Debate on Reproductive Justice: To what Extent

is “Altruistic Surrogacy” Morally Permissible?

Subject registered: Philosophy

Word Count: 3774
TABLE OF CONTENTS

Abstract

Introduction

Investigation on the Essence of Surrogacy

Perspective from Anti-natalism

Questions on “Altruistic Deeds”

Conclusion
Introduction
With the advent of Assisted Reproductive Technologies (ART), gestational surrogacy has
been more accessible for individuals or couples (intentional parents) to pursue children with
genetic bounds with them1. The objective of the paper is to discuss the moral validity of the
action of “altruistic surrogacy” by dissecting the permissibility into three fundamental
problems--the philosophical nature of the action with respect to the society, the examination
on the ethical necessity of gestational surrogacy, and the evaluation on the power dynamics
implicated by the term “altruistic.” Three questions (what, why, who) regarding altruistic
surrogacy go forward one by one, based on the philosophical characteristics of pregnancy, the
second part is going to further argue the pros and cons of surrogacy through the perspective
of care ethics. Finally, comparing to the physical and economic exploitation of commercial
surrogacy, this paper is going to call into doubt of the non-profit and “altruistic” essence of
the labour of giving birth and the underlying patriarchal values behind the technology of IVF
and blood relationship. This essay focuses solely on the philosophical analysis of the idea
with certain reference to biological aspects and avoid discussion on transnational surrogacy
or legal views surrogacy involving contract laws. Additionally, this is essay does not focus on
further psychological investigation on intentional parents in every surrogacy case or the
corresponding sociological research, which are also crucial in deciding if the altruistic
surrogacy is moral.
The word “surrogate” is rooted in Latin “Subrogate” (to substitute), which means “appointed
to act in the place of.” 2 Surrogacy is separated into two kinds--traditional surrogacy and
gestational surrogacy. Traditional surrogacy, also known as partial or genetic surrogacy,
involves artificial insemination. The process does not require the Ovum Pick-up(OPU)
surgery and artificial fertilization (IVF) because the surrogate mother will only borrow the
sperm from the intended father to form a zygote. On the other hand, most couples seeking for
surrogacy when do not have the condition to bear a child. Gestational surrogacy, or full
surrogacy, involves IVF to make “an embryo from the intended parents or from a donated
oocyte or sperm3” which is finally transferred to the surrogate uterus. The surrogate mother in
gestational surrogacy is “injected” with an embryo and carries the child who has no genetic
connection with her.
This essay mainly focusing on the latter form of gestational surrogacy. Two important roles
are worth mentioning: the surrogate mother and the intentional parent or parents. The
surrogate mother are the women who hold the intentional to give away third new-born after

1
Patel, NayanaHitesh, YuvrajDigvijaysingh Jadeja, HarshaKarsan Bhadarka, MolinaNiket Patel, NiketHitesh Patel,
and NilofarRahematkhan Sodagar. “Insight into Different Aspects of Surrogacy Practices.” Journal of Human
Reproductive Sciences 11, no. 3 (2018): 212. https://doi.org/10.4103/jhrs.jhrs_138_17.

2
“What Is the Difference between Altruistic Surrogacy and Commercial Surrogacy?” Brilliant Beginnings, June 25,
2020.

