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)

Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation. The position is defended that allowing reproductive tourism is a (...) form of tolerance that prevents the frontal clash between the majority who imposes its view and the minority who claim to have a moral right to some medical service. Reproductive tourism is moral pluralism realised by moving across legal borders. As such, this pragmatic solution presupposes legal diversity. (shrink)

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much (...) less consideration given to more recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices. (shrink)

Background/IntroductionInfertile couples that travel to another country for reproductive treatment do not refer to themselves as “reproductive tourists”. They might even be offended by this term. “Tourism” is a metaphor with hidden connotations. We will analyze these connotations in public media discourses on “reproductive tourism” in Israel and Germany. We chose to focus on these two countries since legal, ethical and religious restrictions give couples a similar motivation to travel for reproductive care, while the (...) cultural backgrounds and conceptions of reproduction are different. Results: Our research shows that the use of the metaphor “reproductive treatment” and its hidden messages depends on the writers’ intention and the target population. Although the phenomenon of patients travelling for reproductive treatment can fit into the definitions of tourism, the term emphasizes aspects that do not reflect patients’ reality. In both the German and the Israeli public media debate the term “reproductive tourism” is either used to criticize the economic aspects of the phenomenon or to attract patients as potential clients. Conclusions: Ethicists should be cautious when borrowing metaphors like “reproductive tourism” from the public debate. Our findings support Penning’s suggestion to use instead an unloaded term like cross-border reproductive care to describe the phenomenon in a more neutral way and to make it explicit whenever criticism is necessary. (shrink)

This article explores the intersections of power within transnational surrogacy in India, using the lens of geography to examine surrogate women’s and commissioning parents’ experiences and perceptions of space and mobility. The author analyzes ethnographic data within a geographical framework to examine how actors embody and experience power relations through space and movement, revealing how power is not simply about who moves and who doesn’t. Rather, in recognizing the specificity of the Indian context, and how different actors inhabit and move (...) through distinct spaces, a geographical lens reveals the shifting complexity of structures of agency and power. Drawing on extensive ethnographic fieldwork in India, the author traces how both surrogate mothers and commissioning parents experience moments of mobility and movement punctuated by intervals of immobility and stillness, in distinct ways that illuminate the power relations inherent in transnational reproduction. (shrink)

Approximately 15% of couples are affected by infertility worldwide. Subsequently, the use of assisted reproductive technologies is becoming increasingly popular, including the use of donor eggs, sperm and embryos. Despite ongoing ethical debate surrounding gamete donation, this is now a widely accepted practice in Western countries. Assisted reproductive technology is becoming more commonly utilised within the Muslim population; however, gamete donation remains a relatively controversial and taboo topic within this religion. Interestingly, there are significant differences in beliefs between (...) Sunni and Shi’a Muslims. Whilst Sunni Islam absolutely forbids the use of third-party reproductive assistance, Shi’a Islam is somewhat more lenient towards this practice. Reproductive tourism has therefore become prevalent in Shi’a Middle Eastern countries that permit the use of donor gametes in assisted reproductive technologies; however, this continues to evoke a strong bioethical debate, particularly around sperm donation. With the increased influx of reproductive tourism, this is beginning to weaken the regional Sunni Islam ban on the use of donor technologies, questioning the morality of their current beliefs. Consideration of religious beliefs is also crucial for patient-centred care in UK patients treated by the National Health Service for fertility issues. Of note, there is a lack of non-Caucasian donors in the United Kingdom. Reproductive tourism is also becoming increasingly common in the United Kingdom and needs to be considered in terms of future patient management in delivering good obstetric care. (shrink)

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.

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)

Investigating maternity tourism to the United States from Russia through the lens of technological mediation, this study foregrounds the geopolitical patterns of human reproduction that shape, and are shaped by, individual choices of maternal healthcare in a neoliberal healthcare market. Following the history of a highly popular Russian-language forum, I demonstrate how this online community gets imbricated into communicative biocapitalism – a neoliberal logic that commodifies the voice of an online user, turning networked publics into markets for medical services. (...) Adding to the literature on data colonialism, I explore a case in which data-driven algorithms effectively alter geographical distribution of reproductive bodies, outsourcing the production of new generations of neoliberal subjects through regimes of technological mediation. (shrink)

