Rfra_Bioethical_principle

Running Head: SURROGACY IN THE UNITED STATES 1
Surrogacy in the United States
Rebekah Frazier
GNRS 504
Azusa Pacific University

SURROGACY IN THE UNITED STATES 2
Introduction
Issue & Dimensions
Infertility is a disorder that can make family planning an extremely difficult and
discouraging process. It can be devastating to realize that a woman or man cannot conceive a
child, or maintain a viable pregnancy. Eighty-five percent of the population will become
pregnant in one year without the use of birth control methods, according to the Center for Young
Women’s Health (2015). Needless to say, if 85 percent of the population can become pregnant in
one year without using contraception, it should not be difficult to conceive. However, according
to the Centers for Disease Control and Prevention (2016), infertility affects 12 percent of women
ages 15-44, and 7.5 men younger than age 45. According to the CDC (2016):
After one year of having unprotected sex, about 15 percent of couples are unable to get
pregnant. About a third of the time, infertility can be traced to the woman. In another
third of cases, it is because of the man (CDC Infertility FAQ’s).
With the only criteria for infertility being one year of unsuccessful attempts at implantation using
no protection, it can be easy for couples to struggle with infertility. This high rate shows an
increasing need for different options for family planning, like surrogacy. The purpose of this
paper is to discuss the different issues associated with surrogacy, and provide solutions for
improvement.
There are different types of surrogacy, with one type being altruistic surrogacy, in which
the surrogate mother is only reimbursed for her expenses related to the pregnancy and birth of
the child; her service and is not a financial arrangement (Bromfield & Rotabi, 2014). Another
type of surrogacy is commercial surrogacy, where the surrogate mother receives compensation

for carrying the child (Advanced Fertility Center of Chicago, 2016). When a pregnancy comes
from an embryo that was implanted in a surrogate mother through In-Vitro Fertilization (IVF),
and is not genetically related to the surrogate mother, that is called gestational surrogacy
(Advanced Fertility Center of Chicago, 2016). Additionally, traditional surrogacy, in which the
surrogate mother is impregnated naturally or IVF, with the father’s sperm and the surrogate is
genetically related to the child (Advanced Fertility Center of Chicago, 2016). The last type of
surrogacy is global surrogacy, in which parents engage into a commercial surrogacy arrangement
across international borders, and are almost always gestational in nature (Bromfield & Rotabi
2014).
One of the first and most famous cases, involving surrogacy in the United States (U.S.),
is the case of Baby M. A couple by the name of The Sterns entered into a surrogacy agreement
with a woman named Mrs. Whitehead and would pay her $10,000 when the child was born.
However, in 1986, when the baby was born, Mrs. Whitehead refused to give up custody of the
child because she had bonded with her and threatened to kill herself if she was forced to give the
baby to the Sterns. Mrs. Whitehead even fled the state to avoid giving the child to the Sterns.
Ethical Theory & Principles
One of the ethical theories and principles that is related to surrogacy is autonomy, which
is respecting someone’s independent health decision(s). This principle relates to surrogacy
because based on this principle, a woman should be able to do what she wants to her body,
including deciding to have a baby, not keeping it, and giving it to a family in need. This raises
the question, “If surrogacy is outlawed in certain states, are the individual rights of women
diminished in those states?” On the other hand, that same autonomy of the surrogate mother is
also challenged when it is time to give the baby she delivered over to the commissioning parents

