“Be it resolved: The prohibition on payment for surrogacy & gametes in Canada should be repealed”

“Be it resolved: The prohibition on payment for surrogacy & gametes in Canada should be repealed”


I’m Trudo Lemmens, I’m a professor here at the Faculty of Law at the University of Toronto I helped organize along with people from Health Law in Canada and the Institute for Health Policy Management and Evaluation, this debate but
also the conference tomorrow If some of you are who are
here are interested still in registering for the
conference tomorrow, there’s some fliers outside,
some posters outside, we already have an event
today at 12:30, a presentation by Josephine Johnson,
so it’s a very intense three days or two days,
actually, with three events on assisted human reproduction. We’re very happy that
you’re here to hear a very, in Canada, certainly,
a very timely debate, between Francois Baylis and Vita Panitch, I will say very little. I will only remind you of one thing. If you have a hearing
disability like I have, you can actually follow
online, the debate, in live text, you can
follow the text on your computer screen, there’s
some information available, in the white forms that you
find on the front table here. You’ll also find flyers there for two books that have been
published in the last three years on assisted human reproduction in Canada. I won’t do very much, I will
only introduce the chair and I will then step back
and actually help manage the cameras, so I’m very
happy that Roxanne Mykitiuk was able to chair this session,
Roxanne is a longstanding colleague and friend, she
is a professor at Oswick Law School, where she teaches
in the area of disability law, health law, bioethics and family law. She is the founder and
director of the Disability Law Intensive Clinical Program
and the new director of Osgood’s part time
MLM program, specializing in health law. Professor Mykitiuk is
also the faculty cochair of Enabled Work, she was
senior legal researcher for the Canadian Royal
Commission on New Reproductive Technologies, so we couldn’t
have a better chair. From 2002 to 2006, she was
a member of the Ontario Advisory Committee, actually,
we were there together, on Genetics, from 2005
and 2008, she was a member of the Ethics Committee of
the Society of Obstetricians and Gynecologists of
Canada, Professor Mykitiuk was scholar in residence in
2009 at the Law Commission of Ontario working on the
disability and law project. Her current research interests focus on the intersection of disability
and reproductive rights, as well as the accommodation of disability in the workplace, Roxanne,
I leave it up to you. Thank you. (audience applauds) Good evening and welcome,
before I introduce you to our two presenters for this evening, I want to take just a
few minutes to outline the current legislative
and regulatory framework within which the issue of
the debate is being situated. And as you know, that issue
is whether the prohibition on payment for surrogacy
and gametes in Canada should be repealed, it was
decided that I should do this rather than the debaters
taking their time this evening doing that. I am not a PowerPoint
teacher and so I am going to muddle my way through this. Okay, just a second here. Okay. Canada’s Assisted Human Reproduction Act, as you can see here, contains
a declaratory statement at a section at the very
beginning that outlines a number of principles that shape or inform the subsequent sections that are
contained in the legislation and also the interpretation
of those sections. One of the principles and there
are a number of principles that are articulated in the
act, one of those principles is articulated here and it says that trade in the reproductive
capabilities of women and men and the exploitation of
children, women and men for commercial ends raise
health and ethical concerns that justify their prohibition,
so arguably that is one section of the
legislation that is relevant to the debate this evening. The legislation then contains
a number of prohibited activities, for the purposes
of the debate this evening, it is sections six and section
seven that are relevant and what you’ll see here is
that section six prohibits anyone from paying a female
person to be a surrogate, from offering to pay her
or advertising to pay her for surrogacy services, okay? It’s also prohibited to accept payment for arranging, offering
to arrange or advertising surrogacy services or as
number three, subsection three says, to pay another person
to do any of those things, okay, so that’s section six. Another one of the prohibited
activities under the act is section seven and that
prohibits anyone from purchasing, offering to purchase or
advertising for purchase, sperm or ova from a donor or
someone acting on their behalf okay, so those are the
prohibitions that are relevant for this evening, you’ll
note, though, that women are not prohibited from
acting as surrogates, and individuals are not
prohibited from donating their gametes under the legislation so it’s the commercialization
of the activity that is prohibited, not
the activity itself. Okay, so. What you’ll see is that section 12 of the Assisted Human
Reproduction Act does allow that in accordance with regulations that are to be made pursuant
to this piece of legislation that gamete donors can be
reimbursed for receipted expenses that are occurred
in the course of donating, that any person can be
reimbursed for expenses incurred for the maintenance or transport of an in vitro embryo
and surrogate mothers can be reimbursed for expenses in relation to the surrogacy
and for loss of work related income during the pregnancy. The problem has been, the
regulations clarifying what those reimbursements
are that are legal under the act were never regulated, were never drafted, rather, okay? However. Recently, on October 26th, 2018, proposed new regulations
were finally released and they state which expenses
incurred by gamete donors and surrogates can be reimbursed. So you’ll see that those include in the case
of donating of ova or sperm and what we’ll see when I flip the screen, this applies also in
the case of surrogates, that travel expenditures,
including transportation, parking, meals, accommodation,
the care of dependents, counseling services,
legal services, sorry, legal services and
disbursements, drugs and device and there’s a particular
section of the Drug Acts that we’ve got to take a
look at in defining those, products or services provided
by a recommended in writing by a medical practitioner,
health disability life insurance and expenditures for
obtaining or confirming medical or other records
are then included in the list of what is
reimbursable expenditures and there’s another provision
that says you need to have a proper receipting
under the legislations, the regulators for those
expenditures to be properly receipted, what we see in
addition is that in the case of surrogacy, maternity
clothes, expenses related to delivery and also
products or services provided by a recommended to
assess, monitor and provide the healthcare through the
majority of her pregnancy, delivery or postpartum
are also included, okay? I’m just gonna back up for a second. In relation to this
maintenance and transport of in vitro embryos, we saw
that we knew that any person could be reimbursed for those expenses. That includes, we see here,
expenses in relation to storage and in relation to
transport, it also includes the cost of the shipping
container and the preparation of those embryos for transportation, okay, so this is a bit of a
clarification there with respect to those expenses and then
finally here we see that there’s also some
stipulations with respect to the criteria in relation to claims for reimbursement in relation
to loss of work related income, okay, so that’s
all I really want to say by way of setting the legislative
and regulatory context within which the debate is being situated. I’m gonna introduce our
two debaters in a second. What I’m gonna do is just
tell you what the framework of the debaters is right now, each of them is gonna
have 12 minutes to make her argument, that is gonna
be followed by a five minute rebuttal, there is then
going to be an opportunity for me to ask a question or two and then I’m gonna open
it up to the floor. I’ve been asked to have
you identify yourself to the speaker and to please
ask your question slowly so that it can be captioned,
okay, so with all that background, I am delighted
to introduce Vida Panitch, first of all, Vida is
an associate professor of philosophy and the director
of ethics and public affairs at Carlton University,
her research addresses the moral boundaries of
the markets, specifically markets in public goods,
including healthcare and education, and physical
goods including body parts and intimate services. Vida’s work explores the
extent to which theories of exploitation and
commodification can help us determine the appropriate
regulation of so called repugnant markets, she is
published in various scholarly journals on a variety of
topics, but her primary scholarly contributions
have explored the dimensions of exploitation and
commodification in the sexual and gestational labor. A couple of her most recent
publications are a book entitled Exploitation,
from Theory to Practice, coedited with Monique
Deveaux, which focuses heavily on exploitation in
gestational and care labor, published in 2017 by Roman and Littlefield and she is currently
working on a single authored monograph, tentatively
titled, Parts and Labor, Market, Morals and the Human Body. Francois Baylis is an
internationally renowned bioethics expert, in 1991,
Francois was a consultant to the Royal Commission on
Reproductive Technologies, from 1994 to ’97, she was a
member of the ethics committee of the society of
obstetricians and gynecologists of Canada and from ’97 to
’98, she was a consultant to the SOGC and the CFAS on
their joint policy statement, Ethical Issues in Assisted Reproduction. From 2000 to 2004, Francois
consulted with Health Canada on various aspects of
the draft legislation and she consulted with
the government of Canada after the Assisted Human
Reproduction Act received royal assent in 2004, from 2006 to 2010, she was a member of the board of directors of Assisted Human Reproduction Canada. Francois is a member
of the Order of Canada and the Order of Nova
Scotia as well as a fellow of the Royal Society
of Canada and a fellow of the Canadian Academy
of Health Sciences. Please join me in
welcoming our presenters. (audience applauds) Okay, hi, everyone, I’m
not gonna say too much by way of preliminary because
I only have 12 minutes and I got a lot of stuff to
get through but I will say just to get started that
a debate on this issue for and against is a
sort of fun way of having the conversation, but
what I want to say is just for any Rebecca Bloom fans out there, the situation is a lot
more nuanced than that so I think I have, I’m
gonna sort of make the case that I’m here to make which
is in favor of a repeal, but I hope that as the debate continues, I’ve had the opportunity
to explain the various ways in which I think this is
a nuanced kind of question that certainly deserves a nuanced answer. So I am a philosopher, I’m an ethicist. The question that I’m
primarily interested in is with respect to, right,
section 2F of the AHRA, which again, tells us that
trade in the reproductive capabilities of women and
men raises ethical concerns that justify their prohibition, right, so I’m really here tonight to talk about what these ethical concerns might be and to see, frankly,
whether they do indeed justify a prohibition
on payment to surrogates and to gamete donors. So the ethical concerns
that tend to get raised in this discourse are around
wrongful commodification of the body in particular,
