Global surrogacy: exploitation to empowerment

Commercial surrogacy has gone global in the last decade, and India has become the international centre for reproductive tourism, boasting numerous high-quality and low-fee clinics. The growth of the surrogacy industry in India raises serious concerns of global gender justice, in particular whether the option is inordinately enticing for women who lack other remunerable options and whether the conditions are adequate and the compensation fair. In this paper I argue that the moral harm of global commercial surrogacy lies in the exploitative nature of transactions involving unequally vulnerable parties. More specifically, I argue that the practice exploits Indian surrogates on the basis of an inter-contractual failure of both justice and consent. I go on to consider an important objection to my use of exploitation as the relevant conceptual tool of analysis. The ethnographic challenge holds that the exploitation lens Occidentalizes surrogacy by conceptualizing the practice in universalizing terms, thereby eclipsing the particularities of the global surrogate's lived experience. I respond by showing that in fact the exploitation and the ethnographic models are not so at odds as they might seem. Provided we are careful in our use of the former to nuance our analysis by appeal to narrative evidence supplied by the latter, we are thereby best situated to identify and address the moral difficulties generated by commercial surrogacy under conditions of global injustice.     

An ethnomethodological approach to examine exploitation in the context of capacity,trust and experience of commercial surrogacy in India

The socio-ethical concerns regarding exploitation in commercial surrogacy are premised on asymmetric vulnerability and the commercialization of women’s reproductive capacity to suit individualistic motives. In examining the exploitation argument, this article reviews the social contract theory that describes an individual as an ‘economic man’ with moral and/or political motivations to satisfy individual desires. This study considers the critique by feminists, who argue that patriarchal and medical control prevails in the surrogacy contracts. It also explores the exploitative dynamics amongst actors in the light of Baier’s conceptualization of trust and human relationship, within which both justice and exploitation thrive, and Foucault’s concept of bio-power. Drawing on these concepts, this paper aims to investigate the manifestations of exploitation in commercial surrogacy in the context of trust, power and experiences of actors, using a case study of one clinic in India. The actors’ experiences are evaluated at different stages of the surrogacy process: recruitment, medical procedures, living in the surrogate home, bonding with the child and amongst actors, financial dealings, relinquishment and post-relinquishment.This study applies ethnomethodology to identify phenomena as perceived by the actors in a situation, giving importance to their interpretations of the rules that make collective activity possible. The methods include semi-structured interviews, discussions, participant observation and explanation of the phenomena from the actors’ perspectives. Between August 2009 and April 2010, 13 surrogate mothers (SMs), 4 intended parents (IPs) and 2 medical practitioners (MPs) from one clinic in Western India were interviewed.This study reveals that asymmetries of capacity amongst the MPs, SMs, IPs and surrogate agents (SAs) lead to a network of trust and designation of powers through rules, bringing out the relevance of Baier’s conceptualization of asymmetric vulnerability, trust and potential exploitation in human relationships. The IPs are exploited, especially in monetary terms. The SMs are relatively the most exploited, given their vulnerability. Their remuneration through surrogacy is significant for them, and their acquired knowledge as ex-surrogates is used for their own benefit and for exploiting others. Foucault’s conceptualization of power is hence relevant, since the ex-SMs re-invest the power of their exploitative experience in exploiting others.     

Is Commercial Surrogacy Baby-selling?

ABSTRACT This essay considers a common objection to commercial surrogacy on the grounds that the child is treated as a commodity for sale by the surrogate and the commissioning couple. I analyse one prevalent argument for the view that commercial surrogacy is a kind of baby-selling, not service-selling. I conclude that this argument rests on an implausible interpretation of what the reproductive services are. I defend an alternative interpretation of typical surrogacy agreements. Furthermore, I argue that this interpretation fails to support the conclusion that the surrogate is primarily or exclusively selling a baby, rather than her reproductive services. My primary concern is to diagnose a conceptual error in an argument against surrogacy. However, the interpretation of surrogacy arrangements that is defended helps to shift the focus from the issue of whether or not the child is degraded to the issue of whether or not the surrogate degrades herself or is degraded by the commissioning couple.     

Failed surrogate conceptions: social and ethical aspects of preconception disruptions during commercial surrogacy in India

Background

During a commercial surrogacy arrangement, the event of embryo transfer can be seen as the formal starting point of the arrangement. However, it is common for surrogates to undergo a failed attempt at pregnancy conception or missed conception after an embryo transfer. This paper attempts to argue that such failed attempts can be understood as a loss. It aims to reconstruct the experiences of loss and grief of the surrogates and the intended parents as a consequence of their collective failure to conceive a surrogate pregnancy.

