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Ethics surrogacy


Surrogacy literally means substitute or 'taking the place of someone else'. In the case of a surrogate mother, she carries a foetus and bears a child on behalf of another person or couple, having agreed to surrender that child to them at birth or shortly afterwards. The act of one woman bearing a child for another is almost as old as child birth itself, and it was even mentioned in the bible. However in the 1980s surrogacy became one of the most controversial forms of baby making. Technically it is very simple, but far more complicated legally and ethically (Downie, 1988). Before the contraceptive pill, abortion and single mothers were accepted; unwanted pregnancies solved the childlessness for many infertile couples.

There are two different types or surrogacy, the first, straight surrogacy, is where a surrogate mother has a child for a couple, where the husband of the couple is the genetic father of the child and the surrogate the genetic mother. The second is Host Mothering; this is where a surrogate carries the genetic child of someone else. This could be both the husband and wife of the couple, alternatively, one or both of the genetic parents could be an anonymous sperm or egg donor. This method is usually through IVF (in-vitro fertilisation). IVF means fertilization outside the body in a test tube. Since the birth of Louise Brown, the first test-tube baby, born in 1978, IVF has resulted in over one million babies worldwide. GIFT (gamete intra-fallopian transfer technique), is also sometimes used in surrogacy cases. GIFT is a procedure in which the eggs are mixed with sperm and the mixture is then injected into the Fallopian tube. The aim of GIFT is to allow fertilization to occur in the right place and implantation at the right time. These methods require medical intervention (Baniassad, 2005).

The inability of couples to have their own children can be a cause of great disappointment, suffering and frustration. It can leave the couple with a feeling of failure and inadequacy. Infertility problems can occur in both men and women and there can be many factors that can affect the chances of becoming pregnant. In approximately 30% of infertile couples, the cause is identified only in the female and in 30% the cause is identified only in the male. In a further 30% of couples, causes can be detected in both partners. In about 10% of cases, the underlying cause is not yet found by the current diagnostic methods. By medical definitions around one in six couples have problems with infertility. Around 1% of couples in the UK rely on IVF procedures. These procedures cost between £2000 and £4000 per cycle and drugs can cost an additional £1000. If IVF is unsuccessful surrogacy is sometimes considered by couples (Goldman, 2005).

Another factor that fuels the need for surrogacy is the unavailability of babies for adoption. Adoption numbers fell from 21,299 in 1975 to 6,533 in 1990. This at least partly reflects the rise in abortions in the same period from 139,702 to 186,912 (Williams 2003). The increasing acceptance of single parent families and unmarried mothers has also played a part in the decrease of babies available for adoption (Downie, 1988).

Dame Mary Warnock chaired The Warnock Report on Human Fertilisation and Embryology; the 15-member committee examined the social, ethical, and legal implications of developments in assisted reproduction. The Warnock committee received many submissions supporting and opposing surrogacy.

Regulation of surrogacy was urgent around the time of the Warnock committee because profit making agencies were just starting in Britain. Warnock’s recommendation was to bring in legislation to make it a criminal offence to set up or operate surrogate agencies. Individuals who were going to enter into private surrogacy arrangements would not be liable to criminal prosecution. This legislation was passed as the Surrogacy Arrangements Act in 1985 (Baniassad, 2005).

The Human Fertilisation and Embryology Act 1990 is the act of parliament that covers all artificial reproduction, including surrogacy. As outlined in the Surrogacy Act of 1985 surrogacy is not prohibited in the United Kingdom, however, it is illegal to advertise the services as a potential surrogate mother and it is also illegal to advertise for a surrogate other to come forward. Therefore the arrangement is usually made by word of mouth. The surrogate mother cannot profit in anyway, but she can charge for her expenses, such as loss of earnings, maternity clothes and medical expenses (Donnellan, 2000).

Most people who consider surrogacy do so as a last resort, usually out of sheer desperation after being unsuccessful with all other infertility treatments available to them. Deciding on surrogacy is a long, hazardous and psychologically demanding route to becoming a parent (Furse, 2001).

Although the defining characteristics of surrogacy are simple, there is a combination of possible ways in which the baby can be conceived. The following chart shows different ways in which a baby can be conceived as a result of surrogacy.




Surrogate mother

Commissioning father

Artificial insemination

Surrogate mother

Commissioning father

Sexual intercourse

Surrogate mother

Anonymous donor

Artificial insemination

Commissioning mother

Commissioning father

Placed in surrogate

Commissioning mother

Anonymous donor

Placed in surrogate

Anonymous donor

Commissioning father

Placed in surrogate

Anonymous donor

Anonymous donor

Placed in surrogate

(Donnellan, 2000)

The surrogacy debate raises important ethical issues for example, if the baby is born as a result of donors, the mother, father or both, the child will have no knowledge of them at all. If the donor parents have donated their eggs/sperm many times it could be that the child has many unknown genetic siblings, this could have catastrophic consequences in later life if two genetically related people enter into a sexual relationship and go on to have children. There is also the risk that children who are born as a result of donor parents will not know if they are in danger of developing any genetic illnesses. For example a person might donate their eggs/sperm for use in infertility treatments and they may not find out until much later that they have an illness like Huntington’s disease. Because of the nature of the illness by the time they have discovered they have the disease their eggs/sperm may have been used many times to produce offspring for others (Fitzpatrick, 2005).

