Surrogacy is not a new phenomenon. In human history, the practice of surrogate motherhood can be traced back to ancient civilizations. The Bible Genesis records the story of Sarai letting her maid Hagar bear a son for Abraham. This is regarded by some scholars as the earliest recorded case of "surrogacy". However, assisted reproductive technology surrogacy in the modern sense - especially "gestational surrogacy" in which genes are separated from pregnancy - only really entered the public eye after the first successful in vitro fertilization surrogacy in the United States in 1985.
Forty years have passed, and surrogacy technology has been widely practiced in dozens of countries around the world, but the ethical controversies surrounding it have not subsided at all. This is not because people lack the ability to discuss rationally, but because the ethical controversy over surrogacy touches on multiple deep-seated values that are difficult to reconcile with each other:
There is no universal standard answer to these questions, because different cultural traditions, religious beliefs, political philosophies and socioeconomic conditions will shape completely different judgment frameworks. Because of this, even within the same country, legislators, medical professionals, feminists, and religious groups often hold very different positions.
Opposition to commercial surrogacy comes from many directions, from radical feminists to conservative religious groups, from child rights advocates to labor rights groups. Although the starting points of each party's arguments are different, they all point to the fundamental ethical issues of surrogacy arrangements.
This is one of the core arguments of the anti-surrogacy camp. In her 1985 book "The Mother Machine," American radical feminist scholar Gena Corea positioned surrogacy as a systematic exploitation of women's fertility. Corea believes that surrogacy turns a woman's uterus into a "commodity" and the pregnancy process into "labor services", which fundamentally devalues the dignity of women as complete human beings, not just their physical functions.
This argument was further developed by the philosopher Elizabeth Anderson. In his 1990 paper "Ethical Issues in Surrogacy Contracts" published in the journal Ethics, Anderson pointed out that certain items and relationships are naturally not suitable for processing by market logic, and the relationship between a child and his mother falls into this category. Commodifying pregnancy causes surrogate mothers to view their emotional connections as "externalities" that need to be suppressed, and this emotional suppression is itself a form of harm.
"When we allow the market to enter the realm of parent-child relationships, we are not simply allocating reproductive resources—we are changing the nature of the relationship itself, subjecting it to the logic of commerce rather than the logic of human dignity."
—Elizabeth Anderson, Ethics, 1990
Even if it is accepted that "informed consent" has ethical validity, critics point out that in reality, the "consent" of surrogate mothers is often made under the background of economic pressure and information inequality, and therefore does not constitute a truly free choice.
The geographical distribution of global surrogacy practices shows a highly unequal pattern: clients are usually from high-income countries, while surrogate mothers are concentrated in middle-income or low-income countries (India was the world's largest surrogacy market before it banned commercial surrogacy in 2015). This structure reflects power inequalities in the global labor market rather than the result of free choice.
Children’s rights activists raise another dimension of ethical questioning from the child’s perspective. The main arguments include:
From the intersection of law and ethics, surrogacy also raises fundamental confusion about the ownership of parental rights. In some legal systems, the person who gives birth is the legal mother by default, which conflicts with the presupposition in the surrogacy contract that the client is the "real parent". When a dispute occurs between the two (for example, the surrogate mother changes her mind and refuses to deliver the child, or the client regrets not wanting the child after the child is born), not only the rights and interests of the child are damaged, but the basic assumptions of the entire legal framework are also affected.
Proponents of surrogacy also constitute a diverse group, including liberal philosophers, reproductive rights advocates, some feminists, and surrogacy practitioners themselves. Their core arguments revolve around the legitimacy of autonomy, informed consent and fair remuneration.
The core ethical basis for supporting surrogacy is the affirmation of reproductive autonomy. Both the client—an individual or couple who is unable to conceive on their own due to medical reasons—and the surrogate mother have the fundamental right to make reproductive decisions.
Philosopher Martha Ertman pointed out in her 2003 paper published in the "California Law Review" that prohibiting commercial surrogacy is essentially the state's forced intervention in individual reproductive decisions. Such intervention requires extremely sufficient reasons in a liberal democratic society. She believes that prohibiting adults from freely entering into surrogacy agreements without proof of clear harm is an undue restriction on personal autonomy.