3
Patel, NayanaHitesh, YuvrajDigvijaysingh Jadeja, HarshaKarsan Bhadarka, MolinaNiket Patel, NiketHitesh Patel, and
NilofarRahematkhan Sodagar. “Insight into Different Aspects of Surrogacy Practices.” Journal of Human Reproductive
Sciences 11, no. 3 (2018): 212. https://doi.org/10.4103/jhrs.jhrs_138_17.
the labour; the “intended” parents are another person or couple who has the intentional for the
birth of the baby and will be responsible for raising the baby. Varied from different countries
and states, laws are different regarding the legal parenthood of the surrogate baby, which this
essay will avert the discussion upon. This paper generally opposes the conduct of altruistic
surrogacy because a) its amplifying on the alienation of labour b) the existence of an
alternation and c) the concern with an authentic “altruistic” deed.
The first part of the paper will divide the process of surrogacy into four parts--in vitro
fertilization (IVF)4, pregnancy, birth, and breast-feeding. By comparing mainly Marx and
Beauvoir’s theory of alienation of labour, this paper argues that altruistic surrogacy, under
most circumstance, fits into the logics of the alienation of personhood. Furthermore, this
essay would argue that surrogacy should be regarded as a form of labour that are highly liable
to alienation. Secondly, this essay pitches the ground of surrogacy with the option of adoption
and call into the doubt of the patriarchal value system emphasizing “blood relationship.” A
supporting point of view of the argument is the care ethical interpretation of motherhood that
it is cultivated through the action of care rather the notion of kinship. Though this part takes
radical stance that nearly denies the necessity of pregnancy, this essay does not fully
undermine the general reproductive rights for most heterosexual and homosexual parents.
The third part of the essay is going to focus on the wider scope of the philosophical
consequence of normalising surrogacy—both altruistically and commercially. A
counterargument of my idea that the less profitable involvement can largely purify the action
of surrogacy is that if the activity is objectively treated as a job, why is further compensation
to the surrogate mother prohibited in most of the countries legalising altruistic surrogacy5? In
the case of surrogacy, we may have to separate the idea of surrogacy as a mean for women to
experience pregnancy and as an end for women to earn money. By comparing surrogacy with
and without the profitable sector, this essay finally argues that Surrogacy should not be
regarded as morally permissible because it coerces women to a worse plight of an existential
crisis regarding reproduction and their body.

In conclusion, under most patriarchal societies, the so-called “altruistic surrogacy” is often a
mirage on having a baby with genetic tie: while there is certain possibility to bring a sense of
satisfaction to surrogate mother and create a genetic-linked neonate to intentional parents, the
deed of altruistic still very much undermines the emotional attachment of the surrogate
mother and their autonomy of their body and reproductive choices. Under society with minor
gaze on women and motherhood, the reproductive rights of unfertilized couples are ought to
be respected. Therefore, altruistic surrogacy is acceptable when the surrogate mother is fully
aware her rights and other choices. While the definition of “altruistic surrogacy” may be

4
Wang, Jeff, and Mark V Sauer. “In Vitro Fertilization (IVF): A Review of 3 Decades of Clinical Innovation and
Technological Advancement.” Therapeutics and Clinical Risk Management 2, no. 4 (2006): 355–64.
https://doi.org/10.2147/tcrm.2006.2.4.355.

5
“Surrogacy Laws by Country.” Wikipedia. Wikimedia Foundation, January 29, 2022.
https://en.wikipedia.org/wiki/Surrogacy_laws_by_country.
universal, the practice and the concept of the “altruistic surrogacy” diverges distinctively
around the world.

The idea of “altruistic surrogacy” bears huge ethical menace under most countries around the
world. Therefore, this essay argues that “altruistic surrogacy” is morally impermissible from
both deontological and consequential points of view.

Essence of surrogacy: Is altruistic surrogacy a form of “alienation of

labour”?

Before we enter the analysis of Marx’s argument on the nature of alienation and exploitation,
it is foremost to mention that the following discussion on the alienation of labour is from a
macro and societal perspective. Therefore, besides the nature of surrogacy, this essay argues
for three criteria to visualize the level of alienation of labour--female’s discourse of power,
female’s legal rights and government capacity of law enforcement. In addition, a line should
be drawn between the reasoning between commercial surrogacy and altruistic surrogacy as
the former is clearly an economic and physical exploitation of women, the latter allows an
alloyed perspective into the action of gestational surrogacy.

As Kant has remarked, “the transference of one’s property to someone else if its alienation.”
The idea using quantified number of currency to sell things are regarded as a deviation from
an object’s original meaning. While Karl Marx believes “work” is that crucial element within
human nature that can be alienated in the society by four aspects. Humans can be alienated
from (a)nature, (b)ourselves, (c) species-being (d) other people.6 Originally, Marx argues the
alienation of nature happens when workers are separated from the natural resources they
obtain to make it a product that is one part of themselves. In the case of gestational surrogacy,
a plausible argument may be: the alienation from nature is manifest in a way by in vitro
fertilization (IVF). The surrogate mother should have the opportunity to bear a children
through natural manners, or at least, endure a process that is less unpredictable than IVF.
While Marx is trying to emphasize the working environment is apart from nature, the later
phases in surrogacy, which are pregnancy, birth, and breastfeeding still seems a fine
embodiment of the surrogate mother to nature.

