» Reproductive Medicine Where the World Finds Bioethics Fri, 27 May 2016 19:30:24 +0000 en-US hourly 1 Taking a ride down the slippery slope Mon, 16 May 2016 15:09:18 +0000

Did you know: we can now make sperm from embryonic stem cells (in mice).  Not only can we create this sperm, but we can use it to successfully fertilize an egg and develop into a fully grown mouse.  And what is the role of bioethics in this scientific discovery, according to the article?  A brief mention of theoretical ethical issues relegated to the end of the news article that no one reads far enough to see, anyway.


Scientific advancements in reproduction have occurred at an unbelievable rate.  We not only have the ability to create sperm, but we can also create an embryo using three genetic donors, choose or reject embryos based on their genetic traits, such as sex, and correct genetic defects by essentially cutting and pasting healthy DNA sequences over defective ones.  Conversely, using such technology, we also have the potential to clone human beings, choose or reject embryos based on traits such as hair color or athletic ability, and irreversibly alter a germ cell line, potentially leading to unknown negative effects in later generations.


While breakthroughs in reproductive technologies have the potential to address issues as important and varied as male infertility, uterine factor infertility, mitochondrial disease, genetic defects and disease, and even artificial gestation, one wonders whether anyone is stopping to ask: to what end?  How will we use this technology?  What are the short- and long-term effects?  How might this technology be misused?  And, my personal favorite, when will we start to regulate how and when we tinker with biology at a genetic level?


Despite the promise of treatment or eradication of genetic diseases using this technology, there is still a persistent and very realistic fear that this technology will be misused.  Even worse, the misuse may become so common as to be considered acceptable, particularly in our profit-driven fertility industry.  Will the desire to prevent Huntington’s disease also lead to the desire to enhance intelligence?  Can we really resist the urge to create so-called designer babies, and should we accept that while some may win the genetic lottery, others will be able to afford to stack the deck?


Bioethicists are sometimes viewed as obstructionists on the path of progress, unnecessarily blocking scientists from discovering all that can be accomplished through science and medicine. (For an excellent rebuttal, read here).  But the very purpose of the vast and diverse field of bioethics is to identify and acknowledge the normative implications of scientific advances and engage in a dialogue that directly addresses the “should” in a world of “could.”  Hence, the age-old question that is often asked but rarely answered: just because we can do it, does it mean we should?


In the world of reproductive technologies and germline manipulation, perhaps the answer, sometimes, is no.



The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.


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Bad Moms, Blameless Dads: Examining How the Media Portrays Age-Related Preconception Harm Mon, 09 May 2016 16:23:44 +0000

As I discussed in a previous blog, the blame for fetal harm is generally directed at women. Some of my colleagues and I, including AMBI faculty member Zubin Master, were interested in examining how fetal harm, and more specifically age-related preconception harm, is portrayed in the media. Our findings were published earlier this year in the American Journal of Bioethics Empirical Bioethics.

Given the significant social change that many people today are delaying childbearing in comparison to previous generations, it is relevant to examine the media portrayal of older parental age and risk to future offspring. Furthermore, there is clear evidence that older parental age carries certain risks to offspring: older age in women and men leads to an increased risk of having children with autism and Down syndrome and older paternal age has also been linked to higher rates of children with schizophrenia. Many people get most of their scientific news from the media, so it is important to examine the accuracy and biases of the information.

Our results indicate that reproduction is still largely seen as the domain of women, rather than of couples or of men. We rarely found articles discussing reproduction as it relates to both women and men as the majority of articles were maternally focused. Even among the articles that were paternally focused, they almost always discussed maternal harm as well. However, the reverse – maternally focused articles containing discussions of paternal harm – were almost nonexistent. This pattern suggests that men alone are never seen as solely responsible for fetal harms, but rather that this responsibility is always shared with women.

Responsibility and blame typically go hand-in-hand and not surprisingly articles were four times more likely to blame women for fetal harms than men. The infrequency of paternal blame suggests that authors either do not recognize men’s contribution to harm due to ignorance or denial, or do not want to hold men responsible for harm. Even when men’s contribution to harm was acknowledged, the authors were more likely to absolve men from responsibility for harm by presenting reassuring information, such as the overall risk of fetal harm is quite low, in conjunction with factual information stating that older paternal age can increase risks to future children. The same sort of reassurance was not seen for women.

