Roots or Routes: Ethics of Surrogacy and Adoption in Motherhood
Introduction
In an age of rapidly evolving reproductive technologies, individuals who cannot carry a pregnancy to term are presented with two primary options: adoption or surrogacy. While both paths offer the opportunity to become a parent, they raise distinct ethical questions. This paper will examine the ethics of agency adoption and traditional/gestational surrogacy, and explore why adoption has historically been seen as the more socially acceptable choice.
It will analyze the similarities and differences between these two options, with a focus on the controversial notion of “baby-selling,” and consider the extent to which this concern is present in each system. To do so, the paper will be grounded in two key bioethical principles: autonomy, the right of individuals to make informed decisions about their lives, and non-maleficence, the obligation to avoid causing harm. These principles will serve as a framework to evaluate whether current adoption and surrogacy systems protect or compromise the dignity and well-being of all parties involved: the children, the birth parent(s), the prospective parents, and the surrogates. Given the ability and resources to pursue either path, is it more justifiable for individuals who cannot carry a child to choose surrogacy over adoption, especially when considering societal needs and the moral implications of creating a biologically related child versus providing a home to an existing child? While the ethical implications of abortion and the beginning of life are beyond the scope of this analysis, it will proceed under the assumption that adoption offers an opportunity for the unborn child to live and be cared for in a stable home. Ultimately, this paper seeks to provide a balanced evaluation of adoption and surrogacy, challenging the assumption that one path is inherently more ethical than the other.
Background
Surrogacy has been around since 2000 BCE, proving it is not a modern invention. However, its modern form typically involves a paid arrangement in which a woman carries a pregnancy for another individual or couple. This paper will focus on two forms of surrogacy: traditional, in which the surrogate is also the egg donor and the prospective father is the sperm donor; and gestational, where the surrogate carries an embryo created from the egg and sperm of the intended parents. In both cases, the prospective parent(s) have a biological connection to the child.
Surrogacy arrangements where neither prospective parents have a biological tie to the child, such as when both the sperm and egg comes from donors, closely resemble adoption. From an ethical standpoint, this paper will consider such cases as functionally equivalent to agency adoption with the key difference being in how the relationship is generated.
Adoption, like surrogacy, provides a means for individuals or couples to become parents when biological reproduction is not possible or desired. In the U.S., agency adoption typically involves adopting a child through a private agency or from the foster care system. Despite its similarities to surrogacy, adoption has often been framed as the more ethical and altruistic choice. Proponents highlight its societal benefits, such as offering an alternative to abortion, preventing children from entering foster care, and removing them from potentially harmful environments (Shannon).
Surrogacy, on the other hand, has long been the subject of ethical controversy. Critics argue that it commodifies both women and children, creating a transactional relationship where human lives are treated as products (Shannon). These concerns have been echoed in recent political and religious discourse. In March 2024, debates around Minnesota Senate Bill SF3504 and House Bill HF3567, which proposed legal frameworks for surrogacy contracts, ignited strong opposition. Conservative groups, including the Minnesota Family Council, compared surrogacy to slavery and claimed it violated the 13th Amendment. Religious advocates like the Minnesota Catholic Conference and the group Them Before Us similarly condemned surrogacy as a form of exploitation and commodification (Ingraham). In January 2024, Pope Francis publicly called for a global ban on all types of surrogacy, labeling it a “deplorable” practice that turns children into objects of trafficking (Matranga).
Surrogacy
First, I would like to provide a brief background on surrogacy and its origins. Surrogacy is when a person, sometimes known as a carrier, agrees to carry a child on for an intended parent(s). There are two types of surrogacy: traditional and gestational. Traditional surrogacy was introduced first and, as technology evolved, gestational surrogacy was introduced.
Traditional surrogacy is a method of assisted reproduction in which a woman, who is the surrogate, carries and gives birth to a child for another person or couple. The surrogate uses her own egg but is artificially inseminated with sperm from either the intended father or a sperm donor. This means that the surrogate is biologically related to the child because her egg is used . Gestational surrogacy, which is also known as host surrogacy, is defined as an arrangement in which an embryo created with gametes from the intended parents or created from a donated oocyte and/or donated sperm is transferred to the surrogate’s uterus. In gestational surrogacy, the surrogate who carries the child has no genetic connection to the child (Patel et al.).
