[The proposal for a regulation on the recognition of parenthood: An attempt to recognize surrogacy in the European Union?] / La propuesta de reglamento sobre el reconocimiento de la parentalidad: ¿un intento de reconocer la gestación subrogada en la Unión Europea?

Within the European Union, EU, a proposal for a Regulation on the recognition of parenthood has been in the pipeline since December 2022. If approved, the filiation of a child will be determined by the law of the country where the pregnant woman habitually resides, even if it is a non-EU Member State. The text obliges States to recognize birth certificates issued by third countries establishing the parentage of a child born from surrogacy agreements. In this paper, we analyze how the proposal interferes with the exclusive competences of EU Member States to regulate parentage and with the rules of international human rights law, including the European Court of Human Rights' case law.

Parents' 'fault' must not weigh on their children. Surrogacy as a universal crime in Italy: Is it compatible with bioethical principles?

Abstract: Assisted reproduction techniques (ARTs) have given rise to novel, non-traditional family models. Still, among the various applications and approaches of 'medically assisted procreation' (MAP), the most divisive one undoubtedly is 'gestational surrogacy' (GS), also in light of the rising number of couples who have chosen it over the past twenty years. Another major implication of ARTs is the creation of intentional (or intended) parenthood in addition to genetic one: the genetic parent's partner is thus defined as the intentional (or second) parent, who by free choice, shares the family project with the genetic parent, even without any biological tie with the child. Hence, the intended parent takes on the same rights and responsibilities towards the child as the biological one. Several countries, including Italy, have enacted norms to discourage cross-border surrogacy, deeming it harmful to the dignity of women and children. Recently, however, the Italian government has decided intensify the fight against this practice: the Chamber of Deputies (Italy's lower chamber of parliament) has passed a law which punishes couples that resort to surrogacy even if the agreement and the birth take place abroad. Therefore, surrogacy would become a so-called universal crime. In light of the fact that criminalization is a serious and highly consequential step, which may have life-changing consequences for the intended parents, the aim of this paper is to assess whether this may be an effective instrument for regulating the interests at stake and, therefore, whether it would be desirable for other countries to follow such a model. Ultimately, it is worth remarking that for those who seek to achieve parenthood, such a desire is among the most profound aspects of a person's existential realization. When due to a delicate balance of ethics standards and potentially conflicting rights, lawmakers inter-vene, an authoritarian approach is unlikely to be beneficial. Offering real alternatives to surrogacy in an organic and pragmatic fashion (i.e. expediting adoption procedures, favoring motherhood at a younger age, when infertility issues are less likely to have set in) may be the best way to disincentivize fertility traveling and make sure the rights, hopes and aspirations of all the parties involved are upheld properly.

The legally charged issue of cross-border surrogacy: Current regulatory challenges and future prospects.

The article aims to shed a light on the unique complexities inherent in surrogacy and the legal-ethical challenges that currently exists even in many advanced democracies, which frequently result in uneven and ill-defined standards and processes. The recent proposal of making surrogacy a "universal crime", meant to prevent cross-border surrogacy, i.e. travels by citizens from countries where it is illegal to countries where it is legal, has also been weighed, by exploring the current legislative state of affairs, trends and future horizons. Recent case-law has been analyzed and interpreted, with a close focus on Italian Supreme Court ruling n. 38162, issued on 30th December 2022 and European Court of Human Rights (ECtHR) rulings issued over the past decade. Uncertainty and ill-defined norms and court rulings risk harming the rights of children, surrogate mothers and intended parents. So far, court decisions have somehow filled the legal vacuum, considering that cross-border surrogacy is not specifically regulated in many countries and the status of children born abroad is still controversial. The views and judgments of supranational courts on the issue need to be accounted for when drafting new specific legislation. It is of utmost importance to uphold the rights of children born through surrogacy abroad, whose best interests risk being damaged. Legislative harmonization at the international level is essential to prevent the cross-border surrogacy trend. The "universal crime" draft bills appear to be difficult to enforce and too vague to be credible at the moment.

Surrogacy: An important pathway to parenthood. A call for international standardization.

