The Weight of Desire: Jung, Surrogacy Ethics, Care and Human Dignity

Before a child is born, adults have already made many arrangements on the child's behalf: embryos are prepared, costs discussed, clinics chosen and documents planned for life after birth. Every arrangement points towards the future. Yet the people carrying them out must live through the present.

The intended parents may still be absorbing the news of a failed treatment. The gestational carrier has to think about who will care for her own children during appointments and how physical discomfort might affect her work. The doctor must decide whether an additional risk is medically justified. Coordinators have to make the details understood across different languages, schedules and expectations.

Surrogacy brings several lives into contact. A family hopes for a child; a woman participates in that hope with her body; clinical and service teams make possible work that no one person could complete alone. Such cooperation can produce profound goodwill. It can also make one person's contribution so familiar that others stop seeing it. The difference lies in the details of how people are treated.

FS describes its philosophy as “Reverence for Life, Sharing True Knowledge” and places informed understanding before a service decision. This gives the discussion a concrete starting point: if life deserves reverence, the people whose labour and bodies help bring it into being deserve the same seriousness. Who receives knowledge about risk, who is able to ask questions, and whose hesitation can change the plan determine what that principle means in practice.

Jungian psychology helps us look more closely.

The self within the wish

Carl Jung left no ethical ruling on modern gestational surrogacy. To use his thought responsibly, psychological concepts must remain distinct from present-day ethical judgment. Shadow, projection, persona and individuation can support self-examination; whether a particular arrangement is acceptable still depends on medical facts, applicable law and the lived circumstances of everyone involved.

In analytical psychology, the persona is the identity through which we meet society. A doctor must appear competent, an adviser dependable, and a parent patient and responsible. These roles are useful. When a person deposits the whole self inside a role, feelings that do not fit the role become hard to admit: doctors can be uncertain, advisers can be eager to close an agreement, and people longing for a child can feel envy, exhaustion or resentment after years of waiting.

The shadow contains what the conscious self-image has not accepted. It may also contain courage that has been suppressed, justified anger and the ability to express a need. A person who must always appear considerate may begin to treat refusal as selfishness and, with time, lose the language for her own discomfort.

In surrogacy this has practical consequences. A carrier asking for rest may simply be tired. Intended parents asking for the costs to be explained again may simply not understand them. A doctor requesting another assessment may be acknowledging the limits of current evidence. Labelling such responses as difficult, distrustful or incompetent pushes everyone towards a performance of being agreeable.

Sometimes helping a person begins by allowing that person to disappoint us.

The wish to become a parent also has many sources. Love for a future child, attachment to a genetic connection, family expectations and the hope that treatment will finally succeed may all appear in the same first consultation. Ethical reflection does not require these motives to be purified of self-interest. It asks a harder question: which wishes belong to the person who feels them, and which have quietly become demands placed on someone else?

Anxiety after years of treatment deserves care. If relief comes to depend on daily reports, photographs of meals and a growing list of restrictions, the carrier may be asked to regulate another person's fear. The intended parents receive brief reassurance, but the next uncertainty calls for greater control. The anxiety itself remains unattended.

Psychological support can help intended parents recognise what they are feeling and find a durable place for that feeling to be held. They can love the child and ask about the pregnancy while gradually accepting that caring for another life does not grant control over every change within it.

The carrier has a life of her own

Public discussion often moves between two narrow portraits of a surrogate mother: a selfless woman making a sacrifice, or a woman driven by money. A human life rarely fits either picture.

A carrier may value compensation and also value the meaning of helping another family. She may feel proud of the pregnancy while wanting less public attention. She may enjoy contact with the intended parents and still want to return to her own life after birth. Her particular experience has to be spoken by her.

When she is placed on a pedestal of selflessness, discussing money can seem ignoble and admitting fatigue can seem weak. Praise becomes another demand when it prescribes how a person ought to live. She should not have to be moving or heroic before she qualifies for proper care.

To recognise the value of gestation is to notice how time is occupied by the body. Appointments require travel, medication must be taken on schedule, physical change can affect sleep and work, and recovery continues after birth. These contributions belong in the arrangement. Clear compensation allows gratitude to remain gratitude instead of replacing payment. Clear care responsibilities reduce the need for the relationship to depend on one person always being accommodating.

A signature by itself does not establish autonomous choice. We need to know whether the carrier can understand the plan in a language familiar to her, speak privately with independent counsel, consider how family pressure affects her decision, and disagree without facing retaliation. Financial hardship can restrict choice. It still does not entitle an outsider to declare that her judgment has no value.

Consent also unfolds through time. Agreeing to enter a process does not mean that the body has already experienced every later change. Understanding a disclosure does not turn future pain into something already known. Discussion should be thorough before the arrangement begins, and explanation and consent must continue when new circumstances arise. Respecting a decision includes respecting the person who makes it as she changes through time.

Freedom has material conditions. A woman is more likely to hold a decision in her own hands when she can ask, compare, hesitate and obtain the support she needs.

The 2023 ASRM Ethics Committee opinion regards ethically conducted gestational-carrier arrangements as acceptable, while stressing the carrier's authority over her medical care, informed consent and independent legal advice. It also states that compensation should not depend on the birth of a healthy child.

