This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings , is exploitative of surrogate women. Arising (...) out of consideration of the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

The introduction of contraceptive technologies hasresulted in the separation of sex and procreation. Theintroduction of new reproductive technologies (mainlyIVF and embryo transfer) has led not only to theseparation of procreation and sex, but also to there-definition of the terms mother and family.For the purpose of this essay, I will distinguishbetween:1. the genetic mother – the donor of the egg;2. the gestational mother – she who bears and gives birth to the baby;3. the social mother – the woman who raises (...) the child.This essay will deal only with the form of gestationalsurrogacy in which the genetic parents intend to bethe social parents, and the surrogate mother has nogenetic relationship to the child she bears anddelivers. I will raise questions regarding medicalethical aspects of surrogacy and the obligation(s) ofthe physician(s) to the parties involved. I will arguethat the gestational surrogate is a womb to rent,that there is great similarity between gestationalcommercial surrogacy and organ transplant marketing.Furthermore, despite claims to freedom of choice andfree marketing, I will claim that gestationalsurrogacy is a form of prostitution and slavery,exploitation of the poor and needy by those who arebetter off. The right to be a parent, although notconstitutional, is intuitive and deeply rooted.However, the issue remains whether this rightoverrules all other rights, and at what price to theparties involved. I will finally raise the followingprovocative question to society: In the interim periodbetween today''s limited technology and tomorrow''sextra-corporeal gestation technology (ectogenesis),should utilizing females in PVS (persistent vehetativestate) for gestational surrogacy be sociallyacceptable/permissible – provided they have leftpermission in writing? (shrink)

In the target article, Kirby (2014) explores conditions under which gestational surrogacy in developing countries (in this case India) may (or may not) be considered as exploitative. The author pro...

Advances in reproductive medicine have provided new, and much needed, hope for millions of people struggling with infertility. Gestational surrogacy is one such development that has been gaining popularity with infertile couples, especially those unable to benefit from other reproductive procedures such as In Vitro Fertilization. For many Muslim couples, however, surrogacy remains a nonviable option. Islamic scholars have deemed the procedure incompatible with Islam and have prohibited its use. This paper examines the arguments presented for proscribing (...) surrogacy arrangements in Sunni Islam in particular. These include preservation of lineage, exclusion of third parties in reproduction, upholding the rights of the child, and protection from the negative effects of surrogacy arrangements. The rationales for banning surrogacy are subsequently refuted utilizing Islamic law “Sharia”, bioethics, and medical evidence. The paper also presents reasons for why surrogacy is not only consistent with Sunni Islamic teachings, but is also both ethically justified and medically necessary. Lastly, Islamic scholars are urged to take into account the arguments presented in this paper and reconsider their rulings on the permissibility of surrogacy. (shrink)

Surrogacy is an encouraging management for many childless couples and can hypothetically resolve many unbearable pain that they are confronted. Initially surrogacy treatment was frowned upon, however, surrogacy is more popularly accepted now a day. Though, surrogacy has not yet recognized by 199 country in the globe. Different country has different regulations on surrogacy. However, “there are some indication of the degree of divergence between official discourse and actual practice of surrogacy throughout world”. There (...) are positive changes in attitude toward surrogacy has been seen in some countries. This special issue of Bangladesh Journal of Bioethics has been organized on surrogacy to see the current thinking of surrogacy around the world and how people come out from the social, religious and political framework. (shrink)

This thesis aims to determine whether international gestational surrogacy contracts are exploitative, and whether they should be prohibited. I chose a group of women working as surrogates at Kaival Maternity Home and Surgical Hospital, in Anand, Gujarat, India as a study group. After examining their life circumstances, I argue that these women live in unjust circumstances caused by institutional sexism and poverty. I critically assess arguments launched against surrogacy, organ trade, and prostitution and find that none of (...) these are sufficient for demonstrating that contracts involving the sale of the body are necessarily exploitative. I find that surrogacy is exploitative because of a complex set of social conditions. Further, the contracts are beneficial to both the woman acting as surrogate and to the couple hiring her. I conclude that international gestational surrogacy is exploitative yet mutually beneficial, and prohibiting surrogacy would be harmful unless accompanied by drastic social change. (shrink)

