Abstract
Surrogacy is one of the most influential modern medical practices in the world. For this reason, it is crucial to note how the practice affects nurses and physicians, in general. The most common problems associated with surrogacy and nursing are ethical in nature. It is critical for nurses to do thorough medical checkups on their patients to solve the ethical dilemmas that might arise in relation to surrogacy. In addition, the intended parents and the surrogate mother have to explain decisions that are to be made based on medical emergencies in the contract. Being keen on these minute details will get rid of bias and confusion when the surrogate mother falls ill. The agreement should also make it easier for the nurses to make health decisions.
Keywords: surrogacy, ethics in surrogacy, pros and cons of surrogacy
Introduction
Surrogacy is defined as the agreement between two parties to carry a pregnancy on behalf of the intended parents, with one or more members representing each party (Parks, 2010). In simpler terms, it is the carrying of a pregnancy by a woman who is not the biological mother of the child. Upon delivery, the child is given back to the biological parents. Surrogacy has been described as one of the best inventions in the modern medicine, as it has helped people who cannot have children for one reason or the other raise a family. However, there are some disadvantages that have been associated with surrogate parenting. This paper discusses the pros and cons of surrogacy, including those that are related to modern medicine and those that are ethical in nature. Additionally, it will discuss how the ethical issues have impacted nursing practice and how the concept can affect nursing, in general. The paper will prove that ethical dilemmas associated with surrogacy can cripple families and define some aspects of nursing in the future at the same time.
Pros and Cons of Surrogacy from a Medical Point of View
As mentioned, surrogacy has been described as one of the best inventions in modern medicine. One of the most relevant medical advantages of surrogacy is the advancement of modern medicine through the concept. For example, it is the idea of surrogacy that allowed scientists and medical practitioners to understand fully how to conceive a baby in the lab. Many surrogate mothers do not have intercourse with the man involved (Bailey, 2011). Medical practitioners realized that they could fertilize a woman’s egg using her husband’s sperm and then insert the fertilized egg into the womb of another woman.
The idea of surrogacy was born to help people who could not give birth, but had no problem conceiving. This type of surrogacy is referred to as gestational surrogacy, as the woman who gives birth is not biologically related to the child. The idea led to other medical advancements, including test tube gestation.
Another pro that can be cited is the advancement of the concept itself. As mentioned, many surrogate mothers do not have intercourse with the father of the child. However, it was determined that insemination can help families where the wife is barren. In fact, the Mary Beth Whitehead case was one where the surrogate, Mary Beth Whitehead, was inseminated with Bill Stern’s sperm. Therefore, the baby is genetically related to Mary Beth Whitehead. Insemination is a procedure where sperms are harvested and injected into a woman at the time of ovulation. No sexual intercourse is involved. This type of surrogacy is referred as traditional surrogacy in the medical field.
Despite the medical advantages of surrogacy, the concept is also medically flawed. Many of the flaws associated with surrogacy tend to be physiological, rather than physical (Bailey, 2011). There have been cases of emotional attachment to the baby, such that the surrogate mother refuses to give the child to its intended parents. This disadvantage affects both gestational and traditional surrogacy (Parks, 2010). However, it is more prevalent in traditional surrogacy. In addition, emotional distress and feelings of dissatisfaction have also crippled some surrogate mothers. Drawing from the Mary Beth Whitehead story, she was so emotionally disturbed by the thought of giving her baby to the Sterns, that she went to court to contest it. During the court case, Mary Beth Whitehead asserted that she had become emotionally attached to the baby.
Additionally, surrogacy can cause health issues for the baby. It is a common occurrence in traditional surrogacy. Health problems can be a significant concern because many surrogate mothers get recruited by agencies and not by hospitals (Bailey, 2011). Such agencies may not be thorough in investigating the health backgrounds of the people involved. In the same breadth, there are hospitals that also ignore the importance of checking the medical history of the surrogate mother. Thus, the baby gets exposed to hereditary conditions that both the biological mother and the father may have. Similarly, gestational surrogacy also does not prevent the baby from catching the biological parents’ genetic conditions. Hospitals and medical practitioners have not been keen in analyzing the health conditions of the parents in gestational surrogacy. It is usually assumed that the biological parents would still have the baby if they were capable, but never consulted with doctors over their hereditary health conditions. For example, an Australian couple recently abandoned their son after realizing that he had Down syndrome (“Conflicting claims over”, 2014). This shows that the doctors were not keen in analyzing the health condition of the biological parents.
It suffices to mention that surrogates who are experiencing pregnancy for the first time through the surrogate pregnancy procedure can also have medical problems that can only be recognized during pregnancy. For example, problems such as miscarriages can occur. Even though there are women who opt to be inseminated again after a miscarriage, there are those who refuse. This not only leaves both parties disillusioned, but it also wastes time and resources.
