|
In surrogate motherhood, one woman acts as a surrogate, or replacement, mother for another woman, sometimes called the intended mother, who either cannot produce fertile eggs or cannot carry a pregnancy through to birth, or term.
Surrogate mothering can be accomplished in a number of ways. Most often, the husband's sperm is implanted in the surrogate by a procedure called Artificial Insemination. In this case, the surrogate mother is both the genetic mother and the birth, or gestational mother, of the child. This method of surrogacy is sometimes called traditional surrogacy.
Less often, when the intended mother can produce fertile eggs but cannot carry a child to birth, the intended mother's egg is removed, combined with the husband's or another man's sperm in a process called in vitro fertilization (first performed in the late 1970s), and implanted in the surrogate mother. This method is called gestational surrogacy.
Surrogacy arrangements are categorized as either commercial or altruistic. In commercial surrogacy, the surrogate is paid a fee plus any expenses incurred in her pregnancy. In altruistic surrogacy, the surrogate is paid only for expenses incurred or is not paid at all.
The first recognized surrogate mother arrangement was made in 1976. Between 1976 and 1988, roughly 600 children were born in the United States to surrogate mothers. Since the late 1980s, surrogacy has been more common: between 1987 and 1992, an estimated 5,000 surrogate births occurred in the United States.
The issue of surrogate motherhood came to national attention during the 1980s, with the Baby M case. In 1984 a New Jersey couple, William Stern and Elizabeth Stern, contracted to pay Mary Beth Whitehead $10,000 to be artificially inseminated with William Stern's sperm and carry the resulting child to term. Whitehead decided to keep the child after it was born, refused to receive the $10,000 payment, and fled to Florida. In July 1985, the police arrested Whitehead and returned the child to the Sterns.
Does Surrogacy Involve Making Families or Selling Babies?
Medical science continues to devise new procedures and treatments that test the boundaries of law and ethics. One such result is modern surrogate motherhood, which has been made possible by Artificial Insemination and in vitro fertilization.
Surrogate motherhood has both advocates and detractors, each with strong arguments in their favor. A number of important questions lie at the heart of the debate over the ethics and legality of surrogacy: Does surrogacy necessarily involve the exploitation of the woman serving as the surrogate mother, or turn her into a commodity? What rights does the surrogate mother have? Is surrogacy equivalent to baby selling? Should brokers or third parties be allowed to make a profit from surrogacy arrangements?
The Case Against Surrogacy Nearly all opponents of surrogacy find it to be a morally repugnant practice, particularly when it involves a commercial transaction. Many base their opposition on religious grounds, whereas others judge it using philosophical, legal, or political criteria.
The Roman Catholic Church is just one of many religious institutions that oppose surrogacy. It is against all forms of surrogacy, even altruistic surrogacy, which does not involve the payment of a fee to the surrogate. It holds that surrogacy violates the sanctity of marriage and the spiritual connection between mother, father, and child. It finds commercial surrogacy to be especially offensive. Commercial surrogacy turns the miracle of human birth into a financial transaction, the church maintains, reducing the child and the woman bearing it to objects of negotiation and purchase. It turns women into reproductive machines and exploiters of children. The church argues that surrogacy also leads to a confused parent-child relationship that ultimately damages the institution of the family.
Some feminists oppose surrogacy because of its political and economic context. They disagree with the notion that women freely choose to become surrogates. They argue that coercion at the societal level, rather than the personal level, causes poor women to become surrogate mothers for rich women. If surrogacy contracts are legalized, they maintain, the reproductive abilities of a whole class of women will be turned into a brokered commodity. Some feminists have gone so far as to call surrogacy reproductive prostitution.
Other critics join with Catholics and feminists to decry surrogacy as baby selling and a vehicle for the exploitation of poor women.
The Case for Surrogacy Advocates for surrogate motherhood propose it as a humane solution to the problem of infertility. They note that infertility is common, affecting almost one out of six couples, and that surrogacy may represent the only option for some couples who wish to have children to whom they are genetically related. Advocates also point out that infertility is likely to increase as more women enter the workforce and defer childbirth to a later age, when fertility problems are more common.
Advocates of surrogacy also argue that Adoption does not adequately meet the needs of infertile couples who wish to have a baby. They point out that there are many times more couples than available Infants. Moreover, couples must wait three to seven years on average to adopt an infant. Here, too, social trends have contributed to a greater call for alternative reproductive options. Most important, an increased use of contraceptives and Abortion and a greater acceptance of unwed mothers have led to a shortage of adoptable babies.
Those who favor commercial surrogacy object to characterizations of the practice as baby selling. A surrogacy contract, they assert, is a contract to bear a child, not to sell a child. Advocates of surrogacy see payment to a surrogate as a fee for gestational services, just like the fees paid to lawyers and doctors for their services. Some advocates even argue that the prohibition of commercial surrogacy infringes on a woman's constitutional right to contract.
Surrogacy is also supported by those who believe that society is served best when the liberty of individuals is maximized. They claim that women and society as a whole benefit from the increased opportunity of choice offered by surrogacy.
Advocates also maintain that in a successful surrogacy arrangement, all parties benefit. The intended parents take home a cherished child, and the surrogate receives a monetary reward and the satisfaction of knowing that she has helped someone realize a special goal.
