Surrogate Gestational Motherhood
Written by L.W. Bilkes & A. Miskin
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Reformed Ethics - Pregnancy/Reproduction

Definition, Indications and Motivations
Surrogate gestational1 motherhood can be defined as an arrangement where one woman carries a pregnancy to term for another woman who is either unable or unwilling to do so. There are two types of surrogate mothers. The one type is ‘partial surrogacy,’ in which the surrogate mother is also the genetic as well as gestational mother of the child. The other type is ‘full surrogacy.’ It involves the transferring of an egg fertilized in the laboratory (in vitro fertilization2) to a woman who then carries it to term and delivers the baby for the couple.

 The contracting couple may opt to make surrogacy arrangements for a variety of medical and personal reasons. First, surrogacy is the option presented to a woman who has been born without a uterus, or who has undergone a previous hysterectomy but retains functioning ovaries, or she may have a non-functional uterus. Second, it is needed if pregnancy threatens the health of a woman who is otherwise fertile. Third, surrogacy is offered to a woman who cannot afford to have her career interrupted by a pregnancy, or to a woman who simply wants a child without the experience of pregnancy. Fourth, single men or women may seek surrogate arrangements in order to have a child to whom they are genetically related.

Most contracting couples choose the procedure primarily for medical reasons. On the other hand, the surrogate mother’s reasons and motivations for entering into this arrangement can be more complex; the main ones identified are the following. First, 90 percent of surrogate mothers are motivated by remuneration. Second, about one-third do it as a cathartic experience to deal with some past emotional trauma. A third reason is that couples do it to work through guilt or other negative feelings, often associated with a past abortion or the giving up of a child for adoption. A fourth reason some resort to surrogacy, at least in part, is because they enjoy being pregnant. A fifth reason is that many do it for an altruistic reason — such as helping an infertile couple. A sixth reason is that some long for a close relationship with the future parents of the child. These findings, reported in U.S. research statistics, have been corroborated by similar studies in France and Britain. Most surrogate mothers are motivated by more than one reason.3

Generic Ethical Concerns
One of the main ethical objections many have against surrogate arrangements is that since typically there is a fee involved, women in financial need are more likely to be surrogate mothers. 'Surrogate mothers are thereby degraded to baby-making machines, and economic exploitation becomes inevitable.'4

Another ethical objection that is mentioned is that a surrogate arrangement 'exposes the woman to great emotional harm as a result of the forced severance of the mother-child relationship. It is generally believed that a woman cannot carry a child for nine months without forming an emotional bond with the child. As a result, most surrogate mothers experience grief upon giving up their children.' Thus, 'commercial surrogacy requires that the surrogate mother deny her own feelings' of motherhood. The process makes her no more 'than a contract labourer, as the pregnancy gradually progresses and … she [has to] repress whatever motherly love she feels for the child.' The result is that 'the surrogate mother is hurt emotionally when she realizes that the contracting couple desires only the "product" of the surrogacy arrangement.'5 The case of Mary Beth Whitehead and William Stern could be cited as an example of this [the case of ‘baby M’]. Stern paid Whitehead, per contractual agreement, $10,000.00 to be a substitute or surrogate mother in place of his wife who was unable to bear children. When the baby was born, Whitehead refused to hand over the child, resulting in a court case in which Judge Sorkow awarded sole custody to the genetic father.

'In response to these ethical concerns, some claim that womb-lending or leasing is no more degrading than selling one’s physical and mental power in hard labour, one’s intellectual power in other professions or one’s physical appearance in the modelling profession; each trade or profession has its own hazards.' Most people, however, 'believe that the risk of economic exploitation is indeed inherent in any commercial surrogacy arrangement and thus commercial surrogacy should be outlawed. Indeed, this is the recommendation of the Canadian Royal Commission.'6

Surrogacy must be opposed in general and commercial surrogacy in particular because they violate the dignity of the gestational mother. The ethics of the Word guard a woman’s personhood, and therefore surrogate motherhood cannot be endorsed.

While it is understandable for a childless couple to desire to have a child borne for them, who is genetically related to at least one of them, there are very serious concerns and objections that should be considered.

