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Marek Vácha 2011. Surogační matka  Surogační mateřství – zahrnuje rozhodnutí ženy otěhotnět a porodit dítě, které zamýšlí po porodu předat jiné ženě/páru,

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Prezentace na téma: "Marek Vácha 2011. Surogační matka  Surogační mateřství – zahrnuje rozhodnutí ženy otěhotnět a porodit dítě, které zamýšlí po porodu předat jiné ženě/páru,"— Transkript prezentace:

1 Marek Vácha 2011

2 Surogační matka  Surogační mateřství – zahrnuje rozhodnutí ženy otěhotnět a porodit dítě, které zamýšlí po porodu předat jiné ženě/páru, která sama není schopna otěhotnět a která pověřila tuto ženu těhotenstvím. Je to „objednávající pár“ („commissioning couple“) kdo se ujme výchovy dítěte poté co jej surogační matka porodí. „Objednávajíccí rodiče“ mohou být genetickými rodiči dítěte, pokud bylo dítě počato technikami IVF.



5 Surrogate Mothers Combination of Gamets 1. those of the husband and wife 2. husband´s sperm and a donated egg 3. the wife´s egg and donated sperm 4. donated sperm and donated eggs from a woman other than surrogate mother 5. the surrogate mother´s egg inseminated by the husband´s sperm 6. the surrogate mother´s egg inseminated by donated sperm

6 Surrogate Mothers Combination of Gamets 1. those of the husband and wife 2. husband´s sperm and a donated egg 3. the wife´s egg and donated sperm 4. donated sperm and donated eggs from a woman other than surrogate mother 5. the surrogate mother´s egg inseminated by the husband´s sperm 6. the surrogate mother´s egg inseminated by donated sperm   gestational surrogacy   traditional surrogacy

7 Gestational Surrogacy  the wife can produce eggs of her own but has one or more fertility problems  a malformed or absent uterus  a medical condition that would make pregnancy dangerous  severe hypertension, diabetes ro lupus  a condition that would endanger the fetus, such as phenylketonuria

8 Situace v zemích Rady Evropy  Velká Británie, Řecko a Rusko povolují surogační mateřství za jistých podmínek  Surogační mateřství povoleno v dalších zemích: Argentina, Australia, Brazil, Canada, Ecuador, Hong Kong, Iran, Israel, Korea, South Africa and the United States.

9 Intermezzo: Rada Evropy  Vznik a členství Rada Evropy, založená v roce 1949, je nejstarší politickou organizací na kontinentu. Rada Evropy: sdružuje 46 zemí, včetně 21 států střední a východní Evropy; status pozorovatele poskytla dalším 5 zemím (Vatikán, Spojené státy americké, Kanada, Japonsko a Mexiko); odlišuje se od Evropské unie, která sdružuje 25 států. Avšak žádná země dosud nevstoupila do Evropské unie, aniž by před tím nebyla členem Rady Evropy; má své sídlo ve Štrasburku v severovýchodní Francii.  Cíle Rada Evropy byla zřízena k: ochraně lidských práv, parlamentní demokracie a zákonnosti; rozvoji celoevropských dohod ke standardizaci sociálních a právních postupů členských zemí; podpoře informovanost o evropské identitě, jež je založena na společných hodnotách a zahrnuje rozdílné kultury.

10 Intermezzo: Rada Evropy členské státy  "bývalá jugoslávská republika Makedonie„, Albánie, Andorra, Arménie, Ázerbajdžán, Belgie, Bosna a Hercegovina, Bulharsko, Chorvatsko, Česká republika, Dánsko, Estonsko, Finsko, Francie, Gruzie, Irsko, Island, Itálie, Kypr, Lichtenštejnsko Litva, Lotyšsko, Lucembursko, Maďarsko, Malta, Moldavsko, Monako Německo, Nizozemsko, Norsko, Polsko, Portugalsko, Rakousko, Řecko, Rumunsko, Rusko, San Marino, Slovenská republika, Slovinsko, Srbsko, Turecko, Ukrajina, Velká Británie, Španělsko, Švédsko, Švýcarsko

