Surrogates and Other Mothers

Surrogates and Other Mothers: The Debates over Assisted Reproduction

Copyright Date: 1994
Published by: Temple University Press
Pages: 264
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    Surrogates and Other Mothers
    Book Description:

    Developments in new reproductive technologies have confounded public policy and created legal and ethical quandaries for professionals and ordinary citizens alike. Drawing from the most current medical, psychiatric, legal, and bioethical literature, Ruth Macklin, noted author and philosopher, presents the arguments surrounding these advances through the voices of fictional characters. The episodes she narrates are based on real-life situations, both from her personal experience as a hospital ethicist and from the public arena, where such controversial court cases as that of Baby M have sparked a multitude of disparate opinions on surrogacy, in vitro fertilization, and egg and sperm donor program.

    Macklin's hypoethical tale centers on Bonnie and Larry, an infertile couple longing for a child. As the couple's quest to become parents begins, they discover that Bonnie is physically incapable of carrying a pregnancy to term. Desperate to explore their options, Bonnie and Larry attempt adoption but are rejected by the agency without explanation. Finally, they contemplate surrogacy as their last chance to have a child. Seeking advice and answers, they consult health professionals, lawyers, pastoral counselors, and a bioethicist. In the course of this complicated and often painful decision-making process, they attend meetings of a government task force on reproduction where they hear both radical and liberal feminist positions.

    Their experiences with friends, family members, two surrogates, hospital ethics committees, and special interest groups underscore the difficulty of coming to a consensus on such issues as AIDS, the right to privacy, premenstrual syndrome, the violation of surrogate contracts, and the responsibilities of therapists and physicians to their patients and to the community at large.

    eISBN: 978-1-4399-0446-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Introduction
    (pp. 1-4)

    The world of modern medicine is constantly in flux. New problems sometimes arise out of nature; others result from scientific or technological advances; still others represent novel social arrangements. Together these problems challenge health professionals, lawyers, policy makers, and citizens to arrive at satisfactory solutions. This book depicts an array of unprecedented challenges to ethics, law, and public policy stemming from new developments in biomedicine.

    A technological advance that has produced legal and ethical dilemmas is the expansion of medical techniques to combat infertility. A related development, the new reproductive practice known as “surrogacy,” has con founded public policy. Progress...

  5. CHAPTER 1 Confronting Infertility
    (pp. 5-26)

    The trip home is a two-hour drive. Larry and Bonnie, a couple in their mid-thirties, say goodbye to Larry’s family after a festive Thanksgiving dinner.

    “You want me to drive?” Bonnie asks Larry. “Are you sleepy?”

    “No, I’m fine,” Larry replies, settling himself behind the wheel. “Fun Thanksgiving, huh Bon?”


    “What’s wrong? I hope you’re not going to start complaining again about how my mother treats you.”

    “No, it’s not that. She was Okay.”

    “Come on, Bonnie, something’s the matter. Tell me.”

    “It’s the same old thing. I always get depressed when we’re around families with kids. What’s wrong...

  6. CHAPTER 2 Debating Assisted Reproduction
    (pp. 27-48)

    Bonnie and Larry slide into seats at the rear of the conference room just as Maura O’Brien, chair of the Task Force on Reproduction, is calling the meeting to order. Ms. O’Brien, an attorney, asks for approval of the minutes of the last meeting. She then announces that the newly appointed chair of a similar task force in a neighboring state is present and suggests that the task force members introduce themselves briefly to the visitor.

    “I’m Father Timothy Reardon, professor of theology at St. Matthews College.”

    “I’m LeRoy Johnson, state assemblyman.”

    “My name is Andrea Goldwoman, and I represent...

  7. CHAPTER 3 Conflicting Views about Surrogacy
    (pp. 49-71)

    Bonnie fidgets while Larry watches the football game. Eventually she complains, “If we don’t make some sort of decision soon, I’ll go crazy. Can't we talk soon—now—about what we’re going to do?”

    “Okay, I promise. As soon as the game is over, I’ll give you my undivided attention.”

    Bonnie has assembled a large manila envelope full of clippings about the Baby M case. She has studied the clippings so that she’ll have answers to anything Larry might ask. Before she broaches the subject of surrogacy, she wants to make sure he has no objections to other features of...

