Parents Of Triplets Born By A Surrogate Sue Hospital For Invasion Of Privacy

An interesting medical invasion of privacy claim out of Illinois:

Surrogate parents of newborn triplets claim a hospital and major media outlets violated medical privacy laws and subjected them to “humiliation, embarrassment and emotional distress” by publishing photos and stories about their newborns. The parents say they never gave Advocate Christ Medical Center permission to release personal information about them or their babies, nor did they agree that the Sun Times, Tribune Co. or WLS-TV could photograph and publish the babies’ pictures.

Bryan and Cynthia became parents of triplets through a surrogate pregnancy in February, according to their complaint in Cook County Court. The children were born seven weeks prematurely and were placed in the hospital’s neonatal intensive care unit. Around the same time, the hospital delivered three other sets of triplets. About three days after the Lindgren triplets were born, Cynthia Lindgren says, she got a call from a nurse who said that news outlets were coming to the hospital to do a story on the four sets of triplets.

The nurse asked for permission to have the Lindgren children filmed, but Cynthia Lindgren said she demurred, saying she would have to speak with her husband. But the hospital let the TV and newspapers go ahead anyway, the Lindgrens say. WLS broadcast footage of one of the Lindgren children and disclosed their medical condition; the print articles also revealed where the family lives and how the children were conceived, the parents say. The Lindgren’ seek damages for intrusion upon seclusion, public disclosure of private facts, and appropriation of name and likeness.

One small nit about this report: the Lindgrens are not surrogate parents. They are the legal, custodial parents and the woman who carried the babies for them was their surrogate.

Teenager Speaks About Being Conceived With The Help Of An Egg Donor

Debunking The Link Between Egg Donors & Prostitutes

The Pulitzer Center on Crisis Reporting debunks the connection between sex trafficking and the fertility industry in Cyprus:

I came to Cyprus almost positive that there was a direct link between sex trafficking and the fertility industry. The beach road in Limassol is dotted with cabarets and brothels where trafficked women are sold by the hour. The country is a repeat offender on the UN Department of State’s anti-trafficking TIPPS report that shows how the government here directly supports the trade in women. The government issues more than 300 special “artist” visas to cabaret workers and the local press is full of accounts of women tricked into working in brothels. The women are forced to pay back their plane tickets to brothel owners and have few rights in the eyes of the law. Along the way into the country they are first screened by doctors at the government hospitals, given a clean chit of health and set to work—a perfect opportunity for a fertility clinic to convince them to sell their eggs. After all, the profile of egg donors and prostitutes is fairly similar—young, beautiful women, mainly eastern European with an aura of fertility.

The facts on the ground, however, did not match the hype. After canvassing three brothels and speaking to sex workers and brothel owners, as well as the top ten anti-trafficking experts in Cyprus as well as two different sources who house and rescue trafficked women, no one had ever heard of anyone in a brothel selling their eggs. Father Savvas Michaelides, a Russian Orthodox priest, with a long flowing beard that is reminiscent of Santa Claus, has spent the better part of the last decade rescuing Russians from the brothels and says that more than 300 have come under his care.

After hearing about possible connections between egg donation and prostitution he frowns. “It seems like it could be possible, but I have never heard such a thing,” he says. His colleague Eleni Pissaridou who runs a shelter for trafficked women said that a study she had conducted last year with more than 100 interviews with sex workers never came across a single case of egg donation.

I asked David Sher, who runs Elite IVF, an egg donation agency, if it was even feasible to harvest eggs from Cypriot Cabarets. “It just wouldn’t make sense,” he said, “To undergo the procedure we need to be sure that the women aren’t having sex while undergoing hormone therapy. They’re very fertile at that time and might get pregnant. Neither the sex worker nor the IVF lab want that.”

For a journalist or academic working on the ethics of tissue donation and sales, a connection between prostitution and medical commerce is something of a holy grail. After all, if sex work is dangerous and exploitative by its very nature, then any related industry that depends on the same pool of workers is similarly corrupt. An academic can apply the same tools of analysis against egg selling as they do sex work.

