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The Yale Journal of Biology and Medicine Sep 2022: This article explores the social media discourse on transnational surrogacy and the issue of surrogacy more broadly considering recent news about the Chinese celebrity...
: This article explores the social media discourse on transnational surrogacy and the issue of surrogacy more broadly considering recent news about the Chinese celebrity Zheng Shuang, which revealed that she had hired a surrogate mother in the United States and had later abandoned the surrogate babies. It aims to provide insight on how Chinese citizenry uses social media to express opinions on ethical and legal issues concerning surrogacy. : We conducted a content analysis of microblogs from the social media platform Weibo posted within a month after the event was reported on January 17, 2021. The entire data set included 37,895 posts, which were analyzed for topic exploration using word frequency and keyword co-occurrence techniques, and a smaller sample of 1,000 posts was selected for an in-depth content analysis. : We established that the words "Zheng Shuang," "surrogacy," "babies," "abandoning babies," and "Zhang Heng" were most frequently used, with "law," "ethics," "justification," "legality," and "illegal" sharing high connections with these keywords. The qualitative content analysis further established that 399 microblogs (39.9%) expressed value judgements towards Zheng Shuang's surrogacy, and 61.9% (n=247) opposed her surrogacy, while only 7.0% (n=28) were supportive. The major reason (n=72) against the celebrity's surrogacy was that it was unfair and risky to surrogate children in this case. One hundred twenty-eight posts made value judgements towards surrogacy in principle, with 115 opposing surrogacy, and only two supportive posts. We also established that users with legal background had very limited presence in surrogacy discussions on Weibo, while users from healthcare professions did not engage at all in the social media debate. : Opposition to surrogacy in Chinese social media discourse is primarily based on ethical and moral objections. The protection of surrogate children and surrogate women's rights was the major concerns expressed by social media users, suggesting that this issue would likely be at the center of a future public debate regarding the regulation of surrogacy. We found the lack of healthcare professionals' perspectives in social media discussions on Zheng's Surrogacy disconcerting and suggest their inclusion in public deliberations to ensure that the public is better educated, and substantive concerns are properly addressed.
Topics: Child; China; Female; Humans; Social Media
PubMed: 36187413
DOI: No ID Found -
Fertility and Sterility May 2020This article aims to identify the main legal and ethical issues around international surrogacy. Owing to the legal diversity and ethical background of such a globalized... (Review)
Review
This article aims to identify the main legal and ethical issues around international surrogacy. Owing to the legal diversity and ethical background of such a globalized practice, a review of the key existing literature on these two matters has been identified and analyzed. The article also identifies and analyzes the most significant legal solutions provided by supranational jurisdictions when dealing with cases of international surrogacy. The scope of the article includes the efforts to reach a minimum legal framework at the international level, with the aim not to standardize but to provide common legal solutions to those travelling abroad to have a child by means of surrogacy.
Topics: Female; Humans; Internationality; Medical Tourism; Policy Making; Pregnancy; Reproductive Medicine; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 32327242
DOI: 10.1016/j.fertnstert.2020.03.003 -
Archives of Disease in Childhood Feb 2021Surrogate pregnancies are becoming more common, but the law governing who can give consent following surrogate births is complex. Parental responsibility (PR) may be...
Surrogate pregnancies are becoming more common, but the law governing who can give consent following surrogate births is complex. Parental responsibility (PR) may be held by a variety of individuals, depending on the specific circumstances.We conducted a survey of paediatric medical staff within Health Education South West to establish knowledge regarding consent for a baby before a parental or adoption order is obtained. Our results showed that 19% of the 47 respondents answered all scenarios correctly. 43% of respondents knew that the surrogate mother had PR in all scenarios; however, 13% incorrectly assumed that either intended parent always had PR. Knowledge of other individuals who could provide consent in the scenarios was variable.Our survey revealed poor understanding regarding medicolegal aspects of consent in these complex situations, emphasising the need for more specific published guidance for primary and secondary healthcare professionals encountering these babies in the early postnatal period.
Topics: Female; Health Personnel; Humans; Infant, Newborn; Informed Consent; Male; Pediatrics; Practice Patterns, Physicians'; Pregnancy; State Medicine; Surrogate Mothers; Surveys and Questionnaires; United Kingdom
PubMed: 31937569
DOI: 10.1136/archdischild-2019-318172 -
The Medico-legal Journal Sep 2020Surrogacy is a controversial issue and most particularly when well-known celebrities have used it. It is a boon for couples where normal pregnancy is not possible but...
