Ethical Issues in Gestational Surrogacy

The introduction of contraceptive technologies hasresulted in the separation of sex and procreation. Theintroduction of new reproductive technologies (mainlyIVF and embryo transfer) has led not only to theseparation of procreation and sex, but also to there-definition of the terms mother and family.For the purpose of this essay, I will distinguishbetween:1. the genetic mother – the donor of the egg;2. the gestational mother – she who bears and gives birth to the baby;3. the social mother – the woman who raises the child.This essay will deal only with the form of gestationalsurrogacy in which the genetic parents intend to bethe social parents, and the surrogate mother has nogenetic relationship to the child she bears anddelivers. I will raise questions regarding medicalethical aspects of surrogacy and the obligation(s) ofthe physician(s) to the parties involved. I will arguethat the gestational surrogate is “a womb to rent,”that there is great similarity between gestationalcommercial surrogacy and organ transplant marketing.Furthermore, despite claims to freedom of choice andfree marketing, I will claim that gestationalsurrogacy is a form of prostitution and slavery,exploitation of the poor and needy by those who arebetter off. The right to be a parent, although notconstitutional, is intuitive and deeply rooted.However, the issue remains whether this rightoverrules all other rights, and at what price to theparties involved. I will finally raise the followingprovocative question to society: In the interim periodbetween today's limited technology and tomorrow'sextra-corporeal gestation technology (ectogenesis),should utilizing females in PVS (persistent vehetativestate) for gestational surrogacy be sociallyacceptable/permissible – provided they have leftpermission in writing?     

A Woman's Choice? — On Women, Assisted Reproduction and Social Coercion

This paper critically discusses an argument that is sometimes pressed into service in the ethical debate about the use of assisted reproduction. The argument runs roughly as follows: we should prevent women from using assisted reproduction techniques, because women who want to use the technology have been socially coerced into desiring children--and indeed have thereby been harmed by the patriarchal society in which they live. I call this the argument from coercion. Having clarified this argument, I conclude that although it addresses important issues, it is highly problematic for the following reasons. First, if women are being coerced to desire to use AR, we should eradicate the coercive elements in pro-natalist ideology, not access to AR. Second, the argument seems to have the absurd implication that we should prevent all women, whether fertile or not, to try to have children. Third, it seems probable that women's welfare will be greater if we let well informed and decision-competent women decide for themselves whether they want to use AR.     

The experience of counselling for UK egg providers

Objective

The aim of this study was to address current gaps in knowledge regarding the appropriateness and quality of counselling provided to egg donors in the UK.

Methods

The present study used a cross-sectional, qualitative design. Semi-structured interviews were carried out with 29 UK egg donors to explore their experiences of egg donation and the counselling received.

Results

Of the 29 participants, 24 had received counselling. The remaining five did not receive counselling because they were either not accepted as a donor (n = 4) or were offered, but chose not to take up the session (n = 1). The findings are presented in relation to five themes: feeling supported via counselling; feeling well-informed; welcoming an individualised approach; the counselling setting; and thinking about the future.

Conclusion

Egg donors in this study had varying experiences of counselling offered to them as part of the egg donation process in the UK.

Implications

The findings indicate that there are some aspects of counselling in the UK that could be improved, including the routine offering of counselling throughout the egg donation process and the tailoring of counselling to meet egg donors' individual needs.     

“Test-Tube Baby” procedures: Stress and judgements under uncertainty

Patients participating in an in vim fertilisation with embryo transfer (IVF and ET) programme face uncertainty at each stage of the procedure. Research on heuristics and on stress lead to predictions about behaviour in situations of uncertainty. It was predicted that IVF and ET participants would overestimate the likelihood of success, due to publicity the process has received, and would underestimate the likelihood of an earlier, less publicised. stage in the procedure. Both predictions were confirmed in a total of 70 participants (26 women at out-patient clines, 23 of their partners and 21 surgical in-patients). All the men and all but one woman overestimated the likelihood of becoming pregnant and having a baby. and most of the surgical patients underestimated the likelihood of egg recovery. Estimates were not related to patients' confidence about their information, confirming previous evidence about confidence in inaccurate judgements based on heuristics. Data on patients' distress as indicated by mood rating show high anxiety at points of uncertainty and Pailure, as found in other studies of stress. While the couples shared their inaccurate judgements. they did not necessarily share their distress. The results are discussed in terms of patients' decision making. coping strategies and the implications for doctor-patient communication.     

