Bob and Jane go to Argentina: The Ethics of Cross-Border Care

Étude de cas (PDF)

Elise Smith, Bioethics Programme, Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
Carolina Martin, Research Ethics Board, Centre Jeunesse de Montréal-Institut Universitaire, Montreal, Canada
Jason Behrmann, Institute of Gender Sexuality and Feminist Studies, McGill University, Montreal, Canada
Bryn Williams-Jones, Bioethics Programme, Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada

Résumé

Cette étude de cas présente l’histoire d’une couple Nord-Américain typique à la recherche de traitements de fertilité sur Internet. Cette recherche les conduit sur des sites de cliniques dans d’autres pays, ce qui les amène à penser à voyager à l’étranger pour des services médicaux – également connu comme le tourisme médical.

Mots clés

le tourisme médical, le tourisme de reproduction, les traitements de fécondation in vitro


E Smith, C Martin, J Behrmann, B Williams-Jones BioéthiqueOnline 2012, 1/3
Reçu: 26 oct 2011 ; Publié: 19 mar 2012 ; Éditeurs: Maude Laliberté et Renaud Boulanger
© 2012 E Smith, C Martin, J Behrmann, B Williams-Jones, Creative Commons Attribution 3.0 Unported License

  • Correspondance: Elise Smith, elise.smith@umontreal.ca
  • Conflit d’intérêts: Smith et Williams-Jones font partie du Comité exécutif de BioéthiqueOnline, tandis que Martin et Behrmann sont des éditeurs de la revue. Cette étude de cas a été examinée par Laliberté, qui est l’une des étudiantes de Williams-Jones, et par Boulanger qui a co-écrit avec Smith.

The Case

Bob and Jane are a typical upper-middle class American couple. They have well paying jobs, comprehensive health insurance and a house in the suburbs – they appear to be living the American dream. There is only one problem. Bob and Jane want a family, but after several years of trying they have been unable to conceive. Jane is growing frustrated, particularly because she always dreamed of having children and the prospect of not having any of her own is depressing. The couple have visited their family physician and consulted specialists at a local fertility clinic; the cause of their infertility appears to be complex, and might require expensive IVF treatments, a service no longer covered by Bob and Jane’s private health insurance.

Searching on the Internet, Bob quickly found quotes for IVF treatment in the US, but with an average price of US$12,400 for one treatment cycle, and given that often more than one cycle is needed, Bob despaired of being able to afford these services. While he and Jane are financially well off, they also have a mortgage and car payments – $12,000 for even one treatment cycle is simply beyond their means.

One evening on the TV news, Bob heard a story about the growing phenomenon of ‘medical tourism’, where individuals travel abroad to receive often lower-priced medical services. He wondered: could they find more reasonably priced IVF if they looked outside the US? And to get best value for their money, would they be able to combine fertility treatment with their annual vacation? Worried about travelling to Europe or Asia given current political tensions and costly airfares, they decided to see if they could find private clinics in Latin America. Together, Bob and Jane conducted another Internet search using ‘medical tourism’ and ‘Latin America’ as keywords; they quickly found private medical clinics in Argentina, Brazil, Columbia, Costa Rica, the Dominican Republic, and Mexico.[1]

Although these countries presented a variety of intriguing destinations from which to choose, Bob and Jane had frequently noticed the same website, linking to private Argentine fertility clinic called Plenitas[2]. Based in Buenos Aires, Plenitas is a “medical organization that provides medical services and treatments in Argentina to people living in other countries”.[1] They offer a variety of cosmetic surgeries (e.g., hair transplants, gastric reduction surgery) and fertility treatments, including IVF and egg donation. Bob and Jane were impressed by the website’s professional look, the detailed information, the highly trained medical professionals, and the glowing testimonials from past clients.

On the clinic’s front page, Plenitas is described as “A healing experience” and a means to “Redefine yourself in relaxing vacation” – a perfect fit for Bob and Jane. Importantly, Plenitas also had the lowest price for IVF of the private Argentine fertility clinics they found in their web searches (US$4,795), which included hotel accommodations, a bilingual personal assistant and on-site transportation. Toll free telephone numbers are listed for the US, Canada, the UK and Germany, and consumers are given straight forward instructions in ‘10 easy steps’ to access the clinic’s services, which include pre-trip contact with the clinic, travel arrangements, upfront payment, information about personal assistants on arrival, medical exams, etc. After reading the website in some depth, Bob and Jane were reassured that even after they returned home, a customer representative would keep in contact and answer any questions they might have regarding Jane’s pregnancy. Ten easy steps, thought Bob and Jane, what could be simpler?

Questions to Consider

  1. Modern health care consumers use the Internet to do their research, talk to friends and work colleagues, and purchase medical services as they would any other consumer product. But what confidence should Bob and Jane have about the services they chose?
  2. Do Bob and Jane know with any certainty if their inability to conceive is the result of Jane’s infertility, and not Bob’s? And are they ready to deal with the issue of a possible multiple pregnancy[2] and ‘selective reduction’ of ‘extra’ embryos[3]?
  3. Bob and Jane are looking for a more reasonably priced option for IVF treatments/services. But are they sufficiently aware about the potential consequences? Although this could be perceived as a solution in the short term, it might raise problems in the future (e.g., risk of infertility associated with the treatment, concerns about safety for their future offspring).
  4. Should Bob and Jane consider the absence of any formal legal framework/regulations in Argentina regarding IVF treatments?
  5. Are IVF services sufficiently important that governments and health insurers should ensure their provision, when compared with other needed health care and social services?

List of References

  1. Plenitas. Tourism in Argentina. Secondary Tourism in Argentina  2008. http://plenitas.com/CommunityServer/blogs/tourism_in_argentina/default.aspx
  2. Doyle P. The outcome of multiple pregnancy. Human Reproduction 1996;11(suppl 4):110
  3. Evans MI, Krivchenia EL, Gelber SE, Wapner RJ. Selective reduction. Clinics in perinatology 2003;30(1):103-12

Suggested Readings

  1. “Symposium: Cross-Border Reproductive Care” 2011. Reproductive BioMedicine Online, 23(5): 535-676 (http://www.rbmojournal.com)
  2. Smith, E.; Martin, C.; Behrmann, J.; & Williams-Jones, B. 2010. “Reproductive Tourism in Argentina: Accreditation and its Implications for Consumers and Policy MakersDeveloping World Bioethics 10(2): 59-69.
  3. Pennings G. Reproductive tourism as moral pluralism in motion British Medical Journal 2006;28:337-341.
  4. Blyth E, Farrand A. Reproductive tourism – a price worth paying for reproductive autonomy? Critical Social Policy 2005;25(1):91-114.
  5. Niederberger CS. Assisted reproductive technologies on the web. Fertility and Sterility 2005;83(3):550-552.

[1] Examples of such sites include www.medretreat.com/destinations/brazil.html, http://www.placidway.com/search/Latin%20America,,/search.html, http://www.discovercolombia.com/category/medellin-hospitals-health-clinics/. Many of these sites include medical tourism destinations in a variety of different countries. This search was done January 27, 2012  

[2] An October 2011 search found that Plenitas and their website (http://www.plenitas.com/) no longer exists; the site now forwards to a medical tourism bank of providers (http://abcmedicaltourism.com/en/providers.php).