Surrogacy is a controversial issue and most particularly when well-known celebrities have used it. It is a boon for couples where normal pregnancy is not possible but can be used for commercial exploitation. The Government of India passed a law on surrogacy in December 2018, which introduced many changes to the pre-existing rules, in particular, it bans commercial surrogacy and curtails the freedom of foreigners to apply for surrogacy in India. This has dealt a major blow to the agencies who organised surrogacy for foreigners. A key reason for passing this law was the unjust treatment of the women who provided surrogacy services. They had poor living conditions and often failed to receive the money that was paid by the intended parents to the agency. There are some countries where commercial surrogacy is legal, including some states in the United States of America, Poland, Russia and many others. Some surrogate mothers suffer complications from the assisted reproductive technologies used; these mainly include ectopic pregnancy, psychological stress and ovarian hyper stimulation syndrome. Same sex couples, single parents and even infertile women should be encouraged to adopt children.
Topics: Health Status; Humans; India; Internationality; Surrogate Mothers
PubMed: 32216696
DOI: 10.1177/0025817219891881 -
Fertility and Sterility May 2020Gestational surrogacy, made possible with the introduction of in vitro fertilization, has expanded family building options while introducing novel challenges to... (Review)
Review
Gestational surrogacy, made possible with the introduction of in vitro fertilization, has expanded family building options while introducing novel challenges to established legal principles involving constitutional, contract, and family law as well as duty of care and negligence. Both legislatures and courts have grappled with how to apply these sometimes-competing areas of law to protect participants and professionals, and to create legally secure families. This article explores the following: the Constitutionally protected rights of privacy and reproductive autonomy of gestational surrogates; Contract Law principles that govern surrogacy contracts; the varied ways states have extended Family Law to establish legally recognized parent-child relationships between intended parents and children born to gestational surrogates; and the legal duties of care medical professionals owe to their patients.
Topics: Confidentiality; Female; Humans; Personal Autonomy; Policy Making; Pregnancy; Reproductive Behavior; Reproductive Medicine; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 32327239
DOI: 10.1016/j.fertnstert.2020.03.015 -
Irish Journal of Medical Science Aug 2021Reproductive surrogacy can be altruistic or commercial, each with complex ethical considerations that are complicated by heterogeneity in governing laws across... (Review)
Review
Reproductive surrogacy can be altruistic or commercial, each with complex ethical considerations that are complicated by heterogeneity in governing laws across jurisdictions. Surrogacy in Ireland is relatively new and largely unregulated, so this review aims to elucidate its current regulatory status and associated ethical issues. AIMS: On reproductive surrogacy from an Irish legal perspective, to: 1. Illustrate the lack of established legislation 2. Describe draft statute 3. Demonstrate the inadequacy of current non-statutory regulation 4. Examine European and Irish Constitutional Law 5. Exhibit challenges in case law for parenthood: i. The lack of recognition of intent to conceive compared to non-Irish jurisdictions ii. The lack of recognition of international surrogacy iii. The lack of procedures to transfer legal parenthood iv. The legal/medical/religious/socioeconomic consequences of 5] i, ii, iii On reproductive surrogacy from an Irish ethical perspective, to: 6. Analyse ethical issues in altruistic surrogacy 7. Evaluate ethical issues specific to commercial surrogacy: i. Financial and emotional exploitation ii. Commodification of children and women's bodies iii. Child welfare iv. Healthcare inequality CONCLUSION: Irish reproductive surrogacy exists in a legislative vacuum and is poorly governed by non-statutory regulation. However, Ireland is free to draft laws aligned with modern societal views on reproduction, which is especially relevant given the recent legalisation of same-sex marriage. Ethically, carrying mothers and children are vulnerable, particularly in commercial arrangements, with significant financial disparities between commissioning and surrogate parties. Altruistic arrangements can be a boon to Irish society if supported by public education and appropriate legal frameworks.
Topics: Child; Female; Humans; Ireland; Mothers; Pregnancy; Reproduction; Surrogate Mothers
PubMed: 33131030
DOI: 10.1007/s11845-020-02402-4 -
Clinical and Molecular Hepatology Oct 2023The current requirement for biomarkers to detect hepatitis B virus (HBV) infection is polarized. One is a fully-automated and highly sensitive measurement system; the... (Review)
Review
The current requirement for biomarkers to detect hepatitis B virus (HBV) infection is polarized. One is a fully-automated and highly sensitive measurement system; the other is a simple system for point-of-care testing (POCT) in resource-limited areas. Hepatitis B core-related antigen (HBcrAg) reflects intrahepatic covalently closed circular DNA and serum HBV DNA. Even in patients with undetectable serum HBV DNA or HBsAg loss, HBcrAg may remain detectable. Decreased HBcrAg levels are associated with reduction of the occurrence of hepatocellular carcinoma (HCC) in chronic hepatitis B. Recently, a fully-automated, novel high-sensitivity HBcrAg assay (iTACT-HBcrAg, cut-off value: 2.1 logIU/mL) has been developed. This attractive assay has been released in Japan very recently. iTACT-HBcrAg can be useful for monitoring HBV reactivation and prediction of HCC occurrence, as an alternative to HBV DNA. Moreover, monitoring HBcrAg may be suitable for determining the therapeutic effectiveness of approved drugs and novel drugs under development. Presently, international guidelines recommend anti-HBV prophylaxis for pregnant women with high viral loads to prevent mother-to-child transmission of HBV. However, >95% of HBV-infected individuals live in countries where HBV DNA quantification is not available. Worldwide elimination of HBV needs the scaling-up of examination and medication services in resource-limited areas. Based on this situation, a rapid and easy HBcrAg assay as a POCT is valuable. This review provides the latest information regarding the clinical use of a new surrogate marker, HBcrAg, in HBV management, based on iTACT-HBcrAg or POCT, and introduces novel agents targeting HBV RNA/protein.
