Ethics and regulation of inter-country medically assisted reproduction: a call for action

Abstract

The proliferation of medically assisted reproduction (MAR) for the treatment of infertility has brought benefit to many individuals around the world. But infertility and its treatment continue to be a cause of suffering, and over the past decade, there has been a steady growth in a new global market of inter-country medically assisted reproduction (IMAR) involving ‘third-party’ individuals acting as surrogate mothers and gamete donors in reproductive collaborations for the benefit of other individuals and couples who wish to have children. At the same time there is evidence of a double standard of care for third-party women involved in IMAR, violations of human rights of children and women, and extreme abuses that are tantamount to reproductive trafficking. This paper is the report of an inter-disciplinary working group of experts who convened in Israel to discuss the complex issues of IMAR. In Israel too IMAR practices have grown rapidly in recent years, mainly because of restrictions on access to domestic surrogacy for same sex couples and a chronically insufficient supply of egg cells for the treatment of couples and singles in need. Drawing upon local expertise, the paper describes documented practices that are harmful, suggests principles of good practice based on an ethic of care, and calls for action at the international, national and professional levels to establish a human rights based system of international governance for IMAR based on three regulatory models: public health monitoring, inter-country adoption, and trafficking in human beings, organs and tissues.Electronic supplementary materialThe online version of this article (doi:10.1186/s13584-016-0117-0) contains supplementary material, which is available to authorized users.

Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review)

“…Each of those parties has its own goals and corresponding ethical and social dilemmas as well. In general, CBRC often involves relatively wealthy patients, the Bfertility tourists,â nd relatively poor donors and surrogates through a process facilitated by brokers with treatments carried out by doctors in clinics abroad [78][79][80][81][82][83][84].…”

Study of the attitude of Bulgarian society towards surrogacy.

“…Israel is a country in which medically assisted reproduction is practiced extensively with almost unlimited public funding [22]. Courts recognize a constitutional right to parenthood, and the Knesset, Israel's parliament, has enacted legislation that establishes a regulatory system of bureaucratic approvals for various third-party medically assisted reproduction practices, based on statutory criteria of eligibility [23]. Israel's Surrogate Mother Agreements Law (1996), was the first in the world to allow commercial surrogacy under the supervision of a statutory committee [24].…”

Updates and reflections about the IJHPR, on the eve of its seventh year

“…In recent years, the journal has been attracting and publishing more articles that take on major, national health policy issues. The topics covered include: reducing the burden of STI infections [ 13 ], Israel’s pediatric dental care reform [ 14 ], strategies for reducing health inequalities [ 15 ], tobacco control policy [ 10 ], educating the future Israeli medical workforce [ 16 ], drug shortages [ 17 ], medically-assisted reproduction [ 18 ], and vaccine policy [ 19 ]. In the absence of the IJHPR, some of these articles might well have been published in other journals and, in a few cases, the authors have frankly shared with us that their submissions had previously been rejected by other journals, usually because of perceived lack of relevance.…”