Although reproductive blame and responsibility is still typically assigned to women, newspapers are increasingly discussing the relationship between paternal age and preconception harm: no articles discussed this relationship in the 1970s or 1980s, 20% discussed it in the 1990s, and nearly 40% discussed it between 2000 and 2012. The increase in articles on paternal harm in the 2000s may be due to the increase in scientific data showing the connection between paternal age and harm, the growing body of social science literature on male reproduction, the rising medicalization of men’s sexuality and reproduction, as well as changes in social norms that make discussions of paternal role and responsibility in reproduction more commonplace.

However, despite the fact that newspapers are actually acknowledging and discussing paternal age and preconception harm, the primary focus of newspaper articles regarding preconception harm remains concentrated on women and articles are more likely to blame women than men for any harm. In short, our analysis of age-related preconception harm reflects the broader gendered social patterns regarding reproduction that tend to minimize, and even ignore, men’s role in and responsibility for reproduction.



The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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Why this lab-grown human embryo has reignited an old ethical debate Mon, 09 May 2016 12:54:50 +0000 0 Can A Hospital Tell A Doctor To Stop Talking About Abortion? Fri, 06 May 2016 12:37:16 +0000 0 Taking Sperm From the Dead Thu, 28 Apr 2016 13:53:22 +0000 0 The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic Wed, 27 Apr 2016 22:18:04 +0000 by Lisa H. Harris, Neil S. Silverman, and Mary Faith Marshall

The inequalities of outcome are, by and large, biological reflections of social fault lines (Paul Farmer)

Three paradoxes characterize the Zika virus pandemic and clinical and policy responses to it:

  1. Zika virus has been shown to cause severe developmental anomalies in the fetuses of infected women. As a result, both women and men in endemic areas are asked to avoid or delay pregnancy. However, access to effective contraception and safe pregnancy termination is either not available (especially for those living below the poverty line) or a crime for many women in Zika-endemic regions.
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BioEthicsTV: A night of consent issues on ChicagoMed Wed, 27 Apr 2016 03:40:58 +0000 by Craig Klugman, Ph.D.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.…

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The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic Tue, 26 Apr 2016 19:54:21 +0000 0 Paternalists at the Gate: Those With Privilege Fight to Keep It Wed, 06 Apr 2016 18:08:45 +0000 by Craig Klugman, Ph.D.

One of the main concepts that most medical ethics instructors teach to their students is that of autonomy—self governance. I usually explain that this evolved in response to the age of paternalistic medicine. During the civil rights movement, where voiceless groups were demanding a voice, patients were among those who received a voice through autonomy. However, recent legislation suggests that the age of paternalism has returned anew, but this time medical authority is wielded by legislators and not physicians trying to ensure their continued privilege in society.…

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BIOETHICSTV: Chicago Med-BIID, post mortem egg retrieval, scope of practice and forgiveness Wed, 06 Apr 2016 06:29:15 +0000 by Craig Klugman, Ph.D.

This week on Chicago Med brought 3 new ethical issues as well as the unsatisfying resolution to a story arc.

Story 1 begins with a patient brought into the ED after trying to saw off his arm in the hardware store. The doctors are able to save it but the patient is upset. Dr. Charles, the psychiatrist, realizes the patient suffers from Body Integrity Identity Disorder (BIID) which is characterized by people feeling a part of their body is not theirs.…

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The ethics of Indiana HB 1337: Outlawing abortion based on race, sex, and disability Fri, 01 Apr 2016 16:06:01 +0000

In March, the Indiana legislature passed and the Indiana governor signed into law HB 1337, a bill that bans abortions for women seeking them based solely on certain characteristics of the fetus, such as race, sex, and disability. Specifically, the bill:

 “Prohibits a person from performing an abortion if the person knows that the pregnant woman is seeking the abortion solely because of: (1) the race, color, national origin, ancestry, or sex of the fetus; or (2) a diagnosis or potential diagnosis of the fetus having Down syndrome or any other disability. Provides for disciplinary sanctions and civil liability for wrongful death if a person knowingly or intentionally performs a sex selective abortion or an abortion conducted because of a diagnosis or potential diagnosis of Down syndrome or any other disability.”