Surrogacy tourism in Asian countries has surged in recent decades due to affordable prices and favourable regulations. Although it has recently been banned in many countries, it is still carried out illegally across borders. With demand for surrogacy in developed countries increasing and economically vulnerable Asian women lured by lucrative compensation, there are efforts by guest countries to ease the strict surrogacy regulations in host countries. Despite a shift toward “altruistic surrogacy”, commercial surrogacy persists. Recent (...) research carried out by international organizations that seek to establish a legal relationship between the commissioning parents and children in cross-border surrogacy arrangements, under the guise of the “best interests of the child,” appears to promote a resurgence of overseas commercial surrogacy rather than restrict it. Further commercialization of surrogacy should be prevented by carefully investigating the reality of the surrogacy process. (shrink)

In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation (UTx) from the perspective of those who may decide to act as gestational surrogates and womb donors, referred to as ‘womb‐givers’. In this article, I advance two sets of claims aimed at critically engaging with some aspects of their analysis. Firstly, I argue that the expression ‘womb‐givers’ obscures the biologically, socially and politically salient (...) issue that those who engage in these practices are primarily persons and women. My contention is that this is of substance in discussions of the burdens and benefits of gestational surrogacy and UTx, which need to consider the specific position that women occupy in society, and the hierarchies that mediate their lives, experiences and preferences. Second, I argue that, if one were to take seriously the experiences and preferences of the women who may engage in these practices, and their bodily autonomy, then gestational surrogacy and UTx should be regarded as biologically and sociopolitically incommensurable. Mullock et al. overlook important aspects of gestational surrogacy, such as the embodied nature of pregnancy and childbirth, the sociopolitical significance of these experiences, and the often‐oppressive social norms that shape them. Whilst biology is not destiny, I suggest that it is socially and politically ‘sticky’ when it comes to this significance and norms, especially within the sphere of reproduction. Towards the end of the article, I query the authors' conceptualisation of bodily autonomy and of the instruments that enable its respect and promotion. (shrink)

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed (...) choice/consent, relevant critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that : 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. (shrink)

John Dewey relates ethics in general with the mode of inquiry. Against the mainstream ethics and moral theories, Dewey reconstructed morality in light of empirical science, providing the necessary steps of pragmatic ethical investigations. In this study, I have revisited Dewey’s ethical inquiry and recent developments of the methods of pragmatist bioethics. Using this approach in ethics, I have examined the development of reproductive technologies and genetics, precisely the moral dilemma of gestational surrogacy at the level of a (...) public issue that needs social policy. In the final part, I have suggested the significance of Dewey’s emphasis on education, deliberative democracy, and institutions and agents’ role as the basis to solve bioethical issues arising in different societal contexts. (shrink)

Shiʿi jurists have three different theories with regard to gestational surrogacy and who should be recognized as the mother of the newborn: (1) the surrogate mother (2) or the ovum provider (biological mother) (3) or both of them. The religious law (al-Aḥkam al-sharʿi) regarding the title of ‘mother’ and issues such as inheritance, will (Waṣiya), marriage, and custody have been discussed by Shiʿi jurists but no exact definition of this term has been provided by them. Because the fertilized (...) ovum is considered the origin of humans and the formation of an embryo also determines the kinship of the newborn, the mother of the child is the woman that fetus created by her ovum. It is this woman who has all the rights and responsibilities of a mother; even if the surrogate mother is considered the mother of the child, she has no rights over the child nor does she have any duties towards him/her. (shrink)

This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings, is exploitative of surrogate women. Arising out (...) of consideration of the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

The article examines the ethics and politics of international gestational surrogacy contracts through a three-dimensional framework that combines political accounts of framework precariousness, accounts of norm incompatibility in contracting scenarios, and feminist accounts of domination. This framework, which can be applied to a host of contemporary bioethical controversies, articulates the ways in which individuals' medical experiences are shaped and determined by social structures that lie beyond their field of control, thus pushing feminist bioethics toward closer collaboration with legal (...) and political theory. (shrink)

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in (...) class='Hi'>surrogacy law and policy. The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere ‘carrier’. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis. (shrink)

United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child–Pare...