In an e-mail to the sex industry magazine Spread, editor Will Rockwell said “it all sounds very seedy, as if as decent people we must believe that evil like this takes place, when you put the words “trafficking” and “eggs” together,” he wrote, but there are other reasons that might compel people to sell their flesh. “Young people in need of high-paid, mobile, and mostly unregulated work often turn to sex work the same as they turn to medical studies or egg-selling.”

Understanding that there is no clean link between human trafficking for sex work and egg trafficking makes this research all the more relevant. Egg selling, it turns out, has its own problems and origins that raise difficult questions about the motivations of egg sellers to approach fertility clinics.

Study Reveals That Infertile Couples Have A More Negative Attitude Toward The Use Of Donor Sperm Than Donor Eggs

Professor Julie Shapiro reflects on a recent study finding that infertile couples view donor eggs much more favorably than donor sperm:

The authors looked at male/female couples who, because of infertility issues, were considering the use of third-party eggs or sperm. They wanted to assess the attitudes of the men and women involved towards the use of these materials, and in particular to compare the attitudes of men and women with regard to third-party eggs and sperm. They concluded

“both men and women from infertile couples have a more negative attitude toward the use of donor sperm than donor eggs. Fears of marital conflict, an incomplete gestational experience and societal opinions of parenting abilities were all worse with donor sperm compared with donor eggs.” (emphasis added.)

Stating this slightly differently, the report also says:

There was a pervasive negative connotation with the use of donor sperm that did not exist to the same degree for donor eggs.”

I think what is noteworthy for me is that men and women agree that the use of third-party sperm is more troublesome than the use of third-party eggs. If I’d had to guess, I would have surmised that sperm posed more of an issue for men while eggs posed more of an issue for women, but that’s not the case.

Assuming the finding is sound (and I’m going to make that assumption since I’ve no reason to question it) the question, of course, is why, across gender lines, there are more negative feelings about sperm than about eggs. At this point I think all the answers I can offer are speculation (this question was not within the scope of the study) but even that speculation is interesting.

One concern was the degree to which the prospective parents might have felt that they would be able to bond with the child. For a couple using third-party eggs, the woman would still be pregnant and give birth, albeit to a child she had no genetic relationship to. Thus, the use of third-party eggs might dilute her social status as mother a bit, but she would still have the experience of pregnancy/birth to rely on.

By contrast, the man’s status as a parent might rest more heavily on the contribution of genetic material. Using third-party sperm would deprive him of that connection. So perhaps all agreed that the loss of genetic connections was more critical for a man than for a woman.

More On India’s Booming Surrogacy Industry

But the usual empowerment vs. exploitation debate eludes something much more fundamental that the surrogate industry reflects about India. India has leap-frogged several stages of development and zoomed straight into a service economy. Indians stock call centers and tech help lines where Westerners can get their questions answered efficiently. In these centers, Indian youths temporarily adopt new personal identities by using Western names and accents—another, milder way that Indians act as “surrogates,” or substitutes for Westerners. The country is romanced by the idea of selling human capital as its next great commodity. So surrogacy resonates not as an old problem of exploiting the poor but as an inevitable part of the “new India,” where the locals provide much needed services for the new global economy. This kind of forward-thinking economic liberation dovetails with an ideology of personal freedom. “I think women should be free to choose what they do with their bodies,” says Dr. Aniruddha Malpani, a fertility specialist in Mumbai. “We shouldn’t treat them as stupid just because they are poor.”

This appeal to modern ideals of self-determination make sense to members of the “new India” like Dr. Malpani and his clients. The problem is that the surrogates are not members of this India. Alan Greenspan writes that “India is fast becoming two entities: a rising kernel of world-class modernity within a historic culture that has been for the most part stagnating for generations.” The surrogates tend to hail from this “historic culture,” which is essentially semi-feudal and pre-industrial. It is this gap that allows for exploitation in surrogacy and other industries to happen, and it is the gap—not surrogacy itself—that is the root of the problem.

