IVF and SurrogacyIVF and Surrogacy

PHL281Y BioethicsPHL281Y Bioethics

Summer 2005 University of TorontoSummer 2005 University of Toronto

Prof. Kirstin BorgersonProf. Kirstin Borgerson

Course Website: www.chass.utoronto.ca/~kirstinCourse Website: www.chass.utoronto.ca/~kirstin

OverviewOverview

……Genetic testing (Purdy)…Genetic testing (Purdy)…

IVFIVF– Definitions/distinctionsDefinitions/distinctions– Singer (for)Singer (for)– Sherwin (against)Sherwin (against)

Selling the body & surrogacySelling the body & surrogacy– Definitions/distinctionsDefinitions/distinctions– Baby M CaseBaby M Case– Murray (~against)Murray (~against)– Steinbock (~for)Steinbock (~for)

Purdy: Genetic Testing Purdy: Genetic Testing and Reproduction and Reproduction

Huntington's Disease (HD)Huntington's Disease (HD): “a devastating, hereditary, : “a devastating, hereditary, degenerative brain disorder for which there is, at present, no degenerative brain disorder for which there is, at present, no effective treatment or cure. HD slowly diminishes the affected effective treatment or cure. HD slowly diminishes the affected individual's ability to walk, think, talk and reason. Eventually, individual's ability to walk, think, talk and reason. Eventually, the person with HD becomes totally dependent upon others for the person with HD becomes totally dependent upon others for his or her care. Huntington's Disease profoundly affects the lives his or her care. Huntington's Disease profoundly affects the lives of entire families -- emotionally, socially and economically… of entire families -- emotionally, socially and economically…

Early symptoms: depression, mood swings, forgetfulness, Early symptoms: depression, mood swings, forgetfulness, clumsiness, involuntary twitching and lack of coordination clumsiness, involuntary twitching and lack of coordination

Later symptoms: concentration and short-term memory Later symptoms: concentration and short-term memory diminish and involuntary movements of the head, trunk and diminish and involuntary movements of the head, trunk and limbs increase. Walking, speaking and swallowing abilities limbs increase. Walking, speaking and swallowing abilities deteriorate. Eventually the person is unable to care for him or deteriorate. Eventually the person is unable to care for him or herself. Death follows from complications such as choking, herself. Death follows from complications such as choking, infection or heart failure” infection or heart failure”

Huntington’s DiseaseHuntington’s Disease

““HD typically begins in mid-life, between the ages of 30 and HD typically begins in mid-life, between the ages of 30 and 45, though onset may occur as early as the age of 2. 45, though onset may occur as early as the age of 2. Children who develop the juvenile form of the disease rarely Children who develop the juvenile form of the disease rarely live to adulthood… live to adulthood…

HD affects males and females equally and crosses all ethnic HD affects males and females equally and crosses all ethnic and racial boundaries. Each child of a person with HD has a and racial boundaries. Each child of a person with HD has a 50/50 chance of inheriting the fatal gene. Everyone who 50/50 chance of inheriting the fatal gene. Everyone who carries the gene will develop the disease. In 1993, the HD carries the gene will develop the disease. In 1993, the HD gene was isolated and a direct genetic test developed which gene was isolated and a direct genetic test developed which can accurately determine whether a person carries the HD can accurately determine whether a person carries the HD gene. The test cannot predict when symptoms will begin. gene. The test cannot predict when symptoms will begin. However, in the absence of a cure, some individuals "at risk" However, in the absence of a cure, some individuals "at risk" elect not to take the test”elect not to take the test”

(Huntington’s Disease Society of America ((Huntington’s Disease Society of America (www.hdsa.orgwww.hdsa.org))))

Reproductive ThresholdReproductive Threshold

Moral Minimalism – “it is morally permissible to conceive Moral Minimalism – “it is morally permissible to conceive individuals so long as we do not expect them to be so individuals so long as we do not expect them to be so miserable that they wish they were dead”miserable that they wish they were dead”

– Puts no demands on usPuts no demands on us– Not many people would want to live in a world where this was Not many people would want to live in a world where this was

the prevailing standardthe prevailing standard– Doesn’t pay much attention to human well-beingDoesn’t pay much attention to human well-being

