Reproductive tourism, the phenomenon of people crossing international borders to purchase assisted reproductive technologies (ARTs) is now a multi-billion dollar industry. Its most ethically problematic manifestation is when citizens of wealthy countries (like Canada and the USA) travel to poorer countries (most commonly India) to purchase the services of a surrogate mother. By some accounts, the Indian ART industry is worth $500 million to $2.3 billion.
In their upcoming paper, Ethical concerns for maternal surrogacy and reproductive tourism in the Journal of Medical Ethics, Professor Raywat Deonandan of the Interdisciplinary School of Health Sciences at the University of Ottawa, along with students Samantha Green and Amanda van Beinum, enumerate the specific ethical challenges posed by this emerging new industry.
Along with six other concerning issues, the authors identified the tension between business ethics and medical ethics as being at the heart of the industry's ethical problem, along with an insufficiently broad definition of informed consent. When desperately poor, illiterate and vulnerable village women are entering into complicated contracts to sell their reproductive health to wealthy foreigners, often some of the softer social risks are not communicated to them, such as their risk of estrangement from their communities, or the risk of domestic unease with their spouses and existing children.
Part of the problem is that when commerce collides with medicine, there isn't an agreed upon ethical framework for establishing rights and responsibilities. In a business negotiation, each actor has to worry about his own best interests only. But in a medical conversation, the clinic is morally responsible for everyone's interests, including both the surrogate's and the client's. This new blend of business and health care has yet to navigate a path between these two poles.
The extent to which Indian ART clinics overtly cater to the needs of non-Indians has always been difficult to determine, as is any sort of measurement of how many foreigners travel to India specifically to seek out ART services, especially maternal surrogacy services. In another recent paper, Measuring reproductive tourism through an analysis of Indian ART clinic websites in International Journal of General Medicine, Professor Deonandan and students Mirhad Loncar, Prinon Rahman and Sabrina Omar analyzed the official websites of 159 Indian ART clinics to determine how many were actively seeking a foreign clientele.
What they discovered was that 86% of the clinics made some mention of reproductive tourism services, with 47% overtly offering surrogates to clients. Their results also hint at a growing domestic market for Indian ART services, truly making this industry a deep, global phenomenon.
The consideration of the global ART industry subtends all of the hot-button topics of our day: women's rights, globalization, the exploitation of the poor, the challenges of creating a family in the modern world, the commoditization of the human body, science advancing faster than society, and the question of how much regulation is needed in the business world. As Canada is one of the few countries in the world with a federal law restricting certain ART practices, many infertile Canadians travel to India to seek out reproductive services. An exploration of the ethics of this practice is therefore relevant to us all.