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Why informed consent is crucial: Surrogacy and the complications that follow

 

“When money is exchanged for pregnancy, some believe, surrogacy comes close to organ-selling, or even baby-selling”

                                                                                                                                                      – Thomas Frank

Surrogacy Guide

1. WHAT IS INITIAL CONSENT

Initial consent, or informed consent is a process taken to get consent from the patient to follow through with a procedure. It assesses the capacity to assent and consent, comprehension, and ongoing consent, which can only be given when the patient is made aware of all the factors of the procedure. The passing of information between the medical authority and the patient must be completely transparent for official consent to be given.

 

 

WHAT IS SURROGACY

 

Surrogacy is when a woman makes an agreement to have a baby for another person or persons, giving up the baby after birth. The baby can be related to the birth mother (traditional), or it can be created from one, or both of the couples’ DNA (gestational).

 

 2. WHY WOMEN CHOOSE TO BECOME A SURROGATE

 

Women can have various reasons for becoming a surrogate. They can have one predominant reason, or a combination of wanting to: help complete another family, feel biologically “useful”, help a family member or friend, receive compensation, or have the benefits of pregnancy. There are more, but these are the main influences that women feel.

3. REGIONAL CONTEXT

All over the world, religion plays a considerable role in morals; what is right and what is wrong. In Jordan, surrogacy and IVF are available, but nothing about it is publicized. To get a view on how the majority of people view surrogacy in this country, taking the most prominent religion in the area and finding what is taught in each will give an understanding of the common view.

In Islam, according to a Shaykh, the use of a surrogate by either traditional or gestational method is akin to adultery, since the semen impregnating the egg is from another man, not the host’s legal husband. Also, mothers are defined as those who conceive and give birth to the child. So with surrogacy, the host is defined as the “real” mother of the child, not the parents the baby is assigned to go to. This can create legal and ethical issues if any complications or issues arise. The surrogate is then defined as the real mother, and has autonomy over the fetus, the same as if it were her own child.

4. HOW INITIAL CONSENT COMES INTO PLAY AND CONTROVERSY THAT FOLLOWS

When a woman becomes a surrogate, she is host to a fetus. Because it is within her body, and she is essentially creating a baby, she has autonomy over the baby like any mother should. However, with initial consent, there is the understanding that the fetus does not belong to the mother like her own child would, even if it may be biologically hers. The baby will go to the designated parents after birth, so even while the host is pregnant, the person(s) the child will go to has autonomy, the same as if they were carrying the child themselves or a spouse to the one carrying. However, there are cases when the host purposefully goes against the wishes of the parents.

In this video, a surrogate does not get an abortion, like the parents requested. To fully understand the implications of this action, each of the principles of bioethics will be analyzed for this specific case.

Principle of Autonomy Principle of Justice Principle of Beneficence Principle of Non-maleficence
The couple the surrogate was helping had legal autonomy over the fetus, so all rights a mother physically carrying would have are given to the parents. This principle was violated the moment the surrogate chose to continue the pregnancy after they couple requested an abortion. With regard to equality, all stakeholders should have an input when deciding a course of action. In this clip, the couple and the surrogate are the main stakeholders. However, because the surrogate is aiding the couple, and the couple have autonomy rights over the fetus, a greater “say” is placed upon the couple. Although the surrogate wanted to give birth, by doing so has disregarded the effect upon the other stakeholders. By giving birth to the baby, the surrogate believed she was following the principle of beneficence, since she wanted to give the child a chance at life instead of taking it away. By not terminating the pregnancy, the surrogate violated the principle of non-maleficence. The decision to abort the fetus was made due to medical complications, and by intentionally allowing the baby to live, is creating even more pain and harm. The parents of the child are harmed, knowing their biological child suffers, and the child will have to live her whole life with the medical condition that was supposed to be avoided.

 

5. HOW SHOULD INITIAL CONSENT BE CHANGED

The process to become a surrogate is extremely selective, and after being matched with a person or couple needing one, consent is required. Throughout the process, assent is given, but to obtain real informed consent, comprehension of all information must be determined. Although it’s already a lengthy legal process , I want consent to be stricter. There are too many cases when surrogates either change their mind, wish to keep the baby, or defy a couple’s request, because either comprehension and understanding of the process and what it entails wasn’t made clear enough to the surrogate, or laws didn’t protect the wants of the parent’s. Along with being stricter, extending the time period to determine consent will be more beneficial, to all stakeholders involved. Continuing to do so throughout the pregnancy might be beneficial as well, to remind hosts that the child is not theirs, to help continue the essential understanding that was required in the beginning of the process.