As I have discussed in a previous blog, sex selection is a frequent occurrence in certain countries, such as India and China, where there is a strong preference for sons. Yet, there is little to no evidence that sex selection abortion is commonplace in the US. Abortion based on the race of the fetus is similarly rare in the US. While the purpose of any law is to prohibit actions it deems unethical or contrary to social norms, regardless of their frequency, due to limited time and resources, it makes sense to focus on bills that address common occurrences or things that are so morally repugnant that the state must take a stand. The main motivating factor for this bill does not seem to be avoiding discrimination based on sex and race, but rather trying to undermine legal access to abortion. Indiana is one of only five states that does not have a hate crime law and it recently rejected another attempt to pass hate crime legislation. It seems odd, and even contradictory, that Indiana is so worried about discrimination against fetuses, but not against legal persons.

The provision outlawing abortion due to disability is also troubling. Women and their families are often faced with very difficult decisions if they find out a fetus they are carrying has a disability and they should have the autonomous right to make decisions that are best for themselves and their families. This bill does allow women carrying fetuses with lethal abnormalities to abort, but they first have to receive materials about perinatal hospice care and complete documentation stating that they received such materials. The knowledge that the fetus has a lethal abnormality is devastating to many women and the idea of carrying the pregnancy to term is often psychologically distressing for them. Requiring them to be counseled about perinatal hospice care seems unnecessary and insensitive. Good physicians already ensure that their patients are adequately informed about their options and this seems to be a form of directive, morally laden counseling that will just make women feel guilty, rather than expanding their choices.

Another aspect of this bill that is quite problematic is that it “Provides that a miscarried or aborted fetus must be interred or cremated by a facility having possession of the remains.” For most abortions, the fetal remains are disposed of with other medical waste. This law, however, requires that the fetal remains are buried or cremated. This is clearly an attempt to elevate the status of the fetus and give it equal rights to legal persons.

This law means that Indiana now has some of the most restrictive abortion laws in the country. While many antiabortion supporters are in favor of this law, it is worth noting that some antiabortion legislators think this bill goes too far. They are concerned that this bill lacks compassion and demeans women. I agree with these concerns and am troubled by the passage of this law for the reasons I have outlined here.



The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

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WHO sees scientific consensus on Zika as cause for disorders Fri, 01 Apr 2016 15:41:24 +0000 0 F.D.A. Eases Requirements on Abortion Pill Label Thu, 31 Mar 2016 12:37:58 +0000 0 A Few Thoughts On Abortion and Valuing Human Life Thu, 24 Mar 2016 16:19:27 +0000

Who could be against life? Ancient natural law theory in the Catholic tradition tells us that human beings desire to live, and that life is good, therefore humans have an obligation to live and not kill other human beings. This ancient wisdom has been instilled into western ways of moral thinking. So, who could not be prolife in terms of how we place value on all individual human life?

Who could be against human freedom? Individual human beings should be free to live peacefully in accordance with their own values and life goals. This is a basic tenet of democracy that has shaped moral and political thinking in the West for the past four centuries. So, who could not be against the exercise of free choice, especially about something so basic as having control over our bodies?

The two value perspectives contained in the prior two paragraphs, all things equal, are eminently reasonable and most ethically unproblematic. These two value positions represent two fundamental principles of ethics—the intrinsic value of all individual human lives and the right of free individuals to govern their own lives and bodies—that guide us in living an ethical life and making ethical decisions. It is when these fundamental principles come into direct conflict that a serious, a near irresolvable, ethical conflict arises. There is no greater direct conflict of these two ethical principles than right of women to have an abortion. It is commonly assumed that one is either on one side of this moral abyss or the other and the twain shall never meet. It seems to me one of the central tasks of ethical reflection on this issue is to find as much meaningful middle ground as possible. In this brief blog I’ll offer a few ideas in this regard, which advocates on either extreme will likely find unsatisfactory.


