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Reproductive outsourcing: an empirical ethics account of cross-border reproductive care in Canada
  1. Vincent Couture1,2,
  2. Régen Drouin3,
  3. Jean-Marie Moutquin4,
  4. Patricia Monnier5,6,
  5. Chantal Bouffard1
  1. 1Laboratory of Transdisciplinary Research in Genetics, Systems of Medicine and Social Sciences, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
  2. 2Bioethics Institute Ghent, Department of Philosophy and moral sciences, Faculty of Letters and Philosophy, Ghent University, Ghent, Belgium
  3. 3Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
  4. 4Department of Obstetrics-Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  5. 5MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
  6. 6The Research Institute of Montreal University Health Center (RI MUHC), Montreal, Quebec, Canada
  1. Correspondence to Professor Chantal Bouffard, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada; chantal.bouffard{at}


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

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

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  • Contributors All the authors have made substantial contributions to the conception, design of the study, acquisition, analysis and interpretation of data. They all participated in the drafting of the work and they approved the final version. VC and CB are responsible for the overall content as guarantors.

  • Funding This research was funded by the Fonds de recherche du Québec en santé (FRQS) in the context of the Transdisciplinary Research Program on Social, Ethical, Medical and Legal Aspects of Reproductive Genetics and Reprogenetics. VC received scholarships from the Fonds de recherche du Québec – Société et culture (FRQSC), the Fondation Desjardins, the CIHR-Quebec Training Network in Perinatal Research, the Maternal & Child Health Research Center of the Université de Sherbrooke, and the Faculty of Medicine and Health Sciences of the Université de Sherbrooke.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Comité d'éthique de la recherche en santé chez l’humain of the CHUS and the MUHC Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.