This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro (...) fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

I consider how a feminist account might address the practice of surrogacy in Japan, both domestically and in the transnational context. Japanese culture emphasizes traditional values, family heritage, and the value of reproduction. Japan offers an interesting case study, since surrogacy is currently under review, and the government is in the process of determining its stance on the practice. I will advocate for legal changes to how surrogacy is treated, suggesting that Japan should eliminate the koseki, or the Family Registration (...) Act, which stipulates that only birth parents may register children as their natural children. A principle of respect for women should be explicitly adopted in setting regulations or guidelines surrounding this practice; additionally, attempts should be made to address citizens’ reproductive needs domestically, thus reducing the global demand for these arrangements. (shrink)

Lawyers tend to look to the law to resolve disputes and to create certainty about the rights and responsibilities of parties to relationships. There is a particularly acute need for certainty in the context of global trade in surrogacy services, both because of the number of parties who may be involved in creating familial relationships and because of the vulnerabilities created as a result of surrogacy arrangements. Participants in the Global Health Challenges conference were invited to consider to what extent (...) law is implicated in global health challenges — both in terms of how law might help to resolve the challenges, and, how law might contribute to or create these challenges. (shrink)

Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: Inbound medical tourism to Canada’s public hospitals; Inbound medical tourism to a First Nations reserve; Canadian patients opting to go abroad for medical (...) tourism; and Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system. (shrink)

Critics of transnational commercial surrogacy frequently call our attention to the race, class, and cultural background of surrogates in the global South. Consider the following sampling from the critics: "the women having babies for rich Westerners have been pimped by their husbands and are powerless to resist" (Bindel 2011); our "rules of decency seem to differ when the women in question are living in abject poverty half a world away" (Warner 2008); and we should worry that "women of color are (...) easier to commodify" (Smerdon 2008, 51-52). Critics suggest—rightly, in my view—that the race, class, and culture of Southern surrogates matter to the moral acceptability of transnational surrogacy. But how, precisely, do .. (shrink)

International surrogacy is an increasingly common phenomenon and an important global health challenge. Legal rules are a key consideration for the participants in international surrogacy arrangements. In some cases the law can help to resolve the complex issues that arise in this context, but it is important to consider the role played by law in contributing to the complex conflicts that such arrangements can generate.

Business ethics should include illicit businesses as targets of investigation. For, though such businesses violate human rights they have been largely ignored by business ethicists. It is time to surmount this indifference in view of recent international efforts to define illicit businesses for regulatory purposes. Standing in the way, however, is a meta-ethical question as to whether any business can be declared unqualifiedly immoral. In support of an affirmative answer I address a number of counter-indications by comparing approaches to organized (...) crime and to corporate crime, comparing the ethical critique of businesses studied in business ethics and those socially banned, and comparing the business ethics assumption as to businesses’ ethicality to societal ethical neutrality regarding war-related businesses. My conclusion: to help advance respect for human rights, business ethicists should apply their expertise to the task of defining illicit businesses. (shrink)

Specific studies of the “situated ethics” of international surrogacy that address the structural conditions and local moral economies that sustain the trade are needed. In this essay, I describe the intimate industry of surrogacy in Thailand, exploring the local moral economy in which surrogacy is described as a form of Buddhist merit making and an opportunity to provide for one’s own children. This offers a further example of how other ethical values beyond the strictly economic are negotiated in commercial surrogacy (...) relationships. Situated ethics allow us to locate and understand the tensions, competing logics, and contradictions within ethical practices. (shrink)

Transnational surrogacy involves the movement of people, gametes, embryos, and surrogates across international borders. It is now possible to obtain ova from Ukraine and sperm from Denmark, and have the resulting embryos transferred to a Thai surrogate for gestation. This new trend in reproductive travel highlights the increasingly globalized, disaggregated, and commodified nature of reproduction. The demand for transnational surrogacy derives from the differential legal status of surrogacy across jurisdictions. Commercial surrogacy is banned in most European countries, Australia, China, Taiwan, (...) Japan, Mexico, Turkey, and some U.S. states. Other countries, such as Brazil, Israel, and the United Kingdom, have .. (shrink)

Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

With advances in assisted reproductive technologies, globalization, and the ease of contact via the internet, the use of gestational surrogates as a family building option has grown significantly over the past decade. In a gestational surrogacy arrangement, unlike a traditional surrogacy arrangement, the surrogate is not the genetic mother of the child she carries; the genetic mother is either an egg donor or the commissioning parent. There are only a handful of countries in which commercial surrogacy is permitted, with the (...) United States and India prominent among them. More surrogacy arrangements are carried out in the United States than in any other nation, and the number of gestational.. (shrink)

Tässä artikkelissa tarkastelen feministisen bioetiikan näkökulmia sijaissynnyttämiseen. Keskityn erityisesti sijaissynnytykseen konstruoimiseen työksi, äitiyden käsitteeseen sekä kaupallisuuden ja sen määrittelemisen pohdintaan. Kysyn, onko sijaissynnyttäjälle maksettava palkkio riittävä tai välttämättä edes moraalisesti keskeisin eettisesti kestämättömän kaupallisuuden määrittäjä. Esitän, että sijaissynnyttämisen mieltäminen työksi voisi auttaa laatimaan eettisesti kestävää säätelyä, jota Suomessa ei tällä hetkellä ole. Sijaissynnyttämisen täyskielto Suomen kaltaisissa korkean reproduktioterveyden, globaalisti verraten pienten tuloerojen maissa ruokkii kolonialistista reproduktioturismia. Katson, että äitiyden käsitteellistä paikkaa sijaissynnytyskonstruktioissa ja sen vaikutuksia sijaissynnytyskäytenteisiin tulisi tarkastella kriittisesti. Nähdäkseni sijaissynnytystä (...) tulisi myös tarkastella suhteessa ammattikasvattamisen ja -hoivaamisen etiikkaan. (shrink)

Transnational reproductive travel is symptomatic of insufficient supplies of reproductive resources, including donor gametes and gestational surrogacy services, and inequities in access to these within domestic health-care jurisdictions. Here, we argue that an innovative approach to domestic policy making using the framework of the National Self-Sufficiency paradigm represents the best solution to domestic challenges and the ethical hazards of the global marketplace in reproductive resources.

Increasing globalisation and advances in artificial reproductive techniques have opened up a whole new range of possibilities for infertile couples across the globe. Inter-country gestational surrogacy with monetary remuneration is one of the products of medical tourism meeting in vitro fertilisation embryo transfer. Filled with potential, it has also been a hot topic of discussion in legal and bioethics spheres. Fears of exploitation and breach of autonomy have sprung from the current situation, where there is no international regulation of surrogacy (...) agreements—only a web of conflicting national laws that generates loopholes and removes safeguards for both the surrogate and commissioning couple. This article argues the need for evidence-based international laws and regulations as the only way to resolve both the ethical and legal issues around commercial surrogacy. In addition, a Hague Convention on inter-country surrogacy agreements is proposed to resolve the muddled state of affairs and enable commercial surrogacy to demonstrate its full potential. (shrink)

ABSTRACTGlobal demand for human ova in in vitro fertilization has led to its expansion in countries with falling average incomes and rising female unemployment. Paid egg donation in the context of national, regional, and global inequalities has the potential to exploit women who are socioeconomically vulnerable, and indeed there is ample evidence that it does. Structural injustices that render women in middle-income countries – and even some high-income countries – economically vulnerable contribute to a context of ‘omissive coercion’ that is (...) morally troubling. When egg brokers or fertility clinics take advantage of these background structural injustices and prospective ova providers’ vulnerability in order to pay them less than they need to meet their livelihood needs, they engage in exploitation. Analyzing paid egg donation as a form of reproductive labor, however, can direct our attention to reforms that would reduce exploitative instances of this practice. In contrast to those who see... (shrink)