Supporters believe that adults have the ability and right to make freely consenting decisions after fully understanding the medical risks, psychological effects, legal implications, and remuneration arrangements of the surrogacy process. Compared with other medical behaviors that require informed consent (such as organ donation, participation in clinical trials), surrogacy is not special enough to need to be separately excluded from the principle of informed consent.
Supporters of the argument that surrogacy driven by financial need is exploitative offer a sharp counterargument: If a certain type of labor is deemed "exploitative" based on economic motivation alone, then many dangerous or strenuous occupations (such as miners, construction workers, cleaners) should also be considered exploitative, but we usually don't judge this way.
Philosopher Anca Gheaus (2012) pointed out that the criterion for judging exploitation lies in whether the transaction is fair (whether the remuneration is reasonable and reflects the effort and risk), whether the information between the two parties is symmetrical, and whether there are coercive factors, rather than just whether there is economic motivation. In surrogacy arrangements with good regulation, transparent contracts and fair compensation, financial motivation alone does not constitute exploitation.
In the view of some supporters, altruistic surrogacy (that is, the surrogate mother does not charge more than the actual cost) embodies one of the noblest human virtues - taking physical risks and sacrifices to help others realize their desire to become parents. The legal frameworks that allow altruistic surrogacy in countries such as the United Kingdom, Canada, and Australia are precisely based on the recognition and protection of this altruistic spirit.
"We accept altruistic acts from humans every day - blood donation, bone marrow donation, living kidney donation. Surrogacy, as an altruistic act, is no more morally questionable than these. The problem is not surrogacy itself, but how to ensure that this act is carried out under fair and transparent conditions."
——Martha Field, professor at Harvard Law School, "Surrogacy: Law and Ethics," 1990
The World Health Organization (WHO) is the most influential international organization on global public health policy, and its stance on surrogacy has attracted much attention from all parties.
The "Assisted Reproduction Technology: Global Policy and Practice" report released by the WHO in 2020 systematically reviews the issue of surrogacy, but deliberately avoids a clear policy position. The core points of the report are as follows:
"Assisted reproductive technologies, including surrogacy, are increasingly used around the world. Countries need to establish rights-based regulatory frameworks to ensure that the rights and health of all participants - including commissioning parties, surrogate mothers and born children - are fully protected."
——WHO, "Assisted Reproductive Technologies: Global Policy and Practice", 2020
The International Federation of Fertility Societies (IFFS) is the most authoritative academic organization representing assisted reproductive medicine professionals around the world. IFFS regularly publishes global assisted reproduction survey reports to systematically review the policies and practices of various countries.
The "Surveillance 2023: International Assisted Reproductive Technology Survey Report" (IFFS Surveillance 2023) released by IFFS in 2023 presents the following important data and positions:
| Surrogacy policy types | Number of countries | Proportion of surveyed countries | typical country |
|---|---|---|---|
| Commercial surrogacy is legal | About 15 countries | about 15% | United States (some states), Kyrgyzstan, Kazakhstan |
| Altruistic surrogacy is legal, commercial surrogacy is prohibited | About 20 countries | about 20% | UK, Canada, Australia, Belgium |
| All forms of surrogacy are prohibited | About 30 countries | about 30% | France, Germany, Italy, China, Japan |
| No clear legal provisions (legal vacuum) | About 35 countries | about 35% | most developing countries |
IFFS is a professional medical organization in its position. Its core focus is the safety, effectiveness and ethical standards of assisted reproductive technology, rather than making an overall policy judgment on surrogacy. However, the IFFS survey report clearly reveals the following trends:
The European Parliament is one of the international legislative bodies that has conducted the most systematic debate to date on the ethics of surrogacy. Although the European Parliament does not have direct legislative power over member states’ surrogacy laws, its resolutions and reports have important reference value for the policy direction of European countries.
