Quebec, the first province and one of the only jurisdictions worldwide to fully fund in vitro fertilization ("IVF") treatments is now scaling back.
Just four (4) years ago the provincial government introduced a publicly-funded IVF program for anyone of childbearing age. However, on November 28, the Health Minister Gaetan Barrette tabled a bill which would drastically decrease the public funding available for IVF treatments.[1]
More specifically, Bill 20 would restrict publicly-funded IVF treatments to cases where individuals being treated for cancer by chemotherapy or radiation are rendered infertile.
In addition, access to IVF treatments would be restricted to women aged 18 to 42, that have tried several other methods and in some cases, who have passed psychological testing. In such cases, Bill 20 proposes a tax credit for one (1) IVF cycle, though physicians have the discretion to perform two (2) cycles in women 37 years of age or older. The tax credit varies between 20 and 80 per cent, based on combined family income.
The proposed bill mandates a number of requirements, including a period of sexual intercourse and a number of artificial insemination attempts prior to IVF. Furthermore, any individual or couple who intends to use donated sperm or eggs must undergo a psychosocial assessment by a psychologist or social worker at their own expense. While future regulations will likely clarify what this assessment would entail, a government report from June of this year suggests that it would establish whether patients would be "fit parents".
Bill 20 specifically provides that it is illegal for women over age 42 to access fertility treatment. Some commentators have argued that this new age limit is at odds with current medical practices. They cite for example, the American Society for Reproductive Medicine which recommends age 55 as a maximum for IVF treatment and the McGill University Health Centre's Reproductive Centre which treats women until the age 50.
Following the enactment of the Bill, physicians who treat women above this age are liable to a fine between $5,000 and $50,000. Moreover, any healthcare worked who directs a person to an assisted reproduction clinic outside of Quebec that is not in conformity with the standards set out in the Bill could be similarly fined. It is noteworthy that these restrictions and the associated penalties would apply even when a couple is willing to pay out of pocket for these services.
The Quebec Federation of Medical Specialists was quick to condemn the Bill and described it as "nonsense".
In a joint press release from Nov. 28, 2014, titled "Fertility professionals decry cuts to successful program," the Canadian Fertility and Andrology Society and the Quebec Fertility and Andrology Society state "This bill contains elements that are of major concern regarding basic rights and freedoms. Denying access to a medical treatment based on age and social condition seems discriminatory and contrary to the democratic values of Quebecers. What is being called into question is the right of certain patients to receive treatment."
Bill 20 does raise a number of legal issues insofar as it draws a distinction on the basis of an individual's age and whether parents have a genetic connection to their children.
Bill 20 will be studied by a parliamentary committee before being adopted as early as spring 2015.
[1] Bill n°20 : An Act to enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, first session, 41st legislature, Québec, 2014, Part II