Since it was introduced, gestational surrogacy has become the more common option. According to a National Institute of Health (NIH) survey study, for the period between 2015 - 2016 out of 222 surrogate respondents, over 80% were gestational surrogates (Fuchs and Berenon). Furthermore, a Stork Surrogacy article stated that roughly 90% of all surrogacy arrangements are of the gestational type. Due to the term “traditional” one would think that it is more popular, however, “traditional” surrogacies are not the norm, and only make up only about 10% of all surrogacy arrangements (Stork Service).
In traditional and gestational surrogacy alike, the intent of the surrogate is to carry the child for the intended parents. This deliberate arrangement allows individuals or couples, who may be unable to conceive or carry a pregnancy to term, to become parents. The surrogate’s role is pivotal in this process, as she agrees to undergo pregnancy with the understanding that the intended parents will raise the child upon birth.
While the intent of the surrogate is to carry the child for the intended parents, the motivation for becoming a surrogate may vary amongst surrogates. The surrogate’s intent can be influenced by a combination of altruistic and financial motivations. Some surrogates are driven by the desire to help others experience parenthood, while others may be motivated by financial compensation, and others may be driven by a combination of both or additional reasons. In the United States, the motivations for surrogacy are mainly altruistic. A 2024 study published in Reproductive BioMedicine Online analyzed 231 U.S. surrogates and found that their main reasons were prosocial and altruistic, with financial gain being a lesser factor (Martínez-López et. al.). Additionally, data from a 2023 survey in the United States revealed that 72% of surrogates cited “the desire to help a couple have a family” as their most important motivation, and 59% highlighted “the calling to help others in need.”. Only 31% considered compensation a very important factor (SurrogateFirst).
Although this is the intent of the surrogate, there have been instances where the intent of the surrogate changes during or after the pregnancy. The first recorded surrogacy agreement in the United States was drafted in 1976 by Michigan lawyer Noel Keane (Worldwide Surrogacy Specialists). In this agreement, the surrogate mother was artificially inseminated with the intended father's sperm and had a genetic link to the child. Consent forms are filled out as a part of these agreements ensuring all parties are equally respected. Most notable is the Baby M case of 1986, which significantly shaped surrogacy laws. This case involved Mary Beth Whitehead, a traditional surrogate who had agreed to carry a child for William and Elizabeth Stern. The baby was conceived through artificial insemination.
However, after giving birth, Mrs. Whitehead refused to relinquish the baby, who was named Melissa Stern (Baby M), and sought to retain parental rights. The New Jersey Supreme Court ruled that the surrogacy contract was unenforceable, declaring that paid surrogacy agreements violated public policy. While the court upheld William Stern’s parental rights as the biological father, it granted Whitehead visitation rights, recognizing her as the legal mother (Rust). This case is one example that raised questions about a surrogate’s intentions and how to respond if those intentions change over time. Following the Baby M Case, in 2018, New Jersey legalized gestational surrogacy. This legalization came after other states began legalizing gestational surrogacy. While there are variations in laws among the 50 states, as of 2025, gestational surrogacy is legal in 49 of the 50 states (“The US Surrogacy Law Map”).
For these reasons, surrogacy contracts in the United States are essential legal agreements that delineate the rights, responsibilities, and expectations of all parties involved in a surrogacy arrangement. These contracts serve to protect both the intended parents and the surrogate, ensuring clarity throughout the process. In the United States, the laws on surrogacy vary by state. Some states have comprehensive statutes permitting and regulating surrogacy agreements, while others may have restrictions or lack specific legislation. New York State became the first state to require that gestational surrogacy agencies be licensed, which requires, among other things, for the agency to be registered with the state and certify its compliance with certain regulations relating to transparency and services provided to the surrogate. This amendment protects both the intended parents and the surrogate and recognizes that agencies are an important third party in these arrangements (Jossell).
Agency Adoption
Next, I would like to outline what agency adoption is and its origins. Agency adoption is when a licensed adoption agency serves as an intermediary between birth parents and adoptive families. Agency adoption became common in the United States in the late 19th and early 20th centuries when children were put in informal adoptions or orphanages and were neglected. During this period, babies were often sold or left without a family to die. At this time, several cases in the U.S. and abroad became known as the Baby Farming cases (“Baby Farming”). Following the Baby Farming cases across the world, in the 20th century, states began implementing adoption laws to ensure children’s welfare. Additionally, organizations formed to ensure agency adoptions have set practices. Two of the most influential organizations at this time were The Adoption Institute and Catholic Charities. One purpose of adoption agencies is to match an expectant parent who does not want to or cannot care for and raise an unborn child with a family. Another purpose is for agencies to find a family to care for a child that is currently in a foster home. In both instances, agencies assess the needs of the child, the needs of the biological mother, and the capabilities of potential adoptive parents to ensure a suitable match (“Using an Adoption Agency”.
