ABSTRACT
This study critically examines the ethical and religious issues surrounding outsourcing pregnancy or gestational surrogacy. The study examines the moral dilemma created by the fragmentation of motherhood into biological, gestational, and social motherhood that has created enormous conflicts over who should be considered a ‘mother’ and the concomitant parental rights and responsibilities for a child. The debates surrounding gestational surrogacy and its implications on existing reproductive rights raises most profound ethico-religious issues on the maternal roles which historically resided in one mother. The overall objective of this research therefore is aimed at evaluating these ethico-religious arguments contiguous to outsourcing pregnancy. In this study, the expository, evaluative and the critical-analytical approaches based on Prudential Personalism ethical model are adopted to evaluate these arguments. Utilizing the Prudential Personalism ethical model, the findings of this study are: that it is not morally justifiable for a fertile woman to abdicate her natural right of reproduction and seek the benefit of that same right through the markets; that the prerogative for an infertile woman to seek the benefits of commercial gestational surrogacy is not significant and sufficient because of the inherent impairments. Besides, gestational surrogacy presents challenges with some ethical and religious objections and unfavourable disposition within the Nigerian context. In conclusion, this study recognizes that gestational surrogacy has the potentials to adversely impact the value of human dignity and the family unit, and therefore a problem of public ethos, with ethical and religious dimensions that requires critical ethico-religious evaluation. This study recommends that a Theo-centric ethics should drive human reproductive scientific advancements; that the ethical and religious implications of outsourcing pregnancy should be of paramount consideration in all gestational surrogacy engagements. Therefore, the ethical and religious import of gestational surrogacy should form a starting point of all engagements and actionable programmes in this novel emerging moral dilemma called “gestational surrogacy”.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Despite the dysfunctionality of modern thought, the role and the place of children in marriage has remained central to many married couples. That children are the beautiful gifts of God in a conjugal union is axiomatic to many adherents of different religions. The divine injunction of procreation “multiply and fill the earth” (The Jerusalem Bible, Genesis 1:28) is an attestation of this divine mandate. This could account for why many married couples, are ready to go any length in the ultimate search for offspring.
Childlessness dates back to primeval history. An interesting biblical account is the narrative concerning Sarah, the wife of Abraham. Sarah could not have children in the beginning. She gave her handmaid, Hagar, to her husband Abraham to produce them a child (Genesis 16:1-5). The human reproductive method used in this narrative was copulation. While it could be exegetically argued that childlessness predates the Abrahamic era with no known cause(s) except as the will of God (1Samuel 1:6), it could, however, be asserted with scientific certainty that the causes of childlessness in our contemporary era are multi-factorial. Current medical survey shows that ten to fifteen percent of married couples are unable to have children on their own today (Grayce Storey 15).
In an attempt at self-reinvention, therefore, modern science has developed means other than the ordination of natural human reproductive system (copulation) in order to give infertile couples the opportunity to enjoy the right of parenting. These extra-natural means of human reproduction include amongst others, Intra-Uterine Insemination (IUI), In Vitro Fertilization (IVF) and most recently, outsourcing of pregnancy or gestational surrogacy (GS). These new human reproductive technologies have spawned a new area of ethico-religious discourse in the field of bioethics which is very challenging, complex and fascinating to its proponents, ethicists and religionists. Outsourcing pregnancy is one of these new human reproductive techniques whereby surrogates are implanted with foreign embryos and paid to carry the resultant babies to term (Rosemarie Tong 1).
Outsourcing pregnancy or Gestational Surrogacy is an arrangement in which one or more persons, typically a married infertile couple (the intended rearing parents), contract a woman to gestate a child for them and then to relinquish the child to them after birth (Tong 3). Gestational surrogacy is also sometimes referred to as “contract pregnancy”. It simply means that this mode of parenting allows a couple to have a child by involving a third party in their relationship who serves as birth mother or surrogate mother (Shein Chang 456).
India today is currently the world capital of outsourced pregnancies and has become a transnational hub for reproductive tourism. In 2002 the India government legalized commercial pregnancy outsourcing in an effort to promote medical tourism, a sector the confederation of Indian industry predicts will generate $2.3 billion annually by 2012 ( Brenhouse 2). Indian surrogate mothers are readily available and cheap, unlike in most developed countries where surrogacy is lawful (Brenhouse 4). According to Brenhouse, the entire process costs customers around $23,000, less than one-fifth of the going rate in the United States of American, of which the surrogate mother usually receives about $7,500 in installments (2). These women are implanted with embryos, using specimens from sperm or egg donors if necessary. Once pregnant, the surrogates are housed in a dormitory so that they can be supervised until delivery (Brenhouse 3). After delivery the child is taken away from the surrogate mother and given to the would-be parents after final payment.