Although increasing in usage, surrogacy remains the most controversial method of assisted reproductive technology. Many Christian ethicists have either objected tout court or expressed strong reservations about the practice. Behind much of this caution, however, lies essentialist assumptions about pregnant women or an overemphasis on the statistical minority of well-publicized disasters. The question remains whether Christian ethical reflection on surrogacy might change if informed by social scientific studies on the surrogacy triad. I offer a feminist Christian framework (...) for surrogacy comprised of seven principles drawn from this literature, the reproductive justice paradigm, human rights, and Reformed theo-ethical norms. I ultimately advance surrogacy under certain conditions as a moral good and focus on “altruistic” arrangements—including my own—without concluding that only non-commercial contracts could pass ethical muster. (shrink)

With advances in assisted reproductive technologies, globalization, and the ease of contact via the internet, the use of gestational surrogates as a family building option has grown significantly over the past decade. In a gestational surrogacy arrangement, unlike a traditional surrogacy arrangement, the surrogate is not the genetic mother of the child she carries; the genetic mother is either an egg donor or the commissioning parent. There are only a handful of countries in which commercial (...) class='Hi'>surrogacy is permitted, with the United States and India prominent among them. More surrogacy arrangements are carried out in the United States than in any other nation, and the number of gestational.. (shrink)

Increasing globalisation and advances in artificial reproductive techniques have opened up a whole new range of possibilities for infertile couples across the globe. Inter-country gestational surrogacy with monetary remuneration is one of the products of medical tourism meeting in vitro fertilisation embryo transfer. Filled with potential, it has also been a hot topic of discussion in legal and bioethics spheres. Fears of exploitation and breach of autonomy have sprung from the current situation, where there is no international regulation (...) of surrogacy agreements—only a web of conflicting national laws that generates loopholes and removes safeguards for both the surrogate and commissioning couple. This article argues the need for evidence-based international laws and regulations as the only way to resolve both the ethical and legal issues around commercial surrogacy. In addition, a Hague Convention on inter-country surrogacy agreements is proposed to resolve the muddled state of affairs and enable commercial surrogacy to demonstrate its full potential. (shrink)

For females without a functioning womb, the only way to become a biological parent is via assisted gestation—either surrogacy or uterus transplantation (UTx). This paper examines the comparative impact of these options on two types of putative ‘womb‐givers’: people who provide gestational surrogacy and those who donate their uterus for live donation. The surrogate ‘leases’ their womb for the gestational period, while the UTx donor donates their womb permanently via hysterectomy. Both enterprises involve a significant degree (...) of self‐sacrifice and medical risk in order to enable another person(s) to become a parent by either providing gestational labour or enabling the other person to undertake gestation themselves. In this paper, we explore the burdens and the benefits from the perspective of the womb‐giver in order to inform ethical debate about assisted gestation. This is a perspective that is often neglected in the bioethical discourse. With both surrogacy and UTx, when success follows the womb‐giver’s sacrifice, the key benefit is delivered to the intending parent(s), but as this article examines, the womb‐giver may also enjoy some unique (relational) benefits as a result of their sacrifice. Ultimately, the choice of how a womb‐giver lends assistance in gestation will impact on their bodily autonomy; some will prefer to carry a pregnancy and others to donate their uterus. We argue that the perspective of the womb‐giver is crucial and thus far has not been afforded sufficient consideration in ethical discussion. (shrink)