In 1987 the New Jersey Superior Court upheld the Stern-Whitehead contract (in re baby m., 217 N.J. Super. 313, 525 A.2d 1128). The court took all parental and Visitation Rights away from Whitehead and permitted the Sterns to legally adopt the baby, whom they named Melissa Stern. A year later, the New Jersey Supreme Court reversed much of this decision (In re Baby M., 109 N.J. 396, 537 A.2d 1227). That court declared the contract unenforceable but allowed the Sterns to retain physical custody of the child. The court also restored some of Whitehead's parental rights, including visitation rights, and voided the Adoption by the Sterns. Most important, the decision voided all surrogacy contracts on the ground that they conflict with state public policy. However, the court still permitted voluntary surrogacy arrangements.
The Baby M. decision inspired state legislatures around the United States to pass laws regarding surrogate motherhood. Most of those laws prohibit or strictly limit surrogacy arrangements. Michigan responded first, making it a felony to arrange surrogate mother contracts for money and imposing a $50,000 fine and five years' imprisonment as punishment for the offense (37 Mich. Comp. Laws § 722.859). Florida, Louisiana, Nebraska, and Kentucky enacted similar legislation, and Arkansas and Nevada passed laws permitting surrogacy contracts under judicial regulation.
In 1989 the American Bar Association (ABA) drafted two alternative model laws involving surrogate motherhood. These laws are not binding but are intended to guide states as they formulate their own laws. One legalizes the practice of surrogate motherhood and makes surrogacy contracts enforceable in court; the other bars the enforcement of contracts in which a surrogate mother is paid to have a child and then give up any claim to the child.
Under either ABA model, states legalizing surrogate contracts limit them to agreements between a surrogate mother and a married couple. A genetic link must be established between the couple and the child, by the husband's supplying sperm or the wife's contributing an egg, or both. To be valid, the contract must be approved by a judge before conception takes place, and it must be accompanied by proof that the wife is unable to bear a child. The surrogate mother has the right to repudiate the contract up to 180 days after conception, in which case she may keep the child. If she does not repudiate the contract during that time, the couple becomes the child's legal parents 180 days after conception.
In 1993 the California Supreme Court issued a landmark ruling declaring surrogacy contracts legal in California. The case, Johnson v. Calvert, 5 Cal. 4th 84, 19 Cal. Rptr. 2d 494, 851 P.2d 776, involved a surrogacy contract between a married couple, Mark Calvert and Crispina Calvert, and Anna L. Johnson. Crispina Calvert was unable to bear children. In 1990 the Calverts and Johnson signed a surrogacy contract in which the Calverts agreed to pay Johnson $10,000 to carry an embryo created from the Calverts' ovum and sperm. Disagreements ensued, and later that year, Johnson became the first surrogate mother to seek custody of a child to whom she was not genetically related.
After the child's birth, the Calverts were awarded custody. Johnson appealed the decision. The state supreme court finally upheld the legality of surrogacy contracts under both the state and federal constitutions. The court held such contracts valid whether or not the surrogate mother provides the egg. The U.S. Supreme Court declined to hear Johnson's appeal.
In many states, surrogacy contracts are considered unenforceable because of existing adoption laws designed to discourage "baby selling." These laws may, for example, forbid any consent to adoption given prior to the birth of the child. They may also make it illegal for a birth mother to receive payment for consenting to give up a child or for an intermediary or Broker to receive a fee for arranging an adoption. In states with these laws, a surrogate mother who wishes to keep the child rather than give it up for adoption may successfully challenge an already established surrogacy contract.
Laws concerning artificial insemination can also conflict with surrogacy agreements. Some states have laws maintaining that semen donors are not legally the fathers of children created with their sperm. These laws were originally designed to facilitate the development of sperm banks. In a surrogacy arrangement, they conflict with an attempt to adopt the surrogate child. Increasingly, states are drafting laws that clarify the legal status of surrogacy arrangements, including who is the rightful parent of a child born through surrogate mothering.
State laws differ in the way they handle surrogate motherhood contracts. Most state laws on the issue are designed to prevent or discourage surrogacy. Four states (Florida, Nevada, New Hampshire, and Virginia) specifically allow surrogacy contracts under certain conditions. Several other states (Arizona, Indiana, Louisiana, Michigan, Nebraska, New York, North Dakota, and Tennessee) specifically prohibit surrogacy contracts as void and in violation of public policy. In some states (Kentucky, Michigan, Utah, and Washington, as well as the District of Columbia) entering into a surrogacy contract or assisting in procuring such a contract is a criminal act, punishable by fine, imprisonment, or both.
State laws likewise vary in the way they handle disputes over custody. Surrogacy laws in Michigan and Washington make custody determinations on a case-by-case basis, attempting to reach the decision that best serves the interests
of the child. In New Hampshire and Virginia, such laws presume that the contracting couple are the legal parents but give the surrogate a period of time to change her mind. In North Dakota and Arizona, the surrogate and her husband are the legal parents of the child.
The Commissioners on Uniform Laws created a stir when it amended the Uniform Parentage Act to authorize gestational agreements as valid contracts. According to the prefatory note to the uniform act, the commissioners determined that such agreements had become commonplace during the 1990s, so the law was merely designed to provide a legal framework for such agreements. However, several organizations have decried the inclusion of these provisions. As of 2003, two states, Texas and Washington, had adopted the new uniform act, while legislatures in four other states were considering its adoption.