Infertility: Couples' experiences and the use of counselling in treatment centres

Abstract

Infertility can have profound effects on couples, who may spend years in an increasingly stressful quest for conception; by law, counselling must be offered to those undergoing licensed treatments. This study found that such couples relied on their own partnership as their main resource for managing stress. Predominantly the partnership was organized in a psychological division of labour -the woman experiencing emotional pain, the man supporting and seeking positive solutions. Normally a functional joint defence, this could become a dysfunctional split under excessive stress. Where counselling was offered directly, with a couple approach, couples who took it up were enabled to re-establish their own defences more adaptively. However, where access to counselling was by clinical referral - often of a distressed woman partner alone - the couple approach was more difficult to apply though apparently no less relevant. The counsellor-clinician partnership could mirror the ‘division of labour’, with a similar tendency towards dysfunctional splitting under stress.     

Risk Information Provided to Prospective Oocyte Donors in a Preliminary Phone Call

In order to accommodate for the present shortage of oocyte donors, oocyte-donation programs place ads in college newspapers and provide large monetary compensation to encourage participation. Large compensation acts as a strong incentive for young women to undergo the potentially risky procedure of donation. In this enticing situation, it is particularly important for programs to fully inform prospective donors of the risks of the procedure so that they can accurately weigh the costs and benefits of donating. However, because oocyte-donor programs must alleviate the shortage of donors if they wish to maintain a financially viable business, there is reason to fear that they may minimize or misrepresent risks when recruiting egg donors. In this pilot study, the risk information provided by programs (n=19) to prospective oocyte donors in a preliminary phone call inquiry was investigated. The majority of the programs provided incomplete and/or inaccurate risk information. Policy changes are recommended to reduce the potential for undue influence and to standardize and regulate the risk information provided to prospective egg donors.     

Valuing the invaluable: Do emotional experiences during fertility treatments affect the willingness to pay for them?

Introduction

This paper extends the accepted economic method of valuation by taking psychological factors into consideration.

Reproductive ectogenesis: The third era of human reproduction and some moral consequences

In a well known story Derek Parfit describes a disconnection between two entities that normally (in real life) travel together through space and time, namely your personal identity consisting of both mind and body. Realising the possibility of separation, even if it might never happen in real life, new questions arise that cast doubt on old solutions. In human reproduction, in real life, at present the fetus spends approximately nine months inside the pregnant woman. But, we might envisage other possibilities. Historically, the first era is the normal conception inside the woman, the growth of the fetus in the womb and then, after nine months, birth and the appearance of a new individual. The second era is In Vitro Fertilisation (IVF). The fetus starts outside the woman as a fertilised egg, moves to the body of the woman and spends nine month there, where the body of the woman and the fetus travel together in space-time to separate at birth. In the third era of reproductive ectogenesis, the two never travel together. The fetus spends its gestational time entirely outside the woman’s body. We have two entities separated in space-time the whole time. The intimate connection consisting in the fetus being a part of the woman’s body is gone. In this paper I will briefly comment on the three eras of human reproduction — and primarily on the relationship between the new individual and the woman — and then spend some time with a fictional story illustrating some moral consequences of the third era. The story is from Pig Pharmaceuticals Limited and how they in the year 2050 report the successful development of pig-related pregnancies with transgenic pigs as surrogate mothers.     

Embryo genetic disorder analysis demonstration project: A model protocol

A demonstration project designed for couples at a minimum 25% risk for having a child with cystic fibrosis is being undertaken using embryo genetic disorder analysis within an organization proficient inin vitro fertilization techniques. Prior to offering the project to patients, issues were identified that needed to be addressed in order to improve the likelihood of success. We then developed a set of protocols that would enable us to introduce this new technology to our staff and to prospective patients in a consistent manner.     

International comparison of parenting styles in ICSI,IVF and natural conception families: Results from a European study

In studies comparing ART children born in different countries cultural factors mediate outcomes on child development and parenting. The aim of the study was to investigate whether the variability between the parents living in different cultures is the same regardless of whether these parents conceived after ICSI–IVF or naturally. Questionnaires measuring parental wellbeing, attitudes to family life and parent–child relationships were distributed to parents of 5-year-old ICSI, IVF and natural conceived (NC) control children in the UK (n = 510), Belgium (n = 512), Denmark and Sweden (n = 400). Participation rates were not known for every conception group in each country. However, the participation rate was 45% in the ICSI and IVF conception groups in Belgium, 90% in the ICSI conception group in the UK and 82%, 76% and 56% in the ICSI, IVF and NC groups, respectively, in Denmark and Sweden. In the UK mothers and fathers experienced less marital satisfaction compared to their counterparts in the other countries. Compared to the mothers in Belgium and in the Nordic countries, the mothers in the UK who conceived after ICSI, IVF or naturally reported more stress from parenting. In Belgium ICSI, IVF and NC mothers were highly committed to work while Belgian fathers were least committed to parenting when compared to fathers in Nordic countries and the UK. Mothers in Nordic countries differed from other mothers in that they described fewer negative feelings towards their ICSI, IVF or NC offspring. Although international multi-centre ART follow-up studies help to investigate the wellbeing of ART children and parents the effect of living in a particular culture or nation needs to be taken into account.