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)

Concerns about exploitation pervade the literature on commercial cross-border reproductive care, particularly egg selling and surrogacy. But what constitutes exploitation, and what moral weight does it have? I consider the relationship between vulnerability, limited choice, consent, and mutually advantageous exploitation. To elucidate the difference between limited choice and consent, I draw on an account of relational autonomy. In the absence of a normative principle of fair distribution, it is unclear whether the providers of reproductive goods and services are treated fairly (...) in such contracts, and therefore whether they have been exploited. I finish with some pragmatic recommendations for minimizing risks and empowering egg sellers and surrogates. (shrink)

To avoid the commercialization of reproduction, the Canadian Assisted Human Reproduction Act prohibits the purchase of human eggs. We endorse this legal prohibition and moreover believe that this facet of the law should not be allowed to have as an unintended consequence an increase in transnational trade in human eggs. In an effort to avoid this consequence, and to be consistent with the AHR Act, we advocate the pursuit of national altruistic self-sufficiency. This article briefly outlines a number of strategies (...) to increase the domestic altruistic supply of third-party eggs and decrease the domestic demand for them. (shrink)

A growing number of infertile couples and other individuals desiring children are seeking to fulfill their desire for parenthood transnationally through the use of donor gametes and a surrogate. The number of “fertility tourists” from developed countries to low-income countries is growing phenomenally. Indian women, too, are participating as producers in these “biocrossings,” turning India into the surrogacy outsourcing capital of the world in the globalized bioeconomy of assisted reproduction. I argue for a ban on commercial egg donation and surrogacy (...) and a social-justice approach that would hold the state responsible for providing basic social goods to low-income households. I also argue for a gender-justice approach so that women would not be compelled to adopt surrogacy as a strategy for survival and upward social mobility. (shrink)

One effect of late capitalism – the commodification of practically everything – is to knock down the Chinese walls between the natural and productive realms, to use a Marxist framework. Women's labour in egg extraction and ‘surrogate’ motherhood might then be seen as what it is, labour which produces something of value. But this does not necessarily mean that women will benefit from the commodification of practically everything, in either North or South. In the newly developing biotechnologies involving stem cells, (...) the reverse is more likely, particular given the shortage in the North of the egg donors who will be increasingly necessary to therapeutic cloning.Although most of the ethical debate has focused on the status of the embryo, this is to define ethics with no reference to global or gender justice. There has been little or no debate about possible exploitation of women, particularly of ovum donors from the South. Countries of the South without national ethics committees or guidelines may be particularly vulnerable: although there is increasing awareness of the susceptibility of poorer countries to abuses in research ethics, very little has been written about how they might be affected by the enormously profitable new technologies exploiting human tissue. Even in the UK, although the new Medical Research Council guidelines make a good deal of the ‘gift relationship’, what they are actually about is commodification. If donors believe they are demonstrating altruism, but biotechnology firms and researchers use the discourse of commodity and profit, we have not ‘incomplete commodification’ but complete commodification with a plausibly human face. (shrink)

New developments in biotechnology radically alter our relationship with our bodies. Body tissues can now be used for commercial purposes, while external objects, such as pacemakers, can become part of the body. Property in the Body: Feminist Perspectives transcends the everyday responses to such developments, suggesting that what we most fear is the feminisation of the body. We fear our bodies are becoming objects of property, turning us into things rather than persons. This book evaluates how well-grounded this fear is, (...) and suggests innovative models of regulating what has been called 'the new Gold Rush' in human tissue. This is an up-to-date and wide-ranging synthesis of market developments in body tissue, bringing together bioethics, feminist theory and lessons from countries that have resisted commercialisation of the body, in a theoretically sophisticated and practically significant approach. (shrink)

In this collection of essays Onora O'Neill explores and argues for an account of justice that is fundamentally cosmopolitan rather than civic, yet takes serious account of institutions and boundaries, and of human diversity and vulnerability. Starting from conceptions that are central to any account of justice - those of reason, action, judgement, coercion, obligations and rights - she discusses whether and how culturally or politically specific concepts and views, which limit the claims and scope of justice, can be avoided. (...) She then examines the demands and scope of just institutions, arguing that there are good reasons for taking the claims of distant strangers seriously, but that doing so points not to a world without boundaries but to one of porous boundaries and dispersed power. Bounds of Justice will be of interest to a wide range of readers in philosophy, politics and international relations. (shrink)

In her long-awaited Responsibility for Justice, Young discusses our responsibilities to address "structural" injustices in which we among many are implicated, often by virtue of participating in a market, such as buying goods produced in sweatshops, or participating in booming housing markets that leave many homeless.

