Ruth Walker

Altruism and Generosity in Surrogate Motherhood

Abstract In this chapter we address the problematic nature of altruistic motivation, commonly required of surrogate mothers, live organ donors, clinical research participants and health professionals. Altruism, understood as involving a desire to help others, often to a self-sacrificing degree, gives rise to various conceptual and ethical difficulties. We argue that encouraging the virtue of generosity is preferable to requiring altruistic motivation, because generosity is consistent with reciprocation as well as legitimate concern for self. A correct understanding of generosity also alleviates concerns about exploitation and commodification. Our focus in this chapter is on surrogacy, but our arguments apply to other domains as well.

Surrogacy, Compensation, and Legal Parentage: Against the Adoption Model

Surrogate motherhood is treated as a form of adoption in many countries: the birth mother and her partner are presumed to be the parents of the child, while the intended parents have to adopt the baby once it is born. Other than compensation for expenses related to the pregnancy, payment to surrogates is not permitted. We believe that the failure to compensate surrogate mothers for their labour as well as the significant risks they undertake is both unfair and exploitative. We accept that introducing payment for surrogates would create a significant tension in the adoption model. However, we recommend rejecting the adoption model altogether rather than continuing to prohibit compensation to surrogates.

Law and Regulation

Without certainty over legal parentage, the intended parents cannot trust the surrogate completely. The professional model uses the agreement to establish the parental rights of the intended parents before the surrogate becomes pregnant. She is never the legal mother of the baby and so does not relinquish it. This removes the problem of transferring parental rights, whether by adoption or some other mechanism. Intention is the basis of legal parentage rather than genetic relationship, gestation or best interests. Once a pregnancy is established no one can change their minds.

TrustTrust worthiness and Care

Trust is a core value in surrogacy. Intended parents face risk and uncertainty in case the surrogate decides not to relinquish the baby. Surrogates fear that intended parents will not take the baby or will renege on their agreement with her. Commercial contracts cannot establish trust and a relational bond is too fragile to do so if something goes wrong. The professional model adopts the concept of professional trust where licensing, regulation, and selection for ethical qualities make practitioners trustworthy. Sanctions for unethical conduct protect users of the service.

The Professions and Professional Ethics

The professional model requires support from the relevant professionals to all parties during the process. This chapter outlines the distinct role of each of these professions, namely legal and medical practitioners, social workers, counsellors, nurses and midwives. All surrogacy arrangements, traditional or gestational, are formal. They have to be approved and conducted through fertility clinics. All surrogates must be registered to ensure that they are medically and psychological healthy and have the necessary ethical awareness and appreciation of the duties they have towards the intended baby and the intended parents. Similarly, the intended parents must understand their responsibilities to the surrogate as well as her rights. She cannot keep the baby but she has other important rights as a patient and autonomous person.

ExploitationExploitation and Commodification

The biggest worry about surrogacy is that it exploits women and turns them and the babies into commodities. This chapter explores exploitation and commodification in detail. It shows that some arrangements, including altruistic surrogacy, do exploit women but that exploitation could be reduced and potentially eliminated in the professional model. Some commercial arrangements commodify women, especially in transnational surrogacy, but this could also be avoided.

Altruism and Generosity

Surrogates are vulnerable because they are expected to be motivated by altruism. Altruism requires selfless giving with no prospect of reward. The dominant theme is that surrogates give the ‘gift of life’. In living organ donation, where this idea has been in use for much longer, it has been a burden to donors whose own needs are never acknowledged and who bear significant personal costs as a result. This chapter shows that the core moral value in surrogacy and donation should instead be generosity and the appropriate response to a generous act is gratitude. Gifts should be acknowledged and reciprocated, and surrogacy and donation are no different. Generosity is also consistent with compensation.

Three Models of Surrogacy

Currently just two forms of surrogacy arrangement are recognized: altruistic and commercial. Altruistic surrogates are not paid. This seems unfair to many people, given the risky and arduous nature of pregnancy. Commercial surrogates receive financial compensation. However, this gives rise to the concern that they are motivated only by money and not by a desire to help others. This chapter introduces a third way, the professional model, which is based on an analogy to the caring professions. It treats surrogates fairly by paying them, while at the same acknowledging that their motives are good.

Trustworthiness and Care

Trust is a core value in surrogacy. Intended parents face risk and uncertainty in case the surrogate decides not to relinquish the baby. Surrogates fear that intended parents will not take the baby or will renege on their agreement with her. Commercial contracts cannot establish trust and a relational bond is too fragile to do so if something goes wrong. The professional model adopts the concept of professional trust where licensing, regulation, and selection for ethical qualities make practitioners trustworthy. Sanctions for unethical conduct protect users of the service.

Trust worthiness and Care

Trust is a core value in surrogacy. Intended parents face risk and uncertainty in case the surrogate decides not to relinquish the baby. Surrogates fear that intended parents will not take the baby or will renege on their agreement with her. Commercial contracts cannot establish trust and a relational bond is too fragile to do so if something goes wrong. The professional model adopts the concept of professional trust where licensing, regulation, and selection for ethical qualities make practitioners trustworthy. Sanctions for unethical conduct protect users of the service.