Surrogacy: An Ethical

Dilemma
By: Saria Merriweather
Nurs 305
 What is a surrogate?
Gestational Traditional
 When a woman agrees to become  Using the sperm of the intended father or
pregnant for a couple, they undergo from a donor, the surrogate is the egg
in-vitro fertilization or gamete donor and is biologically related to the
transfer. The woman carries the fetus
fetus to term and releases the  This type of surrogacy is less common, and
newborn to the couple after birth- has increased emotional and legal risks d/t
has no biological relation to fetus the biological relation to the child
 Other names for gestational  Also called partial surrogacy, genetic
surrogates- gestational carriers, host surrogacy
surrogate, full surrogate
Paternal Genes Maternal genes Type of Surrogacy Conception
Intended father Surrogate Mother Traditional Artificial Insemination
Donor Surrogate Mother Traditional Artificial Insemination
Intended father Intended Mother Gestational IVF/embryo transfer
Donor Intended Mother Gestational IVF/embryo transfer
Intended Father Donor Gestational IVF/embryo transfer
Donor Donor Gestational IVF/embryo transfer
 Surrogacy is related to nursing care
because of the holistic care the nurse
must provide for all the patients involved:

Surrogate Fetus
How is it Nurses also care for the surrogate

related to mother and their rights, advocate,

educate, help deal with feelings of
lost, grief, guilt, and treat them intra
Nurses must advocate for the
fetus/child and provide care for the
child

Nursing Care of and postpartum

Intended
Parents
the
Childbearing
Family? Surrogacy is a means of overcoming
childlessness for couples unable to
carry their own pregnancies due to
infertility, medical conditions, or
sexuality, Nurses provide education,
emotional support, advocate for these
parents
Surrogacy is an alternative to adoption that allows the possibility of parents to be biologically
related to their children
But to do so, it is risking someone else’s body for your own personal benefit.
Why is surrogacy an ethical dilemma?
 Many Dilemmas

• Candidate selection
• Bodily autonomy for the surrogate
There are many ethical • Harm to child/surrogate, HIV etc.
dilemmas related to • Congenital anomalies
Surrogacy. Some of them • Should you tell the children how they were conceived
include: • Legal issues of citizenship
• Unsuccessful attempt

It has been argued that

surrogacy could lead to
moral confusion, economic
exploitation, and
psychological harm
Dilemma In India

 https://www.youtube.com/watch?v=_k_h-Z-Lv2c
 Example Scenario

 Problem: A 28 year-old woman was diagnosed with uterine cancer. Before having a hysterectomy procedure, she
had several eggs removed for possible fertilizations in the future. She later got married and wished to have
children of her own. The couple utilized a commercial company in India to find a surrogate mother. The
husband’s sperm was used to fertilize one of the wife’s frozen eggs, and the embryo was implanted in the
surrogate mother. The couple paid all of the woman’s pregnancy-related expenses, such as hospital bills, and an
extra $10,000 as compensation for her surrogacy. After carrying the pregnancy to term, the surrogate claimed to
be too attached to “her” child to give it up.
The Dilemma

 The surrogate mother doesn’t want to give up the baby she has carried
for a couple and now feels an attachment to. The nurse has to decide
who to promote bonding with the newborn and how to navigate caring
for all members involved.
Discuss

How do you think How should the

What do you think
the intended parents nurse handle the
about this situation?
feel? surrogate mother?
 Guiding the nurse
 With all these issues associated with surrogacy, what is a nurse to do? How do we navigate
caring for our patients in this most ethical way possible?