As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical (...) research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (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 (re)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)

The United Kingdom is the first and so far only country to pass explicit legislation allowing for the licensed use of the new reproductive technology known as mitochondrial replacement therapy. The techniques used in this technology may prevent the transmission of mitochondrial DNA diseases, but they are controversial because they involve the manipulation of oocytes or embryos and the transfer of genetic material. Some commentators have even suggested that MRT constitutes germline genome modification. All eyes were on the United (...) Kingdom as the most likely location for the first MRT birth, so it was a shock when, on September 27, 2016, an announcement went out that the first baby to result from use of the intervention had already been born. In New York City, United States-based scientist John Zhang used maternal spindle transfer to generate five embryos for a woman carrying oocytes with deleterious mutations of the mitochondrial DNA. Zhang then shipped the only euploid embryo to Mexico, where it was transferred to the mother's uterus. Zhang's team's travel across international borders to carry out experimental procedures represents a form of scientific tourism that has not been properly ethically explored; it can, however, have seriously detrimental effects for developing countries. (shrink)

This paper draws on the concepts of reproduction and scale to suggest that Skeggs and Wilson, in their contributions to this issue of Feminist Legal Studies, both identify a future-oriented reworking of historically accumulated value. The spectacular emotional labour of British reality television and the parody of mechanistic labour in Bangkok’s sex shows may be seen as instances in the affective search for future security in transnational markets. Capitalist subjectivities are still being produced through these gendered and sexual activities, but (...) they are being produced with television audiences and sex tourists whose geopolitical baggage becomes part of the show. (shrink)

One of the areas of concern raised by cross-border reproductive travel regards the treatment of women who are solicited to provide their ova or surrogacy services to foreign consumers. This is particularly troublesome in the context of developing countries where endemic poverty and low standards for both medical care and informed consent may place these women at risk of exploitation and harm. We explore two contrasting proposals for policy development regarding the industry, both of which seek to promote ethical (...) outcomes and social justice: While one proposal advocates efforts to minimize cross-border demand for female reproductive resources through the pursuit of national self-sufficiency, the other defends cross-border trade as a means for meeting the needs of vulnerable groups. Despite the conflicting objectives of the proposed strategies, the paper identifies common values and points of agreement between the two, including the importance of regulations to safeguard those providing ova or surrogacy services. (shrink)

Surrogacy tourism in Asian countries has surged in recent decades due to affordable prices and favourable regulations. Although it has recently been banned in many countries, it is still carried out illegally across borders. With demand for surrogacy in developed countries increasing and economically vulnerable Asian women lured by lucrative compensation, there are efforts by guest countries to ease the strict surrogacy regulations in host countries. Despite a shift toward “altruistic surrogacy”, commercial surrogacy persists. Recent research carried out by (...) international organizations that seek to establish a legal relationship between the commissioning parents and children in cross-border surrogacy arrangements, under the guise of the “best interests of the child,” appears to promote a resurgence of overseas commercial surrogacy rather than restrict it. Further commercialization of surrogacy should be prevented by carefully investigating the reality of the surrogacy process. (shrink)

This essay will focus on the moral issues relating to surrogacy in the global context, and will critique the liberal arguments that have been offered in support of it. Liberal arguments hold sway concerning reproductive arrangements made between commissioning couples from wealthy nations and the surrogates from socioeconomically weak backgrounds that they hire to do their reproductive labor. My argument in this paper is motivated by a concern for controlling harms by putting the practice of globalized commercial surrogacy (...) into the context of care ethics. As I will argue, the unstable situations into which children of global surrogacy arrangements are born is symbolic of the crisis of care that the practice raises. Using the Baby Manji case as my touch point, I will suggest that liberalism cannot address the harms experienced by Manji and children like her who are created through the global practice of assisted reproductive technology. I will argue that, if commissioning couples consider their proposed surrogacy contracts from a care ethics point of view, they will begin to think relationally about their actions, considering the practice from an ethical lens, not just an economic or contractual one. (shrink)

