Why would a woman choose to carry a baby for another person? Should money be involved? Does surrogacy exploit vulnerable women? And what other ethical issues are involved in the surrogacy process?
In the BBC World Service's The Why Factor: Surrogacy podcast, Mary-Ann Ochota interviews individuals with a variety of connections to surrogacy: surrogates, intended parents and an anti-surrogacy activist, as well as representatives from a US fertility clinic, Families Through Surrogacy (a not-for-profit organisation), and the University of Cambridge's Centre for Family Research.
Despite the obvious limitations of a 23-minute podcast, it manages to provide important background information while also engaging (albeit superficially) with some of the ethical issues surrounding surrogacy and flagging up issues which could form the basis of future debates.
The podcast outlines the differences between traditional, gestational, altruistic, and commercial surrogacy, and explains that different countries have different laws governing surrogacy. These range from outright bans to permitting so-called 'commercial' surrogacy.
Although not discussed in depth, it also highlights other important issues, such as the impact on the surrogate's own children, the need for surrogate-born children to know their creation story, whether there should be an age-limit for intended parents (an intended mother in her mid-sixties is discussed), and who the child's true parents are.
In terms of the ethical issues involved in surrogacy, the podcast does, to a certain extent, explore the issue of the exploitation and motivation of surrogates. In my view, one of the best aspects is that it includes interviews with surrogates (rather than just industry professionals) and that these surrogates are from very different backgrounds and cultures. It was particularly valuable to be able to compare the experiences and motivations of surrogates in Canada (which permits altruistic surrogacy), Oregon, USA (which permits commercial surrogacy) and India (which permits commercial surrogacy - although no longer for foreign intended parents - see BioNews 913).
However, in my opinion, the podcast has several flaws, particularly as its main aim is to investigate the motivations, experiences and possible exploitation of surrogates.
Firstly, it does not properly explore the possibility that it is exploitative not to compensate surrogates (beyond reimbursing expenses), particularly when everyone else involved - doctors, agency, lawyers - are being paid, and surrogates are undertaking the riskiest job. These risks are highlighted by the Oregon-based surrogate, who sadly had to undergo a hysterectomy after giving birth.
Secondly, I feel that it could have investigated, to a greater extent, whether the motivations of compensation (being paid a sum over and above reasonable expenses) and altruism (wanting to help individuals who are unable to conceive and carry a child themselves) are mutually exclusive, or whether these can in fact co-exist. Although this was touched upon in the interviews with the Oregon and Indian-based surrogates, both stories were tinged by the sad though very rare outcome for the Oregon surrogate, and by the problematic practices of the clinics and agencies in India.
In my view, a more balanced presentation could include an interview with a surrogate who had not experienced a rare complication and who is based in a commercial surrogacy jurisdiction, such as California, where there is greater socioeconomic parity between the surrogate and the intended parents. In my experience, having worked alongside US surrogacy agencies and law firms (including in California), altruism and the desire to be compensated are not mutually exclusive aims.
Thirdly, the podcast failed to address the possible exploitation of intended parents, who are often so desperate to have a child (perhaps following unsuccessful IVF or repeated miscarriages) that they can be equally vulnerable and therefore are also in need of protection.
Overall, this podcast provides a good general introduction to surrogacy and is aimed predominantly at individuals who have no or little prior knowledge of this complex area. However, I would have liked to have seen the issues around exploitation explored in a more thorough and balanced way.
An interesting follow-up topic would be how to address the various risk factors involved in surrogacy and how this should be regulated, on both a domestic and international scale. After all, it is fairly straightforward to highlight the benefits and risks involved in surrogacy, but much more difficult to devise a regime whereby surrogacy arrangements can still take place with the proper protection of all parties involved. Given that the Law Commission is currently reviewing if and how surrogacy law should be reformed in England and Wales, a podcast addressing different reform proposals would be extremely valuable.