Reproductive health technology allows married couples who experience infertility to have a child through assisted reproductive technology (ART), such as the in vitro fertilisation (IVF) process. The transfer of the extracted embryo to the woman’s womb is called surrogacy technology (gestational surrogacy). The legality of the practice of surrogacy is still questionable, both on a national and international level. This research discussed the legality of surrogacy in some religious countries, focusing on Indonesia. This research used (...) normative juridical research methods or literature review through a comparative religion-legal approach. This study indicated that most do not have a specific legal instrument regarding surrogacy practice. International law also does not have a standard legal instrument regarding the legality of surrogacy. Legality is determined by each religious country’s national laws and customs. For example, Indonesian law prohibits this practice implicitly under Law No. 36 of 2009 concerning health. The United Kingdom legalised surrogacy through the Surrogacy Agreement Act 1985, which was amended to the Human Fertilization and Embryology Act 2008, Greece through the Greek Legislation Law 3089/2002 and Law 3305/2005, and India through the 2019 Surrogacy Regulation Bill. Those countries have their limitations and characteristics that rule surrogacy. Surrogacy is indeed a technological advancement in the health sector. However, for countries that are influenced much by religion, technological advances sometimes conflict with the culture and the belief that has long been followed by most of the population. For Indonesia, the largest of Sunni Islam ruled surrogacy against the law. Next, Iran, as a Shia Islam country, ruled that surrogacy is a legal action.Contribution: The research provided information and knowledge regarding the different settings of surrogacy practice. Most religious countries bravely rejected or put strict limits on the practice of surrogacy. (shrink)

In an evolving global market of procreation, surrogacy is increasingly practiced and raises many ethical issues in terms of respect of the dignity of women, their bodily integrity and the consideration of the best interests and kinship of the unborn child. Faced with such ethical questions, the legal response in international law was tepid, while that of the States was fundamentally disparate, varying between systems of prohibition or legal framing of this practice and others that tolerate surrogacy but (...) do not regulate it. This article seeks to analyze the different ethical issues raised by surrogacy, then focuses on the various legal trends prohibiting or totally or partially authorizing this practice, and studying the legal treatment reserved by international law to this question. (shrink)

In gestational surrogacy arrangements, the womb is often figured as a holding environment that brings the child of commissioning parents to fruition but does not shape fetal identity. This article probes the racial imaginary of such a figuration—what I term the “nonracializing womb”—where gestation is seen as peripheral to racial transmission. Drawing on feminist science studies frameworks and data from interviews with parents who commissioned surrogates, this article traces the cultural politics of the nonracializing womb, positioning it as (...) an index for broader understandings of race, reproductive labor, and kinship that hinge on nuclear and biogenetic forms. It then problematizes this figure of gestation by engaging emerging research on environmental epigenetics, which offers a lively model of pregnancy as shaping fetal biology, blurring the lines between surrogate and fetus. I argue that epigenetics offers a resource to reimagine gestation as a racializing process, by theorizing race not as solely genetic, but as relational, socio-environmental, and forged through distributed kinship lineages. (shrink)

Klein, Renate The practice of surrogacy in Australia has been controversial since its beginning in the late 1980s. In 1988, the famous 'Kirkman case' in the state of Victoria put surrogacy on the national map. This was a two-sisters surrogacy - Linda and Maggie Kirkman and the resulting baby Alice - in which power differences between the two women were extraordinarily stark: Maggie was the glamorous and well spoken woman of the world; Linda who carried the baby, (...) was the demure school teacher in child-like frocks and pig tails. Their IVF doctor applauded altruistic surrogacy. He called it 'gestational surrogacy' and proclaimed that if the so-called surrogate mother didn't use her own eggs, thus wasn't the baby's 'genetic' mother, no attachment would ensue! This statement is haunting us to this day. It is patently absurd: as a baby grows in a woman's body over the nine months of the pregnancy, it is hard to see why the 24/7 presence of the baby inside her body, its growth, its interaction with her would be any different whether s/he has the mother's genes! (shrink)