Gestational surrogacy or outsourcing of pregnancy is a new reproductive practice commonly accepted as an increasingly prevalent phenomenon. The Hague Conference on Private International Law recent report have documented a rise in the practice of outsourcing of pregnancy, to include arrangements across international borders (6-8). However, precise statistics relating to surrogacy are hard to estimate for a number of key reasons. First, although gestational surrogacy does requires medical intervention, officially reported statistics do not necessarily record the surrogacy arrangement, but often only the IVF procedure (Human Fertilization and Embryology Authority 4). Second, in many countries, there is simply no legal provision, regulation or licensing regime for either fertility treatment and/or surrogacy. According to the Policy Department C of European Parliament, this means that there are no formal reporting mechanisms, which can lead to a rather ad hoc collection of statistics by individual organizations, if indeed they are available at all (9). Finally, in countries where surrogacy is legally prohibited, those involved could potentially face criminal prosecution, thus exacerbating the difficulties of collecting relevant and accurate data.
Despite these problems, one can still point to a number of factors which signal a rise in the practice of outsourcing pregnancy. First, a simple internet search reveals a plethora of agencies and clinics that very explicitly seek to facilitate outsourcing pregnancy arrangements. Sometimes these are voluntary organizations like COTS (Childlessness Overcome through Surrogacy), which seek to match willing surrogate mothers and hopeful parents on a non-commercial basis (COTS 7); while others operate on a commercial basis either as part of a fertility clinic or in partnership with fertility clinics (The Policy Department C of European Parliament 9). Second, there are also increasingly frequent stories in the media about surrogacy arrangements: whether positive or negative, successful or unsuccessful; as well as references to gestational surrogacy in popular arenas, such as television shows. Finally, there has been a recent surge in reported law cases relating to surrogacy across a number of jurisdictions. Interestingly, while some of these law cases do involve private disputes between the parties to the arrangement, the primary thematic trend relates to arrangement with respect to the legal status and legal parenthood of the children involved (The Policy Department C 9).
Some countries like Canada, the United Kingdom, France, Norway, and Italy do not allow commercial surrogacy and it is illegal for a woman to receive payment for her reproductive services specifically. But in the United States and India commercial surrogacy is legal and remains a luxury of the wealthy (Karen Busby and Vun Delaney 20).
In Nigeria, there is no clear and well defined legislation on what constitute outsourcing pregnancy as it is a new concept in Nigeria, and the country is yet to acknowledge and provide legislation to govern this emerging concept. According to Oluchi Azoro-Amadi, the need for gestational surrogacy legislation in Nigeria cannot be overstated as most countries have moved from acknowledging its existence to providing legislation to govern surrogacy contract (2). Azoro-Amadi further observes that it is pertinent that the issue of the legality or illegality of the concept of outsourcing pregnancy be put straight so that the Nigerian populace can understand their rights if any within a contract of gestational surrogacy (6). It is one line of reasoning that incidences of baby factories, illegal sale of babies, babies being swapped in hospitals, stolen from the arms of their mothers amongst others are direct results of the void created by the lack of any legislation or express legitimization of the concept of gestational surrogacy. This will probably continue until the issue of legalizing or non-legalizing surrogacy whether commercial or altruistic is properly addressed (Azoro-Amadi 2).
On Wednesday June 1, 2011 the Nigerian police raided a home used by teenage girls to have babies that were then offered for sale. According to Bala Hassan, police commissioner for Abia State:
We stormed the premises of the Cross Foundation in Aba following a report that pregnant girls aged between 15 and 17 are being made to make babies for the proprietor. We rescued 32 pregnant girls and arrested the proprietor who is undergoing interrogation over allegations that he normally sells the babies. Some of the girls told police they had been offered to sell their babies for between 25,000 and 30,000 naira (192 dollars) depending on the sex of the baby. The babies would then be sold to buyers for anything from 300,000 naira to one million naira (1,920 and 6,400 dollars) each. (qtd. in David Smith A6)
In 2007, Osato Giwa-Osagie (a renowned professor of obstetrics & gynaecology) announced to Nigerians that his team has successfully performed a surrogate pregnancy at the OMNI Advanced Medical Centre in Lagos with a little over N1million. According to him the pregnancy was outsourced to a single lady in her 30s who graciously carried the pregnancy at the cost of N200, 000. The N200, 000, was a compensation for the lady that carried the pregnancy, while the balance was paid for the medical bills and cost of In Vitro Fertilization (qtd. in Franca Omo 1). Interestingly, the lady that carried the pregnancy on behalf of the couple hails from the South Western part of the country and lives in Lagos, while the couple from the South Eastern part of the country, resides in the east. But the hospital ensured anonymity between both parties. The carrying mother was referred to the hospital by somebody who had discussed it when they met and were talking socially about modern fertility. The person told her that people were doing it, and anyone who accepted the offer would be paid for it, so the lady took up the offer. Giwa-Osagie further maintains that in the last two years, over 20 Nigerian couples have approached the hospital for the same purpose including three Nigerians resident abroad (qtd. in Omo 3).
