Philosophy, Bioethics, and Health, Vrije Universiteit, Amsterdam, The Netherlands.
Dept. of Medical Humanities, Amsterdam University Medical Center, Location VU Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands.
Med Health Care Philos. 2020 Dec;23(4):621-630. doi: 10.1007/s11019-020-09976-x. Epub 2020 Sep 14.
It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India (where commercial surrogacy was legal until 2015) are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage (in high income countries such as the Netherlands), or Fair-Trade guidelines (in lower-middle income countries such as India). An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad.
代孕的合理报酬尚不清楚，因为各国意见不一，商业代孕和利他性代孕都有伦理缺陷。在跨境代孕的情况下，这些伦理缺陷会加剧。本文探讨了代孕的合理报酬，并就如何在国际背景下确保这一点提出了相关规定。对商业代孕进行了规范性伦理分析。探讨了反对商业代孕的各种论点，例如代孕者的剥削和商品化、生殖能力和儿童。我们认为，虽然可能会出现商品化和剥削问题，但这些问题并非代孕所特有，而应在一个不平等的世界的更广泛背景下加以理解。此外，至少有一些这样的论点基于象征性修辞或缺乏对现实世界经验的了解。根据这一批评，我们认为商业代孕是可以被证明合理的，但如何以及在什么情况下取决于具体情况。代孕者应获得足够的报酬，并且应制定相关规定。在本文中，荷兰和印度（商业代孕在 2015 年之前是合法的）是在许多方面存在差异的两个案例。在这两种情况下，代孕都可以被视为一种合法的劳动形式，需要与其他劳动形式相同的工资和安全标准。代孕报酬需要足够高，以避免因低报酬而受到剥削，这可以通过最低工资机制（在荷兰等高收入国家）或公平贸易准则（在印度等中低收入国家）来确定。应该制定一项管理商业代孕的国际条约，并要求设立保护代孕者利益的地方专业机构。全球范围内应允许商业代孕，这也将减少准父母在国外寻求代孕服务的需求。