In vitro fertilization (IVF) and surrogacy have enabled many to achieve their dreams of parenthood. With a turnover of $500 million, reproductive tourism in India has helped transform the country into a “global baby factory.” However, as the surrogacy industry grew, so did concerns of women’s exploitation, commodification of motherhood, and human rights violations. In an effort to prevent women from being exploited, the Indian government had taken successive administrative measures to regulate surrogacy. The Surrogacy (Regulation) Bill, 2016 (...) and Assisted Reproductive Technologies Bill 2008 were introduced in the Parliament to regulate various aspects of surrogacy arrangements. Yet, it was not until 25 January 2022, that the Surrogacy (Regulation) Act, 2021 went into effect. The Act does, however, leave certain important points unaddressed. The article claims that the legislation’s purposeful exclusion of the LGBTQ population and emphasis on “familial altruism” stinks of inequity and moral conservatism. It also delineates the mechanics of altruistic surrogacy by examining documents that illustrate how the connections between money and morality are framed via the framing of altruism. The article therefore demands that a comprehensive dialogue must be held considering the socio-economic realities of Indian society, or else India risks enacting yet another law that cannot be implemented or that society dislikes. (shrink)

Can't Regulate, Won't Regulate? As the global trade in human eggs continues to expand with logarithmic momentum, it is frequently argued that we could not regulate it even if we wanted to. Not all commentators do want to, of course. Many view regulation as counterproductive: reports have suggested that FDA governance has had the perverse effect of increasing levels of reproductive tourism to Latin America. Most of the other chapters in this volume are broadly in favour of letting (...) market forces take their course, with varying degrees of control. I will examine whether reproductive freedom and choice really are all-important. Before I begin that analysis, however, I need to clear away the argument that we cannot control black markets in human body parts, including eggs, even if we want to. This argument is common to commentators from many positions in the political spectrum. Some writers assert that “baby markets,” comprising egg sale, surrogacy, and paid adoption, are so firmly established that prohibiting or regulating them salves our collective conscience but amounts to no more than hypocritical pretense. Other commentators claim that the burgeoning demand for eggs simply makes even an honest attempt to ban markets unrealistic or imply that the natural and laudable desire for “procreative liberty” would inevitably drive couples to defy paternalistic legal bans. On any of these accounts, regulating global markets in human tissue is said to be a lost cause. I argue the opposite. (shrink)

In the case of surrogacy, it is not new biotechnologies themselves that have challenged well-established principles in law and ethics, but rather political and social phenomena such as commodification of women’s reproductive tissue and labour, demands to allow new ways of forming families and (before Covid-19, at least) the comparative ease of international travel that enabled cross-border surrogacy to develop into a market valued at up to $2 billion annually in India alone as of 2016 (Dickenson 2016, citing an (...) estimate from The Indian National Commission for Women). This phenomenon stands the usual truth on its head: it is not new technologies but new pressures that have challenged the existing law and ethics of surrogate motherhood. (shrink)

This article uses narrative accounts of women who are intended parents to show the health and financial implications of infertility treatments (particularly in vitro fertilization), underregulation, and lack of funding in the United States and abroad. It argues that providing access to infertility treatment and regulating for safety are necessary means of protecting the health of women diagnosed with infertility and women who, through the sale of their reproductive goods and services, are the catalysts to conception. Many moral ambiguities (...) arise from the utilization of assistive reproductive technologies to treat infertility, requiring careful scrutiny of market and nonmarket values. (shrink)

There’s no doubt that medical ethics should be ‘grounded’, in the sense that it aims to make a practical, normative contribution to significant ethical issues in medicine. There are a number of ways in which ethics can do that, two of which feature in this issue of the Journal of Medical Ethics. One way is by responding to significant new policy or legal developments that will have an impact on clinical practice. This issue discusses two legal developments that matter to (...) patients and healthcare professionals: the sanctions applied to Dr Bawa-Garba and the Supreme Court’s ruling on the withdrawal of artificial nutrition and hydration. A second way of grounding ethical analysis in the reality and complexity of ethical issues is by using empirical methods. There are two papers in this issue from Canada that illustrate how the subtleties of complex ethical issues can be teased out via qualitative methods. Medical tourism is an important and rapidly developing phenomenon that raises a set of interesting and tricky ethical issues.1 It has been discussed in the Journal of Medical Ethics before and its implications for end of life, dentistry and other health interventions have been explored.2 3 Reproductive tourism occurs in many countries and the complications it can create for issues such as the citizenship of resulting children have been discussed at some length in the JME.4 5 Reproductive tourism is a good example of an area where it is particularly important for ethical analysis to be grounded in the facts and reality of a situation and an empirical approach to ethics is therefore a good option for this topic. In this issue, Couture et …. (shrink)

