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Learning Objectives:-
- Ethical issues associated with pre-implantation/prenatal testing and embryo selection, genetic testing and screening after birth
- Ethical, legal and professional aspects of contraception, artificial reproductive technologies, termination of pregnancy and neonatal care
- Human Fertilisation Embryology Act 1998, Surrogacy Act 1985, Abortion Act
- The need for the doctor to be aware of all laws regarding surrogacy to correctly inform the patient
- The need for the doctor to fully advise the patients of what is required in the procedure, in order for them to be able to make a fully informed decision
Students need to:
- Articulate what is involved in the surrogacy procedure
- Identify whether it is legal within the UK
- Recognise who the parents are: biological and legal
Legal Aspects of the case
- Under the Surrogacy Arrangement Act 1985, it is not legal to enforce surrogacy arrangements, regardless of whether a contract has been signed, or the surrogate expenses paid.
- Under the Human Tissue and Embryo Bill, the surrogate mother, the woman carrying the child as a result of embryo implantation in her, is the legal mother of the child. Regardless of whether the child is genetically related to her or not, it is her legal right to keep the child.
- According to the Human Fertilisation and Embryology Act 2008, parenthood can be transferred to the intended mother and father of the child by one of two ways after birth of the child: parental order, or adoption of the child.
- Until parenthood is transferred, the legal father of the child, or second parent, is the surrogate's husband or partner providing he has consented to being the father/second parent.
- To acquire parental order, specific conditions must be satisfied: the application must be submitted before 6 months of age of the baby; one of the intended parents must be the egg or sperm provider, i.e. be genetically related to the child; and the intended parents must be husband and wife, have a civil partnership, or two partners who are living together.
- If these requirements are not met, then the intended parents can chose to adopt the baby, and this must involve a registered adoption agency in the surrogacy process.
Ethical Issues Raised
- Does the benefit of the virtue of carrying a baby for an infertile couple balance the health risk of pregnancy and IVF treatment to the surrogate? Pregnancy can cause physiological changes to the human body, and she may develop conditions such as gestational diabetes, pre-eclampsia, or placenta accreta. There are also other ways for the couple to have a child. However, by adopting the surrogacy method the couple are able to have a child that is genetically theirs.
- The surrogate mother already has children of her own; will the impact of the pregnancy affect the existing children, physically or mentally, or the ability of the mother to care for them? Would any desire to keep the baby coexist with the ability to support her existing children and the baby adequately?
- If multiple foetuses were to develop, should the couple chose to continue the pregnancy with the same number of foetuses? While this gives them the opportunity to have a bigger family, only carrying one foetus improves the chances of growth and development of that one foetus. Additionally, if there were multiple births would the couple be able to support the babies adequately in terms of emotional, physical and financial support?
- Is it ethical to offer and accept money in exchange for surrogacy? Such contracts may be regarded as commodification of pregnancy and children. Such a system may also operate as a means for potential surrogates to obtain financial gain. However, is it ethical not to support the surrogate financially? She would have increased her expenditure, e.g. on food, and it is important in pregnancy to eat healthily for the growth and development of a child.
- The surrogate mother already has children of her own, and the impact of the pregnancy on the existing pregnancy must be considered.
In Clinical Practice
- There is an increased health risk for the surrogate by becoming pregnant: she may develop conditions such as gestational diabetes, pre-eclampsia, or placenta accrete.
- If the surrogacy route is taken, the surrogate is the legal mother of the baby and has the legal right to change her mind and keep the baby. Therefore it is important that the surrogate and intended parents trust each other and are clear about their intentions. However if the surrogate decides to keep the baby then this may cause emotions and psychological trauma to the intended parents.
- The risk of breakdown in surrogacy arrangements must be considered by clinicians as this may cause harm to the potential child, or existing children.
- The surrogate will be carrying the baby for 9 months and may inevitably become attached to the child: this may cause her emotional and psychological trauma to give the baby away.
- IVF can lead to multiple births, which can cause health risks to the surrogate and the potential foetus(es) and lead to pre-term labour and neonatal complications. The patient, Jen, will have to have invasive procedures in order to obtain the gametes.
References
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Authors: Titiksha Masand, Navta Masand
Editors: Philip Xiu, Jacky Wong
Voice Actors: Zoe Monnier-Hovell, Tom Jones, Ross D'Souza