I. THE EVOLUTION OF U.S.

SURROGACY LEGISLATION
Surrogacy practice in the United States began in the late 1970s and
early 1980s. 28 Initially, no states had legislation specifically addressing the
practice.29 During the early years, there was also no "unified position" of
feminist advocates and organizations regarding surrogacy.3 0 Like others,
feminists were grappling with their position on the practice.
This began to shift during the famous Baby M litigation.3' The Baby M
case involved a dispute between Mary Beth Whitehead, a woman who had
acted as a genetic surrogate, and the intended parents, Elizabeth and Bill
Stern.32 The case was the first disputed surrogacy case in the U.S. to result in
an appellate court decision. 33 The legal proceedings were carefully followed
in newspapers around the country.34 As the LA Times wrote at the time: "for
many feminists, the Baby M case crystalized anger and focused attention on
commercial ramifications of reproductive technology as well as what author
and Ms. Magazine editor Letty Cottin Pogrebin . . . called the concomitant
'potential for exploitation of poor women."'"3 By the time the Baby M case
culminated in 1988,36 the dominant public position of feminists was to oppose the
practice of surrogacy altogether.37
Some surrogacy opponents grounded their opposition in concerns regarding the
implications for women's bodies and women's reproductive
rights. For example, some feminists opposed the practice of surrogacy because, they
argued, "surrogacy degraded the female reproductive function."38
As expressed in a NY Task Force Report issued in 1988, "the characterization of
gestation as a 'service' . . . depersonalizes women and their role in
human reproduction.""9 Others raised concerns about the possibility of exploitation
of women, particularly poor women and women of color who,
they feared, would be coerced into making this reproduction-related decision.40
According to a group of feminist advocates, permitting surrogacy
would enable "an elite economic class to exploit a poorer group [of women]
as breeders."41 Some surrogacy opponents feared that women who agreed to
act as surrogates might later change their minds. Surrogacy bans, therefore,
would protect women from these "potential psychological . . . risks" associated with
this possibility.4 To be sure, the position of feminists was not monolithic. Some
feminists voiced early opposition to surrogacy bans. 43 For example, Lori B. Andrews
warned in 1988 that the rationales used to oppose the practice of surrogacy "may
come back to haunt feminists in other areas of procreative policy and family law."44
A "cornerstone" of feminist policy, she argued, is the principle that "women have a
right to reproductive choice."4 5 This includes the right to decide to act as a
surrogate (so long, she continued, as the woman maintained the right to make
decisions about her body and the pregnancy).46 The most vocal public position of
feminists at the time, however, was in opposition to surrogacy. These feminist
opponents of surrogacy were joined in their efforts by religious conservatives. 47 For
religious conservatives, "[s]urrogacy was simply one dimension of a larger threat to
core Catholic beliefs about family formation posed by new reproductive
technologies."48 Initially, this unlikely coalition turned out to be quite influential.49
Most surrogacy legislation enacted in the 1980s and 1990s were laws banning
surrogacy.50 Writing in 1990, Andrews reported that "10 states ha[d] made some
kinds of surrogate contracts unenforceable in court, including two that ha[d] also
outlawed surrogacy for pay.""' By contrast, a smaller number of states had taken
steps to permit the practice.5 2 Eventually, however, the legislative trend shifted. 53
Since the mid1990s, every state that has enacted surrogacy legislation in the U.S. has
enacted legislation that permits and regulates surrogacy. 54 (A few additional states,
including Arkansas, 5 Florida, 6 and Virginia, 7 have permissive surrogacy schemes
that predate this turning point.) This shift occurred for a range of reasons.58 First,
time and experience proved that surrogacy bans did not end its practice in the U.S.
Instead, surrogacy practice grew and expanded, 59 even in states without permissive
legislation.60 Parties often found ways around the bans. Intended parents could, for
example, work with a person acting as a surrogate in another state.6 ' When
practiced in a state without clear law, the parties to a surrogacy arrangement
typically had few if any basic safeguards and protections, and they often lacked
certainty about their legal statuses.6 2 Second, time and experience also revealed
