Last month Health Canada released draft language specifying what constitutes a legitimate and legal reimbursement for expenses incurred during gamete provision or surrogacy. Section 12 of the Assisted Human Reproduction Act states that reimbursements must be made “in accordance with the regulations” which have not existed (until now). The lack of regulation has created confusion and wariness about the legality of reimbursing expenses in surrogacy or gamete donation. Indeed, the only criminal charge under the Act was around reimbursement without receipts, as required by the Act.
In January, when Health Canada released its summary of feedback from their initial consultation, I wrote about some of my concerns related to or raised by reimbursement. Some concerns have not been alleviated, such as the bureaucracy required to administer reimbursements. Other parts of the proposed regulation make me optimistic, especially around meliorating a financial burden that surrogates and egg donors may experience.
Françoise Baylis wrote optimistically for the Impact Ethics blog that these regulations will contribute to a sustainable non-commercial system in Canada. My recent work explores ethical justifications for non-commercial surrogacy regulation in Canada. Thus, I am curious about how these regulations will impact surrogates’ and donors’ lived realities. Will an adequate reimbursement system address economic vulnerability? Or, will surrogates and donors recommend that compensation or payment is needed? Is this proposed language reflective of an adequate reimbursement system? Below are some brief comments. I benefited from discussing some of these issues with my feminist bioethics seminar as well. (THANKS y’all!)
For information on how to submit a comment to Health Canada about these regulations, visit this link.
All the paperwork
Reading the proposed language on requirements for reimbursement (section 6) makes navigating the online expense claim system we use at work seem simple. (Probably helpful to note I usually screw something up with that system). Surrogates have to explain each expense and support their claims with careful documentation. This process seems onerous. Now, I don’t send many invoices, and I imagine that there’s already software that can make this process much less burdensome.
Though the process is burdensome, there is something positive to be said about clear and thorough record-keeping, especially if there is a dispute somewhere down the line. Burdensome paperwork is not necessarily a bad thing, and would aid enforcement. I merely want to note that the process outlined in the draft language is much more onerous that the explanations I have to give for work-related expenses. I suspect that the invoicing software programs that I hear advertised on podcasts might find a new clientele base . . .
Many things count!
One thing I am pleased to note is what seems to be a generous take on legitimate expenses. Of course, receipts are still required, in most instances. That being said, the list of categories of reimbursable expenses includes transportation, counselling, clothing and needed equipment, as well as “expenditures for products or services that are provided by or recommended in writing by a person who is authorized under the laws of a province to assess, monitor and provide health care to a woman during her pregnancy, delivery or the post-partum period.”
These categories are worded in a way that invites a broad interpretation. Ontario, where I live, regulates a number of healthcare professions. Although midwives are the only profession with an expressed scope to care for pregnant women, many of the professionals recognized by Ontario might be able, it seems to me, to provide authorization for a particular example.
There may be some question about what constitutes the post-partum period. Six weeks is a common way of referring to the post-partum period. Usually six weeks refers to the time frame for regular medical check-ups for a person who has given birth. However, many conditions require a greater time frame for assessment. Researchers indicate that for pelvic floor conditions, six months is the upper-limit for a delayed post-partum period. The Canadian Mental Health Association stipulates that post-partum depression can begin up to a year following birth. Attention to donor and surrogate experiences might be a way to determine a reasonable time frame for when women might need to access healthcare resources following their donation or surrogacy. This is one area where we want a broad rather than a narrow interpretation.
Upfront expenses a burden?
Some concerns I have with the proposed language are more concerns with the Act itself. Though I understand why receipts are asked for, this process burdens surrogates or donors with paying up front and waiting for reimbursement. With the paperwork process, donors and surrogates may submit reimbursement claims in larger batches rather than as they come in. My ideal system, which is arguably inconsistent with (and at least absent from) section 12 of the Act, would have a mechanism for advances that might alleviate the burden of paying up front for costs.
All my dependents?
One final qualm, which I raise partially in jest and partially in full seriousness: if care for dependents can be reimbursed (which it should) why can’t animal companions be considered dependents, at least in some contexts? Those of us with animal dependents still have to pay for their care when we travel overnight. Making sure my rats are cared for is a constraint around my travel, and I imagine I’m not the only person whose ability to travel for a few days (say, to donate eggs where the intended mother lives and will she will undergo IVF) depends on having animal family members cared for.
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