ABSTRACT
This study critically examines the ethical and religious
issues surrounding outsourcing pregnancy or gestational surrogacy. The study
examines the moral dilemma created by the fragmentation of motherhood into
biological, gestational, and social motherhood that has created enormous
conflicts over who should be considered a ‘mother’ and the concomitant parental
rights and responsibilities for a child. The debates surrounding gestational
surrogacy and its implications on existing reproductive rights raises most
profound ethico-religious issues on the maternal roles which historically
resided in one mother. The overall objective of this research therefore is
aimed at evaluating these ethico-religious arguments contiguous to outsourcing
pregnancy. In this study, the expository, evaluative and the
critical-analytical approaches based on Prudential Personalism ethical model
are adopted to evaluate these arguments. Utilizing the Prudential Personalism
ethical model, the findings of this study are: that it is not morally
justifiable for a fertile woman to abdicate her natural right of reproduction
and seek the benefit of that same right through the markets; that the
prerogative for an infertile woman to seek the benefits of commercial
gestational surrogacy is not significant and sufficient because of the inherent
impairments. Besides, gestational surrogacy presents challenges with some
ethical and religious objections and unfavourable disposition within the
Nigerian context. In conclusion, this study recognizes that gestational
surrogacy has the potentials to adversely impact the value of human dignity and
the family unit, and therefore a problem of public ethos, with ethical and
religious dimensions that requires critical ethico-religious evaluation. This
study recommends that a Theo-centric ethics should drive human reproductive
scientific advancements; that the ethical and religious implications of
outsourcing pregnancy should be of paramount consideration in all gestational
surrogacy engagements. Therefore, the ethical and religious import of
gestational surrogacy should form a starting point of all engagements and
actionable programmes in this novel emerging moral dilemma called “gestational
surrogacy”.
CHAPTER
ONE
INTRODUCTION
1.1 Background to the Study
Despite the dysfunctionality of modern
thought, the role and the place of children in marriage has remained central to
many married couples. That children are the beautiful gifts of God in a
conjugal union is axiomatic to many adherents of different religions. The
divine injunction of procreation “multiply and fill the earth” (The Jerusalem Bible, Genesis 1:28) is an
attestation of this divine mandate. This could account for why many married
couples, are ready to go any length in the ultimate search for offspring.
Childlessness dates back to primeval
history. An interesting biblical account is the narrative concerning Sarah, the
wife of Abraham. Sarah could not have children in the beginning. She gave her
handmaid, Hagar, to her husband Abraham to produce them a child (Genesis
16:1-5). The human reproductive method used in this narrative was copulation.
While it could be exegetically argued that childlessness predates the Abrahamic
era with no known cause(s) except as the will of God (1Samuel 1:6), it could,
however, be asserted with scientific certainty that the causes of childlessness
in our contemporary era are multi-factorial. Current medical survey shows that
ten to fifteen percent of married couples are unable to have children on their
own today (Grayce Storey 15).
In an attempt at self-reinvention,
therefore, modern science has developed means other than the ordination of
natural human reproductive system (copulation) in order to give infertile
couples the opportunity to enjoy the right of parenting. These extra-natural
means of human reproduction include amongst others, Intra-Uterine Insemination
(IUI), In Vitro Fertilization (IVF) and most recently, outsourcing of pregnancy
or gestational surrogacy (GS). These new human reproductive technologies have
spawned a new area of ethico-religious discourse in the field of bioethics
which is very challenging, complex and fascinating to its proponents, ethicists
and religionists. Outsourcing pregnancy is one of these new human reproductive
techniques whereby surrogates are implanted with
foreign embryos and paid to carry the resultant babies to term (Rosemarie
Tong 1).
Outsourcing pregnancy or Gestational
Surrogacy is an arrangement in which one or more persons, typically a married
infertile couple (the intended rearing parents), contract a woman to gestate a
child for them and then to relinquish the child to them after birth (Tong 3).
Gestational surrogacy is also sometimes referred to as “contract pregnancy”. It
simply means that this mode of parenting allows a couple to have a child by
involving a third party in their relationship who serves as birth mother or
surrogate mother (Shein Chang
456).
India today
is currently the world capital of outsourced pregnancies and has become
a transnational hub for reproductive tourism. In 2002
the India government legalized commercial pregnancy outsourcing in an effort to
promote medical tourism, a sector the confederation of Indian industry predicts
will generate $2.3 billion annually by 2012 ( Brenhouse 2). Indian surrogate
mothers are readily available and cheap, unlike in most developed countries
where surrogacy is lawful (Brenhouse 4). According to Brenhouse, the entire
process costs customers around $23,000, less than one-fifth of the going rate
in the United States of American, of which the surrogate mother usually
receives about $7,500 in installments (2). These women are implanted with
embryos, using specimens from sperm or egg donors if necessary. Once pregnant,
the surrogates are housed in a dormitory so that they can be supervised until
delivery (Brenhouse 3). After delivery the child is taken away from the
surrogate mother and given to the would-be parents after final payment.
