1. Surrogacy Rels 300 / Nurs 330 19 November 2014 300/330 - appleby1

2. Traditional Surrogacy  ova of gestational/surrogate mother  sperm of contracting father; AI (or IVF)   both genetic link and biological link between surrogate and baby  after birth, surrogate terminates her parental rights  contracting man is recognized as father  contracting mother does a step-parent adoption  e.g., Baby M 300/330 - appleby2

3. Terms of the Contract: 3 parties 1. Richard Whitehead (husband of Mary Beth Whitehead) o gave consent for Mary Beth to be inseminated with sperm of William Stern o agreed to terminate his parental rights and surrender custody of infant upon birth 2. Mary Beth Whitehead o agreed to artificial insemination and to form no “parent-child relationship” with fetus/infant o agreed to assume all risks of pregnancy and childbirth o at birth, to surrender her parental rights to William Stern 300/330 - appleby3

4. Terms of the Contract: 3 parties 3. William Stern o agreed to pay $10,000 to Mary Beth W. upon surrender of live child o if miscarriage prior to 5 th month, no payment o if miscarriage after 5 th month, $1,000 o if stillborn, $1,000 o agreed to pay lawyer Noel Keane $10,000 for arranging contract Elizabeth Stern – no part in contract; after birth, she would adopt baby o Elizabeth Stern was not infertile 300/330 - appleby4

5. In the Matter of Baby M: 1988 Plaintiffs: William and Elizabeth Stern Defendant: Mary Beth Whitehead 300/330 - appleby5 Plaintiffs' Claim: That Mary Beth Whitehead should surrender the child she conceived via artificial insemination with William Stern's sperm, in compliance with the terms of the "Surrogate Parenting Agreement" Verdict: Mary Beth Whitehead's parental rights were terminated and Elizabeth Stern was granted the right to immediately adopt William Stern's and Whitehead's daughter. The New Jersey Supreme Court overturned this verdict in part on February 2, 1988, when it restored Whitehead's parental rights and invalidated Elizabeth Stern's adoption of Baby M, but granted William Stern custody of the infant.

6. What went wrong? Mary Beth changed her mind Mary Beth HAD bonded with the fetus/newborn o after conceiving, gestating and giving birth to Baby M, she felt like the baby’s mother o she refused the $10,000 and refused to terminate her maternal rights New Jersey Supreme Court overturned lower court’s ruling: o surrogacy contract was invalidated; adoption was annulled; Mary Beth’s parental rights were restored o William Stern awarded custody; Mary Beth had significant visitation rights 300/330 - appleby6

7. What have we learned from the case of Baby M? Significance: 25 years ago; This was the first widely followed trial to wrestle with the ethical questions raised by "reproductive technology." What does it mean to be a “mother” or “father”, or to “parent” an infant? What do you think? Who should be recognized as the father of Baby M?  Richard Whitehead: yes? no? why?  William Stern: yes? no? why? Who should be recognized as the mother of Baby M?  Mary Beth Whitehead: yes? no? why?  Elizabeth Stern: yes? no? why? 300/330 - appleby7

8. More complex forms of surrogacy GESTATIONAL SURROGACY: 1 Gestational mother has no genetic link to child  using ova and sperm of contracting couple  cycles of 2 women are synchronized using hormones  ova fertilized using IVF technology  embryo(s) transferred to surrogate 300/330 - appleby8

9. GESTATIONAL SURROGACY: 2 donor egg, father’s sperm intended mother has no ova; or advanced maternal age no female partner maternal genetic concerns use IVF technology embryo transfer 300/330 - appleby9

10. GESTATIONAL SURROGACY: 3 contracting woman’s egg, donor sperm poor sperm motility or mobility; male infertility paternal genetic concerns IVF technology embryo transfer surrogate gestation 300/330 - appleby10

11. GESTATIONAL SURROGACY: 4  donor egg, donor sperm  genetic concerns for both contractors  desire for no biological / genetic link with offspring  advanced parental age  IVF; ET; surrogate gestation 300/330 - appleby11

12. Application Fee $500 Consulting & Legal Expenses $15,000 – $20,000 Medical Expenses $5,000 - $50,000 Advertising/Administrative Expenses $5,000 Psychological Fees $1,600-2,000 Miscellaneous Surrogate Benefits $750 - $2,000 Surrogate's Fee $0 - $20,000 http://www.surrogatemothers.com/expense.html http://www.surrogatemothers.com/expense.html 300/330 - appleby12

