Send to

Choose Destination
J Med Ethics. 2019 Jan;45(1):41-47. doi: 10.1136/medethics-2017-104515. Epub 2018 Oct 9.

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

Author information

Laboratory of Transdisciplinary Research in Genetics, Systems of Medicine and Social Sciences, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Bioethics Institute Ghent, Department of Philosophy and moral sciences, Faculty of Letters and Philosophy, Ghent University, Ghent, Belgium.
Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
Department of Obstetrics-Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
The Research Institute of Montreal University Health Center (RI MUHC), Montreal, Quebec, 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.


artificial insemination and surrogacy; in vitro fertilization and embryo transfer; patient perspective; reproductive medicine; social aspects

Conflict of interest statement

Competing interests: None declared.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center