Gestational
surrogacy or outsourcing of pregnancy is a new reproductive practice commonly
accepted as an increasingly prevalent phenomenon. The Hague Conference on Private International Law recent report have
documented a rise in the practice of outsourcing of pregnancy, to include
arrangements across international borders (6-8). However, precise
statistics relating to surrogacy are hard to estimate for a number of key
reasons. First, although gestational surrogacy does requires medical
intervention, officially reported statistics do not necessarily record the
surrogacy arrangement, but often only the IVF procedure (Human Fertilization
and Embryology Authority 4). Second, in many countries, there is simply no
legal provision, regulation or licensing regime for either fertility treatment
and/or surrogacy. According to the Policy Department C of European Parliament,
this means that there are no formal reporting mechanisms, which can lead to a
rather ad hoc collection of statistics by individual organizations, if indeed
they are available at all (9). Finally, in countries where surrogacy is legally
prohibited, those involved could potentially face criminal prosecution, thus
exacerbating the difficulties of collecting relevant and accurate data.
Despite these problems,
one can still point to a number of factors which signal a rise in the practice
of outsourcing pregnancy. First, a simple internet search reveals a plethora of
agencies and clinics that very explicitly seek to facilitate outsourcing pregnancy
arrangements. Sometimes these are voluntary organizations like COTS
(Childlessness Overcome through Surrogacy), which seek
to match willing surrogate mothers and hopeful parents on a non-commercial
basis (COTS 7);
while others operate on a commercial basis either as part of a fertility clinic
or in partnership with fertility clinics (The Policy Department C of European
Parliament 9). Second, there are also increasingly frequent stories in the media
about surrogacy arrangements: whether
positive or negative, successful or unsuccessful; as well as references to gestational
surrogacy in popular arenas, such as television shows. Finally, there has been
a recent surge in reported law cases relating to surrogacy across a number of
jurisdictions. Interestingly, while some of these law cases do involve private
disputes between the parties to the arrangement, the primary thematic trend
relates to arrangement with respect to the legal status and legal parenthood of
the children involved (The Policy Department C 9).
Some
countries like Canada, the United Kingdom, France, Norway, and Italy do not
allow commercial surrogacy and it is illegal for a woman to receive payment for
her reproductive services specifically. But in the United States and India commercial
surrogacy is legal and remains a luxury of the wealthy (Karen Busby and Vun
Delaney 20).
In
Nigeria, there is no clear and well defined legislation on what constitute
outsourcing pregnancy as it is a new concept in Nigeria, and the country is yet
to acknowledge and provide legislation to govern this emerging concept. According
to Oluchi Azoro-Amadi, the need for gestational surrogacy legislation in
Nigeria cannot be overstated as most countries have moved from acknowledging
its existence to providing legislation to govern surrogacy contract (2). Azoro-Amadi
further observes that it is pertinent that the issue of the legality or
illegality of the concept of outsourcing pregnancy be put straight so that the
Nigerian populace can understand their rights if any within a contract of gestational
surrogacy (6). It is one line of reasoning that incidences of baby factories,
illegal sale of babies, babies being swapped in hospitals, stolen from the arms
of their mothers amongst others are direct results of the void created by the
lack of any legislation or express legitimization of the concept of gestational
surrogacy. This will probably continue until the issue of legalizing or
non-legalizing surrogacy whether commercial or altruistic is properly addressed
(Azoro-Amadi 2).
On Wednesday June 1, 2011 the Nigerian
police raided a home used by teenage girls to have babies that were then
offered for sale. According to Bala Hassan, police commissioner for Abia State:
We stormed the
premises of the Cross Foundation in Aba following a report that pregnant girls
aged between 15 and 17 are being made to make babies for the proprietor. We
rescued 32 pregnant girls and arrested the proprietor who is undergoing
interrogation over allegations that he normally sells the babies.
Some of the girls told police they had been offered to sell their babies for
between 25,000 and 30,000 naira (192 dollars) depending on the sex of the baby.
The babies would then be sold to buyers for anything from 300,000 naira to one
million naira (1,920 and 6,400 dollars) each. (qtd. in David Smith A6)
In
2007, Osato Giwa-Osagie (a renowned professor of obstetrics & gynaecology)
announced to Nigerians that his team has successfully performed a surrogate
pregnancy at the OMNI Advanced Medical Centre in Lagos with a little over N1million. According to him the pregnancy
was outsourced to a single lady in her 30s who graciously carried the pregnancy
at the cost of N200, 000. The N200, 000, was a compensation for the lady
that carried the pregnancy, while the balance was paid for the medical bills
and cost of In Vitro Fertilization (qtd. in Franca Omo
1). Interestingly, the lady that carried the pregnancy on behalf of the couple
hails from the South Western part of the country and lives in Lagos, while the
couple from the South Eastern part of the country, resides in the east. But the
hospital ensured anonymity between both parties. The carrying mother was
referred to the hospital by somebody who had discussed it when they met and
were talking socially about modern fertility. The person told her that people
were doing it, and anyone who accepted the offer would be paid for it, so the
lady took up the offer. Giwa-Osagie further maintains that in the last two
years, over 20 Nigerian couples have approached the hospital for the same
purpose including three Nigerians resident abroad (qtd. in Omo 3).