To exercise one’s freedom meaningfully requires information and education, and many surrogates are deeply ignorant about what the procedure entails. It is not uncommon for surrogates to authorize contracts with a thumbprint as opposed to a signature because they are illiterate. Even those who are literate often aren’t able to read the contracts, which tend to be written in English. Lack of technological understanding among rural Indians also breeds misconceptions about surrogacy. Many, for example, thought that it would be necessary to sleep with another man in order to conceive. Even the pricing structure of surrogacy perpetuates social inequality: Many religious Indian surrogacy clients would prefer for their child to be birthed by an upper-caste brahmin, so high-born surrogates can get paid up to double.

These problems are hardly going to stop the phenomena of surrogacy in India from spreading, though. In fact, one might even suggest that India is moving towards a surrogacy-based economy, in which Indians—in call centers and fertility clinics alike—specialize in substituting Westerners in a cheaper, more efficient way.

UK Considering Increasing Donor Compensation – But Is It Enough?

Welcome news out of the United Kingdom:

The body that regulates fertility treatment in the UK is considering increasing compensation for egg and sperm donors.

Women who donate eggs are currently paid £250, but this could rise considerably under moves to address egg and sperm shortages at IVF clinics. Many fertility clinics have long waiting lists, driving some childless couples abroad. No decision will be made until the end of a public consultation next year.

A spokesperson for the Human Fertilisation and Embryology Authority (HFEA) told the BBC: “We will be looking at a number of issues related to donation policies, one of which will be compensation given to donors. We haven’t decided on a figure.”

The HFEA is holding a three-month public consultation into its donation policies, starting in January 2011. It follows concern over the number of Britons travelling to countries such as Spain to receive IVF because of shortages of donated eggs and sperm in the UK.

In the UK, egg and sperm donors cannot be paid but can claim “reasonable expenses” for travel and loss of earnings. This is limited to a maximum of £250 per cycle of egg donation or course of sperm donation.

Some fertility experts say this is too low to attract donors, and they should be paid more for their time and efforts. Reports have suggested around £800 or more per cycle of egg donation but this has not been confirmed.

Susan Seenan of the support group, Infertility Network UK, which helps infertile couples, said it was right to look at all the policies surrounding egg and sperm donation. She said: “We know that many patients are travelling abroad for treatment, often because of the severe lack of sperm and egg donors in the UK.

“Although many patients do receive a high standard care abroad, this is not ideal and the rules and regulations in other countries can be totally different from that in the UK.” She said patients deserved access to safe, regulated treatment in their own country, and there was a need to find some way of increasing the number of both sperm and egg donors in the UK.

While this news is promising, I am not certain that the additional £800 is enough to incentivize an otherwise apathetic donor population. Egg Donors in other countries are routinely receiving 5-10 times that amount in order to address egg and sperm shortages. Just to provide some context, the American Society of Reproductive Medicine has set $5,000 as the maximum amount of egg donor compensation that does not require additional justification and $10,000 as the maximum cap. Further, the ASRM had some other interesting observations about donor compensation:

Payments to women providing oocytes should be fair and not so substantial that they become undue inducements that will
lead donors to discount risks. Monetary compensation should reflect the time, inconvenience, and physical and emotional demands associated with the oocyte donation process. A 1993 analysis estimated that oocyte donors spend 56 hours in the medical setting, undergoing interviews, counseling, and medical procedures related to the process. According to this analysis, if men receive $25 for sperm donation, which this analysis estimated as taking 1 hour, oocyte donors should receive at least $1,400 for the hours they spend in the donation process (14). In 2000, the average payment to sperm donors was $60–$75, which this analysis suggests would justify a payment of $3,360–$4,200 to oocyte donors.

