International Surrogacy with Stephen Wilkinson

My guest today is Lancaster University professor Stephen Wilkinson and I’m joined by two UVA Law 3L co-hosts, Makenna Cherry and Meghana Puchalapalli. Wilkinson is a Professor of Bioethics, Associate Dean for Research for the Faculty of Arts and Social Sciences, and Chair of the University Research Ethics Committee.

Much of his work is about reproductive ethics and the regulation of reproductive technologies, especially the ethics of selective reproduction. A book on this topic (Choosing Tomorrow’s Children, Oxford University Press) was published in 2010. Since then, particular interests have included ethical issues raised by uterus transplantation, non-invasive pre-natal testing, mitochondrial replacement, new sources of eggs and sperm, genome editing, surrogacy, and public funding for infertility treatment.

Another abiding interest is the commercial exploitation of the human body, which was the subject of his first book, Bodies for Sale (Routledge, 2003), which we discuss in this episode, together with his 2016 article, Exploitation in international paid surrogacy arrangements, which appeared in the Journal of Applied Philosophy. 

Professor Stephen Wilkinson Bio, Lancaster University: https://www.lancaster.ac.uk/ppr/people/stephen-wilkinson

Exploitation in international paid surrogacy arrangements
Wilkinson, S. 05/2016 In: Journal of Applied Philosophy. 33, 2, p. 125-145

Bodies for sale: ethics and exploitation in the human body trade
Wilkinson, S. 2003 New York : Routledge. 248 p. ISBN: 9780415266253 .

Transcript

Kim Krawiec: And one of the primary things that I remember about that conference that you and I went to was that it was in Ottawa in February, and it was the coldest I have ever been in my life. Do you remember that? Maybe it wasn't as memorable for you, but I'm from North Carolina, and so the notion that there was an ice sculpture festival right cross from our hotel.

Stephen Wilkinson: Yeah, no, I remember it well, and it was still good.

Kim Krawiec: Hey, everybody. Welcome to the Taboo Trades podcast, a show about stuff we aren't supposed to sell, but do anyway. I'm your host, Kim Krabbik.

Kim Krawiec: My guest today is Lancaster University professor Stephen Wilkinson. Wilkinson is a professor of Bioethics, associate Dean for Research for the Faculty of Arts and Social Sciences, and chair of the University Research Ethics Committee. Much of his work is about reproductive ethics and the regulation of reproductive technologies, especially the ethics of selective reproduction. A book on this topic, Choosing Tomorrow's Children, was published in 2010. Since then, particular interests have included ethical issues raised by uterus transplantation, noninvasive prenatal testing, mitochondrial replacement, new sources of egg and sperm, genome editing, surrogacy, and public funding for infertility treatment. Another abiding interest is the commercial exploitation of the human body, which was the subject of his first book, Bodies for Sale, which we discuss in this episode. Together with his 2016 article, Exploitation and International Paid Surrogacy Arrangements, which appeared in the Journal of Applied Philosophy.

Kim Krawiec: I'm here today chatting with my co hosts Megana and McKenna, in advance of our discussion with Stephen Wilkinson later today. So, guys, first introduce yourselves and say hi to our listeners.

Makenna Cherry: Hi. My name is McKenna. I am a three L here at UVA. I'm from a place called Worcester, Massachusetts, and that spelled really funny, so good luck if you are trying to look that up at home.

Kim Krawiec: One of my good friends from law school was from Worcester. So this is how I know how to say it and spell it.

Meghana Puchalapalli: Hi. My name is Megan Polly. I'm a third year law student. I am originally from Indiana.

Kim Krawiec: You both specifically chose this episode to be cohost for. What was it about the topic that attracted you and made you want to engage with Steven and with this topic? So, Megan, I'll start with you this time.

Meghana Puchalapalli: Jobs has been on my mind many people. Yes. So this is something that jumped out to me as the implications of jobs could be more tangible than the rest of the topics. And like I said, I'm from Indiana, which has tried to implement some of the strictest abortion bans. So a lot of what opponents of the abortion bans were saying is legislators weren't considering the implications of these bans, how it's going to affect employment? And so this made me think, how is it going to affect surrogacy? Is there going to be more international surrogacy and Indiana? Stuff like that?

Kim Krawiec: Great. And so, McKenna what about you?