In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid (‘commercial’) or unpaid (‘altruistic’); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to (...) navigating questions about the moral legitimacy of surrogacy; in the final part, I reject other moral heuristics that might be proposed as alternatives to the commercial/altruistic dichotomy, and reiterate that a virtue-ethical framework is the most suitable way forward. (shrink)

This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction technologies (ART), particularly the surrogacy. For that purpose, we interviewed: 1) a lesbian woman who had her daughter through her partner's pregnancy, using ART with anonymous donor semen; 2) a gay man who, together with his partner, used a surrogacy service under contract via a specialised offshore agency; 3) a woman who was a surrogate, in Brazil, for her (...) sister-in-law and brother who lived abroad and, from abroad, sent an embryo fertilised for surrogacy; 4) a woman who resorted to her sister-in-law in order to be a mother by surrogacy, with ovules from the woman herself fertilised with semen from her husband; and 5) the sister-in-law mentioned in 4), who acted as surrogate for her brother and his wife. These interviews made it possible to think about the discursive construction of the legitimacy of such parenthoods, as it is produced by access to, and manipulation and circulation of, reproductive technologies and persons. This biomedical management of bodies sets up a material and discursive circuit that, in turn, produces a complex web of personal, normative, legal, professional and market relationships, particularly with a view to construction of a parenthood anchored in a notion of biologically-constituted origin. In this respect, biological, affective and social bonds merge to produce a precise placement of who is the father and/or who is the mother, as well as who are the important others and how they are linked to the child in a broader web of parenthood. (shrink)

Gestational surrogacy relies on a legal agreement between the surrogate and the intended parents to define the roles and responsibilities of the parties, including explicit consent by the surrogate to allow the physician to release all pregnancy-related medical information to the intended parents. In the event of surrogate misconduct, however, physicians may feel conflicted if the surrogate asks the physician to withhold information about potentially dangerous behaviour in pregnancy from the intended parents. While the American Society for Reproductive (...) Medicine guidelines may support disclosure over the objections of the surrogate, the authors argue that such disclosure is a violation of the surrogate’s rights and the physician’s ethical and professional duties. A surrogate’s confidentiality must be maintained as it is an essential element of the physician–patient relationship. (shrink)

The gestational surrogate – and her economic and educational vulnerability in particular – is the focus of many of the most persistent worries about paid surrogacy. Those who employ her, and those who broker and organize her services, usually have an advantage over her in resources and information. That asymmetry exposes her to the possibility of exploitation and abuse. Accordingly, some argue for banning paid surrogacy. Others defend legal permission on grounds of surrogate autonomy, but often retain (...) concerns about the surrogate. In response to the dilemma of a ban versus bald permission, we propose a 'soft law' approach: states should require several hours of education of surrogates – education aimed at informing and enhancing surrogate autonomy. (shrink)

Within the ethics and science literature surrounding uterus transplantation (UTx), emphasis is often placed on the extent to which UTx might improve upon, or offer additional benefits when compared to, existing ‘treatment options’ for women with absolute uterine factor infertility, such as adoption and gestational surrogacy. Within this literature UTx is often positioned as superior to surrogacy because it can deliver things that surrogacy cannot (such as the experience of gestation). Yet, in addition to claims that (...) UTx is superior in the aforementioned sense it is also often assumed (either implicitly or explicitly) that UTx is less fraught with ethical difficulties and thus should be considered a less morally problematic option. This article seeks to examine this assumption. Given that much UTx research has been performed in Sweden, a country where surrogacy is effectively although not currently explicitly forbidden, we do this through an analysis of the arguments underpinning a 2016 Swedish white paper which considered amending existing policy such that altruistic surrogacy arrangements would be permitted. By applying the white paper’s arguments for a restrictive position on altruistic surrogacy to the case of UTx using living altruistic donors we find that such arguments, if they hold in the case of surrogacy, apply similarly to UTx. We thus suggest that, for reasons of consistency, a similar stance should be taken towards the moral and legal permissibility of these two practices. (shrink)