because it is still her health decision to give up the baby. This is especially true if the mother
forms an attachment or bond with the baby and no longer wants to get rid of the child. This
proposes the questions, “Is it ethical to make a woman give up a baby she carried for nine
months?” and, “Is it ethical for a surrogate to be inseminated or impregnated with an embryo,
knowing it is for someone else, then decide to keep the baby?”
Fidelity is another principle that questions the ethics of surrogacy because of issues that
arise once the baby is finally born. In the case of Baby M, the surrogate mother decided to forfeit
the $10,000 paid to her to carry another couple’s child so that she could keep the baby. The court
decided that the surrogate mother had rights to see her child because it was a traditional
surrogacy and gave custody to both parties, the hopeful couple and the surrogate mother.
Subsequently, the genetic link between the surrogate and the child led to an increase in desire for
gestational surrogacy. This issue has still occurred even after this court case and proposes the
bioethical dilemma question, “In the cases of surrogacy, who is the true parent of the unborn
child?” Furthermore, questions regarding the surrogate mother’s role after the child is born,
especially if the surrogacy is a traditional surrogacy in which the surrogate is related to the child.
Is it ethical to move on and not let the child know the woman who brought it into this world?
The third bioethical principle involved in surrogacy is the principle of beneficence, which
is the desire to do good. The cases of altruistic surrogacy are the best definition of beneficence
because the purpose is to provide a baby to longing parents, with a minimal cost to them.
Considering the dramatic changes that pregnant women undergo, and that surrogacy is largely
commercialized, altruistic surrogacy is a very generous act. However, to some extent, surrogacy
in general has evidence of beneficence because someone is offering their body as a tool to
provide happiness for others, even if they are paid to do so.

The last bioethical principle involved in the topic of surrogacy is nonmaleficence, which
is to do no harm. This principle relates to surrogacy because of IVF. In-vitro fertilization is
usually attempted multiple times because of the desire to successfully create a pregnancy.
According to the Society for Assisted Reproductive Technology (SART) (2016), the chances of
fertilization vary by age and number of babies desired, with the chances lowering as the age and
number of babies increases. For those that believe that conception begins at fertilization, this can
pose a problem of doing harm to the fetus or embryo that was created for the IVF and terminated
or failed. Some might ask if this counts as a waste or as murder, to create a life to have it be
unsuccessful.
Policy
The policies that govern and regulate surrogacy in the U.S. vary across the fifty states.
For example, according to The Center for Bioethics and Culture Network (CBC) (2012),
Colorado, Florida, California, and Iowa are favorable toward surrogacy. Between those states,
some are more favorable toward gestational as opposed to traditional. The CBC (2012) stated
that Delaware, Indiana, and Michigan are unfavorable toward surrogacy. Virginia, Washington,
Pennsylvania, Oregon, and New Mexico are favorable toward surrogacy if it is not compensated
(CBC, 2012). Between those states, some are only favorable toward gestational or traditional,
and only if there is a medical need for it. States like Georgia, Hawaii, Maine, Missouri, Montana,
and West Virginia have no court cases on which to base laws on, so surrogacy is riskier in those
states (CBC, 2012). A surrogate can give birth in those states, and the paternity will be
ambiguous, which will require those in the surrogacy agreement to go to court to decide who the
legal parents of the child are.

There are no current policies that regulate surrogacy clinics well, or require them to post
certain statistics for public records. Additionally, there are not many legislative stances on
children’s rights and best interests, when considering the child’s role in surrogacy arrangements.
One clear issue with the current surrogacy legislature is that there is no standardized legislature
that applies to all states, each set of laws vary by state and complexity of each case presented.
The implications of this include people traveling to certain states to carry and deliver babies
there so that there are no paternity issues.
Ethical & Cultural Dynamics
Opponents
There are many public opinions related to the topic of surrogacy and its ethical
foundations. One opponent argument is that surrogacy turns living beings into objects that can be
bought or sold. The implication of this would be that the quality or value of life is reduced in
these unborn children. Also, opponents have proposed that people should adopt instead of
populating the planet with more children; rather, homes should be given to those already in need.
Another surrogate-opponent argument is that when surrogate mothers forfeit the child they
deliver to the parents who paid her, the surrogate does not fulfill her responsibilities as a mother
to that child. As a result, this argument states that the surrogate mother would not be providing
the child with the nourishing environment that it deserves.
Another argument against surrogacy claims that surrogacy straddles the line of
prostitution, “Some see surrogacy as a subtler form of prostitution; the woman in effect sells her
womb and relinquishes control of her body,” (Damelio & Sorensen, 2008, p. 270). For other
opponents of surrogacy, the belief is that surrogacy is a form of exploitation. Crozier (2014)
provides a definition of exploitation, “Exploitation occurs in a transaction when one party…