Introduction to Surrogate Motherhood
What is the goal of the human race? Science tells us, the goal of the human race is essentially the same as that of a basic human cell. Survival! If the ultimate goal of humanity is survival, then this necessarily means reproduction. Humans can only survive if they continue to reproduce. However, should this reproduction be through only "natural" means? What about couples who are not able to reproduce? That is, either the male or the female is sterile? Is that the end of the story for them? In an instant, a couple's dreams of having a family, raising children and having someone to take care of them when they get older, can be shattered, not through any fault of their own. Is this fair? Under these circumstances, the couples who want to have children have only a few options. They can choose not to have children, they can adopt, or they can take advantage of reproductive technology and have a child through assisted reproductive methods. The legal, moral and religious implications of undertaking such a task are many.
First, some argue that the Constitution implicitly provides a right to procreate. Others claim that where this right is not explicit, it should not extend to reproductive technology. Furthermore, the law often cannot adequately deal with questions such as what constitutes a "parent", that have traditionally been defined in biological terms. Cases over the past ten years have forced the courts to address the issue whereas courts are reluctant to "make law" and prefer to leave such decisions to the legislatures. Consequently, legislatures have had to face the challenge of regulation and about one-half have not adequately addressed the issue.
This "altering" of nature has given rise to moral and religious questions as well. Is it against the laws of nature to produce a child in a laboratory? Most of the reproductive techniques involve means other than traditional procreation. Also, is commercial surrogacy the "selling of babies?" From a conservative social perspective, assisted reproductive techniques involve the commodofication of babies, since gestational surrogate contracts usually involve payment to the gestational surrogate in exchange for carrying the child for an infertile couple.
From the religious perspective, some religions do not permit reproduction through means other than natural procreation because a child is seen as a "gift" from God rather than a fulfillment of a couple's psychological needs. Others allow assisted reproduction methods as a last resort for infertile couples and still others encourage such means in order to benefit the population of its adherents.
Next, assuming a couple chooses assisted reproductive methods to have a child, problems may arise if the arrangement between the parties, in a surrogacy contract, for example, go awry. Who is legally entitled to keep the child? Who is the mother? Who is the father? What rights does each possess? Further, assuming the parties have no contractual conflicts but the child is born with some birth defect. Should the surrogate mother by liable for tort? Should it matter whether she abused drugs during her pregnancy? Should the child have a tort claim against the surrogate? Legislation addressing these issues seems to be lacking in most states.
This annotated bibliography provides an overview of surrogate motherhood by presenting arguments in favor of and against surrogate motherhood, and similar reproductive practices. It will explore the role of the law in determining what constitutes a "parent" and what his or her rights and obligations are to the child; the rights of the surrogate mother in terms of the child, and the child's rights. This annotated bibliography will also provide the religious perspective from the Christian, Catholic, Jewish, and Islamic points of view. Additionally, ethical issues will be addressed as well as the role of courts and legislatures in addressing these issues. The constitutional issues of the right to privacy and the right to procreate will also be explored. Finally, proposed framework for effective legislation and facts and statistics related to infertility and surrogate motherhood, and components of a successful surrogate arrangement are included. After reading this annotated bibliography a reader should have a better understanding of surrogate motherhood and issues associated with it, based on a broad range of perspectives.
MOTIVATIONS OF SURROGATE MOTHERS:
PARENTHOOD, ALTRUISM AND SELF-ACTUALIZATION
(a three year study)
Author: Dr. Betsy P. Aigen
The public controversy over surrogate motherhood is accelerating. Because surrogacy questions cherished cultural beliefs and ideals regarding the mother-infant relationship, it inenvitably stimulates intense anxiety and discomfort. Women who choose to bear children voluntarily for someone else reap disdain, and are seen as cold, heartless, and mercenary, because they seem to so easily ìgive away their babies". Even in the absence of the issue of fee payment, there is a clear moralistic underpinning to the arguments against surrogacy, which is rarely stated overtly, that choosing to have a baby for someone else is reprehensible because it represents a ìrejection" of the infant by its biological mother. These women, who are seen as being prompted by materialistic motives, are correspondingly seen as coming from a financial and/or social ìunderclass". This is perceived as making them vulnerable to being exploited by reproductively ìprostituting" themselves. Finally, they are assumed to suffer a serious traumatic experience because of the perceived ìloss" they suffer in surrendering the infant to the couple.
Although critics have been vocal and strident, there is little actual data to substantiate these claims. This study was a preliminary effort to assess the reality of the assumptions behind this stereotype, to clarify their motives.
METHOD
Interviews
Two hundred potential surrogates applying to The Surrogate Mother Program of New York were screened using a series of three semi-structured interviews, 90 minutes each, to assess their motivation, feelings about surrendering the baby, and a number of related attitudes. General demographic data, medical history, as well as information regarding their current and past life situation, were asked for as well, including childhood relationships. Questions also pertained to their state of emotional health, and corresponded to a traditional clinical interview. The following is a very brief summary of the results of this three year study.