This comprehensive review examines the multifaceted landscape of surrogacy, a revolutionary treatment for infertility. The study examines historical origins, shifting trends, medical considerations, psychological implications, legal complexities, international variations, and ethical dilemmas surrounding surrogacy. With the advent of assisted reproductive technology, gestational surrogacy allows intended parents a genetic connection to their child. Medical facets encompass indications for gestational surrogacy, drawing attention to maternal health risks and infertility factors. Evidence indicates that medical outcomes are comparable to conventional pregnancies, suggesting a viable reproductive solution for intended parents. Due to the complex nature of surrogacy psychological and emotional vulnerability is inevitable; yet studies underscore positive psychological well-being and satisfaction among gestational carriers (GCs), intended parents (IPs) and children. Surrogacy also has many religious dimensions, as each religion has its own perspective on the distinctive process of creating life and its outcomes, such as, the determination of the child's mother according to their beliefs. Legal considerations emerge as a fundamental aspect, with differing regulations globally. The review emphasizes the significance of comprehensive agreements to safeguard the rights and responsibilities of surrogates and IPs. The unique surrogacy laws in Israel serve as a noteworthy example, reflecting a progressive approach that provides a promising template to establish crucial international guidelines on surrogacy. The absence of international consensus necessitates attention from the global community to address key concerns, including the well-being of GCs, legal recognition for IPs, and the child's best interests, with the goal of establishing a universal standard of care in the field.

Consensus-Driven Recommendations to Support Physician Pregnancy, Adoption, Surrogacy, Parental Leave, and Lactation in Emergency Medicine.

The emergency department clinical environment is unique, and guidelines for promoting supportive and equitable workplace cultures ensure success and longevity for pregnant persons and parents in emergency medicine. There is paucity, variability, and dissatisfaction with current parental (historically referred to as maternity and paternity) leave policies. This paper describes the development of consensus-derived recommendations to serve as a framework for emergency departments across the country for incorporating family-friendly policies. Policies that foster a family-inclusive workplace by allowing for professional advancement without sacrificing personal values regardless of sex, gender, and gender identity are critical for emergency medicine recruitment and retention.

Having children in cross-border contexts: late-family formation among homoparental families in Spain.

Considered until recently unfit to rear children, non-heterosexual people have been excluded from forming families in most countries. Many, worldwide, demand access to family formation, claiming the same aptitudes as heterosexual people for raising children. However, when non-heterosexual singles and couples want to become parents in Spain, they must consider transnational contexts, resorting to inter-country adoption or surrogacy abroad, processes that contribute to delay their family formation. They must consider not only Spanish sociocultural conditions, but other countries' legal restrictions regarding parents' gender, social status, and sexual identity. These families experience great difficulty in gaining access to reproductive health services. Based on multi-site ethnographic fieldwork, this text addresses how, despite legislative changes allowing homoparental family formation in Spain, these parents must overcome complex bureaucratic processes when they decide to have children, while facing homophobic attitudes and policies in their quests to become parents.

Between choices and decisions. Genetics in homoparental families through surrogacy in Argentina. / Entre elecciones y decisiones. La genética en familias homoparentales por gestación por sustitución en Argentina.

Comprehensive access to medically assisted reproduction procedures and techniques in Argentina has been assured by National Law No. 26,862 since 2013. This Law does not include surrogacy procedures, and the lack of specific regulation shifts practices to a paralegal setting. In this context, planned parenthood by male couples through surrogacy is performed through actions that convey demands for access rights and active State policies. For these couples, the argument is that surrogacy is the only option to have a child with a genetic bond with at least one of the two parents and recognize both filiatory bonds. This work results from field work in progress with parents from the Province of Buenos Aires running this practice in Argentina. Based on in-depth interviews, we attempted to rebuild personal experiences and analyze the meanings that the narratives construct regarding their parenting, the biological connections in establishing or defining family relationships, and the importance of genetics in constructing and maintaining affiliations.

En Argentina desde 2013 existe la Ley Nacional 26.862 de acceso integral a los procedimientos y técnicas de reproducción médicamente asistida (TRA). Esta no incluye los procedimientos de gestación por sustitución (GS) y la ausencia de regulación específica mueve las prácticas a un escenario de paralegalidad. En este contexto, las paternidades planificadas por parejas de varones a través de GS se llevan adelante mediante acciones que vehiculizan demandas de derechos de acceso y políticas activas del Estado. Para estas parejas el argumento es que la GS representa la única opción para tener un/a hijo/a con vínculo genético con al menos uno de los dos padres y poder reconocer ambos vínculos filiatorios. El presente trabajo es el resultado de un trabajo de campo en proceso con padres de Buenos Aires que están llevando adelante esta práctica en Argentina. A partir de entrevistas en profundidad intentamos reconstruir las experiencias personales y analizar los sentidos que construyen las narrativas respecto de sus parentalidades, las conexiones biológicas en la creación o definición de los lazos familiares y analizamos la importancia de la genética en la construcción y mantenimiento de vínculos filiatorios.

The future of surrogacy: a review of current global trends and national landscapes.

