Vector Volume 11 Issue 2 - 2017

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as well as facilitating educated discussion about the possibilities of chromosomal abnormalities or multifetal gestation, would also mitigate conflict. Antenatal and postnatal support, including mental health checks, could also be provided through this system. The exclusion of profiting intermediaries increases the likelihood that the interests of all parties would be equally considered, rather than sacrificing the surrogate’s health and experience in favour of maximising profits. Moreover, any surrogacy arrangements would still be constrained by Australia’s existing common law and family law. This ensures that the surrogate maintains all the decisionmaking powers throughout the pregnancy, including her rights to access termination of pregnancy and to bodily autonomy. In terms of the appropriate compensation, it seems prudent to set both a minimum and a maximum limit. Pregnancy is unavoidably risky for a woman, and gestating a growing fetus is no easy task. Why should it not, like many other jobs, receive recompense proportionate to the task? Moreover, pregnancy is intrinsically care-based ‘women’s work’, which is still insidiously undervalued even in modern times. Conversely, to titrate the price of surrogacy to the intensity of a commissioning couple’s desire for a child is hardly ethical. The US can shed light on what prices may look like in an uncapped surrogacy market; the estimated reimbursement for surrogates advertised by leading US agency Circle Surrogacy, not including medical or otherwise associated expenses, is US$30,000.[18] Most couples experiencing infertility would struggle to pay this price, which does not include medical and legal costs. The aim of setting both minimum and maximum limits on a surrogate’s compensation is to strike a balance between the interests of the surrogate and the commissioning parents - or more simply put, ensuring fair pay for fair work. Furthermore, a centralised agency would also offer benefits for children born from surrogacy arrangements. There would exist a database through which children could later in life track down their surrogates should they choose to, just as adopted children can request information regarding their birth origins after turning 18. The laws regarding surrogacy should be standardised across all Australian states and territories. At present, the laws are fractured and discordant, diverging on points including whether same-sex couples should be eligible to be intended parents, the legality of advertisement for surrogacy, as well as that of seeking overseas surrogates. The murky legalities of surrogacy make it confusing for surrogates without deterring commissioning parents; if they are willing to pay tens of thousands of dollars for surrogacy, they would probably be happy to travel to states with more favourable laws.[6] Challenges of decriminalisation of commercial surrogacy One might argue that by decriminalising commercial surrogacy in Australia, we simply shift the burden of exploitation from overseas to our own shores. The concern is that commercial surrogates will be uneducated and disempowered, and have little informed choice in the matter. If we assume that the demographic of paid surrogates in Australia would resemble that of the US, then this concern does not appear to be relevant.[17, 19] Small studies of commercial surrogates in the US have suggested the while surrogates do tend to have lower incomes and less education than commissioning parents, they are generally not of a vulnerable population. In one study, most had gone to college, or at least finished high 13
school, were from middle income earning families, and were in long-term relationships.[17,20] Furthermore, their primary motivation was not the money, but rather to help a couple start their families. While self-report studies do have limitations, perhaps we are too quick to assign altruistic and commercial surrogates into two camps: those who are doing it purely for selfless reasons and those who are doing it for money. The move may also be politically unpopular, with possible public resistance making the implementation slow and difficult. Moreover, creating a system which successfully protects commissioning parents, surrogates, and children born from surrogate arrangements would be a time-consuming and expensive exercise, fraught with pitfalls. Unless it is well-designed, decriminalising commercial surrogacy could perpetuate the very consequences it was designed to mitigate. Why should it not, like many other jobs, receive recompense proportionate to the task? Conclusion Our approach is not to judge the morality of surrogacy, neither promoting or undermining its value as a reproductive option relative to other methods such as adoption. The problem is a thorny and possibly intractable one, and requires careful consideration of racial politics, gender and income inequality, and human rights. Even in a moral grey zone, however, there are things which are arguably more morally reprehensible than