SUBJECTS
The Rejected Group
Individuals were rejected for "emotional" reasons such as:
1. Individuals too ambivalent about becoming surrogates. Serious expressions of conflict over either the responsibility or the commitment of time, energy, and resources required; or uncertainty over whether they would feel comfortable carrying a child that was not "theirs"; or being very anxious about the possibility of social criticism.
2. Individuals overly motivated by the fee.
3.Indivials potentially experiencing too much difficulty in surrendering the baby.
4. Indiviuals likely to suffer severe loss reaction afterwards.
5. Indiviuals in the middle of a "life crisis". Crisis refers to such events as being, at the time of application, in the process of divorce, still recuperating from a divorce, mourning the recent death of a family member or spouse, or being in the midst of an identity crisis, i.e. not knowing what to do with oneís life.
6. Indiviuals trying to use the role of surrogate as a way to deal with a traumatic situation. Efforts to "relive" abandonments suffered in childhood through "identifying" with the infant whom they see as being abandoned by themselves or given away; or unconscious conflict over another child themselves. Being a surrogate would allow the applicant to bear the child yet not keep it. The possibility exists of her changing her mind and keeping the child.
7. Individuals in poor emotional condition,depressed, immature, or unstable.
8. Judged to be dishonest and untrustworthy.
The Accepted Group
The accepted group includes those applicants who did not fall into any category of the rejection categories. They were (at most) minimally ambivalent about becoming surrogates not primarily motivated by the fee, and judged as having little potential difficulty in surrendering the baby. They were emotionally adequate, with no serious outstanding pathology. They were frequently judged to be honest and trustworthy.
In addition, they passed the following criteria:
1. Individuals for whom this would be a positive emotional experience, who feel they would gain by it.
2. High frustration tolerance and ìego strength". People with determination to follow through and the capacity to endure the physical and emotional demands and realities of the process.
3. A history of positive and enjoyable preganancies, both physically and emotionally.
4. Positive relationships with their children, to ensure that they have the necessary concern, understanding, and closeness to deal adequately with their childrenís questions and feelings about the choice of surrogacy.
5. The presence of a supportive home environment, i.e. spouse or significant others, to ensure an adequate environment during pregnacy.
Demographic Characteritics and Attitudes Related to Surrogacy
The mean age of the entire group was 26. Fifty percent were married, and 26% were single. Seventy-five percent were mothers. Forty percent had a history of one or more abortions. Sixteen percent had some relation to adoption (they or a significant family member were adopted, or they surrendered a child for adoption). As a group, they were predominantly white and either Catholic or Protestant. Almost three-fourths came from large families (three or more siblings). The average educational level was 13.3 years. Fifty percent had one or more years of college. Approximately 71% were employed (at least part-time), and 20% were either teachers or nurses. Their mean income level was above $24,000 per year. Twenty-five percent had combined family incomes above $35,000 per year. [This includes women judged to be ìfinancially desperate.] On average, applicants had been interested in being a surrogate for 1 1/2 years. Seventy-five percent wished to meet the couple.
The "average" surrogate emerges as a white mother with a fair amount of education and income. As a group, they cannot be described as destitute or living in poverty, and do not need the fee being paid them for basic survival. On average, they do not report being under serious financial pressure. Further data reflecting this is presented later on. Most of them are parents who know what the experience of bearing a child is about. There is nothing to indicate that they are naive, passive dupes who are desperate and susceptible to exploitation.
Conclusion
Although money is an important motive to many surrogates, it is not their primary motive. Almost all 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. It is, for these women, a particularly female experience, related to the experiences and meaning of biological functioning and motherhood. The love of their children, the gratification their children offer them, and the wish to share these experiences, were often mentioned by these women. These feelings, influenced a number of the motive categories, including empathy with the infertile wife and the drive to generate parenthood for others.
An indirect implications of all this is that these women are as "normal" as anyone else. Previous research assessing surrogates has also found them to be unremarkable and their personalities to be average. Although psychological needs may sometimes, or perhaps even often, be found underlying a number of the motives reported (e.g., guilt), we do not see that this, in an of itself, invalidates the surrogatesí choice. Such conflicts and needs, in part, fuel most "normal" choices and activities of human beings, such as marriage and career. What are "healthy" motives? We do not ban people from becoming CIA agents or test pilots because they are prompted by unresolved wishes.
This does not mean that there are no unhealthy motives for becoming a surrogate and that no discrimination is necessary. On the contrary, the fact that over 40% of our 200 applicants were rejected for emotionally-based reasons, having to do either with poor motives, general life situation, or general emotional makeup, suggests that great discrimination and caution are necessary in accepting individuals for this process. The reasons for rejection listed earlier, as well as the criteria for acceptance, can provide a useful start in the process of providing needed criteria for evaluating surrogate applicants effectively. Additionally, differences in the composition of accepted and rejected groups reflect the importance of assessing motivation and character. Those individuals and parents who are less detached, more connected to the couple, the baby, and probably to their own children and partners, seem to be the ones favored by our selection criteria. The results may also suggest that, in general, parents are better suited to be surrogates than non-parents, in terms of significant traits, motivation, and more adaptive reactions to surrendering the child.
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. A very significant aspect of that image is that of being a mother and, by extension, enabling others to enjoy the pleasures of parenthood that they themselves have had. Because surrogacy involves an act of giving that is personally meaningful to the surrogate, and because what is being given is of unique value, being a surrogate mother has the potential to be a "mutative" event, an experience capable of altering and transforming identity, self-image, and existing psychic structure.
