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.