The issue of surrogacy has received a great deal of attention in the West ever since the famous Baby M case in the latter part of the 1980s. Ethicists, psychologists, and legal experts have struggled with the meanings and implications of this practice, especially in its commercial form. In contemporary times, however, the phenomenon of surrogacy has assumed new dimensions as it travels across national borders in the context of globalization. As a transnational phenomenon, it is now marketed as an (...) attractive part of "Reproductive Tourism," for the most part, by various clinics and organizations located in the global south to some of the so-called "First World nations."Until now, most of the philosophical literature. (shrink)

Selective reproductive technologies, such as preimplantation genetic diagnosis, enable enhanced clinical success rates, create reproductive choices, and produce new commercial opportunities. Drawing upon empirical material acquired during a ten-month period in 2016, this study uses a total of twenty-two in-depth interviews with doctors, CEOs, clinical directors, marketing directors, patient counselors, and embryologists to discuss how traveling for the SRT of gender selection for nonmedical reasons is mediated by fertility clinics and clinicians in Dubai. Multimodal analysis was used to (...) analyze the clinical websites’ key rhetorical and visual features. Meanwhile, interviews and observational studies highlighted the context within which gender selection takes place. Findings revealed that gender selection is promoted as a form of “enhancement” and “family balance,” which, when combined with the ways that Dubai is assembled as a sensory tourist destination, routinize SRTs and lead to an understanding of gender selection as not merely an individualized reproductive journey but an optimization of the family unit. (shrink)

Commercial surrogacy in India is a booming industry however the raising number of poor illiterate women's participation as commercial surrogate poses serious question of coercion, on the other hand it economically empowers them. In this context, this article analyses the crucial question, can coercion be justified when it benefits the poor by investigating commercial surrogates’ life stories and looking into the various types of coercion discreetly operates. It concludes with few recommendations which can help in empowering poor commercial surrogates who (...) involved in commercial surrogacy industry in India. (shrink)

