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Surrogacy - what are the issues?

5/8/2014

 
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The news this week of Baby Gammy, a child born with Down’s Syndrome to a surrogate mother in Thailand and allegedly rejected by his intended parents in Australia (whilst they did adopt his healthy twin sister - http://bbc.in/1lwdFaA), has brought into public focus the complex issues that Surrogacy can raise. As ever, I am not trying to give my opinion or offer any answers - I just want to raise the questions.

What is surrogacy?

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Surrogacy is an arrangement whereby another woman carries and gives birth to a baby for a couple who want to have a child. There can be a number of reasons for making such an arrangement such as repeated miscarriages or a malformed/absent womb.

There are a two main ways that surrogacy can work:

  1. Full surrogacy (or Host or Gestational surrogacy) involves the implantation of an embryo created using either the sperm and egg of the intended parents or a donor or donors.
  2. Partial surrogacy (or traditional surrogacy) involves sperm from the intended father and an egg from the surrogate mother. Fertilization is normally achieved by artificial insemination.

After the birth of the child it is common practice for the baby to be adopted formally by the couple so that they gain legal standing as the child’s parents.

Surrogacy for profit is not legal in the UK (or Australia), although you can do it altruistically and receive expenses from the couple who wish to have a baby. This regulation has led many couples to go abroad to countries where the law is different (such as the USA and Thailand).


What are the issues?

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As seen in the case of baby Gammy, there is the risk of the couple pulling out of the arrangement for one reason or another; they get cold feet; they split up; they become ill or die. This would leave the surrogate in a very difficult position having given birth to a child that may not even be genetically hers. Who will have ultimate responsibility for the child?

On the flip side, the surrogate may want to keep the baby and not allow it to be adopted by the couple - this can be mitigated against by having a very clear contract drawn up in advance, however this would not negate the emotional turmoil a surrogate mother might go through.

The couple may want to have the baby aborted if they discover that it has a disease such as Down’s or Spina Bifida - do they have the right to force the surrogate to undergo the procedure? Is the unborn foetus essentially their property if they have signed contracts and contributed their own genetic material? This leads us to consider whether we want to have the unborn commercialised at all - can a price be realistically be put on a human life?

Is it ethical for a relatively wealthy couple to travel to a less developed nation (as in the Baby Gammy case) to seek a surrogate? Is this a form of human exploitation? Or should we accept that we live in a global environment and this extends to having a child?


As the child grows up, do they have a right to be able to contact the surrogate mother, especially if it was a traditional surrogacy and they have the Surrogate’s genes? Does the surrogate mother have the right to contact the child?

Many will have assumed until now that the “couple” are heterosexual, a man and a woman. What if they are gay or lesbian? Should they be allowed to have a surrogate child? Given that they are allowed to marry in the UK could they be stopped from having a child in this way?

Finally, we might consider if couples have a moral prerogative to adopt children that are already alive and unwanted, rather than creating a whole new life. The urge to have a child that is genetically related to you is a very strong one, but is it more ethical to adopt existing children?


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These are just a few of the issues - I am sure that many of them will be  discussed in tomorrow's Moral Maze on BBC R4 at 20.00 BST. (http://www.bbc.co.uk/programmes/b04cffpz) 


Assisted dying - lessons from the past?

18/7/2014

 
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A debate on assisted dying went on in the House of Lords today and passed it’s second reading - http://www.bbc.co.uk/news/uk-politics-28352680 (follow it’s progress here: http://services.parliament.uk/bills/2013-14/assisteddying.html) however it is unlikely that the bill will pass regardless of the vote today due to the lack of time left in this parliament and a lack of willing by David Cameron. Never-the-less the debate has sparked a huge amount of public interest and 130 lords have requested to speak in the debate - a record number.

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Scholars should always be looking backwards to events of the past to help answer the questions of the present; with this in mind I have decided to compare it to the change in the law in 1967 which legalised Abortion. Although these are not perfect comparisons, I believe there are some illuminating things to think about.


Letting the Genie out of the bottle?

One lesson that should be remembered is that once any such law is past there is almost no way to go back. The Abortion Act, passed 47 years ago, has totally changed british attitudes towards abortion. It has normalised it and made it far less taboo option for women who find themselves pregnant. I am not saying this is a bad thing - arguably thousands of women have been liberated by not having to have an unwanted child.

It could well be the case that a law enabling assisted dying would have the same impact - could dying early become normalised or even expected? This might put extreme pressure on the old and vulnerable. Equally, it might liberate people who feel like a burden and free families from looking after an ill relative for years or decades. Whatever the outcome, just as one could not imagine modern Britain without abortion, so the country would be changed forever, for better or worse, by such a law.


A “Slippery Slope”?

When the Abortion Act was debated in the 1960’s there was little expectation that so many abortions would be performed and yet a huge number has been the reality - 189,931 in 2013. In a debate on the issue on the Today Programme this morning (http://www.bbc.co.uk/programmes/b0499n5z - 1hr 56 mins) Lord Falconer tentatively predicted that the figure in the UK, if it matched the statistics from the State of Oregon, would be about 1,600 people every year. Indeed he said “there would be no slippery slope”. Does the Abortion comparison show us that such a prediction is rather dangerous? Or are the two not comparable?