Methods

Drawing on a qualitative study conducted over a period of eight months between 2014 and 2015 at two fertility clinics in Delhi and two in Kolkata, India, this paper examines the experiences of the surrogates and the intended parents when faced with missed conceptions or failed conceptions during a surrogacy arrangement.

Results

We argue that while the surrogate grieves the non-arrival of a ‘good news’ as an uncertain loss, the intended parents experience yet another, failure in addition to the losses they might have incurred during their previous fertility treatments. The body of the surrogate becomes a site of ‘a lost opportunity’. The surrogate embodies a loss in her quest to achieve social mobility and the intended parents experience a disembodied pregnancy loss. This very emotional experience stands in stark contrast to the conceptualisation of such failed attempts as non-events within the discourse of the surrogacy industry. The experience of loss of the intended parents is recognised but their grief is given no space. We argue that such ambiguity around the nature of losses resulting out of a missed or failed conception during surrogacy is an outcome of lack of interpersonal relationship between the surrogate and the intended parents.

Conclusions

Since commercial surrogacy is a relational process, the only way in which the experiences of losses and failures of the actors at the preconception stage can be better addressed is through developing close sharing and understanding between each other through an ethics of care. Therefore, to nurture caring relationships, surrogacy needs to be understood as a moral commitment by –the surrogates and intended parents. To enable such a commitment, there is a need to reconsider the pre-defined and legally regulated professional duty of the doctors, agents and agencies. It cannot be a one-sided commitment, but has to have elements of mutuality.

     

A case for permitting altruistic surrogacy

Canada's Royal Commission on New Reproductive Technologies rejects all forms of surrogacy arrangement under the rubric of objecting to commercial surrogacy. Noncommercial surrogacy arrangements, however, can be defended against the commission's objections. They can be viewed as cases of giving a benefit or service to another in a way that expresses benevolence, and establishes a relationship between surrogates and prospective 'social' parents that allows mutual understanding and reciprocal personal interaction between them.     

Commodification and commercial surrogacy

... In this article I shall argue tentatively for the claim that commercial surrogacy should be legally permissible. I am more strongly convinced that a commitment to feminism should not predispose anyone against surrogacy. At least, no arguments offered so far should persuade anyone who is committed to equal rights for women and men and the dismantling of gender-based hierarchies to favor either legal prohibition or moral condemnation of commercial surrogacy.     

Two questions about surrogacy and exploitation

In this article I will consider two related questions about surrogacy and exploitation: (1) Is surrogacy exploitative? (2) If surrogacy is exploitative, what is the moral force of this exploitation? Briefly stated, I shall argue that whether surrogacy is exploitative depends on whether exploitation must be harmful to the exploited party or whether (as I think) there can be mutually advantageous exploitation. It also depends on some facts about surrogacy about which we have little reliable evidence and on our philosophical view on what counts as a harm to the surrogate. Our answer to the second question will turn in part on the account of exploitation we invoke in answering the first question and in part on the way in which we resolve some other questions about the justification of state interference. I shall suggest, however, that if surrogacy is a form of voluntary and mutually advantageous exploitation, then there is a strong presumption that surrogacy contracts should be permitted and even enforceable, although that presumption may be overridden on other grounds.     

Novice therapist,the client and therapy: Integrating the triad

Therapy process research focuses on understanding how therapy is conducted by professionals in the field. It is a nascent field of psychotherapy enquiry in India. This paper explores how novice therapists in India perceive their clients, and how this influences the process of therapy. In depth interviews were conducted with ten novice therapists, with less than six years of practice experience, from Mumbai, India. The data was thematically analysed. The data revealed that therapists' perceptions of their clients were defined by socio-demographic features of age and gender, along with presenting complaints and personal attributes. Participants had defined beliefs about good clients as contrasted with difficult ones. Distinct preferences for particular client types were identified. The antecedents to these beliefs were attributed to the therapist's worldview, their training and the supervision received. These views, and the conceptualisation of the client, influenced the choice of client, the process of therapy and how they proceeded with sessions, and their methods of referral. The data from the study has implications for therapist training, supervision and further research.     