State laws and regulations of adoption agencies attempt to make sure that once a child is adopted into a suitable home that their situation will be free from the biological parents asserting rights to raise the child after the fact. Although the intent of the agencies is to provide children with a suitable home that is free of parental right arguments, there have been instances where this does not always happen. For example, in 2009, Christy Maldonado, a single mother of two in Oklahoma, became pregnant by her fiancé, Dusten Brown, a member of the Cherokee Nation. Over text messages, Maldonado asked Brown if he would relinquish his parental rights. Shortly after having the child Christy was struggling financially as a single mom, so she chose to place her child up for adoption through an agency. Matthew and Melanie Capobianco, a couple from South Carolina, adopted the baby girl, named Veronica. Four months later, Dusten found out about the adoption and contested it because he cited the Indian Child Welfare Act (ICWA), a 1978 law designed to prevent the unwarranted removal of Native American children from their families. In the end, the court ruled in favor of Brown, who then regained parental rights over Veronica (Totenberg). Some facts of this case suggest that the Capobianco’s may have engaged in subterfuge to obtain the baby. These actions, while legally strategic, raise ethical concerns about whether the Capobiancos prioritized securing custody over respecting the rights of the biological father and the intent of the Indian Child Welfare Act. It can be argued that such conduct, particularly the misleading of Dusten Brown and improper tribal notification, constitutes subterfuge by circumventing legal protections meant to preserve Native American families. That said, the facts of the case show just how complicated these matters can be. They highlight the importance of having clear, standardized processes for the relinquishment of parental rights. Agencies must be properly regulated to ensure that such life-altering decisions are not handled informally, such as through text messages, but through transparent and legally sound procedures.
In all, agency adoption arose to protect children from neglect and exploitation by creating a structured, regulated process. While its purpose is to ensure the best interests of all parties, especially the child, cases like Veronica’s highlight how there are flaws and imperfections in the adoption process.
Comparative Analysis: Similarities between Agency Adoption and Surrogacy
To better understand the ethical considerations surrounding surrogacy and agency adoption, it is important to first explore the foundational similarities between these two practices. One key similarity between agency adoption and surrogacy is the exchange of money. In agency adoption, adoptive parents pay fees to agencies for services such as home studies, background checks, legal paperwork, and post-placement supervision. These fees for prospective families can range anywhere between $20,000 to $45,000 for adoption in the United States. This total goes to agencies for the work they do to ensure that the adoption process is smooth and successful for the prospective families (“Understanding Adoption Costs”). In terms of the cost breakdown depending on circumstances, the fee for the birth mother does not significantly change based on each circumstance. But, the fees for the adoptive parent(s) can change based on the age of the child and the health of the child. In addition, if the adoption agency is facilitating the adoption of a baby who will be born to a client of the agency who is currently pregnant, the fees that are paid to the agency may include money to provide financial support to the pregnant client (“Understanding Adoption Costs”).
In surrogacy, the fees are generally higher than agency adoption, ranging between $100,000 to $200,000. These fees cover surrogate compensation, medical procedures, legal contracts, and agency fees. Gestational surrogacy in particular uses processes like IVF and the transfer of embryos, which is expensive and may not always work the first time. The surrogate compensation ranges between a quarter to half the price of the full surrogacy agreement (“Being Compensated as a Surrogate”). Surrogates may also be paid through resources they get and support they may receive during and shortly after the birth. Surrogates in many states can receive compensation beyond medical and living expenses, depending on the state’s laws. For instance, New York’s Child-Parent Security Act, effective February 2021, legalizes paid surrogacy and includes a “surrogate bill of rights” ensuring surrogates receive independent legal counsel, comprehensive health insurance, and psychological counseling (Jossell). In contrast, birth mothers in adoption situations are generally only allowed to receive reimbursement for reasonable expenses, not additional payment, to avoid coercion or the appearance of “baby selling.” Surrogacy requires a substantial investment from intended parents in their pursuit of having a child. This investment is something some parents may never need to do to grow their family. Some families have to incur very little out of pocket costs to have children, while others invest significant sums (Circle Surrogacy Marketing Team).