Once a fetus reaches full term and emerges at birth into the world as a separate human being, there is no question about its full moral standing—from my perspective this would include babies with the most serious birth defects, including anencephaly. Some bioethicists believe that a being must have interests to have full moral standing. Since babies with anencephaly, if they survive a short time after birth, have no brain, no capacity to experience pain or pleasure, and no future life, they have no interests. The latter may be true descriptions of babies with this disorder, but they are unequivocally individual human beings. And there is no reason, as the law currently supports, to justify killing or euthanizing the lives of these babies in my view. So can’t the same be said of a fetus from the moment of conception?

It is true that a human embryo is a biologically a distinct form of individual human life and because of that fact has moral worth and deserves respect. But there is a basic aspect of fetal life even after viability and prior to birth that is inescapable: the fetus is dependent on the mother for its life and is part of the woman’s body. There is no protecting the fetus prior to birth without controlling the bodies of pregnant women. At the same time, at the very least, abortion as I am defining my terms is morally concerning and even problematic. I realize many of my pro-choice friends will find that conclusion concerning, but it is simply a consequence of recognizing the moral humanity of fetal life. So the key question then becomes who should make this moral or ethical decision and how should abortion services be regulated under the law?

A moderate position that seeks to preserve as many values as possible in this conflict, it seems to me, will recognize elective abortion as a moral issue but will reject the notion that it should be restricted as a service under the law. For if the law seeks to protect fetal life by restricting abortions, ipso facto, it also seeks to restrict the liberty of the woman to control her body as she so desires. The idea of requiring a woman to keep an unwanted pregnancy is an assault to her dignity as free human being. We cannot pretend to live in a free society where men and women have equal moral worth if we do not extend full moral autonomy to both men and women equally.

I conclude abortion is a moral issue and like many moral issues they are decisions that individual free human people should make and should not be the business of government to regulate. But it is not trivial to recognize abortion as a moral issue. We should not only talk, but also act, like all human life as value. We can provide adequate healthcare to all people, which should include family planning, prenatal, and birth control services for woman. We should provide more day care for parents, particularly single parents and other support services to make having children easier.

In short we can be a society that acts like it values all human life, of which fetal life is a part. But the ethical position of valuing all human life in terms of ascribing full moral standing to individual human beings cannot extend individual fetal life if we are to full value women as autonomous human beings.



The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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Should providers offer oncofertility to patients with a poor prognosis? Tue, 15 Mar 2016 15:08:45 +0000

Whereas quality of life issues for cancer patients used to minimized, and sometimes even ignored, today there is more of a focus on cancer patients’ quality of life post-cancer. One such quality of life issue is oncofertility, which is fertility preservation for cancer patients. In many places, oncofertility is, or is becoming, the standard of care for cancer patients. But should it be offered to all patients? What about patients who have a very bad prognosis?

 Fertility preservation for patients with a poor prognosis raises a host of ethical issues. Providers may worry that discussing fertility preservation will give patients false hope about their prognosis. In other words, these patients may feel their providers deceived them by mentioning fertility preservation, leading them to believe that their prognosis is not as bad as they originally thought.

Yet, at the same time, pursuing fertility preservation may be a source of hope and happiness for patients during difficult times. It may furnish them with mental and physical strength, making them even more motivated to survive for the sake of their potential future children. Additionally, these patients, and their families, may feel a degree of inner peace knowing that part of their lives will continue on in the reproductive material even if they are never used.

Nevertheless, some may argue that, despite any personal and emotional benefits they may experience, offering patients with a poor prognosis fertility preservation options is an unjust allocation of resources. From a utilitarian perspective, it does not make sense to devote resources to patients who will likely not benefit from them. Put differently, resources should be allocated to those who have a high probability of a positive outcome, which means individuals with a poor prognosis should be placed lower on the priority list for receiving fertility preservation resources than individuals with a good prognosis.

On the other hand, if we take a deontological (duty-based, individual rights) approach, providers have a duty to care for their patients. Not offering fertility preservation to all of their patients, including those with a poor prognosis, may be seen as diminishing patient autonomy. According to this view, providers should be more concerned with the needs and rights of their individual patients than with social justice (i.e., fair allocation of resources).

For more on this topic, see my book chapter “Addressing the Three Most Frequently Asked Questions of a Bioethicist in an Oncofertility Setting” in Oncofertility Medical Practice, edited by T.K. Woodruff and C. Gracia.



The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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Zika: An opportunity to improve pre-conception care. Tue, 08 Mar 2016 21:20:58 +0000 by Andrea L. Kalfoglou, Ph.D.

The Zika virus is spreading rapidly throughout parts of South and Central America. Public health officials are concerned because there is a correlation between the emergence of the Zika virus and a dramatic increase in number of babies born in Brazil with a severe birth defect called microcephaly.

The CDC has warned women from the U.S. who are pregnant or thinking about becoming pregnant not to travel to certain areas in Central and South America. Additionally, infectious disease specialists are concerned that Zika may adapt to transmission by a type of mosquito common in 32 states in the U.S.…

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Zika Kills Cells Key to Fetal Brain Development, Study Says Fri, 04 Mar 2016 18:31:23 +0000 0 First Uterus Transplant in the US Gives 26-year-old Woman Chance at Pregnancy Wed, 02 Mar 2016 17:34:06 +0000 0 All Surrogacy is Exploitation – The World Should Follow Sweden’s Ban Tue, 01 Mar 2016 19:48:56 +0000 0 Cleveland Clinic Performs First U.S. Uterus Transplant Fri, 26 Feb 2016 00:52:52 +0000 by Craig Klugman, Ph.D.

Almost like Aphrodite herself, surgeons at the Cleveland Clinic this week may have given fertility to a 26-year-old woman through a 9-hour uterus transplant operation. The transplanted uterus was from a deceased woman. This was the first such surgery in the United States, though it has been performed previously in Sweden and Turkey. Of the 9 women in Sweden who had the procedure, 4 have given birth.

The American patient had uterine factor infertility, which result from fibroids, scarification, genetics, or not having developed a uterus.…

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Pope suggests women threatened by Zika virus could use contraception Thu, 18 Feb 2016 18:38:33 +0000 0 Catholic group urges pope to allow contraception to fight Zika Wed, 10 Feb 2016 22:54:43 +0000 0 Oh, baby! Woman’s Fitbit reveals she is pregnant Wed, 10 Feb 2016 21:34:05 +0000 0 Penis Transplants Coming to America Wed, 10 Feb 2016 14:31:59 +0000 The New York Times recently reported that physicians will soon undertake the first penis transplants in the U.S. The goal of this procedure is to restore everyday functionality as well as sexual functioning for men with genitourinary injuries, which are injuries involving loss of part of all of the penis and/or testicles. The donated penis will come from a deceased donor, with that donor’s permission. Penis transplants have only taken place in China in 2006, where the procedure failed due to the recipient psychologically rejecting the transplant, and in South Africa in 2014, where the procedure was successful. 

For the time being, this procedure will be limited in the U.S. to men who lost their penis in military service. In the last 15 years, over 1300 men have suffered genitourinary injuries in Afghanistan or Iraq, mainly due to homemade bombs. Almost all of these men are under 35 years old.

One objection to penis transplantation is that it is not life-saving. While it is true that penis transplants are not life-saving, much of modern medicine focuses on improving quality of life (e.g. glasses for poor vision, over the counter medication for the common cold, physical therapy for back pain, assisted reproductive technologies for infertility, etc.). While a genitourinary injury may not be visible to others, the effect on the individual can be devastating. For many men, the penis is a symbol of his masculinity and not having “normal” genitals can impair his gendered and sexual identity. As I have discussed in my published research,

“the male genitals are generally central to a man’s coherent sexual identity, and are associated with stereotypical masculine traits like “strength” and “courage.” Because of the personal, as well as social, significance of the male genitals, having “misfunctioning” (e.g. impotent, prematurely ejaculating, infertile) genitals or genitals that look “abnormal” (e.g. small penis, missing a testicle) can diminish men’s sense of masculinity.”