It is exactly the fact that these otherwise individuals, through their biological ability to bear children, feel that they can achieve some measure of greatness that would otherwise be beyond them, that makes being a surrogate so psychologically extraordinary. They feel this moment of greatness as a permanent possession. The memory of this action is a permanent psychological reserve against negative emotional states and events. The motives for becoming a surrogate mother cannot be glibly dismissed as mere "acting out".
In contrast to the stereotype of a heartless, misguided, impoverished woman primarily motivated by money, surrogates emerge here as average mothers, often trying to further the goals of their children and families.
Ethical Problems Surrounding Surrogate Motherhood
Surrogacy, umm. What comes to mind? I put the question to my class and their responses were; “like your godmother or foster mother”, “not your biological parent”, “to have someone have your baby for you” and “transplanting an egg and sperm inside you if you are having trouble having a baby”. Finally a surrogate mother is a woman who carries a child usually for an infertile couple. My student’s primary focuses are moral issues. The question may be asked, Is it wrong for a woman to loan her body out to someone for a fee? Why would a woman want to become a surrogate mother? What are the legal, moral, and religious issues involved in surrogacy? I find that their interest far surpasses their knowledge. They are molecules of vibrant energy bouncing around with many questions. It is my intent with the knowledge extrapolated from my seminar and the support of my professor that I will be able to answer all of their questions.
My unit will be taught in an eighth grade science class. I plan to address the moral issues of surrogate motherhood. The areas to be developed in this unit are:
1. What is surrogacy and the types of surrogacy
2. Who should or should not be a surrogate; is surrogacy for you
3. Religion, from a Christian’s point of view how surrogacy is perceived
4. Surrogacy and the Law
My class is highly opinionated. They were awestruck at the idea of a mother giving a child she gave birth to away. They totally ignored the idea of signing a contract. Morally they felt that surrogacy is “wrong”. I am not sure what made them so overtly irate. Was it my presentation or was it not being able to give them more information? Nevertheless, they left the door ajar indicating that they needed more time to think and talk the issue out.
Included in this unit are vocabulary list, resources, lesson plans, reading lists, and a bibliography.
INTRODUCTION
Ten to fifteen percent of married couples are unable to have children. Surrogate mothers are not a new solution to the old problem of not being able to reproduce an offspring. Surrogacy has been around a long time and dates back to biblical times. An interesting bible scenario is Sarah, the wife of Abraham. Sarah could not have children in the beginning. She gave her handmaid, Hagar, to her husband Abraham to produce them a child. The method used was copulation. The outcome in this arrangement did not prove to be a productive one and ended in disaster. In this scenario the spouse became jealous, the surrogate became proud and refused to give up the identity of the child and consequently the spouse had both her and her child ousted.
WHAT IS SURROGACY AND THE TYPES OF SURROGACY
A surrogate mother is a woman who carries a child, usually for an infertile couple. Making a decision to become a surrogate mother or hiring a surrogate requires a lot of planning, thought, and preparation. Becoming educated will help to alleviate some of the anxiety and disappointment that may result.
There are two types of surrogacy, traditional and gestational. The traditional type of surrogacy involves the surrogate mother being (AI) artificially inseminated with the sperm of the intended father or sperm from a donor when the sperm count is low. In either case the surrogate’s own egg will be used. Genetically the surrogate becomes the mother of the resulting child.
In case of a sperm donor, cryopreserved sperm may be used. This process involves placing the sperm in liquid nitrogen and storing in an insemination facility. The sperm is thawed just prior to being used. For a better pregnancy rate the sperm collection is usually placed into the uterus or fallopian tube rather than into the cervix.
How long a sperm can remain cryopreserved is uncertain, but success has been recorded over 16 years. Cryopreservation process includes:
- Collecting the sperm (masturbation)
- Chemical removal of water; this process prevents the formation of ice crystals
- A cryopreservant buffer for support and protection (glycerol)
- Actual freezing in liquid nitrogen 196(C, in plastic straws, glass ampules, or cryovials. These vials can be transported worldwide. The preserving of the sperm allows time for the results of the donors test to be gathered.
The intended father’s name is put on the birth certificate. The couple will have to consult a lawyer and the wife will have to do a “stepmother adoption” in order for both spouses’ names to be put on the birth certificate. Laws vary from state to state and a knowledgeable lawyer will make the transition easier.
Gestational Surrogacy
In order for a pregnancy to take place, a sperm, egg, and a uterus are necessary. In gestational surrogacy, the surrogate mother has no genetic ties to the offspring. Eggs and sperm are extracted from the donors and in vitro fertilized and implanted into uterus of the surrogate. This is an expensive procedure. Again, the unused embryos may be frozen for further use if the first transfer does not result in pregnancy.
An indicator that a surrogate is needed is medical disorders that affect the ovaries. These medical disorders include: damaged ovaries caused by endometriosis, destroyed ovaries caused by previous chemotherapy, menopause (egg production ceases), severe ovulatory disorders (polycystic ovaries), wife’s genetic disorders, or premature ovarian failure. In these scenarios, the surrogate donates both the egg and the uterus. The surrogate is artificially inseminated (AI) by placing the sperm of the husband into the uterus of the surrogate at the fertile time of the cycle, which is just prior to the egg reaching the uterus. If pregnancy does occur, in the third trimester of the pregnancy the couple may petition the court to have their names put on the birth certificate. Since laws do vary from state to state the couple may want to consult a lawyer. They will have a knowledgeable attorney negotiating in their behalf and a better chance of their wishes becoming a reality.