the erosion of altruism in society, and the potential
for the exploitation of vulnerable members of our society. So I’m just gonna speak
to each of these points because for the sake of arguing in favor of a repeal on this
prohibition, I’m gonna try to tell you that I don’t think these are persuasive ethical concerns. Okay. So we’ll start with commodification, or wrongful commodification, when we make an anti commodification
argument, what we’re saying is that some things
shouldn’t have a price tag or a dollar value, presumably
because they are valuable beyond price, okay? So one way we can make this case is to say that the body has a
kind of intrinsic value and that we disregard that intrinsic value when we assign it a kind of
use value or instrumental values accorded with a price. So is it wrong to assign
a price tag to the body? Maybe, but guess what, we
do it every day, right? You all sell your body
every day, there is no job you can do without it
and we may want to draw some kind of distinction
between the inside of the body and the outside of the
body, but I challenge you to try to use the outside
of your body for work without also using the inside of your body so the idea that we
shouldn’t commodify the body because it has some
kind of intrinsic value, maybe that’s true, but
we do it all of the time. We might kind of isolate
gametes and surrogacy as the kinds of things, specifically, that shouldn’t have a price tag, oh, but they do, right, the
global fertility market is worth something around $20 billion and it’s growing by like 9% annually so it has a price tag,
somebody is making money off this, off surrogacy,
off gamete donation, somebody is making lots of money. So why shouldn’t surrogates
and gamete donors? There’s already a price tag. What about the argument
that we shouldn’t assign price tags to these items
or the body because it undermines human dignity? Dignity’s a slippery term in ethics because people use it all the time for whatever their pet cause happens to be so if somebody says it’s
undignified to assign a price tag to the body,
somebody could just as easily reply, well, it’s
undignified not to be paid for the work that you do. Right? Wage, wages are a way
of recognizing, valuing people’s contributions and
so not according a wage could be considered undignified. So could telling people
what they can and can’t do with their bodies, so dignity
just doesn’t get us very far because, right, it can be
appealed to, apologies. It can be appealed to on
either side of the argument. What about altruism? This is in many respects
another way of making a kind of commodification claim. It’s another way of saying
some things shouldn’t have a price tag because when
we assign them a price tag, we are allowing the market to penetrate a sphere of human relations
where it oughtn’t. We are allowing market
norms like self interest to infiltrate relationships
that should be governed by beneficence, right,
not by personal gain or not by a motive for personal gain. So the worry about altruism is a worry that when we
introduce a profit motive, into a certain kind of relationship, we crowd out the motives to
do good for others, right, to act out of beneficence,
to be altruistic. But the truth is, these things
are not mutually exclusive. Think about a pediatric oncologist. Right, she gets paid a lot
of money but we still think she does noble work, right, we don’t think that her interest in
cashing a paycheck eclipses whatever is altruistic about the work that she has chosen to do,
right, as opposed to being a CEO of some oil company. She’s clearly chosen to do
something that provides good to others, we don’t blame
her for accepting payment for this, we don’t think it
erodes her altruistic motives. Moreover, there are lots
of ways to promote altruism in our societies, we could ask farmers to reserve a share of
their grain for the hungry. We could ask homeowners
who have an extra room in their house to share
it with a woman who needs to escape a bad relationship. There’s all sorts of ways
we could promote altruism that we do not. So I worry that when we
talk about the altruism of surrogates and of gamete
donors and specifically egg donors, what we’re
actually doing is appealing to something that I call
the patriarchal expectation of gendered altruism. Women in our society are
expected to be altruistic. The gender roles they are
assigned are associated with actions and undertakings
that are primarily beneficent in nature
and we criticize women who flout their gender
norms precisely because they are not exhibiting
the kind of altruism that we expect women to exhibit. One little, you know, one little way of looking
at this is to note that two-thirds of organ donors are women and two-thirds of kidney donors are women and two-thirds of recipients are men. So right, 70% of organ donors are women and 70% of kidney recipients are men. Women are being much
more altruistic, right? They are doing the giving,
men are doing the receiving. I think this very much
has to do with a gendered expectation of altruism and
so I worry when we pick out undertakings that we associate
with women and say no, these must be done purely from altruism, what we’re actually doing
is not talking about altruism at all but
about gender inequality. Okay, so the third type of
ethical concern that gets raised are concerns about
exploitation and what I said earlier, you know, the
question is nuanced, this is why, I think that this
is a very legitimate worry. And a lot of my research
focuses on exploitation and what it means and when
it happens and what to do about it, so there are criteria. That make something an
exploitative transaction. There could be deception, misinformation, coercion, inducement,
‘kay, and I don’t have a ton of time, but I’m happy to come back to some of these points. I think the most relevant one is the worry about inducement, that
is the offer of payment might be tempting to
somebody who would prefer not to do this, right, but can’t quite refuse because she has no other options. I think this is a legitimate
worry and I definitely think it’s a legitimate
worry when we’re talking about global surrogacy, global
egg donation in particular. What I want to say in response to this, however, is that I think
our legislative efforts should be spent advocating
for a basic income. There’s a lot of research
that is starting to show that women are far less
likely to go into the intimate trades, by which I
primarily mean the sex work, when they have a regular income that they can count on. We don’t have enough data
on this, too bad Ontario didn’t go ahead with its
pilot, we might have generated more data, but there is
reason to think that women will enter the intimate
trades at a lower rate where they have a basic income to count on so I’m not sure that the
worry about inducement justifies a ban on paying
surrogates and egg donors. I think it speaks in favor
of a federal basic income. Primarily because if we
acknowledge that surrogates go into work they might
rather not do but they need the money, well, so do
a lot of people, right, there’s a lot of wage labor
that is induced or exploited in this sense, and again,
I think a basic income might be a way of addressing that. How am I doing for time? WOMAN: You’ve got four minutes. Okay, so I’m gonna say
something that’s a little bit contentious and then
I’m gonna say something that’s a bit more of an olive branch in the four minutes remaining. One of the other criteria for
calling something exploitative is that there’s an injustice that occurs, usually with respect to how
some set of goods is divided up between the people who
have interacted together to produce that good,
right, so when we talk about sweatshop labor being exploitative, what we mean is the workers
aren’t getting paid well among many other things, right? Unsafe work conditions, et cetera, but they’re not being paid
properly so when we use the term exploitation,
what we very often mean is that somebody is being
underpaid or not paid at all. So when we talk about surrogacy, paid surrogacy as being exploitative or paid gamete donation
as being exploitative, I suggest that in fact unpaid
surrogacy is exploitative to the extent that it represents
an unfair distribution of the value that is created. From that interaction. We might even go so far as
to say that exploitation happens when somebody isn’t paid, right, while others get rich off the transaction that she is a part of
but also she is exploited if she is deceived in
any way by the people that she transacts with, in particular, if the people that she transacts with tell her, well, you can’t
have a share of this money because what you do is too
valuable to have a price, while they pocket all of it, okay? So not only is an injustice
occurring in this kind of transaction, but a
manipulation or a deception that undermines autonomy. As a final point, what I want to say is with respect to payment
versus reimbursement, right, we’re in the process of clarifying what surrogates and gamete donors
can be reimbursed for, I think this is a
valuable exercise, right, that is, I don’t think we
should scrap the whole project. I think talking about
reimbursement is way better than not talking about
reimbursement, but what I want to say is this kind of an
academic distinction and unfortunately, it’s a burdensome one. That is, I’m happy to
know that gamete donors and surrogates can be
reimbursed, and particularly reimbursed for lost labor costs, but when we reimburse
for lost labor costs, what we are effectively
doing is reimbursing for what economists
call opportunity costs, what you could be doing,
what you could be making if you weren’t doing this. And this is a key justification for wages. Reimbursing somebody for
lost opportunity costs is a key argument for why we
pay wages in the first place. The problem with reimbursement
is that it imposes burdens on surrogates
to justify themselves. They have to get a letter
testifying that they would have made this or made that by whomever, who would have
been paying them otherwise. I don’t think we have a
rationale for imposing this kind of burden on surrogates. I think we need one and we need one that doesn’t appeal to the
commodification, altruism, or exploitation objections
that isn’t prepared to meet those objections and
I don’t think we have as yet in our public dialog met
those challenges, thank you. (audience applauds) Thank you. Well, this is the end of the PowerPoint. Okay, start again. Thank you very much, I
want to start with a very strong statement that I
support family making. I think it’s a wonderful
thing, that people are able to have children and I recognize
that a number of people are confronted with challenges
in pursuing that goal. If children are wanted and
cherished, it’s a great thing. And that’s whether we’re
talking about heterosexual families, homosexual
families, single parenting or any other number of
combinations because parenting is about willfully taking
on responsibilities to care for another human
being and to bring them up to be a member of a
civic society and I think that’s a wonderful thing. The second thing I want to say very clearly is that I support the legislation, that
doesn’t mean there aren’t a few things I would
like to see be changed like everyone, I’m sure
there’s at least a line or two that you’d rather say
something else but by and large I support the orientation,
the direction and specifically with respect to tonight’s
topic, I support the commitment to having a system that’s
founded on altruism, not commercialization and
so basically what that means is I think that the
system we have in place of reimbursement which you’ve
already heard has taken a long time to get in place
and I have been one of its loudest critics with
respect to that particular issue but we have experience