Exploitation locates what it is we recognize as bad when we judge a situation to be exploitative. Ideal for courses in social and political philosophy, public policy, or political science.

The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization . The province of Ontario recently de-insured IVF. Both provinces cited cost-effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine (...) three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights-based and needs-based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance-based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means-tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy-makers alike. (shrink)

Journal of Global Ethics, Volume 9, Issue 3, Page 329-343, December 2013.

Next SectionReproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, eight such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.

In Why Some Things Should Not Be for Sale, philosopher Debra Satz takes a penetrating look at those commodity exchanges that strike most of us as problematic. What considerations, she asks, ought to guide the debates about such markets? What is it about a market involving prostitution or the sale of kidneys that makes it morally objectionable? How is a market in weapons or pollution different than a market in soybeans or automobiles? Are laws and social policies banning the more (...) noxious markets necessarily the best responses to them? Satz contends that categories previously used by philosophers and economists are of limited utility in addressing such questions because they have assumed markets to be homogenous. Accordingly, she offers a broader and more nuanced view of markets--one that goes beyond the usual discussions of efficiency and distributional equality--to show how markets shape our culture, foster or thwart human development, and create and support structures of power. (shrink)

Reproductive tourism is a manifestation of a larger, more inclusive trend toward globalization of capitalist cultural and material economies. This paper discusses the development of cross-border assisted reproduction within the globalized economy, transnational and local structural processes that influence the trade, social relations intersecting it, and implications for the healthcare systems affected. I focus on prevailing gender structures embedded in the cross-border trade and their intersection with other social and economic structures that reflect and impact globalization. I apply a social (...) connection model of responsibility for unjust outcomes and consider strategies to counter structural injustices embedded in this industry. The concluding section discusses policy reforms and proposals for collaborative action to preclude further injustices and extend full human rights to all. (shrink)

Since the development of assisted reproductive technologies, infertile individuals have crossed borders to obtain treatments unavailable or unaffordable in their own country. Recent media coverage has focused on the outsourcing of surrogacy to developing countries, where the cost for surrogacy is significantly less than the equivalent cost in a more developed country. This paper discusses the ethical arguments against international surrogacy. The major opposition viewpoints can be broadly divided into arguments about welfare, commodification and exploitation. It is argued that the (...) only valid objection to international surrogacy is that surrogate mothers may be exploited by being given too little compensation. However, the possibility of exploitation is a weak argument for prohibition, as employment alternatives for potential surrogate mothers may be more exploitative or more harmful than surrogacy. It is concluded that international surrogacy must be regulated, and the proposed regulatory mechanism is termed Fair Trade Surrogacy. The guidelines of Fair Trade Surrogacy focus on minimizing potential harms to all parties and ensuring fair compensation for surrogate mothers. (shrink)

It is argued that there are good reasons for believing that commercial surrogacy is often exploitative. However, even if we accept this, the exploitation argument for prohibiting (or otherwise legislatively discouraging) commercial surrogacy remains quite weak. One reason for this is that prohibition may well 'backfire' and lead to potential surrogates having to do other things that are more exploitative and/or more harmful than paid surrogacy. It is concluded, therefore, that those who oppose exploitation should concentrate on: (a) improving the (...) conditions under which paid surrogates 'work'; and (b) changing the background conditions (in particular, the unequal distribution of power and wealth) which generate exploitative relationships. (edited). (shrink)

This essay provides a rationale for a regulated market for human oocytes. Although the commodification of human oocytes raises important moral concerns, these concerns do not justify laws banning commerce in human eggs. Given the burgeoning ART industry and the growing oocyte market, the most prudent course of action is to develop regulations for the human oocyte market that are designed to protect and promote important social values, such as health, safety, liberty, and respect for human life. Other responses, such (...) as banning the sale of eggs altogether or allowing donors to be compensated only for their services, would either create a black market or would lead to corruption and abuse. Society still needs to debate specific rules and policies that should govern the human egg market, but further discussion of that important task is best left to legislative bodies and other commentators. (shrink)

