The ethics of surrogacy

Surrogacy is often thought to be a ‘treatment’ option for the infertile or an alternative to adoption, and so to be celebrated in fulfilling people’s desires to be parents. However, surrogacy also brings a wealth of more complex ethical issues around gender, labour, payment, exploitation and inequality.

As a philosopher at the University of Birmingham, I am interested in ethical issues such as these. Further, as recently appointed Chair of Surrogacy UK’s  (SUK) Ethics Committee, I help the organisation think more about the ethics of their internal procedures and external public policies.

Payment

Take the issue of payment: surrogacy involves literal labour (physical and often emotional effort in both gestating and birthing). However, many see it as distinct from labour (working in a factory or teaching a class). This raises an ethical question around whether surrogacy is different from other kinds of paid work and, if it isn’t, shouldn’t we remunerate surrogates?

Some philosophers argue that surrogacy is unique when compared to other work. For instance, they claim that women are intimately connected to their reproductive capacities and bodies (so pregnancy and birth are special and should not be bought), or that being pregnant requires an unusual time commitment (unlike other kinds of work, the woman works for 24 hours a day, seven days a week, for nine months).

Others argue that there is equivalence to traditional work. Various occupations demand control over the body (ballerinas and astronauts are heavily controlled in what they can eat and how much they exercise, just as surrogates are) and longevity of work (writing a book can take longer than gestating and delivering a baby). All this work should be paid, so the argument goes.

In my own research, I have argued that what partly constitutes this difference is the ‘product’ of this labour. It is not an inanimate object, like a doll on a production line, or even a one-off performance by a ballerina. It is a living human child. The labour of the surrogate and the ‘result’ of the labour together put surrogacy at a different point on a spectrum of various types of ‘work’. To avoid concerns about commodification here, we should resist payment.

Gender

Ethics also come into play when thinking about the gendered nature of surrogacy and intended parenting. Biologically, the surrogate has to be someone with the capacity to gestate and give birth – usually a woman. As gendered labour, surrogacy triggers important feminist concerns, such as about bodily autonomy, vulnerability, inequality and rights.

For example, whether women who are surrogates maintain autonomy over their body when they are carrying a foetus for another individual or couple, or when decisions are being made about what happens to that foetus when there is disagreement. I think about the complexity of these sorts of questions and defend the importance of protecting and promoting women’s autonomy in my broader work on feminist conceptions of autonomy.

Intended parenthood raises feminist concerns too, such as on gendered roles and expectations. This includes whether women in particular feel that being mothers is critical to being ‘proper’ women (and hence why they might pursue surrogacy if they cannot carry their own children). Likewise, women might feel breastfeeding is what ‘real’ mothers (and women) do (and why intended mothers – ie, women who are not pregnant – might want to induce lactation).

Interestingly, at SUK’s annual conference in September, it was noted that lactation can be induced in men using a similar process as for non-pregnant women. (It has been used for a transgender woman who wanted to breastfeed recently too). For feminists worried about unequal gender roles in parenting in general, this could be further ammunition for dispelling myths about women as ‘natural’ carers because of their biological capacities.

Exploitation

A final ethical issue to mention is exploitation. The UK, Ukraine, US, Australia and India have different regulations about surrogacy. Some countries see the surrogate, while others the intended mother, as the legitimate mother. Some favour altruistic forms of surrogacy, while others allow commercial forms. Some countries give parental rights to intended parents before or at the birth of the child, while others only after six weeks.

There are good reasons to worry about a country-specific approach to surrogacy, as outlined in the recent Conversation article I wrote with my colleague, Dr Gulzaar Barn. In particular, the country-specific approach opens up the potential to exploit legal loopholes, intended parents, and, ultimately those doing the majority of the labour – surrogates.

Despite the inevitable difficulties of securing global agreement, concerns about exploitation – of all parties, but especially the most vulnerable – provides a significant reason to push for a global approach to surrogacy arrangements.

These are just three ethical puzzles of surrogacy. All of the themes, and more beyond, require careful consideration since what we think about each is not just philosophically intriguing but is likely to have implications for how we believe our practice, laws and policy should be shaped. As the UK is currently reviewing its legislation on surrogacy, giving attentive thought to these issues is a particularly timely demand on all of us.

If you are interested in discussing such themes more, SUK is currently looking for members to serve on its Ethics Committee. For more information and details about how to apply, visit their website.

Dr Herjeet Marway
Lecturer in the Department of Philosophy, University of Birmingham and Chair of Surrogacy UK’s (SUK) Ethics Committee