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Reproductive gifts and gift giving: the altruistic woman.

Reproductive Gifts and Gift Giving: The Altruistic Woman

In the aftermath of the "Baby M" case, the surrogacy debate has mostly left the media forum and entered the state legislatures. Many of these legislatures are now debating the legal status of surrogate contracts. Where legislative committees have opposed commercial contracts, they have tended to view alternative noncommercial surrogate parenting arrangements as ethically and legally permissible. An underlying theme here is that noncommercial arrangements are seen as altruistic This article examines the implications of an altruistic ethic, particularly in reference to surrogacy, and highlights its problems for women in the reproductive realm.

Gifts and Gift Giving

In his well-known study, The Gift Relationship: From Human Blood to Social policy, Richard Titmuss opposed commercial systems of blood supply to noncommercial and altruistic systems of blood giving. Titmuss's concern was to shore up the spirit of altruism and voluntarism which he saw declining in western societies. His analysis is, in the main, a positive assessment of the possibilities of altruistic blood donation. But Titmuss also understood that giving was influenced by "the relationship set up, social and economic, between the system and the donor," and that these relationships are "strongly determined by the values and cultural orientations permeating the donor system and the society in general." [1] The dialetic between values and structural factors emerges strongly in his work. We must ask, he wrote, if there is truly "no contract of custom, no legal bond, no functional determinism, no situations of discriminatory power, domination, constraint or compulsion, no sense of shame or guilt, no gratitude imperative and no need for the penitence of a Chrysostom" (239). The role of cultural values and constraints in shaping gift-giving arrangements is vital.

In the case of many new reproductive practices, and surrogacy especially, "the donor system" mainly depends on women as the gift givers--women who donate the use of their bodies and the fruit of their wombs. Those who endorse altruistic surrogacy as an alternative to commercial surrogacy accept, without comment or criticism, that it is primarily women who constitute the altruistic population called upon to contribute gestating capacities. [2] The questions that Titmuss raised about "contract of custom," "functional determinism," "situations of discriminatory power," "domination, constraint or compulsion," as well as possible "shame or guilt" and a "gratitude imperative" form part of the unexamined hallowing of altruistic surrogacy.

This unexamined acceptance of women as reproductive gift givers is very much related to a longstanding patriarchal tradition of giving women away in other cultural contexts--for sex and in marriage, for example. Following Titmuss, we must continually in these discussions of altruism ask: who gives and why? But further, who has been given away historically and why" In this sense, women are not only the gift givers but the gift as well. The pervasiveness of women's personal and social obligation to give shapes the contexts of reproductive gifts and gift giving. We see this most clearly in the situation of so-called altruistic surrogacy.

Altruism versus Commercialism

Those critical of commercial surrogacy often contrast it to noncommercial or altruistic surrogacy. The New Jersey Supreme Court, in its appellate judgement, In the Matter of Baby M, found surrogate contracts contrary to the law and public policy of the state. Nonetheless, it concluded that there were no legal impediments to arrangements "when the surrogate mother volunteers, without any payment, to act as a surrogate." [3] Many state legislative committees are taking action to prohibit commercial surrogacy but are leaving untouched the whole area of noncommercial surrogate practices. altruism and voluntarism emerge as moral virtues in opposition to commercialism. George Annas, who has opposed commercial surrogacy, is sympathetic to the view that "one can distinguish between doing something out of love and doing it for money. As long as existing adoption laws are followed, voluntary relinquishment of a child to a close relative (such as an infertile sister) seems acceptable." [4] Such a scenario has in fact already been played out.

In this country, one publicized case of altruistic surrogacy occurred in 1985 when Sherry King offered to become pregnant for her sister, Carole, who had undergone a hysterectomy eighteen years before. Sherry King provided both egg and womb. "I know I couldn't be a surrogate mother for money.... I'm doing this for love and for my sister." [5]

Such agreements have not been confined only to sisters. In 1987, a forty-eight-year-old woman, Pat Anthony, acted as a surrogate mother for her daughter and gave birth to triplets in South Africa. The attending obstetrician, Dr. Bernstein, commented: "We feel that what Pat Anthony has done for Karen is the acceptable face of surrogacy.... There was no payment, no commercialism. It was an act of pure love." [6] Thus altruism becomes the ethical standard for an affirmative assessment of noncommercial surrogacy.