How Civil Society Organisations Changed the Regulation of Clinical Trials in India

ABSTRACT

In 2005 India changed its pharmaceutical and innovation policy that facilitated a dramatic increase in international clinical trials involving study sites in India. This policy shift was surrounded by controversies; civil society organisations (CSOs) criticised the Indian government for promoting the commercialisation of pharmaceutical research and development. Health social movements in India fought for social justice through collective action, and engaged in normative reasoning of the benefits, burdens and equality of research. They lobbied to protect trial participants from structural violence that occurred especially in the first 5–6 years of the new policy. CSOs played a major role in the introduction of new regulations in 2013, which accelerated a decline in the number of global trials carried out in India. This activism applied interpretations of global social justice as key ideas in mobilisation, eventually helping to institutionalise stricter ethical regulation on a national level. Like government and industry, activists believed in randomised controlled trials and comparison as key methods for scientific knowledge production. However, they had significant concerns about the global hierarchies of commercial pharmaceutical research, and their impact on the rights of participants and on benefits for India overall. Pointing to ethical malpractices and lobbying for stricter ethical regulations, they aimed to ensure justice for research participants, and developed effective strategies to increase controls over the business side of clinical research.     

Donation, surrogacy and adoption

ABSTRACT The Warnock Report fails to reveal an important underlying principle concerning the donation and transference of gametes and embryos. This principle contrasts sharply with the principle that children are non-transferable. Consideration of where to place the line between transferable embryos and non-transferable fetuses, or children, yields a conception of surrogacy that would set it apart from adoption. The paper argues for a coherent system of surrogacy supported by regulative institutions in which surrogacy is seen to facilitate an acceptable form of parenthood.     

Families created through surrogacy arrangements: parent-child relationships in the 1st year of life

Findings are presented of a study of families created through surrogacy arrangements. Forty-two surrogacy families were compared with 51 egg-donation families and 80 natural-conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, the quality of parent-child relationships, and infant temperament. The differences that were identified between the surrogacy families and the other family types indicated greater psychological well-being and adaptation to parenthood by mothers and fathers of children born through surrogacy arrangements than by the natural-conception parents.     

The Formal Systems Response to Violence Against Women in India: A Cultural Lens

Violence against women (VAW) has become an increasingly salient issue in India, with women at risk for different forms of gendered violence. While there may be universal elements in the international phenomenon of violence against women, it is a complex, multifaceted phenomenon that takes shape in a particular sociocultural context. The current study employs a narrative framework to systematically examine how culture is expressed in the formal systems response and women's help‐seeking in two metropolitan cities in India. Specifically, we sought to understand, among formal system responders (a) what characterizes the dominant cultural narratives on violence against women in India; and (b) how these are reflected in community narratives of formal responders. Interviews were conducted with formal responders working in different types of local agencies (e.g., police, health centers, and non‐governmental agencies). The paper illustrates the major themes that emerged from participants’ narratives describing the multilevel influences that shape the formal system response to violence against women and women's help‐seeking efforts. The implications of these findings for effective response and directions for future research are summarized.     

Families created through surrogacy: mother-child relationships and children's psychological adjustment at age 7

Each year, an increasing number of children are born through surrogacy and thus lack a genetic and/or gestational link with their mother. This study examined the impact of surrogacy on mother-child relationships and children's psychological adjustment. Assessments of maternal positivity, maternal negativity, mother-child interaction, and child adjustment were administered to 32 surrogacy, 32 egg donation, and 54 natural conception families with a 7-year-old child. No differences were found for maternal negativity, maternal positivity, or child adjustment, although the surrogacy and egg donation families showed less positive mother-child interaction than the natural conception families. The findings suggest that both surrogacy and egg donation families function well in the early school years.     

Law and LGBQ-Parent Families

This paper addresses how the law affects LGBQ-parent families. We first outline the legal landscape that LGBQ parents face in the US, underscoring that it varies drastically by state and creates inequity for families. Reviewing existing social science research, we then address how the law affects three processes for LGBQ people: desiring parenthood, becoming a parent, and experiencing parenthood. Our review indicates that the law affects if and how LGBQ people become parents. LGBQ people consider the law as they make decisions about whether to pursue adoption, donor insemination, or surrogacy and often view the latter two pathways as the most legally secure. Further, the law continues to be salient for LGBQ parents throughout parenthood and affects family well-being. Specifically, legal inequity diminishes parent’s well-being, the relationship among couples who are parenting, and parents’ ability to effectively advocate for their children in institutional settings like healthcare contexts. Finally, we address directions for future research for scholars interested in the law, family processes and outcomes, and LGBQ families.     