Another similarity between agency adoption and surrogacy is a third-party facilitator. A third-party facilitator is where agencies, who are typically regulated by the respective state, are supposed to ensure that the relevant legal processes are followed. In surrogacy, agencies often facilitate the matching of intended parents and surrogates, handling the legal and medical arrangements necessary for the pregnancy, while also ensuring that the surrogate’s health and rights are protected. Reputable surrogacy agencies ensure the surrogate’s informed consent and maintain standards throughout the process and will exclude from consideration any forms of surrogacy or adoption that are not conducted ethically or in compliance with established legal and professional standards. Surrogate agencies need to maintain a professional system when seeking out surrogates because there is a risk of commodification of the surrogates bodies that these agencies can cause. By “recruiting” surrogates from specific social classes or not following specific procedures to hire surrogates, these agencies can risk exploiting women for their bodies and possibility for the compensation they may receive. Surrogacy agencies play a crucial role in maintaining a professional approach that satisfies both the surrogate and the intended parents. (Doron).
In agency adoption, the agency serves as the third-party facilitator, being a means of support for the biological parents and the prospective family. The agency often handles the legalities of the adoption, including the relinquishment of parental rights by the birth parent(s) and the transfer of legal guardianship to the adoptive parents. Since the agency adoptions charge for the work they do, some critics argue that the high fees associated with adoption agencies makes the adoption process feel like a transaction (Shannon). There is no law that requires adoption agencies to charge money for adoption fees; it is a state-by-state decision. For instance, in California, private adoption agencies must obtain approval from the state’s Department of Social Services before charging or collecting any fees for their services. In cases where payment would cause economic hardship to the adoptive parents or when necessary to facilitate the placement of a “hard-to-place” child, California’s regulations allow public adoption agencies to waive, defer, or reduce fees (“Adoption Agency Fees”). Mia Tuan, the author of the book, “Adoption and the Market: The Ethics of Private Adoption Agencies,” argues that agencies, although effective in the work they do, may prioritize financial gain over ensuring the best interest of the child or birth parents (Tuan).
It is important that these adoption agencies similar to surrogacy agencies put their financial gain aside and work for the families that are trying to build a family. This is in order to not put a job, position, or compensation higher than the life of a child (Baron et al.). It should be noted that both the surrogacy process and the adoption process have the potential for fraud, abuse and manipulation by bad actors (either those running the agencies, biological parents, or individuals seeking to gain parental rights over a child). For purposes of this paper, I will be comparing the ethics of surrogacy run by a reputable agency versus adoption run by a reputable agency. One other key point to acknowledge is that while surrogacy laws and regulations are new as compared to adoption laws and regulations, some of the negative viewpoint of surrogacy may have come from the fact that it had not had as much process and regulation surrounding it in the recent past.
The last key similarity I want to acknowledge is the legal movement of a child from one person to another. In both scenarios, there is a transfer of parental rights from the birth parents or surrogate to the intended parents. This process necessitates legal procedures to establish the legally recognized parents of the child (Baron et al). In gestational surrogacy, the surrogate has no genetic connection to the child. Many states allow intended parents to obtain a pre-birth order, which legally establishes them as the child’s parents before birth.
This means their names can be placed directly on the birth certificate at birth, avoiding the need for adoption proceedings. However, some states require a post-birth parentage order, which transfers parental rights after the child is born. Traditional surrogacy is more difficult in its legal forms because of the biological relation between the surrogate mother and the child. Oftentimes, the agreements are made before the birth of the child but have the intended parents sign off as “step-parents” (“Establishing Parentage in Surrogacy”). This is because there are so many legal complexities with traditional surrogacy so these forms give more flexibility to surrogates changing their minds. Regardless, intended parents typically trump surrogates in gaining full parental rights of their child and the child is immediately moved to the intended parents. Of course the timing it takes for a child to be moved from the surrogate to intended parents varies based on state laws but typically the intended parents take custody immediately following the birth of the child.
Agency adoption involves terminating the biological parents’ rights and transferring those rights to the adoptive parents. When the birth parents choose to place their child for adoption, some states legally allow a period of time for them to consider and finalize this decision known as the revocation period. This period of time makes it so parents have not made an impulsive decision and are not pressured into making this decision. After this period of time and once the parents choose to set their child up for adoption, the parents’ parental rights are gone (Page).