Proponents of outsourcing pregnancy see no problem with it. They consider it a win/win situation for all those involved. The infertile married couple gets a baby; the surrogate mother receives huge sum of money. Proponents argue that fundamental human rights support commercial gestational surrogacy: the right to procreate and freedom of contract. The thinking is that fully informed autonomous adults should have the right to make whatever arrangement they wish for the use of their bodies and the reproduction of children so long as the children themselves are not harmed (Abigail Haworth 4).
There is no gainsaying the fact that outsourcing pregnancy has brought joy to many infertile married couples. The question must however be asked whether commercial gestational surrogacy is morally defensible. It might be regarded as such by appeal to the liberal freedom of contract, which protects the rights of adults of sound mind and full information to contract for the performance of services they desire at a price they are willing to pay, or to offer services for a fee they find compensatory (Vida Panitch 340). It might also be defended on the grounds that it provides a source of independent income to poor women whose economic options are otherwise quite limited. And also, it might be defended on the grounds that it satisfies the reproductive rights of richer women who have chosen to delay child-rearing to pursue a career or other projects of interest to them and who would otherwise be biologically, legally, and economically prevented from exercising that right (Panitch 339). But there is a decidedly more pressing reason to be concerned with the practice, namely, to examine if gestational surrogacy exploits the reproductive labour of poor women in developing countries like India and Nigeria.
There is no doubt that gestational surrogacy is a highly controversial form of infertility treatment, with views varying widely between faiths, personal beliefs and national legislation. There is also a range of far more personal surrogacy issues to consider, such as whether the intended parents will bond with the child in the same way as would the parturition mother; as well as the difficulty of whether the child should be told about his or her origins.
The most worrisome dimension is the abdication of a woman’s natural reproductive right for cosmetic reasons and outsourcing that same right to another woman. Ethical questions must therefore be asked as to the right for a woman to rent out her womb for a fee? Can the “womb” be subjected to the invisible hand of the market forces of demand and supply? Why are people apparently more willing to accept a practice that was once considered abnormal, immoral or distasteful? Are there some values that are higher than market values? Is paid gestational surrogacy ethical? Is outsourcing pregnancy by developed countries to underdeveloped and developing countries ethical? Although at the most fundamental level, paid gestational surrogate motherhood could be interpreted as an economic transaction, the reality is far more complex due to the degree of intimacy involved. Inclusive to the basic economics of the markets are layers of emotional complexity, rights of bodily autonomy, and the unaddressed questions of women’s rights in developing countries. Furthermore should legal motherhood be attributed on the basis of parturition or genetic make-up? Similar difficulties can arise in relation to legal fatherhood, as well as the recognition of two parents of the same sex.
Therefore, this study sets out to answer some basic hypothetical questions which include among others: Is it morally justifiable to subject the gift of the womb to the market forces of demand and supply? What are the religious implications of outsourcing pregnancy? Can non-commercial pregnancy outsourcing be religiously justified? And what are the positives of outsourcing pregnancy in an age of growing childless couples?
1.2 Statement of the Problem
There is currently a growing pregnancy outsourcing industry, namely clinics offering couples the opportunity to “rent a womb". These clinics are becoming home to an ever growing number of young women, anxious for the opportunity to trade their ability to carry a much desired child in exchange for the cash that will change their entire fortune. Childless couples are flocking to India and some Nigerian fertility clinics to obtain the services of these ready and willing women. The question is: what are the ethical and religious implications of paid pregnancy?
1.3 Justification of the Study
Some studies have already been done in the field of pregnancy outsourcing, among which are New Trends in Global Outsourcing of Commercial Surrogacy: A Call for Regulation by Ruby Lee, wherein he examines the emerging threat of pregnancy outsourcing and called for a legislation and guide to the practice (Lee 277). On his part Michael Sandel in his study Markets and Morals discusses the social issues surrounding pregnancy outsourcing to India. While Ishika Arora in her book Wombs for Rent: Outsourcing Surrogacy to India, asserts that pregnancy outsourcing is a multimillion dollar industry that recruits poor Indian women as surrogates for foreign citizens as an unethical business that should be banned by the government (Arora 3). She further asserts that the rapid growth of this industry warrants a thorough examination of many of its aspects including safety, human rights, and legal issues. Mainly, Arora’s assertion begs for answer to the question: “Is this exploitation?” Proponents of outsourcing pregnancy justify this act through monetary compensation, but through the analysis of the different facets of this lucrative business, it can be proved that outsourcing surrogacy merely allows people of richer nations to exploit the poverty-stricken women of less developed nations. Consequently, it hinders further social, political, and economic development for these nations and should be deemed illegal (Arora 3).