takes advantage of another party’s vulnerability to negotiate … a more favorable outcome for
themselves … than would otherwise be possible” (p. 38). According to the definition of
exploitation, Kirby (2014) believes that surrogacy occurring in low income women is
exploitative, in that women do not have the autonomy to set rules in the contracts. Damelio and
Sorensen (2008), echo this thought when they discuss exploitation and coercion because of the
compensation that is received by surrogates, “So even in straightforward cases of coercion, the
target can be left with other choices, but they are severely unappealing,” (p. 5).
Proponents
The response to those who believe surrogacy turns humans into commodities, is that
parents do no pay to “own” children, like someone would own a cheeseburger purchased at a fast
food chain. Hanna (2010), stated, “Provided that a woman’s reproductive labor would ordinarily
give her parental rights, the commissioning couple acquires parental rights by paying for rights
to the woman’s labor, not by paying for rights over a child,” (p. 5). This states that in the same
way a nurse is paid for her labor of helping patients, a surrogate is paid for her labor of
childbirth, and because of the payment for labor, the child is subsequently inherited with it. This
is not the same as merely paying for a child, as Hanna (2012) reiterates, “… rights over the
products go to the person who has rights or proprietary claims over the labor, not the person who
performs the labor,” (p. 5). As a result, commissioning parents are paying for a service.
A defense for the claim that surrogate mothers do not meet their maternal responsibilities
for the child, is that if parental rights are relinquished when the surrogate makes a surrogacy
contract with parents, the responsibility is now that of the commissioning parents. Additionally,
responses to the argument of prostitution state that, “… people are allowed to sell their bodies in
a broad variety of other ways … In the USA, people can sell eggs, sperm, plasma or hair; and

they can accept jobs that are known to compromise their physical health,” (Damelio and
Sorensen, 2008, p. 2). This shows that even surrogacy might involve selling one’s body, there are
other ways that people “sell” their bodies, that have no stigma attached to it. For instance, house
maids put their bodies through strenuous activity in order to complete their jobs. Based on this
argument, should they not be able to clean houses for money?
Other proponent arguments of surrogacy include that adoption is a long process and
therefore an unfavorable option to those seeking children in a quicker timeframe. After all, who
has the right to dictate how long people should be forced to wait until they can be called parents?
Another argument for surrogacy uses the principle of autonomy, in that a woman should be able
to make her own health decisions, like have an abortion or have a child for somebody that cannot
bear children. Surrogacy being banned can be considered an infringement on human rights,
specifically the autonomy of women in their own health care decisions. Additional proponents
include that the pay rate to become a surrogate is initiative enough to try surrogacy. Also, some
women feel joy when they are able to bring a child to families who are unable to make their own.
Personal Opinion
On the premise of human rights, I believe that women should be able to engage in
surrogate agreements because they provide hope for families that are unable to conceive children
of their own. Furthermore, I believe that decisions about a woman’s body or a woman’s health
care concerns should be hers and hers alone to make. I believe that the gift of motherhood is very
precious, and if some are unable to naturally create it, distress and unhappiness can ensue. As a
future nurse, I also believe that it is important to keep an open mind about different health
decisions. For instance, sexual reassignment surgeries, abortions, or genetic engineering are also
topics I may deal with in my future as a nurse, and it is important for me to provide care for those

patients in the same way as any other patients. I believe that other people’s health decisions are
not my business, and until the health topic becomes harmful to the patient and those around
them, I will no longer support it.
Nursing Profession and Recommendations
Nursing attitudes toward surrogacy seemed very nonjudgmental toward the topic of
surrogacy. Church and Ekberg (2013), interviewed nursing students on their opinions of
surrogacy and found that, “… all students recognized the issue of women’s choice in relation to
childbearing, and considered the use of ART to support the individual’s right to reproductive
autonomy,” (p. 6). Other studies predominantly indicated that nursing attitudes toward surrogacy
involved greater regulation of practice and further research.
These nursing attitudes arise from increasing interactions in the hospital setting. Nurses
can interact with these parties to take the surrogate mother’s vital signs, to help admit her when
she is in labor, to take care of her after the baby is born, or many other ways. The encounters that
the nursing field has with surrogacy, calls for changes in surrogacy legislature, in order to elicit
positive outcomes for all involved. Schafer (2014) explains the need for improvement of
surrogacy legislature, “Optimal outcomes will occur only through clear policy development,
coordinated multidisciplinary efforts, and fair equitable care with a focus on meeting physical
and psychosocial needs for all involved,” (94).
Another nursing attitude toward surrogacy was the idea of personal beliefs. In order to
provide the best care to any patient or parties involved in the surrogacy, it is important to
consider personal views prior to job selection. Church and Ekberg (2013) emphasize this further,
“It is important to consider that the discussion of ethical issues can arouse feelings based on
personal experiences which may at times conflict with professional attitudes,” (p. 7). For