Altruism also is invoked to soften the pecuniary image of commercial surrogacy. Noel Keane, the well-known surrogate broker, has made an educational video called "A Special Lady," which is often shown to teenage girls in high schools and other contexts, encouraging them to consider "careers" as surrogates. The video promotes the idea that it takes a special kind of woman to bear babies for others, and that women who engage in surrogacy do so not mainly for the money but for the special joy it brings to the lives of those who can't have children themselves. A 1986 article in The Australian used exactly the same "special" appeal to argue "Why rent-a-uterus is a noble calling." Sonia Humphrey, the author, stated:

It does take a special kind of woman to conceive, carry under her heart and bear a child which she knows she won't see grow and develop. It also takes a special kind of woman to take a baby which is not hers by blood and rear it with all the commitment of a biological mother without the hormonal hit which nature so kindly provides.... But those special women do exist, both kinds. Why shouldn't both be honored? [7]

Altruism holds sway. Part of its dominance as an ethical norm derives from its accepted opposition to commercialism. Particularly in the current debate about legalizing surrogate contracts, opponents contend that these contracts make children into commodities to be bought and sold. They allege that this is tantamount to baby selling, and some have renamed the practice commercialized childbearing. Many have focused on the economic exploitation of the women who enter surrogate contracts, women who are in need of money or are financially dead-ended. In these perspectives, the ethical objection is restricted to the fact that a price tag is attached to that which should have no price. The corollary is often that surrogacy "for free" is morally and legally appropriate.

More significant for the dominance of altruism in the reproductive context, however, is the moral celebration of women's altruism. As Caroline Whitbeck has stated in a different context, "the moral expectation upon women is that they be nurturant, that is, that they ought to go beyond respecting rights and meet the needs of others." [8]

The Moral Celebration of Women's

Altruism

The cultural norm of the altruistic woman who is infinitely giving and eternally accessible dervices from a social context in which women give and are given away, and from a moral tradition that celebrates women's duty to meet and satisfy the needs of others. The cultural expectation of altruism has fallen most heavily on pregnant women, so that one could say they are imaged as the archetypal altruists. As Beverly Harrison notes:

Many philosophers and theologians, although decrying gender inequality, still unconsciously assume that women's lives should express a different moral norm than men's, that women should exemplify moral purity and self-sacrifice, whereas men may live by the more minimal rational standards of moral obligation...perfection and self-sacrifice are never taken to be a day-to-day moral requirement for any moral agent except, it would seem, a pregnant woman. [9]

Harrison calls this a "supererogatory morality," acts that are expected to go beyond the accepted standards of obligation. Although traditionally women have been exhorted to be passive, simultaneously they are expected to be more responsible than men for meeting the needs of others. "We live in a world where many, perhaps most, of the voluntary sacrifices on behalf of human well-being are made by women, but the assumption of a special obligation to self-giving or sacrifice...is male-generated ideology" (62). The other side of this altruistic coin is male self-interest. A man is allowed to be more self-seeking, to go to great lengths to fulfull his self-interests, and this has been rationalized, in the case of surrogacy, as genetic continuity and "biological fulfillment." [10]

This is not merely an ideological pronouncement about female self-giving and male self-seeking. It raises complex questions about moral double standards in a cultural context where men as a class set the standards and women live them out, where inequality is systemic, and where women have an investment in their own subordination. This does not mean that every man is self-interested and every woman is altruistic. Were that the case, surely the biological determinists would be right!