Makenna Cherry: Yeah, so I think there are a few things. One is my family has a history of endometriosis and fertility struggles. And I know I've had this conversation with my mother about possibly being a surrogate for my sister. And these are things that I've had to think about a lot in my life. And it's definitely been a scary thought and not one that I take lightly. But it's gotten me thinking more about surrogacy in general and, like, the moral implications, everything like that. And it's something that I've had to, I think, grapple with and something I'm not even sure still how I feel to this day, even after a lot of reflection on the topic of is surrogacy moral? Is it not what cases? And I also like the international flavor because I am going to London after I graduate here and plan to. I just like seeing the effects of globalization on some trades that are taboo.

Kim Krawiec: Yeah, great. I didn't know this about you. It's so funny. I see you every week. Awesome. But didn't know you were going to London and also didn't realize that you had this personal connection with the surrogacy question. It's interesting because, you know that last week we had Mary Anne case on, and Ryder had a personal connection with her topic, which was sperm donation. So that's two in a row, which is interesting. Final thing is what are you hoping to learn from Stephen today? What is it that you are hoping to get out of our discussion? So, McKenna, I'll go back to you. What are you hoping to get out of our discussion today?

Makenna Cherry: Yeah, I guess it's just, like, continuing that question. On the morality, I think Steven presented a really interesting legal and policy analysis about surrogacy. I bought a lot of his arguments about the, you know, this is a symptom of capitalism. Like, a lot of these flaws are with this. But I'm more interested to hear more about just the inherent, I almost think difference of, like, what surrogacy. The inherent I think it's almost separated from capitalism in a way, like, what makes it special and is it special maybe by the end of this? I'll think it's not, but I think I would like to hear more about that.

Kim Krawiec: Yeah, I think that's a really interesting question and perspective, and we all kind of discussed it as a class together. I think that one of the things that Steven's paper does is point out the extent to which it's not special, that many of the objections that we have or that people have to international surrogacy arrangements could actually be leveled at all sorts of trade arrangements between wealthy and low and middle income countries. But that doesn't mean that there isn't anything special about surrogacy. And I think that it would be useful, helpful to try to get some purchase on what that might be. And I do think that papers like Stevens that are pointing out the extent to which it's not different can help set the stage for figuring out what might be different, which in turn could lead us, hopefully, to some answers about what a regulatory framework could look like or an ethical trade across borders with regard to surrogacy could look like. Megan, what about you? What are you hoping to get out of the discussion today?

Meghana Puchalapalli: Going off of what you guys said? I'm just interested in exploring the kind of then diagram of international surrogacy and other types of exploitative labor yeah, I.

Kim Krawiec: Think that will be interesting. Again, something that came up in class with people pointing out a bunch of potential comparisons, right. That we talked about. For example, Rahima brought up the comparison to sex work. Some folks brought up the comparison to low income factory or agricultural labor. And some people, I think it was Mary brought up the comparison to prison labor, which we talked about with Jonathan Peterson a couple of weeks ago. So I'm also looking forward to those discussions. Okay, great. Well, let's go talk to Stephen and our colleagues. Hey, Steven. Welcome.

Stephen Wilkinson: Nice to you all.

Kim Krawiec: Thanks so much for doing this. So I should first introduce McKenna and Megan's. They are the co host for this episode. They helped choose the questions and kind of organize them. And we also, just before you joined the three of us, did a little roundtable talking about the topic and the paper and our interest in it and what we're going to talk about today. Steven, I thought we could start out by just getting you to tell us a little bit about this paper exploitation and international paid surrogacy arrangements which appeared in the Journal of Applied Philosophy. I also have a paper in that volume and one of the primary things that I remember about that conference that you and I went to was that it was in Ottawa in February and it was the coldest I have ever been in my life. Do you remember that? Maybe it wasn't as memorable for you, but I'm from North Carolina and so the notion that there was an ice sculpture festival right across from our hotel.

Stephen Wilkinson: No, I remember it well. It was still here. The weather here in North England is sort of damp and cool, but we're very rare. We don't get that much snow ice occasion. So it was a shock to me. I think it must have been one -20 or something from celsius it was really cold.

Kim Krawiec: Yeah, it was really, really cold.

Stephen Wilkinson: I went outside without a hat and I had to run straight back into the hotel because I thought I was delighted.