These principles recognise both the carrier's capacity to participate and the fact that a worthy shared purpose does not erase bodily risk. Respect may appear in the pause after a question while others wait for her answer. It may appear when a need she has expressed is written into the care and payment plan. Her contribution can be honoured, while her worth continues to include the whole life beyond it.

What an agency carries

Cross-border surrogacy places a great deal of knowledge in the hands of a relatively small number of professionals. Families may not understand clinical records. Carriers may be unfamiliar with contractual language. Doctors cannot substitute for lawyers on parentage or birth registration. Information moves between these people, and the agency has considerable influence over how it moves.

That influence can accelerate a decision. It can also improve the conditions under which a decision is made.

A test report should distinguish what is known from what remains uncertain. A meeting should leave time for a person who speaks slowly or in an unfamiliar language to finish. A change in cost should explain the cause and who will bear it. None of this is as visible as an embryo transfer, but it determines whether people understand what is happening to them.

If FS's commitment to “Sharing True Knowledge” is carried into surrogacy practice, knowledge should preserve each participant's capacity for judgment. Intended parents need to understand their choices, and carriers need to understand their own circumstances. The clearer the adviser is, the more able everyone becomes to ask what a test is for, compare a fee schedule, or pause the arrangement. A knowledge service becomes credible when it can accept those outcomes.

Jung's idea of projection is especially useful here. People sometimes mistake their expectation of another person for a quality that person already possesses. An adviser hoping for smooth cooperation may read politeness as agreement and silence as the absence of concern. Intended parents may experience a carrier's warmth and assume that everyone already shares the same view of prenatal testing, delivery and contact after birth.

One simple practice can help: a meeting note can separately record what a person said, how others understood it, and what still needs confirmation. This allows misunderstanding to surface before the next step. It is a communication proposal made here, not a therapy technique prescribed by Jung.

An agency's responsibility is most visible after disagreement appears. Imagine that a doctor recommends delaying an embryo transfer after the intended parents have booked travel and the carrier has rearranged her family life. The coordinator must explain the clinical reason, recalculate costs and work through the revised arrangements. Telling one person to consider the greater good simply leaves the difficulty with whoever finds it hardest to refuse.

This is a hypothetical working situation, but it points to a value that can be tested: capable coordination helps people deal with disagreement without requiring someone to surrender a reasonable need merely to keep the programme moving.

Surrogacy also contains a structural asymmetry. One party bears most of the cost, another bears the pregnancy, and others carry professional duties of judgment. All deserve equal respect, but they do not face the same risks. A vote-counting approach can leave the person in the minority to bear the consequences accepted by the majority. When one body carries the medical burden, the weight given to her view cannot be calculated by headcount.

An agency may earn a reasonable income. Any commercial relationship behind a clinic recommendation, the recipient of each fee, and the treatment of payments after a pause should be explained. Acknowledging interests gives people a chance to assess information. Benevolent language can obscure the very factors that influence judgment.

Applied to an organisation, Jung's shadow invites self-examination. Who reviews an adverse event? Can an employee raise a problem without being suppressed? Is an adviser's reward tied only to signing? These questions deserve more managerial attention than a demand that every employee possess noble motives. Good systems help ordinary people act responsibly while under pressure.

Humility in the clinic

Reproductive medicine has opened possibilities for people whose hopes of parenthood might otherwise remain unrealised. Embryology, medication management and clinical assessment embody substantial expertise. A clinic's positive value includes respect for that ability and clarity about what it cannot promise.

The intended parents bring their hope into the consultation room. The doctor must consider an actual body, specific test results and probabilities. Every technology used for the person in front of the doctor needs a sufficient medical reason. One more intervention may add burden; a decision to pause may preserve a later opportunity.

Embryo number offers one example. ASRM's 2022 practice guidance strongly recommends single-embryo transfer in gestational-carrier cycles to reduce risks associated with multifetal pregnancy. The clinical team must still individualise care under the standards and law that apply.

A more cautious plan may bring disappointment about time or money. Expertise becomes a resource shared by the whole group when the doctor explains why the disappointment is medically necessary, the agency helps revise the plan, the intended parents recognise who bears the risk, and the carrier participates directly in the discussion.

Clinical humility is concrete. It means explaining where a report applies, what a probability cannot tell us, whether the evidence is sufficient and whether new information changes the original plan. A doctor need not perform omniscience. Saying “we do not yet know” gives the next test or consultation a clear purpose.

The clinic is also a place where the carrier must be seen. She comes there for her own medical care. Conversation should include what she says about medication, sleep, pain and bodily change, rather than treating fetal measurements as the only subject. Disputes about prenatal testing or other interventions must follow local law and professional ethics. The expectations of the people paying the fees do not replace her medical consent.

Intended parents also need care. Waiting for results can produce intense anxiety; a change of plan can bring helplessness. Clear reports, a realistic time for the next information, and suitable emotional support can give anxiety somewhere to go and reduce the pressure displaced onto the carrier or clinical team.