that some of the key concerns held by surrogacy opponents had not borne out, or at
least not to the degree some feared. For example, most people acting as surrogates
in the U.S. and the U.K. report that the experience was a positive one, or least not
a highly negative one. 63 Few people acting as surrogates in the U.S. and
countries with similar legal regimes describe the arrangement as a coercive
one. 64 In addition, while people acting as surrogates in the U.S. generally
have fewer financial assets than intended parents, they tend not to be poor.65
Another factor is advocacy. Initially, there were few organized supporters of
surrogacy practice. That changed. Over time, more families have been
formed through surrogacy. These families and an established web of surrogacy
practitioners who represent them now actively push for permissive surrogacy
regimes.66 LGBTQorganizations have also joined in these efforts.
On the flip side, some of the strong feminist opposition to surrogacy dissipated. 67 As
lawyer and advocate Sara Ainsworth put it: "It's rarer [now] than
it was in the '80s and '90s to see feminists flat-out opposing surrogacy."6 Together,
these forces led to a shift in favor of permissive legislation.69
Many of these new statutory schemes incorporate inclusive rules regarding
intended parents.70 Inclusive, permissible surrogacy regimes offer a way for
all people-regardless of sex, sexual orientation, or marital status-to form
and protect families. 7
' In this way, inclusive surrogacy schemes further the
goals of equality and procreative liberty.72
Permitting surrogacy, some argue, also protects women's autonomy by
allowing them to decide to act as a surrogate.73 Some permissive schemes
also expressly protect the person's decision making and bodily autonomy
during their pregnancy. This is true in Washington state, for example. As
discussed in more detail below,7
4 Washington's newly enacted surrogacy laws
declare that "[t]he agreement must permit the woman acting as a surrogate
to make all health and welfare decisions regarding herself and her pregnancy
and, notwithstanding any other provisions in this chapter, provisions in the
agreement to the contrary are void and unenforceable. This is not true of all
statutory surrogacy schemes, however. In contrast
to the Washington law, some existing surrogacy laws include provisions that
are in tension with the goal of promoting the "ability of people to make
'decisions about [their] own bodies, sexuality, and reproduction."'76 Here, I
am speaking of laws in a number of states that allow for potentially sweeping
control over the lives, bodies, and decisions of people acting as surrogates.
Of the seventeen jurisdictions that enacted permissive surrogacy regimes
since 2000,77 six expressly permit the direct regulation of the bodies of pregnant
people, even over their contemporaneous objection. 78 Indeed, the laws
in some of these states require that regulation.79
Illinois is an example of a state that includes these types of troubling
statutory provisions. Illinois law states that a surrogacy agreement can require the
person acting as a surrogate to "undergo all medical exams, treatments, and fetal
monitoring procedures that the physician recommended for
the success of the pregnancy."0 Similar language appears in the laws of other
states, including Delaware," Nevada, 2 and Oklahoma." The Oklahoma
scheme expressly declares that such contractual clauses are enforceable.8
4
If specifically enforced, this kind of authorized contract clause could
result in a person being forced to undergo an invasive, risky medical procedure like a
cesarean section over their clearly stated, contemporaneous objection. Not only
would that result interfere with the person's bodily integrity in
the moment, it could also have more long-term consequences. "Women who
have cesareans are more likely to experience death, emergency hysterectomy,
blood clots and stroke, surgical injury such as bladder and uterine lacerations,
hemorrhage, infection, and intense and prolonged postpartum
pain."5 Cesareans are also associated with future infertility or complications
in future pregnancies. 86
A contract clause authorized under these laws could also require the
person to undergo an unwanted selective reduction when it is "recommended
to improve the outcome for the remaining fetus(es)."87 Theoretically, this too
could be required over the objection of the person acting as a surrogate as
surrogacy contracts often "provide that the intended parents have the right to
make all termination decisions."" Indeed, among other things, the contract
in the Baby M case included the following clause:
13. MARY BETH WHITEHEAD, Surrogate, agrees that she
