Surrogacy Done Ethically

Surrogacy done ethically with man pushing out a block with the title Ethics

In this article, we seek to explore the arguments for and against surrogacy.  In the interest of objectivity, we will consider all positive and negative angles.  It can be an emotive subject for obvious reasons, as we cannot escape the fact that surrogacy gives hope to individuals and couples who would not otherwise be able to create a family of their own.  It also comes with complex social, moral, ethical, and legal issues that must be considered.  However, when surrogacy is practiced ethically and with a solid legal foundation, surrogates’ and intended parents’ rights are protected and respected equally.


Regarding the types of surrogacies, they typically fall into two categories.  They may be compensated or uncompensated – depending upon whether the surrogate receives financial consideration for her pain and suffering during and after the pregnancy.  If a surrogate receives money for the arrangement, it is considered compensated.  If she receives no compensation beyond reimbursement of her medical and other pregnancy-related expenses, along with the insurance coverage for her, it is referred to as uncompensated. 


Some articles refer to altruistic and commercial surrogacy.  However, it can be argued that all surrogates are altruistic.  Money can sometimes be a motivation, but in a similar vein, money also motivates other vocational roles, such as doctors, nurses, or people who work for charities for a salary.  By its very nature, every surrogate puts her heart and soul into the pregnancy as she nurtures the little being developing inside her.  The definition of “Altruistic”: is the selfless concern for the well-being of others, unselfish, embodies EVERY surrogate.  Each surrogate is a unique, beautiful person, and our world should honor and adore every one of them.


In one of my consultations, an intended parent seemed scornful of surrogates and did not want to get to know her.   I asked her, “How many people do you know?”  Surprise showed on her face.  “Okay, I will help you.   Can we agree you probably know somewhere from 5 to 200 people?” I asked.  Still with a look of consternation on her face, she nods.  “Out of that many people, how many do you think are nice people, people you want to share a meal with?”  I inquired.  “Could we agree that at least 20-50, but probably more?”  Again, the nodding of the head, but now the expression is more of confusion and annoyance.   “So,” I continue, “you know at least 200 people, of which at least 50 you would consider sharing a meal with and spending time with.  But it is interesting that none of them will help you have a family.  You are asking a stranger to offer you a helping hand in achieving one of the most precious and important journeys of your life.  But despite all this, you have no interest in sharing a meal with this gracious surrogate or getting to know her.”  That magical moment – now the intended mom got it.   I can see confusion, embarrassment, and acceptance on her face.   Our conversation goes on to what she can do to make this journey as pleasant as possible for her lovely surrogate. 


Surrogacy is something unimaginably beautiful and can be undertaken ethically, and here are some thoughts for consideration:


Qualifying Criteria


  • Surrogates must be older than 25 years.
  • Surrogates must have given birth to at least one child and has, or is, raising that child.
  • Surrogates must have a history of uncomplicated pregnancy or pregnancies and their delivery records (if they can be obtained) must be approved by a qualified doctor at the fertility clinic.
  • A Surrogate must be a legal citizen or resident of the country where she signs the contract.
  • A life insurance policy covering her should be active before she begins any medication or undergoes an embryo transfer, whichever is sooner. The beneficiaries of this life insurance policy must be her family.
  • The identity of the intended parents and surrogate must be known to each other. If there is any doubt that either party would use this information to benefit themselves financially, the parties should not enter into an agreement with each other.



