Down with the fertility police

Proposals that women who are too fat, too thin or over 40 should be denied IVF are draconian attempts to define what is a `good parent'

Fat people, apparently, don't deserve to have children. Nor do people who are too old or too young, too thin, or, by default, too poor. Such are the recommendations of the British Fertility Society (BFS), a group of IVF specialists, which this week has set out to try to clarify guidelines on who should receive fertility treatment on the NHS. It's a good job most people can get pregnant naturally, or the fertility rate really would be in trouble.

The headlines went along the lines of `Call for fertility ban for obese', and focused on the proposal to refuse treatment to women with a body mass index (BMI) above 29 (about 12 stone for a woman of average height) until they initiated a `weight reduction programme', and to refuse free treatment point blank to women with a BMI over 36. But fat women were not the only ones in the firing line: underweight women (about eight stone) would be made to gain weight, and women over 40 would be barred automatically from treatment.

In fairness to the BFS, its intention is to reduce current `unequal access' to NHS-funded IVF treatment, which arises from Primary Care Trusts' arbitrary use of `social criteria' to determine who should be allowed free IVF. For example, some PCTs refuse to fund couples who already have children, some refuse to treat smokers, and many set different obesity limits, resulting in a bewildering array of restrictions. And some of the BFS's recommendations are progressive - for example, that single women and same-sex couples should be treated the same way as heterosexual couples, and that couples with children from a previous relationship should not be excluded from access to NHS treatment.

But any use of `social criteria' to bar people from IVF treatment is a problem, because it draws a moral distinction between those who are worthy of being given the chance to be a parent, and those who are not. By these criteria, fat women and older women are being labelled undeserving of a treatment offered to everybody else - being told that they don't deserve to have a baby, because they've left it too late or eaten too many pies.

Medics will argue that there are medical reasons for these restrictions - that IVF treatment is less likely to work for women who are old or fat, and that if it does work, the pregnancy will carry greater risks for mother and child. Well, if that's the case, tell your patients of the risks, and let the decision about whether to proceed be made by the doctor and the patient, not by a list of standard regulations.

While young women in the peak of health are doubtless the fertility specialist's preferred patients, presumably they are the least likely to need assistance. Pregnancy, for any woman, is reasonably risky: and if fat women can choose to take that risk when conceiving naturally, why not when they are having fertility treatment? IVF, like most medical procedures, is not something that people generally do for the hell of it; they turn to assisted fertility when nature, or other circumstances, let them down. It's unpleasant, unreliable and can be bad for your health - yet still people do it, because their desire for a child outweighs those other concerns.

Fertility treatment gives society the ability to overcome one of the unfairnesses caused by nature. Why should we want to compromise that by adding some socially-constructed unfairnesses of our own?

As things currently stand, the BFS's recommendations probably won't have a practical impact upon that many people - largely because provision of IVF treatment on the NHS is so limited. PCTs have been instructed by the government to offer women at least one free cycle, which is arguably neither use nor ornament - the need for speed (often precisely because women seeking treatment are older) and for more than one treatment cycle means that many people go private anyway. As ever, it is those who can't afford the thousands of pounds that fertility treatment requires who end up suffering the consequences of these restrictions most directly.

But the moral impact of these recommendations is widespread, reaching beyond IVF patients to everybody who wants a child. Once again, we are presented with an official viewpoint on what it means to be an acceptable parent - a non-drinking, non-smoking, mature-but-not-old, slim-but-not-too-thin caricature straight out of the New Labour Book of Boring. Fertility treatment is supposed to offer people more choices; instead it has become another stick with which to beat us into conformity.

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NHS RELUCTANT TO ADOPT EVEN THE MOST BENEFICIAL NEW TECHNOLOGY

The National Health Service could save at least 500 million pounds a year by adopting techniques that could halve the recovery time of patients after surgery. A new trial at the Freeman Hospital in Newcastle upon Tyne has shown that bowel surgery patients were ready to be discharged in just 7 days, rather than 14. The surgeons told a conference in Lisbon yesterday that better preparation and education of patients, greater use of keyhole surgery and a technique for improving fluid balance and blood circulation during and after surgery could greatly reduce the recovery period. The trial was the latest evidence of the effectiveness of CardioQ, a blood monitoring device developed by a British company, Deltex Medical.

If repeated across the country, the savings to the health service would exceed last year’s NHS deficit of 500 million pounds. However, the device was used in fewer than 5 per cent of possible NHS procedures, reflecting the difficulty of getting new devices used by the service. Alan Horgan, consultant colorectal surgeon at the Freeman Hospital and leader of the study, said: “These results are remarkable. Everyone involved in surgery and NHS management should read this study. “Fluid-balance during and after surgery is incredibly important to patient wellbeing. Our surgical recovery programme means the Freeman Hospital is already a leader in recovery times, but the CardioQ has allowed us to get even better. We have proven that it is possible to save the NHS both time and money, while also enhancing patient care.”

CardioQ works by monitoring how much blood the heart is pumping. Blood lost during operations is “topped up” by using a colloidal solution that mimics the behaviour of blood. Getting the volume exactly right is critical to ensuring that sufficient oxygen is delivered to the organs. Too little can lead to organ failure and even death. But too much can cause heart failure, so doctors have had to tread a fine line between the two. CardioQ monitors blood volume using an ultrasound probe inserted down the throat. The probe measures blood flow by bouncing ultrasound waves off blood cells flowing through the aorta, the main blood vessel.

