As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in (...) New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (shrink)

I Norge er ikke surrogati tillatt, og myndighetene fraråder norske statsborgere å benytte seg av surrogati i utlandet. I denne artikkelen fokuserer vi på kommersiell gestational surrogati og stiller spørsmålet: Bør man tillate at norske statsborgere benytter seg av surrogati i India? De etiske problemstillingene rundt surrogati er mange og sammensatte og blir spesielt utfordrende når tjenesten tilbys i et land med store kulturelle og økonomiske forskjeller både internt og i forhold til Norge. Vi baserer analysen og drøftingen av dette (...) etisk utfordrende spørsmålet på Beauchamps og Childress sin veletablerte metodiske tilnærming innen biomedisinsk etikk. Vi anvender de fire allmennmoralske prinsipper: respekt for autonomi, velgjørenhet, ikke-skade og rettferdighet på sakskomplekset for å synliggjøre spenningene involvert i dette etiske dilemmaet. Med full bevissthet om at det ikke finnes noen lettvinte og omkostningsfrie løsninger på dilemmaer generelt og dette spesielt, konkluderer vi med at interessene til de berørte parter, og spesielt surrogatmødrenes, kan bli bedre ivaretatt om surrogati tillates under omfattende reguleringer. Dersom man velger å gjøre praksisen illegal, vil man også miste mulighetene til å påvirke prosessen og sikre rettighetene til de involverte partene.Nøkkelord: surrogati, Norge–India, utnyttelse, autonomi, regulering av prosessenEnglish summary: Should Norwegian citizens be permitted to use surrogacy in India?Surrogacy is not permitted in Norway, and the government strongly advises against Norwegian citizens travelling abroad to have children through the use of the surrogacy industry. In this article, we focus on commercial gestational surrogacy and debate the question: Should Norwegian citizens be permitted to use surrogacy in India? The ethical concerns regarding surrogacy are complex and are especially challenging when the service is offered in a country with big cultural and economic differences both internal and in comparison to Norway. We base our analysis of this ethical, challenging question on Beauchamp’s and Childress’s well-established approach within biomedical ethics. We apply the four principles of respect for autonomy, beneficence, nonmaleficence and justice to shed light on the conflicts of interests in this ethical dilemma. With full awareness that there are no simple and correct solutions to dilemmas in general and on this issue, especially, our conclusion is that the interests of the involved parties, and especially those of the surrogate mothers, might be better attended to if surrogacy is allowed with extensive regulations. If this practice is made illegal, the opportunity to influence the process and secure the rights of the involved parties is lost. (shrink)

Transnational reproductive travel is symptomatic of insufficient supplies of reproductive resources, including donor gametes and gestational surrogacy services, and inequities in access to these within domestic health-care jurisdictions. Here, we argue that an innovative approach to domestic policy making using the framework of the National Self-Sufficiency paradigm represents the best solution to domestic challenges and the ethical hazards of the global marketplace in reproductive resources.