[Editor’s Note: Jennifer Lahl is the president of the Center for Bioethics and Culture. She has 25 years of experience as a pediatric critical care nurse, a hospital administrator, and a senior-level nursing manager. Lahl’s feature film, #BigFertility, looks at the business behind fertility medicine. She spoke to Charles Camosy about her work.]
Camosy: Tell us a bit about the “state of play” currently with artificial reproductive technologies (ARTs). How often are they being used? What is your sense of trajectories for its use in the future?
Lahl: This is really a moving target as the technology as well as the laws around the use of these novel technologies are always changing. I just read today about a new assisted reproductive technology used by a lesbian couple that allowed both of the women to “carry the baby” before birth. It’s being called ‘effortless reciprocal’ in vitro fertilization (IVF).
Another news story recently reported on a single business man who has eight children via surrogacy. As far as the laws go around ART and especially, third-party ART (using “donor” eggs or sperm or surrogate mothers), that too is a moving target as one country forbids or outlaws one practice and the market moves to another country. My sense is this is a growth industry though and many of the financial news outlets are reporting that this industry will be valued at $30 billion by 2023.
You made a film about surrogacy titled #BigFertility. Why did you choose to focus on this aspect of ARTs?
As a nurse, I’ve always been troubled by the ethics or lack of ethics in using another person’s body to help another person, or couple have a baby. These are still relatively new technologies, so we are still learning the risks to women and children’s health as we go. Second, money plays a coercive role in informed consent and decision-making since we know it is typically low- or lower-income women who make the decision to sell their eggs or ‘rent’ their wombs.
There are very few instances where medical doctors will use non-patients who are financially compensated to do something with their body which may be harmful to them. When we see how organ donation is practiced in the U.S., first we know that those who decide to be a living organ donor benefit from years of research: First, in animal testing and then in clinical trials using humans. Safety has always been at the forefront of organ donation and the policies around the practice. Is this safe? How do we know it is safe? This gives informed consent meaning. Also, organ donation policy prohibits compensation as we don’t want people to make decisions based on financial need that is not in their own best health interest.
This is not the case when asking women to sell their eggs as no long term safety studies have ever been done. As it relates to the risks to surrogate mothers and the children they carry, we are just now beginning to get some serious studies in the medical literature that shows this is risky to women and the babies.
It troubles me deeply, that the medical profession is willing to risk the health of otherwise healthy women, who are not patients. Adding to this unethical use of the woman’s body is the corruption of paying women to risk their health. So, just like “Big Tobacco” or “Big Pharma” – which is more interested in profits and not the health of people – “Big Fertility” has a profit motive bottom line that doesn’t concern itself with the health of those whose bodies they need to “help” someone else. We thought it was important to point out that fertility medicine has become another money driven industry and has lost its ethical road map in practicing proper medicine.
Catholic social teaching focuses a lot on social structures of sin, especially consumerism. How is consumerism related to what’s happening with #BigFertility?
I agree that consumerism is not a virtue, especially when it comes to exploiting others for our gain. Consumerism is at the heart of #BigFertility. In this film, you will meet a surrogate mother who carried twins for a couple in Spain, where all surrogacy is illegal. This couple paid an extra $5,000 to have a girl and a boy embryo transferred because they wanted a child of each sex. What happened in this case though is the girl embryo didn’t implant and the boy embryo naturally twinned. This particular couple was very mad because they didn’t get what they paid for and had ordered. If that is not consumerism, then I don’t know what is.
Sadly, this sort of story and attitude around ordering children to our specifications because we have money to spend is all too common. As the famous movie GATTACA portrays, ‘why leave anything to chance’ when we can control and have the children of our own desires.
Few understand that the U.S. is quite different from most of the rest of the world and how we view and practice surrogacy. Can you say something about this?
It’s so refreshing for me to work outside the U.S. where there are so many countries that prohibit surrogacy or have changed their laws to shut down their borders and close loopholes. Many countries rightly view surrogacy as a human rights violation to women and children.
A leading French feminist (who is part of our international campaign StopSurrogacyNow) said in the Huffington Post that surrogacy is, “a matter of violence against women” and that it makes “pregnancy and childbirth a paid service (that is) the most formidable violence against women since the time of Slavery.” Renate Klein, a leading feminist in Australia has a new book out, Surrogacy: A Human Rights Violation.
But here in the U.S. and Canada, we believe the myth that surrogacy can be properly carried out with strong contracts and adequate laws and regulations. Of course, when we push against that narrative we realize that you can never legislate health risks away.
In 2015, an American surrogate named Brooke Brown died. She was carrying twins for a couple in Spain (again, where surrogacy is illegal) who also died, one day away from a schedule full-term pregnancy that had otherwise been uneventful until Brooke suffered placental abruption. What laws, regulations or contractual protections could have been in place that would have saved these three lives? None.
As consumerism and the technological imperative push the developed West in terrible and often dehumanizing directions, many of us–across party lines–have a deep sense that something about this direction is wrong. In your work, have you come across people from diverse political backgrounds who have this sense about #BigFertility?
I love the work that I am privileged to do with a very diverse coalition. When you see these issues as violating the rights of human beings and denying humans the dignity of not treating them as commodities – egg vendors, “gestational carriers” – you can build a big tent. Many people agree with my concerns about the economic injustices, the real risks to maternal/child health as well as the commercial industry that is set up to pit the wealthy against the poor.