Age-based restrictions on reproductive care: discerning the arbitrary from the necessary.

Abstract

Policies that determine whether someone is allowed access to reproductive healthcare or not vary widely among countries, especially in their age requirements. This raises the suspicion of arbitrariness, especially because often no underlying justification is provided. In this article, we pose the question-under which circumstances is it morally acceptable to use age for policy and legislation in the first place? We start from the notion that everyone has a conditional positive right to fertility treatment. Subsequently, we set off to formulate a framework that helps to determine who should be excluded from treatment nonetheless. The framework's three core elements are: choosing and ethically justifying exclusion criteria (target), determining the actual limit between in- and exclusion (cut-off), and selecting variables that help to predict the exclusion criteria via correlation (as they are not directly measurable) (proxy). This framework allows us to show that referring to age in policy and legislation is only ethically justifiable if there is a sufficiently strong correlation with a non-directly measurable exclusion criterion. Moreover, since age is only one of many predicting variables, it should therefore not be ascribed any special status. Finally, our framework may be used as an argumentative scheme to critically assess the ethical legitimacy of policies that regulate access to (fertility) treatments in general.