instance, if a nurse is not okay with abortion or surrogacy, it is important that the nurse consider
whether she should accept a labor and delivery unit job offer because her personal views might
hinder her ability to provide care.
Nurses also suggested that the amount of regulation that surrogacy clinics are subjected
to, or a lack thereof, needs further attention. Bromfield and Rotabi (2014), stated that, “…
surrogacy clinics and living conditions of surrogates must be monitored in a manner that is
consistent with accreditation of medical facilities,” (p. 133). If surrogacy clinics were to be
regulated more, it would hold each party accountable for their actions if errors occur in the
process. For example, if a surrogate mother bonded and wanted to keep the baby, the law would
make sure the commissioning parents would get the baby. In contrast, if the baby were born with
defects, the regulations would make sure that surrogate parents did not forfeit the baby to the
surrogate mother because they did not want the responsibility. An additional regulation that
needs to be monitored better is the transactions that occur in surrogacy arrangements. According
to Bromfield and Rotabi (2014), “… the compensation for surrogates, must be managed in a
manner that is both transparent, as well as safeguarded, including how financial incentives are
used in the consent process.,” (p. 132). This would ensure that surrogates are not pressured or
coerced into making surrogacy arrangements based on financial exploitation. This would also
help prevent fraud toward the parents, institutions, and surrogates.
Additional considerations involved the health care that is provided to the surrogates
should cover any health care bills that are acquired because of the pregnancy, including delivery
and the time period after. Subsequently, in the same way that the surrogate should receive
adequate coverage, the well-being of the child should also be considered further. Therefore, more
research needs to be done on the long-term effects surrogacy has on the mental well-being of the

child. Many opponents of surrogacy have made claims according to the “best interests of the
child,” yet fail to expand on what normal best interests of children are.
In order to improve research on surrogacy, the Centers for Disease Control and Prevention
(CDC) need to collect more information from assistive reproductive technology (ART) clinics,
“… the CDC collects information by IVF cycle, rather than individual patient, making it difficult
to estimate the number of individuals who participate in ART,” (Gugucheva, 2010, p. 7). This
type of information, including number of surrogate births, number of surrogacy clinics, or
number of surrogate members to clinics, is necessary to understand the full capacity that
surrogacy operates and the influence it has.
Conclusion
Surrogacy is an appeasing alternative for those who cannot conceive naturally, however it
is an extremely controversial subject. Different quarrels with surrogacy involve human rights,
human commodification, parental rights, and many other facets. With varying and non-
standardized legislature across the country, there are many states that have no stance on
surrogacy at all. In order to further develop the opinions or legislature that governs surrogacy
practices, more inquiries and research needs to occur regarding the implications surrogacy has on
society and the the parties involved in surrogate contracts. Further research also needs to be done
so that laws can even be established or debates started in certain states that lack in legislature
regarding this topic. Surrogacy can be a blessing, when both parties involved have adequate
support so that either is not abused or taken advantage of.