On September 27, 2016 people across the world looked down at their buzzing phones to see the AP Alert: “Baby born with DNA from 3 people, first from new technique.” It was an announcement met with confusion by many, but one that polarized the scientific community almost instantly. Some celebrated the birth as an advancement that could help women with a family history of mitochondrial diseases prevent the transmission of the disease to future generations; others held it unethical, citing medical (...) tourism and consequences for the future of the therapy. The child in question was actually born a few months earlier on April 6, 2016, but the research was published a few months later in the October edition of Fertility and Sterility. The mother carries DNA that could have given the baby Leigh Syndrome, a severe neurological disorder characterized by psychomotor regression that typically results in death between ages two and three.[1] Also known as subacute necrotizing encephalomyelopathy, Leigh Syndrome is caused by genetic mutations in mitochondrial DNA, which causes defective oxidative phosphorylation. Because people with this condition cannot re-form ATP, “demyleniation, gliosis, necrosis, spongiosis, or capillary proliferation”[2] can occur, thereby producing bilateral lesions across the central nervous system. The 36-year-old mother previously had four miscarriages and successfully birthed two children, both of whom survived less than six years due to the syndrome. For religious reasons, the mother opted for Spindle Nuclear Transfer instead of Pronuclear Transfer,[3] which many religious organizations oppose because it entails the destruction of fertilized eggs.[4] In Pronuclear Transfer, both the parent and donor egg are fertilized. The parent’s nuclear material is then removed from the egg containing mutated mitochondria and inserted into the fertilized donor egg—from which the original nuclear material has been removed and destroyed. Spindle Nuclear Transfer, on the other hand, removes the mother’s nuclear material from the egg with unhealthy mitochondria, then implants it into a donor’s egg. The newly created egg is then fertilized with the father’s sperm. This Spindle Nuclear Transfer was performed in Mexico by a team of doctors led by Dr. John Zhang, the founder of the New Hope Fertility Center in New York City. In their report, the doctors outline that five oocytes were successfully reconstituted, four of which developed into blastocysts. Only one was euploid: containing 46 XY chromosomes. Researchers then biopsied that blastocyst and found that the transmission rate of maternal mtDNA was, “5.10 ± 1.11% and the heteroplasmy level for 8993T>G was 5.73%.”[5] This indicates that at the blastocyst stage, around five percent of the mitochondria are from the original maternal egg with the mutation for Leigh Syndrome. After birth, they biopsied different tissues and found that they had an average of less than 1.60 ± 0.92% of transmitted mtDNA from the original maternal egg. The baby is reportedly doing well and the team of doctors concluded that “[h]uman oocytes reconstituted by SNT are capable of producing a healthy live birth. SNT may provide a novel treatment option in minimizing pathogenic mtDNA transmission from mothers to their babies."[6] Even when considered theoretically, Spindle Nuclear Transfer is controversial. Many doctors believe that the risks at this stage of research are too great. Dr. Trevor Stammers, a bioethicist at St. Mary’s University in London, points out: “We do not yet have a clear picture of the interaction between nuclear DNA and mitochondria.”[7] Others hold that faulty mitochondrial DNA can still be transferred during the procedure. Still more argue this technology could create problems because of germline modification.[8] Dr. Paul Knoepfler, a cell biologist at the UC Davis School of Medicine, explains: “Since this is uncharted territory and the children born from this technology would have heritable genetic changes, there are also significant unknown risks to future generations.”[9] However, proponents counter these arguments. They say the benefits outweigh the risks, as “mitochondrial replacement techniques [like Spindle Nuclear Transfer] would eliminate maternal transmission of mitochondrial disease… allowing a woman with a family history of mitochondrial diseases to ensure her children would not be affected.”[10] Additionally, experts say that no symptoms will occur if less than 20% of the transferred mitochondrial DNA is faulty.[11] And while opponents see potential germline modification as a problem, advocates answer that this could stop a family history of mitochondrial disease, which they deem a more serious concern. In this case specifically, however, there are more issues at hand. While the team of doctors did eliminate the possibility of germline modification by selecting a male embryo, there are other ethical concerns. Some argue that this case could be described as “medical tourism.” While New Hope Medical Clinic does maintain a branch in Mexico, Dr. Zhang stated that Mexico has “no rules.”[12] It is a country with underdeveloped regulations, making it difficult to confirm that doctors adhere to widely-held medical and ethical standards. Furthermore, while it is highly unlikely that the child will develop Leigh’s Syndrome, Dr. Dietrich Egli of the New York Stem Cell Foundation says the 5% mitochondrial transfer rate indicates that the technique “was not carried out well.”[13] He points to studies of embryos where the rate of mtDNA transfer was almost ten times lower. Spindle Nuclear Transfer is currently legal in the UK,[14] and many are hoping to see it legalized in the US, although Congress currently prohibits the FDA from considering applications that would entail trials in people.[15] While Dr. Zhang’s work is arguably revolutionary, many wonder if the manner in which this study was performed—in Mexico and with a high mitochondrial transfer rate—will impact the technology’s future in the US. Last week, Dr. Zhang presented the report to scientists gathered in Salt Lake City, saying that while science isn’t a race, it is “in a sense, a race for the family to find a cure, to find hope.”[16] Only time will tell if this study set back other families racing and hoping for a cure. References 1. "Leigh Syndrome." Genetics Home Reference, US National Library of Medicine, 25 Oct. 2016. Accessed 26 Oct. 2016. 2. McKusick, Victor A., and Ada Hamosh. "LEIGH SYNDROME; LS." Online Mendelian Inheritance in Man, Johns Hopkins University, 20 Jan. 2016. Accessed 30 Oct. 2016. 3. Zhang, J, H Liu, S Luo, A Chavez-Badiola, and Z Liu. "First live birth using human oocytes reconstituted by spindle nuclear transfer for mitochondrial DNA mutation causing Leigh syndrome." Fertility and Sterility, vol. 106, no. 3, 2016, pp. e375-76. Accessed 30 Oct. 2016. 4. Sample, Ian. "‘Three-parent’ babies explained: what are the concerns and are they justified?" The Guardian, 2 Feb. 2015. Accessed 30 Oct. 2016. 5. Zhang, et al. 6. Ibid. 7. Knapton, Sarah. "Three-parent babies: the arguments for and against." The Telegraph, 3 Feb. 2015. 8. Ibid. 9. Ibid. 10. "Mitochondrial Replacement Therapy FAQs." New York Stem Cell Foundation Research Institute, New York Stem Cell Foundation. Accessed 30 Oct. 2016. 11. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 12. Hamzelou, Jessica. "Exclusive: World’s first baby born with new “3 parent” technique." New Scientist, 27 Sept. 2016. Accessed 30 Oct. 2016. 13. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 14. "3-Person IVF: A Resource Page." Center for Genetics and Society, 24 Oct. 2016. Accessed 30 Oct. 2016. 15. Ritter, Malcolm. "Baby born with DNA from 3 people, first from new technique." Associated Press, 27 Sept. 2016. Accessed 30 Oct. 2016. 16. Chen, Daphne. "Controversy swirls around first three-parent baby." Deseret News, 19 Oct. 2016. Accessed 30 Oct. 2016. Works consulted Swetlitz, Ike. "FDA urged to approve ‘three-parent embryos,’ a new frontier in reproduction." STAT, 3 Feb. 2016. Accessed 30 Oct. 2016. (shrink)