from around the world that actually suggests
that other countries which have a very similar
healthcare system to ours, other countries that appears
to have social values that are very similar to ours
are able to work effectively with an altruistic system. Canada has had one in
theory for a very long time. It’s never had a chance
to work and I’m excited for the regulations to
come in play and for us to allow it to have a chance. The next thing that I want
to say is that the principles stated at the beginning are
strong, powerful ethical statements about what the
legislation is attempting to achieve because in
fact, policies are attempts to put in place some
formal mechanisms to deal with our social values, beliefs and mores. This is the principle
that you’ve already seen. It’s the one that’s at issue here and again, what we’re talking about then is an ethical reason to
justify the prohibition. Now one thing I want to say very clearly with respect to this prohibition is that the legislation does not target
the women who participate in these activities, the way
the prohibitions are written, one is looking to identify the buyers as the people who are in
fact violating the law. And I think here, that’s an
important thing to remember especially when we hear
comments to the effect that people are being victimized or people are being criminalized, we
can’t make those statements in general ways like that,
we need to be very clear what we’re talking about. Now as you’ve already heard
from an ethical point of view, the most contentious
issues really anchor around what we refer to as the
twin risks of coercion and exploitation, but
what’s important for you to appreciate is although
we talk about these often together, they are in
fact discrete, coercion, we often think about in terms
of the exercise of power, threats to competent,
autonomous decision making and the same is true with
respect to exploitation in some measure, but what
I think’s really important to appreciate, at least in this context is that the worry with
prospective coercion is not the big stick
but rather the carrot, the inducement and the
question is at what point does the inducement become
such that it is difficult if not impossible to
refuse or to walk away? And when we talk about
exploitation, what we’re really talking about there is the
issue of unfair advantage and one of the things that’s
quite interesting in this context is there’s a lot of
effort that goes into saying this is about mutual advantage. They get money, I get a
baby, but I want to say very clearly that least
from my perspective, we do in fact have exactly the situation that was alluded to by Vida,
a situation of injustice in terms of thinking
about what are the harms that are being incurred
and what are the benefits that are being secured and these in fact devolve unto different people. Now one of the things that
I am clearly committed to is the idea that it’s a
good that shouldn’t have a price tag, but what
I want to insist upon is that I am not using the
term good in its commercial context of a good and a
service but really in that it is something that is
good and there are many good things in the world
that we shouldn’t attach a price tag to, one of the
things I find most difficult in terms of making the
arguments that I wanted to make is that very often I find
that there’s a distraction. In this particular debate,
much attempt, I would say, has been made by a number
of people to misdirect the conversation by saying
in the context of the debate about payment, that it’s really terrible we are criminalizing
people in this context by paying for sperm, ova, et cetera. One of the things that I
think’s important for people to appreciate is that this
really is misdirection insofar as the issue about criminalization has nothing to do with payment,
it has to do with a law, the federal government
exercising its power in accordance with the Constitution and in fact, you could decriminalize this and have every single one of the provinces in theory introduce a
prohibition on payment so the issue here really is
about the level of government, not the issue of payment. The other thing that we
constantly hear about in the context of the art
of misdirection is that it’s really terrible that
people could end up in jail for as much as 10 years and
have a fine of up to $500,000. Now what’s important for people to know is that that sounds quite
draconian and people are quite upset about
this, but in 14 years, we’ve in fact only had one conviction and in that context, the fine was $60,000, not 10 years in jail, not $500,000 and I think that the kinds of examples that I hear in this debate
is, oh, I’m gonna end up in jail because I’ve given a woman flowers and I want to say come on,
we have to actually focus on what’s really at stake
and what’s at issue. Again, in the context
of what I think of as the art of misdirection,
we’re often hearing that Canadian citizens are
suffering from infertility and they shouldn’t be
denied the same opportunity to build a family, one of
the things I want to say when I put that up there is
that there’s equivocation around what suffering
from infertility means because there’s actually
physical, medical infertility. There’s also social infertility
and we don’t have equity if you want to think about it in terms of the same opportunity by just putting money on the
table because in other contexts that’s not in fact how
people are making families. They’re not doing it through
money so you can’t kind of have it both ways in
terms of the kind of claim that’s being made. The last claim that I hear
often is that one of the reasons that it’s really important
that we should have payment is that currently that
the situation is such that donors aren’t always being truthful and then we have substandard
sperm, for example, in terms of quality but
if we were to pay for it, we would have control and in fact, this is a very slippery
argument because it creates the exact incentive
for people to misdirect and perhaps to not
provide full information. Because there’s in fact money at stake. We hear a version of this
argument and now we’re looking at the art of money,
that people will be paid under the table, that there
will be a black market, arguably we’ve had that for 14 years, and that’s just not a good
enough reason to not legislate about anything, right, I
mean, you take your pick, you could just say yes, but
people are gonna do it anyways and you would say well, that’s true. That would even be true
of something like murder. People will do it
anyways, that doesn’t mean it’s not a reason to legislate. The problem of undersupply
is also often named and again, it’s in a context
where I don’t understand why we think that it’s a
supply and demand problem but moreover, even if I grant that, why would we think that it’s
a supply that we would meet or that we would meet
that demand through money? I would say we currently
have a problem of undersupply with respect to solid
organs, we don’t say, we don’t have enough kidneys,
let’s go out and buy some. And so I think it’s a
really interesting thing that we think this is the
way to solve this problem. Doctors who perform IVF and
a whole bunch of other people make money, so do lawyers, so do brokers, why shouldn’t the women? And I hope we come back to this issue. I don’t have time to go
into it in great detail now but I would say by analogy,
well, the same thing is true for the transplant doctor
and the same thing is true for any other number of places
in the context of healthcare Yes, not everybody gets
paid and yes we might think that in certain contexts,
we need to look at that. The bottom line of what
I hope we come back to is the claim ultimately in this
arena, no matter what argument we introduce or how
sophisticated we make it, is ultimately about a vision
of the world we want to live in The world I want to
present to you is a world in which we do not
actively encourage people to put their body bits
into the marketplace. Instead, we find out why
they feel the need to do this and we see if there are
opportunities to respond to some of those concerns. Vida has suggested maybe
it’s a basic income. I might have some other suggestions, but I think we need to think
about who are the people that in many cases are finding
themselves in this situation? Now, please understand
this is not a statement that does not recognize
that women are competent, capable and can autonomously
choose to participate in these activities and
choose to do so for money. I am not disputing that,
I grant that as a fact. What I am saying is that I
don’t want that as a matter of public policy, that we
invent this new job category as though this is something
that we want to have as a future for our world. We’re all worried about how
it is that we represent this and what it does to our pictures of women and this is what you find on
the internet when you just put in the word surrogacy and payment and I didn’t actually
cherrypick this so I invite all of you to go and look,
this is what you find and what I wanna say is most distressing is that they’re all headless, you know, and you might be saying
that that has to do with respecting privacy, but
the most interesting thing is you don’t see that when
you’re looking at egg donors. They all have faces and
they are all beautiful and I worry about what’s going
on in the marketing there. I want to end by sharing
with you two videos that I’ve prepared,
they’re part of a series. The series is called the Body Economy, the first one is on eggs, the
second one is on surrogacy, I have one planned on
plasma, I have one planned on selling your hair, I
have one planned on selling your breast milk, I
really think that this is a broader issue and I really
am arguing to keep the body out of the economy. The body economy, surrogacy
in the marketplace, being a parent is hard
work, a lifelong project full of interesting challenges. (baby cries) Pregnancy and delivery are also hard work. We call it labor for a reason, right? What if a pregnant woman
is delivering a baby for someone else? It’s a huge responsibility and an amazing gift. Should she be paid for her services? Reimbursed for her expenses or both? I’m Francois Baylis, I’m a bioethicist at Dalhousie University. This year, the government
of Canada is drafting new regulations to
strengthen the 14 year old Assisted Human Reproduction Act. And surrogacy is on the agenda. Currently, Canada prohibits
paying for surrogacy. Instead, the law allows
women to be reimbursed for pregnancy related expenses. But some including private
fertility clinics, lawyers and brokers, want Canada to go further, and adopt a fee for service model. If women are autonomous beings, shouldn’t they have the right to charge for providing such a valuable service? In an ideal world, every
surrogate would feel 100% empowered and equal to all
the people she’ll deal with. She would not feel coerced or exploited. But in the real world we
know consent and autonomous decision making can be
compromised when money is on the table. That’s why we don’t allow
people to sell their organs for transplantation. Our goal should be to
strengthen the current legal framework that permits
reimbursement of expenses and allows one to give
the ultimate gift of life without cost to herself and
without potential compromise to her autonomy. Learn more at impactethics.ca
and join the conversation on Twitter at #thebodyeconomy. Thank you very much, that’s
the second of the videos, if you’re interested, they’re on YouTube, look up #thebodyeconomy. Thank you. (audience applauds) ROXANNE: So we’ll give you
five minutes each to respond. Can people hear me through this mic? You have to turn it on. Oh, (laughs), that makes sense. It’s the mute button. There we go. Yes? Are we better?
Closer. Any better?
