2013 Theses Bachelor's

Defining Necessity: The Politics of Knowledge in Ontario’s and Quebec’s In Vitro Fertilization Funding Debates

Yannekis, Gia

Rapid advances in reproductive technologies have led to unprecedented shifts in debates about regulation of, and access to, these services. In a world where a single cycle of in vitro fertilization (IVF) costs upwards of $10,000, questions arise about whether and, if so, why public money should fund IVF. To examine the politics at the core of this complex ethical and practical dilemma, this thesis explores the political decision-making processes underlying two notable pieces of IVF funding legislation: Ontario’s 1993 decision to remove IVF from its government-provided health insurance and Quebec’s 2008 decision to fund three rounds of IVF for all citizens. Through these case studies, this thesis examines the patterns of interaction between non-governmental stakeholders in IVF funding decision-making forums and seeks to determine which mechanisms these stakeholders employ to shape medical funding decisions more broadly. Further, it explores the relationship between professional and lay expertise in political forums. Testing the assertions of past research, this study seeks to ascertain whether lay experts have gained substantial political credibility in these Canadian provinces. To answer these questions, I completed a textual analysis of 37 parliamentary debate records and 65 newspaper articles spanning two provinces and twelve years. I coded the records for each stakeholder’s framing of their stance on IVF issues and for the relative standing of different categories of stakeholders in both the media and political arenas. These results revealed medical professionals’ and professional organizations’ continued dominance in IVF funding decisions, particularly in Ontario. In Quebec, key lay experts, such as infertility advocacy organizations and public figures, moderated this dominance. Comparison of stakeholder standing and framing in these two cases further suggests that the greater heterogeneity of stakeholders represented in decision-making forums in Quebec was an important factor in promoting Quebec’s decision to fund the service. Indeed, while many of the same frames were deployed in the two provinces, lay experts in Quebec reinforced frames presented by professional witnesses and likely played a role in Quebec’s pro-funding decision. Ultimately, professionals still firmly control medical funding decision-making processes in Canada, though lay experts of various kinds are becoming more prominent as advocates for the public.