Kim Krawiec: So tell us a little bit about the paper and if you don't mind, can you also talk about your book Bodies for Sale, which deals with some of these same themes. And I just want to say I had read the book before I was rereading it this summer in connection with another project I'm working on and it's such a good book I really want to recommend it to everybody. A lot of the issues that we're going to be talking about today are dealt with in more detail in the book and so I think it's a really helpful resource.

Stephen Wilkinson: Provided the context. So I suppose my initial interest in these practices back many years was actually in I suppose practices which are seen as sort of ethically commendable when done for free, but ethically problematic when paid. So a really clear example of this is live organ donations. So people sending kidneys so alive organ donations usually seems an extremely commendable thing to do, heroic as his donation as well. But the paid versions of those practices seems to be problematic. So that obviously answer the question about why does payment do that. So that led ultimately to sort of the bodies for sale which is around 20 years old now.

Kim Krawiec: We'Re not that old.

Stephen Wilkinson: I think it finds unbelievable and that sort of broadens it out looks at practice and surrogacy is one of them. I do think surrogacy is different in some ways, a more complicated organ. And that's because I think the ethics of unpaid surrogacy is not more complex and more ethically controversial than the ethics of live organization, which doesn't say, that's complete without issues. But I think nearly everybody thinks that's a good thing is done correctly, whereas so obviously I think there's more debate about whether so obviously is not without having obviously, even when I'm paying, when you have there's a payment contractor dimension into it that just adds all these extra issues into the mix. Obviously. So more complicated because there are issues like creating a new person and that person's huge person's interest or right and obviously the relationship between parties can be quite complicated. So embodies the two parts of the book is trying to sell that out explicit a number of of sort key concepts that people use in the ethical debate. So exploitation is one of the main ones. Also issues around objectification commodification and more sort of pragmatic arguments around Palmer in there. It's fundamentally an ethics book, it's got some sort of bits on regulation largely kind of British focused in there and the second part of various examples including what was called the time gene patenting so we can see and we can tell the main ones. I think originally I was going to do many more examples but I realized once I had was so complicated, three key ones was probably not probably five or six that could have been a two volume book. So that was that. And then this paper I suppose really arose after conference that you mentioned earlier, which was a really nice way of learning what other people are doing in this area as well. And it was a really good attempt to update specifically around the question of paid international surrogacy which was the subject of a conference and such a lot of debate at that time instead is focuses much more on how other concepts exportation is raised in the context of international paid surrogacy rather than surrogacy more generally. And so the sum overlap there could be but I was trying to sort of tone it down and look specifically at this topic and what exploitation issues it raises and especially in the paper international page are obviously worse than domestic is one of the questions I raised in Pagans as well.

Kim Krawiec: I am going to turn it over to Megan who is going to start us out with a question about surrogacy and the comparison to other professions.

Meghana Puchalapalli: Hi there. Hi Steven. Thanks for talking with us today. So I wanted to start out with something you said. It's kind of the premise of your entire article is that paid service is no worse than other exploited of commercial transactions such as poorly paid and dangerous factory work. I was hoping we could dive a little bit deeper into the comparison because we in class brought up some inherent differences. But I was thinking about the requirement for additional health care and especially in India there would be an additional social stigma that I don't think we fully come to terms with in the west emotional labor. Another classmate brought up kind of the irreversibility of it that you can't really clock out as you can for factory work. So we just wanted to hear your thoughts on that.

