Surrogacy: Counselling, Screening and the Role Of Money

In the past several days I’ve done two posts on a very messy surrogacy case in the UK.   (The links to the opinion and a tiny bit of press are in those earlier posts, and you should go read them to get up to speed anyway.) 

Thinking about what went wrong in that case lead me to emphasize the crucial role screening and counselling play in making surrogacy work.   That assertion obviously bears a bit further discussion.   Then, too, it’s fairly obvious that introducing money (or perhaps more precisely, financial gain) into the equation makes things yet more complicated.   Those are the things I mean to discuss here.  

 I have two virtually instinctive reactions to the idea of screening/counselling.  One is that surely the need for them is obvious, the second is that surely the danger of such requirements is also obvious.   But on the theory that obvious to me may not be obvious to everyone, perhaps I should elaborate. 

I’ll start by saying that I think surrogacy can be a useful option and I have no inclination to ban it.   (South Dakota is apparently considering such a move, and I might discuss this at another point.)    I’ve written quite a bit on the blog about this so if you wanted to examine my views in more detail, feel free–use the surrogacy tag.

That said, it is also clear to me that surrogacy is not for everyone.  (Witness the UK case that started this thread.)   It’s a complicated arrangement, both emotionally and legally.   It seems obvious to me that before someone goes down this road–whether as a surrogate or as an intending parent–one ought to give it some thought.   There are hard questions you should ask yourself.   And truly, you should have some idea what the relevant law is.  

Some people, maybe even most people, will do some of these things themselves.   But not everyone will do all of them and many people won’t do some of them.   I suppose my desire to require counselling/screening arises from this observation.   Counselling/screening is a way to increase the likelihood that the people who choose to engage in surrogacy will be people who have thought it through with knowledge of the relevant things.   I imagine a system in which the parties to the UK case would have figured out at the beginning that it was not a good idea to proceed.  

Now maybe what I want to say is that the devil is in the details.   It’s all very well and good to say that counselling and screening are important.  But what does that really mean?   Who provides the counselling and the screening and what is their interest?  

It’s easy to see that “counselling” can be a facade for “persuading.”  I’m thinking here about the role counselling has played in the abortion debate.   It’s apparent to  me that much of what is suggested as “mandatory counselling” is in reality material designed to dissuade a woman for choosing to have an abortion.   In the same way, “counselling and screening” could be a way for those who would bar surrogacy to achieve their end by less obvious and more palatable means. 

There’s risk on the other side, too, however.   If someone has a financial interest in qualifying as many people as possible for surrogacy, then the counselling that person provides may be skewed towards minimizing the difficulties.   Here I think of the mortgage originators who were eager to sell loans to anyone, because for every loan sold, they made money.  

I don’t mean to make this sound worse than it is.   We do require informed consent (which includes counselling) for medical procedures and for the most part I think it works quite well.   Thus it is clear that effective counselling/screening can be done.   When done properly they facilitate individual autonomy, which I’m inclined to think is a good thing. 

What makes the debate about counselling/screening for surrogacy more complicated is that with surrogacy, as with abortion, the very utility/morality of the basic procedure is controversial.  The debate around both is also highly politicized.  And so the counselling/screening question becomes one more terrain where the struggle is played out. 

This doesn’t help me answer any questions, but it does help me understand why they are hard questions.  

There’s one other abortion/surrogacy similarity that may have some bearing here, though for not I’ll just toss it out.   In both debates there is extensive focus on the possibility than one will regret a choice one makes.   I’m generally inclined to think risking regret is a necessary part of any choice  (cue Humphrey Bogart at the end of Casablanca)  but somehow in these two situations the regret gets special treatment.  Thought would be a thought for another day.

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8 responses to “Surrogacy: Counselling, Screening and the Role Of Money

  1. Not just financial interest but ethical and personal interests as well. For instance – if I were to chance upon anyone considering anonymous conception or upon anyone considering giving a child up for adoption I’d be “counseling” them against it until they ran screaming from the room with both hands over their ears! And you know there is no financial motivation for me to do that. There are many people equally passionate on both sides of the fence who have absolutely no financial motivation for dragging their soap boxes around where ever they go.
    For this reason I think the best the law could ever hope to do is make it mandatory that people who are thinking of abandoning their parental obligations be made aware of the legal implications of those choices at the time they are made and also make them aware that the law can always change. Whats legal today may be illegal tomorrow and vice versa. That seems to me to be the only fair and balanced way to approach the topic of counseling.

  2. “…made aware of the legal implications of those choices at the time they are made and also make them aware that the law can always change. …That seems to me to be the only fair and balanced way to approach the topic of counseling.”

    Do you mean only counsel about legalities and nothing else (not emotional/social/family issues)? I blogged about this from my biased-soap box here (remove spaces to link):
    ht tp : //familyscholars . org /2011/01/20/caution-biased-counseling/

    Caution: biased counseling
    Karen Clark 01.20.2011, 11:24 PM

    Follow the money, politics, advocacy (agenda):

    Over the years, I’ve heard through the grapevine that some (many?) people feel that they received biased counseling. They didn’t feel that they were given enough information to make informed choices and they later regretted those choices.

