September 15, 2017

New Zealand’s one-child policy

Posted in Cancer at 10:03 pm by Chris

I had cause this week to be reminded of New Zealand’s one-child policy. What’s that you say, we don’t have a one-child policy? Oh, but we do. Here’s how it works. If you’re a cancer patient, hypothetically speaking about to have such intensive chemo that your ability to produce gametes will be permanently destroyed (or your existing gametes rendered inviable), you can opt to have sperm or eggs frozen in the event that you wish to pursue IVF or some such reproductive technology in the future. The public health system will pay the costs of all this — and for the uninitiated, those costs include not just initial consultations, but the ongoing costs of keeping things in cryogenic storage — but only if you don’t already have children. If you already have one child, you’re paying the bills yourself. In other words, in New Zealand, the government has chosen to pay the medical costs of you having just one child.

Note that we’re not talking about whether or not the public system should bear the cost of assisted reproductive technology for couples in some circumstances. I think that’s a reasonable discussion to have, actually, given the expense that can be involved. No, that decision has already been made, and the answer is yes, it will. But not if you already have children, even one. In a country with an average birthrate over 2, the government will only sanction you having one, unless you pay for it yourself.

Practically, this was just an inconvenience for me, and cost me money at a time two years ago when I didn’t have any money to spare. Ethically, it’s extremely bothersome: ethically, I see no difference between deciding not to pay for a second child before birth, and a second child after birth. No, we won’t cover the expenses of your second child because you’re already receiving a benefit for the first. No, your baby can’t have any expensive medical procedures because you’ve already got a child. The difference is that those types of decisions are made at high levels by ministers, or senior staff in government departments who are accountable to same. The decision not to fund reproductive technologies for cancer patients who already have one child was presumably made by a bureaucrat in an anonymous office somewhere. But that bureaucrat was no doubt looking at the bottom line in a budget they’d been told to balance. They’d been given directions from on high that their budget mattered more than people’s lives, and been given a mandate to make arbitrary decisions based on someone’s personal circumstances. The effect is that same. The moral process is the same.

I’m not aware that “existing reproductive status” is covered in the Bill of Rights Act. It really should be, and it’s consistent with the moral stance behind not discriminating on the basis of age or gender. I’m pretty sure (not a lawyer, but I know some) that it is explicitly covered in employment legislation: employers aren’t allowed to ask you if you plan to have another child, no matter how many you already have. Nor does the number of children you already have affect your entitlement to paid parental leave, or your eligibility for any number of mechanisms of state support, up to and including education and healthcare for those children. Nor should it. The fact that it’s allowed to affect this one small corner of an entitlement to state support (and again: the government has already decided that it will fund this service) suggests that these other inclusions might just be conventions, rather than something we can rely on. I don’t think that’s good enough.