Stephen Wilkinson: Yeah, well, that's a good question to start with, I suppose it's not necessarily a premise of my argument. I think it's more I'm asking the question really specifically in relation to exploitation, are there any differences which are sustainable? And to be fair, I don't get time to look at all of the possible differences in the paper. I'm doing the paper now which looks at a few other possible differences. Definitely. Let me just start it again. When you're asking whether something is like a thing or not, there's always going to be a list of things in which respect a similar list of differences and differences. So clearly, so it is different in some ways to manufacture labor, as you say, a child is created, there are potential psychological and emotional bonds and social relationships created. So there definitely are differences. I think the question is are those differences of a kind which underpin a sort of fundamental ethical difference and which also may then be mistake a further step to then could they underpin a regulatory or legal difference? So of course there are differences. I think my general trust on those things like social and emotional harm is that you have to just take a sort of empirically, well informed you of how bad those things are. So clearly if somebody's working in a dangerous factory environment or damaged construction environment, empirically we'd have to look at what the harms are there and what the risks are, and they're different in different type of wrists and some type of harm and the harms that might be forced surrogates. But of course, that doesn't necessarily mean that they're worse. They may be the same, they may be worse, they may be better. So I think we can sort of, perhaps do sort of harm ranking and see which of these things, although there are differences, although there were emotional psychological dimensions, I don't think that necessarily means that surrogates is worse. You'd have to look at on a case by case basis as how the surrogates were doing and how they were treated. And of course, one of the main pieces of the paper, and this would apply to other occupations as well, is that we should do what we can to make surrogacy better. We should do what we can to sort of be that through regulation or other forms of encouraging best practice, trying to reduce the harm, improve the quality of consent, improve the quality of health care, all those things which are contingent features to see whether we can make it the most ethical version of the practice that we can. So there are definitely differences. Whether there are differences of a kind that is so fundamental that federal government is ethically in a much worse position than the practice is not clear. Because I think in both cases you could have defective consent. In both cases you could have harm and risk, which is at an unacceptable level. And I guess we'd have to also ask the surrogates themselves or the perspective surrogates, what their own perspective was. They would be quite keen to not impose a view of their welfare on them. I think we've got as far as we can to get their take on it, and if they still want to do it, having considered the risks and benefits, it's not necessarily in a different position to other forms of dangerous or risky labor. And of course, it might not be risky in some cases, really good versions, though I guess you might actually become more people. Welcome. So I don't speak about it too negatively.

Kim Krawiec: One of the things I appreciate about your paper, Steven, is the extent to which it does highlight the ways in which surrogacy is not different. Because that, I think, can help, even for people who believe it's different, I think it can help us hone in on what those reasons are. And I don't want to suggest that surrogacy is no different from anything else. But I do also feel like if we searched hard enough, almost every concern that we could list about surrogacy, we would in fact find a corollary in some other professions somewhere that we're allowing people to do without that much fanfare. And I think that Megan brought up the sort of emotional labor, and I think she's right, that's clearly an element of surrogacy. But as you know all too well, that is an element of much of the work that women do in India and in the UK and in the US and all over the world. So much domestic work that women are involved in involves quite a lot of emotional labor and also quite a lot of risk sometimes. So I think it's helpful to sort of figure out what is and isn't different. We next had a series of questions about global power relations. I'm going to start with Bridgett.

Bridget Boyd: Hi, Steven, thanks for joining us. My question is about the idea of moral neutrality. Your paper states that surrogate's background poverty is not morally neutral when it's caused by the wrongful actions or omissions of others. The paper also states that one very general reason for thinking that the background poverty might not be morally neutral is the huge disparity in wealth and income between rich and poor countries. Does this latter statement require the assumption that poor countries face economic difficulties as a result of wrongful actions or emissions by wealthier countries?

Stephen Wilkinson: I think the answer is that's probably no, but I think it's best if they qualify now. So I suppose what they say is that there are two different types of ways in which the background conditions could be really problematic. One of them is to do the past actions of states or groups of people. So, for instance, if these if the disparity of wealth or if the impoverished conditions are the results of colonialism which took place in the past, or unfair trade practices now, then I think you've got there in a position where there's a sort of actively imposed, unfair, sort of coerced set of background conditions that are due to the past actions of nations in history. So is that sort of wrong? The other source of the moral issue is, I think, just the disparity per se. So you can actually imagine a situation where you have two continents that never had any contact with each other or minimal contact, and one of them is very well off and the other one is very badly off. So there's a very uneven distribution of wellbeing between those two. Well, I think even if it hasn't been colonialism, which hasn't in this Dutch experiment, I think you still might say that the wealthy countries have got a sort of positive moral obligation to help the ones which are not. So I think there are two sources of the claim that the background is more problematic. One would be the past Royal Collections or present Royal Collections, and the other one would be the sort of broader egalitarian claims that the poorer country has on the richer country. And of course, in that case, the wrong would be a role of omission if the rich country fails us to help.

Kim Krawiec: So I have some questions about that, Steven, but I want to turn first to McKenna and Mary, because they have sort of variations on this theme, and by the time they're done I may no longer have a question for you. So, McKenna, let me turn to you.