There is, moreover, a distinct moral language that is part of this tradition that celebrates women's altruism. It is the language of selflessness and responsibility toward others in which women's very possibilities are framed. It is the discourse of maternalism, which traditionally has been the discourse of devotion and dedication in which women turn away from their own needs. It is also the discourse of maternal destiny in which a real woman it a mother, or one who acts like a mother, or more specifically, like the self-sacrificing, nurturant, and care-taking mothers women are supposed to be. If a woman chooses a different destiny and directs her self elsewhere, she risks placing herself outside female nature and culture. This language also encases women's activities in mothering metaphors, framing many of the creative endeavors that women undertake. Motherhood becomes an inspirational metaphor or symbol for the caring, the nurturing, and the sensitivity that women bring to a world ravaged by conflict.

A body of recent feminist literature, exemplified in the work of Carol Gilligan, has valorized women's altruistic development as the morality of responsibility, emphasizing that this is morality "in a different voice" from men. Formerly a mainstay of separate but equal ideology--as in "vive la difference"--this same discourse is now being transformed by some feminists into an endorsement of women's difference in human and moral development. Yet as Catharine MacKinnon notes,

For women to affirm difference, when difference means dominance, as it does with gender, means to affirm the qualities and characteristics of powerlessness... So I am critical of affirming what we have been, which necesarily is what we have been permitted.... Women value care because men have valued us according to the care we give them. [11]

Altruism has been one of the most effective blocks to women's self-awareness and demand for self-determination. It has been an instrument structuring social organization and patterns of relationship in women's lives. The social relations set up by altruism and the giving of self have been among the most powerful forces that bind women to cultural roles and expectations.

The issue is not whether altruism can have any positive content in the lives of women, but rather that we cannot abstract this question from the gender-specific and gender-unequal situation of cultural values and structures in which new reproductive practices are arranged. This is not to claim that voluntary and genuine magnanimity does note exist among women. It is to say that more is at stake than the womb, the egg, or the child as gift--and the woman as gift giver.

Creating Women in the

Image of Victim

Altruism is not crudely obligatory. The more complex issue is what kind of choices women make within the context of a culture and tradition that orients them to give and give of themselves. To paraphrse Marx, women make their own choices, but they often do not make them just as they please. They often do not make them under conditions they create but under constraints they are powerless to change. The social construction of women's altruism should not reduce to creating women in the victim image.

Yet when feminists stress how women's choices are influenced by the social system and how women are channeled into giving, for example, they are reproached for portraying women as passive victims. Lori Andrews in her essay "Alternative Modes of Reproduction" for the Rutgers Reproductive Laws for the 1990s project faults feminist critics of the new reproductive technologies for embracing arguments based on "a presumed incapacity of women to make decisions." [12] For such detractors, pressure seems to exist only at the barrel of a gun. [13]

For women gifts play many roles. They generate identity, they protect status, and they often regulate guilt. Women who don't give--time, energy, care, sex--are often exposed to disapproval or penalty. But the more important element here is that on a cultural level women are expected to donate themselves in the form of time, energy, and body.

Emile Durkheim, in his classic work Suicide, maintained that suicide, seemingly the most individual of acts, must be viewed as the result of certain facts of the social milieu, what he called courants suicidogenes. One of these social currents was altruism. Durkhiem discussed altruistic suicide as the manifestation of a conscience collective--the capacity of group values and forces to supersede the claims of individuality and, in the case of soldiers and widows, for example, to influence a tendency to suicide. Durkheim observed that altruistic suicide involved a group attachment of great strength, such that individual assertion and fulfillment and even life itself became secondary. The ego was given over to and eventually absorbed in another, having been stripped of its individuality. Altruism resulted when social integration was strong, so binding that the individual became not only absorbed in the group but in the group's expectations. [14]

Durkheim's analysis of social integration is especially applicable to the social construction of women's altruism of which I speak. For women, family expectations often generate this kind of social integration, with family values and inducements over-riding a woman's individuality. This is especially evident in the context of family surrogacy arrangements.