will not abort the child once conceived except, if in the professional medical opinion
of the inseminating physician, such action
is necessary for the physical health of MARY BETH WHITEHEAD or the child has been
determined by said physician to be
physiologically abnormal. MARY BETH WHITEHEAD further
agrees, upon the request of said physician to undergo amniocentesis (see Exhibit
"D") or similar tests to detect genetic and
congenital defects. In the event said test reveals that the fetus is
genetically or congenitally abnormal, MARY BETH WHITEHEAD, Surrogate, agrees to
abort the fetus upon demand of
WILLIAM STERN, Natural Father . Two states-Florida 90 and Louisiana 91-go even
further. The statutes
in these two states require the person acting as a surrogate "to agree[ ] to submit to
reasonable medical evaluation and treatment and to adhere to reasonable medical
instructions about her prenatal health."9 2
Four states-Delaware, Illinois, Nevada, and Oklahoma-also include
statutory provisions that allow the agreement to require the person acting as
a surrogate to "abstain from any activities that the intended parent or parents
or the physician reasonably believes to be harmful to the pregnancy and future
health of the child."93 The authorized contractual clauses could and
often do cover conduct that is already prohibited under other laws, like ille-
gal drug use. These statutory provisions, however, permit requirements that
go far beyond prohibiting illegal conduct. Indeed, it is common for surrogacy
contracts to address issues as far ranging as whether and how much the person
acting as a surrogate can or must exercise, what kind of food they should
eat, whether they can use a microwave, how much sleep they should get, and
whether they continue to work.94 Some intended parents seek not only to
impose these rules but also to monitor compliance. Based on her study of
surrogacy contracts, Hillary Berk writes that one "California lawyer explained that 'it
is not unusual' for [intended parent] clients to request 'nanny
cams' for 'more access' to police the rules."95 Other intended parents "request
that their surrogates move in for 24-7 monitoring."96
In most cases, the intended parents and the person acting as a surrogate
are in alignment with regard to behavior during the pregnancy. Most pregnant
people-including people acting as surrogates-do their best to create
the conditions for a healthy and successful pregnancy. This is no small task.
The list of dos and don'ts of a healthy pregnancy is long and complicated.
For example, pregnant women are advised to eat fish, but not too much fish,
and only certain kinds of fish.97 They are advised to gain weight, but not too
much weight. 98 With regard to some issues, there may be no consensus. Advice
about whether and how much to exercise during pregnancy is a good
example. Again, most pregnant people do their best to provide for a healthy
pregnancy. However, in other contexts pregnant people generally99 have the right to
make these decisions for themselves.1 00 Laws that potentially authorize 24-hour
surveillance of pregnant people should be cause for concern.
To be sure, despite the express declaration of enforceability in some of
these statutory provisions, there are serious and unresolved questions about
whether such a provision would indeed be enforceable and, if so, whether it
would be specifically enforceable.101 Some scholars, for example, argue that
contract clauses related specifically to abortion decisions are not enforceable.102
That is the case, it is said, because the right to terminate a pregnancy
is an "inalienable" right.103 (Others disagree.1 04 ) With respect to other medical
decisions, some claim that any such clauses cannot, at the very least, be
specifically enforced under general rules of contract enforcement. Courts
typically will not order specific enforcement with regard to "personal services,"los
some argue. To date, however, there are no published decisions
addressing whether these or other similar kinds of surrogacy contract clauses
are enforceable and, if so, how I do not intend to wade into that debate. My point
here is a different
one. Regardless of whether these kinds of contract clauses are permissible or
impermissible under other existing legal doctrines, they are troubling from a
normative perspective. Laws like the ones described above rest on the principle that
women's decisions about their own bodies and their own health can
be subordinated to the wishes and interests of others.1 07 The state should not
condone their use and inclusion through its surrogacy laws
美國的代孕實踐始於 1970 年代末和 1980 年代初。28 起初，沒有任何州立法明
確規定這一實踐。29 在早期，女權主義者和組織對於代孕也沒有“統一立場”。
30 像其他人一樣，女權主義者正在思考他們對這種做法的立場。