Makenna Cherry: Hi, Steven. Thank you so much for being here today. But my question so I understand this argument that we are operating under global capitalism and ultimately this coercion caused by poverty as a result of the government, which I don't think like necessarily nullifies, like the consent of the surrogate. I just feel like for me, and knowing the history of the UK and India, I just see one big factor that might be specific to this case, which is colonialism. It seems like this paper notes that because of the UK's stringent laws, that's why many go to India to seek surrogates. And while India's own policies have contributed to its poverty, isn't it right to say that British colonialism contributed possibly more to that? And doesn't this add maybe an extra layer to this example of international surrogacy that might blur the line of consent or third party coercion specifically because the UK has had a significant direct impact on India's current economic position?

Stephen Wilkinson: Yeah, I think there's a lot of merit in that plane. I suppose specifically around surrogacy. I guess the question is, the question would be raised, is surrogacy in a different position than any other sort of trade? So I suppose we've got to keep coming back to that question. So I don't think the colonialism point weighs particularly heavily against surrogacy as opposed to any other sorts of trade that you might have, as long as surrogacy can be the same other ethical standards that other trade could. But as I hinted out earlier, I think the colonial past, given the assumption that that has caused it to be worse off than it otherwise would be, that probably doesn't add an added sort of moral dimension to the background moral conditions. But I don't think it's anything that's going to be a special problem for surrogacy, going to just raise issues of coercion and consent when you're looking at trade sort of more generally. So if the UK is sort of if the Pope's colonial era that we're in now is sort of if the conditions of that are very much caused by a wrongful coming in your past, then, yes, clearly that does give a negative spin on the background conditions, which I think could generate that sort of coercion argument.

Makenna Cherry: Yes, that's kind of meaning.

Kim Krawiec: What is then the sort of moral response to this? In other words, you highlighted differences that might be caused by past actions of which colonialism would be one versus just the problems in stemming from disparity between a rich country and a poor country that have no past history. I mean, presumably the answer isn't that we stop all trade with those lower income countries. So what would you say? Does this lead us to? Is there a higher moral obligation to help or to scrutinize a higher obligation to scrutinize our transactions more carefully? And now I don't mean just surrogacy, I mean all economic transactions.

Stephen Wilkinson: Yeah, I think it's probably the latter. I think it definitely generates I don't know. There are some triggers, I think, that tell us to be ethically cautious and to make sure that I suppose that will trigger moral concerns and some heads. I think the solution is going to be as suggested in the paper. Really? Why don't we because a fair trade sort of model of surrogacy ensure that everybody gets better consent and by the consent would include taking care of a wide range of contextual factors and try to do what we can to get conditions to be fair and get paid to be at a fair level. And of course, lots of questions about what counts as a fair level. But I think that ultimately that there is a response. It's not to withdraw from trade because that would potentially harm the very people that this policy is supposed to protect. It's to just make sure that we apply bicycle standards. As somebody who lives in the UK, I suppose as an individual, I think, well, I need to be especially mindful in my thinking about this, of the sort of colonial legacy that there is and to be sensitive to that and try to think through what obligations that generates. But I think the answer that I've got hasn't changed fundamentally in the light of trying to have that sensitivity. It just means that I think we need to be extra careful not to allow very explosive versions of this practice to go ahead, but that would go for any sort of trade.

Kim Krawiec: Mary has a question which is actually prompted by our discussion a couple of weeks ago with Jonathan Peterson, who you probably know, Stephen. He's from Loyal in New Orleans. It was his chapter in the Commodification Handbook on Prisons and Commodification. Okay, Mary.

Meghana Puchalapalli: Hi, Steven.

Mary Talkington: Thanks for joining us. Yeah, as Kim said, I read your discussion of how exploitation of surrogates may be alleviated, at least in part by improving their paying conditions. It reminded me of a discussion we had a podcast a few weeks ago regarding the exploitation of incarcerated people through prison labor. And so in that discussion, we concluded that paying incarcerated people more fairly rather than just like a couple of dollars a day for work and ensuring that they could work under better conditions, it helped reduce exploitation concerns, but it didn't fully eliminate them. When incarcerated people were deprived of basic needs by an institution and then working to fulfill them, such as being deprived of adequate food or hygiene products, I was just wondering if you see a parallel kind of between the situation and then the situation of surrogates and elsewhere who are facing, like, the background property and coercion.

