Between Policy and Practice: Interdisciplinary Perspectives on Assisted Reproductive Technologies and Equitable Access to Health CareAuthor(s): Joanna Mishtal,Collective
The articles in this Symposium are the product of an interdisciplinary meeting ‘Between Policy and Practice: Interdisciplinary Perspectives on Assisted Reproductive Technologies and Equitable Access to Health Care’, which was held at the Brocher Foundation, Hermance, Switzerland, 5–7 July, 2015.
The Symposium brought together a diverse, interdisciplinary group of scholars and experts involved in research, publication and advocacy work in the area of assisted reproductive technology (ART) policy, healthcare policy, bioethics, patient rights, and patient experiences with ART. Our aim in organizing the Symposium was to examine ART in Europe from a multi-disciplinary as well as a cross-national perspective, and consider ways in which ART health policies could be improved and harmonized with specific legislative solutions and advocacy efforts. In addition to policy questions, we were also interested in engaging with current debates about 'on the ground' experiences and challenges in clinical and advocacy areas, ethical concerns, and directions for future scholarship. The Symposium therefore convened both scholars and nongovernmental organization advocates, with a range of speakers covering five disciplinary areas: (i) medical anthropology, (ii) bioethics, (iii) law, (iv) sociology, and (v) health advocacy. Moreover, participants’ expertise included experiences and research from a range of geopolitical contexts, from nations that currently have comprehensive ART policies to those that have recently introduced and/or inadequate regulation or subsidies for infertility care.
This Brocher Symposium encompassed 4 specific goals: (i) to identify the key areas of concern regarding the legal, ethical, health, and social impacts of inadequate ART regulation and reimbursement, (ii) to isolate and discuss practical effects of implementing specific policies in particular national contexts in European nations, (iii) to identify the advantages and challenges of particular policy solutions regarding ART by comparing policy and provision in various European nations, and (iv) to establish which advocacy efforts are both feasible and effective in different socio-political contexts with the goal of improving equitable access to reproductive health and rights.
The papers, which were presented during the meeting, address these goals, and in particular focus on various forms of mobility and transformation: patients travelling to seek care, emerging new actors, changing legal systems, and transformation of the terms and concepts of ART debates. As we suggest, ART should be recognized not as a stable field or concept, but as dynamic assemblages (Collier and Ong, 2005) between and beyond the countries, policies and practices. Charis Thompson argues for an understanding of ART in the clinical context as an ‘ontological choreography’ which displays ‘the dynamic coordination of the technical, scientific, kinship, gender, emotional, legal, political, and financial aspects of ART clinics’ (Thompson, 2005, 8). We suggest that this dynamic coordination also has a place in the larger assemblages outside of the ART clinics, in the domains of regulation, advocacy, and transnational circulation of discourses, healthcare services, and patients.
An important thread that runs through most papers in this Symposium is the question: What is the role of the state in a liberal democracy in shaping/ensuring access to healthcare and regulating its safety, but also in dealing with questions of equality and discrimination in this arena? Fundamentally, many of the papers lead us to ask how to address collective forms of suffering in an era of individualized responsibility promoted by neoliberal ideals about self-care as a way to justify cutbacks in social services, healthcare included. The role of the state links with complex questions of national sovereignty to shape national policy according to the local cultural and historical specificities, especially within the EU, whereas Jill Allison (Allison, this volume) by way of contrast shows, some transnational conventions apply, including human rights. But we can also ask: What is the role of the supranational legal system in shaping policies at the national level when such policies vary dramatically? What about the role of the World Health Organization (WHO) and other international health actors? To address this question, Charis Thompson (2015)) proposes to launch a multidisciplinary international data collection project to first arm ourselves with data on inequities, then pursue ways of remedying more concrete examples of inequities, but the question arises – is this a vision for supranational or national-level governance? In contrast, it might be reasonable to argue, as Guido Pennings (2015)) has, that a uniform European legislation is impossible and ethnocentric, and that cross-border reproductive care (CBRC) is the solution to uneven regulation as patients seek what they need across national borders. But should we essentially agree with the inequalities experienced on the ground? What about the exploitation of some poorer nations with less restrictive laws? After all, as patients take advantage of inexpensive infertility care by traveling abroad (for example to Eastern European nations), the local population there might find the same care unaffordable because of lack of state subsidies for infertility treatment. What is affordable to foreigners therefore becomes at the same time emblematic of structural inequalities and particular politics of morality at play in the local healthcare systems (Mishtal, 2015). The export side of this cross-border equation also raises concerns. If we agree that CBRC is the answer to uneven access, will we become like the ‘old people’ in Norway, described by Renate Kurszus (2015)), who prefer to ‘export’ their health and social problem to be remedied by other states? Or will this be, as Pennings (2015)) argues, a rather democratic free flow of services and a kind of homeostatic distributive justice where local cultural specificities can be respected via diverse laws (restrictive or otherwise), while at the same time seekers of ART can find services in a country as suits their needs?
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Professor Daniel Wikler, Harvard University
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