always be taken for granted as purely altruistic. Motives such asredemption, guilt or money (as is the case in commercialsurrogacy) demonstrate that the decision to become a surrogateis based on a complex range of factors and psychologicaldispositions.
FRAGMENTATION OF THE MATERNAL-INFANT BOND
Important biological bonds are established between the motherand her foetus during pregnancy. Even the scent of a newborncan attract the mother, as each mother can identify her owninfants’ odour when presented with the odour of several otherbabies.
One of the most concrete examples of the importance of the maternal-child bond comes from foetal-maternal physiol-ogy. The hormone oxytocin plays a crucial role in priming thegestational mother to respond in accordance with her naturalmaternal instincts. It is a response triggered by skin to skincontact and eye gazing, which promotes further psychologicaland physiological bonding.
An interesting study by Widstrom
revealed that if the lips of an infant touch the mother’snipple in the first hour of life, a mother will decide to keep herbaby in her room 100 min longer on the second and third day during her hospital stay than another mother who does nothave contact with her infant until later. Additionally, thedevelopmental psychology literature indicates that there is acrucial window of time from the moment of birth onwards,whereby a baby begins to form cognitive attachments throughinteractions with the gestational mother.
The cognitivepsychology literature on early childhood development alsoemphasises the importance of the psychological bonds formedfrom birth and onwards.
Humans have a very basic response to expressions of emotionin others, and infants in particular display a basic drive to matchbehaviour and psychological expressions in persons closest tothem at the earliest of stages. Numerous studies have revealedthat infants react to their mother’s emotional expression withtheir own. They seek out the most immediate emotional beingto participate with in an ‘‘inter-subjective game’’. Rather thanliving in a buzz of ambivalence or confusion as envisaged by some, an infant’s behaviour is innately fashioned to coordinatewith the social behaviour of other people. This demonstratesthat an infant already has the cognitive mechanisms andpsychological capacities in place to influence as well as beinfluenced by other people, and in particular his or her birthmother.
Therefore, at the very least, one ought to beconcerned with any process that disrupts the importantbonding between mother and child which begins duringgestation and continues after birth. Surrogacy ruptures thisbonding.Such is the strength of the bond and emotional attachment of the surrogate mother to the child that there have been many cases from around the world where a surrogate mother has beenunwilling to relinquish her child; consider, for example, theBaby M
and Evelyn cases.
As evidenced in these much-publicised cases, having to relinquish a child can be heart-wrenching, the end result being custody battles. Added to this isthe evidence that surrogates may live with the psychologicalburden associated with giving up their gestational child formany years.
These matters reinforce the difficulty, if notimpossibility for a surrogate mother to give informed consent.In relation to the difficulties with relinquishment, certaincritical questions must be asked. What happens when there is areluctance or refusal to stick to the original surrogacy agreement
What if neither the surrogate nor the commission-ing parents want the child
By its very nature, a surrogacy arrangement is likely to lead to more custody disputes becausethe child is born into such unusual circumstances by being theoffspring of more than one family group. No legislationpermitting surrogacy can accommodate such complicationswithout leading to seriously undesirable consequences such aslitigation, custody battles, all of which occur at the expense of the child’s welfare.It could be argued that an argument against fracturing thematernal-infant bond in the case of surrogacy also applies tocases where a mother gives up her baby for adoption. As such,why would surrogacy be more ethically objectionable
Firstly,the arguments prescribed here do not constitute an objection toadoption per se, since the crucial distinction between adoptionand surrogacy is that the latter is an intentional decision torelinquish a child to a commissioning couple without thewelfare of the child being paramount, whereas adoption is, in asense, ‘‘rescuing’’ a child from difficult circumstances, in whichcase it is the child’s welfare that is of primary concern.The fracturing of family structures, due to divorce orseparation, neglect and abuse is highly undesirable and childrenwho find themselves in such unfortunate circumstances becomeno less than innocent victims. Single mothers who are socio-economically disadvantaged may decide that placing the childup for adoption is in the best interests of her child (suchcircumstances are unfortunate and obviously undesirable). Insome extreme cases of neglect, there may be grounds forremoval of the child for adoption or placement in foster care.However, giving up a child for adoption is a decision that isnever taken lightly. It is essentially a decision that is predicatedon the primacy of the child’s welfare. It is essentially concernedwith finding the best outcome for the child given theunfortunate situations that many find children find themselvesin, which often cannot be reversed. The essential differencebetween surrogacy and adoption is, with regard to surrogacy,that the surrogate mother and commissioning parents haveintentionally and consciously decided, prior to the conceptionand birth, to hand the child from the gestational mother to thecommissioning couple. The ethically relevant difference residesin the difference in relation to intentions and foreseeableconsequences. In a surrogacy arrangement, unlike adoption, thewelfare of the child is not the primary objective, but instead, itis subordinated to fulfilling the desires of an infertile couple tohave a child. It might be expected that a child born of surrogacy would experience the difficulties experienced by an adoptee inaddition to those unique to surrogacy.
CONTRACTUAL ISSUES AND HEALTH RISKS
A diagnosis of disability or disease, even if equivocal, could leadto serious problems with a surrogacy arrangement. For example,a prenatal diagnosis of disability or perceived imperfection couldresult in the commissioning couple reneging (such a case hasalready occurred in the US).
In the case of a diagnosis of disability, depending on the circumstances and severity, theoption of abortion could be considered by the surrogate;however, differing moral perspectives on abortion have thepotential to result in an irresolvable stalemate. The surrogatemay still wish to proceed with the birth; however, thecommissioning couple may no longer want the child. Alternatively, the surrogate may choose an abortion contrary to the wishes of the commissioning couple.Given that gestational surrogacy involves ART, the healthrisks in ART are pertinent to surrogacy. According to a recentreview, ART is responsible for approximately 50% of allmultiple births worldwide,
and about half of IVF pregnancies
Law, ethics and medicine
J Med Ethics