Choice and necessity

Today at work, someone compared IVF to having cosmetic surgery. Not to go into detail, but just to put things in context, we were having a discussion about the extent to which my employer should offer medical leave for an IVF cycle.

The person to whom I was speaking remarked that in some ways, IVF is more like cosmetic surgery than, say, a triple bypass. Because, they reasoned, it involves an active "choice" on my part in relation to a "non-essential procedure", whereas something like heart surgery is a "medical necessity".

This got me thinking about the concept of "choice" and "necessity" in relation to infertility treatment. I was distracted all afternoon, rolling this around in my head, until at one point I was so vexed that I resorted to drawing little diagrams and flowcharts.

What I came up with remains, to my mind, somewhat unsatisfactory, so I thought I would put it out en blogue for my wise friends to chew over. In the meantime, if you can stand it, I offer you some fumbling analysis of my thinking.

Let's start with this notion of "choice."

The problem is, when we refer to choice in connection with family building, it normally tends to be approached from the Fertile Perspective. In the Fertile's construct, the decision to have a family is invariably followed by a pregnancy and a birth. A couple chooses to reproduce, they take the necessary steps in the usual way of these things, and as a result, they are parents. They can also choose not to have kids, in which case, things remain as they are- just the two of them, until death do them part or until one of them runs off to Las Vegas with the pool guy/gal.

Of course, from an Infertile Perspective, things are quite different. The option of remaining childless is open to them, but the other route- so easy and available to others- is not. To get to where the fertile couple are, some definitive action is required- choices within a choice. To seek medical treatment or to adopt. Otherwise, by default, they are likely to be stuck within the status quo.

It's when you reach that point- the choice within a choice- that the Fertile Perspective simply does not work. In some ways, it's like comparing apples and oranges. The outcome may be exactly the same, but the means by which an infertile couple gets there make it something quite different, almost a hybrid of its own. And in the process, what might have ordinarily been a positive decision- to live child free- becomes not a choice at all, but rather, a worse case scenario, thrust upon them against their will.

To use another rather grim analogy- in ascending a perilous rocky mountain face, a climber's arm accidentally becomes trapped under a boulder, and he cannot free himself. He is miles from civilization, and no one hears his cries for help. Eventually, he realises that although he cannot reach his phone or his water bottle, he can grasp his pocket knife with his spare hand.

What does he do? Unless he cuts off his own arm, he will almost certainly die in that spot. Amputation or death, those are his options. He still has to make up his mind. But to me, the involuntary nature of his dilemma again makes it something quite different from a "choice" in the traditional sense of the word.

Admittedly, this is an extreme example, and I am not exactly suggesting that infertility creates such a black or white, life or death position. But it seems to me that it is somewhat the same as the Fertile/Infertile Perspective. The trapped climber facing an awful moment is suddenly having an entirely different experience from his best friend who uneventfully climbed this same rock yesterday. Both make certain choices along the way. But for one them, it ultimately becomes a decision about whether to cut off his own arm, rather than, say, where to stop for lunch. In the end, the divergence between their experiences is so great that the only thing they really have in common is that both of them decided to make the climb in the first place.

So, "choice" is somewhat problematic. What about necessity?

When I hear our decision to undergo IVF wrapped up in the same sentence as "cosmetic surgery", it makes me bristle. I guess because everything about that equation seems wrong to me. I can see where that mindset comes from- the old mantra that IVF is not considered medically "necessary". But then, a lot of ailments are not life-threatening and we don't automatically go around accusing people who seek a remedy of being selfish and self-serving.

Nor do we, as a rule, make arbitrary distinctions about those life-threatening illnesses, for example distinguishing between someone born with a congenital heart defect as opposed to someone who directly contributed to their state. For example, the guy next to me received a medical leave of absence to undergo that triple bypass. A medical necessity, they said, albeit in his case, a condition largely brought on by years of smoking, heavy drinking and excessive consumption of bacon sandwiches. But they don't talk about that. He had to have the treatment, because regardless of how he got into that state, it is now life-saving and essential.

Whereas IVF is not. It is "something you are choosing to do".

Which takes me back to the point I was trying to make above, albeit perhaps not very well. Somehow, labelling IVF treatment as a "choice" in this context seems to be an overly simplistic and inappropriate way of briskly packaging up a personal tragedy and thrusting it back on the person who has the misfortune to find themselves in this position in the first place. Justifying it with a dash of what is "necessary".

Slotting assisted reproduction in with cosmetic surgery, as if decisions about whether to live without breast enlargements or collagen lips are somehow just the same as a decision to live without children for the rest of your life.

Comments

[reprogirl]

I just can't believe someone said that. To your face. At work. Sometimes people are just such a waste of oxygen.

Is this person a mother? Did she take maternity leave, or any leave for pregnancy disability? By her logic that wasn't "medically necessary," because, after all, it was the result of her choice.

[zarqa]

I could use some liposuction on my midsection. I'd look better in a bathing suit. And I'd also be putting less strain on my heart. So which is it, choice or necessity? Eventually the question becomes meaningless.