A critical examination of the above literature shows a deficit of perceptive, which only considered the legal and economic perspectives of pregnancy outsourcing without any consideration given to the ethical and religious perspectives. This is the gap this study sets out to fill.
Other scholars and researchers have dwelt on other aspects of pregnancy outsourcing. France Winddance Twine in his book Outsourcing the Womb: Race, Class and Gestational Surrogacy in a Global Market maintained that pregnancy outsourcing is a quiet revolution of the past three decades and that the way children enter families has changed radically among upper and middle class families. He is of the opinion that infertility is increasingly defined as a medical problem that could be solved with assisted reproductive technologies (ART) rather than through adoption (Twine 21). Twine discovers from his study that recent statistics show that 1 in 10 couples are experiencing trouble conceiving a child naturally and are turning to various forms of assisted reproductive technology (ART), commercial gestational surrogacy prominent among them (Twine 21).
Sarmishta Subramanian, Stephanie Nolen and Agnihotri Gupta in their separate studies on the prevalence of outsourced pregnancy in India suggest wider estimates of 100–150 babies born to surrogate mothers in India each year. The total cost to prospective parents being about $10,000, and this medical reproductive tourism according to them is estimated to be a $445 million business in India, with the potential to grow in the near future to $2.3 to $6 billion (Subramanian 9, Nolen 3 and Gupta 30).
Where do we draw the line in things that can be outsourced? This is the question asked by Arlie Hochschild in her book: The Outsourced Self: Intimate Life in Market Times. Alison Lynch discusses the new trend whereby women in America outsourced their pregnancies so they do not miss out on opportunities at work or ruin their figures. These women maintained that if they can hire people to do their cleaning and shopping, there is nothing wrong with outsourcing pregnancy too? Therefore women in America with no known fertility issues are outsourcing childbirth through the use of social surrogates.
Sayantani DasGupta and Shamita Das Dasgupta in their book Globalization and Transnational Surrogacy in India: Outsourcing Life discusses the phenomenon of transnational surrogacy which has given rise to a thriving international industry where money is being ‘legally’ exchanged for babies and ‘reproductive labor’ has taken on a lucrative commercial tone (DasGupta and Dasgupta 120).
A critical review of the studies of Twine, Subramanian, Nolen and Gupta, Arlie Hochschild, Sayantani DasGupta and Shamita Das Dasgupta shows that these studies centered mainly on the social and medical perspectives of outsourcing pregnancy and how pregnancy outsourcing is fast becoming a multibillion dollars industry in India, with a major focus on medical tourism. An ethico-religious evaluation of outsourcing pregnancy is clearly obscured in these previous studies. To fill this gap, this study will underscore the importance and denude the philosophico-religious issues regurgitated by gestational surrogacy.
Papal encyclicals like Evangelium Vitae, Humanae Vitae, Casti Connubii, Mater et Magistra, Familiaris Consortio and Dignitas Personae all dwelt on the dignity of the human person and not specifically on pregnancy outsourcing. The lack of specific treatment of pregnancy outsourcing in these documents and other encyclicals is understandable, as pregnancy outsourcing is a new emerging moral dilemma in bioethics.
In summary, there is a clear testament to the fact that there are lots of studies on the legal, medical, commercial and social perspectives of pregnancy outsourcing. These previous engagements had focused mainly on the scientific and economic perspectives of outsourcing pregnancy. The ethical and religious concerns are rarely made explicit in these discussions, and therefore not adequately scrutinized or debated. This has created a deficit in the examination of the ethical and religious perspective of outsourcing pregnancy. The justification of this study is to fill this yearning gap of having an ethico-religious evaluation of this new emerging moral dilemma called “outsourcing pregnancy”, as the ethical and religious stakes surrounding outsourcing pregnancy cannot be avoided or reduced. Failure to have this evaluation could have catastrophic implications. Responses must be thoroughly considered, with ethical and religious implications in mind in order to avoid creating new paradigms of distorted values and misdistribution, as well as render even more vulnerable those who have already found themselves uprooted by other socio-economic and ideological struggles. The need for an ethical and religious approach to outsourcing pregnancy is therefore profound and compelling.
The formulation of an ethical and religious response to outsourcing pregnancy will have profound implications for the immediate and future well-being of a number of persons who are the immediate victims of outsourcing pregnancy, namely that outsourcing pregnancy raises not only a number of questions that have to do with medical science, but also, many questions of a more universal nature that are based on philosophical, ethical and religious assumptions with colossal ethical and religious implications which have largely been ignored in all previous pregnancy outsourcing engagements.
