surrogacy, wrtitten report

8/2/2019 Surrogacy, Wrtitten Report

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DEFINITION

Surrogacy or Surrogate means substitute. In medical terminology, surrogacy indicates an arrangement

whereby a woman agrees to undergo the pregnancy, labor, and delivery for another individual who either

cannot or chooses not to.

TYPES OF SURROGACY ACCORDING TO THE PROCEDURE

There are 2 types of surrogacy according to the procedure traditional and gestational surrogacy.

In traditional surrogacy, also known as 'full' or 'straight' surrogacy, a woman is pregnant with her own biological

child, but the child was conceived with the intention of turning it over to be raised by others such as the

biological father and possibly his spouse or partner. The child may be conceived via home artificialinsemination using fresh or frozen sperm or impregnated via IUI (intrauterine insemination), or ICI (intracervical

insemination) which is performed at a health clinic. The intended father's sperm can be used, or a sperm donor

can be used. Donor sperm is used in cases where the intended parents are both female, or when the intended

parent is a single woman.

In gestational surrogacy, a gestational carrier has an embryo to which she has no genetic relationship,

transferred to her uterus and carries the resulting child to term. After birth, the gestational carrier turns the

child over to the biological mother and father to raise, or to the adoptive parent(s) (in which case, the embryo

would have been a donated embryo).

According to the arrangement, there are also 2 types of surrogacy commercial and altruistic surrogacy.

The arrangement is called a commercial surrogacy if the carrier gets compensated for carrying and delivering the

child (besides medical and other reasonable expenses). If the carrier receives no compensation (besides medical

and other reasonable expenses) for carrying and delivering the child, the arrangement is sometimes referred to

as an altruistic surrogacy, which is generally done by a friend for the intended parent(s).

REASONS FOR NEEDING A SURROGATE

An indicator that a surrogate is needed is medical disorders that affect the ovaries. These medical

disorders include: damaged ovaries caused by endometriosis, destroyed ovaries caused by previous
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chemotherapy, menopause (egg production ceases), severe ovulatory disorders (polycystic ovaries), wifes

genetic disorders, or premature ovarian failure. In these scenarios, the surrogate donates both the egg and the

uterus.

Indicators for a gestational carrier are evident when the uterus and fallopian tubes are unable to

perform the designed function. Some of these disorders or abnormalities include:

- Hysterectomy

- Myomectomy in the uterus

- Damage from infection or IUD

- Malformed uterus

- Pelvic adhesions causing distortion to bowel

Some physiological impediments that can be life threatening would also necessitate in considering a

gestational carrier are:

- Cardiac disease

- Diabetes

- Potentially dangerous drugs (drugs that can harm developing fetus)

-History of ectopic pregnancies

- Emotional factors

- Physical disabilities (weight gain causing stress on back and legs)

PROCEDURE FOR BECOMING A SURROGATE

In order to become a surrogate the individual undergoes a series of tests prior to the planting of the egg,

sperm, or both. Some of these tests include:

- Hysteroscopy/HCG, this procedure determines the fallopian tubes are clear and the size and shape of

the uterus

- Infectious disease test, to ensure there are no contagious diseases present

- A mock cycle, to see how the uterine linings will react to hormone replacements (estrogen)

- Pap smear to check for a healthy uterus


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- A physical, to see if there are any physiological impediments that would hinder the surrogate in

carrying the baby

- Trial transfer, to check the length of uterus to find out how far to insert the catheter, which will be

loaded with embryos

- Psychological testing, to check motivations, attitudes, and commitment

SURROGACY AND THE BIBLE

One of the oldest examples of Surrogacy in the Bible can be seen in the book of Genesis with Abraham,

who fathered a child by the servant woman Hagar. Genesis 16 talks about how it was his wife Sarah's idea

because she was not able to bear children, and quotes her as telling Abraham And Sarai said unto Abram,

Behold now, the LORD hath restrained me from bearing: I pray thee, go in unto my maid; it may be that I mayobtain children by her. And Abram hearkened to the voice of Sarai. (Gen 16:2). Of course we know the story of

Abraham, Sarah and Hagar was not without trials and tribulations. Sarah became jealous of Hagar and Hagar did

not want to give baby Ishmael to Sarah to raise with Abraham.

SURROGACY AND THE LAW

The legal aspects surrounding surrogacy are very complex and mostly unsettled. There is a default legal

assumption in most countries that the woman giving birth to a child is that child's legal mother. In some

jurisdictions the possibility of surrogacy has been allowed and the intended parents may be recognized as the

legal parents from birth. Many states now issue pre-birth orders through the courts placing the name(s) of the

intended parent(s) on the birth certificate from the start. In others the possibility of surrogacy is either not

recognized (all contracts specifying different legal parents are void), or is prohibited.