Minimally Satisfying Lives – “we ought to try to provide Minimally Satisfying Lives – “we ought to try to provide every child with something like a minimally satisfying life” every child with something like a minimally satisfying life” (523)(523)

– Minimally satisfying = many elements. Purdy focuses on Minimally satisfying = many elements. Purdy focuses on ‘health normal for that culture’ (for this argument)‘health normal for that culture’ (for this argument)

– Huntington’s disease does not meet this standard (in virtually Huntington’s disease does not meet this standard (in virtually all societies) according to Purdyall societies) according to Purdy

Purdy’s ArgumentPurdy’s Argument

1.1. We ought to provide every person with a minimally satisfying life We ought to provide every person with a minimally satisfying life [from Utilitarian or Contractarian moral theory][from Utilitarian or Contractarian moral theory]

2.2. People with HD* are unlikely to live a minimally satisfying life People with HD* are unlikely to live a minimally satisfying life [empirical claim][empirical claim]

3.3. People currently living with HD are at high risk of passing on HD to People currently living with HD are at high risk of passing on HD to their childrentheir children

4.4. We ought to prohibit people currently living with HD from having We ought to prohibit people currently living with HD from having genetically related childrengenetically related children

5.5. People currently living with HD are morally obligated to prevent People currently living with HD are morally obligated to prevent the conception of genetically related children (or test for and abort the conception of genetically related children (or test for and abort fetuses with HD)fetuses with HD)

*Huntington’s disease is used here but may be replace by *Huntington’s disease is used here but may be replace by any any other genetic disease that we know to be the cause of a other genetic disease that we know to be the cause of a life life that is not minimally satisfying as defined by Purdythat is not minimally satisfying as defined by Purdy

AnalysisAnalysis

Objection: Right to reproduceObjection: Right to reproduce

– What reasons do we have for this right?What reasons do we have for this right?– Love, companionship, shaping a new generation? Love, companionship, shaping a new generation?

Reply: adoption, AI, egg donation, IVF, cloningReply: adoption, AI, egg donation, IVF, cloning

– Immortality, mini-me? Immortality, mini-me? Reply: narcissistic? false?Reply: narcissistic? false?

Objection: Right not to knowObjection: Right not to know

– Defensible only when ignorance does not put others at Defensible only when ignorance does not put others at serious riskserious risk

Implications?Implications?

Genetic EngineeringGenetic Engineering

TreatmentTreatment EnhancementEnhancement

Reproductive TechnologiesReproductive Technologies

Natural human reproduction = sexual intercourse, tubal Natural human reproduction = sexual intercourse, tubal fertilization, implantation in the uterus, and subsequent fertilization, implantation in the uterus, and subsequent in in uteroutero gestation gestation

Reproductive technologies replace one or more of these steps:Reproductive technologies replace one or more of these steps:

Artificial InseminationArtificial Insemination – often used to overcome male infertility (with – often used to overcome male infertility (with original male’s sperm or with donor’s sperm). Also sometimes used as a original male’s sperm or with donor’s sperm). Also sometimes used as a form of positive eugenics. Can be used in conjunction with surrogacy to form of positive eugenics. Can be used in conjunction with surrogacy to overcome female infertility. Replaces first step.overcome female infertility. Replaces first step.

In Vitro Fertilization (IVF)–In Vitro Fertilization (IVF)– “fertilization in a glass”. Sperm and egg “fertilization in a glass”. Sperm and egg united in a petri dish, grown to eight-cell stage. Combined with embryo united in a petri dish, grown to eight-cell stage. Combined with embryo transfer. Replaces first two steps.transfer. Replaces first two steps.

Future possibility of Future possibility of ectogenesis (artificial gestation)ectogenesis (artificial gestation) – artificial – artificial womb would replace final two stepswomb would replace final two steps

Note: development of PGD (preimplantation genetic diagnosis) allows Note: development of PGD (preimplantation genetic diagnosis) allows couples at risk of transmitting genetic diseases who make use of IVF to test couples at risk of transmitting genetic diseases who make use of IVF to test and discard affected embryosand discard affected embryos

In Vitro Fertilization (IVF)In Vitro Fertilization (IVF)

Reproductive technologies such as Reproductive technologies such as IVF bring the embryo outside of the IVF bring the embryo outside of the human bodyhuman body

‘‘Test tube babies’Test tube babies’

