Pope Francis' misguided call for a ban on surrogacy

In a recent speech, Pope Francis deemed surrogate motherhood “deplorable” and called for a universal ban on its use. He asserted that surrogacy represents “a grave violation of the dignity of the woman and the child.”

The Pope is partially right. Monitoring commercial surrogacy or pregnancy for hire in poor nations needs improvement. Regulations in wealthy nations need to be upgraded as well. Too often, surrogates hired in the U.S. are exploited; in many states, they lack independent legal counsel and a clear exposition of their rights. Efforts are underway to change that. For example, New York State is considering legislation to better protect surrogates and the children they help create.

The Pope’s condemnation ignores the fact that commercial surrogacy is not the only mode of surrogacy. And not all instances of commercial surrogacy threaten the “dignity of the woman and the child.”

The Pope is misguided in lumping in cases of gestational surrogacy motivated by love and altruism, which are praised in the Bible and the Torah, with commercial surrogate arrangements in which abuses are far more likely to occur. When a sister volunteers to help another sister who lost her uterus due to disease, that act of altruism ought to be seen as commendable, pro-life and respectful of the bonds among family members.

Who seeks surrogacy? In the overwhelming majority of cases, the intended parent is physically unable to carry a pregnancy. Cancer survivors' reproductive systems might be damaged by the surgery, chemotherapy or radiation needed to treat their cancer. Conditions such as lupus and diabetes can make it unsafe for women to carry a pregnancy. Some women are simply too medically frail to carry a baby safely to term.

For others, such as those born with an intersex or genetic polymorphism and without a functional uterus but who identify as women, gestational carriers are the only option for biologic parenthood.

Who is willing to be a surrogate? People who neither intend nor desire to be the parent of any resulting child. They are, however, not “trafficking in” or selling children. Surrogates are participating in an efficacious, medically safe process, and thus give one of the most priceless gifts one person can give another. This is true whether they are fairly compensated or, as the Pope’s condemnation unfortunately ignores, are doing so altruistically, as sisters, mothers or friends.

Compensated carriers have complex contracts and transparent regulations related to reimbursement that can lead to exploitation. Often, reimbursement is only for direct medical expenses and lost time from employment. No one becomes independently wealthy from serving as a gestational carrier. Legitimate uncompensated expenses for surrogates often include day care, quality food, health insurance and transportation.

Often, surrogates have already had their own children and now want to help others realize their dreams of parenting a genetically related child. They may also need money. Those mixed motivations for entering into commercial surrogacy don’t fit well under the Papal description of “deplorable.”

As for adoption, that is a complicated, expensive and often a lengthy process. Few infants are available through public adoption, and a current or prior medical condition such as cancer or diabetes might exclude women from eligibility.

Children come into our lives in many ways. All are a gift. As the Pope said, “A child is always a gift.” Let’s not broadly limit how those gifts are delivered. Commercial surrogacy needs reform. But the need for reform does not justify prohibition.

This guest essay reflects the views of NYU Grossman School of Medicine faculty Arthur Caplan, professor of bioethics, and Gwendolyn Quinn, professor of obstetrics and gynecology.