South African law currently forbids those seeking to arrange a surrogate motherhood agreement from creating a child that will not be genetically related to at least one of them. For a surrogacy contract to be legally valid, there must be a ‘genetic link’ between the child created through a surrogate and the parents who will raise it. Currently, this law is being challenged in the High Court of South Africa, and in this article I critically explore salient ethical facets (...) of the dispute. I argue that the law is unjust and should be revised. (shrink)

It is now medically possible for a baby to have two biological mothers. A fertilized ovum from one woman can be implanted into a second woman for gestation in her uterus. In fact, there have been several such cases. The ova donor is the mother in the genetic sense: her genetic material,along with that of the sperm donor,appears in the developing baby. The uterine hostess is the birth mother: she gestates the fetus and gives birth to it. In essence, the (...) two female reproductive functions, genetic and gestational, can be and have been divided from each other. Our current conception of biological maternity has lagged behind these technological marvels and still assumes that both functions will be performed by the same woman. At a time when two "biological mothers" can and do make claims for the same child,each on the ground that she is the "true mother", it is crucial to examine our concepts of biological maternity and their relation to our social policies about maternity in these cases. In this paper I will argue that the best social and legal policy would involve a prima facie preference for the claims of the gestational mother over the claims of the genetic mother for custody of the child in a contest (if there is no question of parental unfitness on either side). That is, in any dispute, presumption should be in favor of the gestational mother. This argument is made independent of considerations about pre-birth and pre-conception contracts, because the issues raised about the roles of gestational and genetic maternity are substantial in themselves and have obvious implications about the acceptability of such contracts.Rather, I argue that a revision of our concept of biological maternity which emphasizes the importance of gestation and which would prefer the claims of the gestational over the genetic mother would have positive benefits for both women and newborns. (shrink)

A serious moral weakness of reproductive ‘surrogacy’ is that it can be harmful to the children who are created. This article presents a proposal for mitigating this weakness. Currently, the practice of commercial ‘surrogacy’ operates only in the interests of the adults involved , not in the interests of the child who is created. Whether ‘surrogacy’ is seen as the purchase of a baby, the purchase of parental rights, or the purchase of reproductive labor, all three views (...) share the same significant flaws. They endorse the transfer, for a fee, of the infant from the woman who gestated it to those who commissioned it, but without justifying such a transfer; they fail to demonstrate that the commissioners have any entitlement to the infant, or, for that matter, suitability to be the infant's parents; and they fail to take any notice of the infant's needs, interests, and wellbeing. A mere genetic connection is not enough to establish that the commissioners are entitled to receive the baby or that they are competent to raise it. Their good intentions, however caring, are not enough. Therefore, just as in the practice of adoption, there should be a formal institutionalized system for screening and licensing the prospective social parents, which would make the infant's needs, interests, and wellbeing paramount. I reply to several potential objections to this proposal, including the objection that genetic parents who raise their own child are not screened and licensed. (shrink)

According to Chloe Romanis, it is worth distinguishing interventions such as surrogacy, uterus transplantation (UTx), and potentially artificial placenta technology, as falling under the genus assisted gestative technologies (AGTs) rather than the more general term assisted reproductive technologies (ARTs). The proposed genus of assisted gestative technologies is a helpful first step in the endeavour to distinguish between the different ethico-legal landscapes across various ‘assisted reproductive technologies.’ Yet, if assisted gestative technologies can be considered a genus of assisted reproductive technologies, (...) we might consider surrogacy, uterus transplantation (UTx), and artificial placenta technology their individual species. Between these various species of AGTs, I would argue, there remains enough ethico-legal diversity to warrant independent discussion about the descriptive and normative functions of each AGT and the relationship between gestation, genetic relatedness, and legal/moral parenthood. (shrink)

As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through (...) empirical research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (shrink)

