Testing the limits of freedom of contract: the commercialization of reproductive materials and services

This article examines the cases for and against commercializing, or "commodifying," reproductive materials and services. Using a supply/demand third-party framework, three basic scenarios in which commercial-exchange relationships may be possible--exchange of gametes and zygotes, exchange of gestational services, and exchange of fetal material--and the major parties of interest, or stakeholders, are identified. The study sketches the liberal, essentialist, and radical contingency theories that shape the debate over the commercialization of reproductive materials and services. The article then attempts to derive some basic governing principles that reflect as much common ground as possible amongst these various normative perspectives, while recognizing that complete reconciliation is impossible. Taken together, these principles are designed to reflect a strategy of "constrained commodification," where commercialization or commodification, that is, financial remuneration, plays a relatively neutral role in the utilization of reproductive materials and services. In light of these principles, the article concludes by sketching legal and regulatory regimes with respect to the exchange of gametes and zygotes, gestational services, and fetal tissue.     

Reviews

Wing Thye Woo, Stephen Parker & Jeffrey D. Sachs (eds), Economies in Transition: Comparing Asia and Eastern Europe. Cambridge, MA: MIT Press, 1997, xiv + 412 pp., £33.95 h/b, £16.95 p/b.

Guy Standing, Russian Unemployment and Enterprise Restructuring: Reviving Dead Souls. Basingstoke: Macmillan, 1996, xxix + 404 pp., £45.00.

Ellen Mickiewicz, Changing Channels: Television and the Struggle for Power in Russia. New York: Oxford University Press, 1997, xiii + 340 pp., $35.00.

Naum Nim (ed.), Dos'e na tsenzuru, No. 1. Moscow: Fond zashchity glasnosti, 1997, 208 pp.

Taras Kuzio, Ukraine under Kuchma: Political Reform, Economic Transformation and Security Policy in Independent Ukraine. Basingstoke: Macmillan, 1997, xxiii + 281 pp., £50.00.

Mary Buckley (ed.), Post‐Soviet Women: from the Baltic to Central Asia. Cambridge: Cambridge University Press, 1997, xvii + 316 pp., £15.95.

Neil Hood, Robert Kilis & Jan‐Erik Vahlne (eds), Transition in the Baltic States: Micro‐level Studies. Basingstoke: Macmillan, 1997, xv + 299 pp., £50.00.

V. Stanley Vardis & Judith B. Sedaitis, Lithuania: The Rebel Nation. Boulder, CO: Westview Press, 1997, xi + 242 pp., £14.50.

Lonnie R. Johnson, Central Europe. Enemies, Neighbours, Friends. Oxford: Oxford University Press, 1996, xii + 339 pp., £15.99.

Gale Stokes, Three Eras of Political Change in Eastern Europe. Oxford: Oxford University Press, 1997, xvi + 240 pp., £13.99.

Kevin F. F. Quigley, For Democracy's Sake: Foundations and Democracy Assistance in Central Europe. Washington, DC: The Woodrow Wilson Center Press, 1997, xix + 190 pp., £13.00.

James Gow, Triumph of the Lack of Will. International Diplomacy and the Yugoslav War. London: C. Hurst and Co., 1997, 343 pp., £14.95.

Robert Chenciner, Daghestan: Tradition and Survival. Richmond: Curzon, 1997, xi + 307 pp., £25.00

William C. Wohlforth (ed.), Witnesses to the End of the Cold War. Baltimore: Johns Hopkins University Press, 1996, xvi + 344 pp., $39.95.

Vladimir N. Brovkin (ed.), The Bolsheviks in Russian Society: The Revolution and the Civil Wars. London: Yale University Press, 1997, vi + 333 pp., £21.00.

Carl Van Dyke, The Soviet Invasion of Finland 1939–40. London: Frank Cass, 1997, xiv + 288 pp., £35.00.

Maurice Friedberg, Literary Translation in Russia: A Cultural History, University Park, Pennsylvania: The Pennsylvania University Press, 1997, viii + 224 pp.     

Reviews

The Possessed and the Dispossessed: Spirits, Identity and Power in a Madagascar Migrant Town by Lesley A. Sharp.

University of California Press, Berkeley and London. 1993. xx plus 345 pp. including maps, illustrations, tables, notes, bibliography and index.

Marketing Africa's High Value Foods edited by S. Jaffee and J. Morton. World Bank, Kendall/Hunt Publishing Company, Iowa. 1995. 503 pp. including bibliography and index.

Democratisation and Demilitarisation in Lesotho: The General Election of 1993 and its Aftermath edited by Roger Southall and Tsoeu Petlane. Africa Institute of South Africa, Pretoria. 1995. xvii plus 193 pp. R60 ($30).

A Culture of Censorship: Secrecy and Intellectual Repression in South Africa by Christopher Merrett.

David Philip, Cape Town; University of Natal Press, Pietermaritzburg and Mercer University Press, Macon (Georgia). 1994. xv plus 296 pp. including notes and index. Paperback. Price R54,95.

The Eritrean Question: The Conflict Between the Right of Self‐Deter‐mination and the Interests of States by Eyassu Gayim.

Iustus Förlag AB, Uppsala (Sweden). 1993. 716 pp. including figures, tables, notes, maps, annexures bibliography and index. Paperback.

The Rwanda Crisis 1959–1994 — History of a Genocide by G. Prunier. Hurst & Co. London. 1995. xiii plus 389 pp. Paperback. Price £12.50.

Entrance into Reproductive Life: A Demographic Expression of Socio‐Economic Changes in a Senegalese Rural Area by Valérie Delaunay. Centre Français sur la Population et le Développement (CEPED), Paris. 1994. Les Etudes du CEPED No 7. xxii plus 326 pp. including figures, maps, tables, appendices and bibliography. Paperback. Price 90FF.

Verso un Nuovo Sudafrica: Dall'Apartheid allo Stato Multietnico by Chiara Robertazzi.

Milan: Francoangeli. 1995. 130 pp. Paperback.     

Setting limits through global budgeting: hospital cost containment in Rhode Island

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.