Surrogate births, Japan debates

Main Category: Public Health
Article Date: 27 Feb 2004 - 0:00 PDT

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Despite its wide acceptance of various innovative medical practices, Japan still seems to be ambivalent toward surrogate childbirth, which is controversial but not technically difficult.

The 10th installment in Matters of Opinion follows the theme: 'Should surrogate childbirth be accepted by Japanese society?' The topic was debated by Yahiro Netsu, director of Suwa Maternity Clinic, and Michiko Ishii, a professor of law at Tokyo Metropolitan University.

Netsu, 61, argued that surrogacy represented a scientific breakthrough in efforts to help women unable to carry a baby in their wombs, while Ishii, 51, insisted that the method posed various risks for those involved, including the possibility that the procedure could erode families ties.

What's surrogate birth ? There are two methods of surrogate birth--childbirth involving a surrogate mother, and surrogate childbirth involving a host mother.

Childbirth involving a surrogate mother involves artificial insemination of an egg from the surrogate with sperm from the husband of an infertile woman. The fertilized egg implanted in the surrogate mother develops until childbirth. The surrogate mother is genetically related to the child.

Surrogate childbirth involving a host mother requires an egg to be removed from an infertile woman and artificially fertilized with sperm from her husband. The embryo is then implanted in the womb of a host mother, where it develops until childbirth. The host mother is not genetically related to the baby. This method can be best utilized by a woman who was born without a womb or had to have her womb removed for some reason.

Pro (Yahiro Netsu): Science offers hope for childless couples

The Daily Yomiuri: What did television personality Aki Mukai's successful effort to have a baby through surrogate birth in the United States mean to you?

Yahiro Netsu: Ms. Mukai's action has done much to support my argument concerning surrogate conception in recent years, although I wish she had tried to have a baby in Japan. Still, her coming out with a desire to have a baby through surrogate birth was an attempt to overcome the status quo in which the biological mother of a baby is defined as the legal mother of the child in this country. She has played a great role in encouraging infertile couples in Japan to follow suit.

Why should surrogate childbirth involving a host mother be recognized as a legitimate solution to infertility?

Surrogate childbirth is a breakthrough in efforts to help women without wombs have babies of their own. Progress in reproductive medicine has made this possible.

Today, in vitro fertilization has been accepted as a legitimate form of reproductive medicine. Artificial insemination by donor (AID) also has played a pioneering role in this regard. If an artificial reproductive method involving sperm can be approved, I don't see why using another's eggs must be banned. It should be remembered that various artificial methods and devices have been accepted and used in the field of reproductive medicine for many years, including ovulation-inducing drugs.

Many critics have said that the principal duty of medical doctors is not just to accommodate the wishes of patients.

I've sought to help six women have babies through surrogate birth. Two of them had children in fact. All these women were born without wombs, or had to have their wombs removed for some reason. No one would dispute that they deserved genuine sympathy.

Meanwhile, I have never accommodated the wishes of any women seeking surrogate childbirth just because they don't want to go through labor.

How do you relate surrogate childbirth to medical ethics?

Simply put, it's a matter of whether you are accustomed to it or not. By and large, medical ethics reflects what kind of thinking prevails in a given time. In this sense, the prevalence of AID today shows how much members of the public have become used to it.

Undoubtedly, some risks are involved in surrogate childbirth--a baby born with disabilities, for example. What if a woman requesting a surrogate birth refused to take such a child?

That could happen to any ordinary married couple who have a baby just like others. Some men and women may be irresponsible enough to abandon their babies. They also may refuse to take their babies home from hospitals where they were born with physical defects. It's a matter of how they have been raised and educated. The art of reproductive medicine requires a relationship of mutual trust among those involved.

If any infertile married couples refuse to take babies born with disabilities as a result of surrogate childbirth, the government must look after those children, just as it deals with ordinary children abandoned by their parents.

Still, no such system has yet been established.

If no one takes such a baby, I will. The responsibility to raise such hapless babies rests with me while the system is not yet in place. If I die, my children will take care of the children instead.

Should childbirth involving a surrogate mother also be accepted in Japan?

Our recognition of surrogate childbirth should go that far in the future. Acceptance of both AID and surrogate birth involving a host mother is tantamount to giving a green light to childbirth involving a surrogate mother. Even so, it will be extremely hard to win support for this in Japan.

Should a surrogate mother be involved on a voluntary basis if such a scenario transpired?

Precisely. No commercial purposes should be pursued in this, either. If they delivered babies as surrogate mothers, many Japanese women would find it difficult to accept that the children did not belong to them. You can hardly expect them to serve as surrogate mothers purely on a commercial basis, as in the United States.

Efforts to place a legal ban on surrogate conception are gathering momentum. Do you intend to take any specific actions if such a law has been established?

I've strived--and will continue to strive--to prevent that from taking place. If a ban on surrogate birth is written into law, I'm determined to file a lawsuit against the government, insisting that it runs counter to the Constitution.

Is there anything you're sorry about regarding your successful efforts to help the two women have babies through surrogate births?

I've lost contact with both women now. The first woman was proud that she was the first to have a baby through surrogate birth in Japan. But an expose of her case by a national newspaper inflicted unbearable pain on her. A series of ensuing negative reports about surrogate birth by that paper played a primary role in undermining efforts to facilitate the method in this nation.

Eventually, she wanted me to leave her alone. Something similar happened to the second woman. An excessive measure of media attention given to the two women has left them feeling as if they have done something outrageous. Early recognition of surrogate birth by the public would ease the psychological burden carried by such women.

--Interviewed by Daily Yomiuri Staff Writer Kiyotaka Shibasaki

Con (Michiko Ishii): Risks to host mother; child's welfare of concern

The Daily Yomiuri: What is the rationale behind a proposed total ban on surrogate birth--a central pillar of a report issued by a government advisory panel to which you belonged?

Michiko Ishii: A serious question should be raised about whether it would be possible to preclude surrogate childbirth being done on a commercial basis.

To continue reading this, go to:
http://www.yomiuri.co.jp/newse/20040227wo34.htm