1.4 Objectives of the Study
The overall aim of this study is to undertake an ethical and religious evaluation of outsourcing pregnancy. The specific objectives of this study are to:
(a) examine if it is morally right for a fertile woman to abdicate her natural right of reproduction and seek the benefit of that same right through the markets;
(b) examine the prerogative of an infertile woman who seeks the benefits of gestational surrogacy;
(c) ascertain the religious and the ethical mandate of a woman who wants to become a gestational surrogate mother;
(d) explore the moral and religious issues involved in outsourcing pregnancy through the markets;
(e) determine if outsourcing pregnancy to underdeveloped and developing countries is a means of economic empowerment or human exploitation, and
(f) determine current deposition of Nigerians to outsourcing pregnancy.
1.5 Definitions of Terms
This section defines the terminology used in the study given the unfamiliar and often contested nature of surrogacy-related terminology. While this study has adopted the meaning of the terms below, it also acknowledges that some terms continue to prove problematic in sufficiently capturing both the empirical realities and the subjectivities of the persons involved. The key terms defined in this study are: “Outsourcing Pregnancy”, “Gestational Surrogacy”, “Ethics”, “Ethical Models”, “Religion”, “Evaluation” and “Market”.
1.3.1 Outsourcing Pregnancy
The English Oxford Living Dictionary defines the word “Outsourcing” as the contracting or subcontracting of activities to obtain goods or a service from an outside supplier (par 1). Outsourcing is often an integral part of downsizing or reengineering also called “contracting out”. Dave Jamieson defines the word “outsourcing” as the act of one company contracting with another company to provide services that might otherwise be performed by in-house employees. Often the tasks that are outsourced could be performed by the company itself, but in many cases there are financial advantages that come from outsourcing (45). Merriam Webster Dictionary simply defines outsourcing as the procurement of some goods or services needed by a person or organization from outside sources and especially from foreign or nonunion suppliers (96). Outsourcing has become a major trend in human resources over the past decade as more and more companies, large and small, are turning to outsourcing as a way to grow while restraining payroll and overhead costs.
Many large companies now outsource jobs such as call center services, e-mail services, and payroll. These jobs are handled by separate companies that specialize in each service, and are often located overseas. There are many reasons that companies outsource various jobs, but the most prominent advantage seems to be the fact that it often saves money. Many of the companies that provide outsourcing services are able to do the work for considerably less money, as they do not have to provide benefits to their workers and have fewer overhead expenses to worry about. Depending on location, it may also be more affordable to outsource to companies located in different countries (WiseGeek 34). This strategy may also lead to faster turnaround times, increased competitiveness within an industry and the cutting of overall operational costs. Businesses can reduce labor costs significantly by outsourcing certain tasks, while companies may simultaneously have access to technology without investing large amounts of money to own the technology (Investopedia 84).
Linda Wylie defines pregnancy as the interval of time beginning when an egg and sperm unite and ending when a baby is born. A full-term pregnancy lasts nine months (38 to 40 weeks). The nine months are divided into trimesters. The first trimester is when the embryo develops, the second trimester is when the embryo turns into a fetus, and third trimester is when the fetus gains weight and gets ready for birth (172). A trimester is any of three periods of approximately three months each into which a human pregnancy is divided (Wylie 173).
Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins (Wylie 172). Pregnancy can occur by sexual intercourse or assisted reproductive technology. It usually lasts from the last menstrual period (LMP) and ends in childbirth. An embryo is the developing offspring during the first eight weeks following conception, after which, the term fetus is used until birth (Steven Abman 46). Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination (American Pregnancy Association 67). Pregnancy may be confirmed with a pregnancy test (National Institute of Child Health and Human Development NICHD 90).
Prenatal care improves pregnancy outcomes. Prenatal care may include taking extra folic acid, avoiding drugs and alcohol, regular exercise, blood tests, and regular physical examinations (NICHD 91). Complications of pregnancy may include high blood pressure of pregnancy, gestational diabetes, iron-deficiency anemia, and severe nausea and vomiting among others (Christopher Bottomley 250). Term pregnancy is 37 to 41 weeks, with early term being 37 and 38 weeks, full term 39 and 40 weeks, and late term 41 weeks. After 41 weeks, it is known as post term. Babies born before 37 weeks are preterm and are at a higher risk of health problems such as cerebral palsy (Bottomley 251).
“Outsourcing pregnancy” is the contracting of pregnancy to a surrogate. It is an arrangement or agreement whereby a woman agrees to carry a pregnancy for another person or persons, who will become the newborn child's parent(s) after birth. Intended parents may seek pregnancy outsourcing arrangement when either pregnancy is medically impossible; pregnancy risks present an unacceptable danger to the mother's health, or in the case of same sex couple's preferred method of having children. Monetary compensation may or may not be involved in these arrangements. If the surrogate receives money for the surrogacy, the arrangement is considered commercial surrogacy, if she receives no compensation beyond reimbursement of medical and other reasonable expenses it is referred to as altruistic (Lisa Feldstrin 7).