這在著名的 Baby M 訴訟案中開始轉變。31 Baby M 案涉及 Mary Beth Whitehead

與預期父母 Elizabeth 和 Bill Stern 之間的爭議。32 該案是美國第一起引發爭議的
代孕案件，並最終得出了上訴法院判決。33 新聞報紙仔細關注了法律程序 34
當時洛杉磯時報寫道：“對於許多女權主義者來說，Baby M 案凝聚了憤怒並集
中注意力商業生殖技術帶來的影響以及作者兼《Ms. Magazine》編輯 Letty Cottin
Pogrebin 所稱的貧窮婦女被剝削可能性。”35 到 Baby M 事件在 1988 年達成高
峰時 36 ，女權主義者占支配地位公眾立場是完全反對代孕實践 37

某些反对代孕实践者基于对妇女身体和生殖权利影响方面提出反对意见。例如，
某些女权主义者反对这种做法是因为他们认为，“ 代孕降低了女性生殖功能
”38 正如 1988 年发布的纽约工作组报告所表达：“将妊娠描述为‘服务’...使
人格化了妇女及其在人类繁殖中扮演角色。”39 其他人则担心贫困、肤色不同
等弱势群体会被迫进行这个与生育相关决策而受到剥削 40 根据一组女权主义倡
导者称：允许使用替身母亲将使“精英经济阶层能够开发一个更穷困（ 女性）
作为育种家庭。“一些反對代孕的人擔心，同意擔任代孕母親的女性可能會改
變主意。因此，禁止代孕可以保護女性免受與這種可能相關的“潛在心理風險
”的傷害。當然，女權主義者的立場並不是單一的。有些女權主義者早期就反
對禁止代孕。例如，洛瑞·B·安德魯斯（Lori B. Andrews）在 1988 年警告說，用
來反對代孕實踐的理由“可能會回到其他生殖政策和家庭法方面困擾女權主義
者”。她認為，“女性有權選擇生育”是女權主義政策的“基石”，包括決定
作為代孕母親（只要該女性仍然保持對自己身體和妊娠做出決定的權利）。然
而，在當時最公開聲明立場上，大多數女權主義者都反對代孕。這些反對派與
宗教保守派一起努力。尤其是針對天主教信仰核心關於家庭形成所面臨新型生
殖技術帶來威脅問題中，“代孕只是其中之一”。最初，這個看似不太可能結
盟卻非常具影響力。20 世紀 80 年代和 90 年代制定了大部分禁止或限制使用合
法化程度低下、甚至無效果等各式各樣地區法案来规范这种行为。

1990 年撰写时, 安德鲁斯报告说：“10 个州已经使某些类型 的替身合同无法在

法院执行, 其中两个州也已经取缔了付费 产子。”与此相比, 较少数州已经采取
措施允许这种实践 。但后来立法趋势发生了转变 。自 20 世纪 90 年 以来 , 美国
每一个通过替身立 法 的 州 都 制 定 了 允 许 和 规 范 替 身 操作 的 法 律。(还
有几个州如阿肯色、佛罗里达和弗吉 尼亚等，在这个转折点之前就已经存在容
许替身计划) 这种转变出现了多种原因：首先 ，时间和经验证明 ，美国境内对
于该项实践进行禁止并不能结束其实践 。相 口 增 加 和 扩 展 ，即使 在 没 有
容 许 立 法 的 州 内 ， 实 行 方 式 经 常 找 到 继续进行下去方式；例如打算当
父母可以与在另一个州担任替身角色的人合作。
当在没有明确规则约束情况下开展业务时，则通常不存在基本保障措施，并且
他们通常缺乏关于他们法律地位方面确定性 60 個政黨經常找到規避禁令的方法。
例如，預期的父母可以與在另一個州擔任代孕人員的人合作。當在沒有明確法
律的州實行時，代孕安排的各方通常缺乏基本保障和保護，並且他們經常對自
己的法律地位缺乏把握。第二，時間和經驗也顯示出，一些代孕反對者所持有
的關鍵憂慮沒有得到證實，或者至少不像某些人所擔心的那樣嚴重。例如，在
美國和英國充當代孕人員大多報告說這是一次積極或至少不是高度負面影響力
的經歷。在美國和具有相似法律制度國家中充當代孕人員較少描述該安排是強
制性安排之一。此外，在美國充當代孕人員通常比預期父母資產更少，但他們
傾向於不貧窮。

另一個因素是宣傳活動。最初幾乎沒有組織支持代孕實踐者。這已改變了。隨
著時間推移，越來越多家庭通過代孕形成了，并且現在由表示他們利益的既定
网络上工作中介主動推動開放式代孕制度.同性戀組織也加入了這些努力。

另一方面, 一些強硬女權主義反對派消失了. 此外, 從事從事辯護工作及提供協助

Sara Ainsworth 如下表述: "現在看到女權主義者直接反对使用替身生育方式比 80
年代和 90 年 月要罕见." 这些力量共同促使立法朝着开放型立法转变.

