Consideration of the gestational carrier: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Owen Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Susan Gitlin, Sigal Klipstein, Laurence McCullough, Richard Paulson, Richard Reindollar, Ginny Ryan, Mark Sauer, Sean Tipton, Lynn Westphal, Julianne Zweifel, …
Ethics Committee of the American Society for Reproductive Medicine (2018). Consideration of the gestational carrier: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2018.08.029
Ethics Committee of the American Society for Reproductive Medicine. Consideration of the gestational carrier: an Ethics Committee opinion. Fertility and sterility. 2018. doi:10.1016/j.fertnstert.2018.08.029
Ethics Committee of the American Society for Reproductive Medicine. "Consideration of the gestational carrier: an Ethics Committee opinion." Fertility and sterility, 2018.
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RRM Academy Synopsis
ASRM holds gestational carriers ethical with "safeguards"
A 2018 ASRM Ethics Committee opinion holds that using a gestational carrier is ethically permissible when the parties receive counseling. The carrier alone consents to her own care. The committee weighs existing research and moral arguments.
Study at a glance, Ethics Committee opinion: ASRM holds gestational carriers ethically permissible with counseling. Source: Ethics Committee of the American Society for Reproductive Medicine, 2018, PMID 30396538.
Key Findings
The Committee holds that gestational-carrier arrangements are "ethically permissible" when everyone involved receives psychological, medical and legal counseling.
Paying a carrier is "ethical" in the Committee's view when the payment avoids "undue inducement." Payment should not depend on the birth of a healthy child.
The carrier keeps final say over her own medical care, including decisions about prenatal testing, ending the pregnancy and reducing a multiple pregnancy. Her authority holds regardless of the contract.
The Committee says carriers need their own independent lawyer. Carriers should be at least 21, healthy, and have delivered a healthy child after at least one uncomplicated pregnancy.
In the United States between 1999 and 2013, the share of assisted-reproduction cycles involving gestational carriers "increased from 1% to 2.5%."
The ASRM Ethics Committee's Position
“Intended parents engage with gestational carriers in an attempt to achieve their personal reproductive goals.”
Quoted verbatim from this paper.
Interpretation
The ASRM Ethics Committee issued this opinion from moral argument, earlier studies and ethical reasoning. Traditional surrogacy is set aside; the opinion covers gestational carriers only. Legal questions go to state law, which the committee says varies a lot. The authors trace the long debate to deep conflicts of values. The authors note that research on carriers' own experience is still "extremely limited." The findings support further research into how carriers experience the process.
RRM Context
The gestational-carrier process starts with IVF, after an embryo already exists. The opinion's topic is safeguards for carriers and intended parents. Restorative reproductive medicine starts earlier, asking why a pregnancy cannot be carried and treating the cause when one is found. The committee's focus on full information and consent fits the restorative principle of evaluation before treatment.
Our editorial summary of this paper, not the article's abstract.
Abstract
Intended parents engage with gestational carriers in an attempt to achieve their personal reproductive goals. All gestational carriers have a right to be fully informed of the risks as well as the contractual and legal aspects of the gestational-carrier process. Gestational carriers have autonomy in making their own decisions regarding medical care and should be free from undue influences by the stakeholders involved. They should have free access to and receive psychological evaluation and counseling before, during, and after participating. Gestational carriers require independent legal counsel regarding the execution of contracts. This document replaces the document of the same name, last published in 2013 (Fertil Steril 2013;99:1838-1841).
Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology, 2017
Ethics and Policy › Reproductive Ethics › Third Party Reproduction · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies
Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Owen Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Susan Gitlin, Sigal Klipstein, Laurence McCullough, Richard Paulson, Richard Reindollar, Ginny Ryan, Mark Sauer, Sean Tipton, Lynn Westphal, Julianne Zweifel, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, O Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, Sue Gitlin, S Gitlin, S Klipstein, Larry McCullough, L McCullough, Rick Paulson, Dick Paulson, Rich Paulson, R Paulson, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, G Ryan, M Sauer, S Tipton, L Westphal, J Zweifel
PMID 30396538 30396538 DOI 10.1016/j.fertnstert.2018.08.029 10.1016/j.fertnstert.2018.08.029 Ethics Committee of the American Society for Reproductive Medicine et al. 2018, Ethics Committee of the American Society for Reproductive Medicine 2018
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