Modern surrogacy made its mark in 1976 when attorney Noel Keane drafted what is widely considered the first formal legal surrogacy agreement in the United States. Since then, alongside the rise of in vitro fertilization (IVF), surrogacy has grown in popularity, bringing with it a host of ethical concerns.
Recently, Live Action highlighted the viral story of surrogate mother McKenna West, who was asked to abort a baby boy after the intended parents learned he had hypoplastic left heart syndrome (HLHS), a serious but often survivable heart condition. West has since filed for custody of the child.
A similar situation occurred more than a decade ago. Crystal Kelley refused to abort Seraphina Harrell, a baby diagnosed with multiple severe birth defects, despite being offered $10,000 by the biological parents to undergo an abortion. Seraphina ultimately lived until she was eight years old.
Even a quick online search reveals numerous similar cases, along with broader ethical concerns surrounding surrogacy laws and regulations worldwide. Questions have been raised about issues such as sex offenders obtaining custody of children through surrogacy arrangements, intentionally creating family structures without a mother or father, and the extent of a surrogate’s legal rights to protect a child from abortion.
At the heart of these stories, and much of the current public debate, is a fundamental question about the rights of the child: Should children be treated as human beings with inherent dignity, or as products subject to the preferences and expectations of others?
In 2024, AAPLOG addressed these concerns in its Committee Opinion, “Ethical Treatment of Human Embryos.” Assisted Reproductive Technologies (ART), including IVF and surrogacy, raise significant ethical concerns due to common industry practices that can treat human embryos as commodities rather than unique human lives.
The principle that human subjects should never be subordinated to the interests of science or society is not unique to reproductive ethics. The International Council for Harmonisation’s Good Clinical Practice guidelines state that “the rights, safety, and well-being of the trial subjects are the most important considerations and should prevail over interests of science and society.”
What we have seen in both surrogacy and IVF suggests that the interests of science, technology, and societal desires can sometimes outweigh the interests of preborn children, whether they are developing in the womb or preserved in frozen storage. When children are commoditized before they even have a chance to live, society becomes desensitized to their inherent value. The result can be the abortion of children diagnosed with genetic conditions, the routine destruction of embryonic human beings, and even the devaluation and exploitation of surrogate mothers themselves.
These concerns extend to the women who carry these pregnancies. Research has shown that surrogate mothers face increased risks of complications such as postpartum hemorrhage, severe preeclampsia, and premature birth. Yet discussions about surrogacy often focus primarily on meeting the desires of adults rather than weighing the potential costs to both children and the women carrying them.
As the saying goes, “Just because you can doesn’t mean you should.”
In the case of surrogacy, the ethical concerns are substantial and far-reaching. If current trends continue, it is likely that America will see more stories like these in the years ahead, forcing society to confront difficult questions about the value of human life, the rights of children, and the limits of reproductive technology.
We encourage our members to read AAPLOG’s “Ethical Treatment of Human Embryos” Committee Opinion and listen to our podcast episodes with Jennifer Lahl, founder of the Center for Bioethics and Culture, about some under-discussed facts and ethical considerations of gestational surrogacy.
