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The Ethics of Surrogacy: Understanding the Surrogate Debate

In conversation with Jeff Hu, director of SurrogateFirst, we delve into the ethical and moral considerations of surrogacy. If you’re considering having a child by surrogate, you’ll need to consider these important ethical questions.
The Ethics of Surrogacy
Updated: November 10, 2023
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From Khloé Kardashian to Chrissy Teigen, more and more celebrities are speaking openly about using surrogates to carry their children. This celebrity trend has prompted the topic of surrogacy to become more commonly discussed by the general public.

For those who struggle with infertility or face barriers in creating their families, this normalization of surrogacy has helped reduce the stigma around it. However, there remain ethical and moral factors that must be considered by intended parents before making this decision.

To help you make this important decision, we’ve laid out the ongoing debates surrounding the ethical issues of surrogacy. We will consider costs, fair pay for labor, surrogates’ rights, and other moral and societal stances around how we talk about and treat surrogates.

What is Surrogacy?

Surrogacy is a reproductive arrangement in which a woman, known as a surrogate or gestational carrier, becomes pregnant and carries a child for another individual or couple, known as the intended parents. There are two primary types of surrogacy:

  1. Traditional Surrogacy: In traditional surrogacy, the surrogate uses her own egg and is artificially inseminated with the sperm of the intended father or a donor. This means the surrogate is genetically related to the child she carries.
  2. Gestational Surrogacy: In gestational surrogacy, the surrogate does not provide the egg. Instead, an embryo is created through In Vitro Fertilization (IVF) using the eggs of the intended mother or egg donor and the sperm of the intended father or sperm donor. The resulting embryo is then transferred to the surrogate’s uterus. The surrogate in gestational surrogacy is not genetically related to the child.
Gay couple at a doctor's appointment to discuss surrogacy
Image source: iStock

Surrogacy is often sought by individuals or couples who are unable to conceive and carry a pregnancy themselves due to various reasons, such as fertility issues, medical conditions, or same-sex couples.

Surrogacy is a complex process involving legal, medical, emotional, and ethical questions. The laws surrounding surrogacy vary by both country and state, and these laws can impact the rights and responsibilities of all parties involved.

Ethical Considerations of Surrogacy

Surrogacy is a complex and emotionally charged topic with several ethical and moral considerations. Here are some key points to consider:

Autonomy and Informed Consent

Surrogates must provide informed consent. It’s crucial to ensure that the surrogate fully understands what consent means including the process, risks, and potential emotional challenges. They should have the autonomy to make decisions about their bodies. It is important to have a surrogacy contract that protects the rights and autonomy of the surrogate mother.

Intended parents must respect the autonomy and informed consent of the surrogate. They should ensure the surrogate fully understands the process, potential risks, and emotional challenges. All parties should willingly participate in the surrogacy arrangement.

Surrogacy Costs

Surrogacy is costly; it can be unaffordable for those with limited financial resources and/or lower socioeconomic situations.

We spoke with Jeff Hu, Director of SurrogateFirst about the costs of surrogacy in the USA. He explained that the financial burden of surrogacy is the biggest challenge for intended parents. Most intended parents will be under budget, resulting in even more financial stress down the road.

Hu shared that currently, there aren’t many options in terms of financing from traditional lenders.

“There is a lack of assistance in the form of private scholarships or financial support from the government and employers are not providing sufficient infertility benefits to their employees,” explained Hu.

Hu shared that the cost of surrogacy ranges between $150,000 to $200,000. This includes the following:

  • Medical care (IVF cycles, medical clearance, doctor visits)
  • Total compensation of the surrogate (including base compensation and variable costs)
  • Egg donation if necessary (egg donor compensation and agency fee)
  • Professional services (surrogacy agency fee, lawyers, psychological review)
  • Insurances (health and life)

“The cost variations are based on the intended parents’ requirements as well as the number of transfers it takes to conceive and have a healthy delivery,” explained Hu.

Compensation for the Surrogate

Pregnant surrogate at the hospital. Is surrogacy ethical?
Image source: iStock

Surrogates are often compensated for their time, effort, and the physical demands of pregnancy. Hu explains that surrogates are paid for more than just carrying a baby. Compensation is comprised of cash-based compensation, benefits and other circumstantial occurrences.

“Surrogates are compensated for the time and effort it takes to qualify to become a surrogate, and the pain and suffering it takes to carry a full-term pregnancy; as well as to be protected from any medical costs and potential loss (of life or reproductive function),” adds Hu.

Ethical concerns can arise if the compensation is perceived as exploiting the financial vulnerability of the surrogate and/or making pregnancy and childbirth a commodity. This could compromise the voluntariness of the agreement.