Used most commonly by people Used most commonly by people with certain types of infertility (ex/ with certain types of infertility (ex/ blocked fallopian tubes), and by blocked fallopian tubes), and by couples who don’t want to pass on a couples who don’t want to pass on a genetic disease (ex/ MS, genetic disease (ex/ MS, Huntington’s)Huntington’s)

Arguments Against IVF (with Arguments Against IVF (with objections - Singer)objections - Singer)

1.1. IVF is unnaturalIVF is unnatural

– Modern medicine as a whole? (Ex/ prescription drugs, Modern medicine as a whole? (Ex/ prescription drugs, surgery, chemotherapy)surgery, chemotherapy)

– Using our intellect to overcome adversityUsing our intellect to overcome adversity

2.2. IVF is risky for the offspringIVF is risky for the offspring

– Rate of abnormality with IVF is similar to that with Rate of abnormality with IVF is similar to that with natural reproduction (slightly higher but within natural reproduction (slightly higher but within reasonable limits)reasonable limits)

……

3.3. IVF separates the procreative and the conjugal IVF separates the procreative and the conjugal aspects of marriage and so damages the marital aspects of marriage and so damages the marital relationshiprelationship

– IVF can actually strengthen marriage, as infertile couples IVF can actually strengthen marriage, as infertile couples will then be able to have a much wanted childwill then be able to have a much wanted child

4.4. IVF is illicit because it involves masturbationIVF is illicit because it involves masturbation

– Even if a prohibition on masturbation for sexual pleasure Even if a prohibition on masturbation for sexual pleasure could be defended, in this case masturbation is being could be defended, in this case masturbation is being used to strengthen the marriage bond and procreate & used to strengthen the marriage bond and procreate & this would seem to warrant separate analysisthis would seem to warrant separate analysis

……

5.5. Adoption is a better solution to the problem of Adoption is a better solution to the problem of childlessnesschildlessness

6.6. IVF is an expensive luxury and the resources would IVF is an expensive luxury and the resources would be better spent elsewherebe better spent elsewhere

These objections to IVF rely on the principle that we ought to These objections to IVF rely on the principle that we ought to find loving families for unwanted or orphaned children before find loving families for unwanted or orphaned children before creating additional childrencreating additional children

Recall: Singer is the philosopher who made the argument about Recall: Singer is the philosopher who made the argument about our moral obligations to those in absolute poverty (from the our moral obligations to those in absolute poverty (from the first lecture). first lecture).

– ““We cannot demand more of infertile couples than we are We cannot demand more of infertile couples than we are ready to demand of ourselves. If fertile couples are free to ready to demand of ourselves. If fertile couples are free to have large families of their own rather than adopt destitute have large families of their own rather than adopt destitute children from overseas, infertile couples must also be free children from overseas, infertile couples must also be free to do what they can to have their own large families.” (537)to do what they can to have their own large families.” (537)

……

7.7. IVF allows increased male control over IVF allows increased male control over reproduction and hence threatens the status of reproduction and hence threatens the status of women in the communitywomen in the community

– Women have been actively involved in developing IVFWomen have been actively involved in developing IVF– IVF was developed in part because of the demands of IVF was developed in part because of the demands of

infertile couples – often it is the woman who is most infertile couples – often it is the woman who is most distresseddistressed

– Even if ectogenesis is developed, this should be Even if ectogenesis is developed, this should be embraced as an expansion of women’s choices rather embraced as an expansion of women’s choices rather than as an expansion of male control; it could remove than as an expansion of male control; it could remove the final biological barrier to true equalitythe final biological barrier to true equality

– Note: also raised in Sherwin’s articleNote: also raised in Sherwin’s article

Women and IVFWomen and IVF

““What is the relationship between IVF and women’s What is the relationship between IVF and women’s oppression?”oppression?”

Sherwin argues that IVF is morally problematic because:Sherwin argues that IVF is morally problematic because:

1.1. Patriarchal Social Conditioning: ‘Breeders’Patriarchal Social Conditioning: ‘Breeders’

Why do couples have such a strong desire or ‘need’ for Why do couples have such a strong desire or ‘need’ for children of their own? Assumed to be a natural desire or children of their own? Assumed to be a natural desire or need, but…need, but…

Women are socially conditioned to believe that they are Women are socially conditioned to believe that they are only ‘true’ women if they bear children – the desire or only ‘true’ women if they bear children – the desire or ‘need’ for genetically related children is, at least in part, ‘need’ for genetically related children is, at least in part, socially and culturally constructed socially and culturally constructed

IVF only adds to the inescapability of this conditioning – it IVF only adds to the inescapability of this conditioning – it further entrenches these valuesfurther entrenches these values

Objections?Objections?