Increasingly the body is a possession that does not belong to us. It is bought and sold, bartered and stolen, marketed wholesale or in parts. The professions - especially reproductive medicine, transplant surgery, and bioethics but also journalism and other cultural specialists - have been pliant partners in this accelerating commodification of live and dead human organisms. Under the guise of healing or research, they have contributed to a new 'ethic of parts' for which the divisible body is severed (...) from the self, torn from the social fabric, and thrust into commercial transactions -- as organs, secretions, reproductive capacities, and tissues -- responding to the dictates of an incipiently global marketplace. Breaking with established approaches which prioritize the body as 'text', the chapters in this book examine not only images of the body-turned-merchandise but actually existing organisms considered at once as material entities, semi-magical tokens, symbolic vectors and founts of lived experience. The topics covered range from the cultural disposal and media treatment of corpses, the biopolitics of cells, sperm banks and eugenics, to the international trafficking of kidneys, the development of 'transplant tourism', to the idioms of corporeal exploitation among prizefighters as a limiting case of fleshly commodity. This insightful and arresting volume combines perspectives from anthropology, law, medicine, and sociology to offer compelling analyses of the concrete ways in which the body is made into a commodity and how its marketization in turn remakes social relations and cultural meanings. (shrink)

Four decades after the Baby M case that led to the prohibition of commercial surrogacy in New York, much has changed in the infertility industry. Advanced technologies including the advent of gestational carrier pregnancies had made it easier and more efficient to create IVF embryos at a distance and over time, accelerating a boom in cross-border, reproductive services and allowing compensated surrogacy to flourish in a growing number of surrogacy-friendly states and beyond. For international couples, the USA has become (...) a hot spot for “circumvention tourism” given its first-rate medical care, ample supply of willing gestational carriers, burgeoning interest in family building among gay couples, and immediate USA citizenship for the child. This commentary reviews selected sociocultural and global forces that helped set the stage for the passage of the Child-Parent Security Act in New York state in 2021, and the efforts by its opponents for stronger protections not only for gestational carriers, but for gamete donors and the donor-conceived offspring. I argue that despite more responsive medical and legal guidelines, the high market demand and economic profits, combined with the lack of regulatory teeth, faulty assumptions about health risks and decision-making autonomy, and inadequate research on long-term health outcomes, continue to make compensated gestational surrogacy in the state of New York a high-risk venture without adequate informed consent. Possible unintended consequences and future research questions are proposed. (shrink)

some years, the German public has been debating the case of migrant workers receiving German benefits for children living abroad, which has been scandalised as a case of “benefit tourism.” This points to a failure to recognise a striking imbalance between the output of the German welfare state to migrants and the input it receives from migrant domestic workers. In this article I discuss how this input is being rendered invisible or at least underappreciated by sexist, racist, and classist (...) practices of othering. To illustrate the point, I will use examples from two empirical research projects that looked into how families in Germany outsource various forms of reproductive work to both female and male migrants from Eastern Europe. Drawing on the concept of othering developed in feminist and postcolonial literature and their ideas of how priv‐ ileges and disadvantages are interconnected, I will put this example into the context of literature on racism, gender, and care work migration. I show how migrant workers fail to live up to the normative standards of work, family life, and gender relations and norms set by a sedentary society. A complex interaction of supposedly “natural” and “objective” differences between “us” and “them” are at work to justify everyday discrimination against migrants and their institutional exclusion. These processes are also reflected in current political and public debates on the commodification and transnationalisation of care. (shrink)

