A Dutch couple, Mr & Mrs Peters, had been trying to have a baby for over ten years. As a last resort they commissioned a British woman, Karen Roche, to be a surrogate mother and bear a child for them. However, three months into the pregnancy, Mrs Roche claimed that the Peters were not sufficiently committed to the child and that she had had an abortion.
The story reached the British tabloid press and over the ensuing months several new twists emerged. The Peters claimed that Mrs Roche had phoned them to demand more and more money and had threatened them with an abortion unless they paid up. Later still it was discovered that Mrs Roche had not carried out her threat. She had made up the story about the abortion in order to deter the Peters from claiming back the child when it was born. Instead she completed the pregnancy and kept the child as her own. The Dutch couple are still trying to win back 'their' child through the courts.
What is surrogacy?
Surrogacy literally means 'taking the place of someone else'. In the case of a surrogate mother she carries a fetus and bears a child on behalf of another person or couple (termed the commissioning person or couple), having agreed to surrender that child to them at birth or shortly afterwards.
Why have a surrogate mother?
10% of couples are infertile by accepted medical definitions. Some are helped by pharmacological manipulation, IVF (in-vitro fertilisation) or GIFT (gamete intrafallopian transfer) techniques. However, these have a high failure rate, as well as being expensive and time consuming. In addition they are contra-indicated if it is very risky or impossible for the woman to carry a baby. Examples include cases of uterine absence or anomalies, a history of severe pregnancy-related illness, severe medical disorders or recurrent miscarriage.
There are also those who seek a surrogate mother for reasons other than infertility. Some are not prepared to undergo the physical, social, psychological or financial inconvenience of pregnancy. There is also increasing demand from gay couples.
One further factor fuels the need for surrogate mothers: the unavailability of babies for adoption. Adoption numbers fell from 21,299 in 1975 to 6,533 in 1990. This at least partly reflects the rise in abortions (from 139,702 to186,912 over the same period) and the increasing acceptance of single parent families (the number of dependent children in one parent families rose from 1.3 to 1.9 million over the same years).
Who does the child genetically belong to?
The sperm and the egg that give rise to the embryo that the surrogate mother bears can come from a number of different sources.
If the commissioning couple can produce viable sperm and ova these can be fertilised in vitro and the resulting embryo implanted into the surrogate womb. However, it might be that either the commissioning man or woman is unable to produce viable gametes. Sperm or ova in this case must be obtained by donation from a third party.
If both partners of the commissioning couple are unable to produce viable gametes then both sperm and egg must come from donors. Here the resulting child is genetically unrelated either to the commissioning couple or to the surrogate mother but to two unknown gamete donors!
Confused? Well that's not the end of it. Potentially the surrogate mother could contribute genetically to the child. Using AI (artificial insemination) her ovum could be fertilised with sperm from a donor or the commissioning male. To take things one step further the surrogate mother could conceive a child with her own partner and then give it up to the commissioning couple.
Who does the child legally belong to?
Four pieces of legislation relate to issues of surrogacy. The Warnock Report (1984), the Surrogacy Arrangements Act (1985), the Human Fertilisation & Embryology Act (1990) and the Parental Orders (HF&E) Regulations (1994). Between them they state that:
- Surrogacy is not illegal in the UK.
- Surrogacy arrangements are not enforceable in law.
- A child born as a result of surrogacy is the legal child of the surrogate mother, not its genetic parents. Thus a commissioning couple has no legal right to the child they have commissioned if the surrogate mother refuses to give it up after birth - even if it is genetically their child.
- It is an offence in the UK to advertise either that one is looking for or is willing to be a surrogate mother.
- Any commercial interest in the arrangement by the commissioning couple, the surrogate mother or a third party is illegal.
- The surrogate mother can, however, receive payment for the necessary expenses of the pregnancy. What this should include is still under debate. Karen Roche, the surrogate mother in the case given at the start of this article, was thought to have received £12,000 from the Dutch couple. Many argue that sums of this amount render the legislation given in the previous point meaningless.