The Journal of Medical Ethics discusses how altruistic surrogacy (unpaid surrogacy) and commercial surrogacy (paid surrogacy) affect the morality of the practice. The journal argues that if commercial surrogacy were to be eliminated, the ethical issues surrounding surrogacy may be reduced. Individuals who chose to become surrogates would be “motivated by purely ‘altruistic’ aims,” rather than driven by money.

Surrogate’s Health and Well-being

Intended parents have a responsibility to protect the surrogate’s physical and emotional well-being throughout the pregnancy. Ethical surrogacy contracts should include safeguards to protect the surrogate’s health and ensure proper prenatal care, address health concerns, and be prepared for potential complications.

Surrogates may face long-term emotional, psychological, or physical impacts from the surrogacy process. Ethical surrogacy considers these potential long-term consequences and offers support.

Surrogate’s Rights and Decisions About Their Body

Surrogates should have the right to make decisions about their bodies. Ethical surrogacy respects a woman’s right to decide when and how to become pregnant and carry a child.

Intended parents should treat the surrogate mother with respect and dignity. This includes valuing her as a partner in the surrogacy journey, recognizing her sacrifices, and providing emotional support.

Hu provides an example of the surrogate’s decision to be vaccinated:

“[Vaccination] has now become a standard question to confirm upfront with the surrogate. Again, it is 100% the decision of the surrogate to determine. Some intended parents and clinics require mandatory vaccination to become medically cleared, and some do not.”

Pregnancy Termination

What happens if there are complications during the pregnancy or concerns about the health of the child?

Hu shares that asking the surrogate about their termination stance and having a clear understanding of this is crucial before finding an intended parent match.

“It is 100% the surrogate’s decision if they have a No Termination stance or if they will leave it to the doctor’s discretion if medically necessary, or if they allow termination at the full discretion of the intended parents,” he explains.

Relationship with the Child and Future Considerations

Surrogacy rights
Image source: iStock

Some surrogacy arrangements involve traditional surrogacy where the surrogate’s own egg is used. In such cases, the surrogate may have a biological connection to the child. Ethical concerns can arise about the surrogate’s relationship with the child.

Honesty and transparency are crucial. Intended parents should be forthright about their intentions, including their desires for a relationship between the surrogate and the child, if any.

Intended parents should also think about the long-term consequences of surrogacy, including how they will explain the surrogacy to the child, family, and friends.

Legal Protections and Parental Rights

Surrogacy laws vary from one place to another. Ethical surrogacy ensures that the intended parents have the legal rights to the child, and the surrogate has the right to make decisions about her health and body. Ethical surrogacy should take place within a legal framework that protects the rights and interests of all parties involved.

It’s important to approach surrogacy with a deep understanding of the ethical considerations and to work with professionals who are experienced in surrogacy law and ethical practices. This helps ensure that surrogacy is carried out in a way that respects the rights and well-being of all involved.

Ethical Decision Making

Close up shot of pregnant belly. Is surrogacy ethical?
Image source: iStock

Intended parents should make ethical decisions before starting the surrogacy process. They should consider the best interests of the child, the surrogate, and themselves.

Hu shares some of the moral questions and ethical decisions that intended parents must consider before starting their surrogacy journey:

  • Is surrogacy socially acceptable?
  • Should surrogacy be reserved based on medical needs?
  • Is it okay to pursue surrogacy to protect your career and/or to not suffer the pain and physical aspects of pregnancy?
  • Is it okay to pay someone else to have a baby for me?
  • Should surrogacy be a last resort and used only when the individual or couple can not physically carry due to medical reasons or if they are a same-sex couple?

Intended parents need to approach surrogacy with a deep sense of responsibility, respect, and ethical awareness. Working with experienced professionals, such as attorneys, surrogacy agencies, and mental health experts, can help navigate the ethical considerations involved in surrogacy to ensure that the process is conducted in an ethically sound manner.

Sources +

Blazier, J., & Janssens, R. (2020). Regulating the International Surrogacy market: the Ethics of Commercial Surrogacy in the Netherlands and India. Medicine, Health Care and Philosophy, 23.

Marway, H. (2018, September 27). The ethics of surrogacy. University of Birmingham.

Oakley, J. (1992, October 1). ALTRUISTIC SURROGACY AND INFORMED CONSENT. Bioethics; Wiley-Blackwell.

Saxena, P., Mishra, A., & Malik, S. (2012). Surrogacy: Ethical and Legal Issues. Indian Journal of Community Medicine, 37(4), 211.

Surrogacy Contracts - American Surrogacy. (n.d.).

van Niekerk, A., & van Zyl, L. (1995). The ethics of surrogacy: women’s reproductive labour. Journal of Medical Ethics, 21(6), 345–349.

Zohny, H. (2022, April 11). Does money affect the morality of surrogacy? Journal of Medical Ethics Blog.

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