title: 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.
authors.affiliation: Department for Reproduction and Society, International Center for Health Law and Ethics, Haifa University, Haifa, Israel.
authors.forename: Carmel
authors.initials: C
authors.lastname: Shalev
authors.affiliation: Morgan Centre for Research, University of Manchester, Manchester, UK.
authors.forename: Adi
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Federmann School of Public Policy and Government, Hebrew University of Jerusalem, Jerusalem, Israel.
authors.forename: Hedva
authors.initials: H
authors.lastname: Eyal
authors.affiliation: Task Force on Human Trafficking, Jerusalem, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Leibel
authors.affiliation: Center for the Rights of the Child and the Family, Sha'arei Mishpat Law School, Hod HaSharon, Israel.
authors.forename: Rhona
authors.initials: R
authors.lastname: Schuz
authors.affiliation: Department of Gynecology, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
authors.forename: Talia
authors.initials: T
authors.lastname: Eldar-Geva
mesh_terms: D002648:Child; D032921:Consensus; D005260:Female; D014943:Global Health / Q000941:ethics; D006806:Human Rights; D064410:Human Trafficking / Q000517:prevention & control; D006801:Humans; D007231:Infant, Newborn; D007246:Infertility / Q000628:therapy; D007557:Israel; D008297:Male; D057193:Medical Tourism; D062486:Public Health Surveillance; D027724:Reproductive Techniques, Assisted / Q000941:ethics* / Q000331:legislation & jurisprudence
keywords: Cross-border reproductive care; Egg donation; Ethic of care; Human rights; Human trafficking; Medically assisted reproduction; Reproductive ethics; Surrogacy