Journal of Global Ethics, Volume 9, Issue 3, Page 329-343, December 2013.

Commercial surrogacy arrangements now cross borders; this paper aims to reevaluate the traditional moral concerns regarding the practice against the added ethical dimension of global injustice. I begin by considering the claim that global surrogacy serves to satisfy the positive reproductive rights of infertile first-world women. I then go on to consider three powerful challenges to this claim. The first holds that commercial surrogacy involves the commodification of a good that should not be valued in market terms, the second that (...) it involves the exploitation of the labor of disadvantaged women, and the third that it depends on the illegitimate privileging of positive rights over negative rights. I reject the first of these challenges and argue that global surrogacy arrangements are indeed exploitative on the dual basis of what I call intracontractual injustice and intercontractual coercion. The latter, I contend, depends on a preexisting negative rights violation, which cannot be permitted for the sake of satisfying another's positive reproductive entitlement. I conclude not in favor of a global ban but with suggestions on how developing nations that permit commercial surrogacy might better protect the negative reproductive rights of their female citizens, thereby making them less vulnerable to exploitation. (shrink)

Consensus is lacking among research ethicists on the question of how broadly to understand the requirements of non-exploitation in international clinical research. Two types of principles have been proposed, minimalist and non-minimalist, grounded in two opposing conceptions of exploitation, transactional and systemic. Transactionalists have offered principles, which, it has been argued, are satisfied by minimal gains to vulnerable subjects measured against an unjust status quo. Systemicists have advanced principles with decidedly non-minimal mandates but only by conflating the obligations of clinical (...) research with those of First World citizenship. My aim here is to break this deadlock by offering grounds for a non-minimal requirement of international research ethics grounded in a transactional conception of exploitation. I do this by arguing that a subject's gains must be measured not only within the transaction, relative to her own starting point and to the share of gains enjoyed by her co-transactor, but also across transactions, so as to ensure parity of benefit to trial participants whenever, and wherever, parity of burden is assumed. (shrink)

People tend to be repulsed by the idea of cash markets in kidneys, but support the trading of kidneys through paired exchanges or chains. We reject anti-commodification accounts of this reaction and offer an egalitarian one. We argue that the morally significant difference between cash markets and kidney chains is that the former allow the wealthy greater access to kidneys, while the latter do not. The only problem with kidney chains is that they do not go far enough in addressing (...) equality concerns, and we show how the introduction of cash payments by the state could remedy this. (shrink)

A private, for-profit company has recently opened a pair of plasma donation centres in Canada, at which donors can be compensated up to $50 for their plasma. This has sparked a nation-wide debate around the ethics of paying plasma donors. Our aim in this paper is to shift the terms of the current debate away from the question of whether plasma donors should be paid and toward the question of who should be paying them. We consider arguments against paying plasma (...) donors grounded in concerns about exploitation, commodification, and the introduction of a profit motive. We find them all to be normatively inconclusive, but also overbroad in light of Canada’s persistent reliance on plasma from paid donors in the United States. While we believe that there are good reasons to oppose allowing a private company to profit from Canada’s blood supply, these concerns can be addressed if payment is dispensed instead by a public, not-for-profit agency. In short, we reject profiting from plasma while we endorse paying for plasma; we therefore conclude in favour of a new Canadian regime of public sector plasma collection and compensation. (shrink)

The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization . The province of Ontario recently de-insured IVF. Both provinces cited cost-effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine (...) three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights-based and needs-based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance-based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means-tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy-makers alike. (shrink)

Anti-commodification theorists condemn liberal political philosophers for not being able to justify restricting a market transaction on the basis of what is sold, but only on the basis of how it is sold. The anti-commodification theorist is correct that if this were all the liberal had to say in the face of noxious markets, it would be inadequate: even if everyone has equal bargaining power and no one is misled, there are some goods that should not go to the highest (...) bidder. In this paper, I respond to the anti-commodification critique of liberalism by arguing that the political liberal has the wherewithal to account not only for the conditions under which goods should not be sold, but also for what kinds of goods should not be for sale in a market economy. The political liberal can appeal to a principle of equal basic rights, and to one of sufficiency in basic needs and the social bases of self-respect, I argue, to account for what’s problematic about markets in civic goods, necessary goods, and physical goods including body parts and intimate services. (shrink)

Egalitarian liberal political philosophers have been at pains to show that there is a nonnegligible “place” for liberty within the framework of an egalitarian theory of justice. Thus, many have insisted that, when redistribution is required in order to achieve greater equality, assets should be transferred in the most abstract form possible, ideally through a system of cash transfers. In this article we argue that this strategy has the potential to generate significant violations of neutrality. The problem arises from the (...) fact that individuals with certain rates of time preference often want to use social institutions as self-binding mechanisms and as a result may exhibit a preference for in-kind benefits or other institutional arrangements that are frequently misclassified as paternalistic. We argue that egalitarians who rely on cash transfers as a way of accommodating the demands of liberty do so at the expense of neutrality. (shrink)

According to Philippe Van Parijs, the superiority of an unconditional basic income (UBI) over conventional means-tested liberal welfare state programs lies in its decommodifying potential. In this article I argue that even if a UBI was sustainable at high enough a level to lessen the extent to which an individual is forced to sell his or her labor power in the market, it would nonetheless have the adverse and simultaneous effect of forcing that individual into further market transactions to satisfy (...) his or her most basic needs. I conclude that the relative directness with which a welfare regime responds to basic needs qualifies as a crucial dimension of decommodification, and that the conventional liberal welfare state scores rather higher along this dimension than a UBI would. (shrink)