Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India
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REVIEW ARTICLE
Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India Jaden Blazier1 · Rien Janssens2 Accepted: 27 August 2020 © The Author(s) 2020
Abstract It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India (where commercial surrogacy was legal until 2015) are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage (in high income countries such as the Netherlands), or Fair-Trade guidelines (in lower-middle income countries such as India). An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad. Keywords Ommercial surrogacy · Market · Exploitation · Commodification · Regulation
Introduction Surrogacy occurs when a woman gestates and gives birth to a child for the intended parents.1 The surrogacy process is beneficial for parents who are unable to procreate, but it is riddled with ethical challenges. Where surrogacy is permitted, a subject of ongoing debate is the question of * Rien Janssens [email protected] Jaden Blazier [email protected] 1
Philosophy, Bioethics, and Health, Vrije Universiteit, Amsterdam, The Netherlands
Dept. of Medical Humanities, Amsterdam University Medical Center, Location VU Medical Center, PO Box 7057, 1007MB Amsterdam, The Netherlands
2
proper remuneration for surrogates. Surrogacy remuneration generally comes in two forms: altruistic (unpaid) surr
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