Although potential harm must be acknowledged and addressed, financial compensation may be defended on ethical grounds. First, providing financial incentives increases the number of oocyte donors, which in turn, allows more infertile persons to have children. Second, the provision of financial or in-kind benefits does not necessarily discourage altruistic motivations; indeed, in surveys of women receiving such benefits, most reported that helping childless persons remained a significant factor in their decisions to donate (4, 7–9). In a recent survey of donors who had been compensated up to $5,000, 88% of subjects reported that the best thing about the donation experience was ‘‘being able to help someone’’ (8).

Third, financial compensation may be defended on grounds that it advances the ethical goal of fairness to donors. There is no doubt that egg donors bear burdens on behalf of recipients and society, and compensation for bearing those burdens are justified morally. Because the burdens of donation are similar regardless of the ultimate use of the oocytes, compensating egg donors for fertility therapy differently from donors for research cannot be justified. Thus, we disagree with the recommendation of the National Academy of Sciences with respect to compensation for oocyte donation for stem cell research (10).

The failure to provide financial or in-kind benefits to oocyte donors would arguably demean their significant contribution. Such an approach also would treat female gamete donors differently from sperm donors, who typically receive a financial benefit (albeit a modest one) for a much less risky and intrusive procedure. Fourth, the pressures created by financial incentives do not necessarily exceed and may be less than those experienced by women asked to make altruistic donations to relatives or friends.

It will be interesting to see if the UK can solve its shortage by bumping up the compensation to One Thousand Pounds (or approximately $1,500 U.S. Dollars).

A Critical Look At The International Egg Donation Industry

Scott Carney, from a publication called Fast Company, takes a critical look at egg donation (he prefers the term “egg sales”) on the international level. Notwithstanding my disagreement with some of the reporting (including the evident bias), it nevertheless is a very informative and important read and among the most comprehensive exposé’s I have read. Among the highlights:

Krinos Trokoudes knows this much about women: “If you pay something,” he says with a smile, “you get lots of girls.” Coming from a silver-haired man in a white lab coat, the remark sounds a little unseemly, but he does not mean it the way you may think. Trokoudes is an embryologist. His business is harvesting human eggs, and every year, hundreds of women are impregnated at his Pedeios IVF Treatment Centre in the Cypriot capital, Nicosia. In 1992, he made the Guinness Book of World Records after a 49-year-54-day-old patient he had impregnated via in vitro fertilization delivered a healthy baby girl; at the time, the mother was the oldest person ever to have given birth after IVF. Trokoudes’s record has since been shattered (two years ago, a 70-year-old Indian woman birthed IVF-conceived twins), but his achievement helped establish Cyprus’s reputation as a home of doctors who are willing to push the frontiers of the fertility industry.

Over the past decade, global demand for human eggs has grown uncontrollably, proliferating in lockstep with a fertility industry that has become a billion-dollar global behemoth. Three decades after the introduction of in vitro fertilization, some 250,000 test-tube babies are born each year. While the vast majority are still the products of their biological mother’s eggs, the desire of older, often postmenopausal women to become moms has fed the rapid growth of egg trading, a business that now reaches from Asia to America, from the richest neighborhoods of London and Barcelona to backwaters in Russia, Cyprus, and Latin America.

This business features well-meaning doctors and assembly-line charlatans, desperate parents and unlikely entrepreneurs, and the most unusual sourcing: women of childbearing age. It is unevenly regulated when it is regulated at all, producing startling, tech-driven examples of the comparative advantage that economist David Ricardo described in the early 19th century. Poor women from poor countries sell their eggs to entrepreneurial doctors, who then sell them to rich aspiring parents from rich countries. This has given rise to a set of spectacularly engaging issues: Is it really okay to treat a woman the way we treat a hen, pumping her up with hormones so we can farm more eggs for sale? Do the standards we apply to produce ball bearings also apply to the stuff of life and the women who bear it? Is a human egg a widget and the donor nothing more than a cog?