A contributing factor as to why the gestational surrogacy is the more expensive procedure is that centers have been known to give hormones to the egg donor causing them to hyperovulate hence, enhancing the uterus for conception. Indicators for a gestational carrier are evident when the uterus and fallopian tubes are unable to perform the designed function. Some of these disorders or abnormalities include:
- Hysterectomy ñ uterus and tubes absent
- Myomectomy ñ surgical removal of a noncancerous tumor from muscle
- Damage from infection or IUD (intra uterine device ñ a type of birth control
- Malformed uterus
- Pelvic adhesions causing distortion to bowel
Some physiological impediments that can be life threatening would also necessitate in considering a gestational carrier are:
- Cardiac disease
- Brittle diabetes
- Potentially dangerous drugs (drugs that can harm developing fetus)
- History of ectopic pregnancies
- Emotional factors
- Physical disabilities (weight gain causing stress on back and legs) Procedure For Becoming a Gestational Surrogate In order to become a surrogate the individual undergoes a series of tests prior to the planting of the egg, sperm, or both. Some of these tests include.
- Hysteroscopy/HCG, this procedure determines the fallopian tubes are clear and the size and shape of the uterus
- Infectious disease test, to ensure there are no contagious diseases present
- A mock cycle, to see how the uterine linings will react to hormone replacements (estrogen)
- Pap smear to check for a healthy uterus
- A physical, to see if there are any physiological impediments that would hinder the surrogate in carrying the baby
- Trial transfer, to check the length of uterus to find out how far to insert the catheter, which will be loaded with embryos
- Psychological testing, to check motivations, attitudes, and commitment
Once all of the testing is completed and out of the way, the surrogate and/or egg donor are both usually given a birth control pill to synchronize their cycles and then a subcutaneous injection of Lupron, a steroid, which will shut down the production of hormones to control the cycles. Hopefully this process will ensure that the surrogate’s uterus is ready to receive the embryo. Since the surrogate’s cycle is a week or more ahead of the Egg Donor it will make the uterus more ready to receive the fertilized eggs. Once the cycle starts the Lupron dose is decreased and estrogen replacement is added.
The egg donor starts on fertility hormones on day three to stimulate her ovaries to produce more eggs than the norm. A shot of HCG is given, which includes a (LH) lutinizing hormone surge causing the eggs to mature at a rapid pace. The drugs given to stimulate the ovaries produce more than enough eggs for a single implantation. After thirty-six hours have passed, the eggs are retrieved and fertilized with waiting sperm. The fertilized eggs are then incubated for 2-5 days. When the fertilized embryos have developed to their proper stage they are loaded into a special syringe with a flexible catheter and inserted through the cervix into the uterus. Usually 3 of the 2-day-old embryos are used and the others are frozen. After the transplant has been completed, a 3-day bed rest is usually required.
After a pregnancy has been confirmed an ultrasound is done. In 6 weeks a check is done for a heartbeat. After 12 weeks the surrogate is released to a regular OB/GYN. Regular check-ups are still needed to ensure that hormone levels are maintained. Once the placenta takes over the hormone replacement is discontinued.
WHO SHOULD BE A SURROGATE?
If ever a woman should decide to become a surrogate, a word of caution, do not go into this endeavor blindly. All of the ramifications should be taken into consideration.
What groups of people mostly consent to becoming a surrogate? Statistically, mostly educated women with 13 or more years of education. It was not primarily a money factor that led them to make the decision. Mostly these women are employed and are not undergoing financial difficulties. They are predominately Catholic or Protestants.
The women want the intending family to enjoy the special love of a child and the wholesome gratification of their own child(ren). The surrogate is empathetically driven to share what they have, and relieve some of the social stigma of not being able to produce a child.
Some stresses associated with being a surrogate are: insemination (over several months), pain, unpleasant side effects, depression, sleep disturbance, guilt difficulty remaining unattached, intrusive or aloof couples, relinquishing, etc. It takes a special person to become a surrogate. If you cannot adhere to the demands no matter how much a person may wish to help out, don’t think about it!!!
RELIGION
The command given to man was to be fruitful and multiply (Gen. 2:28). When looking at the role religion plays or has played in surrogate motherhood, we tend to look at the story of Abraham and Sarah. The moral and ethical issue surrounding the scenario was Sarah arranging for Abraham and Hagar to have them a child. It was the practice of her native country where there was no hope in bearing children for the spouse to give her maid to provide an heir for the family. This was one of the legal codes of Mesopotamia. Precisely the wife determined the rights of the offspring.
God did not condone the practice of surrogacy. Abraham was accused of following in the footsteps of Adam. They allowed their spouses to lead them astray instead of trusting and obeying. The outcome was suffering and disappointment. Scriptures also tells us that their imagined blessing proved to be a curse. Domestically there was a lot of tension, heartache, and hatred between the women.
