NEW YORK (ABP) — The Church of England recently issued a statement identifying organ donation — even by living donors — as a Christian duty motivated by compassion and a mandate to heal. But what about donating a womb for nine months?
Surrogacy—when a woman agrees to gestate and give birth to a child for others to raise — has ethicists, religious scholars, scientists and even feminists pondering the ramifications of such an arrangement.
Most agree procreation is a privilege, not a fundamental human right. But consensus on what should happen legally, morally and physically after procreation is years — if not decades — away.
Jonathan Tran, an assistant professor of ethics at Baylor University, believes while most couples may agree it is a privilege to bear children, they're willing to pay — or do — just about anything for that privilege. That's where the ethical dilemmas come in.
“It's a result of capitalist notions of entitlement,” Tran said. “Doctors simply become practitioners using those technologies to give the consumer whatever they want.”
Inevitably, the question of who should bear children — and by what methods — remains deeply divisive.
Traditional surrogacy combines a surrogate's egg with the biological father's sperm, but embryo transfer surrogacy is increasingly common, which uses an embryo created from gametes of both biological parents. The first American baby conceived via such an arrangement was born in 1986.
Groups like Baptists for Life and the National Council for Adoption do not support surrogacy; others especially are opposed when it is used to produce children for homosexual couples. Most Catholic leaders, staunch in their objection to procreation that doesn't involve sex, also have spoken against the practice.
“I just can't go along with surrogacy,” said Jeffrey Keenan, director of the National Embryo Donation Center and longtime reproductive specialist. “It just sounds to me to be a bad idea for a woman to carry a pregnancy and then give it up, even though she enters into it with that forethought and knowledge. I don't agree with surrogacy myself and certainly don't advise it.”
Some ethicists, especially on Catholic and evangelical fronts, say that — at best — surrogacy undermines the intimacy of marriage. At worst, they say, it's tantamount to adultery.
Keenan, who is Catholic, said the idea of “an additional party in the marital relationship” can be harmful to an otherwise strong marriage. Others say separating the act of sex from actually conceiving children causes frustration, confusion and isolation between spouses.
“Essentially, it makes marriage a type of business partnership where having sex or not having sex becomes a project for the couple,” Tran said.
Jonathan Tran
Perhaps surprisingly, Catholics, evangelicals and feminists agree on one aspect of surrogacy: It has the potential to dehumanize, or even enslave, women. These critics say splitting half-siblings and “selling” babies should be banned. They say it is paternalistic for rich people to buy the rights to a low-income surrogate's womb — that if an hourly rate is computed for her pregnancy, she earns much less than minimum wage.
While it is illegal in the United States to sell human eggs, most surrogate mothers make thousands of dollars for their peripheral troubles. Nationwide, the going rate hovers around $20,000 to carry one child, plus $5,000 per additional child. The amount doesn't include legal fees, doctor bills, medications or incidental expenses like maternity clothes.
Michele Shoun of Baptists for Life said she would not go so far as to characterize surrogacy as “slavery,” but the fact that it's a paid service means it's not a celebration of life, either.
“It's a transaction in which a child is bought and sold, and there are many problems with that,” she said via email. “It's also one more symptom of ‘freedom of choice' — a dubious proposition if ever there was one.”
Fertility clinics receive no government funding and therefore are under no federal oversight, although Congress recently passed a law that requires them to start collecting some data on clients. Still, Shoun and others say, questionable ethical practices — by doctors trying to give women the best odds of getting pregnant — can be prevalent.
Couples believe they can control fertility procedures so “nothing outside the bounds is done, but I have a hard time trusting the fertility clinics,” Shoun said. “Much of fertility assistance is tainted.”
State laws vary when it comes to surrogacy. New Jersey, New Mexico, Oregon and Washington allow surrogacy. Laws in Nevada, New Hampshire, Tennessee, Texas, Utah and Virginia permit surrogacy for married couples only. Illinois, Indiana, Louisiana, Massachusetts, Nebraska, New York and North Dakota technically prohibit surrogacy agreements—but loopholes exist. Michigan law prohibits compensated surrogacy. It is legally unclear whether surrogacy is permitted in Maryland, Missouri, Ohio, Pennsylvania, South Carolina and Wisconsin. For all other states, no legal provision exists for or against surrogacy.
In states that allow surrogacy, contracts define parenthood, adoption, visitation rights and anonymity clauses. Lawyers help parents predetermine what happens in the event of a miscarriage, whether to “selectively reduce” embryos if a large number of them become viable in the uterus, and what to do if the fetus develops a birth defect and neither the surrogate nor the biological parent wants the child.
What is more, advocate groups like Resolve argue governments should not interfere with the veritable “wild west” frontier of surrogate parenting. They say banning it could create an underworld market much worse than the existing system.
Surrogate mothers themselves say surrogacy gives them a sense of confidence and fulfillment in doing a humanitarian act.
A three-year study of 200 potential surrogates applying to The Surrogate Mother Program of New York seemed to back the claim that “although money is a motive for many surrogates, it is not their primary motive.”
“Almost all (surrogates) report a variety of emotional reasons for undertaking surrogacy, and many of these can be grouped together under the heading of wishes to enable parenthood, to feel self-actualized, and to enhance their identity,” Betsy Aigen, founder of Childbirth Consultation Services, wrote in the study overview.
“It is, for these women, a particularly female experience related to the experiences and meaning of biological functioning and motherhood.”
The 1996 study found that, contrary to popular perceptions that surrogate mothers are uneducated, rural and poor, the average is Caucasian with decent education and income.
“Most of them are parents who know what the experience of bearing a child is about,” Aigen wrote. “There is nothing to indicate that they are naive, passive dupes who are desperate and susceptible to exploitation.
“Being a surrogate is a life experience that allows some women real success in altering their emotional state in a direction they desire and fulfilling ideal images of themselves.”
At its heart, the debate may indeed be primarily about the definition of true motherhood and personal fulfillment for woman.
And while science continues to present new options in the quest for parenthood, the progress is a testament to what some see as God-given intellect and ingenuity. Even some conservative ethicists are asking, “If we have the proper technology, why not use it?”
It may take a generation or two to find out.