In recent decades, debates about exploitation have tended to be subsumed by debates about choice and autonomy. This phenomenon has affected international feminism adversely, creating polarized debates over such issues as prostitution. Equally grave is the more recent tendency, even among some feminists, to assume that a woman’s free choice to accept payment for egg “donation” in somatic cell nuclear transfer stem cell research absolves researchers of any charge of exploitation or abuse of research subjects. This paper suggests that much (...) of this dissension among feminists is due to conflicting understandings of the crucial but neglected concept of exploitation. Analyzing two possible senses of exploitation—a disparity between value “in” and value “out” versus an affront to dignity—this paper argues that both are underpinned by what Carole Pateman identifies as gender subordination. In conclusion it is suggested that transnational feminism return to a more traditionally feminist stance, which explicitly focuses on opposing the subordination and exploitation of women. (shrink)

Scholarship aiming to describe the wrongness of exploitation, especially when it is voluntary and mutually beneficial, has increased greatly in recent years. In this paper, I expand the scope of this discussion by highlighting a set of additional ethical concerns associated with many cases of mutually voluntary and beneficial exploitation. Specifically, I argue that the phenomenon of persons desperately seeking out and gratefully accepting exploitative interactions raises special moral concerns. The element of voluntariness is key to understanding how and why (...) some exploitative interactions are degrading to exploitees. When an exploitative offer does not allow the exploitee sufficient progress toward a decent minimum of human functioning, these offers can create what I call a 'demeaning choice', where the exploitee may either accept the status quo or accept an offer that improves the exploitee's insufficiently. In these cases, the exploitee's participation in the interaction contributes to its demeaning quality, creating a form of `surface endorsement' of the treatment that she receives. (shrink)

Commercial surrogacy arrangements now cross borders; this paper aims to reevaluate the traditional moral concerns regarding the practice against the added ethical dimension of global injustice. I begin by considering the claim that global surrogacy serves to satisfy the positive reproductive rights of infertile first-world women. I then go on to consider three powerful challenges to this claim. The first holds that commercial surrogacy involves the commodification of a good that should not be valued in market terms, the second that (...) it involves the exploitation of the labor of disadvantaged women, and the third that it depends on the illegitimate privileging of positive rights over negative rights. I reject the first of these challenges and argue that global surrogacy arrangements are indeed exploitative on the dual basis of what I call intracontractual injustice and intercontractual coercion. The latter, I contend, depends on a preexisting negative rights violation, which cannot be permitted for the sake of satisfying another's positive reproductive entitlement. I conclude not in favor of a global ban but with suggestions on how developing nations that permit commercial surrogacy might better protect the negative reproductive rights of their female citizens, thereby making them less vulnerable to exploitation. (shrink)

This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings , is exploitative of surrogate women. Arising out of consideration of (...) the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

My project here is to argue for situating moral judgments about Indian surrogacy in the context of Reproductive Justice. I begin by crafting the best picture of Indian surrogacy available to me while marking some worries I have about discursive colonialism and epistemic honesty. Western feminists' responses to contract pregnancy fall loosely into two interrelated moments: post-Baby M discussions that focus on the morality of surrogacy work in Western contexts, and feminist biomedical ethnographies that focus on the lived dimensions of (...) reproductive technologies and how they are embodied and negotiated in specific cultural contexts. Both approaches have their shortcomings. Uncritically extending Western moral frameworks (for example, liberal feminist political values) to Indian surrogacy work raises the specter of discursive colonialism; with it, worries arise about how Western normative traditions can distort, erase, or misread non-Western subjects' lived experiences. Feminist biomedical ethnographic approaches correct this, but raise the specter of a weak moral absenteeism; with it, concerns arise about under-theorizing the structural harms and injustices shaping surrogacy worker's lives. I suggest that we might reduce these shortcomings by framing normative and ethnographic engagement with global surrogacy as questions of reproductive justice. (shrink)

Over the last couple of decades, oocyte donation has become common, important, and sometimes lucrative. Women who donate eggs are often offered fees, though ostensibly only to offset their expenses and limited to no more than $10,000, following recommendations adopted by the fertility industry. Is the industry adhering to its recommendations? A study of advertisements published in college newspapers raises questions.

