In 2016 and 2017 Health Canada solicited feedback related to drafting regulations to clarify sections of the Assisted Human Reproduction Act. This month they released the “What We Heard Report,” which disseminates feedback received from the summer 2017 call for public comments. This consultation focused on health and safety issues with gamete donation (section 10), reimbursement for expenses in egg donation and surrogacy (section 12), and enforcing and administering the Act (sections 45-58).
As my research on surrogacy turns to the Canadian context, I’ve been thinking more about reimbursement and tensions between unpaid and paid surrogacy. If you don’t already know, payments for surrogacy are criminalized in the Act. Part of what makes clarifying section 12 so important is that fertility professionals, commissioning parents, surrogates, and egg donors need clarification about ethical and legal guidelines with respect to reimbursing expenses incurred in relation to surrogacy or egg donation.
I’ve only skimmed the report. Below, I flag a few issues related to reimbursement I want to think about more.
- I worry that bureaucratic regulation creates or exacerbates ethical problems. For example, the Act limits legitimate reimbursements to those which have a receipt. As the Report indicates, managing receipts can be a nightmare for all parties involved, including the organization that stores them. Regulations may aim to provide protections, but they can reinforce or create new problems when the regulatory framework is overly bureaucratic. (I’m using “bureaucratic” in the value-laden negative sense that Hannah Arendt criticizes).
- How do we define exploitation? Advocates for both paid and unpaid surrogacy make claims about exploitation. While there is certainly an empirical component to determining exploitation, the conceptual terrain around this concept is slippery. Good thing I have Monique Deveaux and Vida Panitch’s 2017 collection Exploitation in my “to read ASAP” stack! My own view is that questions around payment won’t solve the exploitation debate. Paid and unpaid surrogacy can be sites of exploitation.
- How do we have a helpful public dialogue about the meanings and limitations of “altruism”? Conflicting feedback in the Report about the relation between payment, compensation, gratitude, exploitation, and coercion express lingering anxieties about altruism and how we value the labor performed by surrogates or egg donors. I almost dislike the term “altruism” as applied to surrogacy and egg donation. My dissatisfaction with “altruism” talk stems from the term’s ambiguity. Does it refer to someone’s motivations to provide reproductive services? Does it refer to the lack of payment? Does it indicate something about intangible benefits that a person gains in providing reproductive services? Is it used as a synonym for non- or less-exploitation? Is it being depicted as good against the ‘evils’ of commercialization?
What are your thoughts about the feedback Health Canada received? Check our recent blog posts on the importance of feminist analyses on assisted reproduction as you mull over this Report. The July 2017 Health Canada Report, “Toward a Strengthened Assisted Human Reproduction Act,” would also be a good read.
Two side notes. First, the online version of the report includes a helpful diagram to illustrate scalar differences between reports about “most,” “many,” “some/others,” and “few” in summarizing feedback. Second, while section 12 also applies to sperm donation, I’m more interested in egg donation and surrogacy.
Photo credit
Gerome Viavant
(Viavant depicts Alexander Milov’s “Love,” which I interpret differently in the context of assisted reproduction than the artist’s intentions to depict the isolation of adulthood.)