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ALTRUISTIC MOTIVES
For many women who have undergone repeated attempts at assisted reproductive technologies (ART) or those who have a non-functional uterus, surrogacy is often viewed as a viable alternative. It also seems to be a preferable alternative to adoption, given the importance placed on having a genetic link between child and parent, and being in close proximity to the gestational process. Pregnancy though is a profound experience that is unique amongst couples in which the outcome and their ability to manage the pregnancy are often unpredictable.
The biological and psychological health of the surrogate and child ought to be considered when commissioning couples and potential surrogates are making an informed decision to enter into an arrangement. However, given that the long-term health outcomes, relational complexities and the social implications of surrogacy are largely unknown, it seems difficult if not impossible for a potential surrogate to give informed consent. The ethical dilemmas are not only recognised by many individuals but also by governments, which is reflected in the legislative responses that attempt to deal with surrogacy arrangements. Some countries have opted for legislation permitting altruistic surrogacy (such as in the Australian Capital Territory) instead of commercial surrogacy (which is permitted in countries such as India and some states in the US), presumably because the latter gives rise to the potential for exploitation. Furthermore, surrogacy is illegal in some countries such as Germany and Italy, 1 2 because it is regarded as being contrary to basic moral principles and human dignity.
In the context of altruistic surrogacy, one must ask: can a close relative or friend, viewed as a potential surrogate mother, provide genuine informed consent? Is she making an autonomous decision free from coercion, particularly in complex family contexts? Is she aware of the emotional impact of giving up a baby that she has carried for nine months? Can a potential surrogate mother be apprised of, process and understand all the details about pregnancy complications, risks associated with ART, psychological ramifications for herself, the child she may carry and others, the terms of a surrogacy contract and implications for future relational complexities, let alone the broader ethical implications for the community-about which she may have a genuine interest?
Consider, for example, women with low self-esteem,...