Cooperation does not dilute the doctor's duty. A contract reviewed by a lawyer, a plan introduced by an agency and fees already paid cannot replace clinical judgment in the room. When each profession retains its own capacity to decide, their responsibilities can protect participants in complementary ways. If every party passes responsibility to the previous link, a file full of signatures may still contain questions that no one has truly answered.

Clinical skill opens an opportunity for life. Clinical restraint protects the person carrying that opportunity. Both are reasons to trust a clinic.

The time that care requires

A programme can settle accounts at milestones. A body recovers at its own pace. After birth, the intended parents begin caring for an infant through day and night. The carrier experiences postpartum change while returning to work, family and the emotional demands of ordinary life.

Each person has entered a different time.

A thoughtful arrangement addresses these times before birth. Who coordinates postpartum appointments? How are agreed expenses paid? How will complications be treated? Where can psychological support be reached? What form of contact after birth reflects everyone's wishes? Support should not depend on permanent emotional closeness, nor should a carrier have to repeat the story of her contribution to qualify for it.

The ASRM ethics opinion says that carriers should have access to appropriate obstetric care and follow-up treatment for pregnancy-related complications. Actual protection must be built through locally enforceable medical, insurance and contractual arrangements.

Gratitude may sustain a relationship, but it can also prescribe one. A carrier does not owe the intended parents endless warmth or constant availability. Intended parents should not have to display happiness in public to prove that they are grateful. People can agree how they will remain in contact and allow those needs to change.

For FS, “Reverence for Life” has meaning in moments that disappear from celebratory photographs. Designing postpartum care into the service, defining who answers a call, who follows up and which costs are protected are practical demands made by the philosophy. Service documents and execution records should be able to answer those questions.

This distinction keeps a principle serious. It gives the team a direction against which practice can be tested, and it tells families what evidence can support trust.

The future voice of the child

In Two Essays on Analytical Psychology, Jung connects individuation with becoming oneself and considers how a person may become estranged from the self through excessive identification with an external role. Applied carefully to parenthood, the idea suggests an ethical demand: learning to know oneself also means recognising that another person has a life we cannot prescribe in advance.

A child will have a temperament, interests and feelings about the story of birth. The child may want to know the carrier, or may have no interest for a time; may feel settled by the family story, or return to it repeatedly at a certain age. Adults deserve recognition for the effort of welcoming the child. That effort does not entitle them to a particular response.

A child owes no one a predetermined feeling.

A UK study followed families to age 20 and compared 65 families formed through third-party assisted reproduction, including 22 surrogacy families, with 52 families formed through unassisted conception. It found no differences between the groups in the measured indicators of psychological wellbeing and family relationships. The sample was specific and modest in size. The findings cannot guarantee every surrogacy experience, and they do not support predicting a person's psychological fate from the manner of birth alone.

Families still have to answer questions that research cannot answer for them. A child's birth story can distinguish genetic, gestational and parenting contributions truthfully and develop in detail as the child's understanding grows. Necessary records should be preserved with attention to the privacy of everyone involved and to applicable rules. The child's questions deserve patience and should not carry the task of protecting an adult's image.

The carrier's contribution can be remembered. The work of clinicians and coordinators can be appreciated. The parents' daily care has its own weight. Recognising one contribution does not reduce another. Several people may participate in the beginning of a life, while the child remains free to tell that beginning in a language of their own.

Wholeness through dependence

Surrogacy reveals something often concealed by adult roles: we need other people. Intended parents may need another woman's help. A carrier needs reliable medicine, fair compensation and support for daily life. Doctors depend on accurate information. Agencies depend on each person expressing needs honestly.

Admitting dependence can be unsettling. Those paying may expect control. Those helping may fear that refusal will appear cold. Professionals may feel that uncertainty weakens authority. Jung's account of individuation invites us to ask what exists beyond these roles: a person can acknowledge a need while allowing another person to have a different need.

This is practised in the next meeting. Intended parents name their fear of failure. The carrier describes what her body is experiencing. The doctor explains the present limit of judgment. The adviser records disagreement and searches for a workable arrangement. If no plan can respect the expressed wishes of the participants, a pause deserves serious consideration. Human wholeness includes freedom from having to satisfy every expectation in order to prove one's worth.

Ethical disagreement about surrogacy remains. ASRM accepts compensated arrangements when its stated conditions are met; ESHRE's 2025 ethics statement supports non-commercial surrogacy in specified circumstances. Recognising the positive contribution of carriers, agencies and clinics does not dissolve economic inequality or conflicts of interest. Keeping these questions visible gives positive values an honest foundation.

FS's philosophy can be expressed more deeply here: give knowledge to the people who must decide, use professional ability to understand and address what they are carrying, and continue care into the days when no one is eager to display an outcome. Real people must perform each step. They must also be able to raise objections, identify failures and improve the work.

Years later, a child may find a preserved record and ask about those who took part. The family might say that a woman went through the pregnancy and also had a family and a life of her own; that doctors considered risk with care; that someone explained and organised the process and continued working when events went wrong. The child's arrival contained the labour, choices and care of many people.

The rest of the story will be told in the child's own voice.