11 USA  1987  $ for the surrogate mother  $ for the lawyer  $ for the medical expenses involved and for the maternity clothes  1994  $  The couple´s joint annual income exceeded $ , whereas the surrogate´s annual income was $ 8 000

12 Techniky asistované reprodukce  homologní fertilizace (AIH Artificial Insemination Husband) = dárci gamet je rodičovský pár  heterologní fertilizace (AID Artificial Inseminaion Donor) = dárci spermie/oocytu je osoba mimo rodičovský pár

13 Mateřství  genetická matka  gestační matka  sociální matka  … v ideálním případě je to jedna osoba

14 Gestational mother  Nemá žádné genetické vztahy k dítěti  Nemá v úmyslu být sociální matkou  gestational bonding - vznik citové vazby mezi gestační matkou a dítětem

15 Surogační mateřství  „komerční surogace“  „altruistická surogace“

16 Arguments for/against surrogacy  of the estimated four thousand children born to surrogates from the late 1970s to the early 1990s, only twelve surrogacy- related cases have been filled in American courts  Dorff, E.N., (2003) Matters of Life and Death. A Jewish Approach to Modern Medical Ethics. The Jewish Publication Society, Philadelphia, PA, p.59

17 Arguments for surrogacy  it enables infertile couples to have children with the gamets of at least one of them

18 Arguments for surrogacy  Surrogate mothers are not generally black and poor  the typical surrogate mother was twenty-eight years old, married with children, employed full- time, and had thirteen years of education. Her husband was supportive of her decision to serve as a surrogate. Most were Caucasian, middle-range in income bracket, in good health, and had positive experiences in past pregnancies. While money was a factor in choosing to become a surrogate, it rated consistently lower than the desire to help another couple. (Rabbi Spitz, 1996)

19 Arguments against surrogacy  surrogacy will accentuate the social and economic differences between relatively rich couple and lawyer as against the relatively poor surrogate mother  argument of „inherent slavery“  surrogacy widens the gap between the races and classes „in a womb/pregnancy market“  only the rich will be able to pass down their genes in this way

20 Arguments against surrogacy  a feminist approach:  since surrogacy contracts typically limit a woman´s sexual activity after insemination, govern the drugs and foods she can consume, and have attempted in some cases to remove her option of abortion, surrogacy verges on the enslavement of women (Carole Patman)

21 Arguments against surrogacy  And so some see paid surrogacy as akin to prostitution in which a woman sells (or rents) her body to a client willing to pay for it. Reproductive organs are purchased by patrons of surrogacy just as sexual organs are purchased by patrons of prostitutes.  In both cases, women are being valued for--and frequently reduced to--biological capacity.  A related point voices concern about how paid surrogacy renders those women who are already economically marginalized even more vulnerable to coercion and manipulation by those with greater means. 

22 Arguments against surrogacy  prostitution is in some sense a degradation of oneself - in the same sense that prostitution is a degradation primarily because it entails the loveless surrender of one´s body to serve anothe´s lust, and only derivatively because the prostitue is paid.  it is also to deny the meaning of the bonds among sexuality, love and procreation  Kass, L.R., (2002) Life, Liberty and the Defense of Dignity. Encounter Book, New York, London. p. 101

23 Arguments against surrogacy  the buying and selling of human flesh and the dehumanized uses of the human body ought not to be encouraged.  Kass, L.R., (2002) Life, Liberty and the Defense of Dignity. Encounter Book, New York, London. p. 101

24 Arguments against surrogacy  in ovum surrogacy using the husband´s sperm (the most common type of surrogacy), the wife is being asked to raise a child who is genetically her husband´s but not hers - and one carried by another woman to boot.