The importance of processes relating to the legal movement of a child is to protect against the stigma and past concerns relating to potential “baby-selling” and commodification. Legal processes prevent baby-selling by ensuring transparency, oversight, and standards in child placement. But, all of the similarities between agency adoption and surrogacy risk the commodification of a child. The concept of “baby-selling” gained notoriety during the famous Baby M Case of 1986 (Worldwide Surrogacy Specialists). This case introduced the term “baby-selling” because critics argued that by entering a contract in which Mary Beth Whitehead was compensated for carrying and relinquishing her biological child, the arrangement commodified human life, reducing the baby to a product in a financial transaction (Rust). Baby selling is seen in all three of these similarities due to the commonality of risk of positioning children as commodities rather than human beings with inherent dignity. Though framed as covering medical and administrative costs, the exchange of money blurs the line between facilitating parenthood and commodifying children (“Being Compensated as a Surrogate”). The legal transfer of parental rights in both processes reinforces the perception that children can be exchanged through structured agreements. This raises the question: should there be a monetary value to human life or is human life invaluable and is the monetary value placed on the baby’s life or for what the surrogate mother goes through?
In summary, although surrogacy and agency adoption are often perceived as distinct, they share foundational similarities that require careful ethical scrutiny. From financial transactions and third-party facilitation to the legal reassignment of parental rights, both practices walk a fine line between enabling family creation and commodifying human life. Understanding these overlaps is essential for evaluating which system, if either, more justly upholds the rights of the child, birth parents, and intended families involved.
IV: Comparative Analysis: Differences between Agency Adoption and Surrogacy
Although there are parallels between agency adoption and surrogacy, there are also distinct differences between the two processes. A primary difference between agency adoption and surrogacy lies in what leads to the creation or conception of the child. In adoption, the child’s conception occurs prior to the adoption agreement. Whereas in surrogacy, conception is an integral part of the process and the surrogacy agreement precedes conception.
The motivations behind each process further highlight this difference. Intended parents in surrogacy arrangements make a conscious and deliberate decision to have a child, often after struggling with infertility, which affects approximately 19% of women in the United States at some point in their lives (Centers for Disease Control and Prevention). Gestational surrogacy, in particular, is frequently chosen when a woman faces medical complications preventing her from carrying a pregnancy safely, such as recurrent pregnancy loss. In these cases, surrogacy serves as a means for intended parents to fulfill their strong desire to raise a child who is biologically related to them. Additionally, LGBTQ+ couples, particularly male same-sex couples, often rely on surrogacy as their primary means of biological parenthood. According to the Family Equality Council, approximately 63% of LGBTQ+ millennials are considering expanding their families, with many exploring surrogacy as an option (“LGBTQ Family Building Survey”). This difference also has to do with the biological link between the child and the ultimate parties with legal parental rights. Since adoption occurs when biological parents choose not to raise their child and place them for adoption, there is not a biological connection between the parents and the child.
The reasons for giving a child into adoption vary but commonly include financial instability, lack of support, young maternal age, or personal circumstances, such as career or educational goals. According to the National Council for Adoption, approximately 18,000 infants are placed for adoption in the United States each year, with birth mothers often reporting that their choice was based on their inability to provide the life they wanted for their child (National Council for Adoption). However, it is important to recognize that in some cases, external circumstances heavily influence a biological parent’s decision. Factors such as unplanned pregnancy, financial hardship, or even situations of sexual assault can impact a birth parent’s ability to raise their child, making adoption the best or only viable option. While adoption is often framed as a voluntary choice, the extent to which external pressures limit a birth parent’s options complicates this perspective. The agency’s role in this is to work to find a suitable home based on the birth parents’ decision or, in some cases, state intervention. Furthermore, the role of agencies highlights a fundamental difference in intent of the birth parents: in surrogacy, intended parents are proactively seeking to bring a child into their lives, often as a solution to infertility or other medical concerns.