others. Australian couples are resorting to the unregulated and deeply unethical commercial surrogacy market in developing countries, as a result of the failure of our current system. Working towards a safer, more regulated model of surrogacy should be on the Australian and international agenda. Acknowledgements The authors would like to acknowledge the contribution of ideas and research from their fellow medical students, Su Ern Poh and Eli Ivey. Photo credit http://maxpixel.freegreatpicture.com/Pregnant- Pregnancy-Pregnant-Woman-M-Mother-2640994 https://www.pexels.com/photo/pregnancy-pregnantmotherboard-parenthoof-57529/ http://www.publicdomainpictures.net/view-image. php?image=54223&picture=man-holding-newborn Conflicts of interest: None declared Correspondance keyurd12@gmail.com References 1. Company H. The American Heritage Dictionary entry: surrogate [Internet]. Ahdictionary.com. 2017. Available from: https://www.ahdictionary.com/word/search.html?q=surrogate 2. Australian Institute of Health and Welfare. Adoptions Australia 2011-12. Canberra: AIHW; 2012. Contract No.: CWS 42. 3. Baby Gammy case reveals murky side of commercial surrogacy [Internet]. The Conversation. 2014 [cited 1 October 2017]. Available from: https://theconversation.com/ baby-gammy-case-reveals-murky-side-of-commercialsurrogacy-30081 4. Crouch S, Waters E, McNair R, Power J, Davis E. Parentreported measures of child health and wellbeing in same-sex parent families: a cross-sectional survey. BMC Public Health. 2014;14(1). 5. Stuhmcke A. The regulation of commercial surrogacy: The wrong answers to the wrong questions. Journal of Law and Medicine. 2015;23:333. 6. Everingham SG, Stafford-Bell MA, Hammarberg K. Australians’ use of surrogacy. The Medical Journal of Australia. 2014;201(5):270-3. 7. Alford P. Surrogacy Scandal Widens with Southeast Asia Infant Trafficking Operation Exposed. The Australian. 2014 9 August 2014. 8. Murdoch L. Australian couples’ baby plans in limbo as Cambodia bans commercial surrogacy. The Sydney Morning Herald. 2016 4 November 2016. 9. Saxena P, Mishra A, Malik S. Surrogacy: ethical and legal issues. Indian Journal of Community Medicine. 2012;37(4):211. 10. Deonandan R, Green S, van Beinum A. Ethical concerns for maternal surrogacy and reproductive tourism. Journal of Medical Ethics. 2012;38(12):742-5. 11. Trimmings K, Beaumont P. International surrogacy arrangements: legal regulation at the international level: Bloomsbury Publishing; 2013. 12. Fact sheet - International surrogacy arrangements [Internet]. Border.gov.au. [cited 1 October 2017]. Available from: http://www.border.gov.au/about/corporate/information/factsheets/36a-surrogacy#offshore 13. Birth, adoption and surrogacy [Internet]. Smartraveller.gov. au. [cited 1 October 2017]. Available from: http://smartraveller. gov.au/guide/all-travellers/birth-death-marriage/pages/birthadoption-and-surrogacy.aspx 14. Macaldowie A, Wang YA, Chambers GM, Sullivan EA. Assisted reproductive technology in Australia and New Zealand 2010: AIHW; 2012. 15. Wodak A. The failure of drug prohibition and the future of drug law reform in Australia. Australian Prescriber. 2015;38(5):148-9. 16. Review of the Adoption Act 1984. Melbourne: Victorian Law Reform Commission; 2015. 17. Busby K, Vun D. Revisiting The Handmaid’s Tale: Feminist theory meets empirical research on surrogate mothers. Can J Fam L. 2010;26:13. 18. Circle Surrogacy. Anticipated Costs for Gestational Surrogacy [Available from: http://www.circlesurrogacy.com/ costs. 19. Jadva V, Murray C, Lycett E, MacCallum F, Golombok S. Surrogacy: the experiences of surrogate mothers. Human Reproduction. 2003;18(10):2196-204. 20. Ciccarelli J, Beckman L. Navigating Rough Waters: An Overview of Psychological Aspects of Surrogacy. Journal of Social Issues. 2005;61(21):21-43. 14
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Page 3 and 4: Contents Editor’s Note: Turning U
Page 5 and 6: Non-Health for Non-Persons: Rohingy
Page 7 and 8: Rohingyan regions of Myanmar. Force
Page 9 and 10: Individual and interpersonal While
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Page 21 and 22: Western institutions including Brow
Page 23 and 24: Key messages • Fossil fuel divest
Page 25 and 26: Coal combustion affects the water a
Page 27 and 28: is questionable. The Northern Austr
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Page 33 and 34: iced tea and coffee, and lemonade.
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Page 37 and 38: Drug Control in Australia: Where to
Page 39 and 40: and substance use programs).[9] Cri
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Page 45 and 46: et al. Concurrent outbreaks of deng
Page 47 and 48: Family, Unity and Success - Austral
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Page 51 and 52: Ultimately, the conference epitomis
Page 53 and 54: Welfare cuts to refugees, AMSA Glob
Page 55 and 56: Start where you are, use what you h
Page 57 and 58: Where to now? - Vector Journal & GH
Page 59 and 60: major hurdle. As detainee 982 (name

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