Regardless of whether the surrogate mother is the biological mother or not, in law she is still seen as the mother of the child and once the child is born the commissioning parents have to go through strict lengthy adoption procedures. The surrogate mother has the legal right to change her mind at any time and keep the baby herself. The commissioning parents might also change their minds during the pregnancy, there is also the risk that the commissioning parents might refuse to have the child if it has any disability or abnormality (Donnellan, 2000).

There are many social and emotional implications of surrogacy, they can be very complex and many people can be affected; A surrogate mother must be sure of her own motivation and her own strength as the reality of child birth and the separation from the baby may be both physically and emotionally demanding, making her unwilling to hand over the baby. The strong emotions after birth make it hard for the surrogate to part with the child regardless of how businesslike the actual conception and pregnancy has been. Even if the baby is not genetically hers and the pregnancy is achieved by IVF the surrogate’s body has to be artificially prepared to carry the pregnancy. Whilst the surrogate mother may avoid bonding with the baby, this might happen naturally and unexpectedly after the birth. Knowing this the commissioning mother might have feelings of resentment or jealousy towards the surrogate mother and the baby. The fact that her husband has had a baby with another woman may be hard to overcome and could cause resentment within the relationship (Baniassad, 2005). The impact of surrogacy may go even further, for example grandparents, aunts and uncles might worry that they will treat the baby differently from other children within the family if they are not their blood relatives.

The commissioning father, if he is the genetic father, may develop physical, psychological and emotional feelings towards the woman carrying his baby, on the other hand if his partner is the biological mother and the father is a donor, he might develop a feeling of jealousy and resentment.

The surrogate mother’s family must also be considered, she may have children already and the impact of seeing their mother pregnant and not having a baby at the end could be confusing and upsetting for them. The surrogates husband or partner may have negative feelings about the pregnancy and the effect it may have on the family life. (Shannon,1998)

Most importantly, there are, of course, also concerns for the child; some of the commissioning parents might deceive him or her about their origins. If the child is not told of their origins they will inevitably find out sooner or later leaving them feeling hurt and psychologically damaged. Even if the parents are open with the child they might still be left with feeling of not knowing to whom they belong, because it is possible that the child could in fact have five parents; the surrogate mother, the commissioning couple and the egg and sperm donors. If they are the product of two donors they will never know their real origins. This of could leave the child very confused. As they grow older they might see themselves as a product that has been manufactured to satisfy an adult need. They might feel that they were sold and their surrogate mother only had them for financial gains. On the other hand if the commissioning parents are open and the situation is explained to the child from an early age, this could make the child feel a special and wanted planned edition to the family knowing that their parents and surrogate mother went to such lengths to bring them into the world. (Downie, 1988)

It has been suggested that such children may feel a certain amount of anxiety about being ‘different’ from their friends. They may sometimes feel pressure to live up to the expectations of their parents who went to great lengths to have them. However, these concerns do not appear to reflect the reality for children from other ‘different’ families such as those resulting from infertility treatments or adoption. More positively it has been suggested that children conceived as a result of surrogacy arrangements may in fact, be proud of their parents and the surrogate mother for their existence. (Johnson, 1990)

The connotations of surrogacy could, in theory, go on for years, as there could be claims of paternity or maternity rights along with custody and access demands and maintenance and financial issues (Anon, 2000). There could be problems with inheritance claims; where by the child born as a result of surrogacy could challenge the last will and testament of their biological parent, depriving her ‘own’ children of part of their inheritance.

Surrogacy is sometimes criticised because it is alleged that it undermines the family, but families in Britain are varied anyway and the traditional nuclear family consisting of a working father, a mother who is a housewife and children, makes up less than 15% of all households.

If everything goes to plan and the surrogate mother delivers the baby and hands it over, either at the birth or shortly afterwards, the commissioning parents then have to embark on a journey to become the legal parents of the child. They have to get a parental order, which is obtainable by application to the courts. This makes the commissioning parents the child’s legal parents; this has the same effect as adoption (Shannon, 1998).

Some surrogate mothers others have nothing more to do with the child once they have been handed over to the commissioning couple. Others stay in contact with the child; this is especially the case when it is a close friend or family member who has carried the child as a selfless act of assisting the couple with their childlessness (Downie, 1988).

Surrogacy is generally only entered into after great consideration and usually as a last resort for childless couples, generally after all other treatments have been attempted. The number of babies born as a result of Surrogacy is relatively low as it still remains a comparatively rare form of infertility treatment. There is a very limited amount of research available into the effects upon the children, the surrogate mother and the commissioning parents. The cases highlighted in the press are usually negative, but this only concerns a small percentage of the babies born as a result of surrogacy. It would seem that the majority of people who are involved in surrogacy agreements benefit, the commissioning parents get a much wanted and cherished baby and the surrogate mother, and possibly her family, benefit emotionally.



Anon (2000) Surrogacy : The Issues <> (Accessed 26th April 2005. 20:15)

Baniassad, E (2005) Surrogacy < /> (Accessed 3rd April 2005)

Donnellan, C (1997) Surrogacy & IVF Cambidge, Independent

Downie, S (1988) Baby Making: The Technology and Ethics London, The Eldon Press

Fitzpatrick, M (2005) Surrogacy: NHS and Ethics Lecture Sutton Coldfield College (March 2005)

Goldman, K.E (2005) Infertility < > (Accessed 3rd May 2005, 14:45)

Johnson, A.G (1990) Pathways in Medical Ethics, London, Hodder & Stoughton

Shannon, T.A (1988) Surrogate Motherhood: The Ethics of Using Human Beings New York, The Crossroad Publishing Company

Williams, J (2003) (Accessed 20th April, 18:20)

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