The practice of surrogacy is frequently the subject of media, scientific, social, regulatory and policy attention. Although it is, for many, an accepted form of assisted reproduction for those who would otherwise not be able to have children, surrogacy often generates strong feeling, particularly where there is any possibility of exploitation. Therefore, there is disagreement about how it should be regulated. In some countries, surrogacy is prohibited in any form, although this does not stop people using it. In others, it is unregulated but still practised. In some nations it is regulated in either a 'commercial' or an 'altruistic' model. This review article considers the possible regulatory future of surrogacy, initially from a UK perspective considering a recent review of the legal framework in a country where surrogacy works well (although some cross borders to access it), and then through an assessment of global trends and other national perspectives. It concludes that the international regulation of surrogacy, although potentially desirable, is unlikely. This being the case, it would be preferable for individual nations to regulate surrogacy so it can be undertaken in ways that are safe, ethical and protective of the best interests of children, surrogates, intended parents and families.

An Award of Damages for Commercial Surrogacy Overseas?

This article examines the United Kingdom Supreme Court decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. The case centred on whether damages could be awarded for the cost of a commercial surrogacy arrangement in California, following clinical negligence by the hospital that left the plaintiff unable to carry her own children. After examination of this case, the article outlines and compares the United Kingdom and Australian surrogacy laws. It then discusses how a similar case would be decided in Australia and argues that the result would be the same in some Australian States. It also discusses the concept of reproductive autonomy and the importance of this concept when considering cases involving the loss of fertility.

Gestación por sustitución ¿y Derecho penal? / [Surrogacy and criminal law?]

La gestación por sustitución es una vía para poder tener descendencia que, en nuestro país no es aceptada y ello nos ha llevado a un alto turismo reproductivo cuyas consecuencias derivan en una inseguridad jurídica inaceptable en un Estado Social y Democrático como el nuestro; inseguridad que alcanza incluso al ordenamiento penal. Por ello, se hace necesario una aproximación a este fenómeno, sus consecuencias y posibles soluciones. (AU)

Surrogacy is a way to have offspring that is not accepted in our country and this has led to a high level of reproductive tourism whose consequences lead to unacceptable legal uncertainty in a Social and Democratic State like ours; insecurity that even reaches the penal system. Therefore, an approach to this phenomenon, its consequences and possible solutions is necessary. (AU)

Medical and mental health implications of gestational surrogacy.

Gestational surrogacy in the United States has quadrupled since 1999, but to date, only a few states explicitly permit compensated gestational surrogacy. Current legal prohibitions are often influenced by outdated and stereotyped understandings of surrogacy. It is increasingly important to understand the current literature about the medical and mental health impacts of surrogacy and how state legislatures have addressed compensated gestational surrogacy in recent years. Based on this review, we found no evidence of substantial adverse medical or psychological outcomes among women who are gestational carriers or among the children they give birth to. The literature suggests that gestational surrogacy is a safe and increasingly popular option for families as long as rigorous screening and medical, psychological, and social supports are equitably provided. As states move to responsibly legalize and regulate gestational surrogacy, there is a continued need for further longitudinal studies on the health and psychological outcomes of gestational surrogacy.

Mapping transnational commercial surrogacy arrangements in South and Southeast Asia.

Transnational commercial surrogacy is a form of medical tourism undertaken by intended parents in an attempt to seek surrogates in other countries. Most intended parents are from developed countries and seek their surrogates from developing countries, predominantly from South and Southeast Asia. This arrangement led to the establishment of surrogacy businesses in South and Southeast Asia, in countries such as India and Thailand. Subsequently, the business was banned in these countries, which led to a trend of moving it to neighbouring countries where there were no regulations or restrictions. This paper maps the movement of the industry and calls for attention to re-consider or re-frame commercial surrogacy in an international framework.

Addressing legal issues in cross-border gestational surrogacy: current topics and trends.

This article provides a general overview of the practical management of legal issues in cross-border gestational surrogacy. Particular problems arising from the global pandemic as well as a number of proposed solutions are presented and analyzed. A section addressing the involvement of the fertility center in such arrangements is included. Additionally, the article discusses how parentage and citizenship are handled abroad, with a focus on the United Kingdom.

Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives?

Background and objectives: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods: To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results: SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion: With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.

Legal considerations in reproductive medicine.

Legal issues affect reproductive medical practice throughout the entire world. The breadth and depth of this interrelationship extend far beyond the scope of one series of articles in Views and Reviews. Given this limitation, we have chosen to present five topics, all different, but illustrative of key concepts that influence our practice of reproductive medicine. Our hope is that this "medical-legal sampler" will both inform and provoke thoughtful consideration of the ways we can best and most responsibly practice and serve our patients.

Consent for babies born following surrogate pregnancies.