There are deep divisions within the European Parliament on the issue of surrogacy, which are roughly divided along the following lines:
| position camp | core proposition | Mainly support the political stance of members of parliament |
|---|---|---|
| Ban commercial surrogacy | Commercial surrogacy is an exploitation of women’s bodies and should be banned through coordinated international treaties | Some left-wing and Christian democrats |
| Altruistic surrogacy licensing group | Allow non-commercial surrogacy while establishing a strict regulatory framework to protect the rights of all parties | Some green parties, liberals |
| Sovereignty retentionists | Surrogacy legislation is a sovereign matter for member states and the EU should not interfere | Most center-right, conservative |
| rights framework | On the basis of respecting the laws of member states, ensure that the basic rights of surrogate children are uniformly protected within the EU | bipartisan human rights advocate |
In 2014, the European Parliament passed a resolution related to the "Martina Andreeva Report", which clearly defined "commercial surrogacy" as an "act contrary to human dignity" and called for its ban. At the same time, altruistic surrogacy was treated differently as another issue. This is the clearest stance the European Parliament has taken on the issue of surrogacy so far, but it should be noted that European Parliament resolutions are not legally binding on member states.
In 2023, when the European Parliament was discussing the EU Parenthood Regulation, it once again touched upon the issue of cross-border determination of the paternity of surrogate children. The focus is: when a child born to a pair of citizens of an EU member state through surrogacy in a legal surrogacy country (such as the United States or Georgia) returns to a member state that prohibits surrogacy (such as France or Germany), how is the child's parental rights determined? There is still no unified solution at the EU level to this problem.
Academic circles have discussed the ethics of surrogacy for nearly 40 years, forming several important theoretical threads. The following summarizes the core views of several representative scholars.
Gena Corea is one of the first scholars to systematically criticize surrogacy technology. In her "Mother Machine" published in 1985, she analyzed surrogacy within the context of the development of reproductive technology as a whole and believed that modern reproductive technology, including surrogacy, is essentially the technical control and exploitation of women's fertility by a patriarchal society.
Corea's critique has a clear structural perspective: the issue is not whether individual surrogate mothers are "voluntary", but how the entire social structure defines women's fertility as an exploitable resource. She is deeply skeptical of the effectiveness of "informed consent" in the context of structural inequality.
Harvard Law School professor Martha Field provided a very different perspective in her 1990 book "Surrogacy: Law and Ethics." Field believes that the legal treatment of surrogacy should be based on respect for individual autonomy, and excessive interference disrespects the abilities of adults.
Field particularly emphasized that surrogacy contracts should be allowed, but adjustments need to be made in the contract execution mechanism: the surrogate mother should be allowed to change her mind within a certain period after delivery (similar to the "cooling off" system in adoption) to protect the expression of her true wishes, and the best interests of the child should be the priority criterion in the final decision.
Modern scholar Anna Storrow (New York Law School) represents a more refined middle position. In her 2012 paper "Transnational Surrogacy and Children's Rights," she pointed out that the core issue in the surrogacy ethics debate lies in the incommensurability between different value frameworks: For feminists who emphasize collective value and female solidarity, the analytical framework of individual "consent" itself is the problem; while for liberals, ignoring the position of individual consent is a kind of patriarchal arrogance.
Storrow proposed that the solution to this dilemma lies not in which side "wins" the ethical debate, but in establishing specific institutional guarantees so that the rights of all parties in surrogacy arrangements are protected in real rather than formal ways.
Since the 2020s, ethical discussions have increasingly turned to empirical research exploring the actual long-term effects of surrogacy. The following are the conclusions of several representative studies:
Religious traditions are a force that cannot be ignored in discussions about the ethics of surrogacy, especially in countries and regions where beliefs deeply influence policy making.
| religion | General stance on surrogacy | core ethical arguments | Typical policy impacts |
|---|---|---|---|
| Roman Catholic | Express objection (including all forms) | The sanctity of marriage and natural procreation; assisted reproduction separates human procreation from marital union | Prohibition legislation in Catholic countries such as Italy and Poland |
| Islam (Sunni) | mainstream opposition | Prohibition of third parties other than genetic parents from intervening in reproduction; clear requirements for parental rights | Banned in most Sunni Muslim countries |
| Islam (Shia) | Partially allowed | Iran's Supreme Leader Ayatollah Ali Khamenei's decree allows genetic parents to use surrogates, but with conditions | Iran is the only country in the Middle East that allows surrogacy |
| Judaism | Allowed by majority (under certain conditions) | Fertility orders (pikuach nefesh) take precedence; Modern Orthodox rabbinical rulings allow with conditions | Israel allows surrogacy (limited to married heterosexual couples) |
| Protestant | Position differentiation | Interpretations vary widely among sects, ranging from prohibition to conditional permission. | Britain and Northern Europe allow altruistic surrogacy |
| Buddhism | No unified position | Focus on motivations and results, preferring case analysis; the principle of compassion can support altruistic surrogacy | Buddhist countries in Southeast Asia have different stances |
It is worth noting that there is often a gap between religious stance and legal practice. Iran is a typical case: As an Islamic republic, Iran allows surrogacy through Shiite religious rulings, making it one of the countries with the most liberal surrogacy laws in the Middle East. Israel has transformed the Jewish reproductive command into a legislative basis and established one of the earliest legal frameworks for surrogacy in the world (the 1996 Surrogacy Agreement Law).