No. Okay, I’m just gonna go. So I think, I mean I agree with so
much of what Francois says. You know, I am attracted, I am interested in this topic because I
think it is a complex one, it’s a complicated one
and many of the points that Francois has raised are ones that I agree with to a large extent, so I’ll just speak to a few of them. On a kind of more
philosophical side of things. The point about whether
something can be understood to be a good in a non
commercial sense such that when we commercialize
it it’s no longer good in the same sort of way, well, let’s think about
what other kinds of goods there are in society,
in the sense of value not in the sense of a
commodity, right, art is a good. Right, it’s important to our social lives. It could be important to our
flourishing to experience, to participate in art,
and yet it has a price tag and the fact that you buy
tickets to go to the theater, you know, these should be subsidized and there should be art
that’s made accessible, but the mere fact that it has a price tag doesn’t necessarily
undermine the extent to which it’s a good in the non
commodities sense of that term. Even something like
healthcare or education. These are goods, these are social goods. Just because our insurance
company or our province pays our health bills doesn’t
mean there isn’t a bill. Every service you get from
your doctor at the hospital has a price tag, it’s
just that the bill goes to somebody else but we
praise our healthcare system. And we talk about health as a social good so the mere fact that
something has a price tag doesn’t undermine the
extent to which it xan still be celebrated as a
meaningful and important social good. The other point I want to
raise is with respect to this question of coercion
and I think we’re both in agreement that this
is a significant worry and one that we need to address. If it’s true that surrogates
and donors are being coerced, either by another individual
or simply by the fact of their own circumstances. Here, sorry, this is a
problem, so one thing I want to flag that hasn’t gotten raised yet is that a bill was proposed this year in Parliament by a member of Parliament who has proposed repealing
and replacing various aspects, this is bill C404, various
aspects of the AHRA. And in particular, he’s
proposing replacing the language in section six and seven against payment, removing and replacing
that language with language around consent and coercion
so that the most important principles to protect when
we’re talking about surrogacy and gamete donation is not
that these should be not commodified or commercialized
but that the people engaging in these practices
are properly consenting, that they’re capable of consenting, that they’re not being coerced,
so I’m just gonna quickly read you the language that has been proposed in bill C404 to replace a particular subsection, subsection six. With respect to the reimbursement
for surrogate mothers in the Assisted Human Reproduction Act. The proposed replacement
says, no person shall counsel or induce a female person
to become a surrogate mother or perform any medical procedure
to assist a female person to become a surrogate mother,
knowing or having any reason to believe that the female
person is under 21 years of age, incapable of consenting to
becoming a surrogate mother or as being coerced by
a third party to become a surrogate mother and I
think we can understand third party quite
broadly, right, certainly in the philosophical
literature on coercion, third party could mean an
individual or it could mean one’s unfortunate circumstances,
so this is not to say that I think we need
to immediately abolish these sections in the
AHRA and replace them with what’s being proposed here. We have good reason to
think this bill is not going to become law, but
I think it highlights an interesting point which is
that if what we’re ultimately worried about is coercion
and exploitation, then why don’t we just say that? Why are we talking about
payment if what we really want to be protecting people from is coercion? Let’s just say that in the law, right, and I think we can do that without criminalizing payment,
right, not to engage in misdirection, but just
for the sake of ease, I think we can talk about
consent and coercion instead and address the important
philosophical and ethical concerns that we have. (audience applauds) So there are three things that Vida said that I completely agree with. I think at the very
beginning of her first slide appropriately lists what
the ethical concerns are. They are around the issue of
commodification of the body, they are around the issue
of erosion of altruism, and they are around the
potential for exploitation, so I agree with that framing. I also agree with her
comments with respect to the kinds of claims that get made about this undermining dignity
and that very often this is spurious insofar as it can be used in multiple ways,
following either direction. However, I’m not surprised
that people do that because dignity is in the
principles that are stated at the beginning, but it’s
not an area that I go to in terms of making arguments
and the third place where I agree is with
respect to the comments she made about patriarchal
expectations of gendered altruism, I think we do need
to pay attention to that. Where we disagree really
is kind of in the framing or in the conceptual understanding
of a couple of things. So first of all, I’ve never
actually said it’s too valuable to put a price on
it and I’ve never actually talked about it as
being of intrinsic value so at least in my case,
that’s not what I’m trying to articulate, what I’m
trying to articulate is what’s at stake in changing the system from an altruistic one to a commercial one and what’s at stake is us. Our relationships amongst each other. If I tell you that I have
a loving relationship with my parents and then I
also tell you that we’ve agreed that I will love them because
they will pay me $100 a week until I die or they die,
you might really wonder about the nature of that
relationship, right, and it doesn’t mean that
it’s in fact not true, right? I might love them very
much and they might love me very much, but there is
something that starts to be seen as different. There’s a certain kind of feeling you get when you walk somebody across the street just to be kind versus
you stand there and say, I’ll take anybody across
the street for a dollar. It just seems like a
different kind of activity and that’s what I’m
asking us to think about. What happens when we take
relationships and we ask to be kind or to transact
only if we’re given a commercial benefit? Another comment that was
made was to the effect that we do this every day, put
our body in the marketplace every day, that’s absolutely true, but there’s lots of things that we do every day and we
do them in different ways which make them slightly different. But more importantly, the
fact that we do something and that we do it every
day doesn’t make it right. One of the things that I often would teach in the context of some
undergraduate courses I used to give is I would ask
people how many of them shop at Dollarama and many of them
do for all kinds of reasons, many of them good reasons,
and then I asked them to think about how stuff gets in the
store for a dollar, right? How did it get there for a dollar? Think of where it’s coming from, think of what it’s made of, think about the lights
that have to be turned on, the rent that has to be
paid, the people that are working there, how did it
get there for a dollar? You can tell me and I can
tell you about the sweatshops that make my running shoes. There’s a lot of things in the world that are coercive and exploitative, and I benefit from them and it’s wrong and I’m not a perfect
person and I continue to participate in some
of those activities, but I think it’s really
important that I be able to name them and that
I not be proud of them and that at least in this arena, if there’s an opportunity to stop it before it gets to the
point that I don’t know how to dismantle it, then
I think that’s something worth trying to do. The other thing that I
think’s really important and I really wanna kinda end on this point is that everybody talks about
coercion and exploitation and they have a different
take on it and I want you to think about it in these terms. I think that when you
think about the worry about coercion, the risk
is that you’re gonna pay them too much, that’s the inducement, you’ve offered them
what, what’s a fair wage if you’re wanting to really think about it in the marketplace and at what
point is it not a fair wage, it’s an inducement, they can’t say no and then the flip side
of that is at what point is it exploitation, you didn’t pay them
enough and you’re actually exploiting them and the interesting thing is I have yet to find
somebody who wants to stand up and say that they support payment and that this is what they
believe is a fair wage, that this is neither
coercive nor exploitative, that they have hit the
sweet spot and I have yet to have somebody tell me that. In the early days people were quite happy to say that with respect to sperm because that’s all that
there was on the marketplace at the time and they
used to use the example of jury duty and we’re talking $75. That’s not what people
are talking about today and we’re talking about
ova and we’re talking about surrogacy, both
of which are a lot more labor intensive than what
we might have expected from men in terms of
masturbating to provide a sample and so in that context, I
think it’s really important if we’re gonna have honest discussions that somebody be prepared to
say, not in a frivolous way but in a meaningful way
what they think is neither coercive nor exploitative
and I don’t have an answer yet from anybody who’s
actually maintained that. I have answers from all kinds
of people, including myself, who take an hourly wage
of minimum wage and try to figure that out, but we
come up with astronomical figures, I can get the
cost of a surrogacy easily up to $150,000 just by
starting with minimum wage and a 24 hour a day work
and then I want to say, well, what’s fair vacation
pay or time off work? Oh, they don’t get any, starting to sound more like indentured slavery, okay, and I say that in a context where I know it’s got rhetorical force but it’s really just to push the issue. If we’re talking money,
we should be talking with real dollars and cents
so that we actually know what’s coercive, what’s not coercive, what’s exploitative, and
what’s not exploitative. (audience applauds) All right, thank you both. Before I open it up, thanks. Is this one working?
Yes. I guess, Francois, my question to you, which is something that
I sometimes worry about which is, is placing Canada’s regulations, both as regulations but
also as prohibitions in a broader international context, which is if Canada is to
continue its prohibitions, I think we all know or many of us know, the international context
does not replicate the Canadian situation, that there are probably people who will then access ova. We can’t hear you.
You can’t hear me? So the point that I’m
making, can you hear me now? Now you can hear me, okay. The point I am making is
that, is my concern about the implications of the
prohibitions in a broader international context and the issue of, say, forum shopping and so what the prohibition does is to induce Canadians to seek ova
donors, for example, from countries which do permit trade in ova or do also encourage Canadians to seek,
to enter into surrogacy arrangements in other
countries which do, rather, permit paid surrogacy arrangements and so while the prohibitions protect Canadian women, and for the most part it is Canadian women,
they do nothing in a sense to protect women in other
countries and I know that it’s difficult for
Canadian legislation to do that but there is nothing that prohibits or has an impact on
that kind of forum shopping and I’m just wanting to hear, really, what your thoughts are
about that broader societal or broader international phenomenon. So I have a number of comments. One of them is to say
is that as I suggested in my opening remarks,
many of the countries that actually have very similar
healthcare systems to ours also have prohibitions and
also allow for reimbursement and not for payment,
examples there would include places like New Zealand,
Australia, the United Kingdom, Belgium, Finland, Ireland,
Israel, et cetera. So first of all, Canada
is not the outlier. If you want to look at outliers, one of the things that I think
is true that you can look to the South, we are very
close to the United States. Therefore we’re influenced
by the United States. If I think back to Mr.