In order to accommodate for the present shortage of oocyte donors, oocyte-donation programs place ads in college newspapers and provide large monetary compensation to encourage participation. Large compensation acts as a strong incentive for young women to undergo the potentially risky procedure of donation. In this enticing situation, it is particularly important for programs to fully inform prospective donors of the risks of the procedure so that they can accurately weigh the costs and benefits of donating. However, because oocyte-donor programs (...) must alleviate the shortage of donors if they wish to maintain a financially viable business, there is reason to fear that they may minimize or misrepresent risks when recruiting egg donors. In this pilot study, the risk information provided by programs (n=19) to prospective oocyte donors in a preliminary phone call inquiry was investigated. The majority of the programs provided incomplete and/or inaccurate risk information. Policy changes are recommended to reduce the potential for undue influence and to standardize and regulate the risk information provided to prospective egg donors. (shrink)

The American Journal of Bioethics, Volume 11, Issue 9, Page 33-35, September 2011.

Despite its title, Alan Wertheimer’s new book is not another tiresome exploration of Marxist economic theories. Indeed, there is virtually no extended discussion of Marxism at all, since Wertheimer believes that what is unique to that perspective is highly problematic, given that when Marxists simply assert that capitalists do exploit wage laborers they are appealing to “the ordinary notion that one party exploits another when it gets unfair and undeserved benefits from its transactions or relationships with others”. His goal is (...) to analyze this ordinary sense of exploitation, to explore in detail some of the many forms it can take, and to begin some serious thinking about what he terms its moral weight and its moral force. This groundbreaking work, the first book-length treatment of its subject from a broadly analytic standpoint, should do much to disabuse non-Marxist philosophers of the notion that exploitation is largely peripheral to the central questions of moral and political philosophy. (shrink)

In Canada there is a growing demand for human eggs for reproductive purposes and currently demand exceeds supply. This is not surprising, as egg production and retrieval is onerous. It requires considerable time, effort, and energy and carries with it significant physical and psychological risks. In very general terms, one cycle of egg production and retrieval involves an estimated total of 56 hours for interviews, counseling, and medical procedures. The screening carries risks of unanticipated findings with severe consequences for insurability. (...) The daily hormone injections can be painful and uncomfortable, causing cramping, abdominal pain, nausea, vomiting, bloating, mood changes, and irritability. (shrink)

This article focuses on the transformation of the female reproductive body with the use of assisted reproduction technologies under neo-liberal economic globalisation, wherein the ideology of trade without borders is central, as well as under liberal feminist ideals, wherein the right to self-determination is central. Two aspects of the body in western medicine—the fragmented body and the commodified body, and the integral relation between these two—are highlighted. This is done in order to analyse the implications of local and global transactions (...) in women’s reproductive body parts for their right to self-determination and individual agency and what this means for their embodiment. We conclude by exploring whether women can become embodied subjects by exercising their proprietary right to their bodies through directing technology to achieve their own goals, while at the same time being fragmented into parts and losing their personhood and bodily integrity. (shrink)

Stem cell research has important implications for medicine. The source of stem cells influences their therapeutic potential, with stem cells derived from early-stage embryos remaining the most versatile. Somatic cell nuclear transfer (SCNT), a source of embryonic stem cells, allows for understandings about disease development and, more importantly, the ability to yield embryonic stem cell lines that are genetically matched to the somatic cell donor. However, SCNT requires women to donate eggs, which involves injection of ovulation-inducing hormones and egg retrieval (...) through laparoscopy or transvaginal needle aspiration. Risks from this procedure are fiercely debated, most notably risk of ovarian hyperstimulation syndrome (OHSS). This review examines risk of OHSS resulting from oocyte donation. We conclude that risk posed by OHSS in egg donation is not significant enough to warrant undue concern, and much of this can be eliminated when proper precautions are taken. This bears relevance to the future of stem cell research policymaking. (shrink)