The situation of the Egyptian maid could very well be mirrored today. Being a surrogate gave Hagar an elitist feeling and she became pompous and proud. Hagar would not consent to the plan to turn her child over to the mistress. Her question was, why should her child be passed off as the wife’s son? She had second thoughts and this still happens today. Biblically the very bitter dissension between the offspring’s of Sarah and Hagar is so intense until the repercussions are felt in the modern world today. Sarah’s descendants, the Jews, and Hagar’s descendants, the Arabs, are still contending for the possession of the Holy Land.
Considering all of the pain and heartache associated with surrogacy in the Bible the scenarios emphatically point out man choosing to be selfish. They made laws for self-aggrandizement. Some feel that the inability to conceive is a result of past sin and they are being punished.
It is the belief of many Christians that God has given man the freedom of choice. It is a common belief that the use of technology is a personal decision between a couple and God. Christians agree that a stable and supportive family benefits the child. This will limit the assisted reproductive technology to married couples only where one or both partners are unable to either produce eggs or sperm, or carry a pregnancy. This supports the principle that God is the moral Arbiter of the world who differentiates with absolute exactness, the moral from the immoral, and is also a loving and compassionate God.
In vitro fertilization can bring about the ethical issue of being able to pass on social and spiritual heritage to the offspring if the genetic make-mp cannot be passed. Another issue to be considered is the number of ova that are fertilized with in vitro fertilization. Discarding the unused embryos does not follow Biblical principles. The availability of cryo-preservation or freezing is available to bring about some relief of this problem. This procedure can allow the couple to have more children in the future. Biblically, life starts at conception and all stages of development are important. In using the current technologies including in vitro fertilization there are chances of multiple births. In the case of multiple fetuses, severe prematurity and nonñsurvival of babies may occur. A solution to this problem may be selective termination of embryos in utero. This can raise moral issues. Is it right to intentionally take the life of a fetus to spare one or others? Should the pregnancy continue and possibly risk the survival of all the babies?
Another issue that should be considered in sperm or egg donations are the feelings of surrogate. How does the husband or wife feel about a third party being involved in the conception of their child? Is their privacy being invoked? When, if ever, will the recipient parent tell the child about the manner of his or her conception? Technology is expensive and certainly in the manner in which the couple will use their finances, both of them should be in agreement. Christians believe that God has given them the responsibility of being stewards. Therefore, how and for what money is spent is very important. Man’s knowledge is a gift and a blessing when used in the proper manner.
Adventist Protestants believe that medical technology has enhanced human procreation through such procedures as in vitro fertilization, (AI) artificial insemination, cloning and yes, surrogacy embryo transfer. In seeking to do God’s will, these options have raised serious ethical questions.
Christians agree that being barren (childless) weighs heavily upon couples, as we saw in the Abraham and Sarah scenario. Many are sad because of infertility and turn to reproductive technology for assistance. The question they ponder is when should assistance be used or if it should be used at all. This becomes a mind-boggling issue.
Adventists believe that God is concerned with all dimensions of human life and his principles should be followed. God gives the power to procreate. This gift should be used to glorify God. It is believed that:
1. Procreation is God’s plan (Gen. 1:28); children are blessing from God, (Ps. 127:3, 113:9) medical technologies that aid infertility that does not venture from biblical principles are acceptable in good conscience.
2. All developmental stages of life should be respected (Gen. 1:5, Ps. 139:13-16)
3. The decision to use medical technology is a personal matter. There are acceptable reasons and forms of Christian service that may limit or refrain procreation (1 Cor. 7:32,33)
4. Due to cost, Christian stewardship is a relative factor (Prov. 3:9)
As Christians apply these principles to their decision-making they can be confident that the Holy Spirit will be there to assist them. Infertile couples should always keep the door ajar, so if necessary they can fall back on adoption as an alternative. I am aware however, that there are some that do not exactly follow these beliefs. They may choose other logic to arrive at their desired goals. I am not saying that this is wrong, only let your research and conscience be your guide.
THE SURROGATE AND THE LAW
It is advantageous to be well informed of your rights before deciding to become a surrogate. Therefore, seeking legal counsel is a necessity. The lawyer will assist the surrogate in defining her right, prior to signing any document. It is important for the surrogate to be knowledgeable of her rights as well as the rights of the infertile couple. Once the contract is agreed upon and signed, a lot of the surrogate’s privacy is done away with. The infertile mother is privileged to accompany the surrogate to her medical appointments and be present when certain examinations are conducted.
In case of a married surrogate the spouse is a necessary party and many states presume him to be the genetic father. If the spouse is not in full agreement a contested legal proceeding may ensue.
In the traditional scenario of an unmarried surrogate with a semi-permanent significant other, some states may allow him the rights of a common law husband and he is at liberty to contest the legal proceedings. In either case the surrogate’s spouse or significant other would have to agree to sexual abstinence during the duration of fertilization or embryo transfer. These men are also subject to infectious disease testing. Diseases could be problematic during pregnancy or delivery.
When it comes to compensation to the surrogate, this issue comes under close scrutiny. The surrogate is usually paid $10,000.00 for her services upon completion of her contract. If the contract is not fulfilled she gets nothing (if she backs out). If the pregnancy results in a miscarriage, the surrogate receives partial payment. If for any reason renumeration is out of order, it is looked upon as baby selling (reproductive prostitution, baby trade, selling body and parts, prostitution, renting uterus) by the pregnant woman. The law frowns upon baby selling and in many states it is classified as a felony and punishable by heavy fines and many years in prison.