- Once the surrogate mother has given up the child to the commissioning couple they have to go through an adoption procedure for that child to become theirs legally. However, if either of them is genetically related to the child they can instead apply for a court 'parental order'. They can do this between six weeks and six months after the birth, the advantage being that it takes far less time than the adoption process.
Before we can answer this question we need to examine child bearing from a biblical perspective.
A biblical view of fertility and child bearing
God created humankind male and female, instituting the marriage bond for companionship and procreation. Some witty commentators have pointed out that God's command to 'be fruitful and increase in number' is the only one we willingly obey!
In Scripture children are seen as a blessing and a gift from God. They are neither a right nor a consumer object.
However, humankind's rebellion against the authority of God (the fall) affected all aspects of our being - spiritual, social, psychological and physical, including fertility and child bearing. Childlessness is a painful reality for many couples.
Yet the fall does not nullify God's commands. We are still to 'fill the earth and subdue it'. Many Christians understand science as part of this subduing process. It is therefore good and right to use scientific means to aid fertility and help infertile couples, providing these means do not contravene any of God's laws. The end does not justify the means. We need to be sure that our use of science is in accordance with the ethical principles God has revealed in his word.
This leads to the first question directly relating to surrogacy.
Do the techniques used contravene biblical ethics?
The conception of a surrogate pregnancy may involve IVF or the use of donor gametes. Are these processes that Christians should employ?
In each IVF cycle more embryos are 'created' than can be implanted into the uterus of the mother. The excess embryos are either frozen for later use, used in scientific research or discarded. Is this acceptable in the light of biblical understanding about the status of the human embryo? It seems from Scripture that there is a real sense of continuity between the adult person and the 'embryo person' from the time of conception. The Bible makes no distinction between a born and an unborn child as illustrated by the Greek word, brephos, used to describe both the intra-uterine baby Jesus (Lk 1:44) and the babe wrapped in swaddling clothes (Lk 2:12). Biologically we might also point out that what marks a human being as different from other living organisms is the possession of the human genome. An embryo is thus a human being with potential . Francis Collins, head of the US genome project, recently admitted his own inability 'scientifically, to be able to perceive a precise moment at which life begins other than the moment of conception'. Biologically and biblically there seems to be little doubt that the fetus is a human being.
Furthermore, surrogate pregnancies can also involve the use of donor gametes. Does this constitute a violation of the marriage bond? Some see it as breaking the 'one flesh' principle of Genesis 2:24 by introducing a third party into the marriage. By so doing it complicates family relationships, raises issues for the child about his/her genetic origins, leading to possible problems of attachment for the social but not genetic parent of the child.
A fuller discussion of these two issues, central to most of the ethical debates surrounding the beginning of life, can be found in past editions of Nucleus and other CMF publications. We need to be aware that our answers to these questions will reflect on our attitudes to surrogacy. We cannot view surrogacy in ethical isolation from the reproductive technologies it often employs.
But not all surrogate pregnancies use these techniques. What other ethical issues are involved?
Whose interests come first?
A recent article in The Bulletin of Medical Ethics stated that 'In all cases the interests of the potential child must be paramount'. We do well to heed this advice: the danger is that the child's wellbeing could become confused with the commissioning couple's desires. What then are the interests of the potential child? What could go wrong?
It is difficult to assess the psychological morbidity of a child knowing that it was conceived and then given up by its mother as part of a contract. However, we do know that the attachment of infants to their parents is recognised across most social science disciplines as a fundamental psychological process affecting human development. A number of longitudinal studies have been carried out which show that attachment in infancy strongly influences many aspects of psychological adaptation including social behaviour, affect regulation, cognitive resources and psychological disturbance.
The effect of gamete donation on a child so conceived also needs to be considered. Most people have a strong desire to know who their genetic parents and family are, especially during adolescence when identity issues need to be worked through.
Is surrogacy wise for family relationships?