25 Explanatory Memorandum by Mr Michael Hancock Historická situace  The first historical reference to surrogacy arrangements is in the Old Testament (Genesis 16 and 30). In Ancient Rome, arrangements of this kind were made in order to continue the lineage in spite of infertility and maternal and infant mortality[i].  In some African communities, an infertile woman may marry a fertile woman, who conceives a child with the infertile woman’s husband; the child is considered to be the child of the infertile woman. There are other possible approaches: conceiving a child by the brother of the infertile husband or the sister of the infertile wife, adoption, etc.…”in most parts of Africa, biological parenthood is deemphasized to the advantage of social parenthood”[ii]. Such practices are widespread in many other cultures[iii].  [i] Thomas, I. Histoire de la famille. Monde lointain. A. Burguière (ed.)  [ii] Giwa-Osagie O. Social and ethical aspects of assisted conception in anglophone sub-Saharan Africa. In Current practices and controversies in assisted reproduction. WHO, health/infertility/report.pdf health/infertility/report.pdf  [iii] Daniels K., The policy and practice of surrogacy in New Zealand. In Surrogate Motherhood- International perspectives. Hart Publishing

26 Explanatory Memorandum by Mr Michael Hancock Po narození  As a general rule, the parents remain in contact with the gestational mother after the birth of the baby by sending cards and photographs and/or getting together. In the most successful cases, “the perfect journey”, a very close and lasting relationship is formed, particularly between the two women[i].  The term “sister” or “friend” is often used to describe the new relationship created by the surrogacy arrangement: “For all participants, it was more than a simple business arrangement that would automatically terminate once the baby had been delivered to the commissioning parents”.  [i] Kleinpeter, et al. (2001). Satisfaction with surrogate mothering: A relational model. Journal of Human Behavior in the Social Environment, 4 (1), 61-84

27 Explanatory Memorandum by Mr Michael Hancock Emočně obohacující zkušenost  Overall, the gestational mothers found it to be an emotionally enriching experience without any negative effects on them or their families[i].  Gestational mothers may be more interested in the pregnancy – which allows them to attain their ideal self-image – than in the foetus itself: they may feel “stronger, solid and more confident than is their usual experience of themselves”. Comparing their own pregnancies with carrying a child for someone else, they are quick to acknowledge that the baby isn’t their own. Many refer specifically to the joy of being pregnant, saying that surrogacy allows them to be pregnant and to give birth without the responsibility of bringing up the child.  [i] Brazier al. Surrogacy - Review for health ministers of current arrangements for payment and regulation. 1998

28 Explanatory Memorandum by Mr Michael Hancock Záruka non-komercionalizace  The principle of non-commercialisation of the human body  This principle complements the first and states that agreements which treat the human body, its products or parts as financial assets are prohibited. However, in many countries, sperm and egg donation give rise to payment: “There should be no compensation to…donors for providing the oocytes. However, this does not exclude the reimbursement for expenses, time and risk which are associated with the donation” (IFFS international consensus on assisted procreation, 2001).  Similarly, as regards protocols relating to medical research with no direct benefit,  Recommendation R(90) 3 of the Committee of Ministers to the member States concerning medical research on human beings states that: ”expenses and any financial loss may be refunded and in appropriate cases a modest allowance may be given for any inconvenience inherent in the medical research”.

29 Explanatory Memorandum by Mr Michael Hancock Tradiční rodina je mýtus  …this is part of the reason why it has been more readily accepted than surrogacy arrangements. However, births outside marriage, reconstituted families, single- parent families, adoptive families and same- sex parenting have created a host of alternatives, and the traditional family is now just one of many forms of family. In this context, surrogacy arrangements may be seen as just another means of starting a family. The “family” argument used against surrogacy arrangements is ill-founded, unless one wishes to condemn everything which falls outside the parameters of the traditional family.