However, a more serious issue came with the alienation of “ourselves”. Marx argues that
alienation of ourselves occurs when “work” is externally imposed on us. The exhausted labor
denies people’s value in themselves. As a result, Marx states that the worker “feels himself to
be freely active only in his animal functions--eating, drinking and procreating...while in his
human functions he is reduced to an animal.” In the case of surrogacy, the surrogate mother is
constantly carrying a child not from her own, rather a child from others and will be raised by

6
Marx, Karl, Cedar Paul, and Eden Paul. Capital. London: Dent, 1974.
others. From the point of view of ‘others’, surrogate mothers can be reckoned as merely
containers for the baby. However, a discrepancy of Marx’s idea of human and animal
function is put forward--Does the action for being a container lean towards human or animal
function? Like Mill’s identification of higher and lower happiness, Marx seems to emphasize
that humanistic creativity in labour grants itself with value and prevent it from alienation. The
repetitive works that can be replaced by machines therefore leads to such alienation of labor.
When we look back to the issue of altruistic surrogacy, it seems just a matter of time that
artificial womb7 can replace pregnancy in the future. There is thus limited space for
“creativity” during the process, such restriction is largely based on biological existence. A
critique of this view is Simon de Beauvoir’s idea of the constructed value of females and their
bodies.

I argue that though the action of surrogacy demonstrates human function to a greater extent,
pregnancy can be a form of alienation for most women. The first evidence is that we fail to
find a proper practice of surrogacy in most of the animal world and women’s intentional
surrogacy is rather a product from human society that offers women with the choice to divide
the action of pregnancy and parenthood. In Second Sex, Beauvoir wrote, “It is not the nature
that defines women; it is she who defines herself by dealing with nature on her own account
in her emotional life.” I think a female’s positive will to use her privilege of pregnancy is
remarkable. In Beauvoir’s account for the biological composition of women, she marks the
fact that most females in sexual reproduction species are alienated, or even, enslaved by the
whole species, the destiny to pass down the gene. A debate therefore should be raised, is it
just because it was written and heavily emphasized in the animals’ DNA that reproduction is
their destiny should we accept the fact that we should distinguish the situation of
reproduction for humans and animals? According to Beauvoir, it was a universal account for
all females being condemned to passing down the genes for the species because of the pain of
labouring8. However, from the scope of human species and societies, the distinction of the
homo sapiens are far out of the horizon. To pass down gene for the continuation of a species
therefore is not justified for the sake of a “greater good.” This further supports my argument
that the means of surrogacy is rather functional to a system based outside objective
necessities. With any outside forces or societal beliefs that directly link the female body to
womanhood, surrogacy reveals an intrinsically alienated relation between the two, which is,
unfortunately, the circumstance under most societies.

In regards of the issue with female body, several academic papers draw an analogy between
surrogacy and prostitution9. Personally, I find it inappropriate because the womb is the most
distinctive biological difference between males and females as the latter can be practiced by
7
Partridge, E., Davey, M., Hornick, M. et al. An extra-uterine system to physiologically support the extreme
premature lamb. Nat Commun 8, 15112 (2017).

8
The Second Sex. Erscheinungsort nicht ermittelbar: Vintage Classics, 2015.

9
SERA, JEAN. “Surrogacy and Prostitution: a Comparative Analysis,” n.d.
both sex and surrogacy is an exclusive option for females. Bearing in mind, the essence of
alienation identifies the otherness in story— “her body is something other than herself.”
Surrogacy especially magnifies such “otherness” not only because of the huge pain and
suffering one must undergo during pregnancy, but also because the new-born is going to be
given away after labour. It does not matter if the process involves a certain economic
transaction, the instrumental use of the body is amplified throughout surrogacy.

Another reason to argue that surrogacy is the alienation of labour is the female’s
physiological reaction to labour—change in bone structure and breast. As marked by
Beauvoir, “Breastfeeding is also an exhausting servitude; a set of factors —the main one
undoubtedly being the appearance of a hormone, progesterone…he arrival of the milk is
painful and is often accompanied by fever…feeds the new-born to the detriment of her own
strength.” I’m trying to highlight the fact that the biological bases of the surrogate mother
determine the fact that she must endure a certain level of bodily alienation during surrogacy.
If the baby is taken away right after labour, the surrogate mother would have to undergo a
series of reactions from her body that was genetically designed to welcome a new life of her
own; if the baby is sent away after months of breastfeeding, the surrogate mother would have
to overcome the emotional bond between her and the neonate. I would argue that the process
of bearing a child to women is like the creation of a pre-industrial revolution handicraft to
craftsmen.