Family Ties, Gifts, and the

Inducement of Altruism

The potential for women's exploitation is not necessarily less because no money is involved and reproductive arrangements may take place within a family setting. The family has not always been a safe place for women. And there are unique affective "inducments" in familial contexts that do not exist elsewhere. Although there is no "coercion of contract" or "inducement" of money, there could be the coercion of family ties in which having a baby for a sister or another family member may be rationalized as the "greatest gift" one woman can give to another.

Thus we must also examine the power and role of gifts in shaping social life. In The Gift: Forms and Functions of Exchange in Archaic Society, Marcel Mauss contends that gifts fulfill certain obligations. These obligations vary, but in all these instances--whether gifts are used to maintain social affection or to promote unity or loyalty within the group--they are experienced as prescriptive and exacting. [15] This is true on a cultural level, as Mauss has pointed out, but it is even more true on a family level, the context most often cited as the desirable site of altruistic reproductive exchanges.

Family opinion may not force a woman, in the sense of being out-rightly coercive, to become pregnant for another family member. However, where family integration is strong, the nature of family opinion may be so engulfing that, for all practical purposes, it exacts a reproductive donation from a female source. And representing the surrogate arrangement as a gift holds the woman in tutelage to the norms of family duty, represented as giving to a family member in need.

Within family situations, it may also be considered selfish, uncaring, even dishonorable for a woman to deprive a relative of eggs or her gestating abilities. The category of altruism itself is broadened in family contexts to include all sorts of nontraditional reproductive "duties" that would be frowned on if women undertook them for money. Within families, it may be considered selfish for a woman to deprive her husband of children by not allowing the reproductive use of another female family member, especially because the arrangements will be kept within the family.

It is also highly likely that those with less power in the family will be expected to be more altruistic. Indeed they may be coerced to be so, as happened to Alejandra Munoz. Munoz, a poor, illiterate Mexican woman, was brought across the U.S. border illegally to bear a child for relatives at the urging of many family members. Munoz was deceived about her role, having been told by family members that when she became pregnant, the embryo would be flushed out and transferred to the womb of her infertile cousin, Nattie. When this did not happen, she vowed to end the pregnancy but was beleaguered and thwarted by family members. Her relatives kept her under house confinement until the delivery. When she fought to keep her child, she was threatened with exposure as an illegal alien. [16]

In 1989, a New Jersey State Task Force on New Reproductive Practices recommended that unpaid surrogate arrangements between friends, relatives, or others be made legally unenforceable. One task force member specifically directed her criticism of noncommercial surrogacy to the family context. Arguing that surrogate arrangements between family members portend the same "disastrous implications" as the Baby M contract. Emily Arnow Alman said that she could foresee the "not-so-bright cousin" being exploited to bear a child for a relative. [17]

We might ask further what is suitable matter for exchange. When we speak of reproductive gifts and donations, but more especially in the case of surrogacy, where the gift and donation is the woman's body and ultimately the child who may be born of such a practice, we put the donation of persons side by side with the exchange of objects and things. The director of the New Jersey task force stated: "The task force feels that the state shouldn't confer any imprimatur of legitimacy on the practice of surrogacy in any for," and that "treating women and children and limiting their liberty by contracts enforceable by the state makes them less than human beings." [18]

Gender-Specific Ethics,

Public Policy, and Legislation

While the altruistic woman may be at the center of noncommercial reproductive exchanges, so too is a portrait of science and technology as altruistic. A feature story on the mapping of the human genome in The Economist in May 1986 emphasized that "science's reputation--after Challenger and Chernobyl--could do with an altruistic megaplan." [19] The new reproductive technologies provide science with one part of this image: in vitro fertilization is represented as offering "new hope for the infertile"; surrogacy gives fertile couples the gift of a child; egg donation is helping others to have children. But it is not the technologies that are the sources of these reproductive gifts. It is women, and the historical medicalization of women's bodies in the reproductive context. Women are taken for granted in the name of reproductive research, the advancement of reproductive science, and, of course, the giving of life.

