SUMMARY

Surrogate pregnancy is the practice whereby one woman carries a child for another woman or a couple, under promise of handing over the child after birth. The surrogate mother may become pregnant either by artificial insemination or by implantation of an embryo conceived by in vitro fertilisation. In the first case, she would be both the genetic and the gestational mother (sometimes called ‘traditional surrogacy’); in the second case, the gametes used for the embryo’s conception could come from the commissioning couple or from one or more anonymous donors (‘gestational surrogacy’ stricto sensu). In both cases, the intended mother does not match the carrying mother, which represents a big contrast to the normal case in the field of ordinary assisted reproductive technology. Surrogacy agreements may (or may not) involve the payment of a fee to the surrogate mother, beyond the reimbursement of expenses. From the point of view of the commissioning parents, there can be many reasons for surrogate pregnancy. The main indications for this treatment are related to commissioning mother’s congenital absence of the uterus, or another similar malformation, as well as to a medical record of repeated miscarriages or severe diseases which might threaten the life of the woman were she to become pregnant. A second group is formed by males or male couples, given the fact that they are biologically unable to become pregnant. Thirdly, some women could request treatment by gestational surrogacy for purely social or career reasons, but it is obvious that this behaviour deserves a completely different ethical opinion. From an ethical point of view, the main objections to surrogacy deal with the consideration of the surrogate mother as a productive machine that is run in order to satisfy the reproduction desires of another people. The ethical disapproval is deeper in the matter of remunerated surrogacy agreements, since they could increase the risk of lower-class women being exploited by upper-class ones. As regards the commissioning person or couple, the question is if they could be morally obliged to make an adoption of a pre-existing baby instead of having a new child made. In fact, surrogacy agreements could be seen as a sort of fraud of legal rules on child adoption, since these rules forbid the biological mother to get paid for the child, to elect the adoptive parents and to give her consent before the conception of the baby. For all these reasons, surrogacy agreements are seen as contrary to public policy and therefore void and unenforceable in many countries. But one should wonder if these legal provisions are in the best interests of the child. Our conclusion is that the best option lies in the regulation of this treatment, provided that it is subjected to severe requirements controlled by a judge or an administrative authority, such as all parties having received previous legal and medical counselling, the surrogate mother having a minimum age and good psychophysical conditions, or she having not been paid consideration for carrying the child, apart from the reimbursement of expenses.