13. 300/330 - appleby13 DAY & EVENING 1-888-SURROGATE (317) 996-2000 scl@surrogatemothers.com

14. http://surrogate-donation.com/surrogates_catalog.shtml 300/330 - appleby14

15. http://surrogate- donation.com/surroga tes_catalog.shtml http://surrogate- donation.com/surroga tes_catalog.shtml MomService Surrogate Catalogue: http://surrogate- donation.com/surroga tes_catalog.shtml http://surrogate- donation.com/surroga tes_catalog.shtml 300/330 - appleby15

16. WHAT ARE YOU PAYING FOR? WHAT SHOULD YOU EXPECT TO GET FOR YOUR MONEY? For $100,000... 300/330 - appleby16

17. Typical Fees Paid to Surrogates and Donors in the US  compensation for gestation - $25,000  egg donor - $5000  support group attendance - $100/month  maternity clothing - $600  IVF attempt - $600  insemination attempt - $250 300/330 - appleby17

18. Other Costs  health insurance, life insurance, psychological counselling, child care, lost wages, housekeeper, multiple pregnancy, medications, court fees, legal fees, parental relinquishment fee, step parent adoption, paternity testing…  total cost (in the US), with a surrogacy agency, ranges from $27,000 to $120,000 300/330 - appleby18

19. Would YOU engage in Surrogacy? I would consider being a gestational surrogate if:  I would never be a gestational surrogate because:  I would consider being a gestational surrogate if:  I would never be a gestational surrogate because:  I would consider using a gestational surrogate if:  I would never use a gestational surrogate because:  I would consider using a gestational surrogate if:  I would never use a gestational surrogate because:  300/330 - appleby19

20. What ethical concerns does surrogacy raise in your mind?  Deontological issues  Utilitarian analysis  Virtue perspectives  Natural law concerns  Feminist / care issues  Autonomy  Beneficence  Non-maleficence  Justice  Confidentiality  Trust / truthfulness  Privacy  Parenting 300/330 - appleby20

21. Australian couple abandons Down syndrome baby from Thai surrogate “ Surrogacy Australia says it is shocked and outraged that an Australian couple abandoned a baby in Thailand with his surrogate mother after he was found to have Down syndrome and a life- threatening heart condition. “Pattaramon Chanbua has told the Australian Broadcasting Corporation (ABC) she gave birth to twins after agreeing to be a surrogate with a promised payment of about $16,000.” 300/330 - appleby21 http://www.cbc.ca/n ews/world/australia n-couple-abandons- down-syndrome- baby-from-thai- surrogate- 1.2726057http://www.cbc.ca/n ews/world/australia n-couple-abandons- down-syndrome- baby-from-thai- surrogate- 1.2726057 (video)

22. “She said she refused, as it was against her Buddhist beliefs. Abortion on the grounds of foetal impairment is illegal in Thailand.” The contracting parents said “they were angry that the surrogacy agency had not conducted tests earlier because by the time they found out about the baby's condition, it was too late in the pregnancy to abort the foetus. “Had they known earlier, he said, they probably would have terminated the pregnancy.” http://www.bbc.com/news/world-asia-28732511 300/330 - appleby22 Pattharamon Chanbua, who has two other children, said the couple had asked her to have an abortion when she was told of the baby boy's condition four months after becoming pregnant.

23. SURROGACY & DISABILITY When a surrogacy contract has been entered into, how should parenting responsibilities be determined if the expected infant is twins, is born with cerebral palsy, Down syndrome or spina bifida? 1.The contract should be enforced so that the contracting parents assume parenting responsibilities for the infant/twins. 2.The contract should be written in a way that assigns parenting responsibilities to the surrogate. 3.The pregnancy should be closely monitored so that a handicapped fetus can be identified and aborted. 4.The contract should stipulate that parental responsibilities may be refused in the case of a handicapped infant. 5.We think that... 300/330 - appleby23

24. Assisted Human Reproduction Act: Prohibitions related to surrogacy In Canada, it is a crime to pay (in cash, goods, property or services), offer to pay or advertise to pay a woman to be a surrogate mother. The AHR Act does not: Prohibit surrogacy itself, as long as a surrogate mother in Canada makes this decision for altruistic reasons (i.e., without financial or other gain); Criminalize a woman who agrees to be or becomes a surrogate mother. It is paying, offering to pay or advertising that consideration will be paid to a woman for surrogacy that is illegal. 300/330 - appleby24 Health Canada www.hc-sc.gc.ca