Stephen Wilkinson: Yeah, that's an interesting point. I think there's at least a structural parallel in that population that you mentioned. Incarcerate people is the population that is sort of vulnerable to exploitation and so we tend to be sensitive to putting in place processes and regulations to prevent that. And again, although it's not an issue I particularly studied in detail, I guess insofar as I have thought about it, it would be that giving a fair rate of pay and ensuring that there's a good degree of voluntariness specifically to the labor aspect of it is going to at least reduce and possibly eliminate the exploitation in there the incarcerated population. If you make the assumption that the people that we're talking about are there for justifiable reasons, I don't know whether that is an operating assumption. If you assume that they were no.

Kim Krawiec: Because we're American, Stephen.

Stephen Wilkinson: It's an assumption for the sake of our exactly. I think it's been vocally imprisoned and sort of just imprisonment. So if somebody is wrongfully imprisoned and I think probably almost anything that happens in that situation is liable to be exploitative, you've missed there because they just shouldn't be in that situation in the first place. If it's a case of just in prison, whatever that is, then I suppose as long as the incarcerated people's basic needs are met and then all of the things that ethically demanded of the prison, if that's all done, and they're not threatened with the deprivation of that, then I don't see why they couldn't work nonexploitatively in that context. Obviously, I think a lot of hinges on whether the background conditions are just or unjust. I don't know. So what was the reason why given why this couldn't be completely unexplored in your earlier discussion?

Kim Krawiec: So, if I recall correctly, the prisons are depriving individual prisoners of basic needs. The example that Mary brought up were feminine hygiene products, which are necessary but not provided. And therefore prisoners have to work in order to have enough income to buy these things that are necessary and are frequently doing so, maybe always doing so under conditions that anyone who's not incarcerated would not be willing to work in, both from a pay perspective and safety and other perspectives. Yes.

Stephen Wilkinson: Okay, that's interesting because that does parallel quite closely structurally what I want to say about exploitation and touristy in order, which is that this is a case where people are being wrongfully deprived of their basic needs and sort of forced to work in order to get their basic needs. The claims should be they really should have their basic needs met with whether they work or not. And that's how you get a sort of consent. So there's something about the background conditions there which clearly seems to have ended up very hard, at least very hard to make that a non exclusive situation. So my only answer, I think, was perhaps thinking about more than idealized, if there's such a thing, an idealized incarcerated situation where people were being sort of kept in relatively humane, but nonetheless restricted conditions. It sounds like the Nova you raise is one where it would be hard. To it looks like there's a degree of coalition there.

Kim Krawiec: So I understand the point that there is perhaps some moral obligation on wealthier countries to provide some basic needs to poorer countries, especially if those wealthier countries have played a role in making them poor, as many have, perhaps most have. But it doesn't feel comparable to me to the treatment of prisoners, people who are being held against their will and under the complete and continuing control and domination of the jailers. I don't know, maybe a spectrum, but to me the moral obligation and the moral wrong and those two cases doesn't feel quite comparable, although both might be concerning. I don't know if that if you would agree or disagree with that, Stephen.

Stephen Wilkinson: Yes, I think there is a spectrum, and I think the case we're talking about is much further down on one end than the Incarceration. I mean, an intermediate case might be a case where one country is deliberately impoverishing another through, for example, military intervention. So if one country protects the second country and then sort of was economically exploiting the residents of the second country, and that this formula had been a sort of strategy or tactic to make that happen. So that would be more like a prison case. I think global trade is not quite like that. It's got lots of imperfections, so it's not quite such a clear or extreme case of that sort of coercive background conditions.

Kim Krawiec: Yes, I agree with you. The example that came to my mind that would be more similar to the prison example was a case where another country purposely impoverished another country so that they would have to transact with them on unfair terms. And that sounds more similar to the prison example to me. So next we have rahima.

Rahima Ghafoori: Hi, Steven. So I was wondering, do you believe that the push to ban international surrogacy is a case of the west injecting its morals and values into a non Western setting, and then when, in your opinion, is paternalistic intervention in the context of surrogacy justified?