Proponents of outsourcing pregnancy
see no problem with it. They consider it a win/win situation for all those
involved. The infertile married couple gets a baby; the surrogate mother
receives huge sum of money. Proponents argue that fundamental human rights support
commercial gestational surrogacy: the right to procreate and freedom of
contract. The thinking is that fully informed autonomous adults should have the
right to make whatever arrangement they wish for the use of their bodies and the
reproduction of children so long as the children themselves are not harmed (Abigail Haworth 4).
There is no gainsaying the fact that
outsourcing pregnancy has brought joy to many infertile married couples. The
question must however be asked whether commercial gestational surrogacy is
morally defensible. It might be regarded as such by appeal to the liberal
freedom of contract, which protects the rights of adults of sound mind and full
information to contract for the performance of services they desire at a price
they are willing to pay, or to offer services for a fee they find compensatory
(Vida Panitch 340).
It might also be defended on the grounds that it provides a source of
independent income to poor women whose economic options are otherwise quite
limited. And also, it might be defended on the grounds that it satisfies the
reproductive rights of richer women who have chosen to delay child-rearing to
pursue a career or other projects of interest to them and who would otherwise
be biologically, legally, and economically prevented from exercising that right
(Panitch 339). But there is a decidedly more pressing reason to be concerned
with the practice, namely, to examine if gestational surrogacy exploits the
reproductive labour of poor women in developing countries like India and Nigeria.
There is no doubt that gestational
surrogacy is a highly controversial form of infertility treatment, with views
varying widely between faiths, personal beliefs and national legislation. There
is also a range of far more personal surrogacy issues to consider, such as
whether the intended parents will bond with the child in the same way as would
the parturition mother; as well as the difficulty of whether the child should
be told about his or her origins.
The most
worrisome dimension is the abdication of a woman’s natural reproductive right
for cosmetic reasons and outsourcing that same right to another woman. Ethical questions must therefore
be asked as to the right for a woman to rent out her womb for a fee? Can the
“womb” be subjected to the invisible hand of the market forces of demand and
supply? Why are people apparently more willing to accept a practice that was
once considered abnormal, immoral or distasteful? Are there some values that are higher than
market values? Is paid gestational surrogacy ethical? Is outsourcing
pregnancy by developed countries to underdeveloped and developing countries
ethical? Although at the most fundamental level, paid gestational surrogate
motherhood could be interpreted as an economic transaction, the reality is far
more complex due to the degree of intimacy involved. Inclusive to the
basic economics of the markets are layers of emotional complexity, rights of
bodily autonomy, and the unaddressed questions of women’s rights in developing
countries. Furthermore should legal motherhood be attributed on the basis of
parturition or genetic make-up? Similar difficulties can arise in relation to
legal fatherhood, as well as the recognition of two parents of the same sex.
Therefore,
this study sets out to answer some basic hypothetical questions which include
among others: Is it morally justifiable to subject the gift of the womb to the
market forces of demand and supply? What are the religious implications of outsourcing
pregnancy? Can non-commercial pregnancy outsourcing be religiously justified?
And what are the positives of outsourcing pregnancy in an age of growing
childless couples?
1.2 Statement of the Problem
There is currently a growing pregnancy outsourcing
industry, namely clinics
offering couples the opportunity to “rent a womb".
These clinics are becoming home to an ever growing number of young women,
anxious for the opportunity to trade their ability to carry a much desired
child in exchange for the cash that will change their entire fortune. Childless
couples are flocking to India and some Nigerian fertility clinics to obtain the
services of these ready and willing women. The question is: what are the ethical
and religious implications of paid pregnancy?
1.3 Justification of the Study
Some
studies have already been done in the field of pregnancy outsourcing, among
which are New Trends in Global
Outsourcing of Commercial Surrogacy: A Call for Regulation by Ruby Lee,
wherein he examines the emerging threat of pregnancy outsourcing and called for
a legislation and guide to the practice (Lee 277). On his part Michael Sandel
in his study Markets and Morals
discusses the social issues surrounding pregnancy outsourcing to India. While
Ishika Arora in her book Wombs for Rent:
Outsourcing Surrogacy to India, asserts that pregnancy outsourcing is a
multimillion dollar industry that recruits poor Indian women as surrogates for
foreign citizens as an unethical business that should be banned by the
government (Arora 3). She further asserts that the rapid growth of this
industry warrants a thorough examination of many of its aspects including
safety, human rights, and legal issues. Mainly, Arora’s assertion begs for
answer to the question: “Is this exploitation?” Proponents of outsourcing
pregnancy justify this act through monetary compensation, but through the
analysis of the different facets of this lucrative business, it can be proved
that outsourcing surrogacy merely allows people of richer nations to exploit
the poverty-stricken women of less developed nations. Consequently, it hinders
further social, political, and economic development for these nations and
should be deemed illegal (Arora 3).