Although consideration for the child is paramount we also need to think about the relationships that surround that child. There is the surrogate mother, her family and the commissioning couple to take into account. What is the psychological effect on the mother of giving up the child she has carried in her womb for nine months? What if she wants to keep the child rather than hand it over? What if the commissioning couple don't want the child once it is born? Perhaps the child will be handicapped: who will look after it? What effect will seeing a sibling 'given away' have on the surrogate mother's children? Will surrogacy open the door to further distortions of family dynamics such as the case of Edith Jones, a grandmother who carried a baby for her own daughter?
Is surrogacy wise for society?
Many issues that at one level are personal choices need also to be examined on a larger scale: how will they affect the society in which we live? Some might argue that surrogacy is a form of class abuse in which rich middle class couples commission working class mothers to have babies for them. Or does it encourage us to see children as a material product that can be ordered and delivered to fulfil a consumer demand, rather than a gift and a responsibility?
These questions are hard to answer with the information presently available but they need to be thought about if we are to fully examine the ethics of surrogacy. On the face of it, surrogacy may seem to be a reasonable response to the pain of a childless couple. However, does it risk causing more pain than it relieves for individuals, families and society?
Interestingly there are two cases of surrogacy in the Bible, both of which illustrate the distortion of family relationships and society that result. Genesis 16 tells us the story of Abram and Sarai who were childless. Sarai gave her servant Hagar to Abram and said to him, 'Sleep with my maidservant; perhaps I can build a family through her'. In Genesis 30 very much the same scenario occurs but this time it was Rachel who said to her husband Jacob, 'Here is Bilhah, my maidservant. Sleep with her so that she can bear children for me and that through her I too can build a family'.
In both cases family discord resulted. After Hagar gave birth to Ishmael she began to despise Sarai who subsequently sent her away. We are told that Ishmael would 'live in hostility towards all his brothers'. He became the father of the Arab peoples and enmity between them and the Jews lives on until this day.
In Genesis 30 Bilhah gives birth to Dan. Jacob has other children: four sons by concubines, six sons and a daughter by his wife Leah and only two sons, Joseph and Benjamin, by his favourite wife Rachel. Ten of the twelve brothers are jealous of Joseph, the special son; he is puffed up with the pride of being a favourite. They conspire to sell him into slavery, the rest, as they say, is history.
From these passages it seems that there were two failures. The first, a failure to wait on God and trust him, led to the second, a wrong attitude to the marriage bond. Even though both Jacob and Abraham were within their legal rights we learn from Jesus and the epistles that one man and one woman in a lifelong exclusive sexual relationship is God's desire for his people. The use of a surrogate mother was taking matters into their own hands rather than trusting in God: it lead to disordered family and social relationships.
Louise Brown, the first IVF baby, was born in 1978: she is now 20 years old - university age. Perhaps someone we know, though they may not have told us, was conceived with the help of IVF or other fertility technologies. Soon we may know people who are children of surrogate mothers. How then should we respond?
It is good for us to remember that all human life is loved and known by God however that life was conceived. God loved Hagar and Ishmael, sending an angel to guide her and promising descendants through him too numerous to count. God also loved Joseph's brothers enough to save them from starvation and to bring about a family reconciliation. Ten of the twelve tribes of Israel have their roots in these brothers. All are equal in God's sight and God loves all equally. In him we find our true identity, our true value and life.
What then can we conclude on this complex and emotive issue? From Scripture several things seem clear:
- Infertility is a result of the fall and brings sadness to God as well as humankind.
- We can use the God given gift of science to try to restore fertility providing it does not contravene other ethical laws such as respect for the embryo as human life or violation of the marriage bond.
- Surrogacy on the face of it seems a loving response to the pain of childlessness. However, a closer look reveals that it may open the door to even greater pain for potential children, families and society.
- For some Christian couples infertility and childlessness will be a painful reality, one that cannot be changed without breaking God's moral code for life and for human relations.
- However, as Christians we have one further hope: that all things will work out for good, even childlessness. Whatever our situation, no matter how painful, whether we are married or single, have children or are childless, were conceived naturally or by IVF, we are all equal before God. Each of us is equally in need of his grace and equally able to enjoy his rest and a relationship with him for eternity.
'Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.'[32