These are fundamental questions about outsourcing and efficient markets, except that they involve people, not things. Unfortunately, nearly all of the Western world has punted on the ethical dilemmas. Some countries, like Israel, prohibit egg harvesting on their own territory yet still reimburse citizens for IVF, even if it’s done with donor eggs, as long as they’re acquired elsewhere. U.S. law says nothing about egg donation, though the American Society of Reproductive Medicine has nonbinding guidelines that deem unethical any payment beyond reimbursement for lost wages and travel. In Cyprus as in the rest of the EU, “compensation is allowed, but payment is not,” says Cypriot health ministry official Carolina Stylianou, who leads the regulation of the island’s fertility clinics. Yes, that is as murky as it sounds.

All this mystery has helped create a vibrant marketplace, with a wide range of prices and available services. In the U.S., a full-service egg implantation — including a donated egg, the lab work, and the IVF procedure — costs upward of $40,000. In Cyprus, you can get the same service for $8,000. In the U.K., a prospective parent might wait two years to get an egg, given that country’s strict limits on egg donation. In Spain, on the other hand, waiting times are extremely short — you can have an egg implanted two weeks after requesting one. And as for selling (or donating, if you prefer) an egg, the price is truly all over the map: An American woman gets an average of $8,000 per batch of eggs, but can ask upward of $50,000 if she’s an Ivy League grad (a 100-point increase in SAT score correlates with a $2,350 rise in egg price); on the other hand, an uneducated Ukrainian flown to Cyprus for the extraction process will get a few hundred dollars — and a few days in the sun — for her eggs….

For now, we’re left to consider Alma Hassina and Yehonnatan Meir, the babies bouncing on the laps of Aron and Shatzky. There is no word to describe their relationship. Born of the same egg donor, fertilized by the sperm of different fathers, and delivered from the womb of a surrogate mother, they are both twins and half-siblings. They’re also poster children for the possibilities enabled by IVF and globalization. And for kids like them, prospective parents will do just about anything.

This article was funded in part by a grant form the Pulitzer Center on Crisis Reporting.

I will have some observations about this article shortly.

Burgeoning Surrogacy Industry In China Raising Legal & Moral Issues

China has quietly emerged as one of the most active countries in the world when it comes to surrogacy:

BEIJING, Aug. 17 (Xinhuanet) — More than four years after sparking a nationwide debate over its ethical and legal propriety, China’s surrogate mother industry seems to have found acceptability — if not respectability. In fact, wombs-for-rent businesses are thriving in the world’s most populous country, where some studies indicate an estimated one in eight couples face fertility problems. Reports of a secretive surrogate pregnancy service, operating in a legal “gray area,” were widespread in early 2006 and intermediary websites were recruiting volunteers despite a government crackdown.

The industry in China is based on gestational surrogacy, whereby a woman agrees to become pregnant via embryo transfer. She is not the biological mother of the child and relinquishes it to its biological mother or father after its birth. No official statistics are available on the number of surrogate pregnancy agencies in China, but the Guangzhou-based Southern Metropolis Weekly newspaper estimated in April last year that around 25,000 surrogate children had been born in China in the past three decades.

Jiang Lei, who has been introducing childless couples to surrogate volunteers for two years, estimates surrogate mothers give birth to about 500 to 600 babies on the Chinese mainland annually. He reckons no more than 50 such agencies exist on the Chinese mainland, mostly in the cities of Beijing, Shanghai, Wuhan, Guangzhou and the country’s northern Hebei Province. A surrogate costs about 300,000 yuan (US$44,320) to hire in Beijing, says Jiang, who claims his agency, accounts for about more than 80 percent of the market in the capital. The agency’s website, daiyunguke.com, breaks down the cost as: fetus implantation 60,000 to 95,000 yuan; brokerage fees for the agency 140,000 yuan; surrogate mother 100,000 yuan; monthly apartment rent 3,000 yuan; and maternal care 2,000 yuan.

The intermediary charges clients 30,000 to 40,000 yuan in “connection fees” for doctors who carry out the fertilization procedures, says Jiang.Jiang, 27, says his agency helps up to 200 couples to find surrogate mothers each year, with a successful in-vitro fertilization rate of just over 50 percent.