Housefather, he repeatedly said in early debates that, you
know, surrogacy is legal in most of the United States, that’s actually not true,
in the United States, if you look at each of
the individual states, there are 11 that permit
payment for surrogacy. There are eight that permit
payment for surrogacy. There are 31 that are silent,
so what is true globally is that there are a lot
of places that are silent and people then move to
try to set up a business and sometimes they get shot
down and sometimes they don’t. The fact that people are
moving globally is true in this arena, it’s also true for access to all kinds of healthcare,
we now have the term medical tourism, people move around. We also have scientific
tourism, scientists move around. We’re not gonna be able
at this point to have a global position, I say at this point, possibly we will later and
I’ll come to that in a minute but what I think is
important is that a country, when they introduce
legislation, regulations, policies, guidelines,
they’re actually making a public statement about
what they believe in, recognizing that other
countries might believe in something else and I
think one of the things to pay attention to is
that just as we’re now having a conversation about
possibly allowing this, there are other places which
in the past have allowed it that are now stopping it and
so I think we have to pay attention to not only
where they are but where there are trends, the
last point that you raised is around the extraterritoriality
and that actually at some point is a choice. We don’t have very much
that is extraterritorial in a Canadian context
but one thing we have for example is child
abuse, you do it here, you do it there, we don’t
care, you come to Canada, we’re coming after you, you
could, if you wanted to, have a similar thing, Canada
has chosen at this point not to do that, and one
of the things that I think is interesting to think
about there is we do have at least at a global
level, a Hague convention with respect to child
adoption and recently there were efforts, initiatives, questions about whether we should
have a Hague convention with respect to surrogacy
and one of the things that was interesting is
that at those meetings, the people who were there
from the adoption side were saying look, the reason
that we have a Hague convention is to stop people coming
and stealing our children and it seems very odd
that you would now have a Hague convention to allow people to come and use our women, so I
think there’s interesting conversations that need
to happen globally. I think, Vida, my question
for you has to do with one of the issues that
we haven’t talked about. We talked about and here I’m thinking the
ova donor circumstance. Jeff Miska’s in the
audience, this is something that he talks more about,
there’s actually physicians obligations to do no harm and
so in situations of ova donor in particular when the ova donor is not using the eggs for her own purposes but is actually undergoing egg
retrieval for purposes only of ova donation, his argument
is that the physician is in fact doing surgery that
is unnecessary and is in fact breaching his ethical obligations
or her ethical obligations by putting that woman through
an unnecessary surgical procedure for something
that is not for her benefit. So I just wanted to hear what your response is to that argument. So is this one working? Okay, is the argument,
does that argument pertain only to women who undergo
this for the purposes of selling their eggs
or for women who do this for the purposes of donating their eggs? I think it would apply in both situations and usually women who
are donating are doing it after they have already.
Right. They’re doing it after
they’ve used the eggs for their purposes as well. So I think there’s an important
distinction to be made between the way that we
have these conversations about these practices writ large and the way that we have
these conversations about these practices qua commercial practices. So you know, my interest
or my concern is in the ways in which we sort of praise in many other contexts
egg donors and praise altruistic surrogates and
yet condemn the practice of commercial surrogacy or
the practice of commercial egg donation, so for me the
important kind of ethical line is the line we seem to draw
between these very same practices on the one hand and these practices when
a dollar changes hands so whether or not, and I think
there’s a very interesting question we could be asking
about whether people have a right to have children
and whether the satisfaction of that right ends where
other people’s bodies begin so do we indeed have a
right to have children if our capacity to do so depends on gametes that come from donors or wombs that belong to other people? So I think the question that
you’re raising is really a question around how far
do we think this right to reproduce extends and
not so much a question, is it okay to pay people
for the sorts of practices they engage in and those are just two distinct ethical questions, right, should we be
doing this stuff at all? And if we’re gonna do
them, should we continue to distinguish between
paying and not paying as a boundary of moral concern? Can I just answer that? I think just again to highlight,
I think where we’re coming from in different places,
I actually don’t agree that there’s a right to have children. Children is about
responsibilities and hopefully taking on those responsibilities but I think one of the
things that’s a really weird thing in the Western world is
whenever we want something, we just call it a right and rights have to come from somewhere and I just don’t grant that
we have a right to children. Right, but by way of clarification, I am confounded by that question
so I am sympathetic to that position, so I
don’t mean to actually like come down on the side of we absolutely do have a right, I think, I
think there are good reasons, I think that that language
is not appropriate when we talk about the having of children and the building of families so I actually agree with that
and I thank you for that, for the comment. So I want to open it up to the floor now. I think there are, yes, there are mics, there are mics on the floor. And again, if you could
just introduce yourself before asking a question. I’m Bobaku Obahu. My question is for Francois. Thank you for a very interesting talks and the concepts. So I wanted to probe the point about gender goods or goods and whether a specific answer means
that, the question that Professor Panitch asked about what is a good in this
context, like if it’s gendered? Now I want to suggest
that, and this is something that I open up for you to
respond to, that you can actually find a list of things that are goods that we don’t pay for. Or that good means we don’t pay for and that the list will
be predominantly things that women do, taking care of children, picking up much of the work when it comes to interdependence, housework, and there’s a pattern there
when it comes to things that are good in the same family context that seem to be things that women do, we decide to treat as not
work that should be paid for, right, there’s a pattern,
there is a social justice issue and how would you,
professor, respond to that? Does society have a, is
there an obligation or not as members of society to correct
that social justice issue? So I think that that’s
a very important point and I agree with you to a large extent. I think we need to be
careful when we defend the failure to pay for various forms of
women’s work or perhaps not to pay adequately or
fairly for various forms of quote unquote women’s work that we are encountering an instance
or a version of gender inequality, right, so it’s
a social justice issue, so I guess I was trying to
flag precisely that point when I raised this issue about gendered altruism and the ways in which we continue to ascribe
to women roles and duties in society that are precisely the ones we don’t seem to think
of as deserving of a wage and that we justify this by
appealing to their better nature, right, they’re better suited to, better predisposed to
acting altruistically and so we use that precisely
as grounds to not afford fair remuneration to
the work that women do. So I mean, I think I… Sorry, I think I want to come at that from a couple of different angles. Part of it is that I don’t
actually want to buy into the language of commerce
and so I’m actually not typically wanting to
think about it either as goods or services, even
thinking about it as wages so then when I’m thinking about it, I’m thinking well, what
are things that are good that don’t have money attached to them? Well, you know, I think it’s
really good that we have the Amazon, the forest, right? And other people want to
put a price tag on that and then want to transact
as to whether we can cut the trees down or not,
what your carbon footprint is or not, whether the world
owes something to Brazil in order for them to protect
the forest, et cetera, and all I’m saying is that
I find it very difficult when we have no way of
understanding or having conversations about
things that are valuable, things that are right to
do without quickly trying to turn that into something
that has a cash amount associated with it and
so I think that’s part of what you’re hearing in my conversation, it’s a frustration that
we don’t seem to have a way to do anything
except through capitalism. So that’s one thing I
worry about generally. I think the other thing
that I worry about, though, is I did say at the beginning,
I have some sympathy for that claim, about the
gendered role of altruism, but I think I am wanting to
at least say in principle here we are looking at both sets of gametes so the claim about payment is
being made for both parties in principle, the other
thing that I think is really important is that when you
listen to some of the discussion part of the argument that’s
been advanced for why we should pay for it in Canada
is that it’ll be cheaper for people if we pay women
in Canada and you know, partly that might be because
you don’t have to fly to India, but that’s really
not what they’re thinking about because certain countries
like India, it’s already relatively cheap, but other countries, like the United States,
it’s very expensive. I don’t know if people
are traveling to access these services whether they’re
gonna take the discount option in India or the Cadillac option in the United States,
but I am worried about people articulating a value that, well, we can do it for less
in Canada so that’s why we should do it in Canada. Do you just mean it’s because
the healthcare system’s gonna pay for a lot of
the care for the women? Therefore, in fact, all of
us are going to be paying for that, is that what you mean by that? So I think what we need to
think about what are all of the pieces of the
conversation once we start talking about the money
and again, how much money and I’m still waiting for somebody tell me what they think the
right dollar amount is? WOMAN: Hi, so we spent quite
a bit of time speaking about wages today, and I am
sure you both will know that the proposed regulations
that have been put out and you probably noticed
that postpartum costs are not present for surrogates at all, so as whereas every other
woman in Canada is covered to 17 weeks maternity,
right now a surrogate is not entitled to her net lost wages at all regardless of whether or
not she has help or not, based on my reading, an ova donor as well, so for example, including
in an altruistic model, and I mean completely altruistic model, (speech drowned out by noise) she’s in the clinic for two weeks, her net lost wages are not
entitled to be reimbursed to her and this becomes criminal activity. To my mind, this is actually
just a different part of section two, under taking
care of the best interests of women and protecting their health. I’m curious if the both
of you or either of you commenting on this, this
is actually something I’ve brought to you. First of all, I think as you know, Health Canada is stuck with
respect to the issue of ova and basically what’s
important is that in writing regulations, one is not in
a position to contravene the act, what the act currently
says is that lost wages can be paid for surrogacy. Do I think that there are
situations where ova donors are going to lose wages,
might be very sick, might have ovarian
hyperstimulation syndrome, might be in the hospital,
et cetera, et cetera, do I think that from an
equity point of view, they ought to have access to that? Absolutely, I’ve asked Health
Canada if they can do anything in terms of creative
thinking that would not be a violation of the act because the intent in bringing in the
prohibition was that this was not going to be a surreptitious
way of giving wages and so I think in terms of
intent it ought to be possible but that’s gonna be a legal
decision as to whether or not actUally making those
payments would be seen as a contravention to the act,
the regulations cannot in law contravene the act. WOMAN: I would agree, they
can’t contravene the act. I think the loss from section 12 sub one and would love it if both
of you would actually encourage Health Canada to
improve section 12 sub one. I did have one other point,
Francois, if you want to ask. Please slow down.
