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Parenthood, Redefined: 11 Hard Questions About Surrogacy

Contributing biologically to a child's creation no longer directly implies parenthood. Surrogacy has shaken up traditional ideas and beliefs about sexuality, reproduction and filiation. The author poses key questions that must be answered to ensure that surrogacy is driven by both science and ethics.

Image of four adults and two children walking by the water in Shanghai

Family at waterside in Shanghai

Loola Pérez


MURCIA — We live in a rapidly changing society, particularly when it comes to interpersonal and familial relationships. Assisted reproductive technology (hereafter ART) has shaken traditional ideas about sexuality, reproduction and filiation.

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The act of child creation now goes beyond the sexual encounter between a man and a woman. Not only is reproduction without sex possible, it is also possible that there is no filial relationship between the participants who conceive a baby.

In some cases, those who gestate do not use their own eggs, such as with partner-assisted reproduction (ROPA) for couples who both possess female reproductive organs, often lesbians. In another example, sperm donors renounce their parental rights over the babies conceived.

To put it another way, contributing biologically to the birth of a child does not directly imply parenthood. The mother is no longer necessarily the one who gives birth, despite what ancient Roman law may have decreed, nor the one who provides the ovum for the gestation. Likewise, the father is no longer unquestionably the one who physically inseminates, or donates the sperm.

No international consensus

Medical advances in the last 40 years have revolutionized biological reproduction. Biological heredity is no longer synonymous with true parenthood. Inevitably, this has had a social and legal impact around kinship. Parenthood is the result of loving and caring for a child, rather than having engaged in a physical act (reproduction), providing genetic material (gametes) or carrying a baby in the womb for nine months (gestation).

If the history of humanity can hardly be understood without the history of technology, the changing history of the family cannot be understood today without knowing the progress of reproductive technologies.

ART opened up a world of possibilities for people who experience infertility for medical reasons (i.e. due to disease, illness or injury) or who experience "structural infertility" as a single individual or same-sex couple wishing to have a child. This world of possibilities has given rise to an important (and exciting) legal, social, political and ethical debate, without any international consensus.

Risk of reproductive tourism

Currently, here in Spain, surrogacy has become a major political issue. To be clear, surrogacy is defined as a person voluntarily — for altruistic or financial reasons — agreeing to gestate a baby and then entrust it to the intended parents after the birth. After prior agreement between the parties, gestation occurs as a result of artificial insemination or with an oocyte provided by the gestating person or by implanting an embryo that may (or may not) come from the intended parents. For people who wish to become single parents through surrogacy, the genetic material may or may not be their own — or may be partly their own and partly from a donor.

The trend is towards regulation.

Each country approaches surrogacy differently. But given the international scope of the phenomenon, the trend is towards regulation: this is the only way to keep things legal, ensure protection for pregnant women and babies, and counter reproductive tourism. On top of the duties and rights of all involved, a legal framework guarantees the respect of surrogacy and ensures that abuses and malpractice are prosecuted.

Image of egg cell and its membrane being approached by a sharp object

Oocyte with zona pellicida

ZEISS Microscopy

Questions raised

This has sparked arguments for and against, as well as a myriad of questions. We will conclude this exploration with a list of some of the toughest ethical and practical questions:

1. Is having children a right?

2. What criteria should be made universal to prevent surrogacy from becoming an exploitative process? Can we assure understanding of informed consent, taking mental health, individual vulnerabilities and the risk of poverty into account?

3. Should some kind of emotional or familial relationship be sought between the gestational carrier and the intended parents?

4. Should a person's freedom and bodily (and personal) autonomy be limited by states, thus preventing them from participating in surrogacy processes?

5. How far can this fit in with feminist claims of "my body, my choice," "my body is mine" until it contradicts the moral values of the Nanny State?

6. Should financial compensation for pregnancies be considered a form of exploitation?

7. Can pregnant people, in a commercial model of surrogacy, be considered patient-workers? Thus, wouldn't their human rights and labor rights be more protected in this model, similarly to those who participate in clinical trials?

8. If surrogacy is a process only affordable for the privileged, shouldn't similarly costly procedures such as IVF or cosmetic medicine operations be banned for the same reason?

Individual vs. society

9. Should surrogacy be made available only to individuals or couples experiencing infertility, or also to those experiencing “structural infertility”?

10. Would surrogacy be considered more ethical by the public if the intermediary agencies were exclusively non-profit organizations?

11. Can adoption really be considered as an alternative to surrogacy?

We are facing a debate where (individual) desires, (human) rights and (community/social) duties take on great importance. This debate could be very interesting and useful for our society, as long as we avoid intransigence, moral panic and reductionist arguments.

We have the opportunity to influence scientific progress and growth of bioethical knowledge. It is urgent that the debate should be oriented towards biomedical research, while ensuring the process and participation of all parties remains ethical, as well as civil, in our public debate.

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Not Your Grandma's Nonna: How Older Women In Italy Are Reclaiming Their Age

Women in Italy are living longer than ever. But severe economic and social inequality and loneliness mean that they urgently need a new model for community living – one that replaces the "one person, one house, one caregiver" narrative we have grown accustomed to.

Not Your Grandma's Nonna: How Older Women In Italy Are Reclaiming Their Age

Italy is home to many elderly people and few young ones.

Barbara Leda Kenny

ROMENina Ercolani is the oldest person in Italy. She is 112 years old. According to newspaper interviews, she enjoys eating sweets and yogurt. Mrs. Nina is not alone: over the past three years, there has been an exponential growth in the number of centenarians in Italy. With over 20,000 people who've surpassed the age of 100, Italy is in fact the country with the highest number of centenarians in Europe.

Life expectancy at the national level is already high. Experts say it can be even higher for those who cultivate their own gardens, live away from major sources of pollution, and preferably in small towns near the sea. Years of sunsets and tomatoes with a view of the sea – it used to be a romantic fantasy but is now becoming increasingly plausible.

Centenarians occupy the forefront of a transformation taking place in a country where living a long life means being among the oldest of the old. Italy is the second oldest country in the world, and it ranks first in the number of people over eighty. In simple terms, this means that Italy is home to many elderly people and few young ones: those over 65 make up almost one in four, while children (under 14) account for just over one in 10. The elderly population will continue to grow in the coming years, as the baby boomer generation, born between 1961 and 1976, is the country's largest age group.

But there is one important data set to consider when discussing our demographics: in general, women make up a slight majority of the population, but from the age of sixty onwards, the gap progressively widens. Every single Italian over 110 years old is a woman.

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