In a short video below, it is shown how complicated surrogacy can become without initial consent.

In the link below, there’s a survey to get some personal input about surrogacy and consent :
Create your own user feedback survey
6. CONCLUSION
Any legal or medical contract made should always include initial and informed consent. In surrogacy, there is the risk the host will form emotional attachments to the fetus and possibly take a course of action that doesn’t follow ethical principles. To avoid this, or to prevent it with better accuracy, a more stable and longer period of time should be dedicated towards recognizing proper consent. Continuing to evaluate consent throughout the pregnancy should be considered as well. When a surrogate doesn’t abort the fetus like the parent’s have requested, or decides to keep the baby instead of giving, the decisions are either impulsive or developed over some time. With constant reminder and reaffirmation of the terms the surrogate and the parents have reached, hopefully the number of surrogates attempting to keep the baby for themselves or any other issue will be decreased.
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COMMENTS: 9
  1. April 26, 2018 by Julianna Garber

    I’m curious as to what peple think about how much of the laws should be build nationally or regionally rather than by the people themselves. I think it is really important to have choices defined before contracts are signed, but not have these be defined by the government. For example, if a couple chooses to abort for any number of scenarios, I think that this should be thought through and agreed on by the surrogate before the IVF, but not perscribed as legal or illegal before.

  2. April 27, 2018 by Morinsola.Tinubu

    Great job with this presentation! I found the infographic to be informative and I liked that you included a video with a personal narrative because it definitely compelled me and drew me closer to your topic. My only advice is that I would love to hear more about what led you to this topic. I think that this topic is something that not too many people our age think about so I am glad you are addressing it. I also think that you could include more suggestions on how we can help and spread awareness about this topic. Great job!

  3. April 28, 2018 by Hanan.Sherka

    I never thought of the complications that could come with surrogacy, and you really highlighted the nuances and the different levels to it. This is very informative, and easy to follow. I think the idea of more time for decision is a great one, and you tackled this very difficult and complicated subject really well. Great work, it shows that you put effort!

  4. April 28, 2018 by Shealyn.Kennedy

    This is a very complicated issue, both ethically and legally. I agree that the guidelines should definitely be written before the pregnancy to reduce legal issues. However, there is still moral and ethical debates over who has a right to the baby if there were any complications, the parents who the baby is assigned to go to or the surrogate. Good job! This really made me think about how complicated and risky surrogacy is. Do you know of any instances in which the baby’s health wasn’t stable? What did the surrogate do? How did the legal parents react?

  5. April 28, 2018 by Arianna

    This project was really interesting because I never saw surrogacy as this complex. I never thought about how big the issue of autonomy is. In my opinion, no matter the type of surrogacy, once the surrogate signs a contract naming them the surrogate, they are handing the rights of the fetus over to the couple who will be raising it and therefore relinquishing their autonomy over the process. I wonder if there are any legal implications for a surrogate not following the couple’s wishes? Overall this presentation and your clear analysis of how it relates to the principles of bioethics definitely sparked my interest and curiosity.

  6. April 29, 2018 by cyan

    Thanks!
    The only complications I found that regarded the baby’s unstable health was when the legal parents wanted to abort the fetus/not keep it, but the surrogate couldn’t comply due to the emotional attachment. Sometimes there are lawsuits, but mostly emotional harm stems from it because the child is born and given up and the legal/biological parents have to live knowing they have a child suffering under the care of others.

  7. April 29, 2018 by PRINCESS NAFAA ALI

    Very well written and researched, hats off to Ms. Brady

  8. April 29, 2018 by Cassidy.Mott

    Hi! I had previously no knowledge that this was a problem, and think that it is extremely complicated to legally deal with a surrogate taking the baby. I wonder if she could possibly be charged with any legal crimes? I always thought that there was little drama when it came to surrogacy because the surrogate knew what they would be signing up for. Overall I think that you did a really nice job on your project.

  9. April 30, 2018 by CC Yin

    Wow! You’re project is so great! First, I just want to say, I love the pictures, formatting, table, polls, and video, you’re project is beyond engaging. You also have great content and cover the bioethical perspectives in depth. Great job!!

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