[MsPrufrock]

Ah yes, but the poor man who needed a triple bypass did not put himself in that position. He smoked, ate fatty foods, drank heavily...but no one ever told him these things would be detrimental to his health! Therefore, it's not his fault, and hence it is just a necessity of life when he needs surgery.

This issue comes up all the time, doesn't it? People who are infertile due to circumstances beyond their control are selfish and grouped in with those with superficial concerns, ie plastic surgery. As Reprogirl stated, what about maternity leave? Apparently trying to have a child is akin to plastic surgery, but actually succeeding is a medical neccessity? Ugh.

[Anna]

Hi, really great analysis... wish I had the answer but I don't. I wonder if I had asked myself this question 5 years ago, pre-infertility, what my answer would have been. I'm not sure I would have understood the issue. It is so hard to put yourself in anyone elses shoes unless you've been there... so many of my friends just don't "get it" and I think they probably think the same thing about IVF...it's a choice, we could, after all, "just adopt." But I know they don't mean it to be mean... they just don't get it... and I have a hard time talking to them about it.
I just had a conversation with a friend & said J & I are considering IVF, she said, "what is that, a new drug." And she's really kinda smart.... I was blown away and totally envious of her ignorance.

[Jessica]

I agree with reprogirl--if medical leave is already considered appropriate for those who choose to have children. Infertile people simply need theirs starting a little earlier.

Does this person also begrudge women maternity leave? Since they could have chosen never to have children? If not, well, they get some leave for making the choice that they will have children, and so should you.

[Jessica]

Left that "if" dangling up there--poor thing

[InSpring]

Did this person have bad cosmetic surgery - are there silicone implants where his/her brain is suppose to be?

[Louise]

I can't believe the nerve of that person, equating infertility treatments to cosmetic surgery. Actually, yes I can unfortunately. People say assinine things all the time. Sorry you have to deal with someone like that.

[InSpring]

One more thought - do these people know that infertility is a recognized disability and that you could actually go out on disability for this reason while the same does not hold true of cosmetic surgery?

[JJ]

Something else to mull over, in Canada (Ontario at least)infertility treatments are not covered. Why? Because being infertile doesn't effect "quality of life."

Riiiight.

[Anna H.]

Ugh. That's just a crappy thing to have to hear -- and like Reprogirl said, at work of all places.

You should tell your co-worker that when you go in for your IVF, not only will you be having a baby *implanted*, but you're also getting a little lipo, a tummy tuck, a butt lift and some big old fake boobs while you're under. Because it's the same thing, right?

Sorry you have to put up with such assholes, Mare. Does your job pay for a mental health leave to recover from dealing with pricks? Because you deserve one of those, my friend.

xxoo

[Emily]

What a fucking idiot. I like how you daintly used the word vexed whereas I would have bitch slapped them into yesterday. Yeah, I'm loving the 'choices' I have in front of me every fucking day. They're such great 'choices' that everyone wants to be me right?

Riiiiight.

[Dead Bug]

Ah, but IVF *is* like cosmetic surgery: like, for example, cosmetic breast reconstruction surgery after a radical mastectomy. Both procedures are there to fill a painful, gaping emptiness, no?

We did not choose to be infertile; infertility chose us. I didn't wake up one morning at age forty-six and say, gee, I'm in menopause but, dammit, I deserve a child! Brew me up one, Doc!

We are broken, we need to be fixed, no different from a fractured ankle or a harelip.

The man with the triple bypass? He chose to put himself at risk. Would I deny him the right to treatment? Hell, no. Unless he also wants to deny you a leave-of-absence for IVF treatment.

--Bugs

[Bente]

I think that IVF could be in a new category, why does it have to be compared to the extreme of heart surgery, or the unextreme(sorry, I'm tired) of cosmetic surgery? I don't know alot about IVF procedures, just what I've read, but I would have to say you'd odviously need a fair amount of time off for it.

[Meg]

This is really weird to see this in your post. I heard the same thing said on talkback radio in Australia yesterday. I was blown away by the nastiness of it. It looks like the government is going to limit IVF subsidising and cut women off at 42. For the last few years it has been unlimited and although expensive still affordable ( about $3000. as oposed to $8000 a cycle.)This person conveniently forgot that IVF people also pay taxes.
I can't imagine how you coped having someone say it to your face, you are a very strong person. These days I'm either close to tears or ready to rip someone's head off, when I hear hurtful comments. May I borrow some of your arguments?

[-Blue]

Ugh! Aaaghh ... no words to say.

I can only hope that this arsewipe was at least thinking of the sort of cosmetic surgery that Bugs mentioned (breast recon after mastectomy) ...

Nope. That still doesn't make it any less idiotic a thought. Sorry, thought I had a scrap of reason there.

What fucking morons you encounter, Mare. I'm so sorry.

