Wombs for hire

When the world was simpler, a man and a woman got together to start a family. From their union, another human being was conceived and nurtured in its own mother’s womb until it was born. Today, through the wonders of in-vitro fertilization (IVF), a zygote may be created from the pairing of a human sperm and an ovum on a Petri dish, outside of the sexual act, and inserted in the uterus of another woman who is not the source of the egg.

This deconstruction of the human reproductive process has spawned a flourishing medical practice and has produced various remixing possibilities that pose complex ethical, moral and legal questions. The first “test tube baby,” Louise Brown, was born in 1978. Since then, IVF has helped countless couples who, for any number of reasons, could not have their own babies the normal way. Its inventor, the physiologist Robert G. Edwards, received the Nobel Prize for Medicine in 2010.

Some of the complex issues that have grown around the creative use of IVF were thrown in bold relief last week by a case that rocked social media. We may piece together the basic elements of this developing story from numerous postings on the Web. An Australian couple traveled all the way to Thailand last year to engage the services of an agency that specializes in what has come to be known as “surrogacy service.” This expensive service entails finding a young woman of reproductive age, who, for a fee, is willing to grow a client couple’s fertilized egg in her womb.

The agency the couple commissioned is reportedly run by an American national, and is quite popular among foreigners. It has contacts with most of the 40 or so fertility clinics that operate in Thailand, and with discreet hospital-based obstetricians who understand the nature of such arrangements. The service includes harvesting the sperms and the eggs, and the delicate preparation of the hired womb for the implantation of the fertilized egg. It also entails counseling of the surrogate mother and close monitoring of the pregnancy.

But, sometimes, Nature refuses to cooperate, and throws in surprises. In this particular case, the pregnancy yielded twins—a boy and a girl. The biological parents took the girl home with them to Australia, and left the boy behind with the surrogate mother. Named “Gammy,” the abandoned baby has Down syndrome, and suffers from a congenital heart condition and a recurrent lung infection. He is now seven months old.

The surrogate Thai mother, Pattaramon Chanbua, who has two young children of her own, told the media that she took on this contract so she could use the money (about P1 million) for the education of her own children.  But, she dotes on Gammy as if he were her own child, and does not mind spending her money to make him well, except that his medical expenses have grown by the day.

Netizens would not let this situation pass without comment. They have expressed their disgust for the Australian couple in the harshest terms possible, while lavishing praise on the Thai woman’s amazing generosity. They have raised money to pay for Gammy’s medical needs. The fund is now more than 10 times what was paid to Pattaramon as surrogate fees.  The furor has roused the Thai military government to action, leading to a crackdown on surrogacy agencies and a close look at the unregulated proliferation of fertility clinics.

Consequently, about 200 Australian couples who are waiting for the delivery of their babies from Thai wombs face uncertainty. There are no binding legal guarantees available in such transactions. A surrogate mother can quickly change her mind after developing a bond with the life growing inside her and may simply walk away with the baby.

In countries that allow surrogate pregnancies, proof of kinship between the surrogate mother and the biological parents is required. Any hint of commerce intruding in the process is prohibited. More problems lie ahead for foreign clients after the baby is born. How is immigration supposed to know the difference between a baby delivered by a surrogate mother and a trafficked baby? The legal issues can be very complicated indeed.

The ethical and moral issues are probably even more complex. Instead of adopting a child, a process that can often be as tortuous, it is natural for would-be parents to want to have children who are sprung from their own genes. Thus, they see nothing morally and ethically wrong in assisted reproduction. Likewise, host women might look upon surrogate motherhood as not much different from nursing someone else’s baby with one’s own milk. It could be an act of the highest altruism.

Real-life situations, however, are seldom as simple. Globalization in an unequal world has brought with it all kinds of transactions, including—as improbable as it may sound—the transnational trade in wombs and outsourced babies. Indeed, today, one can choose not only the women who will carry the baby to full term, but also the anonymous donors from whom eggs and sperms may be sourced. This reality is too far ahead of existing legal systems, and challenges moral and ethical sensibilities everywhere.

Law tells us what is permitted and what is not. Morality defines our duty to others. Ethical reflection lets us know how we must live. Whichever lens we use, we cannot ignore the fact that human reproduction belongs to the sphere of the family. Any interference in its processes by the market, being alien to its code, is likely to spawn the knottiest legal, ethical and moral questions. Should parents have the option to purchase the gender or skin color of their child? Do they have the right to return or refuse a commissioned baby that is not to their liking?