Two doctors providing a safeguard?

Another striking similarity between the two cases is that two doctors are required by law to authorise an abortion and the Assisted Dying Bill would demand the same safeguard. The intention of the “two doctor rule” was a good one, to protect doctors from prosecution and ensure that the process would only go on legitimately.

However, the reality 47 years on is that in many cases the doctors work for the same clinic whose sole income and raison d'etre is to perform abortions. There is no way in reality that one is going to prevent the other from going ahead. Indeed, some are now calling for the removal of this provision (Hall, p6). Would we see the same eventually in assisted dying? Would this safeguard become defunct?


Preserve of the rich?

A final comparison is the similarity in availability of assisted dying today in Britain and Abortion pre-1967. Before the abortion act it was the preserve of wealthy to hire private doctors (Hall, p4) whilst the poor had to resort to risky “backstreet” abortions. The act made this much more egalitarian and gave access to many more people - this resulted in fewer unnecessary deaths.

Similarly, the wealthy can still travel to countries such as Switzerland if they wish to die; Dignitas alone claim that 694 people traveled from the UK in 2009 (The Guardian). Those not wealthy enough to enlist the help of such organisations have to risk prosecution here at home and only have amatuer skills to perform the act. Legalising it might have the same egalitarian effect and arguably be more compassionate?


The Weakness of any analogy

As I said at the start of this post - this analogy may not be a good one, but I hope it has highlighted some interesting debates.


References:

Memorandum submitted to the House of Commons Science and Technology Select Committee inquiry: Scientific developments relating to the Abortion Act 1967 September 2007, Lesley A. Hall http://www.historyandpolicy.org/docs/abortion_act_1967.pdf

Assisted suicide statistics: the numbers Dignitas helps to die, by country, Simon Rodgers, 2010 http://www.theguardian.com/news/datablog/2010/feb/25/assisted-suicide-dignitas-statistics



Can war ever be limited?

17/7/2014

 
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The news today of Air Malaysia Flight MH17 which was shot down over The Ukraine (http://www.bbc.co.uk/news/world-europe-28354856) has highlighted, yet again, how warfare and conflict is not nicely contained to a war-zone, but spills out to affect people with no connection or influence upon the war. This has also been seen this week in Gaza where innocent bystanders have been killed in Israel's attempt to kill Hamas leaders (http://www.nbcnews.com/storyline/middle-east-unrest/innocent-gone-israeli-strike-gaza-kills-four-children-n157301). These kinds of incidents lead us to consider carefully what the limits of modern warfare are and how politicians, strategists and ethicists should respond.

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There is a long history of thinkers suggesting that there should be a distinction made between combatants and non-combatants. This goes back as far as the Middle Ages when in the 10th century leaders of the "Peace for God" movement “forbade all acts of warfare or vengeance against clerics, pilgrims, merchants, Jews, women, and peasants” (Bellamy, 31) and was most clearly articulated by St Thomas Aquinas in the thirteenth century when he wrote that there should be “complete prohibition on killing the innocent” (Bellamy, 40). This was and is held in high regard by followers of Thomas and remains part of Modern Just War Theory. This is categorised as part of Aquinas’ Jus in Bello - conditions to be regarded during warfare. Modern Scholars such as Brian Orend state that terrorist attacks aimed at non-combatants are “always an impermissible tactic, since it involves the killing of innocent civilians” (Orend, 70)

The principle is clearly very hard to argue against - as a principle. Those who are not killing others, regardless of their political views, nationality or location should be left alone. I have always regarded this as a “quid-pro-quo” sort of argument. You would not want members of your own society to be killed or injured in such a way and so you should not kill others. Kant would thoroughly approve.

But does this principle work in reality? Can a nation or group start a conflict and really hope to keep innocents out of it?


Well before you say no - and start to slag off St Thomas Aquinas - it might be worth remembering that warfare was very different in Thomas’ day. There was, quite literally, a field of battle; rulers agreed through negotiation where and when the battle was fought and codes were followed as a matter of chivalric honour. This was wonderfully satirised in Asterix in Britain (click on the image to enlarge)

With this in mind it is not surprising that Aquinas views the killing of innocent with moral horror. You would have had to go out of your way as a Knight of foot soldier to kill bystanders. You could be in the next village, out of ear-shot, and not even know a war was going on! However in the modern era, with weaponry that would have been unimaginably powerful to Thomas and totally indiscriminate when fired or detonated, the death of innocents has seemingly become an inevitability. Added to this war is not fought under the same strict conditions and, as can be seen in Israel/Palestine and The Ukraine at the moment, war is not necessarily even “declared” as such. 

Has warfare changed so much that the JWT is now redundant?

On the one hand you could say; it is a principle, and the principle is a good one even if it is not often maintained in the modern world. 


Or you might say; warfare is so powerful and indiscriminate that you cannot go to war “morally” in the modern world and so one should not go to war (the thinking of Contingent Pacifism)

References:

Bellamy, Alex. Just Wars. Cambridge: Polity Press, 2006. 
Orend, Brian. The Morality of War. Toronto: Broadview Press, 2006.
 
https://blogs.montclair.edu/tae/files/2010/11/TAE-Vol.-1-Issue-1_Just-War.pdf




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