Another key difference between agency adoption and surrogacy is the government’s role in these processes and the incentives that come along with it. In agency adoption, government agencies and private adoption organizations work within a structured legal framework designed to protect the best interests of the child. Federal and state governments regulate the adoption process, ensuring that adoptive parents meet specific criteria and that children are placed in safe and stable environments. Additionally, adoption comes with financial incentives, such as the Adoption Tax Credit, which allows adoptive parents to receive financial assistance to offset adoption-related costs (National Council For Adoption). The Adoption and Safe Families Act (ASFA) of 1997 further incentivizes states to improve adoption rates, particularly for children in foster care, by offering federal funding for increased adoption placements. For instance, states receive monetary bonuses for each adoption finalized above a baseline number, with additional funds allocated for the adoption of children with special needs. These incentives aim to reduce the time children spend in foster care and to encourage the adoption of children who might otherwise face challenges in finding permanent homes (Adoption Tax Credit Questions).
Unlike the federal influence and incentives relating to adoption, there are not similar federal incentives or influence relating to surrogacy. Surrogacy is largely governed by state laws. This creates a patchwork of laws where some states fully support and regulate surrogacy, while others heavily restrict or even ban certain forms of surrogacy arrangements. Unlike adoption, surrogacy does not receive government incentives or financial assistance, as it is often viewed as a private agreement rather than a solution to child welfare concerns. The lack of support in the federal government for surrogacy could be due to the fact that the rise in surrogacy is a more recent phenomenon as opposed to adoption and from the fact that the children do not already exist. The variance between state laws can also provide an unnecessary stigma relating to surrogacy. For example, some states allow for surrogates to be compensated, and others do not. Still others are more restrictive on what qualifies as a reimbursable expense. When rules are inconsistent, it can lead to inappropriate stigmas or backlash (“The US Surrogacy Law Map”.
In all, agency adoption and surrogacy differ in how and why the child is brought into the world, the presence of biological ties, and the level of government involvement. Adoption responds to often unplanned circumstances and is guided by legal frameworks and financial incentives. Surrogacy, on the other hand, is a planned path to parenthood, often chosen for medical or personal reasons, and is governed by varying state laws without federal support. These differences highlight the contrasting intentions and structures behind each process and examining them through bioethical values help highlight the rights of the stakeholders.
V. Reproductive and Personal Autonomy
Autonomy is the bioethical principle that holds that, in general, an adult should be able to make their own decisions regarding their body. In the context of surrogacy and agency adoption, autonomy plays a crucial role in determining the rights and responsibilities of intended parents, surrogates, biological parents, and the child.
For intended parents, surrogacy provides a way to exercise reproductive autonomy. Individuals who cannot conceive or carry a child themselves have the right to pursue surrogacy in order to have a biologically related child. However, the exercise of autonomy in surrogacy also invites ethical scrutiny. From a utilitarian perspective, adoption may be seen as the more socially beneficial path, as it helps to reduce the number of children in foster care and addresses an existing societal need. In agency adoption, intended parents also exercise autonomy by choosing to adopt. While they do not share a biological link with the child, adoptive parents often have the ability to select certain characteristics, such as race or age, in the adoption process. This reflects a different expression of autonomy, one not tied to biological connection but to the intention of forming a family.
The autonomy of the birth mother is also central to both surrogacy and adoption. In surrogacy, a woman voluntarily agrees to carry a child for intended parents, demonstrating her autonomy in choosing to become pregnant for someone else. In adoption, the birth mother exercises autonomy by deciding not to parent. While the decision to place a child for adoption is often based on personal or financial challenges, these factors can complicate true autonomous choice. For instance, a birth mother facing economic hardship may feel she has no viable alternative. Furthermore, societal stigma surrounding adoption, reflected in language like “giving up” a child, can further pressure her decision. Contemporary adoption practices have started to shift this terminology to “placing a child for adoption,” in recognition of the thoughtfulness and intention behind the decision.
Children are also impacted by autonomy, even if they cannot fully exercise it themselves. In surrogacy, legal agreements often determine the level of future contact between the surrogate and the child, which can impact the child’s understanding of their identity. The Verona Principles advocate for a child’s right to know their origins, emphasizing the importance of transparency in surrogacy arrangements (“International Social Service”). If a child later learns about their surrogate or meets her unexpectedly, it may lead to emotional challenges or confusion. In agency adoption, children may be more aware of their placement and transitions, especially if adopted at an older age. This awareness can lead to feelings of abandonment or mistrust, complicating their relationship with adoptive parents.