‘Fair trade’, ‘ethical’ and ‘sustainable’ consumption emerged in response to rising concerns about the destructive effects of hedonic models of consumption that are typical of late capitalist societies. Advocates of these ‘markets for virtue’ sought to supplant the insatiable hedonic impulse with a morally restrained, self-disciplining disposition to consumption. With moral markets currently losing their appeal, we respond to the tendency to view hedonism as an inhibitor of moral market behaviour, and view it instead as a potential enabler. Drawing upon (...) the concept of ‘alternative hedonism’ (Soper, J Consum Cult 7:205–229, 2007; Cult Stud 22(5):567–587, 2008; Ethics and morality in consumption: interdisciplinary perspectives, Routledge, London, 2016; A new hedonism: a post-consumerism vision, the next system project, 2017), we illustrate how consumers experience both morality and pleasure concurrently; show how they attempt to reconcile these aspects of the experience and elucidate the implications of doing so. Using the moral market for ethical tourism as an exemplar of ‘alternative hedonism’, we identify three ‘self-managing strategies’—moderating, abiding and levelling—that re-structure the moral order of consumption in meaningful ways and with profound outcomes. In the context of anxieties about personal, social and ecological consequences of consumption, we show empirically how self-managing strategies reify a less contradictory framing of consumption by tapping into alternative cultural discourses on morality. We discuss the consequences of these strategies, highlighting how they may legitimise and sustain consumption via moral markets despite the reproduction of social inequality and ecological threats. (shrink)

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)

Machine generated contents note: Introduction. -- Acknowledgments. -- The Author. -- 1 Ethical Theories and Bioethics in a Global Perspective. -- Theories of Ethics. -- Are Theories of Ethics Global? -- Can Theories of Ethics Encourage People to Do the Right Thing? -- 2 Autonomy and Informed Consent in Global Perspective. -- Ethical Principles and Practical Issues of Informed Consent. -- Does Informed Consent Really Matter to Patients? -- Is Informed Consent a Universal Principle or a Cultural Value? -- 3 (...) Withholding or Withdrawing Treatment and Physician-Assisted Suicide. -- Withholding or Withdrawing Treatment at the End of Life. -- Assisting Patients in Committing Suicide. -- 4 Ethical Issues in Reproductive Health. -- Ethics of Abortion in Different Times, Places, and Cultures. -- Current Ethical Issues in Abortion. -- Assisted Reproductive Technology and Stem Cell Research. -- Emergency Contraception. -- Ethics of Imposing Conditions on Funding. -- 5 Ethical Issues of Female Genital Mutilation. -- The Facts About FGM. -- FGM as a Challenge to Ethical Relativism. -- Ethics of FGM for Adult Women. -- 6 Ethical Issues of Research with Human Subjects. -- Background Information and the Belmont Report. -- Autonomy and Voluntary Informed Consent. -- Beneficence and Cost-Benefit Analysis. -- Issues of Justice and Fairness for Human Subjects. -- 7 The Right to Health Care, and Ethical Obligations to Provide Care. -- Is There an Ethical Right to Health Care? -- Ethical Obligations of Health Care Professionals. -- Ethical Obligations of for-Profit Health Care Providers. -- 8 Ethical Issues in Rationing and Allocation of Limited Resources. -- Levels of Allocating Resources. -- Methods of Rationing Health Resources. -- Comparative Effectiveness Research and Cost-Effectiveness Analysis. -- 9 Ethical Issues of Health Insurance and Health System Reform. -- Ethical Issues in Financing Health Services and Designing Insurance Systems. -- Fundamental Values of Health Systems. -- 10 Ethical Issues in the Movement of Patients Across National Borders. -- Ethical Duties to Provide Health Care to Undocumented Aliens. -- Ethical Issues in Medical Tourism. -- 11 Ethical Issues in the Movement of Health Care Professionals Across National Borders. -- Ethical Issues in the Migration of Health Professionals. -- Proposed Solutions and Their Ethical Implications. -- Fair Treatment of Health Care Workers from Other Countries. -- 12 Corruption and Informal Payments in Health Systems. -- Payment of Informal Fees by Patients and Their Families. -- Is Corruption Bad for Your (and Other People's) Health? -- References. -- Index. (shrink)