这些新立法计划中许多都包含关于预期父母包容性规则. 包容、可行 的替身生

育制度为所有人-无论其性别、性取向或婚姻状态-提供组建并保护家庭 的方式.
以包容性代孕計劃進一步促進平等和生育自由的目標。有人主張允許代孕也保
護了婦女的自治權，因為它使她們能夠決定擔任代孕者的行為。一些寬鬆的方
案還明確保護了人在懷孕期間做出決策和身體自治權。例如，在華盛頓州，新
制定的代孕法律規定：“協議必須允許作為代孕母親的女性對自己和自己的懷
孕做出所有健康和福利決策；儘管本章其他規定相反，協議中與此相抵觸的條
款無效且不可執行。”然而，并非所有立法上都是如此。与华盛顿州法律形成
对比，一些现有代理怀孕法律规定与促进“人们决策其自身身体、性别和生殖
能力”的目标存在紧张关系。我指的是许多国家允许对担任替代母亲者进行可
能具有全面控制权力干预其生活、身体及决策权力之立法情况。从 2000 年以来
实施宽松代理怀孕制度共 17 个司法辖区中，6 个明确允许直接监管怀孕者甚至
在他们同时反对下进行监管。事实上，在其中一些国家/地区中，该项立法要求
加强管理限制权利。“以包容性代孕計劃進一步促進平等和生育自由的目標。
有人主張允許代孕也保護了婦女的自治權，因為它使她們能夠決定擔任代孕者
的行為。一些寬鬆的方案還明確保護了人在懷孕期間做出決策和身體自治權。
例如，在華盛頓州，新制定的代孕法律規定：“協議必須允許作為代孕母親的
女性對自己和自己的懷孕做出所有健康和福利決策；儘管本章其他規定相反，
協議中與此相抵觸的條款無效且不可執行。”然而，并非所有立法上都是如此。
与华盛顿州法律形成对比，一些现有代理怀孕法律规定与促进“人们决策其自
身身体、性别和生殖能力”的目标存在紧张关系。我指的是许多国家允许对担
任替代母亲者进行可能具有全面控制权力干预其生活、身体及决策权力之立法
情况。从 2000 年以来实施宽松代理怀孕制度共 17 个司法辖区中，6 个明确允许
直接监管怀孕者甚至在他们同时反对下进行监管。事实上，在其中一些国家/地
区中，该项立法要求加强管理限制权利。“四個州-特拉華州、伊利諾伊州、內
華達州和俄克拉荷馬州-也包括法定條款，允許協議要求擔任代孕人的人“避免
從事預期父母或醫生合理認為對胎兒和未來健康有害的任何活動。”93 授權的
契約條款可以並且通常涵蓋已在其他法律下被禁止的行為，例如非法藥物使用。
然而，這些法定規定允許要求超出禁止非法行為的要求。實際上，代孕合同通
常涉及範圍廣泛的問題，如代孕者可以或必須多少運動、他們應該吃什麼食物、
是否可以使用微波爐、他們需要多少睡眠以及是否繼續工作等等。94 一些預期
父母不僅希望強制執行這些規則，還希望監督其符合情況。根據她對代孕合同
的研究，Hillary Berk 寫道，“加利福尼亞州一位律師解釋說‘讓（預期父母）
客戶’要求‘保姆攝像頭’以便更好地接近警方规则是'不尋常'。”95 其他预
期父母“要求他们的代孕者 24 小时监视。”

在大多数情况下, 预计受孕者和扮演代孕角色者在妊娠过程中会达成共识. 大部
分怀孕女性 - 包括扮演代替角色者 - 尽力创造一个健康成功怀孕所需条件. 这并
不是小任务. 健康怀孕清单长而复杂. 例如, 怀孕女性建议摄入鱼类, 但不能太多,
只能摄取某种类型 97; 建议增重, 但不能增重太多 98; 在某些问题上可能没有共
识. 关于是否以及应该锻炼身体到什么程度这个问题就是一个很好例子.

再次说明，在某些立法条文中明确声明可执行性之外还存在严重而未解决的问
题：这样一个条款是否真正可执行？如果可执行，则具体实施方式为何？101
例如有学者认为与堕胎相关具体约束条款无效 102；因为终止妊娠权利是"不可
转让" 的 103 （其他人持反对意见 104）。关于其他医学决策方面，则有人声称
至少不能按普通服务规则进行具体实施 105 。 法院通常不会针对 "个人服务" 下
达具体实施命令 106 。迄今为止，并没有公开发表裁决来处理此类或类似于此
类别型号产生争议时如何执行。

我并不打算深入探讨这场辩论。我的观点与此无关 無論這些契約條款在其他現
有法律學說下是否允許，從規範的角度來看，它們都令人不安。上述類似的法
律建立在一個原則之上，即女性對自己身體和健康的決定可以被他人的意願和
利益所支配。國家不應該通過其代孕法律容忍它們的使用和包含。