Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India

Abstract

As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology (ART) Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents' demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded.

“There are many eggs in my body”: medical markets and commodified bodies in India

“…Women's bodies have become consumer commodities for the huge reproductive industry, where the agents, and women themselves, prepare and groom their bodies to increase their market value, not knowing the risks involved (Tanderup et al, 2015b) and the long term impacts on their bodies.…”

“…There are only the guidelines of the Indian Council of Medical Research and the Ministry of Health and Family Welfare, or rather, Indian Government guidelinesthe "National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India" (2005)to follow, but these are merely guidelines and are not mandatory. These guidelines have little constitutional validity in terms of enforcement, and studies have shown clear violations of these guidelines (Team S.A.M.A., 2000;Tanderup, Reddy, Patel, & Nielsen, 2015b). Nevertheless, the guidelines are strikingly recalled by doctors and embryologists during interviews.…”

Normativity and Culture in the Context of Modern Medicine: A Prospective Vision of an Elective Affinity

“…Such a cultural taming of the ethical debate must be understood as a result of negotiating between the local and global context in which such debates are evolving and -at least for a particular moment in time -are fixable as culturally 'significant.' From a distant, comparative view there gleam some peculiarities: for instance, Indian sociologists have pointed out, despite critiques of the large economic and caste disparities, that it would be important to see the agency and opportunities for self-determination for surrogates, even in situations of commercial surrogacy (Tanderup et al 2015). In Germany, the agency of surrogates is rarely considered as leading point but ethicists have emphasized rather the 'best interest of the child' as a criterion of legitimization.…”

Current perspectives on the ethics of selling international surrogacy support services

“…2,3,12,26,28,29,[36][37][38][39][40][41] In these countries, an initial cursory explanation is given to women about surrogacy and legal contracts. This constitutes predetermined legal and medical consent.…”