Women and IVFWomen and IVF

2. Decrease in Autonomy2. Decrease in Autonomy

When other opportunities for fulfillment, self-worth, intimacy, When other opportunities for fulfillment, self-worth, intimacy, and accomplishment are not present in women’s lives and accomplishment are not present in women’s lives (meaningful jobs and relationships/friendships, for example), (meaningful jobs and relationships/friendships, for example), having children becomes the one outlet for these desires. having children becomes the one outlet for these desires. Providing yet another way for women to have children (while Providing yet another way for women to have children (while the social conditions under which women are employed in the social conditions under which women are employed in lower-paying and less satisfying jobs is unchanged) is lower-paying and less satisfying jobs is unchanged) is problematicproblematic

IVF looks like an increase in reproductive autonomy but IVF looks like an increase in reproductive autonomy but actually represents a decrease in reproductive autonomy if you actually represents a decrease in reproductive autonomy if you take the context of these decisions seriouslytake the context of these decisions seriously

Offering more choices does not always mean increasing Offering more choices does not always mean increasing autonomyautonomy

– Examples: PAS/euthanasia and the elderly, Cochlear Implants, Examples: PAS/euthanasia and the elderly, Cochlear Implants, Prenatal Genetic TestingPrenatal Genetic Testing

Objections?Objections?

Women and IVFWomen and IVF

3.3. Continued Medicalization of Pregnancy and BirthContinued Medicalization of Pregnancy and Birth

Technologies applied to pregnancy and birth (scheduled Technologies applied to pregnancy and birth (scheduled doctor appointments throughout pregnancy, forceps, lab doctor appointments throughout pregnancy, forceps, lab coats, masks, bright lights, labour timelines, coats, masks, bright lights, labour timelines, episiotomies, caesareans, fetal heart monitors)episiotomies, caesareans, fetal heart monitors)– These controls have in the past often become coercive and These controls have in the past often become coercive and

contrary to the interests of womencontrary to the interests of women– Many recently proven ineffective in top quality studiesMany recently proven ineffective in top quality studies

Increases outside control of women’s bodiesIncreases outside control of women’s bodies– Shifts power away from the womanShifts power away from the woman– Decreases autonomy and self-esteemDecreases autonomy and self-esteem

Objections?Objections?

SurrogacySurrogacy

A method of assisted reproductionA method of assisted reproduction

““Surrogacy refers to an arrangement whereby a woman Surrogacy refers to an arrangement whereby a woman agrees to become pregnant for the purpose of gestating agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. She may and giving birth to a child for others to raise. She may be the child's genetic mother or not, depending on the be the child's genetic mother or not, depending on the type of arrangement agreed to.” - type of arrangement agreed to.” - WikipediaWikipedia

The surrogate may also be referred to as a ‘contract The surrogate may also be referred to as a ‘contract mother’ or ‘gestational carrier’mother’ or ‘gestational carrier’

Chosen by gay male couples, infertile couples, busy Chosen by gay male couples, infertile couples, busy working couples…working couples…

Surrogacy RelationshipsSurrogacy Relationships

Commercial / AltruisticCommercial / Altruistic Traditional Surrogacy – AI + gestationTraditional Surrogacy – AI + gestation Gestational Surrogacy – IVF + gestationGestational Surrogacy – IVF + gestation

Parenthood:Parenthood:– GeneticGenetic– GuardianGuardian– Gestational (women)Gestational (women)

Main Argument For SurrogacyMain Argument For Surrogacy

AutonomyAutonomy

– Increased choice and controlIncreased choice and control

Option for couples who may have no other Option for couples who may have no other means of having childrenmeans of having children

Option of employment for women willing to be Option of employment for women willing to be surrogatessurrogates

Selling Ourselves?Selling Ourselves?

