Cross-Border Reproduction: An "Ethic of Care" and an Unregulated Market

Concerns about cross-border fertility arrangements – especially human rights violations of women serving as surrogate mothers or providing eggs – brought 23 participants (including myself) from 14 countries  to a three-and-a-half-day workshop at the Brocher Foundation near Geneva, Switzerland in January.

The event was called Inter-country medically assisted reproduction: Conceiving a human rights ethic of care, and its aim was “to explore and conceptualize ethical principles for a human rights-based regime of governance that might offer an alternative to the unregulated market.” It was co-organized by Carmel Shalev of the Department for Reproduction and Society at Haifa University’s Center for Health, Law and Ethics, and Gabriele Werner-Felmayer of the Division of Biological Chemistry at Medical University Innsbruck and its bioethics network Ethucation.

In addition to intensive discussion, we were treated to a screening of an award-winning documentary about surrogacy in India, Ma Na Sapna (A Mother’s Dream), which to my knowledge has not been widely screened in North America. Austrian director Valerie Gudenus was present, and answered a flurry of questions about the film and the several months she spent with a camera crew at the Akanksha Infertility Clinic.

Workshop sessions were devoted to exploring the meaning of an “ethic of care,” and how it would apply to surrogacy, third-party gamete providers, and embryo selection. Not surprisingly, a range of views surfaced among the gathered public interest and women’s health advocates, bioethicists, biologists, physicians, anthropologists, legal scholars, and others. But there was enough shared perspective for a series of recommendations to emerge, and a report explaining the background and reasoning for them is planned.

Many of the troubling aspects of the cross-border fertility industry that we discussed have become somewhat familiar. One concern that is still overlooked in some media accounts, but that was emphasized in these discussions, is the invisibility of the women who assist infertile couples and individuals in having a child. Another, even less commonly considered, is the rights and well-being of children born as a result of arrangements involving women working as surrogates or to provide their eggs. 

We also discussed the contribution that a “human rights ethic of care” might make to the practice of inter-country assisted reproduction. Even in jurisdictions with significant public policy, and especially in those where regulation and oversight is absent or inadequate, there is still no satisfactory standard of care that takes into account the vulnerabilities and interests of everyone involved in such arrangements for bringing a child into the world. As one participant put it, “Reproduction takes place in response to people's desire or need for child, and it is only appropriate that if people want to start a caring relationship, their efforts should be founded on an ethic of care.”

Two other topics that are less commonly included in conversations about cross-border reproductive care also emerged. One concerned the unique status of First Nations / indigenous peoples. Participants stressed that these groups may hold wider concepts of community ownership, rights, and responsibilities with regard to genetic materials than others, and that their views should be considered in consultations about best practices, regulations, and guidelines for the applications of assisted reproductive technologies.

The session on embryo selection that I chaired together with Australian scholar Andrea Whittaker prompted a discussion of the connections among assisted reproduction, genetic selection, and new germline gene editing techniques including CRISPR-Cas9. There was wide agreement among the participants that pre-implantation genetic diagnosis should be used only for serious medical conditions, wide concern about the cross-border reproductive market for non-medical sex selection, and a strong view that these genetic screening/selection technologies could negatively affect social values of equality, solidarity and diversity.

There was also wide concern about new genetic modification techniques posing the potential for an international market in genetic traits and for genetic stratification. Participants cited the principle of intergenerational responsibility – mandating that the interests of future generations are represented in considerations of these technologies – and encouraged international dialogue that includes civil society groups and community participation.

Image via Flickr

Previously on Biopolitical Times:

• California’s Stem Cell Agency Considers “Editing” Human Embryos
• Tired Tropes and New Twists in the Debate about Human Germline Modification
• DC Symposium: “The Future of Reproduction”
• A Season of Surrogacy Scandals