Ethical Issues Associated with Surrogacy
As can be imagined, there are numerous ethical issues that are associated with surrogacy. One such issue is the feeling of abandonment that surrogate mothers get whenever they give the baby to the intended parents. In the Mary Beth Whitehead case, even though she had entered into the contract to get money, she still became attached emotionally to the baby. She refused to give the child to the Sterns completely, claiming that it was her baby as well. Biologically speaking, the baby was hers; however, she had agreed to give it to the Sterns. The ethical dilemma in this scenario can be analyzed in two ways. The first way is by examining Mary Beth Whitehead’s feelings of abandoning her child. The second way is telling the Sterns that Mary Beth Whitehead had the right to claim the baby as her own. The Sterns had tried getting a child for a long time. However, the couple decided to use a surrogate upon discovering that the wife had multiple sclerosis. They had to wait for nine months to welcome the feeling of parenthood. Thus, telling them that they could not have the baby they knew they were getting at the end of the pregnancy was ethically wrong.
Another ethical issue that can be cited is the right of the child to know about the surrogacy. Many children do not think about how they were born. However, in the cases where the intended parents opted for traditional surrogacy, it may be important to tell the child about it later on when he or she is fully grown and can understand. It is important not only for ethical reasons, but also to avoid future dilemmas, such as the child getting married to their biological relatives (Parks, 2010).
Additionally, there are religious institutions that find the practice wrong (Knoche, 2014). Medical practitioners have been bombarded with both questions and criticism of the religious nature regarding surrogacy. Some people find it unnatural, thus, ungodly. In the same vein, such people traumatized the parties involved in the surrogacy.
The children of the surrogate mother have to be considered, as well, when discussing ethical issues associated with the procedure. Children have to be psychologically prepared for the pregnancy (Knoche, 2014). However, this can be a little difficult, as some of the children may be very young to understand. Psychiatrists have raised concerns over the impact of children seeing their mother pregnant and not seeing the baby at the end of the pregnancy in surrogacy. The situation worsens if the surrogate mother goes through multiple surrogate procedures.
Nursing Implications of the Ethical Issues
There are numerous implications that arise from the ethical issues discussed above. One such implication is autonomy. Autonomy refers to the right of people to make decisions about their medical treatment (Parks, 2010). In surrogacy, the boundaries of autonomy are not defined clearly. For instance, the intended parents may refuse the drugs the surrogate mother wants to use for treatment, yet surrogacy does not prevent women from getting sick. In addition, there are some conditions that crop up due to pregnancy. For instance, hypertension and urinary tract infections are very common in pregnant women. Given that autonomy requires a patient to decide about their treatment, it becomes difficult when the person involved is a surrogate. The surrogate not only treats herself, but she also takes drugs that may affect the baby. In many instances, the drugs taken during pregnancy do not harm the baby, if the surrogate consults with a doctor first (Parks, 2010). However, there are some intended parents who still refuse to expose their child to drugs.
In the same vein, emergency treatment of a surrogate can bring up ethical issues. For instance, there are cases where women have to be given first aid to save their lives. There are also accidents that may prompt the surrogate to get fast treatment. However, the nurses do not have any authority to treat the surrogate without the permission of the intended parents if the agreement forbids. The medical practitioners have a difficult time deciding what they need to do to save the surrogate, at the same time not breaching the surrogacy contract (Haberman, 2014).
Similarly, the choice of ‘best interest’ can cause an ethical dilemma for nurses and medical practitioners, in general. The principle of the best interest denotes that the best interest of the patient should always be put first. Therefore, if a patient decides not to take a treatment, then the medical practitioners cannot force it on the patient. It becomes an ethical dilemma because the surrogate is carrying the child of a different couple (Haberman, 2014). The biological parents have every right to determine the medical procedures done on the surrogate, especially if the procedures may affect the child.
All these ethical dilemmas limit the reach of the nurses and the medics, in general. The nurses are either unable to treat the patient, or they decide to treat the patient and deal with the consequences later. Treating the patient while ensuring the baby is also well is crucial to every nurse. However, there are cases where one’s life is put at risk to benefit the other. In such cases, the nurses and doctors have to analyze the situation carefully and talk to the intended parties to find a solution. However, according to the law, the woman who gives birth to a child is the mother of the child (Knoche, 2014). Thus, the surrogate mother can decide what should be done in the case of a life-threatening situation.
In conclusion, there are various challenges that make surrogacy difficult. For instance, there are medical and ethical problems that may arise in surrogacy, regardless of the type of surrogacy used. For example, there are children who are born with medical conditions that the intended parents do not embrace. A percentage of parents who receive children who have body defects abandon the baby and leave it to the surrogate mother, claiming that the condition came from the surrogate. Additionally, traditional surrogacy can indeed give the child some birth defects that are genetically borrowed from the surrogate. The major ethical issue associated with surrogacy is autonomy, as the surrogate may not be able to decide her treatment. This creates problems because the intended parents may want to control the surrogate, including choosing the kind of medicine she can take.
References
Bailey, A. (2011). Reconceiving surrogacy: Toward a reproductive justice account of Indian surrogacy. Hypatia, 26(4), 715-741.
Conflicting claims over Thai surrogate baby case. (2014). BBC. Web.
Haberman, C. (2014). Baby M and the question of surrogate motherhood. The New York Times. Web.
Knoche, J. W. (2014). Health concerns and ethical considerations regarding international surrogacy. International Journal of Gynecology & Obstetrics, 126(2), 183-186.
Parks, J. A. (2010). Care ethics and the global practice of commercial surrogacy. Bioethics, 24(7), 333-340.