In this study outsourcing pregnancy is a designated term used to refer to a medical procedure whereby surrogates are implanted with foreign embryos and paid to carry the resultant pregnancy to term. After delivery the child is given to the intended parent. In this study outsourcing pregnancy is used interchangeably with different terms such as “gestational surrogacy”, “paid pregnancy”, “contract pregnancy”, “rent a womb”, “wombs for rent” (cf appendix II) and “wombs for hire” (cf appendix III).
1.3.2 Gestational Surrogacy (GS)
“Gestational” is a term relating to pregnancy. The Surrogate Parenting Act 199 of 1988 defines gestational surrogacy as the procedure that occurs when the eggs of intended mother and the intended father's sperm are used to create an embryo (via IVF) that is transferred into and carried by the surrogate mother. With this method, the child born is genetically related to its parents and the surrogate mother has no genetic relation. There are different typologies of gestational surrogacy. (a) Gestational Surrogacy with Donor Embryo (GS/DE) is when the intended parents are unable to produce sperm, egg, or embryo, the surrogate mother can carry a donated embryo (often from other couples who have completed IVF that have leftover embryos. With this method, the child born is not genetically related to the intended parents and the surrogate mother also has no genetic relation (Surrogate Parenting Act 199 of 1988). (b) Gestational Surrogacy with Donor Sperm (GS/DS) is when there is no intended father or the intended father is unable to produce sperm, the surrogate mother carries an embryo developed from the intended mother's egg (who is unable to carry a pregnancy herself) and donor sperm. With this method, the child born is genetically related to the intended mother and the surrogate mother has no genetic relation (Surrogate Parenting Act 199 of 1988). (c) Gestational Surrogacy with Egg Donation (GS/ED) is when there is no intended mother or the intended mother is unable to produce eggs, the surrogate mother carries the embryo developed from a donor egg that has been fertilized by sperm from the intended father. With this method, the child born is genetically related to the intended father and the surrogate mother has no genetic relation (Surrogate Parenting Act 199 of 1988).
In this study Gestational surrogacy refers to all the different typologies of gestational surrogacy, excluding genetic gestational surrogacy. Genetic gestational surrogacy is when the resulting child is genetically related to the surrogate. Gestational surrogacy as used in this study simply means non-genetic gestational surrogacy. Non-genetic gestational surrogacy is when the resulting child is not genetically related to the surrogate; that is the gestational mother is just a gestational carrier (Karisa Ding 3).
1.3.3 Ethics:
The term ethics derives from the Ancient Greek word ἠθικός (ethikos), which is derived from the word ἦθος ethos (habit, "custom"). It is a branch of philosophy (axiology) which comprises the sub-branches of ethics and aesthetics, each concerned with values (Random House Unabridged Dictionary par 1)
As a branch of philosophy, ethics investigates the questions "What is the best way for people to live?" and "What actions are right or wrong in particular circumstances?" In practice, ethics seeks to resolve questions of human morality, by defining concepts such as good and evil, right and wrong, virtue and vice, justice and crime. As a field of intellectual enquiry, moral philosophy also is related to the fields of moral psychology, descriptive ethics, value theory and moral theology.
According to the Internet Encyclopedia of Philosophy, three major areas of study within ethics are recognized today. Which are:
(a) Meta-ethics, concerning the theoretical meaning and reference of moral propositions, and how their truth values (if any) can be determined,
(b) Normative ethics, concerning the practical means of determining a moral course of action, and
(c) Applied ethics, concerning what a person is obligated (or permitted) to do in a specific situation or a particular domain of action (30).
Rushworth Kidder states that "standard definitions of ethics have typically included such phrases as 'the science of the ideal human character' or 'the science of moral duty” (63). Richard Paul and Linda Elder define ethics as "a set of concepts and principles that guide us in determining what behavior helps or harms sentient creatures" (np). The Cambridge Dictionary of Philosophy states that the word ethics is "commonly used interchangeably with 'morality' and sometimes it is used more narrowly to mean the moral principles of a particular tradition, group or individual"(156). Paul and Elder state that most people confuse ethics with behaving in accordance with social conventions, religious beliefs and the law and do not treat ethics as a stand-alone concept (np).
Merriam Webster Dictionary sees the word "ethics" as referring to philosophical ethics or moral philosophy, which is a project that attempts to use reason in order to answer various kinds of ethical questions (par 2). As the English philosopher Bernard Williams writes, attempting to explain moral philosophy: "What makes an inquiry a philosophical one is reflective generality and a style of argument that claims to be rationally persuasive"(2). Williams describes the content of this area of inquiry as addressing the very broad question, "how one should live" (1). Ethics can also refer to a common human ability to think about ethical problems that is not particular to philosophy. As bioethicist Larry Churchill has written: "Ethics, understood as the capacity to think critically about moral values and direct our actions in terms of such values, is a generic human capacity"(253). Anthony Echekwube in his book Contemporary Ethics: History, Theories and Issue, defines ethics as the systematic study of the fundamental principles of the moral law; or the normative sciences of human conduct, which means that ethics is a normative science as distinct from the empirical sciences.