Some commentators maintain that gestational surrogates are not ‘mothers’ in a way capable of grounding a claim to motherhood. These commentators find that the practices that constitute motherhood do not extend to gestational surrogates. We argue that gestational surrogates should be construed as mothers of the children they bear, even if they fully intend to surrender those children at birth to the care of others. These women stand in a certain relationship to the expected children: they live (...) in changed moral circumstances by reason of their pregnancy, and they engage in the practices said to define motherhood in the post‐birth context. By contrast, ovum donors and embryo donors are not similarly ‘mothers’ because they do not find themselves involved in these circumstances. Not all women involved in three‐parent in vitro fertilization qualify as mothers either. Given this analysis of mothering, we note that transmen who gestate children are engaged in mothering activity even if they otherwise function as a father to those children. By itself, this defence of the maternity of gestational surrogates does not confer moral title to the children they bear; gestation would not by itself override the contractual arrangements gestational surrogates have made regarding the disposition of their children. This interpretation of gestational surrogates as mothers does, however, undercut cultural understandings of these women as mere ‘vessels’, devoid of entitlement to respect as persons and parents. We also consider the meaning of mothering for ‘brain‐dead’ women kept alive to give birth and for the prospect of extracorporeal gestation. (shrink)

This paper analyzes the following question: What do women deserve, ethically speaking, when they agree to gestate a fetus on behalf of third parties? I argue for several claims. First, I argue that gestational motherhood’s moral significance has been misunderstood, an oversight I attribute to the focus in family ethics on the conditions of parenthood. Second, I use a less controversial version of James Rachels’s account of desert to argue that gestational mothers deserve a parent-like voice as well (...) as significant care and support, conclusions that have implications for commercial surrogacy. Finally, I argue that we should not make requests of others when fulfilling them will lead others to deserve goods we cannot reasonably expect them to receive, and I conclude based on this thesis, what I call the “strings attached thesis,” that pro-life arguments in support of prohibitions on abortion commit their proponents to policies which they may not be willing to support. (shrink)

In law and common-sense morality, it is generally assumed that adults who meet a minimum threshold of parental competency have a presumptive right to parent their biological children. But what is the basis of this right? According to one prominent account, the right to parent one’s biological child is best understood as being grounded in an intimate relationship that develops between babies and their birth parents during the process of gestation. This paper identifies three major problems facing this view—the explanatory, (...) adjudicatory, and theoretical problems—and explains how an alternative autonomy-based account is capable of avoiding them. (shrink)

Recent cases in the United States and Australia have catapulted surrogacy into the forefront of debates and public policy regarding new procreative technologies, even though gestating and birthing a baby for another woman does not necessarily involve artificial insemination or in vitro fertilization. Feminists have condemned commercial surrogacy because it borders on baby selling and exploits women. Similar criticism has appeared in the mass media, but these forums, as well as the medical profession, have considered noncommercial surrogacy (...) as more acceptable because of the absence of monetary exchange. Using two cases of surrogacy, this article argues that the distinction between commercial and altruistic surrogacy is socially constructed rather than based on self-evident or intrinsic differences. Both types of surrogacy involve the application of pervasive gender norms specifying that women's motivations to have children should be based on emotion, selflessness, and caring, not on self-interest, financial incentives, or pragmatism. Applying these norms renders commercial surrogacy deviant, but altruistic arrangements more acceptable. However, the article's central argument is that both types of agreement can entail exploitation, the denial of the birth mother's rights, and the severe reduction of her autonomy. (shrink)

The case law surrounding surrogacy, in vitro fertilization, genetic donation, and legal parenthood is notoriously confused. Yet the issues involved in these cases are of fundamental importance to our most basic rights. To make matters worse, ongoing developments in technology continue to push the conceptual limits of both our legal and moral schemes. In this paper I argue that the concept of ‘parenthood’ is deeply ambiguous and attempt to carefully untangle the notion into two distinct concepts – one biological (...) and largely descriptive, and the other social and profoundly normative. I argue that the social notion of parenthood is a complex function of intentions, actions, and emotional states. It is a concept both defined and constrained by social norms. The biological notion of parenthood, for its part, cannot be understood in strictly genetic terms. I offer, instead, a more fleshed out view that treats biological parenthood as a family resemblance concept. Finally, I discuss the role of gestation in the context of a powerful feminist critique and argue that although gestation is a biological phenomenon, it is a mistake to think that its relevance is limited to biology. In fact, what is special about gestation, in the context of parenthood and obligation, is its distinctly social role. By shifting the discussion of gestation away from biology and toward the realm of the social, we can make better sense of the disputes that manifest themselves in the literature and in the law. (shrink)