A
critical examination of the above literature shows a deficit of perceptive,
which only considered the legal and economic perspectives of pregnancy
outsourcing without any consideration given to the ethical and religious
perspectives. This is the gap this study sets out to fill.
Other
scholars and researchers have dwelt on other aspects of pregnancy outsourcing.
France Winddance Twine in his book Outsourcing
the Womb: Race, Class and Gestational Surrogacy in a Global Market
maintained that pregnancy outsourcing is a quiet revolution of the past three
decades and that the way children enter families has changed radically among
upper and middle class families. He is of the opinion that infertility is
increasingly defined as a medical problem that could be solved with assisted
reproductive technologies (ART) rather than through adoption (Twine 21). Twine
discovers from his study that recent statistics show that 1 in 10 couples are
experiencing trouble conceiving a child naturally and are turning to various
forms of assisted reproductive technology (ART), commercial gestational
surrogacy prominent among them (Twine 21).
Sarmishta
Subramanian, Stephanie Nolen and Agnihotri Gupta in their
separate studies on the prevalence of outsourced pregnancy in India suggest
wider estimates of 100–150 babies born to surrogate mothers in India each year.
The total cost to prospective parents being about $10,000, and this medical
reproductive tourism according to them is estimated to be a $445 million
business in India, with the potential to grow in the near future to $2.3 to $6
billion (Subramanian 9, Nolen 3 and Gupta 30).
Where do we draw the line in things that can be
outsourced? This is the question asked by Arlie Hochschild in her book: The Outsourced Self: Intimate Life in Market
Times. Alison Lynch discusses the new trend whereby women in America
outsourced their pregnancies so they do not miss out on opportunities at work
or ruin their figures. These women maintained that if they can hire people to
do their cleaning and shopping, there is nothing wrong with outsourcing
pregnancy too? Therefore women in America with no known fertility issues are
outsourcing childbirth through the use of social surrogates.
Sayantani DasGupta and Shamita Das Dasgupta in their book
Globalization and Transnational Surrogacy
in India: Outsourcing Life discusses the phenomenon of transnational
surrogacy which has given rise to a thriving international industry where money
is being ‘legally’ exchanged for babies and ‘reproductive labor’ has taken on a
lucrative commercial tone (DasGupta and Dasgupta 120).
A
critical review of the studies of Twine, Subramanian, Nolen and Gupta, Arlie
Hochschild, Sayantani DasGupta and Shamita Das Dasgupta shows that these
studies centered mainly on the social and medical perspectives of outsourcing
pregnancy and how pregnancy outsourcing is fast becoming a multibillion dollars
industry in India, with a major focus on medical tourism. An ethico-religious evaluation
of outsourcing pregnancy is clearly obscured in these previous studies. To fill
this gap, this study will underscore the importance and denude the
philosophico-religious issues regurgitated by gestational surrogacy.
Papal
encyclicals like Evangelium Vitae,
Humanae Vitae, Casti Connubii, Mater et Magistra, Familiaris Consortio and Dignitas Personae all dwelt on the
dignity of the human person and not specifically on pregnancy outsourcing. The
lack of specific treatment of pregnancy outsourcing in these documents and
other encyclicals is understandable, as pregnancy outsourcing is a new emerging
moral dilemma in bioethics.
In summary, there is a clear testament to the fact that
there are lots of studies on the legal, medical, commercial and social
perspectives of pregnancy outsourcing. These previous engagements had focused
mainly on the scientific and economic perspectives of outsourcing pregnancy.
The ethical and religious concerns are rarely made explicit in these
discussions, and therefore not adequately scrutinized or debated. This has
created a deficit in the examination of the ethical and religious perspective
of outsourcing pregnancy. The justification of this study is to fill this
yearning gap of having an ethico-religious evaluation of this new emerging
moral dilemma called “outsourcing pregnancy”, as the ethical and religious
stakes surrounding outsourcing pregnancy cannot be avoided or reduced. Failure
to have this evaluation could have catastrophic implications. Responses must be
thoroughly considered, with ethical and religious implications in mind in order
to avoid creating new paradigms of distorted values and misdistribution, as
well as render even more vulnerable those who have already found themselves
uprooted by other socio-economic and ideological struggles. The need for an
ethical and religious approach to outsourcing pregnancy is therefore profound
and compelling.
The formulation of an ethical and religious response to
outsourcing pregnancy will have profound implications for the immediate and
future well-being of a number of persons who are the immediate victims of
outsourcing pregnancy, namely that outsourcing pregnancy raises not only a
number of questions that have to do with medical science, but also, many
questions of a more universal nature that are based on philosophical, ethical and
religious assumptions with colossal ethical and religious implications which
have largely been ignored in all previous pregnancy outsourcing engagements.