Surrogacy and the Construction of the Maternal-Foetal Relationship: The Feminist Dilemma Examined

The feminist movement remains fundamentally divided over the issue of surrogacy. Within the confines of this article it is argued that the inadequacy of positions on both sides of the debate rests upon their common tendency to deal with the ethical consequences of surrogacy for isolated agents, without sufficient concern for the broader social implications for all pregnant women in society. In order to clarify the issues involved, feminist theorists must consider the implications of surrogacy in a broader social spectrum. Such an analysis will illustrate that the two-person dichotomous model of the maternal-foetal relationship proposed by the surrogacy arrangement has hugely prejudicial effects on the treatment received by non-contract mothers when they interact with agents of certain social institutions whose prior contact with surrogate mothers has made them more susceptible to conceiving the maternal-foetal relationship as fundamentally disconnected. In a climate of increased medical surveillance and intervention in the non-clinical context of pregnancy, the dangers of adopting this dichotomous model are palpable. Given the oppressive physical and psychological effect that this would have upon the liberty of the majority of pregnant women in society, this article argues that the feminist movement must abandon any promotion of the abstracted model of the mother-foetus relationship that is implicit in its arguments in favour of surrogacy.     

台湾地区“代孕”立法最新进展及其启示

2007年3月21日,台湾地区在广泛调研、民主决策的基础上,终于颁布实施了《人工生殖法》,使争论已久的代孕人工生殖问题与《人工生殖法》正式脱钩,另行规制;此前,《代孕人工生殖法》草案也已经出笼,拟有条件开放代孕人工生殖。相关草案对代孕者、受术夫妻、代孕中介、代孕契约、亲子关系等问题都进行了具体规定。台湾地区的立法经验对祖国大陆完善包括代孕在内的人工生殖法具有一定的借鉴意义。     

Religion, Social Incorporation, and Civic Engagement: Second-Generation Indian American Christians

Recent studies have shown that participation in religious institutions facilitates the civic incorporation of contemporary immigrants. These studies have focused on either the immigrant generation or on the second generation. This paper contributes to the literature by showing how negotiations and disagreements between generations shape the civic engagement of multigenerational Christian congregations. The research is based on a study of congregations consisting of first- and second-generation immigrants belonging to the ancient Malankara Mar Thoma Syrian Christian church based in Kerala, a state in south India. It shows how first- and second-generation Mar Thoma American conceptions regarding ethnic and religious identity and the social obligations mandated by religion were based on very different understandings about Christian worship, evangelism, social outreach, and their interrelationship. The immigrant generation’s ideas were shaped by the doctrines and practices of the Mar Thoma denomination in India, whereas those of the second generation were influenced by nondenominational American evangelicalism. This paper focuses on the second generation and shows how they developed ideas of American identity and Christian obligation in interaction with and often in opposition to those of their parents’ generation, with the result that contradictory forces affected the civic engagement of these multigenerational congregations.     

Broadening behavioral decision research: Multiple levels of cognitive processing

The area of behavioral decision research—specifically, the work on heuristics and biases—has had a tremendous influence on basic research, applied research, and application over the last 25 years. Its unique juxtaposition against economics has provided important benefits, but at the cost of leaving it disconnected from too much of psychology. This paper explores an expanded definition of behavioral decision research through the consideration of multiple levels of cognitive processing. Rather than being limited to how decision makers depart from optimality, we offer a broader analysis of how decision makers define the decision problem and link decisions to goals, as well as a more detailed focus on processes associated with implementing decisions.     

What Do Gestational Mothers Deserve?

This paper analyzes the following question: What do women deserve, ethically speaking, when they agree to gestate a fetus on behalf of third parties? I argue for several claims. First, I argue that gestational motherhood’s moral significance has been misunderstood, an oversight I attribute to the focus in family ethics on the conditions of parenthood. Second, I use a less controversial version of James Rachels’s account of desert to argue that gestational mothers deserve a parent-like voice as well as significant care and support, conclusions that have implications for commercial surrogacy. Finally, I argue that we should not make requests of others when fulfilling them will lead others to deserve goods we cannot reasonably expect them to receive, and I conclude based on this thesis, what I call the “strings attached thesis,” that pro-life arguments in support of prohibitions on abortion commit their proponents to policies which they may not be willing to support.