Laws

Code of
Ethics
Ethical
Policies Principles
Ethical Principles and
Code of Ethics

Autonomy Justice

Benfiecence and
Accountability
Non Maleficence

Fidelity Veracity
 Guiding the Nurse

Justice Autonomy Provision 2 Provision 3 Provision 4

• Must be fair in • The nurse should • The nurse’s primary • The nurse promotes, • The nurse has
providing care to the support the informed commitment is to the advocates for, and authority,
surrogate and intended decisions of the patient, whether an protects the rights, accountability, and
parents, they are all surrogate and parents individual, family, health, and safety of responsibility for
the nurse’s patients, throughout the entire group, community, or the patient. nursing practice,
can’t show any process (Ex. Birth population. makes decisions, and
personal biases plans) takes action consistent
towards either. w/ the obligation to
promote health and
provide optimal care.
Nursing Role
 Nurses must advocate for human rights
protection of women who participate as SMs
without being fully aware of the clinical risks
and the psychosocial ramifications.
 Provide emotional support to all parties
involved
 Informed consent
 Patient education- planning and preparation
 Interdisciplinary care
 Research
 BONDING/ATTACHMENT
Interdisciplinary

 Multidisciplinary research from nurses, midwives, physicians,

bioethicists, legal professionals, psychologists, social workers and other
healthcare providers
 Community/Clinical resources

 St. Joe’s Family Birth Center  AllAboutSurrogacy.com

 Access to birth and baby care plans  Website that provides articles and resources to
prospective surrogates, intended parents, egg
 New parent guide
donors,
 Tools to find Midwives  Has forums and chats to connect with others
 Donor Milk Program
 Also the facility’s policy and procedure manual  GrowingGenerations.com is another site similar
 Nurse Manager to all about surrogacy, has up to date information
on surrogacy, blogs with information and articles.
Nursing Diagnosis

Ineffective Coping r/t inadequate resources, insufficient sense of control,

and insufficient social support aeb inability to deal with situation, inability
to meet role expectations, and ineffective coping strategies
Parental role conflict r/t surrogacy aeb anxiety, fear, frustration, perceived
loss of control over decisions relating to child
Grieving r/t anticipatory/actual loss of significant person, aeb
psychological distress, feelings of despair, anger, blame
Final Thoughts/Questions??
 Reference List
 American Nurses' Association. (2015). Code for nurses: with interpretive statements. The Association.
 A World-Class Egg Donation & Surrogacy Agency. (n.d.). Retrieved from https://www.growinggenerations.com/
 Burrell, C., & Edozien, L. C. (2014, October). Surrogacy in modern obstetric practice. In Seminars in Fetal and Neonatal
Medicine (Vol. 19, No. 5, pp. 272-278). WB Saunders.
 Bacsalmasi, L. J., & Hernandez, D. (2012). Surrogacy: policy development is required for the real parents to stand up. Journal of
Obstetric, Gynecologic, & Neonatal Nursing, 41(s1), S184-S184.
 Ethical Practice: NCLEX-RN. (n.d.). Retrieved November 27, 2018, from
https://www.registerednursing.org/nclex/ethical-practice/
 Family Birth Center. (n.d.). Retrieved from http://www.stjoesannarbor.org/birthcenter
 Frankford, D. M., Bennington, L. K., & Ryan, J. G. (2015). Womb outsourcing: commercial surrogacy in India. MCN: The
American Journal of Maternal/Child Nursing, 40(5), 284-290.
 London, M. L., Ladewig, P. W., Davidson, M. R., Ball, J. W., McGillis, R. C., & Cowen, K. J. (2017). Maternal & child nursing
care. Boston: Pearson Education.
 Sinha, V. (2010, November 09). Retrieved November 26, 2018, from https://www.youtube .com/watch?v=_k_h-Z-Lv2c
 Skove, E. (2018). New Fashioned Families: An Investigation of Bonding with Families Created Using Assisted Reproductive
Technology and Surrogacy. Journal of Prenatal & Perinatal Psychology & Health, 32(3).
 Surrogacy - Gestational Surrogate - Traditional Surrogate - Intended Parents - Egg Donor: Surrogacy Information/Support. (n.d.).
Retrieved from http://www.allaboutsurrogacy.com/