Sorry, I do talk quickly. You keep on asking for
a number and at least with respect to surrogacy,
one of the frameworks that I think of, funnily
enough, is considered to be an altruistic model, so if I look at the United Kingdom, for example, typically, what is considered
altruistic by the courts is 15,000 pounds and anything under that doesn’t have to be accounted
for because their courts have said that this is an
acceptable number that is not coercive, it can be altruistic. So if I put that into Canadian
dollars, it’s actually quite a substantial
amount of money, so think. You think 1500 pounds for
surrogacy is substantial? WOMAN: 15,000, 1500,
and I’d also comment on some of the places you’ve
talked about, Australia, they’re actually the biggest
users of commercial services in the world, per capita basis. New Zealand, they are importing
almost all of their sperm. The UK is importing tons of their sperm, so I actually can’t think of another place where it effectively works. Well, I don’t have those
pieces of legislation in front of me, I’ve read
those pieces of legislation, that’s what they permit and
the fact that we disagree, I’d have to pull out the
pieces of legislation. I’m Dee Trovitsky, University of Montreal. Francois, I’d like to go back
to what Sarah just mentioned, your call for what’s
too high, what’s too low with the concept of
inducement and exploitation attached to these levels. What I’d like to try and
argue is that this is not really about inducement or exploitation. It’s actually about how we
as a society see the nature of the service, of the body of work that’s being provided here. If the CEO of a big
corporation is being offered an exceedingly high salary per year, we would never say that
there is undue inducement or that he can’t or she
can’t say no to the job. If somebody’s cleaning
bathrooms which is a usually undesirable type of job and
they’re not getting a lot of money for it, we’re not
gonna talk about exploitation unless it’s, to talk about exploitation, we need a combination of undesirable and not paid enough, so what makes it so
challenging when we talk specifically about egg
donation and surrogacy, I’d like to argue that it’s about the way that our society sees
the nature of the service and it really is about
gender and cultural norms. So part of it is what Vida
said and Bobaku repeated, reproductive services are
traditionally provided for free, not just in the
context of assisted reproduction, but in general in our
society, so we expect them to be provided for free
also in this new context, but also something that
hasn’t been mentioned yet and that is the intimate
relationship that we think women have with their
fetuses or their eggs so that the separation is
somehow particularly challenging or is a struggle or is a
terrible burden on them so the notion of surrogacy
as a work that requires separation from the baby
after birth or separation from your genetic
material, I often feel that why we are so afraid of
exploitation or inducement it’s because we feel that
providing these services is a uniquely challenging act for a woman and I’d like to challenge that. We have empirical research with surrogates after the act, a few years after the act, had a good experience, no regrets, a lot of high degrees of satisfaction, I’m not talking about India, I’m talking about Western countries where there was a fair amount
of autonomy in the decision, same goes for egg donors
so I’d like us to move away from this constant debate
about inducement, exploitation and look in the face of our
cultural and social norms when we think about the
nature of the services and why they present us
with such a moral challenge when we talk about money. So I think I have two answers to that. The first one is that if
we’re really going to go down that route, and please understand,
what I’m about to argue is not what I believe, it’s not the world I want to
build, but if what we’re saying is that this is important valuable work and women should be
properly compensated for it, then I would be arguing,
every single woman who does it should get
exactly the same wage. I don’t know who’s gonna pay
it, but every single woman who does it because I don’t
just want to pay the woman who are giving the babies away. The ones who make the
mistake and keep them, they don’t get paid, so
I’ve had two children, I should’ve been paid
for those two children, you’ve had a few children,
you should be paid, I mean, if what we’re saying
is that this is valuable labor and people are doing it for
free and they shouldn’t, well, then let’s change the
whole world and let’s pay everyone, not just the ones
that choose to be pregnant for nine months and give away
the baby, we pay everybody. Not an argument that I want
to defend, but it is to make the point that it isn’t just about that, it isn’t about creating
fairness by saying that this is important work and
people shouldn’t do it for free. Other people do it for free, in one sense, and they keep the baby,
so what’s happening then, if you go down that path is
what are you really paying for? Are you paying for the labor
or are you paying for the child and the transfer at the end? If you’re really just
paying for the labor, then I should be able to
sign up as a surrogate and the day I deliver
say, thanks very much, I’m glad I have my 15,000
pounds and I’m keeping the baby so there’s a lot more
that’s going on there and I think the other
thing is that you’ve used the example of the CEO versus the person who might be cleaning, in a sort of two extreme kinds of jobs and whether we can talk
about one as coercion or exploitation, I think
part of when you’re talking about coercion and
exploitation is you’re looking at the target audience,
right, we’re not asking CEOs and I don’t know of a lot
of CEOs that are actually signing up to be surrogates,
but I stand to be corrected if people are gonna tell me
that’s the target audience. I haven’t seen that and so I
think we have to be realistic that when you’re talking
about it, it’s against a particular set of circumstances,
not in the abstract. WOMAN: So just to press the
issue of what are we paying for, there are many proposals
out there about how to actually operationalize the payment so that it’s not for
giving the baby at birth, it’s along the way, there’s
a component of the service that is the IVF itself,
there’s a component in every trimester of the pregnancy. There are many service
elements along the way and each needs to be
compensated appropriately. Hello, my name is Angel Petronagos, I’m from William Osher
L system and Dolhausie, so I’m gonna just ask that we shift direction a little bit and ask really, sort of where the surrogates
are in this conversation and the gamete donors? So on the whole nothing about
us without us principle, one of the things that I
notice over and over again is that they often don’t
get a seat at the table. And from speaking with
them, I know that they want to be at the table and have a
say so I wonder if the panel is able to speak to whether or not you know of examples where surrogates and egg donors in particular and sperm donors as well
have had opportunities in the Canadian context to
answer some of these questions, like what is the appropriate
amount for payment, whether or not they want to be paid and whether or not that is the most important question
to them on the table because in part, I doubt that it is. From when I have talked
to them, they have lots of other concerns and payment
isn’t really one of them, often, so if you could speak to that. I’ll offer comment and then
we have qualified people in the audience, if they
want to self identify and take the microphone,
that would be great, I will just offer the following comments, at least with respect to egg donors, there’s two things I would bring forward, certainly a number of egg
donors I have spoken with are more concerned about
the fact that physicians don’t do the research in order
to get them the information that they require in order
to make informed choices and I find it quite sad that
the CFAS has been very active on the payment debate and not so active on the we’ll do the
research to get the data that women say they want, the
other point that I will make is that I do know of egg donors who have been paid for their services, or goods if we’re talking in those terms and they do feel regret
and not in the context that many people talk about,
which is that they’re worried about some offspring
out there in the world that they don’t know or they’re
worried about infertility. The thing, the worry that
I’ve heard is how many times they’ve taken money and then
the person did not get pregnant and then they feel bad
because they took money and they don’t think that they delivered what was the promise or
the nature of the exchange, and I think there’s something
worth thinking about there because in fact, in a strict
sense, they did exactly what they were asked to do
and what they were paid for and yet that’s not how
they were processing it because the couple is
still without a child. I’ll just add something quickly, so this is not my field of expertise, philosophers really don’t know how to do empirical research, (laughs), shame on us. (audience laughs) I mean that seriously,
somebody should teach us, it’s not coming on, is it the battery? WOMAN: No, no, no, you just
have to press it longer to turn it on. Oh boy, sorry. I will just make reference
to an interesting class action lawsuit that
took place in the states, I’m sure many of you know
about but was brought by a number of egg donors
in the US against the ASRM, the American Society for
Reproductive Medicine who price capped wages as
it were or reimbursements for egg donation and a number
of egg donors got together and said, you know what, we don’t accept your price caps and we
certainly don’t accept your reasons for them and in fact, a good number of them and
I’m sure somebody can tell me the exact number of
claimants in this case, you know, were prepared
to argue that they thought they deserved to be paid
fairly for what they were providing, and I think
that certainly has to say something about the position
of a number of donors in this with respect to your question. I just want to add, the
ASRM case came forward because these women were
racialized and they said our eggs are in fact
worth a whole lot more because there’s so few of
these eggs in the marketplace and so I think again,
something worth thinking about, once you start building a marketplace, it’s what the market will
bear so in that context, white women’s eggs will
be worth less than perhaps women of Asian descent, which
was what was at issue there. My name is Emma Ryan. So my concern with
commercialization in Canada is also an international kind of concern, so given that I think the global landscape for services is kind of contacting, you know, it’s not like
it used to be in Thailand and Nepal, it seems like
commercialization in Canada would really make Canada
an even more attractive international destination,
and I think as we all know there’s lots of potentially
nightmare consequences that could flow from that,
the burden on the healthcare system, conflicting
parentage, misinterpreting, all that sort of stuff,
so I’m really interested in hearing about what
you foresee if there’s commercialization in Canada for Canada on the international stage. So I do happen to think that the advantage of talking
about exploitation as a lens through which to
look at what the harms are allows us to say that
some of these arrangements are better and worse. Unlike talking about
commodification which would just say this entire practice is
wrong, we can’t do any of it. Exploitation allows us to
say, in some instances, something worse is happening
than in other instances and so when we’re looking
at the global stage, I do think there’s lots
of reasons to be worried about global surrogacy as
being more exploitative than surrogacy in California,
which is not to say that surrogacy in California
might not also be exploitative but these are questions, these are relative questions, right? I don’t actually think
