18 August 2014
ByAppeared in BioNews 767
BBC Radio 4, Wednesday 6 August 2014
Presented by Michael Buerk
'Money can't buy you love but it can certainly buy you parenthood'. Or can it? Should it? And if it should, where and how should it be regulated?
These were Michael Buerk's questions at the start of last week's Moral Maze on Radio 4. The show was inspired by the story of baby Gammy (see BioNews 765), one of the twins born to a Thai surrogate mother, and allegedly abandoned by the commissioning Australian parents.
Baby Gammy's story raises many serious questions about surrogacy, not least who has ultimate responsibility for the baby. Accordingly, this debate covered some fairly treacherous ground.
The four panellists argued variations on the theme that surrogacy could, possibly, be OK if done for altruistic, noble reasons but that it had the potential to be exploitative and over-commercialised if the law was not very carefully considered.
Claire Fox and Anne McElvoy generally took the side that the good achieved through surrogacy outweighed the potential harms, whereas Jill Kirby and Matthew Taylor were more concerned by surrogacy's rise as a mainstream option and potential to become a globalised industry.
Following the usual format of the show, the panellists interviewed four consecutive 'witnesses', in this case split broadly two for and two against surrogacy. The discussion was free-ranging and dealt with complex issues. The fact that developments in reproductive technology tend to outpace changes in laws and regulations added further complications.
The first witness, Richard Westoby, provided his perspective as half of a same-sex couple that had a baby using a surrogate mother in the US. It was refreshing to hear his positive experience of surrogacy and he was supportive of the US system, with its clear legal framework and provision for the surrogate mother.
At one point, he was asked whether he was worried by the idea of 'Brave New World'-style designer babies, following a comment that he had evaluated the characteristics of the mother of the donor egg they had used. I was pleased to hear his response - that this was an issue with experimental technologies in IVF rather than surrogacy, which does not in itself enable any selection of a baby's characteristics.
A second provocative question - would he choose to have his baby entirely in vitro if this were possible? - was followed by another balanced response: firstly, it isn't possible; and secondly, if it were, it would at least negate the need to 'hire a womb'.
The second witness, author Julie Bindel raised an intriguing, uncomfortable comparison between paid-for surrogacy and prostitution: both put a price on women's bodies and both are frequently poorly regulated and therefore lead to exploitation.
She also audibly raised eyebrows among the panel with the idea that parenthood is a selfish choice. That statement is a bit clumsy, but I think the point she was trying to make was that it is never essential to have children, so the decision to ask someone else to carry a child on your behalf should not be taken lightly.
Panellist Matthew Taylor expanded on this point throughout the programme, hypothesising a future in which rich mothers would choose to forego the hardships of pregnancy by paying a surrogate to go through it for them, perhaps the inevitable outcome of an increasingly mainstream arrangement?
The third witness, Nicola Scott, a British fertility lawyer, did not agree. In her experience the majority of women would not 'want to use a surrogate if they didn't have to'. However, she was very much in favour of improving the legal framework around surrogacy in this country, where the regulations are currently fairly open to interpretation.
In certain US states, paying for surrogacy is fully legal and heavily regulated (as discussed in BioNews 752). In contrast, there are countries in which surrogacy, while legal, is less stringently regulated and there is a distinct potential for exploitation of women who have few other options to make money (returning to the earlier comparison with prostitution).
In the UK, the law allows altruistic surrogacy, meaning that the surrogate can be paid expenses only. Scott argued that current UK law is old and difficult to understand, often spurring people to look abroad, and that improving the legal framework in the UK might prevent people resorting to the third-world surrogacy options.
The final witness was the most provocative. Dr Helen Watt, from the Anscombe Bioethics Centre, raised some important points, including that being a surrogate mother is 'not just babysitting', but also has physical and psychological implications. However, her assertion that 'children have to be conceived in a way that reflects their dignity' did not find favour with McElvoy, who pointed out that being conceived 'naturally' hardly ensures that a child will not be abandoned or neglected.
Claire Fox also objected to Dr Watt's opinion that 'pregnancy makes a woman a mother', suggesting that the mother of an adopted child might be unhappy with the suggestion that they were less of a mother than if they had carried the child themselves.
Concerns surrounding the rise of a surrogacy industry came up frequently during the programme. Aside from the potential for exploiting women who have few other financial alternatives, arguments were raised that an increase in surrogacy could cause a 'separation of pregnancy and motherhood', resulting in parents becoming more detached from their children. I doubt there is any firm evidence to support this, but accept that it is a complicated issue which would be difficult to demonstrate empirically.
This programme, to me, highlighted how necessary it is to continue debating the place of surrogacy in society (if any), especially as legislation struggles to keep up with scientific advances.