Contemporary academic interest in the human body is a response to fundamental changes in the relationship between body, economy, technology and society. Scientific advances, particularly new reproductive technologies and therapeutic cloning techniques, have given the human body a problematic status. Ageing, disease and death no longer appear to be immutable facts about the human condition. The emergence of the body as a topic of research in the humanities and social sciences is also a response to the women's and gay (...) liberation movements, and environmentalism, animal rights, anti-globalism, religious fundamentalism and conservative politics. Further, the human body is now central to economic growth in various biotechnology industries, in which disease itself has become a productive factor in the global economy and the body a code or system of information from which profits can be extracted through patents. In modern social theory, the body has been studied in the contexts of advertising and consumerism, in ethical debates about cloning, in research on HIV/AIDS, in postmodern reflections on cybernetics, cyberbodies and cyberpunk, and in the analysis of the global trade in human organs. The body is a central feature of contemporary politics, because its ambiguities, vulnerability and plasticity have been amplified by new genetic technologies. (shrink)

_The Business of Being Made_ is the first book to critically analyze assisted reproductive technologies from a transdisciplinary perspective integrating psychoanalytic and cultural theories. It is a ground-breaking collection exploring ARTs through diverse methods including interview research, clinical case studies, psychoanalytic based ethnography, and memoir. Gathering clinicians and researchers who specialize in this area, this book engages current research in psychoanalysis, sociology, anthropology, philosophy and debates in feminist, queer and cultural theory about affect, temporality, and bodies. With psychoanalysis as (...) its fulcrum, _The Business of Being Made_ explores the social constructions and personal experiences of ARTs. Katie Gentile frames the cultural context, exploring the ways ARTs have become a complex form of playing with time, attempting to manufacture a hopeful future in the midst of growing global uncertainty. The contributors then present a range of varied experiences related to ARTs, including: Interviews with women and men undergoing ARTs; A psychoanalytic memoir of male infertility; Clinical research and work with transgender, gay and lesbian patients creating new Oedipal constellations, the experiences of LBGTQ people within the medical system and the variety of families that emerge; Research on the experiences of egg donors and a corresponding clinical case study of successful egg donation; The experiences of ongoing failure which is the often unacknowledged for ART procedures; How and when people choose to stop using ARTs; A psychoanalytic ethnography of a neonatal intensive care unit populated in part with the babies created through these technologies and their parents, haggard and in shock after years of failed attempts. Full of original material, _The Business of Being Made_ conveys the ambivalence of these technologies without simplifying their complicated consequences for the bodies of individuals, the family, cultures, and our planet. This book will be relevant to clinicians, medical and psychological personnel working in assisted reproductive technologies and infertility, as well as academics working in the fields of sociology, literature, queer and feminist theories and at the intersections of cultural, critical and psychoanalytic theories. (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)

In a project The Hastings Center is now running on the future of prenatal testing, we are encountering clear examples, both in established law and in the practices of individual providers, of failures to respect women's reproductive autonomy: when testing is not offered to certain demographics of women, for instance, or when the choices of women to terminate or continue pregnancies are prohibited or otherwise not supported. But this project also raises puzzles for reproductive autonomy. We have learned (...) that some clinicians and patients do not discuss the fact that prenatal testing can lead to a decision about whether to terminate a pregnancy—they just don't talk about it. And while the decision whether to agree to prenatal screening and diagnostic testing is to be made with women's free and informed consent, many screening tests have been routinized in such a way that some women do not even recall agreeing to testing, while others feel that agreeing to testing is what their clinicians expect of them or that the testing is necessary to protect themselves and their families from the significant financial hardship of raising a child with a disability. In the face of these pressures, can one really say that women are freely choosing to undergo testing or are freely choosing to continue or terminate a pregnancy following receipt of test results? The reality of these pressures is requiring us to consider expanding the scope of our investigation beyond the clinical encounter to the broader context—to think harder about what reproductive autonomy means and how best to enhance it. (shrink)

A literary, historical and philosophical discussion of attitudes to blindness by the sighted, and what the blind 'see'.