surrogates in California are being exploited, I do
think surrogates in Nepal have been, certainly, so. I have to admit that I’m
sort of less worried about a kind of exploitation
coming home and more worried about the exploitation
of global surrogates who are really making the
decision against a very, you know, underprivileged
backdrop, right, or a limited set of alternative options
in a way that I just don’t think is true of
Canadian surrogates, right, I think it would be less true
if we had a basic income. Right, but I think the kind of desperation that global surrogates are coming from makes the nature of the
transaction much more exploitative and so I am sort of less worried and I realize that the way
I’m answering your question focuses in on the harms
done to individuals and your question is sort
of a larger picture question of what are some of
the sociological harms. But I think I’m answering
your question that way because those are where
the ethical concerns are that I have, is really with
the treatment of surrogates and so my concerns with
the practice, whatever they may be really does come
down to the women involved. My turn, hi, I’m Meredith Schwartz from Bryerson University and I think some of my questions have
already been touched upon but I guess one of the things
that I was thinking about as you both were speaking is this idea that we ought to pay women when they’re having a
child for someone else and I think that that category
is kind of an interesting category for some of the
reasons that Francois brought up but as someone
who is never gonna have a child, myself, I rely on
other women to have children, right, because if they
don’t have children, then there will be
nobody to take care of me when I’m old and it’s
not gonna be my own kids because I don’t have kids
so when we talk about whether we should pay
women for having children, we often talk about paying
women for having children when they’re having them for someone else but I’m not sure what the
scope of that category is because it seems to me
at that least arguably, every woman is children
for someone else and so the way I think this has
already been answered is that you, Francois, said,
why aren’t all pregnant women, if it’s labor, then why aren’t
all pregnant women paid? And so I just think that’s
kind of an interesting question because we do rely on the
reproduction of the next generation, but it’s
not usually talked about unless the person is going
to relinquish legal control of that child to someone else, which kind of makes it
a strange relationship to children, I think, so anyway. I think that part of the
reason for my saying that is it also becomes a way
of addressing indirectly some of the concerns about
coercion and exploitation. If you just have as public
policy not that only all women will receive child
benefits and six months of subsidized salary
after they’ve given birth but we’ll actually also
provide them with food, money, et cetera, while they’re
pregnant, then it just becomes part of what you’re
entitled to as a citizen and so it just changes
the nature of the reason for the exchange, but,
you know, only because in the interests of time,
it’s 8:30 and nobody has yet volunteered to give me a price,
I’m gonna put one out there so that somebody might wish to respond so, along with colleagues, we submitted the following information to members of Parliament,
pregnancy is a 24 hour a day commitment, seven days
a week for 40 weeks. At a minimum wage of $15 an hour, and accounting for 1600 hours
of work, which is 40 weeks of pregnancy, the cost of
the labor along is $100,800. That’s without addressing
higher wages for overtime, breaks, benefits, vacation
time, reimbursement of expenses, worker’s compensation and so on. And so if we’re not
going to exploit women, surely we at least want
to pay them minimum wage, $15 an hour, we’re now up to over $100,000 and I want to ask the
audience, is that coercive, is that exploitative, is that a fair wage? WOMAN: Minus sleep time, it’s
actually very reasonable. (audience laughs) So are you wanting to half it because you’re sleeping half the time? WOMAN: Not half, but reduce sleep time, I think that’s a very reasonable amount. So is that what we do
with our firefighters when they’re at the
cassam waiting to work? We don’t, we actually pay
them for that time too because they’re on the job.
Okay, I was half teasing because I don’t think it’s
a per hour calculation, I think it’s a global amount.
But that’s not what we do with jobs, right, people
are paid by the hour, that’s how we figure out the hours. WOMAN: Subcontracts are globally. I’m Elise Wander, I’ve
been a surrogate twice. I was not paid, it makes
no difference if I was. I’ve also been an egg donor
six times, I’m a birth mother. I was not paid as a birth
mother to produce a child for amazing parents, I was
not paid as a surrogate. What saddens me about
all of this is that these researchers, these academics,
do not, do not, do not, speak to surrogates, they
do not speak to egg donors. We did a survey, I was a
person in the picture up there. I’m the only person that’s been charged. It was the most terrifying
and the most amazing experience of my life,
to anyone in this room, you say someone buying flowers
will likely not be charged, well, I never thought
I’d have a gun to my head for helping people have
families, but I did and I will say this, we surveyed 400 women that are currently in
the surrogacy process. 98% of them said they
did not want to be paid. What they wanted was to
be able to self direct what the expenses were,
they did not believe Ottawa or some bullshit society
should decide whether a massage should be
something that is reimbursed because she had a massage the month before she became pregnant, we’ve
been lobbying in Ottawa, I brought surrogates and
egg donors to the table for the first time, and I’m telling you, every member of Parliament,
and we’ve seen over 100, and every Senator, we’ve seen 15, said wow, when they heard the
surrogates tell their stories that were compassionate, these
women don’t want to be paid. They want this to be a fair system, they want to self direct
their reimbursement and their expenses, so I wonder,
Francois, I wonder, Vida, are you speaking to these
women because I will bring them to you, I know that Angel
has done amazing work with speaking to surrogates
and speaking to donors and it is necessary for
this work to really happen. (audience applauds) I mean, I absolutely
appreciate that, and as I said, I’m trained in the wrong
sort of thing to be doing this kind of work, I find
these questions fascinating and I am compelled by your
position and your circumstances so my training is as an
ethicist so I think about the kinds of ethical questions
that are at issue here and I largely rely on
the work of other people who are doing the kind of
legwork that you are doing in order that I can kind of
think through the ethical issues so I appreciate the work that’s being done and that’s something I
absolutely want to say and I guess I want to
come back to the question about payment versus
reimbursement because I think, again, I think it’s a
very academic distinction and I agree with you that
if the reimbursements were appropriate, right, I
would be perfectly satisfied and in terms of who gets to determine what counts as appropriate,
well, of course, right, that’s, of course
we absolutely have to be listening to the
voices of surrogates and letting us know what kinds
of reimbursements matter. And how extensive and et
cetera they should be so I suppose thank you for your comment and I absolutely support the position
and I certainly would not be advocating for payment
against the wishes, right, or for repealing the AHRA
against the wishes of the people in this field so my intention really is to draw out concerns or respond to concerns of an ethical nature, right,
in these sorts of practices, but if reimbursement is the strategy, then I’m absolutely all for it. I just happen to think
that reimbursement imposes a very heavy burden on people
who are already carrying a very heavy burden to
justify, right, to provide receipts, to explain
themselves, and I understand that it’s very hard to come
up with the perfect figure that would accommodate all
of these sorts of expenses but I absolutely just think
that when we’re imposing such a, I don’t want to call it a burden, but when somebody is
doing such valuable work that they should then also
have to get forms signed from people attesting to how
much they would otherwise be paid, producing receipts,
negotiating over things like massage, I would like to
see that process simplified and so in some sense I think
like a standardized wage would just simply simplify
that process and remove those kinds of obligations,
so that’s why I think about it in terms of a wage rather
than a reimbursement, but again, I think that
language is just very academic and maybe completely beside
the point, so thank you. So I’m not sure how it is
that you’re understanding or what are you meaning when
you’re saying, do you talk to donors and surrogates, I
certainly talk to them. I am not a skilled empirical researcher and when I have had
grants that have required empirical research, I
have worked very hard to identify people who have
those skills who work with me and who do that work, one of
the things that I actually think is very unfortunate about bioethics is that there are a lot of
people doing empirical research who do not have training
in empirical research, so I admit that I don’t have that training and I do not do that kind of
work without having people around me who are doing that. Do I talk to surrogates,
yes, do I talk to egg donors, yes, I have several members of my family that are born through IVF
so it’s not about whether I talk to people or not, and I– ELISE: I didn’t mean speak
to them, I mean I have a Chinese neighbor, you know,
very similar correlation, and so I’m not saying that,
I’m asking you in your research in your, you know,
presentation where you seem to understand the surrogate
and you seem to understand the egg donor and she
regretted doing it for payment, I’m just wondering, how
many surrogates, how many egg donors and what that
research really looks like from I spoke to 100 people,
I spoke to 1000 people or I talked to my neighbor
who was an egg donor. Well, I can’t answer
those questions for you right now, you can look at
some of my published work and I can certainly talk to
you more directly about that but as I’ve said, that’s
not the focus of my work. My work is primarily
philosophical, which is what I’m trained to do, and
so I work with ideas, but a lot of those ideas
get challenged by talking to people who don’t share
them or they get bolstered by people who do share them. I think that one of the
things that is very important about this part of the
conversation is your claim that it’s 98%, so for example, I
don’t know if it’s 97, 98, 60, whatever, I haven’t done
that work, I’m not skilled to do that work, but I am
prepared to believe you and therefore if that’s the
case I think it’s really sad that we’re having a
discussion about payment if 98% of surrogates would
be happy to work with a good reimbursement system
because then our energy should be going into making it
a good reimbursement system. Now it’s been 14 years for
us to get there, there’s no excuse for that, and I
have been a staunch critic of Health Canada, I think
it’s shameful that we have 14 years of uncertainty
where lots of things were happening that were not
good for any of the parties involved, okay, it’s just
not good to be working in situations of uncertainty. But the one place I think
where I do disagree, perhaps, with some people is with
respect to the claim that the current process
that’s being developed is too burdensome and the
only reason I say that is that there’s two areas
that people have identified as burdensome, filling out these forms and having to keep the
documentation for six years and all I can say back
is I fill out those forms or forms that would be very
similar to that all the time for my employer when I
