What's Wrong With Surrogacy?

Charles J. Dougherty
Center for Health Policy and Ethics

In its purest form, a surrogate mother has no genetic link to the child she bears. An embryo that is the genetic offspring of another couple is implanted in her uterus. The surrogate is a mother only biologically and only for nine months; she gives the child to its genetic parents at birth.

When all goes as planned, a healthy and very much wanted child is born and the three adults involved all get what they contracted for. But is surrogacy ethically acceptable? No was the unanimous view of eight scholars at a recent conference on the issue at Creighton University. They offered a variety of reasons against surrogacy, not all of them equally convincing.

1. Traditional Family-Linked Concerns

Several of the religious traditions represented at the conference have family-linked problems with surrogacy, problems that many outside these traditions will not find compelling. There is the possibility that surrogacy may be a form of adultery. Though there are no sexual relations, there plainly is a reproductive relation with a third party outside of marriage. Surrogacy might also lead to incest of a sort. The child might marry another offspring of the surrogate mother, a child she only gave birth to or a genetic descendent. While there would be no genetic relationship, the marriage partners would be siblings, after a fashion. Finally, inheritance questions could become confounded. Does the child have any right to inherit from a birth mother or not? Finally, some suggested that such interference with a natural process is a violation of God's will, a view that requires powerful assumptions about the relationship between God's will and reproduction. Is it God's will, for example, that an infertile couple not have a genetically-related child even when means to do so are available; or God's will that new reproductive technologies be developed and used?

2. Effects on our Self-Respect as Persons

Another line of argumentation is harder to evaluate. The use of surrogacy, especially the wide use, might lead to a cheapening of our idea of what it is to be a person, to a decline in self-respect. It might cause future generations, for example, to think of the human embryo or fetus as interchangeable parts, reproduction as a mechanical process, wombs as organs for rent, etc. The implication is that thinking of ourselves in this fashion would bring serious negative consequences, a slippery slope concern that is difficult to assess. Surrogacy will probably always represent only a small percentage of births since the more usual method has substantial attractions of its own. If so, surrogacy may have little impact on our self-image, little compared, for example, to the daily assault on respect for persons on television and in the movies.

3. Effects on the Child

Several presenters speculated that surrogacy will create harmful effects on the child. When he or she discovers that gestation and birth involved another mother, the child may be affected by feelings of being different or of having been deceived. This is certainly a possibility to guard against, but it is not substantially different from the challenges facing families that have adopted children--challenges that are routinely met with compassion and success.

4. Untoward Motives

Some of the visiting scholars raised questions about the moral acceptability of the motives of the couples who would seek a surrogate solution. Why shouldn't infertile couples turn to adoption as the solution? Only because they desire a genetically-related son or daughter--and isn't this a morally defective desire? Isn't it self-indulgent to demand a "copy" of oneself and one's partner when so many other children stand in need of loving homes? The trouble with this objection is' that it proves too much. The sort of "self-indulgence" decried here is plainly a most natural desire, accounting in large part for much of human generation. And there is no reason why the infertile should have a special duty to adopt needy children; those with their "own" could also adopt others. But surrogacy certainly does suggest a morally defective motive if it is done for the economic convenience or comfort of the couple rather than as a desperate measure around infertility.

5. Effects on the Surrogate

By far the most persuasive set of arguments against surrogacy involved potentially negative effects on the women who may be motivated to become surrogates for money. There is an obvious possibility for exploitation of poor women who may sell wombs-for-hire. Though it might be argued that adult women should have the right to make such choices for themselves, some choices are so potentially harmful or so inherently degrading that they should not be permitted, at least not as a matter of commerce. Consider the difference in moral complexion between these two cases of surrogacy: a career surrogate contracting for her services as a job versus an unpaid relative or friend motivated by affection for an infertile couple. The first case is objectionable; the second is tolerable, even laudable. This is society's general stance on prostitution versus promiscuity, the marketing of human organs versus donating them as gifts, and the buying and selling of children versus the renunciation of parental rights and adoption. The first activity of each pair is demeaning in itself and can lead to multiple negative consequences because of its commercial motivation. This is also the case with surrogacy.

Money at the Root

There are thus plenty of reasons to be suspicious of surrogate motherhood but the most convincing have to do with the motives of the couple and the effect on the surrogate. Both are connected to problems raised by commercialization of the relationship. It is unseemly to want to buy out of a pregnancy and delivery that is otherwise possible and demeaning to sell one's body to serve such a desire. The potential for abuses by both buyer and seller are serious and far-reaching.

If money lies at the heart of the ethical issue, then Professor Field of Harvard may have offered the best practical advice of the day. She recommended that surrogacy contracts not be made illegal. Instead make them legally unenforceable, allowing the birth mother to change her mind at any time and decide to keep the child. Such a public policy avoids the obvious difficulties of policing a prohibition but will certainly undermine development of a market for surrogate mothers.