It should be seen as dehumanizing to treat a woman in her intimate and sacred role as mother, as an ‘incubator,’ committed even before conception to give up the child, usually for payment of a fee. Surrogacy demeans the birth mother’s status as a person by reducing her to a ‘reproductive appliance,’ and it deliberately severs the relationship between the birth mother and the child, while financial gain often is the main consideration.

Children, as well as our bodies, are gifts from God and are not to be given up for buying or selling.

Ethical Objections from the Word
There are some who use the example of Abraham, Sarah and Hagar (Gen. 16 - without the use of artificial insemination - ART) as a precedent for surrogate motherhood. This example, however, can only serve as a warning, and not as an endorsement of that arrangement. The outcome resulted in contempt, jealousy, abuse, and abandonment. Surrogacy is an example of a wrongful use of modern technology.

Two reasons can be cited why Christians should not consider this method as an option. First, it is clear that a third party is being drawn into the intimate marital relationship. The Dutch ethicist, J. Douma, writes: 'The embryo must originate from the woman and her husband. In other words, the fertilization must occur within the context of marriage… No matter how noble the motive may be of helping a family member, a friend, or whoever to have a child, a third party would be entering the relationship alongside father and mother. The womb is not an incubator or guest room for a child who needs temporary shelter. It is the place where mothers carry their children. If we take this second condition seriously, then we need not be preoccupied with numerous possibilities created by the IVF technique. As Christians we simply cannot take advantage of them.'7

Secondly, when a woman becomes a surrogate mother, she reduces herself to a mere incubator. Surrogacy cheapens the maternal relationship and makes it a tie that may easily be broken. It denies the natural feelings that God has created between mother and child. Christians must uphold and honour this maternal relationship.

If we believe that both marriage and parenthood are God-ordained relationships, then we must reject surrogacy, donating genetic material, and embryo transfer, since they violate those relationships. In order to glorify God, we must protect and preserve human life at all stages of development. For God has known us in the womb: 'Thy eyes did see my substance, yet being imperfect' [Psa. 139:16]. We must protect the marriage covenant - couples must share one another’s burdens and be one as God commands them to be. Furthermore, we must honour the relationship between parents and children. We must value and cultivate a society where attachment to our children is not even considered remotely as a matter of indifference. These attachments are held to be a sacred bond.

The Biblical Notion of Family
Biblically speaking, 'the family has inherent values - such as duty, responsibility and sacrifice.' Sadly, 'the family in the modern Western society … appears to be no more than a part of life that the person must learn to outgrow.'8

This shift in the significance and 'value of the family is both reflected in and compounded by the blurring of family boundaries introduced by ARTs and surrogacy.' 'IVF-ET with surrogate arrangements makes it possible for a child to have three "mothers" – one genetic, one gestational, and one social. Such blurring of family boundaries is cause for great concern for family instability and an identity crisis in the child, as well as practical concerns as to who will be responsible for the child in the case of the social parents’ death or divorce.'9

'In an attempt to minimize the gravity of these problems, some contend that many of the concerns raised by surrogacy are also involved with both the adoption process and blended families. In adoption there is a break between biological and social parenting, while blended families are created by remarriage subsequent to either divorce or death. If these situations are accepted by the society, then (these people claim) there is no reason why ARTs and surrogacy cannot likewise be accepted.'10

In response, it must be pointed out that although there are similarities between these situations, adoption and blended families are basically ‘rescue operations’ to redeem certain unforeseen, unintended, and ill-fated situations. ARTs and surrogacy fundamentally differ in that they create the problems intentionally. They create a blended family with the foreknowledge that it will blur the family lines.

'Some also see that the advent of ARTs may be the occasion for society’s adopting a more flexible and innovative view of the family in which the biological element plays only a relatively small role, allowing other elements such as legal definitions, social customs and "subjective intentions" to move to the fore.' It promotes 'the widespread utilization of reproductive technologies. The biological tie is no longer a defining factor in the family and thus family membership may change according to the circumstances.'11 There is evidence that surrogate parenthood changes the biblical view of family, and opens the way for homosexual and lesbian parenthood.

What is a Person?
Decisions made in the area of reproductive technology should be based upon the view of who we are as individual persons. The godless society we live in says that, as individuals, we are autonomous and independent, free to do as we please and what is most advantageous to us. The Christian, however, sees things differently. His or her identity is inextricably bound to his new identity in the Lord Jesus Christ. Being united with Him by faith, this ‘new creature’ who now has the mind of Christ, says with his or her Master, 'I delight to do thy will, O my God: yea, thy law is within my heart' [Psa. 40:8].