Stephen Wilkinson: OK, that's a great question. So perhaps taking the second one first. Well, I think the starting point for me is always that we should try to get people to make decisions about their own welfare providers that they are told as individuals with sort of mental capacity to do so. I generally want to avoid materialistic policies. And so I think, as I alluded to earlier, I think if we can get the surrogates or perspective surrogates to come to a view themselves, whether it's in their interests, sort of ideal scenario. Having said that, if we're in a non ideal situation where they may not be able to make that decision, or where the level of harm is above a certain level or the level of risk is above a certain level. I'm not totally adverse. To some degree of what would technically I'm trying to call it this, but it will technically be paternalism in the sense it would be putting place measures to protect people's. Wellbeing, for reasons that possibly override their autonomy. I think the other thing said about paternalism is that there's a danger, I think that if you think about prohibitive policies around international pay ferguson there's a danger that if it is an explicitly paternalistic policy, that it will not achieve its aims because it's aimed out to benefit the population. And it does that by removing a particular source of income or possibly forcing that trade to move into the gray market rather than a regulated of a broad market. It could actually have harmful effects rather than rather than positive effects on the population. So I think if you're going to be paternalistic, you need to be confident that paternalism will work and not just for the backfire. I think I'm creating negative effects. So that's a paternalism point.

Kim Krawiec: Yeah.

Stephen Wilkinson: I guess in terms of imposing values, I'm not quite so sure what to say about that. I think the local population should have a strong say in and particularly prospective surrogates and actual servants should have a strong say in saying what's good for them and what's not good for them and what values are operative and so on. Whether this is a case of imposing Western values, I'm not so sure, and I suppose I need to know what values that they were being contrasted with, if you know what I mean. So if you have presented with an alternative sort of scheme for thinking about it, I think that's what I need to do to answer that question more fully.

Kim Krawiec: Rahima do you want to elaborate on what you meant? But I have some thoughts as well. But do you want to elaborate for Steven on what you had in mind when you asked the question about Western values?

Rahima Ghafoori: Yeah, I think, like we discussed in class, western feminism looks a little different than nonwestern feminism and just.

Kim Krawiec: Kind of.

Rahima Ghafoori: The beliefs that we have around, whether it's baby selling or your reproductive autonomy and things like that. I'm just wondering if we kind of put these values or inject these values into a setting where maybe that's not how it's used, it's not baby selling or we I guess that's kind of where my average at.

Stephen Wilkinson: Yes. It's a hard question to answer, by the way, because I think, for one thing, I don't think there was a kind of single settled Western values position on this issue, because it's already a very contentious issue, even within the sort of Western secular bioethics paradigm. So lots of people there's a lot of heated arguments about it, people disagree about it, and yeah, I don't know about the same in India. I'm not really a sufficient expert on Indian cultural values. You can imagine a case where if we were talking about a country which did have a particular I mean, imagine that a hypothetical country rather than the real one, where in that country's, culture, concepts of family and parenthood were completely different to Western concepts or standard Western concepts. I know of them anyway. And perhaps perhaps there was less emphasis on the genetic family or gestational link. And in that country, the hypothetical country, maybe we could say, well, actually, surrogacy is not really such a big issue in this country because the gestation and genetic links and biological links between people are not given primacy, and that's not how families are struggling. It's not how society is structured. So you can imagine a case I can imagine a case where that would be a sort of cultural imperialism imposing our ethical concerns on somewhere that doesn't have them. I'm not sure whether that's true in this case. It may not be. So, yes, I think it has to be case by cases. Look at what values in play. But as I say, I think whichever way you go, there's just no unified sort of Western voice or view on this issue. It's quite contentious across many countries of the world.

Kim Krawiec: That's a good point, Steven. One of the things that occurred to me when Raheema asked her questions and so perhaps Western values is the wrong term for what I was thinking of, which is that since you wrote this paper, india has, of course, cracked down on international surrogacy. And many Indian feminists and Indian scholars have in fact argued that that crackdown, which was celebrated by many feminists outside of India and some within India too, for sure, really failed to appreciate conditions on the many conditions on the ground in India, both economic and social. And that first of all, there was a lack of appreciation for the real shortage of economic options for rural, uneducated Indian women, as well as a failure to appreciate the empowering and therefore destabilizing effect of this new source of income that was available specifically to women and that had not been before. That is something that people have pointed to as being something that drove some of this discussion in ways that weren't perhaps appreciated by people less attuned to the entire cultural and social landscape there.

Stephen Wilkinson: Absolutely. I think that goes back as well to the initial point I made, which is about the I suppose for me that's more about misguided paternalism in the sense that you help them for the population, but you end up just removing a valuable and potentially socially positive form of income. So you sort of make them worse off when you're trying to protect them. So sort of failed. Yeah.

Kim Krawiec: If you enjoyed today's discussion with Stephen Wilkinson, tune in again next week when we discuss the contentious issue of whether international surrogates are really underpaid you.