Anti-natalism and Non-identity problem: Is it necessary to have a

blood-related child through surrogacy?

This part of the essay is going to dissect the deontological grounds for altruistic surrogacy
from the view of the neonate and the mother. By raising the non-identity problem and
emphasizing on an alternative of parenthood, which is adoption, I attempted invalidate the
ground for surrogacy, or ART in general, is to bring more happiness to intended parents’ life
by creating another life. Moreover, this part of the essay argues that the involvement of
another fertile women instead of adoption is an extension to societal demand of womanhood
from individual and marks the consolidated system of kinship instead of care.

The non-identity problem seems to interrogate the ethics of bringing a new life to the world.
The thought experiment supposes that every individual would have a life with unavoidable
flaws. In the case of surrogacy: the intended parents’ alternatives for expecting a new life
is either not to bring anyone in existence or to bring a different life – a nonidentical but
better off person – into existence in place of the one person. It is more explanatory to put the
paradox into extreme situation.10 For example, A’s mother is informed that fetus A has
congenital defect that will bring huge misery to A if A is born. In this case, it is morally

10
Roberts, M. A. “The Nonidentity Problem.” Stanford Encyclopedia of Philosophy. Stanford University, April 2,
2019. https://plato.stanford.edu/entries/nonidentity-problem/.
permissible for A’s mother to have abortion because the bad that an agent confers along with
any unavoidably flawed existence counterbalances the good that an agent confers along with
existence. In more obscure and extreme cases, nevertheless, people argue that because most
of life in general is unavoidably flawed, giving birth to a baby is unethical as the bad
counterbalances the good. An argument formed by anti-natalist philosopher Benatar holds the
premise that “avoiding pain is always good but being denied pleasure is never bad.11” Benatar
further argues that “bring a life into existence will always harm it but failing to bring that
being into existence will only deny them pleasures they’ll never know.12” Therefore,
reproduction is always unethical.

This counterintuitive argument gives ground on why the choice to bring the one person into
the flawed existence is morally wrong through a pessimistic view of human life and method
to use little imaginary amount of happiness to combat huge realistic number of flaws.
Additionally, Benatar seems to argue through the perspective on the universal view to the
total amount of human happiness instead of the individual cases of new-born. I agree on the
logical matrix he used to ‘calculate’ the good and bad but I’m strongly against his evaluation
on the meaning of human life. Every existentialist philosopher will disagree on this method
using predicted future to cut down the present life as they believe the meaning of life is
discovered through experience into this. In addition, such experience is always private the
subject perceiving it. Thus, it is unsound to use the child in a de dicto sense of “future
individuals” to judgement on the de re identity.

My argument unfolds by comparing the choice of creating the new life by surrogacy (de
dicto) to another option of adoption (de re) . As mentioned in the previous part that surrogacy
is rather a physical and psychological challenge for the surrogate mother, the action of
surrogacy involves else’s interests in this sense as it not only a choice between the
intended parents and the baby. There factions in surrogacy contract are morally
equivalent. However, some may argue if three parts are equivalent, does the denial on the
ground of surrogacy undermines the potential right of the infant? In the analysis of the
matrix of de dicto ana de re, which mean concerning the proposition(dictum) and
concerning the thing, the infant has a “precariousness” of existence. As the intended
parents choose to adopt another child to fulfil their will of parenthood, the intentional
baby through surrogacy does not count into a moral existence. Adoption is more ethical
than surrogacy in a way it will largely change the life of another existed being. Such
option not only reduces the harm by the eliminating risk of surrogacy, but also adds to the
good to the adopted child and provide a family for his or her growth.

Famously framed by philosopher John Locke, the aim of procreation is to continue the
species13—remaining the balance of the gene pool--and to educate generation. Yet he was not

11
Benatar, David. The Case for Not Being Born, n.d.
12
Ibid.

13
Locke, John, and Mark Goldie. Locke: Political Essays. Cambridge: Cambridge University Press, 2006.
encouraging unlimited procreation but certain number of children per family to avoid an
explosion in population and the restricted social resources led by the situation. The
educational and non-genetical parenthood is manifested by adoption over surrogacy. Linking
back to the idea of educating child and the action of care to Beauvoir’s account of pregnancy
and motherhood, the process of surrogacy seems rather redundant comparing to adoption.

