The Wrongs of Altruistic Surrogacy
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Gestational surrogacy involves conceiving a child by in vitro fertilization (IVF) or artificial insemination and then transferring the embryo to the uterus of a woman (termed the surrogate) who is not intended to raise the child. After the child is born, the surrogate gives the baby to the person or persons who initiated the surrogacy agreement as a legal adoption. Surrogacy is divided into two main types, commercial and altruistic. In the former, the surrogate mother, sometimes referred to by the awkward euphemisms “gestational carrier” or “host,” is paid for the time and inconvenience of nine months of pregnancy and delivery, and generally there are profit-making individuals and organizations like lawyers and agencies who handle the contracts and arrangements. Altruistic surrogacy, on the other hand, is supposed to be a generous act with no payment to the woman except to cover pregnancy and legal expenses.
The vast majority of surrogate pregnancies around the world are carried out as commercial surrogacy. In 2024, Pope Francis referred to these unethical acts as “deplorable.” e JHHHHHhHe called for a global ban so that the unborn child would not be turned into an “object of trafficking." Experts from 75 countries signed a Declaration of Casablanca in 2023, affirming that surrogacy in any form “violates human dignity and contributes to the commodification of women and children.” Surrogacy, especially altruistic surrogacy, is legal in a few countries on each continent, although there is a legal void in most nations. The US is a top commercial surrogacy destination country, but laws vary widely from state to state.
There are examples of altruistic surrogacy in which a sister agrees to carry a child for her brother who is in a same-sex relationship, or close family friends do it for couples suffering from infertility. Some altruistic surrogate mothers do it for religious reasons. I have even seen the biblical story of Abraham and Sarah turning their slave Hagar into a surrogate used to justify the practice. This episode from Genesis is actually a cautionary tale of how badly such arrangements can go. Hagar and her child Ishmael ended up banished and almost died in the wilderness.
It does seem that the intentions of altruistic surrogate mothers are frequently generous and involve compassion for others who are not able to carry a pregnancy successfully. Nevertheless, one can engage in an immoral action with the best motives and with a good purpose. The means used must also be ethical for an act to be morally good. Altruistic surrogacy retains most of the unethical qualities of commercial surrogacy minus the exploitation of poor women and the repugnant feature of profit-making individuals and entities.
Altruistic gestational surrogacy uses IVF and embryo transfer to achieve pregnancy. IVF is condemned by the Church as a serious offense against the dignity of the human person and may never be done licitly. Generally, surrogacy aggravates the evil of IVF by heterologous artificial fertilization—that is to say, using third party gametes to conceive the child. In modern surrogacy, the baby carried by the surrogate mother is almost never biologically hers. There are practical legal reasons for this, as a surrogate who is also the biological mother of the baby has a much stronger case if she refuses to surrender the child to the contracting intended parents. Thus, altruistic surrogacy also divides the parenthood of the child in ethically problematic ways. This can go to the absurd heights of five separate carefully planned parents; a biological mother and father, adoptive parents, and the “mother” who carries the pregnancy.
It is telling that when agencies that promote surrogacy speak of altruistic surrogacy they speak of its “pros and cons.” First on the list is the strain on relationships. In most cases, the surrogate mother knows or is related to the intended recipient or couple, so the emotional and physical strains on the surrogate are not easy to ignore. The pain of separation from the child carried for nine months is much simpler to dismiss when the surrogate mother is a stranger who lives far away. It is quite difficult to find a woman willing to go through pregnancy and give up the baby to others without being paid. This is an important reason why in Australia they are debating a proposal to legalize commercial surrogacy despite altruistic surrogacy being allowed. Also, if the surrogate mother is acting altruistically, it is much less straightforward for those arranging the pregnancy to demand an abortion if the preborn child is diagnosed with genetic anomalies or “fetal reduction” from twins to a singleton pregnancy.
From a Catholic perspective, it is unacceptable for a woman to lend her reproductive organs to others. The donation and transplantation of reproductive organs such as ovaries and testes are not permitted by the Church. A good summary of why any form of surrogacy is immoral can be found in the Catechism of the Catholic Church.
Techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uterus), are gravely immoral. These techniques (heterologous artificial insemination and fertilization) infringe the child’s right to be born of a father and mother known to him and bound to each other by marriage. They betray the spouses’ “right to become a father and a mother only through each other” (CCC 2376).
Infertility is a great cross, but overcoming this medical problem should never be achieved by using immoral means. All forms of surrogacy are offenses against the rights of children and parents. Women may volunteer to do this with altruistic intentions, but there are many injustices inherent to all forms of gestational surrogacy.
Joseph Meaney received his PhD in bioethics from the Catholic University of the Sacred Heart in Rome. His doctoral program was founded by the late Elio Cardinal Sgreccia and linked to the medical school and Gemelli teaching hospital. His dissertation topic was Conscience and Health Care: A Bioethical Analysis. Dr. Meaney earned his master’s in Latin American studies, focusing on health care in Guatemala, from the University of Texas at Austin. He graduated from the University of Dallas with a BA in history and a concentration in international studies. The Benedict XVI Catholic University in Trujillo, Peru, awarded Dr. Meaney an honorary visiting professorship. The University of Dallas bestowed on him an honorary doctorate in Humane Letters in 2022.