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Baby Gammy: the responsibilities of ART professionals in international surrogacy

18 August 2014
By Professor Eric Blyth
Professor of Social Work at the University of Huddersfield
Appeared in BioNews 767

The 'Baby Gammy' case has sparked worldwide interest and comment. At the time of writing at least some of the 'facts' of what happened, when, and why remain contested. However, as Sascha Callaghan and Ainsley Newson note in their commentary (see BioNews 766), the case highlights troubling issues that have been exercising the minds of some of us for some time (1-4).

Among the key questions that Callaghan and Newson ask are: whether it is 'reasonable [for rich countries] to outsource reproductive requirements to countries where women from deprived backgrounds can obtain a slice of the baby marketplace?' and 'whether selling reproductive services between countries is moral?'; the latter begging the question of whether selling reproductive services anywhere is moral.

While the 'Baby Gammy case' has unleashed global outrage, it would be naïve to think that any national or international body is going to take action soon to address the problems associated with international surrogacy. In 2011, the Hague Conference on International Private Law began to consider the possibility of drawing up internally accepted standards and regulations for international surrogacy similar to those in operation for international adoption (5). However, the formulation of such regulations, if they ever materialise, is a long-term rather than a short-term undertaking (6-8), with the Conference deferring until Spring 2015 a decision on whether and how to pursue this project.

In the meantime, given the divergence of regulatory arrangements between different countries (where they exist), unilateral action by individual governments is likely to perpetuate or aggravate existing problems that have resulted in commissioning parents and babies being stranded – sometimes for years – in both geographical and legal limbo. In the UK, proposals to reform the well-intentioned but ill-conceived laws on domestic surrogacy by removing some of the 'push' factors that drive the international surrogacy market, by legitimising domestic commercial surrogacy, relaxing the requirements for granting a Parental Order, or reducing the rights of surrogates through the introduction of binding pre-conception contracts and transferring legal parentage earlier, are likely to bring about their own problems.

Regardless of their partiality to external regulation, a number of major fertility professional bodies, such as the American Society for Reproductive Medicine, British Fertility Society, European Society for Human Reproduction and Embryology, and the Fertility Society of Australia, nevertheless recognise that responsible fertility care involves paying due regard to the interests of fertility patients, donors (in this case also including surrogates) and children born as a result of fertility procedures. While there will continue to be debate about the precise parameters of such interests (for example, whether the interests of children born as a result of fertility procedures can be secured where they are prevented from knowing the identity of genetic parents or where their conception has been the result of a commercial transaction), there should be little argument with the fundamental principle of 'First do no harm'. Most surrogacy arrangements involve gestational surrogacy and are therefore dependent on the services of an IVF clinic, with attendant professional staff.

Professional bodies and leaders in the field have both the opportunity and the responsibility to be proactive in promoting acceptable standards of care for patients, donors, surrogates and children, wherever IVF services are provided. They can do this by raising these issues as a matter of priority within the global umbrella body, the International Federation of Fertility Societies.

17 October 2016 - by Antony Starza-Allen 
The Parliamentary Assembly of the Council of Europe, a human rights organisation, has voted to reject a proposal to introduce international guidelines on surrogacy and children's rights...
15 June 2015 - by Dr Kirsty Horsey 
A working group from Surrogacy UK has devised an online survey seeking views on people's experiences of surrogacy in the UK and opinions on the way it is regulated...
26 January 2015 - by Julianna Photopoulos 
Baby Gammy, who was born with Down's syndrome to a Thai surrogate mother and was at the centre of a surrogacy scandal last year, has been granted Australian citizenship....
3 November 2014 - by Rebecca Carr 
'Not being able to have children can be a desperate thing,' says political journalist and commentator Isabel Oakeshott. After losing four pregnancies herself, Oakeshott came to a 'drastic solution': she was going to use a surrogate, and one in India at that...
8 September 2014 - by Chee Hoe Low 
BBC Radio 4 's 'The Report' ventured into the ethically controversial area of surrogacy, which made international media headlines following the recent baby Gammy controversy...
11 August 2014 - by Sascha Callaghan and Ainsley Newson 
The story of the baby with Down's syndrome 'abandoned' in Thailand, which has dominated the news, illustrates how the international surrogacy industry has been booming...
4 August 2014 - by Antony Starza-Allen 
A child with Down's syndrome born to a Thai surrogate is reported to have been abandoned by the intended parents, an Australian couple, who have denied the allegations. Conflicting versions of the developing story have been reported....
Responsibilities of ART professionals in international surrogacy ( - 21/01/2015)
ART means assisted reproductive technology; technical methods of assisting human beings reproduce and have offspring.  So the article is questioning what responsibilities doctors have when they are helping patients reproduce themselves.  

Doctors should not offer any services at all to patients who they discover cannot reproduce even with medical assistance.  If it's clear that a doctor cannot help a patient to have their own offspring through IUI or IVF the doctor should make that clear to the patient and should not help the patient obtain someone else's child on the black market and call it a fertility treatment just because the deal was brokered by a physician.  The same can be said for patients who are able to reproduce but don't have a romantic partner to reproduce with; this is not a condition requiring medical treatment of a licensed physician it's a social problem and physicians should not be offering to treat these people with the sperm or eggs of individuals who are willing to have and abandon their offspring.  That is not assisting with a fertility problem its arranging for a child to be abandoned so that a person won't have to cooperate or deal with the other parent of their child.  

Doctors should have a responsibility to stop offering to do things for a patient when it's clear there is either no need for medical assistance or it is clear that medical assistance won't aid them in having their own offspring.  Finding someone to reproduce with is a personal social problem that doctors should not attempt to treat with donated sperm because all they are doing is hooking the patient up with a reproductive partner who promises to abandon any children they may have together.  Lack of a reproductive partner is not a problem that medical science and reproductive technology can fix for a person and so no services should be offered by doctors for patients with this problem because its unethical and requires that a biological parent abandon his or her offspring at birth and that is tragic and sad and not technological nor is it treatment, its just an arrangement that unnecessarily denies people the care and support of both bio parents.  Finding people to have and abandon children with patients who cannot be helped with reproductive fertility treatments is not a medical treatment.  Helping people get other people's kids to raise off the record under the radar without adopting in court is not a medical treatment.  Just stick to practicing medicine and nothing else and you'll see where the limits of your responsibilities stop and where other people's begin.
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