1.4 Objectives of the Study
The overall aim of this study is
to undertake an ethical and religious evaluation of outsourcing pregnancy. The
specific objectives of this study are to:
(a) examine
if it is morally right for a fertile
woman to abdicate her natural right of reproduction and seek the benefit of
that same right through the markets;
(b) examine
the prerogative of an infertile woman who seeks the benefits of gestational
surrogacy;
(c) ascertain
the religious and the ethical mandate of a woman who wants to become a
gestational surrogate mother;
(d) explore
the moral and religious issues involved in outsourcing pregnancy through the markets;
(e)
determine if outsourcing pregnancy to
underdeveloped and developing countries is a means of economic empowerment or
human exploitation, and
(f) determine
current deposition of Nigerians to outsourcing pregnancy.
1.5 Definitions of Terms
This section defines the terminology
used in the study given the unfamiliar and often contested nature of
surrogacy-related terminology. While this study has adopted the meaning of the
terms below, it also acknowledges that some terms continue to prove problematic
in sufficiently capturing both the empirical realities and the subjectivities
of the persons involved. The key
terms defined in this study are: “Outsourcing Pregnancy”,
“Gestational Surrogacy”, “Ethics”, “Ethical Models”, “Religion”, “Evaluation”
and “Market”.
1.3.1 Outsourcing Pregnancy
The English Oxford
Living Dictionary defines the word “Outsourcing” as the contracting or
subcontracting of activities to obtain goods or a service from an outside
supplier (par 1). Outsourcing is often an integral part of downsizing or
reengineering also called “contracting out”. Dave Jamieson defines the word
“outsourcing” as the
act of one company contracting with another company to provide services that might
otherwise be performed by in-house employees. Often the tasks that are
outsourced could be performed by the company itself, but in many cases there
are financial advantages that come from outsourcing (45). Merriam Webster Dictionary simply defines outsourcing as the procurement of some goods or services needed by a person
or organization from outside sources and especially from foreign or nonunion
suppliers (96). Outsourcing has become a major trend in human resources
over the past decade as more and more companies, large and small, are turning
to outsourcing as a way to grow while restraining payroll and overhead costs.
Many large
companies now outsource jobs such as call center services, e-mail services, and payroll. These jobs are handled by separate companies that specialize in each
service, and are often located overseas. There are many reasons that companies
outsource various jobs, but the most prominent advantage seems to be the fact
that it often saves money. Many of the companies that provide outsourcing services are able to do the work for
considerably less money, as they do not have to provide benefits to their
workers and have fewer overhead expenses to worry about. Depending on location,
it may also be more affordable to outsource to companies located in different
countries (WiseGeek 34). This strategy may also lead to faster turnaround
times, increased competitiveness within an industry and the cutting of overall
operational costs. Businesses can reduce labor costs significantly by
outsourcing certain tasks, while companies may simultaneously have access to
technology without investing large amounts of money to own the technology (Investopedia 84).
Linda Wylie defines pregnancy as the
interval of time beginning when an egg and sperm unite and ending when a baby is
born. A full-term pregnancy lasts nine months (38 to 40 weeks). The nine months
are divided into trimesters. The first trimester is when the embryo develops, the
second trimester is when the embryo turns into a fetus, and third
trimester is when the fetus gains weight and gets ready for birth (172). A trimester is any of three periods of
approximately three months each into which a human pregnancy is divided (Wylie
173).
Pregnancy, also known as gravidity or
gestation, is the time during which one or more offspring develops inside a
woman. A multiple pregnancy involves more than one offspring, such as with
twins (Wylie 172). Pregnancy can occur by sexual intercourse or assisted
reproductive technology. It usually lasts from the last menstrual period (LMP)
and ends in childbirth. An embryo is the developing offspring during the first
eight weeks following conception, after which, the term fetus is used until
birth (Steven Abman 46). Symptoms of early pregnancy may
include missed periods, tender breasts, nausea and vomiting, hunger, and
frequent urination (American Pregnancy Association
67). Pregnancy may be confirmed with a pregnancy test (National Institute of Child Health and Human Development
NICHD 90).
Prenatal care improves pregnancy
outcomes. Prenatal care may include taking extra folic acid, avoiding drugs and
alcohol, regular exercise, blood tests, and regular physical examinations
(NICHD 91). Complications of pregnancy may include high blood pressure of
pregnancy, gestational diabetes, iron-deficiency anemia, and severe nausea and
vomiting among others (Christopher Bottomley 250). Term pregnancy
is 37 to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40
weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies
born before 37 weeks are preterm and are at a higher risk of health problems
such as cerebral palsy (Bottomley 251).
“Outsourcing pregnancy” is the
contracting of pregnancy to a surrogate. It is an arrangement or agreement
whereby a woman agrees to carry a pregnancy for another person or persons, who
will become the newborn child's parent(s) after birth. Intended parents may
seek pregnancy outsourcing arrangement when either pregnancy is medically
impossible; pregnancy risks present an unacceptable danger to the mother's
health, or in the case of same sex couple's preferred method of having
children. Monetary compensation may or may not be involved in these
arrangements. If the surrogate receives money for the surrogacy, the
arrangement is considered commercial surrogacy, if she receives no compensation
beyond reimbursement of medical and other reasonable expenses it is referred to
as altruistic (Lisa Feldstrin 7).
