Vincent Couture

Cross-border reprogenetic services.

The purpose of this review is to synthesize the current knowledge on the international movement of patients and biopsied embryo cells for pre‐implantation genetic diagnosis and its different applications. Thus far, few attempts have been made to identify the specific nature of this phenomenon called ‘cross‐border reprogenetic services’. There is scattered evidence, both empirical and speculative, suggesting that these services raise major issues in terms of service provision, risks for patients and the children‐to‐come, the legal liabilities of physicians, as well as social justice. To compile this evidence, this review uses the narrative overview protocol combined with thematic analysis. Five major themes have emerged from the literature at the conjunction of cross‐border treatments and reprogenetics: ‘scope’, ‘scale’, ‘motivations’, ‘concerns’, and ‘governance’. Similar themes have already been observed in the case of other medical tourism activities, but this review highlights their singularity with reprogenetic services. It emphasizes the diagnostic and autologous feature of reprogenetics, the constant risk of misdiagnosis, the restriction on certain tests for medically controversial conditions, and the uncertain accessibility of genetic counseling in cross‐border settings.

Gender Eugenics Between Medicine, Culture, and Society

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Cross-border preimplantation genetic diagnosis

Bayefskys article (2016) reflects upon the different approaches to the regulation of cross-border reprogenetic services (CBRS) and preimplantation genetic diagnosis (PGD) as instituted by more-regulated European countries compared to the laissez-faire approach adopted by the USA. Discussing how the current legal vacuum in the USA attracts couples from countries with more restrictive regulations, Bayefsky thereby makes the issue of reprogenetics policies and CBRS particularly relevant. Taking into consideration our own article on CBRS (Couture et al. 2015) and also ethnographic fieldwork we have conducted in Canadian fertility clinics, we would like to add four additional arguments to Bayefskys analyses: (i) ‘Law evasion’ appears not to be the only motivation for CBRS in American PGD laboratories – we also noted cooperation between centres in analyzing specific or rare diseases as another motivation. (ii) Not only do couples cross borders, but, in most cases, clinics from around the world send biopsied samples to the USA for analyses through ‘transport PGD’. This offers patients from regions where PGD testing is not available the opportunity to access highquality testing. (iii) Bayefsky suggests that the detrimental effect of CBRS is the amplification of the usual risks of PGD. There is also the risk that CBRS may result in suboptimal genetic counselling. Genetic counselling is necessary to help patients understand the implications of genetic testing in the preimplantation period and to assist in their decision-making process. In the context of CBRS, cultural, scientific and linguistic barriers could weaken a couples informed consent. Furthermore, the success rate of clinics

Reproductive outsourcing: an empirical ethics account of cross-border reproductive care in Canada

Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the ‘in and out’ situation of CBRC in Canada, we conducted an ethnographic study taking a ‘critically applied ethics’ approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants’ perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of ‘reproductive outsourcing’ that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders.