Paying for a Child

There’s a not so very recent story from Alternet that I’ve been meaning to comment on for some time.  I’ve been waiting until my thoughts were properly collected, but I’m beginning to think that will take too long, so I figured I’d just start thinking out loud, as it were. 

The story is really worth a read.   It starts me down two different trains of thought.  One is really about surrogacy and that whole set of questions.  I’ve said quite a lot about all that before (just look at the tags–altrusitic surrogacy, gestational surrogacy, plain surrogacy, and so on.)  I should revisit all that to see if I’d still say the same thing, but I won’t do that just now. 

Instead, this story set me thinking about a different and broader topic:   what can/should/do people pay to have a child.   There’s at least two different ways in which one could expand this question.  

I take it as a given that children are not to be bought/sold, but you could quibble with this assumption if you chose to.  Given that point, you could think about all the different things that might count for some as buying a child.  

Surrogacy (Again) in the NYT–Talking to the Children

Once again there is a story in the NYT about surrogacy.   This one is about how people who have used surrogacy talk to their children about the children’s conception and birth.    There’s many things I’d like to say about this one, though if I’m not sure they will all fit together into some grand point. 

First off, the story includes some statistics I find astonishing.   It reports that according to the American Society for Reproductive Medicine–the relevant medical special organization–there were between 400 and 600 birth a year resulting from gestational surrogacy.  (This is surrogacy where the woman who gives birth is not genetically related to the child.  Instead, the egg comes either from one of the intending parents or a donor.)   Now that is a tiny number.     If you poke around the web or this blog you can find some data on the number of live births in the US per year.  From this study it looks to me to be around 4 million births per year.  

Now these numbers are disputed even within the article and I will accept that they are low.   (I will note, though, that I am a bit skeptical of the statistics reported by someone whose income is dependent on the business of promoting surrogacy arrangements.   They might have an interest in erring on the high side.) 

The Logical Extension?: Buying a Child

Over the last year or so there have been occasional stories about the globalization of surrogacy, some of which I’ve commented on here.  Two related stories from the UK have made me want to revisit this thread.   

This story (with it’s rather spectacular headline, but then, this is UK journalism) is really just another instance of the global surrogacy–a minor variation on an established theme.    Here, a UK couple (Nicky and Bobby Bains) purchased a donor egg which was fertilized with the husband’s sperm.   The resulting pre-embryo was then implanted in another woman’s womb.   This last women–the surrogate–eventually gave birth to the child.  

This is essentially routine gestational surrogacy, of the commercial sort, with a global twist.  

Gay Fathers/Lesbian Mothers, III

I’m not sure where or how far I want to take this thread for now.   The last couple of posts seem unsatisfying to me–they aren’t clear enough and they lack direction.  Perhaps all I am ready to do at this moment is not that there are both commonalities and differences between lesbian mothers and gay fathers.

I’ve a bunch of other topics queued up for now anyway, so let me just add one more thought here before I move off for now.  This is really the thought that triggered me to write about this topic now, so I might as well at least flag it.

A few posts back you’ll find an entry about some good news from New York state.  It’s a note about a case in which one woman donated an egg which was then combined with donor sperm. The resulting embryo was then transferred to the other woman who brought the pregnancy to term and gave birth.  As is discussed in that post, under the relevant law (there New York law) the second woman is a mother by virtue of having given birth.  The first women has a number of theories under which she might claim motherhood, but in the case is allowed to adopt her the child (a second parent adoption) in order to ensure portable parental rights.

What the women did here is a fairly elaborate procedure, and it bears some resemblance to several different forms of ART discussed.   So, for example, you could look at the first woman as an egg donor and/or you could look at the second woman as a gestational surrogate (a woman pregnant with and giving birth to a child she is not genetically related to).   But that’s not what the women involved intend to be, for neither egg donors nor gestational surrogates generally intend to be mothers.    (Indeed, there’s a well known CA case, KM v. EG, where the lower courts treated the first woman as an egg donor who therefore had no parental rights.  This result was reversed on appeal.)

The Wrong Embryo

No matter how careful they are, people make mistakes.   And mistakes create situations that no one ever intended, sometimes that no one ever imagined .    One thing this means is that you can learn a great deal by examining what happens when mistakes are made.

There’s a law professor whose written about this and her work is very thought-provoking.   Her name is Leslie Bender and you can find her work at her author page at SSRN (That’s one of those sites you must register for, although registration is free.   You can find my published work there, too.)   It’s worth your time.

Anyway, it is with her work in mind that I approach this next story.    There’s a longer account of the same incident here, one that raises some good points but also omits some details and is frustratingly sloppy in part.

A woman in Japan was undergoing IVF.  Embryos were created using her eggs and were then to be transferred into her uterus.   (One thing I wonder here is where the sperm came from, but let that go for now.)  Three embryos were transferred, two of which were ones created using her eggs.  By mistake, the clinic transferred a third embryo, one created with an egg of another woman who was also undergoing IVF.  The embryos were transferred on September 18 and September 20.

By October 7 it was clear that the woman was pregnant and somehow, around October 16 the doctor began to suspect that growing embryo was the one that had not been created with her eggs.  (I’m weak on the science, but I’d really like to know what would make the doctor suspect this.)   The thing is, there was apparently no way of being certain about this without doing amniocentesis, which could not be done for some time.  

Surrogacy Round-Up

A couple of different items relating to surrogacy have come across my desk (figuratively, anyway) in the past week or two.   Rather than do a series of short posts, I thought I’d try putting them together and then offering some comments.

But before that, a general observation:   It’s striking how much surrogacy is in the news these days.   I know that, given the commercial media and the Internet, news coverage begets more news coverage–once the NYT magazine runs a story on surrogacy, a thousand blogs (mine among them) comment on it and then more news outlets pick it up, some developing their own angles, creating their own news.    Still, even if I do a discount for that, surrogacy seems to be much in the news–more than a year ago or two years ago or five years ago.

Now it is not that the technology has suddenly changed.   The technology of surrogacy (which is basically IVF) has been around for a while now.   I’m sure the techniques and their reliability have improved, but I don’t think it is changing technology that has propelled the issue to higher visibility.    

Twins, half-sisters or something else again?

I’m cleaning out my in-box and have come across a bunch of things I flagged to comment on.   On the theory that it is better late than never, I’ll just choose one and get started.

I have my doubts about this story–there is something about the source that does not inspire confidence.    But there’s two reasons to discuss it whether it is true or not.   One is that as I have been reading news reports about unusual family configurations over the last few years, I have come to think that nothing is too odd to be true.   The range of human diversity is truly amazing.  So it may not be true today, but it could be true tomorrow.   The second is that even if this story is not true, it’s a nice little hypo to think about.  Very challenging for me, given some of the lines I’ve drawn in the past.

So here’s the story in a nutshell.   A heterosexual couple wants to have children but is having trouble conceiving.   They employ a gestational surrogate–in this case a close friend.   The doctor involved creates six pre-embryos from the sperm and eggs of the intending parents–the married couple.   Some are implanted in the surrogate.   Some are implanted in the wife/intending parent.  Both women become pregnant and, within hours, give birth to baby girls.

Enough of What’s the Difference?

I’m sorry to say that for the moment I feel I’ve come full circle without resolving much.   (I suppose when you come full circle you never make progress, do you?   I mean, by definition you are back where you started.)

So I started, now a few posts back, trying to figure out the reason for treating surrogacy (and really more specifically gestational surrogacy) and adoption differently.    I started by observing two differences, either of which might justify different treatment.

As a refresher if you do not want to go look (but really you should, because I did try to be more careful than I am about to be) one was the existence of a genetic link between the pregnancy woman and the eventual child in adoption.  You do not have such a link in the case of gestational surrogacy.  The second was the order in which events occur.  In surrogacy, the pregnancy occurs after (and as a result of) the agreement between the parties.  In adoption, the pregnancy occurs before (and therefore not as a result of) the agreement.

Now for the reasons discussed in the earlier posts, I’m not convinced that either of these possible differences is really persuasive.    Perhaps that is because the rationale lies in the confluence of the two–the fact that the pregnant woman is not genetically related AND that she is pregnant only because of the agreement.  

What’s the Difference, III

This picks up (not surprisingly) from What’s the Difference, II which is a a couple days back.   That post, of course, will send you back to the original What’s the Difference? To make sense of this one, you’ll need to have read the other two.

This is about the difference between adoption (open adoption, specifically) and surrogacy.  And I’m up to examining my proposed difference 2 from last time.   To refresh your memory, difference 2 has to to with the order in which events occur.   Specifically, in an open adoption the pregnancy occurs first and the potential adoptive parents come along afterwords.  Obviously, the agreement isn’t made until after they parties meet.   So the pregnancy precedes the agreement.   In surrogacy the agreement precedes the pregnancy.

Of course, it isn’t simply a question of order–in one instance things happen first A then B and in the other, first B then A.   The more important point is that in adoption the pregnancy exists before the adoption agreement and hence, isn’t caused by the agreement.   In surrogacy, the pregnancy wouldn’t exist but for the agreement.  

Altruistic Surrogacy and the Power of Naming

Some time in the middle of March I wrote a post defining the terms I planned to use in the discussion of surrogacy.   I wanted to be clear about the differences between gestational (or host) surrogacy and regular (or straight) surrogacy.   I also wanted to distinguish between the surrogacy system in use in the UK and the system in use here in the US.  (In the UK, surrogacy is legal as long as no money is paid to the surrogate beyond reasonable expenses.)  I referred to the system in the UK as “compassionate” or “altruistic” surrogacy.    I used those terms because I had seen them bandied about.  And I referred to the US system as “commercial surrogacy” because, at the time, it seemed to me a critical and distinguishing feature of the system here.

Now that was some time ago and the discussion in this blog have proceeded quite a bit.   The distinction between what I’ve been calling “altruistic surrogacy” and what I’ve been calling “commercial surrogacy” has become increasingly importance to my thinking.   (You can see that here, for example.)   Alas, it has also become clear that those were not the best chosen terms to use. I’ve touched on some of the reasons the terms aren’t well chosen before.   But let me draw them together here.