Mental Health Counseling


  • The intended parent(s) and the surrogate should each participate in at least one counseling session before participating in surrogacy.
  • A surrogate should undergo a psychological consultation, an evaluation, and testing before participating. Her partner (husband or significant other) should join her for part of the consultation.  However, the surrogate should also have a private, one-on-one consultation with the counselor.  The counseling sessions are more than just about evaluation but also about educating her and her partner on the process, the risks, her expectations of the process, and the kind of relationship they can expect or desire between her and the intended parents.  This consultation will be instrumental in offering proof that the surrogate voluntarily participated in surrogacy.
  • A process should also be arranged so the surrogate’s partner can talk to the counselor privately if the partner does not want her to be a surrogate. Similarly, a process needs to be discussed to provide a means to inform the counselor of her mental health situation or developments during the pregnancy.
  • Surrogates should undergo psychological testing to assist the counselor in developing a relationship, which will help get a clearer understanding of who she is and her thought processes.
Surrogacy done ethically
  • Surrogates should be entitled to participate in at least 3 group counseling sessions with other surrogate mothers. This should be over her pregnancy and at least one session within the first year after birth. This will permit the surrogate to know other women acting as surrogates and learn their feelings, concerns, joys, and disappointments. 
  • The intended parent(s) should attend at least one counseling session to discuss their expectations of the surrogacy process and their surrogate.
  • Counselors should discuss the surrogate’s unfettered right to make healthcare decisions, such as continuing or terminating the pregnancy for any reason.  If the intended parents request that she terminate a pregnancy and the surrogate elects not to, the intended parents remain the legal parents of the child with all the usual duties towards that child.  It is highly recommended that the intended parents and surrogates seek counseling to openly discuss their feelings on the termination of a pregnancy to ensure they have very similar beliefs.
  • The surrogate should be entitled to counseling sessions during and for at least six months after the pregnancy.





  • Independent and separate legal counsel must represent the intended parent or parents and surrogate.  The surrogate’s legal counsel must not have a financial conflict of interests and not be the owner or related to the owners of the surrogacy (recruiting) agency or the intended parent’s legal counsel.
  • The independent legal counsel of the surrogate cannot be employed or related by the family to the agency or intended parent. A legal clearance letter from the independent attorney is sufficient evidence that she received independent legal advice, and the letter needs to confirm that the consultation was conducted in her native language.
  • All parties must sign the contract in writing before the surrogate takes the transfer or any stimulating medication, whichever is sooner. If the surrogate cannot read or write, the legal contract must be read aloud to her and explained to her.  This interaction should be digitally recorded as proof that each step of these legal requirements was adhered to completely and is evidence that the surrogate voluntarily agreed to the terms.
  • The surrogacy contract must clearly outline the surrogate and the intended parent’s duties and rights, that the intended parents are responsible for all medical expenses arising from this surrogacy arrangement, the terms of any reimbursement to be provided to the surrogate, that the surrogate has the unilateral rights to make all health and welfare decisions regarding herself and this pregnancy and that upon birth the intended parents are to be recognized as the legal parent of the child and to be given sole custody of the child. The contract should also state that the surrogate has the right to withdraw from this contract at any time before an embryo transfer without any financial or other penalty.
  • The contract should provide that the monies needed to pay for the terms of the surrogacy contract will be held in an escrow account for the benefit of the surrogate. The agency or any other third party is not entitled to reduce or deduct any expenses from the monies paid to the surrogate unless expressly outlined in the contract.
  • The intended parent’s and surrogate’s legal counsel must issue a legal letter stating they consulted with their client, how long the consultation took, and that their client has a full legal understanding of the contract terms and was allowed to ask questions and all questions asked were answered to her satisfaction. Each attorney must sign the letter under oath that the contents of the clearance letter are true.



Surrogacy has been an ethical practice in numerous countries across the globe for nearly 40 years.  However, it is essential to acknowledge that, like in any profession, there have been instances where certain agencies, fertility clinics, and attorneys have not upheld ethical standards, resulting in significant harm to surrogates and intended parents.  Unethical practices can, unfortunately, be found in various professional fields, and surrogacy is not exempt from this issue.  The recommendations listed above are meant to guide those who want to practice surrogacy ethically, and we hope that every agency, consultant, fertility clinic, mental health professional, and lawyer will abide by these recommendations. 


Intended parents are strongly advised to discuss these recommendations openly with the individuals and agencies assisting them on their journey to parenthood. By ensuring that surrogacy is conducted ethically, we safeguard our child’s future and their rightful history.  Our collective responsibility is to provide the foundation for a positive and respected field for children born via surrogacy.



Author: Karen Synesiou, Infertility Portal Inc.