SELLING:SELLING:– CarCar– HairHair– BloodBlood– SpermSperm– EggEgg– Parts of organs (ex// Parts of organs (ex//

liver, bone marrow)liver, bone marrow)– Organs (ex// kidney, Organs (ex// kidney,

lung)lung)– BabyBaby– ChildChild– Yourself (into slavery)Yourself (into slavery)

RENTING/LEASING:RENTING/LEASING:– CarCar– Mental labour Mental labour

(workplace)(workplace)– Physical labour Physical labour

(workplace) (workplace) – Sexual organs Sexual organs

(prostitution)(prostitution)– Uterus (surrogacy)Uterus (surrogacy)

SlaverySlavery

““Surrogacy is like slavery in Surrogacy is like slavery in the absence of reciprocity, in the absence of reciprocity, in the fact that one person the fact that one person becomes what Aristotle becomes what Aristotle called an ‘animated tool’ of called an ‘animated tool’ of another, serving simply as a another, serving simply as a means to another’s end” (In means to another’s end” (In Murray, 547)Murray, 547)

Baby MBaby M

Appendix, case 40 (699)Appendix, case 40 (699) 1985 Commercial Surrogacy Agreement 1985 Commercial Surrogacy Agreement Baby M born March 1986Baby M born March 1986 Mary Beth Whitehead (married with 2 children already) – traditional Mary Beth Whitehead (married with 2 children already) – traditional

surrogacysurrogacy William Stern – married to Elizabeth Stern (MS)William Stern – married to Elizabeth Stern (MS) $10,000 – $1,000(>5 months) - $0 (<5 months)$10,000 – $1,000(>5 months) - $0 (<5 months) MBW had emotional attachment to baby & didn’t want to give the baby upMBW had emotional attachment to baby & didn’t want to give the baby up MBW fled the state with the babyMBW fled the state with the baby Changed location and remained hidden for 4 monthsChanged location and remained hidden for 4 months Eventually discovered and baby was returned to the SternsEventually discovered and baby was returned to the Sterns Trial 1 – contract ruled to be valid, MBW’s parental rights were terminated, Trial 1 – contract ruled to be valid, MBW’s parental rights were terminated,

sole custody was awarded to William Stern, adoption by Elizabeth Stern was sole custody was awarded to William Stern, adoption by Elizabeth Stern was authorizedauthorized

Trial 2 (New Jersey Supreme Court) Trial 2 (New Jersey Supreme Court) – Declared contract invalid and unenforceable. Declared contract invalid and unenforceable. – In the end, on grounds of best interests, custody awarded to SternsIn the end, on grounds of best interests, custody awarded to Sterns– But Mary Beth Whitehead’s parental rights and visitation were restored But Mary Beth Whitehead’s parental rights and visitation were restored – 4 main concerns of NJ Supreme Court:4 main concerns of NJ Supreme Court:

New Jersey Supreme Court New Jersey Supreme Court Concerns with Replies Concerns with Replies (Steinbock)(Steinbock)

1.1. Surrogate is not in a position to make an informed Surrogate is not in a position to make an informed decision to surrender her child (paternalism)decision to surrender her child (paternalism)

– Surrogate may underestimate emotional and psychological distress of Surrogate may underestimate emotional and psychological distress of separationseparation

Reply: not good grounds for limiting autonomyReply: not good grounds for limiting autonomy

2.2. Risk of psychosocial harm to the childRisk of psychosocial harm to the child

Reply: speculativeReply: speculative

3.3. Commercial surrogacy contracts are tantamount to Commercial surrogacy contracts are tantamount to baby selling*baby selling*

4.4. Commercial surrogacy contracts allow the rich to Commercial surrogacy contracts allow the rich to exploit the poor*exploit the poor*

*2 Main Concerns with *2 Main Concerns with SurrogacySurrogacy

1.1. CommercializationCommercialization of children of children

2.2. ExploitationExploitation of women who act as of women who act as surrogatessurrogates

1. Commercialization 1. Commercialization

Murray:Murray:

Family relationshipFamily relationship– Nurturing, affection, trust, intimacyNurturing, affection, trust, intimacy– Unconditional acceptance, unchosen obligationsUnconditional acceptance, unchosen obligations

Commercial relationshipCommercial relationship– Exchange of goods and services for moneyExchange of goods and services for money– Control, choice, personal preferenceControl, choice, personal preference– ContractsContracts

What is the impact of allowing commercial relationships to What is the impact of allowing commercial relationships to enter the realm of the family? enter the realm of the family?

