1960s.

Dr. Dominic Wilkinson, associate editor of the journal that published Richie’s paper, also weighed in: “Climate change is important, but carbon caps should be applied equally and fairly. They should not be used to discriminate against those who are single or gay.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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