Wednesday, February 16, 2005
The New England Journal of Medicine has an interesting article on the globalization of reproductive health care and the new tourism that it has created.
To understand these issues, we must understand the role governments play in regulating reproduction. Historically, reproduction has been largely a private affair — occurring out of view of any authority and beyond government's reach. Yet time and again, governments have extended their power into the reproductive realm, determining, for example, the illegitimacy of certain births or the illegality of certain modes of birth control. Even in the United States, where privacy ostensibly reigns supreme, state governments have traditionally wielded authority over such intimate issues as marriage, contraception, and abortion. Meanwhile, state and federal governments have played a steadily expanding role in allocating and providing health care services. Reproductive medicine, therefore, attracts government in two different guises: as an arbiter of reproduction and as a regulator of health care. . . . .
After reviewing some of the conflicting international norms and laws that are pervasive in this area of artificial reproductive technologies, the article suggests a new way to approach this globalization of reproductive health care. It calls for minimal federal regulation and oversight of this emerging industry as well as a new awareness and transparency to these issues. The article states,
Which leaves us with a final option — a messy one, but one that offers the best chance for bringing public policy and order into the realm of assisted reproduction. This path would involve a combination of minimal federal guidelines and increased oversight by individual states. It would mean encouraging the federal government to periodically release guidelines for assisted reproduction, outlawing procedures that Americans deem abhorrent (reproductive cloning, for example, or human–nonhuman chimeras) and imposing the kind of safety standards that prevail in other areas of medicine. Presumably, some of these regulations could subsequently be agreed upon at the international level, curtailing the most egregious prospects for reproductive tourism. Meanwhile, state legislatures would more actively review the fertility procedures practiced in their states. Rather than leaving these decisions to the courts or the vagaries of the open market, they would tackle the complex process of making public policy — determining, for example, whether sex selection is acceptable, whether insurance companies should cover IVF as a medical necessity, and when procedures for assisted reproduction go too far. If states were to make the "wrong" decision, the combined weight of local lobbying and intrastate competition would most likely force a reversal before too long.