In this study ethics is defined as the breach of moral philosophy and moral theology which deals with the moral standard of behavior and what is acceptable. It is a system of fundamental moral principles that affect how people make decisions and lead their lives. Ethics in this study is concerned with what is good for individuals and society.
“Bioethics” the rapid technological advancements in the areas of medicine and health care have given rise to a new discipline known as bioethics. Simply defined, bioethics is the critical examination of the moral dimensions of decision-making in health-related contexts and in contexts involving the biological sciences. It is an interdisciplinary enterprise that studies in depth the moral implications of advances in biological sciences with the aim of providing consistent moral answers that are raised (Antonio Spagnolo par 8).
1.3.4 Ethical Models
Dealing with ethical issues is often perplexing. According to Manuel Velasquez, Claire Andre, Thomas Shanks, and Michael Meyer the first step in analyzing moral issues is to get the facts. But having the facts is not enough. Facts by themselves only tell us what is; they do not usually tell us what ought to be (5). In addition to getting the facts, resolving an ethical issue also requires an appeal to some ethical values. Philosophers have therefore developed different approaches of ethical values to deal with moral issues. These ethical approaches to ethical values are known as ethical models.
Given the fact that ethical dilemmas may not always be readily resolved through the use of codes of ethics, it might be useful to have a framework in which to analyze and make ethical decisions. These ethical frameworks are known as ethical models.
Ethical models are often broadly divided into three types: i) Consequentialist theories, which are primarily concerned with the ethical consequences of particular actions; ii) Non-consequentialist theories, which tend to be broadly concerned with the intentions of the person making ethical decisions about particular actions; and iii) Agent-centered theories, which, unlike consequentialist and non-consequentialist theories, are more concerned with the overall ethical status of individuals, or agents, and are less concerned to identify the morality of particular actions. Each of these three broad categories contains varieties of approaches to ethics, some of which share characteristics across the categories. Some of the most important and useful of these ethical models drivable from these three broad theories are: Emotivism, Voluntarism, Deontologism, Teleological Ethics and Prudential Personalism.
3.3.5 Religion
Religion which is “respect for what is sacred, reverence for the gods"(Douglas Harper 1), "obligation, the bond between man and the gods" (Shorter Oxford English Dictionary 78) is derived from the latin word religiō. Modern scholars such as Tom Harpur and Joseph Campbell favor the derivation from ligare "bind, connect", probably from a prefixed re-ligare, i.e. re (again) + ligare or "to reconnect", which was made prominent by St. Augustine, following the interpretation of Lactantius (John Green 94).
Clifford Geertz defines religion as a cultural system of behaviors and practices, worldviews, sacred texts, holy places, ethics, and societal organisation that relate humanity to "an order of existence"(116). Different religions may or may not contain various elements, ranging from the "divine", "sacred things", "faith", a "supernatural being or supernatural beings" or "some sort of ultimacy and transcendence that will provide norms and power for the rest of life” (Anthony Vergote 16). According to James Swindal, religious practices may include rituals, sermons, commemoration or veneration (of God or deities), sacrifices, festivals, feasts, trances, initiations, funerary services, matrimonial services, meditation, prayer, music, art, dance, public service, or other aspects of human culture. Religions have sacred histories and narratives, which may be preserved in sacred scriptures, and symbols and holy places that aim mostly to give meaning to life. Religions may contain symbolic stories, which are sometimes said by followers to be true, that have the purpose of explaining the origin of life, the Universe, and other things. Traditionally, faith, in addition to reason, has been considered a source of religious beliefs (19). According to the Association of African Studies, there are an estimated 10,000 distinct religions worldwide (119). About 84% of the world's population is affiliated with one of the five largest religions, namely Christianity, Islam, Hinduism, Buddhism or forms of folk religion (Pew Research Center par 12).
The study of religion encompasses a wide variety of academic disciplines, including theology, comparative religion and social scientific studies. Theories of religion offer various explanations for the origins and workings of religion.
In this study, the word religion is used as the belief in and worship of a superhuman controlling power, especially a personal God. Religion is seen as a set of beliefs that is held by a group of people as there are many different religions, each with a different set of beliefs. These beliefs are about the world and the people in it, about how they came into being, and what their purpose is. Each religion also has a "moral code" which is a set of beliefs about how humans should act.