While parenthood focus on the cultivation of spirit and human beings, kinship, which I would
argue it one of the main goals of surrogacy instead of adoption, emphasizes more on the
passing down of genes. It further supports the essence of surrogacy is using female body as a
functional instrument to certain individual gene. However, I would argue that the difference
between two emphasis of reproduction differs from a patriarchal value system and care ethics
system. The former focus on a distant view halting at a point which the neonate carrying his
or her gene is externalized to the physical world. The latter, more like a study of virtue, focus
on the interpersonal and intrapersonal relationship based on the action of care. While the
former may lead to tendency alienating the child, surrogate mother, and even intentional
parents as a creature within the whole pool of species, the latter leave more space for the
growth of humanity part of parenthood.

Comparison between commercial and altruistic surrogacy—Money or

Womanhood
In The Huainanzi: A Guide to the Theory and Practice of Government in Early Han China,
Confucius put forward the idea that if something is moral and commendable, people should
be encouraged with materialistic awards, such as money, to consolidate the values manifested
in their actions.14 The “goodness”, or virtue, in surrogacy, is different from the virtue in brave
deeds when one jumped into deep water saving another. Like mentioned in the previous
analysis, the extended womanhood realized by biotechnologies always hold further
connotation beyond the action itself. According to Confucius, altruistic surrogacy is absurd
because the encouragement of “kind assistance to the infertile couple” is moral, thus should
be awarded. This becomes the basic logic of commercial surrogacy.

In contrast, Kant separate the intrinsic worth and external recognition as “dignity” and
“price” by saying “In the kingdom of ends everything has either a price or a dignity. What
has a price can be replaced by something else as its equivalent, what on the other hand is
raised above all price and therefore admits of no equivalent has a dignity.15” Kant supports
the world-wide definition of surrogacy as it manifests the highest level of dignity, therefore
the noble deed has no toleration of price to equivalent it. This is the foundation of altruistic
surrogacy.

14
ZHANG, xinqing. “The Forth Series of Discussion on ‘Life Dignity’: Dies Surrogacy Offend Human Rights,” n.d.

15
Kant, Immanuel. Groundwork of the Metaphysic of Morals. 4:435. Vol. 4:435. Digireads.com Publishing, 2017.
Though in this highly capitalized world, the rules are always set under the consideration of
economics, this essay call into the doubts into the most crucial step of the two moral
philosophy approach which is determining the “righteous value” that the society is
encouraged to follow. Both systems aim form a consolidated and pure moral system for the
society by promoting and glorifying the desired action among the public. Part of the
difference between two categories of surrogacy is based on its effect on moral system.
Altruist surrogacy, on the hand, is not more purified than commercia surrogacy in the process
of IVF and its effect on surrogate mother.

The alienation of females lies in the process and idea of breeding a life with artificial
technology in another women’s life and neglecting the ties between an emotional mother and
the baby. The extended womanhood refers to a higher and wider range of social expectation
for women to do. They are regarded as capable of bearing child not only for themselves but
others; they shoulder more responsibility to house and are expected to work as a man. If the
value system deeming reproduction is a woman’s destiny is not changed, the more the
woman can do, the more they are limited.
Conclusion

This paper questions the moral permissibility of altruistic surrogacy by dissecting the process
of it into four parts that makes women’s body “other than herself” from biological and
psychological reason. Moreover, it argues another option of adoption is a more ethical way to
experience parenthood without individual emphasis on blood relationship. Lastly, this essay
points out the potential of fake “altruism” that induce women to altruistic surrogacy with the
impact of social conventions.

However, all the arguments in this essay focus on the situation where woman has limited
chances and insights into reproduction and their future. If under a more gender equal society,
the authorization of altruistic surrogacy should demonstrate a high level of women’s
autonomy of their own body and choices. The ability to reproduce is rather a female’s gift to
offer others than a gift by nature that is readily to be borrowed.

This essay is lack of the primary sources from the female and is rather a vision towards the
women’s predicament under most circumstances of surrogacy in an analytical manner. In
conclusion, without the strong and independent desire from the surrogate mother, altruistic
surrogacy is morally impressible for its nature of alienation and with option of adoption.
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