In the adoption procedure the amount of money exchanged is disclosed along with purposes it is intended to be used for. In an informal adoption procedure the amount that is allowed are restricted to the reimbursement of medical fees, cost of living and legal fees. Adoption agencies are flexible in allowing reimbursement expenses. Wages lost due to illness may not be allowed. All compensation issues must be reported.
Some issues arising out of gestational compensation are:
- The pregnancy was deliberate and consciously arranged (after being advised by lawyer)
- Legal matters were agreed upon by all parties (as advised by lawyer)
- Surrogate has no genetic ties
In the state where the child is to be born (if the surrogate just happens to be passing through) has a sufficient connection and has to issue the birth certificate. It is also a legal matter as to whose names are listed on the birth certificate.
It is a requirement of some states that a contract be drawn up among the parties involved in birthing arrangement. All points in the contract should be carefully and fully explored. Parties that should be present are:
- The surrogate (spouse/significant other)
- The infertile couple
- Legal counsel
In order to avoid disputes, most infertility clinics require a contract. Legal counsel is recommended in order that all involved, to ensure that local laws are kept in compliance.
A possible checklist for the surrogate and the intending couple to explore with their attorneys are:
a) The infertile couple (intrusting their child’s care and nurturing to another and surrendering of child)
b) Surrogate (forfeit her privacy) i.e. Roe vs. Wade issue…the U.S. Supreme Court Fundamental Rights of Privacy. The issue includes a woman’s ability to control her reproductive freedom hence her pregnancy
c) Surrogate’s spouse or significant other must agree to sexual abstinence at certain times; must submit to medical examination
d) Infertility physician ñ if insurance is not assessable the infertile couple will assume all costs
e) Psychiatrist/Psychologist/Counselor ñ assists in surrendering the child to the infertile couple and counseling
f) Birthing hospital ñ provide birth certificate information
g) If a contract is not required, they are certainly essential to protect all parties involved in keeping their transactions legal
The surrogate must at no time place the fetus at risk. Behaviors that may lead to inappropriate risk are: taking non-prescription drugs, contraband drug usage, smoking of any type (a word of caution is also to avoid the company of smokers), and alcohol consumption.
It is left up to the laws of a particular state to determine the mother or father of the child prior to birth. All parties must agree to provide affidavits, a court appearance, and testimony to effectuate the designated mother and father of the unborn fetus. The courts will honor contracts and agreements between surrogate and intending parents, unless circumstances significantly change that will jeopardize the best interest of the child. The gestational bond is not an issue. The question is asked, how much bonding actually takes place? The decision is always for the best interest of the child. This may not always be the most applauded solution; nevertheless it is what it always boils down to.
Frozen embryos are costly and should be addressed in the last will and testament of infertile couple. Methods of disposal can be controversial and should be addressed. The methods commonly used are: donate to unknown couple (separate consent is preferred and the parties may wish to screen each other), disposal (thawed embryos degenerate and cease to grow), and tissue donation for medical research. The later is truly an ethical issue that should be explored. The rights to life activists are very vocal on this ethical issue regarding “pre-embryo” embryo. The board of trustees of the American Medical Association (AMA) recommends that the gamete providers (sperm and egg) be the primary authority over the frozen embryos.
CONCLUSION
There are three types of mothers, the genetic mother (provides the egg and ½ of the genetic code ñ 23 chromosomes), the gestational mother (she carries the fetus inside her body), and the social mother (contributor to the raising and care of the child). Each is important for the well-being and development of the child.
Surrogacy is not a simple arrangement; it is extremely complex. The relationships can be stressful, overwhelming, and intense. Patience and perseverance are a must.
Both the surrogate and the infertile couple should obtain legal counsel before agreeing to and signing a contract. It is in their best interest to know how the law addresses certain aspects of surrogacy as it pertains to their particular interest.
Disclosure of the surrogate relationship should be limited so as to avoid unwarranted scrutiny.
Many ethical issues have risen out of this unit. The students are highly opinionated. You can be the judge after analyzing some of the facts. I strongly recommend resource intervention; i.e.: body shop, lawyer, psychologist, social work, etc.
ETHICAL ISSUES
What are the pros and cons of using unused embryos for medical research?
Is there anything wrong with disposal of unused embryos …leaving them on the counter to unthaw and degenerate?
What if the surrogate decides to maintain her privacy?
What if the surrogate and the spouse violate the abstention clause?
What if the surrogate decides to keep the baby?
What if the surrogate with genetic ties demands to visit her child?
Is there anything wrong with a surrogate giving her unused embryos to someone else?
Who should make a decision to unthaw frozen embryos?
Is handing over a child after delivery for a fee “baby-selling”?
Do women participate in surrogacy to save their marriage?
Is it wrong for a surrogate to abort?
VOCABULARY
surrogate
traditional surrogate
gestational surrogate
infertile
significant other
in vitro fertilization
fertilization
compensation
felony
fetus
procreate
abstinence
AI ñ artificial insemination
cryoperservation
Fallopian tube
uterus
menopause
endometriosis
ovary
chemotherapy
implanted
hysterectomy
myomectomy
pelvic adhesion
ectopic pregnancy
|
