Public Health Ethics - Resolution of case.pptx

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1. A Panama Cross-Border Surrogacy and Ethical Dilemmas

2. Case A panamian woman, financially struggling with limited education, agreed to be a gestational surrogate for a foreign couple through an unregulated medical tourism agency. The surrogate’s husband was unaware of the agreement. After a medically uncomplicated pregnancy, she suffered fatal complications during delivery, leaving the newborn with severe cerebral palsy due to hypoxia. The intended parents rejected the child, citing the contract’s clause for a "healthy baby." The surrogate’s husband also refused custody, stating he had no role in the agreement. The clinic sought state intervention, but the government declined long-term responsibility, placing the child in an orphanage and referring the case to an ethics panel. Public Health Ethics: Cases Spanning the Globe Public Health Ethics Analysis, Vol. 3 Editors: Drue H. Barrett, Leonard W. Ortmann, Angus Dawson, Carla Saenz, Andreas Reis, and Gail Bolan.

3. Ethical Principles Autonomy – The surrogate’s consent was obtained, but was it fully informed and voluntary, given her financial vulnerability? Beneficence & Non-Maleficence – Did the medical team ensure her safety, or was her health risk secondary to contractual obligations? Justice – Who is responsible for the abandoned child’s welfare? Was the surrogate exploited due to economic disparity?

4. Theoretical framework Utilitarianism – Maximizing well-being might justify enforcing contracts, but does it neglect the surrogate’s suffering? Deontology – Ethical duties should prioritize human dignity, suggesting the surrogate’s rights were compromised. Virtue Ethics – Moral responsibility demands compassion and fairness in handling the surrogate’s family and child.

5. Recommendations Hold Intended Parents Accountable – Contracts should legally bind them to parental responsibility regardless of health outcomes. State-Funded Medical Foster Care – Instead of orphanages, create specialized care programs for abandoned children with disabilities. Regulated Surrogacy Frameworks – Establish legal protections for surrogates, ensuring independent legal counsel and mandatory partner involvement. Ethical Oversight of Medical Tourism – Implement global standards to prevent exploitation in cross-border reproductive care.

6. Application in local context In Pakistan, surrogacy operates in a legal grey area. The Council of Islamic Ideology (CII) and religious scholars largely oppose it on ethical and religious grounds, as third-party reproduction is considered inconsistent with Islamic teachings. Due to economic hardships, some women still engage in unregulated surrogacy, often facilitated by private fertility clinics or middlemen, without legal safeguards.

7. Application in local context Legal Clarity on Surrogacy – Establish clear regulations aligned with ethical and religious considerations to prevent unregulated surrogacy tourism. Protection for Surrogates & Newborns – Ensure women’s informed consent, medical safety, and legal protections, while preventing child abandonment. Ethical Oversight of Fertility Clinics – Implement strict monitoring to prevent coercion and financial exploitation in surrogacy arrangements. State-Managed Child Welfare – Develop specialized care programs for children born from surrogacy, especially in cases of abandonment or disability.