Given the significance of the male genitals to men, it is not surprising that many male patients find a genitourinary injury to be the worst type of injury possible. According to Scott E. Skiles, the polytrauma social work supervisor at the Veterans Affairs Palo Alto Health Care System who is quoted in the New York Times article on penis transplants, “Our young male patients would rather lose both legs and an arm than have a urogenital injury.”

The psychological suffering caused by genitourinary injuries should not be underestimated. The objection that a penis transplant is merely “elective” and not medically necessary overlooks the profound effect a genitourinary injury can have on a man’s mental health. While there are still concerns about penis transplants, namely the fact that they are still experimental, they should not be equated with other types of surgeries that purely or mostly cosmetic.   


The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.


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Ethicists approve “3 parent” embryos to stop diseases, but congressional ban remains Wed, 03 Feb 2016 23:19:59 +0000 0 Restricting Choices of Childbearing Women Wed, 03 Feb 2016 21:56:12 +0000 by Bela Fishbeyn, M.S.

In this month’s issue of AJOB, Howard Minkoff and Mary Faith Marshall argue that we ought to acknowledge the inherent complexity and personal nature of risks involved in childbirth, and thus defer, when possible, to the decisions made by autonomous mothers-to-be. They place this in opposition to the claim that, “women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk,” and discourage deference to the evaluations of clinicians and judges.…

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Fetal Risks, Relative Risks, and Relatives’ Risks Mon, 01 Feb 2016 21:30:14 +0000 0 Restricting Choices of Childbearing Women Mon, 01 Feb 2016 21:27:07 +0000 0 My Child, Your Womb Thu, 28 Jan 2016 17:31:48 +0000 Gestational surrogacy contracts have been in the news again recently as a gestational surrogate reports that the intended father, having discovered that she is expecting triplets, is demanding that she undergo selective reduction to abort one of the fetuses.  Situations such as these, while often not reported, are not necessarily uncommon.  In 2013, a gestational carrier was offered $10,000 to abort when a second trimester ultrasound discovered congenital heart and brain abnormalities.  Despite a well-established Constitutional right to privacy that includes a pregnant woman’s right to procure – or refuse – an abortion, surrogacy contracts routinely include provisions that not only prohibit a surrogate from having an abortion unless there is a medical need, but also give the intended parents sole discretion to determine whether the surrogate should abort where there is evidence of a physical abnormality or other issue.  Such provisions have not been tested in court, but would almost certainly be unenforceable based on the surrogate’s Constitutionally-protected right to reproductive autonomy.

In India, where there is an estimated $400 million surrogate tourism industry, women agree to be surrogates in exchange for $5,000-7,000, which is far more than they could make otherwise.  In many clinics, surrogates live in dormitories for the duration of the pregnancy and their food and medical care is provided by the clinic.  There are also reports that some clinics have policies against pregnancies of 3 or more fetuses – meaning that selective reduction may occur as a matter of course to reduce the number of fetuses to 2 or 1.  If this is in fact happening, are the surrogates (or even the intended parents) aware of what is happening?  Are they given a voice in the medical care and treatments they receive?  Or are the decisions made by the intended parents or the clinic, and simply imposed on the surrogate?

Surrogacy, as with other assisted reproductive techniques, has been promoted in the name of reproductive autonomy – the right and ability to have more options and exert more control over reproduction.  But in cases such as these, where surrogates are pressured legally, financially and socially to have an abortion, whose reproductive autonomy are we honoring?  While it may be the child of the intended parents, it is the uterus of the surrogate.  The intended parents have an interest in the healthy development and birth of their child, which can be affected by congenital abnormalities, surrogate behavior, or the presence of multiples.  The surrogate has an interest in her own bodily integrity, her own health, and the treatments or procedures performed on her, even in connection with the gestation of another’s child.  Where these interests conflict, whose rights are stronger: the intended parents of the child, or the woman carrying it? 