The ethical dilemma here centers on whether withholding a child’s birth story is ever justifiable. According to the Verona Principles, it is not; children have the right to learn about their origins. This raises a broader ethical question: Should intended parents weigh the potential psychological impact on children when choosing between adoption and surrogacy? Since surrogate-born children are often unaware of their circumstances at birth, parents may delay or avoid disclosing this information, whereas adoptees, especially older ones, may inherently recognize their circumstances. While autonomy focuses on the right of individuals to make decisions about their bodies and lives, the principle of non-maleficence reminds us that these decisions must also consider and minimize potential harm, especially to the most vulnerable party in both surrogacy and adoption: the child.
To sum up, autonomy is a crucial value in surrogacy and adoption as it impacts so many stakeholders: intended parents, birth mothers, and the child. For all of the stakeholders, their autonomy governs for the trajectory of their lives and their relationships within and with their families. Specifically with the child, issues become present with the child’s rights to know their birth origins which makes it important that autonomy is balanced with non-maleficence, leading into the next ethical principle of non-maleficence.
VI. Non-maleficence
The ethical principle of non-maleficence, which centers on the commitment to do no harm, is particularly relevant in the context of surrogacy and agency adoption. The child is a central stakeholder that needs to be considered in agency adoption and surrogacy because adoption and surrogacy is not just a one time decision it has lasting effects on the child.
Children born through surrogacy are often deeply desired by their intended parents, who have planned extensively for their arrival. These children are typically raised in stable environments where their parents have undergone thorough screenings and invested significant resources to bring them into the world. However, as the child grows older there is a risk for identity struggles. Particularly if the child is conceived using donor gametes or if the surrogate has a role in their life, the child may see their value is lesser than a “typical pregnancy” child because they are not biologically related to their parents. Through a non-maleficence perspective it can be argued that surrogacy is a true gift that technology and surrogates have given families to bring a child to their lives that is biologically related to them or not. In this way, children should not feel ashamed and should be able to feel a sense of family with their parents who are biologically related to them or not.
Adopted children can benefit from being placed in homes where they are wanted and cared for, rather than growing up in unstable foster care situations. Adoption provides an existing child with a family, fulfilling a critical societal need by reducing the number of children without permanent homes. However, adoption is not without harm. Many adopted children experience feelings of abandonment, identity struggles, and difficulties reconciling their biological and adoptive families. Open adoptions have attempted to mitigate this by allowing continued contact with biological parents, but this is not always possible or beneficial. Additionally, children who enter adoption through the foster care system may have experienced early trauma, making their transition into a new family more complex. In a study done in the U.S., it states that adoptees represent approximately 2% of the U.S. population, yet they account for about 5% to 17% of adolescents receiving mental health services (Riley). Some people suggest that people who place children for adoption are more likely to have mental health issues, SUD issues, etc., and that these conditions have a genetic component. Others might grant that but suggest that issues associated with being adopted might exacerbate those underlying tendencies/inborn predispositions (Brodzinsky et al.).
On the other hand, there are very few studies that show the statistics of the identity development and mental health of surrogate-born children yet it is believed that, like other children, surrogate-born children may experience mental health struggles. This raises the question of since both surrogacy and agency adoption have the risk of harming a child’s relationship with their parents or family, why do they tend to be viewed differently by society? A 2015 YouGov survey provides insights into American attitudes toward adoption and surrogacy. The survey found that 71% of Americans approve of surrogacy, with 57% supporting laws that allow surrogate mothers to receive compensation. However, when presented with the choice, 50% of respondents believed that couples unable to conceive should opt for adoption, while only 15% preferred surrogacy (Moore).
On the topic of non-maleficence, it is important to view the surrogate and intended parents perspective through the lens of both deontology and utilitarianism. In both surrogacy and adoption, the outcomes can be viewed for their duty and their consequences, yet the impact is different on the child. From a deontology perspective which emphasizes duty and moral obligation rather than consequences the question in surrogacy and adoption alike is if surrogates and intended parents are pursuing either path to satisfy their needs or society’s needs. In surrogacy for instance, is the surrogate pleasing society or the intended parents by doing the work she is doing or is she doing it for herself? This question is relevant because surrogates can sometimes be seen as a means to an end (Shannon). This poses the question of is it harmful to view human life as a means to an end? On the other hand, through deontology, are intended parents only pursuing adoption to satisfy the needs of society instead of pursuing adoption which may satisfy the needs of themselves? If intended parents are influenced by society or the expectation society can pose on people, then the decision of the intended parents is not fully through a deontologist view because the parents are not able to uphold their own dignity. This can be harmful because in the end the intended parents could have a strained relationship with their child or mixed feelings about the adoption process because it wasn’t fully an autonomous decision.
The principle of utilitarianism argues that decisions should be made based on the greatest good for the greatest number of people. In surrogacy, the intended parents and surrogate may get the greatest happiness out of the situation because the intended parents get to have a child and the surrogate gets to do the work of their occupation (Shannon). In adoption, the intended parents get to have a child and the child gets to have a home away from foster care. In addition, adoption can be seen as “helping society out” yet this narrative can often cause more harm (Drustrop). In Drustrops article, she argues that adoptees may feel pressure to show their adoption in a positive light for the broader impact it has on society rather than sometimes showing the true struggle the adoption process can be for adoptees. This relates to non-maleficence because the adoptees and their experiences may be “silenced” by society to please the societal narrative of adoption, harming the adoptees and their family. Although more people in society will be positively impacted by adoption, is it fair to cause more harm to less people in society?
All in all, the value of non-maleficence is especially important through the stakeholder of the child and the principles of deontology and utilitarianism. Collectively, non-maleficence shares the question of how to weigh the harm against the good and to what extent. It is very important to understand that the harm and good in both surrogacy and adoption is something that the intended families, surrogate, and child may be living with their whole life.
VII. Conclusion
While both surrogacy and agency adoption are valid and ethically defensible pathways to parenthood, surrogacy deserves to be viewed with the same moral legitimacy and societal support as adoption, particularly when practiced ethically through reputable agencies. My stance is grounded in the principles of autonomy and deontology, which together uphold the dignity and worth of all parties involved.
Reproductive autonomy is central to this discussion. Just as a birth mother has the right to choose adoption, individuals and couples who cannot conceive naturally should be afforded the same right to pursue surrogacy, especially when it enables a biological connection. Ethical surrogacy, when carried out with full informed consent (all stakeholders able to express and explain what they are agreeing to) and respect for all participants, honors the autonomy of the surrogate, the intended parents, and ultimately the child.
Beyond autonomy, a deontological framework strengthens this position. Deontology emphasizes duty and moral obligation rather than consequences, and from this perspective, society has no duty to elevate adoption as more virtuous than surrogacy. Doing so imposes moral judgment on private decisions, violating Kantian ethics, which demand that individuals be treated as ends in themselves and never merely as means to an end (Wolemonwu). Discrediting surrogacy because of societal preference objectifies the surrogate, the intended parents, and even the child, reducing deeply personal decisions to instruments of a social ideal. Therefore, deontology supports the idea that individuals and couples who cannot carry a child should be free to choose surrogacy without moral condemnation, just as birth parents should be respected for choosing adoption. Both decisions reflect deeply personal duties: the duty to honor one’s desire for parenthood. Society’s role, then, is not to prioritize one path over the other but to ensure that both are regulated in a way that upholds these moral duties.
To move toward this goal, there must be actionable solutions that promote fairness, consistency, and accountability. The legal landscape for surrogacy in the U.S. varies by state. A standardized legal framework across states that incorporates best practices could help decrease stigma. A good example of the value of national standardization is the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Before HIPAA, privacy practices around health records varied widely from state to state and between institutions. With HIPAA, the federal government established a uniform set of privacy and security standards that now protect patients’ health information across the country. This not only improved public trust in the health care system but also enabled smoother coordination of care and greater accountability (US Department of Health and Human Services). By establishing a national framework, HIPAA increased public trust, improved care coordination, and enhanced accountability. Surrogacy regulation could benefit from a similar approach.
Additionally, there should be increased oversight of both surrogacy and adoption agencies. These processes both involve third-party intermediaries who can act either ethically or unethically. Requiring all agencies to be licensed, to adhere to clear ethical standards, and to maintain transparency in their practices and fee structures would reduce the risk of abuse and help build public confidence.
Both surrogacy and agency adoption are ethically complex but ultimately reasonable pathways to parenthood. They are mirror images in some ways, both involving the legal transfer of parental rights, third-party facilitation, and significant emotional and financial investment. However, the societal treatment of these processes is disparate, often placing a moral burden on those who pursue surrogacy while uplifting adoption as the “nobler” choice. This should be reexamined. With proper safeguards, transparency, and ethical oversight, surrogacy can and should be embraced as a morally legitimate option for creating families. Just as adoption evolved from a stigmatized, under-regulated practice into a widely accepted and regulated institution, surrogacy should be granted the same chance to evolve without stigma.
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