Surrogacy involves a private agreement whereby a woman who gestates a child attempts to surrender her (putative) moral right to become the parent of that child such that another person (or persons), of the woman’s choice, can acquire it. Since people lack the normative power to privately transfer custody, attempts to do so are illegitimate, and the law should reflect this fact.

Four decades after the Baby M case that led to the prohibition of commercial surrogacy in New York, much has changed in the infertility industry. Advanced technologies including the advent of gestational carrier pregnancies had made it easier and more efficient to create IVF embryos at a distance and over time, accelerating a boom in cross-border, reproductive services and allowing compensated surrogacy to flourish in a growing number of surrogacy-friendly states and beyond. For international couples, the (...) USA has become a hot spot for “circumvention tourism” given its first-rate medical care, ample supply of willing gestational carriers, burgeoning interest in family building among gay couples, and immediate USA citizenship for the child. This commentary reviews selected sociocultural and global forces that helped set the stage for the passage of the Child-Parent Security Act in New York state in 2021, and the efforts by its opponents for stronger protections not only for gestational carriers, but for gamete donors and the donor-conceived offspring. I argue that despite more responsive medical and legal guidelines, the high market demand and economic profits, combined with the lack of regulatory teeth, faulty assumptions about health risks and decision-making autonomy, and inadequate research on long-term health outcomes, continue to make compensated gestational surrogacy in the state of New York a high-risk venture without adequate informed consent. Possible unintended consequences and future research questions are proposed. (shrink)

Sophie Lewis's Full Surrogacy Now offers both a blistering polemic against work, the family, and capitalism and a grounded scholarly reflection on the current industry practices and future possibilities of surrogacy. Throughout, Lewis offers various formulations of the title's demand:"Full surrogacy now" … is an expression of solidarity with the evolving desires of gestational workers, from the point of view of a struggle against work. It names a struggle that, by redistributing the burdens of that labor, (...) dissolves the distinction between reproducers and nonreproducers, mothers and nonmothers, altogether.Lewis does not endorse the "marketization" of gestation, or "markets per se". Instead, she supports... (shrink)

In July of 2005, Indianapolis witnessed streaming headlines in the local newspaper attempting to distill the confusion surrounding the adoption of two premature infants by an adoptive parent. Thirteen articles and opinion pieces introduced the public to a murky legal and ethical transaction. Stating his overwhelming desire to have children, a New Jersey schoolteacher hired the services of a local attorney. The attorney procured a South Carolina woman for a compensated gestational surrogacy contract. Under the contract, the surrogate (...) and the attorney would meet in Indiana to complete the execution of the contract and transfer parental rights via adoption after the birth of the twins. (shrink)

We propose the ‘patient-worker’ as a theoretical construct that responds to moral problems that arise with the globalization of healthcare and medical research. The patient-worker model recognizes that some participants in global medical industries are workers and are owed worker's rights. Further, these participants are patient-like insofar as they are beneficiaries of fiduciary relationships with healthcare professionals. We apply the patient-worker model to human subjects research and commercial gestational surrogacy. In human subjects research, subjects are usually characterized as (...) either patients or as workers. Through questioning this dichotomy, we argue that some subject populations fit into both categories. With respect to commercial surrogacy, we enrich feminist discussions of embodied labor by describing how surrogates are beneficiaries of fiduciary obligations. They are not just workers, but patient-workers. Through these applications, the patient-worker model offers a helpful normative framework for exploring what globalized medical industries owe to the individuals who bear the bodily burdens of medical innovation. (shrink)