Raffles for IVF Access?

By Nir Eyal

As the New York Times reports (quoting me on the ethics), some American IVF clinics are now running raffles where the prize is IVF services. The contests give clinics publicity and sometimes serve charitable causes. Are IVF raffles unethical? Should we ban them?

Gambles and contests over the ability to have babies represent a new level of commodification—if you will, a new frontier. But they are not always unethical. Clinics do not owe infertile couples free access to IVF services. In some cases, the state and insurers don’t owe it to them either—legally or morally. IVF is expensive and some medical services are needed even more badly. Uninterested couples can avoid these raffles. What these raffles do is to give infertile couples opportunities that they would lack otherwise for obtaining an important benefit, opportunities that go beyond what clinics owe them. Lotteries, in particular, are not necessarily unfair means of distributing resources. Some philosophers deem them very fair. Even when couples with means can buy several raffle tickets, impoverished couples still get better chance of IVF access than under the current system. Money speaks, but it speaks less vocally than in much of American healthcare. In this respect, these raffles are a good parody of our unjust system.

 These contests are games. Conservatives worry that they take infertility or the beginnings of human life too lightly. But light-heartedness could be a good thing in this area. It might reduce the anxiety and the stigma that too often accompany infertility treatment. Associating the conception of new human life with fun? Traditional procreation can do that, too!

In short, not everything that’s odd is unethical. Notwithstanding initial “yuck” feelings, raffles for IVF access are not always morally wrong. It would have been morally more ideal if clinics offered free IVF services to everyone, or prioritized the neediest and the underserved, or gave rich and poor equal chance. But acting less than ideally is not doing wrong.

There are cases in which raffles for IVF access remain unethical. If a clinic makes couples expose themselves to shame in order to win a contest, that’s usually cruel and disrespectful. If a clinic uses some couples’ desperation or misunderstanding of statistics to sell their friends and relations expensive raffle tickets, for a tiny chance of winning IVF access, it deceitfully gains unjustified advantage. If a clinic foreseeably lures in impoverished couples with infertility so severe that (own-) IVF alone would not be of benefit to them, it cynically takes unfair advantages and nurtures false hopes. I doubt, though, that these sporadic cases warrant legislation in this area.

 If anything, there is a case for regulation and ethical recommendations at the professional society level. Self-regulatory bodies could condemn raffles for IVF both in cases of wrongful raffles and, to protect public trust in physicians, in some other cases.