-Blue

[Alicia]

She's an idiot. Get used to it, because once you do have your child you'll have to put up with the same assinine attitude. "Hey, you CHOSE to have a child, don't expect a decent maternity leave," etc. This is something I've been thinking a lot about lately. Parenthood is not a privilege and society shouldn't see it that way. The freakin' species would die out if people didn't "choose" to have children. People who want to raise children have the right to do so, however they manage to get there. And they should be celebrated for doing so.

[Kay]

Infertility treatments are not like cosmetic surgery. Perhaps they are like reconstructive surgery.

Certainly, a person can live a healty life with a deformed face after a terrible accident or even after being born with a congenital anomaly. But generally, we recognize the mental pain associated with, for example, a cleft lip. This condition might make feeding a little more difficult, but certainly it isn't life threatening. But of course we want children to undergo reconstructive surgery to correct this!

I've heard people argue that organ transplantation uses too many resources per person, and that it should not be done. But I bet if they had polycystic kidneys and needed a transplant to survive, they wouldn't be arguing about cost.

[Amyesq]

Does this person have children? Did you ask her how she would feel if she never had them? What did you say, Mare?

I can't believe the incredible ignorance.

[patricia]

Just another blatant show of cluelessness.

Here is one part I agree with with: IVF is a choice, not a necessity, even if we get the shitty end of the infertility stick. However, as you point out, having children in general is a choice as well. And this choice is usually followed by a "traditional" pregnancy. What this idiot should really be comparing is cosmetic surgery to pregnancy in general. After all, the woman chose to get knocked up, and is therefore choosing to go through labor, have a baby, and need maternity leave.

This has always irked me. The "Well, it's not a necessity, it's a choice" argument. Because anyone who goes through infertility treatments is making the EXACT same choice as everyone else who "chooses" to get pregnant. They've chosen to have a (larger) family.

I used to make the argument - based on your moronic co-workers point, that only those who "accidentally" got pregnant should have their pregnancies covered. Everybody else brought it upon themselves and therefore do not deserve any special consideration.

[penelope]

Having worked for a plastic surgeon in a country where looks REALLY matter I would have to say that cosmetic surgery is also very complicated. What about the guy with a birthmark over half of his face, or the person without a real jaw or the relatively heavy woman who couldn't hold down a job in the fashion industry - when I interacted with these people they had very few choices within the society in which they lived. Their surgeries were painful and expensive but REALLY mattered to their quality of life.

So does IVF for many of us - a choice we actually wish we didn't have to make - none of those plastic surgery patients were ecstatic about their choices but rather resigned and miserable.

My brother chose not to have children, his spouse chose otherwise. Did he have a choice to become a father when that was all she wanted? Even for the fertiles it gets complicated.

[AmyW]

Well, you know, I chose to undergo my current IVF cycle just because I really enjoy the Lupron-induced, insomnia-causing night sweats and embarrassing, dripping-wet hot flashes I have been experiencing for the past few days. Really.

[Pamplemousse]

Fuckwits!! Kill 'em.

Sorry, I am a tad pissed off at my elective IVF going south faster than Paris Hilton's knickers.

[Heidi]

I have often thought about the difference between a right and a privilege. Which category does having children fall under? The government/law seems to support that it is a "right". (examples: no one can be denied the right to have kids, leave for infertility treatment is covered under family medical leave act, the Supreme Court ruled that having children is considered a "major life activity" which means being infertile falls under the "Americans with Disabilities Act"...). But isn't it convenient that most insurance companies consider it a "privilege"? That way they don't have to cover it. I love how my insurance company will pay for diagnostic tests for infertility, but not treatment. Yeah, that makes a lot of sense.

[Atlantic]

What an idiot. The difference seems pretty clear to me: cosmetic surgery (as it seems to have been meant here, not reconstructive surgery to correct disfigurement) is 'fixing' something that *isn't broken*.

[moogielou]

Great post, Mare.

[erin]

Seriously, GREAT post. Are you a logic professor?

[Susan]

Great response to a stupid way of thinking. When I called my company's HR department to inquire how to appeal the administration "no coverage for IVF" attitude I was told the same thing! Elective like breast augmentation my ass! I didn't choose IF but I DO choose medical intervention to fix it.
Of course, our administration is all men, middle-aged men who are more worried about viagra coverage.

[Tiffanni]

I am not sure WHY it is, but it's just another prime example of people who know nothing about infertility, have not dealt with infertility, talking out of their asses. I think people who haven't been through it need to shut their damn pie holes.

[ManhattanAnne]

There's a fabulous cartoon in the New Yorker this month: an older gentleman and a younger woman are together at the pharmacy counter. The guy says, "I need the night-before pill and she needs the morning-after one." Such a great sarcastic comment on the essential parity between men's and women's needs in the area of reproductive health, given that Viagra is ften covered by insurance while birth control isn't. It seems to me, as you so rightly point out with your smoker's heart bypass example, that when it comes to matters reproductve, men's needs are couched in terms of medical health, while women's needs are discussed in terms of lifestyle "choice." As Grrl would say, how very boring.

[Julie]

Realllllly smart post.