The trial covered 108 patients. Half were given fluid at the discretion of the anaesthetist, while the other half had their fluid levels monitored by CardioQ. The national average recovery time for bowel surgery is 14 days, but at the Freeman, discharge took an average of only 7 days. The largest part of the improvement was the result of the recovery programme, which included the use of keyhole surgery. But CardioQ also contributed another two days, and patients treated with it also had far fewer post-operative complications — 2 per cent rather than 15 per cent. None needed an unplanned admission to the critical care unit, compared with 11 per cent of patients not treated using CardioQ.

Every day in a general or surgical ward costs 400 pounds per patient. The CardioQ monitor costs 7,000 pounds and the probes used in the trial 55 pounds each, meaning that the monitor could pay for itself in days. It could be used for a range of operations, not just those on the bowel. The National Institute for Health and Clinical Excellence described CardioQ as “standard clinical practice”. Yet such is the reluctance of the NHS to adopt new approaches that it is used in fewer than one in twenty operations in which it could provide benefits. Ewan Phillips, managing director of Deltex Medical, said: “Embracing this technology should be a no-brainer.”

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BRITISH JAILS TOO SOFT

A prisoner has publicly condemned fellow inmates for their "constant bleating" about human rights. Stephen Hardy, who confesses to having spent extended periods of time at Her Majesty's pleasure, won 25 pounds for "star letter of the month" in a prisoners' newspaper with his withering attack on the petty complaints made by his fellow convicts. The letters page of Inside Time, produced by the offenders' charity, New Bridge, is a popular forum for prisoners to air their grievances, many of which hinge on human rights issues. But Hardy reminisces about the "good old days" in prisons when "you had no rights apart from a surname and a number". He points out that prison is a means of punishment and insists that prisoners should pay the price for their crimes.

He writes: "Whenever I've gone out and robbed somebody I didn't read my victims the human rights charter. It was entirely my choice and I've got to pay the price. In case prisoners are scratching their heads wondering where I'm coming from, the operative word is `responsibility'. "So far as human rights are concerned, stick 'em."

Another letter in this month's edition relates to the way in which an inmate tried to use human rights laws to stop prison officers opening letters from his lawyers. But Hardy continues: "Every prison I've been in (and it's a fair few), all I ever seem to hear is this constant bleating about `my human rights', be it due to the food being either too hot or too cold, an officer didn't refer to me as `Mr' or whatever other petty complaints yet another mundane day of incarceration can throw up. "This is now becoming far more commonplace than the other weary old chestnut, `I didn't do it'. Prisoners tend to conveniently forget why they are locked up and forget too the rights of the victims they created."

The writer, who is serving his sentence at the medium-security Albany prison in the Isle of Wight, adds: "In the `good old days' in prison you had no rights apart from a surname and a number. If the food was bad (and trust me it was) or there was some other problem about which we had no rights, then we had a riot - no paperwork, no request/complaints - just a good, old-fashioned punch-up followed on frequent occasions by a good kicking."

John Bowers, the commissioning editor at Inside Time, said: "You can't get a more contentious view than this from a prisoner. It is really the last thing you would expect coming from a prisoner. It will lead to a debate, that's for sure. "This letter will be read, it will be hotly disputed and I expect several irate letters from other prisoners saying, `What the hell is this Stephen Hardy on about?' Every prisoner who reads it will either think it's a load of old rubbish or may even think he's got a point."

Mark Leech, editor of The Prisons Handbook, said: "I find it ironic that Mr Hardy is pooh-poohing human rights by writing a letter to a newspaper - something inmates can only do because they have used human rights arguments to win that right. There was a time when inmates were banned from writing about their prison conditions. "I wonder if he'll send his 25 pound prize to Victim Support?"

Hardy ends his letter by insisting: "I'll do my bird (again) and if I return to prison in the next decade perhaps we'll have plasma screen TVs, access to the internet and all manner of privileges; after all, we wouldn't want our human rights infringed by denying us access to everything we desire in order to be `treated like human beings' would we?" The newspaper also includes an article by Jonathan King, the pop impresario who served three years of a seven year sentence for sex offences, bemoaning the fact that when he arrived at Belmarsh in 2001, there was no in-cell television or electricity.

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NJ: Guns N Rollers airport terror t-shirt alert: "Keen security personnel at Birmingham International Airport ordered a man to turn his t-shirt inside out because it bore a drawing of two crossed guns. Staffordshire design engineer Dave Osbourne was wearing a Guns N Rollers t-shirt. Guns N Rollers are a team in 'an all-female roller derby league located in Portland Oregon,' according to their website. Their logo is a tribute to that of hard rocking, hard drinking, legendarily fractious LA band Guns N Roses. ... As he waited to board the flight to Newark, New Jersey, guards told Osbourne the graphic represented a security risk, and could upset other passengers. ... The 21-year-old said: 'I am all for extra security, but this was just plain stupid.' Bosses at the airport apologised, admitting guards over-reacted."