Australia

In all states in Australia (except Tasmania which bans all surrogacy under the Surrogacy Contracts Act

1993), altruistic surrogacy has only recently become legal.

Canada

Commercial surrogacy arrangements were prohibited in 2004 by the Assisted Human Reproduction Act.

Altruistic surrogacy remains legal.
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France

In France, since 1994 any surrogacy arrangement that is commercial or altruistic is illegal or unlawful

and sanctioned by the law (art 16-7 of the Code Civil).

Georgia

Surrogacy, along with ovum and sperm donation, has been legal in Georgia since 1992. Under applicable

law, a donor or surrogate mother has no parental rights over the child born.

Hong Kong

Commercial surrogacy is criminal under the Human Reproductive Technology Ordinance 2000. The law is

phrased in a manner that no one can pay a surrogate, no surrogate can receive money, and no one can

arrange a commercial surrogacy (the same applies to the supply of gametes), no matter within or

outside Hong Kong. Normally only the gametes of the intended parents can be used.

HungaryCommercial surrogacy is illegal in Hungary.

India

Commercial surrogacy is legal in India, as recognized by the Supreme Court of India in 2002. India is

emerging as a leader in international surrogacy and a destination in surrogacy-related fertility tourism.

Indian surrogates have been increasingly popular with fertile couples in industrialized nations because of

the relatively low cost. Indian clinics are at the same time becoming more competitive, not just in the

pricing, but in the hiring and retention of Indian females as surrogates. Clinics charge patients between

$10,000 and $28,000 for the complete package, including fertilization, the surrogate's fee, and delivery

of the baby at a hospital. Including the costs of flight tickets, medical procedures and hotels, it comes to

roughly a third of the price compared with going through the procedure in the UK.

Israel

In March 1996, the Israeli government legalized gestational surrogacy under the "Embryo Carrying

Agreements Law." This law made Israel the first country in the world to implement a form of state-

controlled surrogacy in which each and every contract must be approved directly by the state.

Italy

Surrogacy, commercial and altruistic, is illegal.

Japan

In March 2008, the Science Council ofJapan proposed a ban on surrogacy and said that doctors, agents

and their clients should be punished for commercial surrogacy arrangements.
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Saudi Arabia

Religious authorities in Saudi Arabia do not allow the use of surrogate mothers. They have instead

suggested medical procedures to restore female fertility and ability to deliver. To this end, Saudi

authorities sanctioned the world's first uterus transplant in an infertile woman.[

Ukraine

Since 2002, surrogacy and surrogacy in combination with egg/sperm donation has been absolutely legal

in Ukraine. According to the law a donor or a surrogate mother has no parental rights over the child

born and the child born is legally the child of the prospective parents.

United Kingdom

Commercial surrogacy arrangements are not legal in the United Kingdom.

United States

Many states have their own state laws written regarding the legality of surrogate parenting. It is mostcommon for surrogates to reside in Florida and California due to the surrogacy-accommodating laws in

these states. Surrogacy is well developed around Camp Pendleton in California. With the

accommodating laws of the State of California and the long overseas deployments of husbands, wives

have found surrogacy to be a means to supplement military incomes and to provide a needed service.

BABY M CASE IN THE UNITED STATES

Baby M (born March 27, 1986) was the pseudonym used In re Baby M, 537 A.2d 1227, 109 N.J. 396 (N.J.

02/03/1988)for the infant named "Sara Elizabeth Whitehead" at her birth, and later named Melissa Stern by her

father by artificial insemination.

Mary Beth Whitehead, was artificially inseminated with William Stern's sperm, making her the mother

of their child. Whitehead had responded to Stern's ad in the Asbury Park Press seeking women willing to help

infertile couples have children. Prior to conceiving their daughter, Whitehead and Stern entered into a contract

they called a "surrogacy contract". Contrary to what was stated in their contract, Stern's wife, Elizabeth, was not

infertile but had multiple sclerosis and was concerned about the potential health implications ofpregnancy. A

medical colleague had warned her that his own wife, who also had multiple sclerosis, had suffered temporary

paralysis during pregnancy.
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On March 27, 1986, Whitehead gave birth to her daughter, whom she named "Sara Elizabeth

Whitehead". Within 24 hours of transferring custody to the Sterns, Whitehead returned to ask for the baby back

and was said to have threatened suicide. Whitehead then refused to return the baby to the Sterns and left New

Jersey, taking the infant with her. The Sterns had the Whitehead family's bank accounts frozen and sought

warrants for their arrests.

