Self-Sufficiency for Surrogacy and Responsibility for Global Structural Injustice

• Author: Katy Fulfer
• Pages: 245-271

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Self-Suciency for Surrogacy and Responsibility for

Global Structural Injustice

Katy Fulfer

A. INTRODUCTION

In this chapter, I present an argument for self-suciency for surrogacy. In

the context of health care, “self-suciency” refers to meeting a community ’s

needs for a medical product or service, usually with unpaid donations from

community members rather than commercial payments or sourcing prod-

ucts and services from outside of the community.1 Because self- suciency

makes use of unpaid, or altruistic, donations, it is often positioned as a direct

contrast to commercialization.2

My defence of self-suciency responds to the limited ability of Canada’s

Assisted Human Reproduction Act3 (AHRA) to address ethical challenges that

arise with transnational surrogacy, where people travel across national bor-

ders to hire a surrogate. Following recent arguments in the literature,

1 GKD Crozier & Dominique Martin, “How to Address the Ethics of Reproductive Travel

to Developing Countries: A Comparison of National Self-Suciency and Regulated

Market Approaches” (2012) 12:1 Developing World Bioethics 45 at 48; Dominique

Martin & Stefan Kane, “National Self-Suciency in Reproductive Resources: An Inno-

vative Response to Transnational Reproductive Travel” (2014) 7:2 IJFAB: International

Journal of Feminist Approaches to Bioethics 10 at 11.

2 John Keown, “The Gift of Blood in Europe: An Ethical Defence of the EC Directive

89/381” (1997) 23:2 Journal of Medical Ethics 96 at 97.

3 Assisted Human Reproduction Act, SC 2004, c 2 [AHRA].

246 |  

I take as a starting assumption the claim that Canada has a moral-political

responsibility to address ethical challenges raised by transnational surro-

gacy.4 I oer self-suciency as a mechanism for taking responsibility.

Second, I articulate the key concepts grounding self-suciency.

Most signicantly, I argue for an interpretation of self-suciency that is

grounded in a relational conception of persons, which recognizes that per-

sons are constituted “in and through relationships.”5 I also seek to expand

the way responsibility has been theorized in self-suciency. Although

reducing reliance on transnational surrogacy has been an important goal

of self-suciency,6 rectifying global injustice has not been central to con-

ceptualizing responsibility in this framework. My primary contribution is

broadening the scope of collective responsibility within self-suciency to

include responsibilities for global structural injustice. Because self-su-

ciency includes obligations to address global structural injustice, it provides

a mechanism for Canada to take responsibility for its role in maintaining

injustices within transnational surrogacy.

Next, I defend self-suciency as an ethical way to govern surrogacy

domestically, pointing to ways in which self-suciency can address eth-

ical challenges within surrogacy in Canada. Although I do not argue

against commercialization per se, I raise points of contrast between the

non- relational foundation of commercialization and the relational founda-

tion of self-suciency.

In this chapter, I advocate a particular relational interpretation of the

foundation for self-suciency. While self-suciency may be practical for

Canada insofar as it is consistent with the legalization of unpaid surrogacy

in the AHRA,7 outlining how self-suciency might be implemented in

4 Maneesha Deckha, “Situating Canada’s Commercial Surrogacy Ban in a Transnational

Context: A Postcolonial Feminist Call for Legalization and Public Funding” (2015) 61:1

McGill Law Journal 31 at 38; Katy Fulfer, “Cross-Border Reproductive Travel, Neoco-

lonialism, and Canadian Policy” (2017) 10:1 IJFAB: International Journal of Feminist

Approaches to Bioethics 225 at 240 [Fulfer, “Cross-Border Reproductive Travel”].

5 Jennifer J Llewellyn & Jocelyn Downie, “Introduction” in Jocelyn Downie & Jennifer J

Llewellyn, eds, Being Relational: Ref‌lections on Relational Theory and Health Law (Van-

couver: UBC Press, 2012) 1 at 4.

6 Crozier & Martin, above note 1 at 48; Martin & Kane, above note 1 at 11; Françoise Bay-

lis & Jocelyn Downie, “Achieving National Altruistic Self-Suciency in Human Eggs for

Third-Party Reproduction in Canada” (2014) 7:2 IJFAB: International Journal of Feminist

Approaches to Bioethics 164 at 167 [Baylis & Downie, “Altruistic Self-Suciency”].

7 AHRA, above note 3, s 6.