Looking at global surrogacy legislation, we can find that the relationship between countries' ethical stance and legal choices is not a simple matter of "making whatever laws they believe in", but is complexly restricted by multiple factors: historical traditions, religious backgrounds, the political power of the feminist movement, the overall orientation of reproductive policies, and the actual pressure brought about by cross-border surrogacy.
France is the representative country in continental Europe that explicitly prohibits surrogacy. France’s Bioethics Law clearly stipulates that any surrogacy contract is invalid and the execution of surrogacy may constitute a crime. France's prohibitive position is rooted in its legal tradition of "indisponibilité du corps humain" (indisponibilité du corps humain), which holds that the human body and its functions cannot be the subject of a contract.
However, the dilemma France faces in practice is that every year hundreds of French families give birth to children through surrogacy abroad, and these children face legal difficulties in determining their paternity when they return to France. A series of judgments by the French Supreme Court from 2014 to 2019 have gradually relaxed the determination of parental rights for these children, creating a contradictory situation in which "the act of surrogacy is illegal and the results of surrogacy are legal."
Since the United Kingdom passed the Surrogacy Arrangements Act in 1985, it has formed a unique model that "allows altruistic surrogacy and prohibits commercial intermediaries." In the UK, surrogates can receive reasonable compensation for their expenses, but surrogacy contracts are not legally enforceable and surrogates always reserve the right to change their decision after delivery. This system design reflects a high degree of respect for the autonomy of surrogate mothers, but it also brings greater legal uncertainty.
Kyrgyzstan has established clear legal recognition of commercial surrogacy through Article 104 of its 2023 revision of the Citizens’ Health Protection Law, and allows foreign clients to participate. The core advantage of its system design is that the contract is legally binding when signed at a notary office, the entrusting parents can be directly recognized as the legal parents of the child, and the entire process is transparent and predictable.
When faced with the ethical controversy over surrogacy, more and more policymakers and scholars have chosen to break away from the binary oppositional framework of "prohibition vs. permission" and instead explore how to maximize the protection of the rights and interests of all parties through system design while recognizing the actual needs of surrogacy. The core proposition of this pragmatic approach is that a complete ban on surrogacy cannot eliminate the demand for surrogacy, but can only push it into underground or cross-border markets with less supervision and higher risks; therefore, replacing simple bans with responsible supervision is more conducive to protecting the rights and interests of vulnerable parties in practice.
Regardless of the overall moral judgment on surrogacy, the following institutional elements are widely considered to be the basic prerequisites for protecting the rights and interests of surrogate mothers:
Cross-border surrogacy (that is, the client is from one country and the surrogacy is carried out in another country) is the biggest legal and ethical problem in current surrogacy supervision. Currently, the Hague Conference on Private International Law is continuing its efforts to promote the formation of an international framework to resolve the issue of cross-border determination of paternity of surrogate children.
The 2023 Hague Conference consultation document on surrogacy states that the priority goal should be to ensure that the basic rights of all children born through surrogacy are protected, rather than trying to form a globally unified standard for the surrogacy practice itself (the latter is an almost impossible goal). This pragmatic stance represents the realistic direction of international legal coordination.
The persistence of the ethical controversy over surrogacy profoundly reflects the difficulty of human society seeking consensus under the conditions of value pluralism. For the foreseeable future, people from different countries and cultural backgrounds will continue to have deep differences on the issue of surrogacy, which cannot be eliminated by any single "right answer."
However, this does not mean that ethical discussions are meaningless. For families considering the surrogacy route, understanding the ethical controversies means:
Ultimately, informed choice—based on understanding rather than ignoring ethical controversies, and recognizing risks to all parties rather than avoiding them—is the most solid ethical basis for surrogacy.
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