In this study outsourcing pregnancy is a
designated term used to refer to a medical procedure whereby surrogates are
implanted with foreign embryos and paid to carry the resultant pregnancy to
term. After delivery the child is given to the intended parent. In this study outsourcing
pregnancy is used interchangeably with different terms such as “gestational
surrogacy”, “paid pregnancy”, “contract pregnancy”, “rent a womb”, “wombs for
rent” (cf appendix II) and “wombs for hire” (cf appendix III).
1.3.2 Gestational Surrogacy (GS)
“Gestational” is
a term relating
to pregnancy. The Surrogate Parenting Act
199 of 1988 defines gestational surrogacy as the procedure that occurs when
the eggs of intended mother and the intended father's sperm are used to create
an embryo (via IVF)
that is transferred into and carried by the surrogate mother. With this method,
the child born is genetically related to its parents and the surrogate mother
has no genetic relation. There are different typologies of gestational
surrogacy. (a) Gestational Surrogacy
with Donor Embryo (GS/DE) is when the intended parents are unable to produce
sperm, egg, or embryo, the surrogate mother can carry a donated embryo (often
from other couples who have completed IVF that have leftover embryos. With this
method, the child born is not genetically related to the intended parents and
the surrogate mother also has no genetic relation (Surrogate Parenting Act 199 of 1988). (b) Gestational Surrogacy
with Donor Sperm (GS/DS) is when there is no intended father or the intended
father is unable to produce sperm, the surrogate mother carries an embryo
developed from the intended mother's egg (who is unable to carry a pregnancy
herself) and donor sperm. With this method, the child born is genetically
related to the intended mother and the surrogate mother has no genetic relation
(Surrogate Parenting Act 199 of 1988).
(c) Gestational Surrogacy with Egg Donation (GS/ED) is when there is no
intended mother or the intended mother is unable to produce eggs, the surrogate
mother carries the embryo developed from a donor egg that has been fertilized
by sperm from the intended father. With this method, the child born is
genetically related to the intended father and the surrogate mother has no
genetic relation (Surrogate Parenting Act
199 of 1988).
In this study Gestational surrogacy
refers to all the different typologies of gestational surrogacy, excluding genetic
gestational surrogacy. Genetic gestational surrogacy is when the resulting
child is genetically related to the surrogate. Gestational surrogacy as used in
this study simply means non-genetic gestational surrogacy. Non-genetic
gestational surrogacy is when the resulting child is not genetically related to
the surrogate; that is the gestational mother is just a gestational carrier (Karisa
Ding 3).
1.3.3 Ethics:
The term ethics derives from the Ancient
Greek word ἠθικός (ethikos), which is derived from
the word ἦθος ethos (habit, "custom").
It is a branch of philosophy (axiology) which comprises the sub-branches of
ethics and aesthetics, each concerned with values (Random House Unabridged Dictionary par 1)
As a branch of philosophy, ethics
investigates the questions "What is the best way for people to live?"
and "What actions are right or wrong in particular circumstances?" In
practice, ethics seeks to resolve questions of human morality, by defining
concepts such as good and evil, right and wrong, virtue and vice, justice and
crime. As a field of intellectual enquiry, moral philosophy also is related to
the fields of moral psychology, descriptive ethics, value theory and moral
theology.
According to the Internet Encyclopedia of Philosophy, three major areas of study
within ethics are recognized today. Which are:
(a)
Meta-ethics, concerning the theoretical
meaning and reference of moral propositions, and how their truth values (if
any) can be determined,
(b)
Normative ethics, concerning the
practical means of determining a moral course of action, and
(c)
Applied ethics, concerning what a person
is obligated (or permitted) to do in a specific situation or a particular
domain of action (30).
Rushworth Kidder states that
"standard definitions of ethics have typically included such phrases as
'the science of the ideal human character' or 'the science of moral duty” (63).
Richard Paul and Linda Elder define ethics as "a set of concepts and
principles that guide us in determining what behavior helps or harms sentient
creatures" (np). The Cambridge
Dictionary of Philosophy states that the word ethics is "commonly used
interchangeably with 'morality' and sometimes it is used more narrowly to mean
the moral principles of a particular tradition, group or individual"(156).
Paul and Elder state that most people confuse ethics with behaving in
accordance with social conventions, religious beliefs and the law and do not
treat ethics as a stand-alone concept (np).
Merriam
Webster Dictionary sees the word "ethics" as
referring to philosophical ethics or moral philosophy, which is a project that
attempts to use reason in order to answer various kinds of ethical questions
(par 2). As the English philosopher Bernard Williams writes, attempting to
explain moral philosophy: "What makes an inquiry a philosophical one is
reflective generality and a style of argument that claims to be rationally
persuasive"(2). Williams describes the content of this area of inquiry as
addressing the very broad question, "how one should live" (1). Ethics
can also refer to a common human ability to think about ethical problems that
is not particular to philosophy. As bioethicist Larry Churchill has written:
"Ethics, understood as the capacity to think critically about moral values
and direct our actions in terms of such values, is a generic human capacity"(253). Anthony Echekwube in his book Contemporary Ethics: History, Theories and
Issue, defines ethics as the
systematic study of the fundamental principles of the moral law; or the
normative sciences of human conduct, which means that ethics is a normative
science as distinct from the empirical sciences.