take a business trip. I have to sit down, I have
to write my name, my address, my employer number, I have
to write down everything and I have to have a
receipt for everything and I have to photocopy
it, et cetera, now– ELISE: Are you getting paid
while you’re making that list and writing that down is my question? Well, you know, the
interesting thing about that is I feel like I work 24 hours a day so I’m really happy that
Marty thinks that she sleeps 12 hours ’cause I sure don’t, no, I mean, I think that
I’m doing it on my own time. I don’t know that my employer thinks that, but I work 12 hour days
and I don’t believe I’m being paid for that,
you know, but honestly, if you wanted to say to
me, we should look at that as something that should be
reimbursable because it takes time to fill that out, I’d
be open to hearing that kind of a comment, I think what
I’m saying back to you is if what you’re saying
is accurate, and I have no reason not to believe
that, that 98% of surrogates want a good functional
reimbursement system, they don’t want to be paid,
then you’re actually saying something that’s very similar
to what I’ve been trying to say is that it’s about
relationships and emotions and things that are
very important to people and we tarnish those by thinking
that those relationships were paid for and I just really do believe that when money changes
hands in certain ways, versus other ways, it
changes something, right? And so to me, that’s a
really important fact and we should be working
with that and we should make the best reimbursement system that we can and I think I have to say,
I thought, I wasn’t sure what we were gonna get
out of Health Canada, I think we’ve got a really
good starting point. I think there are ways it can be improved. Cindy Wasser, I’m a
fertility lawyer in Toronto. This discussion is the
perfect segue to my question which deals with
decriminalization and the issue we have with the proper
reimbursement scheme. So Francois, you alluded to
one of my favorite arguments in your first part of the
debate where you spoke about whether the power of the
criminal law would ever be used against an intended
parent for sending flowers to a surrogate or donor
and you replied with rhetorically, oh, come on, no one but Leah has been prosecuted. For many years, there was
a law in the United States that allowed for the
separation of children from their parents as they
entered the country illegally that government after
government never utilized on moral grounds until the
president of the free world, properly elected, decided to
do it and caged those children for weeks upon weeks,
so the fact that we have criminal sanctions and don’t
use them doesn’t actually protect the public from
them ever being used. There can be in fact an
RCMP investigation into any sanction or any breach
of the current legislation. The sanctions themselves have no separation or no rationale
towards a particular crime. They apply equally to
sending flowers to cloning in your basement, up to $500,000,
up to 10 years in prison or both, and it would be
up to a judge to decide what was the appropriate
measure, not up to you, not up to the RCMP, not
up to the prosecutor. In the meantime, what we’ve got there, everybody would be suffering paying a lot of money to their criminal lawyers, the public would be
paying for the prosecution as they did in Leah’s case for nothing. Her prosecution was a
farce that 16 prosecutors didn’t want to touch,
by the way, I don’t know if you know that, so I don’t
think we should just say, let’s leave it because we don’t use it. I think we need to remove
it and decriminalization would then allow for the
surrogates to and the donors to properly say what their
expenses are and the IPs to deal with it. I disagree with that interpretation and the reason I disagree with
the interpretation is that the way our Constitution is written, the federal government only
has criminal law powers that it can exercise in this arena. But when you say we should decriminalize, what in fact you are
saying is we don’t want the federal government to be involved and what you’re also
saying is we don’t want a uniform system across
Canada, what we want is the provinces to deal with this. Here’s the problem with
having the provinces deal with this, we’ve already
heard about global tourism, what we would be doing then
is introducing a situation in Canada where you
would have another kind of inter provincial tourism,
why do I believe this? If you take it away from the
federal government and you give it to the provincial
government, all you need to get payment on the
table is for one province not to legislate, I guarantee you, I’m willing to put a huge
bet on this, PEI is not going to legislate,
Newfoundland is not going to legislate, neither of those
provinces have IVF clinics. It would be a waste of
public dollars to say it’s illegal to have
payment in our province and I would not want
them spending their time. If we’re talking opportunity
cost, there’s many other things they should spend that on. What about my province, Nova Scotia, what about New Brunswick, unlikely. What about Saskatchewan,
maybe because they’ve actually allowed payment for plasma
so maybe they’re gonna think, well, yeah, let’s allow
this kind of payment, Ontario and Quebec for
sure are gonna legislate. I don’t know which way they’re gonna go but given what they’ve done
on blood, I would imagine that they’d prohibit
payment so my point is that talking about decriminalization
is really just about shifting who’s gonna have
authority and if we bring it back to payment, all
you’re gonna do is end up perhaps with a patchwork
across the country which I don’t think is ideal. Now beyond that, I think
that when you’re talking about decriminalization, if
you’re going to have a law, there has to be a penalty,
we may not like this penalty. Maybe you think it’s the
wrong amount of years and the wrong amount of dollars. If so, I’m happy to engage
with that, it’s quite possible it’s the wrong amount of
years and the wrong amount of dollars, but you can’t
have a law that says you must not do this and
then you do it and you say, oh, okay, we don’t have
a penalty, do it again. That’s just not how laws
work, there has to be a penalty, so we may
not like this penalty, we can have a conversation about it but the other thing I find fascinating is there are many areas of
healthcare, for example, where we have a similar
situation, one that everybody here would be familiar with is
medical assistance in dying. We have a law that says
you can do it in this way. If you don’t do it in this way,
you’re subject to a penalty. Now as it happens, the penalty is lower than in this particular
piece of legislation so as I said before,
if you wanted to argue about have we got the
right numbers, I’m happy to entertain that argument,
but I would stand firm that I do not want this
moved to the provinces, it will be a disaster for us as a country, we already have too many
challenges right now where we cannot get federal
provincial territory agreements and this hurts
Canadians on a lot of fronts. The provinces have the power, however, to regulate in many areas,
as you’ve just noted and that is the process of Canada, that’s how a federal
society works and so they do have provincial prosecution
powers over all kinds of things, regulating fishing, et cetera, there are prohibitions
against everything in every province, that’s the democracy
of the federal nation, so that’s the country we
live in, why not this? Well, as I said, you could argue for that, I just don’t hold that
belief, I just think this is an area where it would be a
benefit to have a uniform system and so I argued for uniformity. Let’s do one more question.
Just one more. We’re at about 10 to nine, so yeah. I’ll be brief.
One more question. Go ahead. Thank you, thank you very
much for your presentations, it’s a treat to hear philosophers. My name Judy’s Ettish
and I work in the faculty of medicine at the University of Calgary. At a pragmatic level, it
seems very unlikely that this bill will pass because I
think that Canadians are– FRANCOIS: Sorry, which
bill are you talking about? The bill that would decriminalize
payment for gametes, embryos, and gestational capacity. FRANCOIS: Okay, so just to
be clear, Mr. Housefather has already acknowledged
that it’s not going anywhere in this particular parliamentary cycle. Right, but just generally,
and the reason I say that is because this would entail
subsidizing an industry and the industry would
then be open to people coming from abroad to have
Canadian women gestate their gametes and then their
child, the child then born would have (speech drowned out by noise) and if the child had
difficulty, then the child would be transferred to Sick
Kids at Canadian expense and the pregnancy would
be subsidized by Canadians so I think if the Calgary
Olympic bid teaches us anything, it’s that electors don’t
want to be taken for suckers and I really think that
it won’t go anywhere. People don’t want our
healthcare system to be used for purposes that don’t
have to do with building a country. I don’t know if this one is working? Okay. (audience laughs) So all I’ll do is raise the possibility that that’s already happening,
because our surrogates are unpaid, that is attractive to citizens from other
nations who come here to– JUDY: I agree with you, but
there’s a problem of supply because if there weren’t,
they wouldn’t be wanting to pay them, so every
industry is different. I mean, we’re seeing that with
marijuana decriminalization. Suddenly, there’s all
talk about their laws of operations, there’s
advertising, it’s an industry and now there’s a
shortage of supply, right, so having an industry
is different from having a practice that involves
relatively few members and is not really in public view. Yeah, I mean, I don’t
know what the numbers are gonna look like in
terms of supply might go up and demand might go down, if it turns out to be quite expensive, they
should be paid $150,000. JUDY: Demand might be very
high in Canada, for example. Guess that depends on how
much we charge in Canada, but the point is well taken,
all I wanted to do was flag that it’s already quite
attractive to foreign prospective parents that surrogates here are unpaid and that we have a
healthcare system for which they don’t also then
need to compensate costs. This is already a bit of a
worry and I share that worry. WOMAN: Foreign insurance
covers international parents. Every hospital across Canada issues a bill to international intended parents. The Canadian healthcare
system has caught on finally, which for us in the
industry is great news. Nobody wants to exploit
Canadian healthcare and I’m telling you,
every international parent that I’ve ever worked with
or that we hear across the country, every good
agency, every good lawyer tells people, get
insurance, it may not cover the whole thing because
there’s no way to opt out of provincial healthcare, but
everybody’s getting a bill. Intended parents coming to Canada know, they are coming not to abuse the system, I can assure of that and
provide you information later. Okay, I think we are at time. So please join me in thanking our answers. (audience applauds) And I think Truda wants to
encourage you to come out tomorrow morning.
Yeah, so, we’ve thanked already the speakers, but I would want to acknowledge
also the support of all the volunteers here,
from Healthline Canada, the Institute for Health Policy
and Management Evaluation, the faculty of law, particularly also the Mary and Phillip Seeman donors,
so we received a donation from the Seeman family, this is part of the Mary and Phillip
Seeman health seminar series so I would like to thank the donors also for their contributions but join me again in thanking the speakers
for an engaging day. (audience applauds) And I invite you to
continue to debate tomorrow, not just on commercialization
but also on donor anonymity, funding for IV, gene editing, and so on, so hope to see many of you tomorrow. (audience applauds) (crowd murmurs)

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