Autonomy and Pregnancy Personal autonomy lies at the heart of the pro-choice movement and is an issue that impacts every pregnant woman. Any person who has been pregnant can tell you that pregnancy has consequences to the individual, both short-term and long-term. Some of those consequences are seemingly minor, but others can be literally life-threatening. However, while the pro-choice anti-choice debate focuses on maternal rights and fetal rights, there is little discussion of the impact of maternal choices on fetuses when mothers choose to carry a pregnancy to term, but engage in behaviors that are less-than-optimum for fetal health. The reality is that maternal behavior has consequences for the lifelong health for the developing child. There are several maternal behaviors, such as alcohol or drug usage during pregnancy that can lead to lifelong disabilities for the developing child. However, there are other maternal behaviors that are linked to optimal fetal health and the question of autonomy goes beyond limiting maternal engagement in negative activities to whether it is appropriate to force mothers to behave in positive activities.

The arguments against maternal autonomy are significant and substantial. However, they should not be confused with an anti-choice position. Determining that a mother who has decided to carry a baby to term should not be permitted to engage in behaviors that put that baby at risk is not the same as saying that women should be required to carry all pregnancies to term. The two positions are distinct and the issue should not be confused with the related, but distinct, issue of abortion.

The first argument against maternal autonomy is that the fetus has no recourse if damaged by maternal behaviors. Children are unable to sue their parents for negligent behavior while in utero because establishing absolute causation is difficult when discussing birth defects. Moreover, monetary damages are insufficient to make a child whole if he or she has been damaged as the result of maternal neglect in utero. Therefore, requiring mothers to adhere to certain behaviors while pregnant appears to be a reasonable way to ensure fetal health.

The second argument against maternal autonomy actually relies upon abortion access. That argument is that pregnancy is a choice, and, that, if mothers make the choice to be pregnant, they are thereby making the choice to engage in behavior that is not harmful to the child. In many ways, this is an extension of current child protective laws. People who choose to parent the children that they deliver are held to a certain standard of care regarding those children, and, if unable to meet that standard, have their rights terminated.

However, one argument in favor of maternal autonomy is the lack of a real societal remedy for mothers who fail to comply with established standards of behavior. If a woman's behavior should be limited because of her choice to carry a child to term, then the logical remedy for a mother who fails to comply with those standards is to abort the pregnancy, thereby ending her obligation to alter her behavior. However, it is already generally acknowledged by most people that, at some point during the pregnancy, the fetus is an autonomous individual. The other possible consequence, which would be restraining the mother so that her activities could be limited during the pregnancy, seems to provide a punishment to the child, and would still appear to promote abortion.

Furthermore, the notion of maternal autonomy is important when one considers that very few pregnant women comply with all of the best behaviors for carrying a child. How would society determine which behaviors were acceptable, and how frequently would a mother have to miss those optimum behaviors to be considered a risk to the child, so that her liberty could be restricted for the remainder of the pregnancy? Moreover, once it was established that a woman's rights could be restricted to protect fetal health at any time...

The literal consequence could be women being forced to conceive and then carry those pregnancies to term. While protecting fetal development from harm is an important societal goal, it must come second to protecting the autonomy of born adult humans.
Surrogacy

The issues of surrogacy is a difficult one because it addresses an issue that may not be addressed in other ways: the right to parent a child with whom one shares a genetic relationship. Only in recent times has surrogacy really become a possibility, but it is wrong to think of it as a purely modern invention. On the contrary, there is a long tradition, particularly in polygamous societies, of secondary wives or concubines bearing children that would be raised by another woman, but share a genetic connection to the father. Moreover, in many of these historic societies, the first wife would have at least the same rights to the child as the actual mother. There is an even darker historical tradition of slave women being forced to conceive and bear children to whom they had no biological rights, and this tradition is far closer to the modern American ethical issue than any tradition of polygamy. Therefore, the issue of surrogacy, while a modern one, does have some precedents.

The most basic argument against surrogacy is that it is the equivalent of paying for a child. In almost all situations, surrogates are compensated, in some way, for carrying a child to term and delivering the child. In some situations, this compensation amounts only to medical expenses or expenses directly related to the pregnancy, while, in other scenarios, the surrogate is directly compensated for her time. The result is that there is an exchange of money that is predicated upon the exchange of a child. Moreover, a potential problem might arise if the surrogate was not paid, and, as a result, refused to relinquish rights to the child, which would make it clear that the child was being exchanged for money.

The second argument against surrogacy is that it exploits financially vulnerable women who are the most likely to agree to engage in surrogacy arrangements. Removing the scenario of friends or family members acting as surrogates, the reality is that paid surrogates are unlikely to come from groups of women that are not financially vulnerable. These women are literally renting their bodies for use, which some people feel is exploitative.

While the financial issues muddy the issue of surrogacy, they are actually not that difficult to comprehend. At some level, all workers are exploited by their employers, who rent their bodies at a certain rate. A construction worker who provides manual labor is renting his body to his employer. Why should a woman be deprived of the ability to earn a significant amount of money in return for carrying a baby to term for a couple who could not otherwise have a baby? While pregnancy does come with some risk and while surrogacy arrangements generally restrict some of a mother's autonomy, there is no suggestion that women enter into surrogacy arrangements under terms that are any less voluntary than any other employment agreement. Furthermore, if it is possible, in some states, to provide financial support to adoptive mothers, without predicating that payment on rendering the child to the potential adoptive parents, it should be equally possible to craft an agreement that allows for payment to the surrogate. Moreover, using donor eggs with donor sperm or the father's sperm could result in a child with no genetic relationship to the surrogate, so that she had no legal rights to the child, removing the legal ability to withhold the child from the parents, and making it clear that the payment was for services rendered during the surrogacy, not for the child.

The final argument in favor of surrogacy is based upon the desire to be parents. It is different to raise a child from infancy than it is to adopt an older child. Many parents who struggle with infertility desire the entire child-rearing experience. Because there is actually a shortage of adoptable infants in the United States, surrogacy may be the only legal alternative for parents to have the entire child-rearing experience. Allowing for surrogacy arrangements helps eliminate ethically or morally challenging scenarios like a father impregnating a third party absent a surrogacy arrangement. As a result, surrogacy actually promotes stability and finality in family arrangements.

Genetic Screening

The question of genetic screening may be the most morally difficult one presented, and part of that difficulty is based in the fact that there is some basic misunderstanding about some of the health regulations regarding communicable diseases. Munson stated that each individual parent is unable to decide whether or not to give children a measles vaccination (2011). However, that is absolutely not true. On the contrary, parents are given an incredible amount of leeway in their choices of medical procedures for their children, even routine medical procedures. Moreover, for doctors to be allowed to force parents to have their children undergo some procedures requires a substantial legal fight…