1.3.6 Evaluation
The Cambridge Advanced Learner’s Dictionary defines evaluation as the act of examining someone or something in order to judge their qualities, success, or needs (par 1). Dictionary.com defines evaluation as the act of estimating or judging the nature or value of something or someone, an estimate or considered opinion of the nature, quality, importance (par 1 and 3). The objective of an evaluation is for the decision maker to develop insight into the decision and determine a clear course of action. Much of the insight developed in the evaluation stage results from exploring the implications of the chosen decision model. Possible actions following the evaluation stage include implementing the recommended course of action, revising the formal model and reevaluating it, or abandoning the analysis all together (Steve Holtzman 67). In this study evaluation is taken to mean the process of assessing and judging something or someone based on a set of standards.
1.3.7 Market
Investopedia defines market is a medium that allows buyers and sellers of a specific good or service to interact in order to facilitate an exchange. This type of market may either be a physical marketplace where people come together to exchange goods and services in person, as in a bazaar or shopping center, or a virtual market wherein buyers and sellers do not interact, as in an online market (5). Market as used in this study is more in line with the notion of a virtual market which refers to people with the desire and ability to buy a specific product or service in the biotech market.
1.6 Scope of the Study
This study is on the ethical and religious perspectives of outsourcing pregnancy and does not pretend to cover the whole subject area of assisted human reproductive technologies (ART) and IVF. While acknowledging that gestational surrogacy is within the preview of In Vitro-Fertilization (IVF), the scope of this study is mainly focused on the religious and ethical implications of paid pregnancy or commercial gestational surrogacy. It is also imperative to state that this thesis is not a medical treatise, but a philosophical-theological evaluation of a medical procedure within the realm of bioethics.
1.7 Research Methods
This study is within the theoretical framework of the Prudential Personalism Ethical Model whose major proponent is Benedict M. Ashley. Prudential Personalism stresses that the "ends” of human action are always persons and the community of interrelated persons responding to each other within the tripartite relationship between God, Man, and Others.
In this study, the expository, evaluative and critical-analytical approaches based on Prudential Personalism ethical model are adopted. The expository approach provided the platform to describe, explain, discuss and give information about the ethical and religious perspective of outsourcing pregnancy. The evaluative method of research was employed to achieve the overall aim and specific objectives of this study. The Evaluative method enabled this research to systematically determine the merit, worth, value and significance of the ethico-religious arguments on outsourcing pregnancy. These were strengthened by the use of primary and secondary sources.
In order to determine contemporary disposition of Nigerians to outsourcing pregnancy, a total sample size of two thousand (2000) questionnaires containing thirty items, aimed at capturing the subjectivity and phenomenology of this study were randomly distributed amongst some selected Nigerians. The questionnaire was stratified to elicit both ethical and religious dispositions. Because of large nature of the study population, a sample size of two thousand (2000) respondents expected to give contrasting views on the same subject, was considered adequate. In order to have a robust evaluation and ensure that the data collected are reliable, the test and retest method was used. The responses were collected and analyzed using simple percentages, based on the fact that the explicit presupposition of this analysis is that persons have a "nature" or certain essential characteristics, which they share universally, which are knowable by reason, which ought never to be violated in moral activity, and which conduce to specific and unchanging moral norms (Siker, 63). In addition to primary sources, secondary sources of data were extensively utilized. The secondary sources of information were writings from philosophical ethicists and religionists. Literary secondary sources provided background information on outsourcing pregnancy which helped to support the development of the main idea of the thesis statement. The study relied extensively on secondary sources which include books, articles, published materials, magazines, newspapers and the use of internet blogs and podcasts.
1.8 Organization of the Work
This study is divided into six chapters. Chapter One gives an overview of the study, setting the tone of the thesis on moral philosophy and Christian moral theology. Chapter Two reviews related and relevant literature to the study with the objective of identifying knowledge gaps that the study intends to fill. Specifically, Chapter Two examines the meaning of outsourcing pregnancy, the types and methods of outsourcing pregnancy, reasons for outsourcing pregnancy and the process of pregnancy outsourcing. It also examines who can be a gestational surrogate, the legal issues in outsourcing pregnancy, the economics of outsourcing pregnancy, including surrogacy in traditional African society and commercial gestational surrogacy in Nigeria. Chapter Three dwells on the ethical perspective of paid pregnancy brining to the fore the ethical issues involved in outsourcing pregnancy. It also carefully outlines and discusses the ethical arguments for and against Gestational Surrogacy. Chapter Four focuses on the interpretation of data concerning current ethical and religious disposition of Nigerians to outsourcing pregnancy. Chapter Five is on the religious perspective of outsourcing pregnancy. The religious issues involved in gestational surrogacy or outsourcing pregnancy also engage our attention in this chapter, extrapolating from these religious issues, the religious arguments for and against gestational surrogacy. Chapter Six discusses some ethical models with a view of accentuating a more robust ethical model for the evaluation of outsourcing pregnancy. An ethico-religious model, namely a prudential personalism model is however adopted in the evaluation of the moral and religious dimensions of paid pregnancy. Emplaced in the chapter also, is the general evaluation, summary, findings, contribution to knowledge, conclusion and recommendations.
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