30 Explanatory Memorandum by Mr Michael Hancock Pozitivní energie pro obě strany  The decision to “work” together sometimes comes from the gestational mother, but is most commonly a joint decision. It is based on objective criteria, but is above all an instinctive choice based on a “gut feeling” between the two women: "Two thirds of the surrogates and intended mothers interviewed described instances of immediately recognising one another at first sight even though they were strangers".  The fear of failure (not finding the right gestational mother, medical treatment ultimately proving unsuccessful) and worries about the conduct of the gestational mother during the pregnancy are the most testing aspects 25, 28, 29. “The best part is having this incredible child who came from so many people putting positive energy together and that those people are still in touch with each other”.  Hence, this is not some impersonal, dehumanised agreement, but a relationship based on mutual, intimate and deep-seated recognition in pursuit of a common goal.

31 Explanatory Memorandum by Mr Michael Hancock Konkrétní kasuitika  One of the chief motivations for gestational mothers is to build a strong relationship with the couple[i]:  "I personally didn't want to reduce my chances of a great relationship based on money alone.[…] my numbers were in the average range (20k), but I was willing to settle at $3500 […] because my IP's lived so close AND because they are such wonderful people ! I personally don't want this to be all about numbers".  [i]

32 Ethical Concerns  what the payment is for?  is it for „the apparatus“ for nine months, or for the baby?  if it is for the baby, then we have gotten into the question of the legitimacy of selling humans  what if the birth mother changes her mind?  Kantians will probably find the whole practice of surrogacy problematic since the birth mother is clearly being used as an incubator and not regarded as a rational factor  but the women is simply using her body like any manual laborer

33 Surogační matka  „Přijde, otěhotní, odnosí, porodí, odevzdá, odejde, může se odlíčit, umejt a jít domů.“  Je tak altruistická, že spolkne jen tak všechny rituály spojené s početím, devět měsíců ne právě nejpohodovějšího života zakončených porodem, po němž bude následovat totální masakr všech biologických, psychologických i spirituálních mechanismů, jež se k mateřství pojí?  V době své plnoletosti má člověk právo znát své pravé biologické rodiče; co asi prožije jedinec v tomto kritickém, ne ještě zcela zralém věku, až se dozví, že si jeho „výrobu“ jaksi objednali, že ho porodila jakási „děloha na leasing“ z gamet, které poskytly nějaké spermabanky nebo ovobanky?  (Radkin Honzák)



36 A surrogate mother who changed her mind about giving her baby to a couple will be allowed to keep her, a judge ruled yesterday. After getting married in 2005, Mr and Mrs W were unable to have a baby following a series of miscarriages. The mother and the couple, known only as Mr and Mrs W, met over the internet in 2009 and made an informal agreement that a baby, fathered by Mr W, would be handed over once born. During the pregnancy the surrogate mother changed her mind and refused to part with the baby when it was born last July. Mr Justice Baker said the now six-month-old baby, identified only as T, had bonded with her mother. "In my judgment, there is a clear attachment between mother and daughter," he said. "To remove her from her mother's care would cause a measure of harm. It is the mother who, I find, is better able to meet T's needs, in particular her emotional needs."

37 During the surrogate pregnancy relations between the trio deteriorated and legal proceedings were launched a week after the birth. Although the judge said he had "formed the clear impression" that all parties were devoted to the baby, he said it was also clear that the baby was "thriving in her mother's care." He added that there had been irresponsible behaviour on both sides, accusing Mr and Mrs W of not telling the whole truth and the mother of adopting a false persona to elicit information from the couple, falsifying a document and lying to the court. The couple had proposed to take over care of the baby immediately, which the judge said showed a "startling lack of insight" of the child's needs. Speaking on the risks of entering into surrogacy agreements, the judge said these were "very considerable." "In particular, the natural process of carrying and giving birth to a baby creates an attachment which may be so strong that the surrogate mother finds herself unable to give up the child," he said. A further hearing is set for next month with an "interim visiting contact" between the natural father, Mr W, and the baby.



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