Altruism cannot be separated from the history, the values, and the political structures reinforcing women's reproductive inequality in our society. Questions such as, Who is my stranger? Which Titmuss designates as the altruistic question with respect to blood donation, cannot be asked within the context of reproductive donations without asking asking the prior question of Who is my Samaritan?

Reproductive gift relationships must be seen in their totality, not just as helping someone to have a child. Noncommercial surrogacy cannot be treated as a mere act of altruism, for more is at issue than the ethics of altruism. Any valorizing of altruisic surrogacy and reproductive gift giving for women must be assessed within a context of political inequality, lest it help dignify inequality. Moral meaning and public policy should not be governed by the mere absence of market values. Moral meaning and public policy should be guided by the presence of gender specificity.

What does this mean? For one thing, it means that any assessment of reproductive exchanges, whether they involve commerce or not, takes as its ethical starting point the question of women's status and how the exchange enhances or diminishes gender inequality. Gender-specific ethics devotes primary attention to the consequences to women. It recognizes not only the harm but the devaluation that happens to all women when some are used for reproductive exchanges.

In Feminism Unmodified: Discourses on Life and Law, Catherine MacKinnon develops this notion of gender specificity as a foundation for legislation. Gender specificity recognizes "the most sex-differential abuses of women as a gender" and the reality that this not a mere sex "difference" but "a socially situated subjection of women." [20] It also recognizes that treating women and men as the same in law, as if all things are equal at the starting point, is gender neutrality.

A gender-specific ethics and public policy confronts the degradation of women in the "private" sphere of reproduction and recognizes the gender inequality that exists as a result, for example, of women's expected altruism. Validating altruistic surrgacy on the level of public policy leaves intact the image and reality of a woman as a reproductive conduit--someone through whom someone passes. The woman used as a conduit for someone else's procreative purposes, most evident in the case of surrogacy, becomes a mere instrument is reproductive exchanges, an incidental incubator detached from the local fabric of social, affective, and moral meanings associated with procreation. Thus the terminology of "donor" is inaccurate; women are more appropriately "sources" of eggs, wombs, and babies in the context of reproductive exchanges. Further, we are not really talking about "donations" here but about "procurement."

Surrogacy, situated within the larger context of gender inequality, is not simply the commercialization of women and children. On a political level, it reinforces the perception and use of women as a breeder class and reinforces the gender inequality of women as a group. This is not symbolic or intangible but strikes at the core of what a society allows women to be and become. Taking the commerce out of surrogacy but leaving the practice intact on a noncommercial and contractual basis glosses over that essential violation.

Proposals that the law keep clear of reproductive exchanges where no money changes hands are based on gender-neutral assumptions. If the harm of surrogancy, for example, is based only on the commercialization and commodification of reproduction, then the reality that women are always used in systems of surrogacy gets no fundamental legal notice. We must note that babies are not always born of surrogate contracts but women are always encumbered.

As a matter of public policy, the violation of a women's person, dignity, and integrity have received no legal standing in most legislation opposed to surrogacy other than as mere allusion (the New Jersey Task Force recommendations are a notable exception). By not giving the violation of women primary standing in legislation opposing commercial surrogacy, women's systematic inequality is made invisible and kept in place. That inequality can then be romanticized as noble in so-called altruistic arrangements.

Gender-specific ethics and public policy raise serious doubt about the concept and reality of altruism and the ways it is used to dignify women's inequality. The focus on altruism sentimentalizes and thus obscures the ways women are medicalized and devalued by the new reproductive technologies and practices. An uncritical affirmation of reproductive gifts and gift givers--of egg donations, of "special ladies" who serve as so-called surrogate mothers for others who go to such lengths to have their own biological children, and of reproductive technology itself as a great gift to humanity--fails to examine the institutions of reproductive science, technology, and brokering that increasingly structure reproductive exchanges.

Women give their bodies over to painful and invasive IVF treatments when it is often their husbands who are infertile. Women are encouraged to offer their bodies in a myriad of ways so that others may have babies, health, and life. These noble-calling and gift-giving arguments reinforce women as self-sacrificing and ontological donors of wombs and what issues from them.