In this study ethics is defined as the
breach of moral philosophy and moral theology which deals with the moral
standard of behavior and what is acceptable. It is a system of fundamental moral
principles that affect how people make decisions and lead their lives. Ethics
in this study is concerned with what is good for individuals and society.
“Bioethics” the rapid technological
advancements in the areas of medicine and health care have given rise to a new
discipline known as bioethics. Simply defined, bioethics is the critical
examination of the moral dimensions of decision-making in health-related
contexts and in contexts involving the biological sciences. It is an
interdisciplinary enterprise that studies in depth the moral implications of
advances in biological sciences with the aim of providing consistent moral
answers that are raised (Antonio Spagnolo par 8).
1.3.4 Ethical Models
Dealing with ethical issues is often
perplexing. According to Manuel Velasquez, Claire Andre, Thomas Shanks, and Michael
Meyer the first step in analyzing moral issues is to get the facts. But having
the facts is not enough. Facts by themselves only tell us what is; they do not usually
tell us what ought to be (5). In addition to getting the facts, resolving an
ethical issue also requires an appeal to some ethical values. Philosophers have
therefore developed different approaches of ethical values to deal with moral
issues. These ethical approaches to ethical values are known as ethical models.
Given the fact that ethical dilemmas may
not always be readily resolved through the use of codes of ethics, it might be
useful to have a framework in which to analyze and make ethical decisions.
These ethical frameworks are known as ethical models.
Ethical models are often broadly divided
into three types: i) Consequentialist theories, which are primarily concerned
with the ethical consequences of particular actions; ii) Non-consequentialist
theories, which tend to be broadly concerned with the intentions of the person
making ethical decisions about particular actions; and iii) Agent-centered
theories, which, unlike consequentialist and non-consequentialist theories, are
more concerned with the overall ethical status of individuals, or agents, and
are less concerned to identify the morality of particular actions. Each of
these three broad categories contains varieties of approaches to ethics, some
of which share characteristics across the categories. Some of the most
important and useful of these ethical models drivable from these three broad theories
are: Emotivism,
Voluntarism, Deontologism, Teleological Ethics and Prudential Personalism.
3.3.5
Religion
Religion
which is “respect for what is sacred, reverence for the gods"(Douglas Harper 1), "obligation, the bond
between man and the gods" (Shorter
Oxford English Dictionary 78) is derived from the latin word religiō. Modern scholars such as Tom
Harpur and Joseph Campbell favor the derivation from ligare "bind, connect", probably from a prefixed re-ligare, i.e. re (again) + ligare or "to reconnect",
which was made prominent by St. Augustine, following the interpretation of
Lactantius (John Green 94).
Clifford
Geertz defines religion as a cultural system of
behaviors and practices, worldviews, sacred texts, holy places, ethics, and
societal organisation that relate humanity to "an order of
existence"(116). Different religions may or may not contain various
elements, ranging from the "divine", "sacred things",
"faith", a "supernatural being or supernatural beings" or
"some sort of ultimacy and transcendence that will provide norms and power
for the rest of life” (Anthony Vergote 16). According to James Swindal, religious practices may include
rituals, sermons, commemoration or veneration (of God or deities), sacrifices,
festivals, feasts, trances, initiations, funerary services, matrimonial
services, meditation, prayer, music, art, dance, public service, or other aspects
of human culture. Religions have sacred histories and narratives, which may be
preserved in sacred scriptures, and symbols and holy places that aim mostly to
give meaning to life. Religions may contain symbolic stories, which are
sometimes said by followers to be true, that have the purpose of explaining the
origin of life, the Universe, and other things. Traditionally, faith, in
addition to reason, has been considered a source of religious beliefs (19). According
to the Association of African Studies, there are an estimated 10,000
distinct religions worldwide (119). About 84% of the world's population is
affiliated with one of the five largest religions, namely Christianity, Islam,
Hinduism, Buddhism or forms of folk religion (Pew Research Center par 12).
The
study of religion encompasses a wide variety of academic disciplines, including
theology, comparative religion and social scientific studies. Theories of
religion offer various explanations for the origins and workings of religion.
In
this study, the word religion is used as the belief in and worship of a
superhuman controlling power, especially a personal God. Religion is seen as a
set of beliefs that is held by a group of people as there are many different
religions, each with a different set of beliefs. These beliefs are about the
world and the people in it, about how they came into being, and what their
purpose is. Each religion also has a "moral code" which is a set of
beliefs about how humans should act.
1.3.6
Evaluation
The
Cambridge Advanced Learner’s Dictionary
defines evaluation as the act of examining someone or something in order to
judge their qualities, success, or needs (par 1). Dictionary.com defines evaluation as the act of estimating or
judging the nature or value of something or someone, an estimate or considered
opinion of the nature, quality, importance (par 1 and 3). The objective of an
evaluation is for the decision maker to develop insight into the decision and
determine a clear course of action. Much of the insight developed in the evaluation
stage results from exploring the implications of the chosen decision model.