Topics: Pregnancy; Female; Humans; Hepatitis B virus; Hepatitis B Core Antigens; Carcinoma, Hepatocellular; DNA, Viral; Liver Neoplasms; Infectious Disease Transmission, Vertical; Hepatitis B, Chronic; Hepatitis B; Biomarkers; Hepatitis B Surface Antigens
PubMed: 36891607
DOI: 10.3350/cmh.2022.0434 -
Philosophy, Ethics, and Humanities in... Jul 2023Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due...
BACKGROUND
Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested.
METHODS
This paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources.
RESULTS
Surrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society.
CONCLUSION
Policies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child.
Topics: Female; Humans; Pregnancy; Altruism; India; Policy; Reproduction; Surrogate Mothers
PubMed: 37420245
DOI: 10.1186/s13010-023-00130-y -
EClinicalMedicine Jun 2023To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate...
Effect on neonatal sepsis following immediate kangaroo mother care in a newborn intensive care unit: a post-hoc analysis of a multicentre, open-label, randomised controlled trial.
BACKGROUND
To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate caregiver and neonate needed to be together continuously, which led to the concept of the Mother-Newborn Care Unit (MNCU). Health-care providers and administrators were concerned of the potential increase in infections caused by the continuous presence of mothers or surrogates in the MNCU. We aimed to assess the incidence of neonatal sepsis in sub-groups and the bacterial profile among intervention and control neonates in the study population.
METHODS
This is a post-hoc analysis of the previous iKMC trial, which was conducted in five level 2 Newborn Intensive Care Units (NICUs) one each in Ghana, India, Malawi, Nigeria, and Tanzania, in neonates with birth weight 1 to <1.8 kg. The intervention was KMC initiated immediately after birth and continued until discharge and compared to conventional care with KMC initiated after meeting stability criteria. The primary outcomes of this report were the incidence of neonatal sepsis in sub-groups, sepsis-related mortality and bacterial profile of isolates during hospital stay. The original trial is registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12618001880235) and the Clinical Trials Registry-India (CTRI/2018/08/01536).
FINDINGS
Between November 30, 2017, and January 20, 2020, 1609 newborns in the intervention group and in the control group 1602 newborns were enrolled in iKMC study. 1575 newborns in the intervention group and 1561 in the control group were clinically evaluated for sepsis. Suspected sepsis was 14% lower in intervention group in sub-group of neonates with birth weight 1.0-<1.5 kg; RR 0.86 (CI 0.75, 0.99). Among neonates with birth weight 1.5-<1.8 kg, suspected sepsis was reduced by 24%; RR 0.76 (CI 0.62, 0.93). Suspected sepsis rates were lower in intervention group than in the control group across all sites. Sepsis related mortality was 37% less in intervention group than the control group; RR 0.63 (CI 0.47-0.85) which was statistically significant. The intervention group had fewer cases of Gram-negative isolates (n = 9) than Gram positive isolates (n = 16). The control group had more cases of Gram-negative isolates (n = 18) than Gram positive (n = 12).
INTERPRETATION
Immediate Kangaroo Mother care is an effective intervention to prevent neonatal sepsis and sepsis related mortality.
FUNDING
The original trial was funded by the Bill and Melinda Gates Foundation through a grant to the World Health Organization (grant No. OPP1151718).
PubMed: 37251633
DOI: 10.1016/j.eclinm.2023.102006 -
The Medico-legal Journal Sep 2020A consideration of the concept, law and practice of surrogacy, and the merits and demerits of the concept. A discussion of payments, foreign surrogacies, delay in...
A consideration of the concept, law and practice of surrogacy, and the merits and demerits of the concept. A discussion of payments, foreign surrogacies, delay in finality, and the need for control and regulation.
Topics: Health Care Costs; Health Expenditures; Humans; Surrogate Mothers; United Kingdom
PubMed: 32437632
DOI: 10.1177/0025817220923688