References
Advanced Fertility Center of Chicago. (2016). Gestational Surrogacy- using IVF and having a
surrogate mother carry the child for you. Retrieved from:
http://www.advancedfertility.com/surrogacy.htm
Bromfield, N. F., & Rotabi, K. S. (2014). Global surrogacy, exploitation, human rights and
international private law: a pragmatic stance and policy recommendations. Global Social
Welfare, 1(3), 123-135. doi:10.1007/s40609-014-0019-4
Center for Bioethics and Culture Network. (2012). State-by-state surrogacy summary. Retrieved
from: http://www.cbc-network.org/wp-content/uploads/2012/08/State-by-
State_Surrogacy_Sum_CBC.pdf
Center for Young Women’s Health. (2015). Birth Control Pills: General information. Retrieved
from: http://youngwomenshealth.org/2013/07/25/birth-control-pills/
Centers for Disease Control and Prevention. (2016). Infertility FAQ’s: What is Infertility?
Retrieved from:
http://youngwomenshealth.org/2009/11/03/success-and-failure-rates-of-contraceptives/
Church, S., Ekberg, M. (2013). Student midwives’ responses to reproductive ethics: a qualitative
focus group approach using case scenarios. Midwifery, 29, (8) 895-901.
doi:10.1016/j.midw.2012.10.005
Crozier, G. D. (2014). Too blunt a tool: a case subsuming analyses of exploitation in
transnational gestational surrogacy under a justice or human rights framework. The
American Journal of Bioethics, 14(5), 38-40. doi:10.1080/15265161.2014.892176
Damelio, J., Sorensen, K. (2008). Enhancing autonomy in paid surrogacy. Bioethics, 22(5), 269
277. doi:10.1111/j.1467-8519.2008.00629.x

Gugucheva, M. (2010). Surrogacy in America. Cambridge, MA: Council for Responsible
Genetics.
Hanna, J. (2010). Revisiting child-based objections to commercial surrogacy. Bioethics, 24(7),
341-347. doi:10.1111/j.1467-8519.2010.01829.x
Kirby, J. (2014). Transnational gestational surrogacy: does it have to be exploitative? American
Journal of Bioethics, 14(5), 24-32. doi.10.1080/15265161.2014.892169
Schafer, D. J. (2014). Gestational carrier delivery: what do I do now? Journal of Obstetric,
Gynecologic & Neonatal Nursing (JOGNN), 43, S86-S97. doi:10.1111/1552-6909.12321
Society for Assisted Reproductive Technology. (2014). Preliminary cumulative outcome per
intended egg retrieval. Retrieved from:
https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0

Rebekah Frazier rfrazier14@apu.edu (909)708-7991
Office of U.S. Senator Pete Aguilar
685 E. Carnegie Drive, Suite 100
San Bernardino, Ca 92408
(909) 890-4445
(909) 890-9643 fax
Dear Pete Aguilar,
I am writing to you today because of my concern about the lack of policy that exists
among the United States, regarding surrogacy. California has developed legislature and has an
accepting policy toward it, however, most states either do not support it or have no legislature on
surrogacy at all. For many couples who enter into surrogate arrangements, many of them have to
uproot their lives to move to states that allow surrogacy, or often travel to far states in order to
proceed with these arrangements, all because they simply cannot conceive naturally. After
having read numerous scientific studies, it is astounding how much research there has yet to be
done on surrogacy clinic policies, surrogate health care provisions, surrogacy’s effect on the
subsequent child, and surrogacy’s implications on family planning. With this information, more
debates can be sparked in congress, leading to possible legislature development on the matter.
Infertility rates are quite common among parents, being 12% in women ages 15-44 and 7.5% in
men younger than age 45, according to the Centers for Disease Control and Prevention (CDC,
2016).
It has been suggested that this issue is not important, and that legislature need not be
created upon the matter because it further divides or confuses the structure and integrity of the
modern family. However, this is false. Surrogacy is an excellent way to provide children to
families who cannot create their own naturally, and allows different parties to work in unity, to
create a loving family. Bills can be presented and debates can be created on this matter so that
the public becomes more aware of the need for better surrogacy legislature. A suggestion could
be to create public health messages or commercials advertising the convenience of surrogacy.
Another suggestion is for surrogacy clinics to make more of their records public so that more
statistics can be made available for researchers to conduct studies on how useful they are.
From a public health and nursing perspective, it is necessary that more legislature be
developed regarding: ease of access to surrogate arrangements in each state, the health care
provided to engaging surrogate mothers, and the implications for the new parents. It is important
to ensure the security of both parties’ needs involved in the arrangement so that fraud does not
occur. Perhaps you could start an initiative that calls for the standardization of a nationwide
surrogacy policy of some sort. This would at least start the process of refining each states’
individual laws on the subject.
Sincerely,
Rebekah Frazier

Rfra_Bioethical_principle

Recommended

Recommended

More Related Content

What's hot

What's hot (19)

Viewers also liked

Viewers also liked (16)

Rfra_Bioethical_principle