Possible actions following the evaluation stage include implementing the
recommended course of action, revising the formal model and reevaluating it, or
abandoning the analysis all together (Steve Holtzman
67). In this study evaluation
is taken to mean the process of assessing and judging something or someone
based on a set of standards.
1.3.7 Market
Investopedia
defines market is a medium that allows buyers and sellers of a specific good or
service to interact in order to facilitate an exchange. This type of market may
either be a physical marketplace where people come together to exchange goods
and services in person, as in a bazaar or shopping center, or a virtual market
wherein buyers and sellers do not interact, as in an online market (5). Market
as used in this study is more in line with the notion of a virtual market which
refers to people with the desire and ability to buy a specific product or
service in the biotech market.
1.6 Scope of the Study
This study is on
the ethical and religious perspectives of outsourcing pregnancy and does not pretend
to cover the whole subject area of assisted human reproductive technologies (ART)
and IVF. While acknowledging that gestational surrogacy is within the preview of
In Vitro-Fertilization (IVF), the scope of this study is mainly focused on the
religious and ethical implications of paid pregnancy or commercial
gestational surrogacy. It is also imperative to state that this thesis
is not a medical treatise, but a philosophical-theological evaluation of a
medical procedure within the realm of bioethics.
1.7 Research Methods
This study is within the
theoretical framework of the Prudential Personalism Ethical Model whose major
proponent is Benedict M. Ashley.
Prudential Personalism stresses that the "ends” of human action are
always persons and the community of interrelated persons responding to each
other within the tripartite relationship between God, Man, and Others.
In this study, the expository,
evaluative and critical-analytical approaches based on Prudential Personalism
ethical model are adopted. The expository approach provided the platform to describe,
explain, discuss and give information about the ethical and religious
perspective of outsourcing pregnancy. The evaluative method of research was
employed to achieve the overall aim and specific objectives of this study. The
Evaluative method enabled this research to systematically determine the merit,
worth, value and significance of the ethico-religious arguments on outsourcing
pregnancy. These were strengthened by the use of primary and secondary sources.
In order to determine contemporary
disposition of Nigerians to outsourcing pregnancy, a total sample size of two
thousand (2000) questionnaires containing thirty items, aimed at capturing the
subjectivity and phenomenology of this study were randomly distributed amongst
some selected Nigerians. The questionnaire was stratified to elicit both
ethical and religious dispositions. Because of large nature of the study
population, a sample size of two thousand (2000) respondents expected to give
contrasting views on the same subject, was considered adequate. In order to have a robust evaluation and ensure
that the data collected are reliable, the test and retest method was used. The responses were collected and analyzed
using simple percentages, based on the fact that the explicit presupposition of
this analysis is that persons have a "nature" or certain essential
characteristics, which they share universally, which are knowable by reason,
which ought never to be violated in moral activity, and which conduce to
specific and unchanging moral norms (Siker, 63). In addition to primary
sources, secondary sources of data were extensively utilized. The secondary
sources of information were writings from philosophical ethicists and
religionists. Literary secondary sources provided background information on
outsourcing pregnancy which helped to support the development of the main idea
of the thesis statement. The study relied extensively on
secondary sources which include books, articles, published materials,
magazines, newspapers and the use of internet blogs and podcasts.
1.8 Organization
of the Work
This study is divided into six chapters. Chapter
One gives an overview of the study, setting the tone of the thesis on moral
philosophy and Christian moral theology. Chapter Two reviews related and
relevant literature to the study with the objective of identifying knowledge
gaps that the study intends to fill. Specifically, Chapter Two examines the
meaning of outsourcing pregnancy, the types and methods of outsourcing pregnancy,
reasons for outsourcing pregnancy and the process of pregnancy outsourcing. It
also examines who can be a gestational surrogate, the legal issues in
outsourcing pregnancy, the economics of outsourcing pregnancy, including
surrogacy in traditional African society and commercial gestational surrogacy
in Nigeria. Chapter Three dwells on the ethical perspective of paid pregnancy
brining to the fore the ethical issues involved in outsourcing pregnancy. It
also carefully outlines and discusses the ethical arguments for and against
Gestational Surrogacy. Chapter Four focuses on the interpretation of data
concerning current ethical and religious disposition of Nigerians to
outsourcing pregnancy. Chapter Five is on the religious perspective of
outsourcing pregnancy. The religious issues involved in gestational surrogacy
or outsourcing pregnancy also engage our attention in this chapter, extrapolating
from these religious issues, the religious arguments for and against gestational
surrogacy. Chapter Six discusses some ethical models with a view of accentuating
a more robust ethical model for the evaluation of outsourcing pregnancy. An ethico-religious model, namely a prudential
personalism model is however adopted in the evaluation of the moral and
religious dimensions of paid pregnancy. Emplaced in the chapter also, is the general evaluation, summary, findings, contribution to knowledge,
conclusion and recommendations.
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