It seems unconscionable that a woman could be forced to undergo an abortion based on enforcement of a contract.  It is equally disturbing to think that an intended parent would be prevented from objecting to an abortion of his or her child because the surrogate was making the decision to abort.  While both of these decisions in the context of a commercial surrogacy arrangement may be considered a breach of contract, and therefore may have monetary damages, what is left in the aftermath?  A parent whose unborn child was aborted without the parent’s permission?  A surrogate who has been abandoned with a newborn she never intended to keep?  These consequences are far weightier than could be compensated for by money.


The problem with blending the rights of reproductive autonomy is trying to separate them again when there is a conflict.  A surrogate will always have the right to determine what happens to her body, which includes the right to have or refuse an abortion, even if the child belongs to someone else.  Is it possible, then, to simultaneously protect the reproductive rights of both the surrogate and the intended parents?  Or will there always be an inherent imbalance of reproductive rights and the potential for coercion in the enforcement of commercial surrogacy agreements?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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Unintended second pregnancies could be avoided Wed, 13 Jan 2016 23:39:41 +0000 0 CDC: Too few schools meet recommendations for sex education Fri, 11 Dec 2015 15:42:34 +0000 0 No Planned Parenthood cut-off in Republicans’ spending draft: Pelosi Fri, 04 Dec 2015 15:48:08 +0000 0 U.S. appeals court rules against Wisconsin abortion doctor law Tue, 24 Nov 2015 19:27:03 +0000 0 Woman Sues Hospital Over Traumatic Birth That ‘Turned Our Family Life Upside Down’ Fri, 20 Nov 2015 23:11:06 +0000 0 S.F. woman who sought to have embryos preserved loses legal case Thu, 19 Nov 2015 21:52:23 +0000 0 Can This Procedure Reverse an Abortion? Wed, 18 Nov 2015 23:12:35 +0000 0 Can This Procedure Reverse an Abortion? Mon, 09 Nov 2015 21:45:54 +0000 0 Sleepwalking Into Infertility: The Need for a Public Health Approach Toward Advanced Maternal Age Sun, 01 Nov 2015 22:48:18 +0000 0 Planned Parenthood revises reimbursement policy after video uproar Tue, 13 Oct 2015 21:54:38 +0000 0 Elective or Life-Saving? Catholic Hospitals and the Ban on Tubal Ligation Tue, 06 Oct 2015 01:10:53 +0000 0 Is it Ethical for Parents to Create a Savior Sibling? Thu, 01 Oct 2015 10:10:53 +0000 0 Pregnant cancer patients shouldn’t terminate or delay treatment: study Tue, 29 Sep 2015 20:41:48 +0000 0 Researchers Apply For Permission To Alter DNA Of Human Embryos Fri, 18 Sep 2015 21:27:08 +0000 0 Is Sex Selection Ethical? Mon, 14 Sep 2015 04:09:02 +0000 0 Coerced sterilization of Canadian indigenous women in 70s widespread: researcher Tue, 01 Sep 2015 19:47:54 +0000 0 Legal case tests religious hospitals’ right to deny procedures Mon, 24 Aug 2015 17:33:58 +0000 0 In graphic detail, medical journal describes ‘heavy overtones’ of sexual assault in operating room Tue, 18 Aug 2015 18:02:29 +0000 0 Investigating Two Claims Against Planned Parenthood: Center of Medical Progress’s Secret Videos Mon, 27 Jul 2015 22:00:39 +0000 by Craig Klugman, Ph.D.

Before you being reading, I have a disclaimer: Growing up, my mother worked for Planned Parenthood. As a nurse, she practiced in their clinics offering well women services, counseling, and contraception. After many years, she went on to direct their clinic’s in vitro fertilization program. I also heard the word “Planned Parenthood” stated with a quick northeastern accent. Said that way, as a child, I thought the place was called “Plant Parenthood” and wondered what plants had to do with women’s health.…

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Not all new mothers in U.S. get advice on breastfeeding, infant care: survey Mon, 27 Jul 2015 20:41:51 +0000 0 India set to become world’s most populous country by 2022 – U.N. Mon, 27 Jul 2015 20:34:20 +0000 0