Wednesday, March 12, 2008

Surrogate motherhood

In animal husbandry, surrogate motherhood is not a new concept. Prized foals or heifers with desirable traits and genes are carried to term by "lesser" individuals within the breed or even occasionally, by individuals of related species. The focus is typically on aspects of efficiency--the gestation and delivery by multiple gestational moms during which time the genetic or donor mom is either aging or competing/producing (i.e., doing what a mare or a prized dairy cow is bred to do). We instinctively understand how humans benefit from this scheme. The assumption is that nature is happy with the chosen super(ior) mom. But we don't ever ask what's in it for the surrogate moms.

In humans, it is another story of course, although surrogate motherhood in people is less common. The answers can surprise us. But the development brings with it a whole new set of questions.

Dr. Naina Patel of Anand, Gujarat, alternatively referred to as Dr. Nayana Patel elsewhere, dominates most articles I read (in North America) about surrogate motherhood in India. In these articles she plays twin roles simultaneously--highlighting her role as the Director of the Akanksha Infertility Clinic and voicing her concerns about the lack of regulations by the Indian Medical Council. Clearly there is an unavoidable conflict of interest for her although she is on record claiming ethical and moral thought processes (but some may consider her ethics and morality selective and subjective). For example, as reported in the WebMD article:

But [Dr.Patel] refuses to treat gay couples, revealing her deeply conservative cultural roots. "I get e-mails from gays and lesbians," she says, "some of them very well written — but I don't feel right about helping them."

If empowerment of impoverished Indian women is one major goal of her program, why discriminate against gay couples who have a legal right to become parents in the countries they originate from?

Nowhere in these articles did I find any description or explanation about what happens when the health of the surrogate mother deteriorates on account of the surrogate pregnancy. Perhaps the situation has not come about yet. It is true that the potential surrogate moms are carefully chosen to be at low-risk for most pregnancy-related adverse events and are even more carefully monitored once they become pregnant. But what happens to the family of the surrogate mother in case of medical emergencies or tragic circumstances arising from the invasive procedures and/or pregnancies? This is a question that is also asked by C.P.Puri, Director of National Institute for Research in Reproductive Health [Link here.] With only about 50 surrogate pregnancies reported from India thus far, sorting out the legal and ethical nuances may not yet be a priority for the country; but I cannot help but think that all political hell will break lose if and when there will be one well-publicized adverse (health) incident.

It is interesting to see how the law regarding surrogacy differs in different countries. Canada, U.K. and parts of Australia do not permit commercial, but allow altruistic, surrogacy. In Israel, commercial surrogacy is legalized but altruistic and familial surrogacy is banned based on religious principles. In the United States, a large number of states have banned all forms of surrogacy (Reilly DR, 2007). The nuances in the ethical and legal aspects of caring (by a physician or another health-care worker) for a surrogate mother are well articulated in the following articles. Read here, here and here.

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