(more…)

The Possible Anti-Competitive Impact Of California’s New Surrogacy Law

My apologies for the stream of consciousness series of posts about the new statute that was signed into law last Friday, regulating the disposition of funds in a surrogacy arrangement. I have received numerous inquiries about the effect and scope of the law and it has provoked a number of questions.

So that my position is unequivocal, I do believe this industry needs to be regulated. The American Bar Association has a model act which goes a long way towards providing a framework to address many of these issues. While more work needs to be done on the ABA Model Act, it should serve as a guide to crafting future legislation. The passage of California AB 2426, while noble in concept, raises more problems than it resolves.

Another issue that occurred to me is that this statute may give attorney-owned surrogate agencies a competitive advantage over their non-attorney owned competitors. An attorney-owned surrogacy facilitator would be able to continue maintaining trust funds at no additional cost to their clients. For those agencies which are not owned by attorneys, they will need to require their clients to either retain the services of an attorney or escrow company at an additional cost (typically $1,500 – $2,000). As a result, those agencies that are not owned by attorneys would be disadvantaged solely due to a legislative presumption that an attorney’s fidelity and integrity are greater than that of a non-lawyer agency owner.

It also bears noting that while under this new law the escrow company must be licensed, bonded and have no conflict of interest with the surrogacy faciliator, the last two requirements do not apply to attorney owned agencies:

For purposes of this section, a nonattorney surrogacy facilitator may not have a financial interest in any escrow company
holding client funds. A nonattorney surrogacy facilitator and any of its directors or employees shall not be an agent of any escrow
company holding client funds.

So to summarize, it is acceptable for an attorney surrogacy faciliator to have a financial interest in the agency and not be bonded (or have any kind of liability coverage), but not for the escrow company. Throw in the additional conflict of interest that exists when the attorney-owned and operated surrogacy agency is also representing the Intended Parents, and the Surrogate in a legal capacity and you have accomplished little to address the overriding concerns in this industry. Parenthetically, under the ABA Model Act, the Gestational Carrier’s compensation has to be placed in escrow with an independent escrow agent prior to the commencement of any medical procedures. Notably, there was no special exception for attorneys or agencies owned by attorneys.

Lastly, given the language of §7960(a)(1), it is unclear whether the law applies to out-of-state surrogacy agencies who solicit California Intended Parents and/or Surrogates. If so, it means all agencies who work with California Intended Parents and/or Surrogates will not be permitted to maintain trust funds but instead would have to require their clients to retain the services of an escrow company or a California attorney. While a boon for California based, attorney-owned surrogacy agencies, it will have an anti-competition impact nationwide while potentially limiting the ability of out-of-state agencies (and their Intended Parents) to work with California Surrogates.

Again, I cannot help but to cynically think that there was an ulterior agenda behind this legislation and we have lost out on an important opportunity to pass serious and meaningful legislation that would protect the infertility community. I also have to wonder if this statute is so infirmed that it would not survive a judicial challenge.

No Words To Describe

Featured Post

Baby Morals: Nature Or Nurture?

A fascinating take on the moral lives of babies:

[O]ur initial moral sense appears to be biased toward our own kind. There’s plenty of research showing that babies have within-group preferences: 3-month-olds prefer the faces of the race that is most familiar to them to those of other races; 11-month-olds prefer individuals who share their own taste in food and expect these individuals to be nicer than those with different tastes; 12-month-olds prefer to learn from someone who speaks their own language over someone who speaks a foreign language. And studies with young children have found that once they are segregated into different groups — even under the most arbitrary of schemes, like wearing different colored T-shirts — they eagerly favor their own groups in their attitudes and their actions…

The aspect of morality that we truly marvel at — its generality and universality — is the product of culture, not of biology. There is no need to posit divine intervention. A fully developed morality is the product of cultural development, of the accumulation of rational insight and hard-earned innovations. The morality we start off with is primitive, not merely in the obvious sense that it’s

…

Asides

• We are re-tooling the blog by giving it a complete face lift. So please excuse the mess as we are updating it. #