Altruistic reproductive exchanges leave intact the status of women as a breeder class Women's bodies are still the raw material for other's needs, desires, and purposes. The normalization of altruistic exchanges may have, in fact, the effect of promoting the view that women should engage in reproductive exchanges free of charge. In the surrogacy context, altruism reinforces the role of women as mothers for others and creates a new version of relinquishing motherhood.

The new reproductive altruism is very old in that it depends almost entirely upon women as the gives of these reproductive gifts. This is not to say that women cannot give freely. It is to say that things are not all that simple. It is also to say that this emphasis on giving has become an integral part of the technological propaganda performance. And finally, it is to say that the altruistic pedestal on which women are placed by these reproductive practices is one more way of glorifying women's inequality.

References

[1] Richard M. Titmuss, The Gift Relationship: From Human Blood to Social Policy (New York: Pantheon Books, 1971), 73.

[2] Men donate sperm, of course, but sperm donation is simple and short-lived. As one commentator put it, comparing the donation of eggs and wombs to the donation of sperm is like comparing the giving of an eye to the shedding of a tear.

[3] Matter of Baby M, 537 A2d 1265 (N.J. 1988).

[4] George J. Annas, "Death Without Dignity for Commercial Surrogacy: The Case of Baby M," Hastings Center Report 18:2 (1988), 21-24, at 23.

[5] "Florida Woman to Be Surrogate Mother for Sister," Greenfield Recorder, 12 November 1985.

[6] Eric Levin, "Motherly Love Works a Miracle," People, 19 October 1987, 43.

[7] Sonia Humphrey, "Why Rent-a-Uterus is a Noble Calling," The Australian, 19 December 1986.

[8] Caroline Whitbeck, "The Moral Implications of Regarding Women as People: New Perspectives on Pregnancy and Personhood," in Abortion and the Status of the Fetus, William Bondeson et al., etds. (Dordrecht: D. Reidel Publishing Co., 1983), 249.

[9] Beverly Wildung Harrison, Our Right to Choose: Toward a New Ethic of Abortion (Boston: Beacon Press, 1983), 39-40.

[10] Matter of Baby M, 217 N.J. Super, 313.

[11] Catherine A. MacKinnon, Feminism Unmodified: Discourses on Life and Law (Cambridge: Harvard University Press, 1987), 39.

[12] Lori B. Andrews, "Alternative Modes of Reproduction," in Reproductive Laws for the 1990's: A briefing Handbook, Nadine Taub and Sherrill Cohen eds. (Newark, N.J.: The State University, Rutgers, (1989), 269.

[13] this reductionistic view has been challenged by many, including the New Jersey Supreme Court, which reversed the trial court's decision in the Whitehead-Stern surrogacy case. To its credit, the court recognized the complexity of consent in its assessment that for the so-called surrogate, money is an "inducement," as is the "coercion of contract."

[14] Emile Durkheim, Suicide: A Study in Sociology, trans. John A. Spaulding and George Simpson (New York: The Free Press, 195), 217-40.

[15] Marcel Mauss, The Gift: Forms and Functions of Exchange in Archaic Societies, trans. Ian Cunnison (New York: W.W. Norton & Co., 1967), see especially ch. 1.

[16] Alejandra Munoz, press conference on the founding of the National Coalition against Surrogacy, Washington, D.C., August 31, 1987.

[17] Robert Hanley, "Limits on Unpaid Surrogacy Backed," New York Times, 12 March 1989.

[18] Hanley, "Limits."

[19] "How to Build a Human Being," The Economist, 24 May 1986, 87.

[20] MacKinnon, Feminism Unmodified, 40-41.

Janice G. Raymond is professor of women's studies and medical ethics, University of Massachusetts at Amherst, associate director of the Institute on Women and Technology at MIT, and author of the forthcoming Technological Justice: Women and the New Reproductive Medicine (Beacon, 1991).
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Date:Nov 1, 1990
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