    I think this is one of the biggest problems involved with the industry and the so called “counseling” surrounding it. Most “counselors” who dare to dig into the issues and problems are not sought out or recommended by people who desperately want a baby (who more often than not most likely want to be talked into how to make it all okay and/or justify their desires). Rather it’s the counselors who support those desires, who often have used “donors” and “surrogates” to make their own children, who are hired and recommended (by the industry/support-advocacy groups etc.)

    Biased with an agenda? Of course.

    That’s a great big huge problem.

    —————————-

    Recommendation by a counselor with out a bias or agenda:

    Gesttalt therapy: the ‘empty chair’ technique – using the empty chair for the would-be child/adult/offspring – putting the focus where it should be.
    Google it.

    • No, I don’t only mean the law. If nothing else, there are clearly ordinary medical issues involved in many ART procedures and, since they are elective, I assume some sort of counselling about risks/benefits would always be appropriate.

      The problem, of course, is that with issues like abortion and ART I think it common for people to have different and conficting ideas about what sorts of risks/benefits need to be included and how the information should be presented. Many people approach these areas with lots of preconceived (forgive the pun) notions, which leads me to have grave concerns about both the style and the substance of counselling.

      Could we really expect someone who believes that parenthood is based on genetics and thus, selling an egg is equivilant to selling a child to give unbiased counselling? How about someone whose livelihood depends on the person agreeing to go ahead with the procedure? I see potential trouble in both cases.

      Which means that what is easy (for me) to agree to in theory turns out to lead to a host of very difficult practical questions that give me pause.

  3. “Could we really expect someone who believes that parenthood is based on genetics and thus, selling an egg is equivilant to selling a child to give unbiased counselling? How about someone whose livelihood depends on the person agreeing to go ahead with the procedure? I see potential trouble in both cases.”

    Right, or that all you need is love to make a family – biology isn’t important/doesn’t make a family mentality/bias- or they if they have a personal or political stake/stance in the social normalization of the practice – all a bias – all troubling…

    • Sometimes I think that they only people with no bias would be those who really do not have any interest in the area–those who don’t care. But it seems ridiculous to say that the counsellors should be chosen from the ranks of the indifferent. Rather, I think there must be some other way to address the bias problem. I don’t have one yet–but I do see the problem.

    • Actually, I have a little quibble here, too. I think a quite possible to believe that love can make a family work and to also believe that providing an egg to a third party for ART is a big deal that one ought to think long and hard about. So I’m not sure this is a fair parallel (to the extent you meant to set it up as such) with the person who thinks all ART with third-party gametes is wrong. The latter has prejudged the merits of the individual case, the former has not done so.

      • YES! Quibble indeed – I would say in response that I agree that love makes a family but I also think dna makes a family and more than just a big deal 😉

        Of course, in both cases, neither family can really trump in the “love” area BUT I do think dna trumps in the family (identity/heritage/ancestry/connections more than just social – but equally meaningful for some/many) area.

  4. Oh love or lack of it makes a family either good or bad, but the family itself exists in ernest regardless.

    Surprisingly I’m leaning toward Julie’s view point here just because in all things I do like to be fair and logical. Oh you’d better believe that I’d be counseling anyone thinking of conceiving anonymously right out of that decision – but again I am aware that I would approach the person with just as much “bias” as anyone trying to sell them on what a noble and empowering thing it is to pretend that their offspring belongs to whomever paid to have them made.

    I had forgotten about the medical aspects making people aware of their own health risks in undertaking the procedure whatever it may be. Thats a reasonable component of counseling that could be delivered in an unbiased way. Unfortunately I think pushing for a law mandating counseling on the psychological aspects of conceiving and abandning children for money would be a waste of time because again, you’d have to consider the sourse and the source would be the clinic that is paying the person to conceive for them.

    You know counseling for donors won’t be necessary, because there are probably very few donors in reality. I’m totally convinced that anonymity of the people hired to conceive has allowed these clinics to simply missappropriate sperm and eggs from its patients that are fertile and then use them to conceive offspring for their other clients. They’ve got complete medical histories on these people, they know what they look like what they do for a living. And they’ll never know. There was a BIG case at UC Irvine or San Diego where hundreds of babies may have been conceived by patients with people who were also patients of the clinic not real donors, I read that the doctors all split to south america. I’ll have to find the link.

    My preferred method of counseling would involve putting the maternally related woman on the certificate as the child’s mother and the woman who commissioned the mother to conceive the child would be listed on the certificate as the intended parent – with all the same legal authority she has now with anonymity and the law that says a “donor” has no legal parental obligations to their offspring.. I just want to see a legal obligation to be named. They’d think twice before doing it.

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