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.

A Step Too Far? Whittington Hospital NHS Trust v XX [2020] UKSC 14.

This comment piece explores the decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. It argues that despite notable shifts in public policy in respect of the acceptability of surrogacy as a means of family formation in the past twenty years, the Supreme Court has taken a step too far in deciding that foreign commercial surrogacy is as widely socially accepted. This impacts on the reasonableness of any claim for damages in negligence for the costs of commercial surrogacy. It is posited that the issue of whether damages for foreign commercial surrogacy are reasonable or not will be the key battleground in future negligence cases of this type.

Los contratos de maternidad subrogada desde una perspectiva del Análisis Económico del Derecho / Surrogacy contracts from an Economic Analysis of Law perspective

La microeconomía permite identificar aspectos clave en las decisiones de los agentes económicos, sin embargo, es insuficiente por cuanto las decisiones no sólo se limitan a lo pactado entre las partes sino también se ven afectadas por políticas de gobierno y el desempeño de la industria. Por otro lado, el análisis de la macroeconomía destaca la existencia de políticas que inciden en el desarrollo del mercado tales como: controles de precios, nivel de institucionalidad, barreras internacionales y oportunidades económicas. El acuerdo de maternidad subrogada es un medio que permite la mutua satisfacción de las partes: el aspecto reproductivo / filial de los padres y el aspecto económico de la madre subrogada. Los controles de precios y barreras internacionales afectan a las madres gestantes en múltiples formas, además los efectos de estos controles varían en cada país. El Perú es un destino potencial para el turismo reproductivo dado los bajos costos de sus servicios médicos y los altos estándares de calidad de estos, así como la jurisprudencia uniforme que viabiliza los convenios de maternidad subrogada, siendo el vacío legal un inconveniente para la realización de este tipo de actos. De legalizarse los acuerdos de maternidad subrogada, el precio de la contraprestación dependerá del estado de necesidad de la mujer y su costo de oportunidad. Una regulación permisiva no siempre asegurará un justo intercambio de recursos si no está respaldada por una adecuada institucionalidad que incentive la reproducción asistida como un derecho de la persona (AU)

Microeconomics allows the identification of key aspects in the decisions of economic agents; however, it is insufficient because the decisions are not only limited to the agreement between parties but also, they are affected by government policies and industry performance. On the other hand, the macroeconomic analysis emphasizes the existence of policies that influence market development such as: price controls, level of institutionality, international barriers and economic opportunities. The surrogacy agreement is a mean that allows the mutual satisfaction of the parties: the reproductive/filial aspect of the intended parents and the economic aspect of the surrogate mother. Price controls and international barriers affect pregnant mothers in multiple ways, and the effects of these controls vary among countries. Peru is a potential destination for reproductive tourism given the low costs of their medical services and high-quality standards, as well as the uniform jurisprudence that makes surrogacy agreements viable. Nonetheless, the legal gap is an inconvenience for the realization of this type of act. If surrogacy agreements are legalized, the compensation price will depend on the woman's state of need and her opportunity cost. A permissive regulation will not always guarantee a fair exchange of resources if it is not supported by an adequate institutional framework that encourages assisted reproduction as a right of the person (AU)

La microeconomia permet identificar aspectes clau en les decisions dels agents econòmics, no obstant això, és insuficient puix que les decisions no només es limiten als pactes entre les parts sinó també es veuen afectades per polítiques de govern i l'acompliment de la indústria. D'altra banda, l'anàlisi de la macroeconomia destaca l'existència de polítiques que incideixen en el desenvolupament del mercat tals com: controls de preus, nivell d'institucionalitat, barreres internacionals i oportunitats econòmiques. L'acord de maternitat subrogada és un mitjà que permet la mútua satisfacció de les parts: l'aspecte reproductiu / filial dels pares i l'aspecte econòmic de la mare subrogada. Els controls de preus i barreres internacionals afecten les mares gestants en múltiples formes, a més els efectes d'aquests controls varien en cada país. El Perú és una destinació potencial per al turisme reproductiu donat els baixos costos dels seus serveis mèdics i els alts estàndards de qualitat d'aquests, així com la jurisprudència uniforme que viabilitza els convenis de maternitat subrogada, sent el buit legal un inconvenient per a la realització d'aquest tipus d'actes. De legalitzar-se els acords de maternitat subrogada, el preu de la contraprestació dependrà de l'estat de necessitat de la dona i el seu cost d'oportunitat. Una regulació permissiva no sempre assegurarà un just intercanvi de recursos si no està recolzada per una adequada institucionalitat que incentivi la reproducció assistida com un dret de la persona (AU)