  8. CHAPTER 4 Counseling HIV-Infected Women
    (pp. 72-96)

    “Hmmm,” Chernacoff muses as she pulls out of the parking lot. “You think it’s immoral for HIV-infected women to have babies?”

    “Yes, I do,” Bernstein asserts.

    “I’m surprised to hear You say that,” Chernacoff says. “You didn’t speak up at the meeting against the morality of women acting as surrogates.”

    “That’s because I don’t think it’s harmful to the children to be brought into the world in surrogacy arrangements. In all probability, they’ll turn out to be normal, healthy infants. But bringing babies into the world who will acquire AIDS is an entirely different matter. Did you ever see any...

  9. CHAPTER 5 Dealing with Medical Labels
    (pp. 97-121)

    Bonnie glances nervously at Larry. Ms. McNeil scrutinizes the three parents, clears her throat, and begins.

    “Thank you all for coming down. We like to discuss things face-to-face with our patients, so we can answer any questions. Now we did the amniocentesis and found no major genetic problems.” Ms. McNeil looks back and forth from one to the other. “In fact, your fetus doesn’t have any genetic diseases. But I must tell you, we found a minor genetic anomaly.”

    Bonnie’s face tenses up. “I knew it. There’s something wrong.”

    “As I said, it’s not a genetic disease. It’s called a...

  10. CHAPTER 6 Controlling Psychiatric Patients
    (pp. 122-147)

    Mercy Hospital is a 750-bed private, not-for-profit facility. Originally owned and operated by a Catholic religious order, the hospital is now secular, affiliated with the local medical school. The hospital has the staffing shortages common to large inner-city institutions. The two top floors are short-term psychiatric wards, where patients are normally admitted voluntarily but can also be involuntarily committed, usually for no longer than three or four weeks. Patients still in need of hospitalization beyond that time are transferred to a long-term psychiatric facility. Because of the staffing shortage, adequate supervision is not available for all patients on the psychiatric...

  11. CHAPTER 7 Abusing and Refusing while Pregnant
    (pp. 148-168)

    Two days later, as the daily group therapy session ends, a psychiatric nurse is waiting for Frannie to emerge.

    “Ms. Amiga, there was a phone call for you during the therapy session. Your brother, Larry Roberts. He asked if you could call him back. He’s at work. Here’s his number.”

    “I have the number, thanks.” Frannie goes to the pay phone and calls.

    “Mr. Roberts, please.” Whén Larry picks up, Frannie says, “Hello, Larry, it’s Fran. l hope you called to say you’re going to spring me from this place.”

    “I wish 1 could. No, I called about the thing...

  12. CHAPTER 8 Grappling with Patients’ Rights
    (pp. 169-193)

    After she is discharged from the psychiatric floor of Mercy Hospital, Frannie Amiga resumes her regular activities. Normally rather energetic, she is surprised to find herself easily fatigued and lethargic. She telephones Dr. Joshua Gold, who told her she could call him at any time if she had any problems.

    “Dr. Gold, this is Frances Amiga. You said to call you if I felt bad again. I’m calling because I’m tired all the time. It’s two weeks already since I left the hospital, but I can hardly drag myself out of bed to go to work.”

    “Maybe your depression hasn’t...

  13. CHAPTER 9 Devising Ethical Policies
    (pp. 194-217)

    The subcommittee charged with devising a living will for AIDS patients agrees that the document should present a full range of choices to patients. Unlike many standard living wills, which focus on the treatments a patient might wish to refuse, the living will for AIDS patients does not make the presumption that patients will want to forgo life-prolonging treatments. One committee member who has worked with AIDS patients observes that many of those who contracted the disease as a result of intravenous drug use are poor or indigent people who have generally lacked full access to the health care system....

  14. CHAPTER 10 Reaching Closure
    (pp. 218-236)

    Teddi Chernacoff is lurching from one meeting to the next. On the same day, the hospital ethics committee is scheduled in the after noon and the Task Force on Reproduction in the evening. Following a medical school seminar in which she makes a presentation on physician assisted suicide, Chernacoff rushes into the ethics committee meeting. She catches her breath and switches bioethical gears from death to birth.

    Dr. Becker calls on Evan to present the polished version of the hurriedly drafted statement on forced cesarean sections he proposed at the previous month’s meeting.

    “Well, this may surprise you, but after...

  15. Notes
    (pp. 237-246)
  16. Credits
    (pp. 247-248)
  17. Index
    (pp. 249-254)