In 1987, New Jersey Superior Court Judge Harvey R. Sorkow awarded custody of Baby M to the Sterns

under a "best interest of the child analysis", validating the surrogacy contract.

On February 3, 1988, the Supreme Court of New Jersey, led by Chief Justice Robert Wilentz, invalidated

surrogacy contracts as against public policy, but in dicta affirmed the trial court's "best interest of the child"

analysis. The Supreme Court remanded the case to family court. On remand, the lower court awarded Sterncustody and Whitehead visitation rights.

When Melissa turned 18 in March 2004, she formally terminated Whitehead's parental rights and

formalized Elizabeth Stern's maternity through adoption proceedings.

Melissa went to The George Washington University and majored in religious studies. She said it was

strange to study the Baby M case in her bioethics class at the university.

There are many emotional and ethical issues surrounding surrogate mothering. If in vitro fertilization is used,

there will be some fertilized eggs that are lost. Many consider this the killing of human life. Often the surrogate

mother will feel an emotional connection to the baby she is carrying, whether or not it is considered hers. She

may have trouble relinquishing the baby after going through the trials and tribulations of pregnancy. This is why

legal counsel is so important. That being said, however, most surrogate pregnancies end without any problems

for either party involved. As long as all of the expectations are known at the onset of the process, both parties

are usually satisfied by the outcome. Some may be concerned that the mothers receiving a child will not show as

much love and care to the child as they would if they had carried the child. But in reality, mothers who turn to

surrogacy are usually desperate to have a child, and as such are even more emotionally attached to their child

than traditional mothers. It is important, however, that both the birth mom and the receiving mom and dad

have emotional support through the process. There are several support organizations to help parents who

choose this option.
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ETHICAL ISSUES ON SURROGATE MOTHERHOOD

Medical science has really progressed rapidly as now it has brought in some of the technological

advancements that can help a childless couple to have their own child in case the mother is not able to bear one

because of infertility. Surrogacy is the available option that such people can go for. This is an arrangement

where a woman is hired for bearing a child for these kinds of couples in which the surrogate mother can either

have it biologically or the embryo may be transferred to her body.

Though it sounds quite advantageous for such couples, there are certain ethical issues related to

surrogacy that are put forward by some kind of people:

-Though the surrogate mother signs a contract with the couple she is bearing a child for but still there are

possibilities that the woman may keep the baby and refuse to return it to the couple.

-The surrogate mother might also demand visitations which may bother the couple in future.

-Some people also have issues like what would they do if the mother decides to abort the child they are

keenly waiting for.

-One of the most important and commonest ethical issues associated to surrogacy is the fact there are

people who consider it as baby selling and thus, stand against it.

-Some people claim that it has turned into a business and therefore, women are thought of as a machine

to bear child. This is what makes people go against such an arrangement.

- There will be a problem with the custody of the child during instances when the intended parents decide

to divorce, or when one or both of the parents die.

- When the baby is born with defect, circumstances may change and may bring problems between the

parties.

-When the child is old enough, does this child need to be introduced to his surrogate mother?

-The child is considered as a science baby

-Infertile couples may consider adoption an option as opposed to having a surrogate.


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ARGUMENTS ON SURROGACY

SURROGATE MOTHERHOOD IS ETHICAL

-It is a solution to infertility after repeated failure to conceive by other means.

-It is unjust that infertile couples should be denied parenthood.

-Intrauterine insemination allows the child to carry at least the fathers biological genes.

-Difficulties inherent in the adoption process

-Also, the presence of a disorder that would place the mothers life in jeopardy if she became pregnant is

a strong argument in favor of the process.

-Proponents cite studies of surrogates that confirm that most surrogates view their experience as positive,

meaningful and empowering.

SURROGATE MOTHERHOOD IS UNETHICAL-The physical and psychological risks to the surrogate mother and the purported long and short-term

physical and psychological hazards to the child.

-Compensated surrogacy arrangements are abused whereby a surrogate is paid to carry a child to

maturity. Opponents denounce these arrangements as the financial exploitation of womens bodies.

-Surrogacy is attacked as an advantage of the rich over the poor, a means of turning surrogate

motherhood into a commercial industry and a convenience for the well-off to avoid childbirth.


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ARELLANO UNIVERSITY

FLORENTINO CAYCO MEMORIAL SCHOOL OF GRADUATE STUDIES

SURROGACY

WRITTEN REPORT

In Partial Fulfillment of the Requirements for the Degree

MASTERS OF ARTS IN NURSING

By

BERNADETTE V. ENDAYA, RN

Submitted to

GEN. MARLENE PADUA

NURSING THEORIES

FEBRUARY 5, 2011


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