Selling ChildrenSelling Children

Usually thought to be wrong because:Usually thought to be wrong because:

1.1. Children have intrinsic moral worth and as such Children have intrinsic moral worth and as such cannot be bought or soldcannot be bought or sold

2.2. Consequences for children would be badConsequences for children would be bad

OR (Murray’s proposal):OR (Murray’s proposal):

3.3. Decreases human flourishing – which is best Decreases human flourishing – which is best achieved within stable loving families and in warm, achieved within stable loving families and in warm, caring (noncommercial) relationshipscaring (noncommercial) relationships

MurrayMurray

““Given the sort of creatures we humans are, our Given the sort of creatures we humans are, our patterns of psychosocial development, our needs patterns of psychosocial development, our needs at different stages of our lives – given these facts, at different stages of our lives – given these facts, certain values, institutions, and practices support certain values, institutions, and practices support our mutual flourishing better than others. our mutual flourishing better than others. Specifically, the values of the marketplace are ill Specifically, the values of the marketplace are ill suited for nurturing the values, institutions, and suited for nurturing the values, institutions, and practices that support the flourishing of children practices that support the flourishing of children and adults within families.” (548)and adults within families.” (548)

Altruistic or gift surrogacy is acceptable as long Altruistic or gift surrogacy is acceptable as long as it is contributing to family valuesas it is contributing to family values

MurrayMurray

Sperm ‘donors’ who are paid are really sperm Sperm ‘donors’ who are paid are really sperm ‘vendors’‘vendors’

Egg ‘donors’/’vendors’ – but much riskierEgg ‘donors’/’vendors’ – but much riskier– Compensation just for time (approx. 56 Compensation just for time (approx. 56

hours)? Inconvenience? Risk? Egg?hours)? Inconvenience? Risk? Egg?

2. Exploitation2. Exploitation

When one party takes When one party takes advantage of another’s advantage of another’s economic need to secure economic need to secure something for considerably something for considerably less than its valueless than its value

What is the price of a baby?What is the price of a baby? In paid surrogacy, something In paid surrogacy, something

‘priceless’ is received in ‘priceless’ is received in exchange for a modest exchange for a modest amount of moneyamount of money

SteinbockSteinbock

Surrogacy is not intrinsically exploitativeSurrogacy is not intrinsically exploitative

It is just a matter of regulations and It is just a matter of regulations and guidelinesguidelines

Allow payment only for medical expenses (as Allow payment only for medical expenses (as in adoption) and with carefully structured in adoption) and with carefully structured contractscontracts

Murray’s Slippery Slope Murray’s Slippery Slope ConcernsConcerns

If we discuss bioethical issues only in terms of choice If we discuss bioethical issues only in terms of choice and control:and control:

– Cloning human embryos, then cloning human Cloning human embryos, then cloning human embryos, freezing them, and implanting them in embryos, freezing them, and implanting them in someone else, then implanting an aborted fetus’s someone else, then implanting an aborted fetus’s ovary, with its millions of yet-unripe eggs, into a ovary, with its millions of yet-unripe eggs, into a woman’s body, so that she might become pregnant woman’s body, so that she might become pregnant with that fetus’s ova (550)with that fetus’s ova (550)

– Surrogacy for convenience?Surrogacy for convenience?

SummarySummary

IVFIVF– Singer (for)Singer (for)– Sherwin (against)Sherwin (against)

Selling the body & surrogacySelling the body & surrogacy– Baby M CaseBaby M Case– Murray (~against)Murray (~against)– Steinbock (~for)Steinbock (~for)

Looking Ahead…Looking Ahead…

Research EthicsResearch Ethics

*ESSAY 2 DUE in tutorial this Wednesday**ESSAY 2 DUE in tutorial this Wednesday*

ContactContact

Prof. Kirstin BorgersonProf. Kirstin BorgersonRoom Room 359S359S Munk Centre Munk CentreOffice Hours: Tuesday 3-5pm and by Office Hours: Tuesday 3-5pm and by appointmentappointmentCourse Website: Course Website: www.chass.utoronto.ca/~kirstinwww.chass.utoronto.ca/~kirstinEmail: kirstin@chass.utoronto.caEmail: kirstin@chass.utoronto.ca