As Christians, the question no longer is, 'What best suits my needs and desires?' but rather, 'What is the Lord’s will in this particular instance?' This is because a radical shift in our view of personhood has taken place. We are no longer independent and autonomous, but subservient and moulded by the will of God as revealed in His Word. Our sole delight is found in doing God’s will in all things.

This extends also to our decisions concerning childbearing. If a reproductive technique does not fit in with God’s revealed will for parenthood, and surrogate parenting clearly does not, then we need to ask Him what His will is with regard to having our own genetic offspring. Ultimately, it is God who opens and closes the womb [Gen. 20:18; 29:31]. Consequently, it might be that He has other purposes for us, such as adopting children or caring for the fatherless.

In the final analysis, surrogate parenthood degrades and exploits women and motherhood. Wisdom would indicate that adoption is clearly a far better course. In fact, adopting children whose personhood is at risk, such as orphans or abandoned children, does the exact opposite of what reproductive surrogacy does; namely, it rescues them from vulnerability, rather than make many vulnerable.

Conclusion
As in most advanced reproductive techniques, there often is a 'sting in the tail' that is often overlooked. Some couples, perhaps thinking it their right to have children, have gone to any and every length to conceive. Sometimes, when pregnancy has resulted, they have experienced all kinds of problems, such as pregnancy loss, deformed children and severe pregnancy-related complications.

This brings to mind the situation that Rachel found herself in. After a long period of barrenness, she cried out to Jacob: 'Give me children, or else I die.' From this response we may conclude that she too thought that childbearing was her right rather than a God-granted privilege. Her frustration is vented against her husband rather than prayerfully and submissively placing it before the Lord. She resorts to using the fertility-enhancing techniques of the day by taking some of Leah’s mandrakes [Gen. 30:15]. But to no avail. Later, however, it was the Lord who graciously opened Rachel’s womb [30:22]. She named her son Joseph, reflecting her desire that God would add another son [30:24]. She still was not satisfied with the Lord’s provision. Eventually, she conceived again, but we read that '…she travailed and had hard labour' [Gen. 35:16]. Before dying, she named her son Ben-oni, which means 'son of my sorrow.' That which had been the deepest longing of her heart, now turned out to be the source of her greatest sorrow.

As Christians we ought to learn lessons from the life of Rachel. Instead of relentlessly pursuing that which we perceive to be our portion, in this case conception and childbearing, we should rather, because of our new identity in Christ, say like our Master, 'Nevertheless, not my will but thy will be done' [Luke 22:42]. In submitting to His will, we may avoid unforeseen grief, but we may also be opening the way for God’s abundant blessings in ways that hitherto were unimagined.

Notes
[1] The gestational mother is the woman who carries the embryo in her womb to term and gives birth to the baby.
[2] See The Messenger, June 2007, p. 14f., for an article on this topic.
[3] Edwin C. Hui, At the Beginning of Life: Dilemmas in Theological Bioethics (Downers Grove: InterVarsity Press, 2002), pp. 205, 206.
[4] ibid., p. 207.
[5] ibid. 208.
[6] ibid., pp. 208, 209.
[7] J. Douma, The Ten Commandments: Manual for the Christian Life, transl. Nelson D. Kloosterman (Phillipsburg: P&R, 1996), p. 255.
[8] Edwin C. Hui, op. cit., p. 212.
[9] ibid., p. 212.
[10] ibid., p. 213.
[11] ibid., pp. 213, 214.

Dr. Lawrence Bilkes is an emeritus pastor in the Free Reformed Church and Dr. Arthur Miskin is a medical doctor working as a missionary minister in South Africa on behalf of the Heritage Reformed Congregations of North America. He is a lecturer at the Mukhanyo Theological College in KwaNdebele and involved in planting an English speaking Reformed church. His wife, Sonya, a gynecologist, ministers to HIV/AIDS afflicted patients in the clinic associated with this work. The Messenger is the monthly magazine of the Free Reformed Churches of North America, from which October 2007 issue the above article is reprinted with permission.