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Joint Committee on International Surrogacy debate -
Wednesday, 20 Apr 2022

Surrogacy in Ireland and in Irish and International Law: Discussion (Resumed)

I welcome the witnesses. We are resuming our comparative examination of surrogacy regulations in other jurisdictions. On behalf of the committee I welcome Ms Natalie Gamble, NGA Law and Dr. Kirsty Horsey, senior research associate, London Women's Clinic. I thank both for joining us today.

Before we begin I will read a note on privilege and some housekeeping matters. Witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in regard to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative they comply with any such direction. For witnesses attending remotely from outside the Leinster House campus, there are some limitations to parliamentary privilege and, as such, they may not benefit from the same level of immunity from legal proceedings as does a witness who is physically present. Witnesses participating in this committee session from a jurisdiction outside the State are advised that they should also be mindful of their domestic law and how it may apply to any evidence given.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable. I remind members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex to participate in public meetings. I will not permit a member to participate where he or she is not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts of Leinster House will be asked to leave the meeting. In this regard, I ask any member participating via Microsoft Teams to confirm, prior to making his or her contribution, that he or she is on the grounds of the Leinster House campus. I remind everyone that masks should continue to be worn throughout the meeting by all present and should only be removed while speaking.

I call Ms Gamble.

Ms Natalie Gamble

I thank the committee for inviting me to speak before it. I have spent the past 15 years working with more than 1,500 families created through UK and international surrogacy.

I passionately believe in ethical surrogacy in which everyone involved gives informed consent, there is a direct relationship between the parties and a fair balance of power, any facilitators play a positive role by promoting safety and stability, and the child’s lifelong welfare is safeguarded.

In my long experience, the overwhelming majority of intended parents are conscientious and want to navigate surrogacy in a responsible way. The overwhelming majority of surrogates make an informed choice to carry a child to help someone else, never intending for that child to be theirs. Research across decades has shown that surrogacy children are thriving. What matters to children is not the number or gender of their parents but the quality of their parental attachments. Children born through surrogacy are, unsurprisingly, loved and cherished.

Since I started out in surrogacy law practice in 2005, I have seen surrogacy grow exponentially. There are now approximately 400 UK parentage applications each year with an even split between UK and international surrogacy arrangements. The growing numbers of children born in this way should not be prejudiced by the circumstances of their births. Other children take for granted their right to secure legal parenthood, nationality, inheritance and identity. Children born through surrogacy deserve the same - to belong in the family they were conceived to be part of, born into and raised by.

As lawmakers, therefore, the challenge for the committee is this: how does it influence the environment for surrogacy to help ensure it operates ethically, and, at the same time, safeguard the interests of the children who are being born? First, in a global digital world, intended parents are no longer constrained by national boundaries. Global surrogacy is a reality. It needs to be managed and not ignored in the hope it will go away. International law increasingly stipulates that children born through surrogacy have a right to recognition, whether under the European Convention on Human Rights, ECHR, as part of EU law or via a future Hague Convention.

Second, promoting ethical surrogacy is a complex task that needs a sophisticated understanding of how surrogacy really works and not simplistic categorisations. It is naive to paint domestic or altruistic surrogacy as wholly desirable and international or commercial surrogacy as wholly undesirable. There are no such bright lines. In truth, there are a range of approaches to surrogacy involving good and bad practice everywhere. A far more useful question is what makes surrogacy ethical and how to promote that.

Third, policies designed to restrict surrogacy practice usually have counterproductive outcomes. In the UK, our 1980s laws restricting surrogacy arrangement intended to stifle surrogacy to make it "wither on the vine". In fact, what has happened is that it has ended up fostering unregulated surrogacy; conducted on social media and driving parents overseas in their hundreds.

So, how do things work in the UK and what lessons can be learned? Initially, UK law treats the surrogate, and, if married, her spouse, as the child’s legal parents, even if the child is born overseas. UK parents can, however, apply to the family court for a post-birth parental order, which extinguishes the status of the surrogate and makes them the legal parents. Importantly, parental orders are distinct from adoption orders, recognising that these are children of assisted reproduction. Before making a parental order, the court must ensure the parents are eligible. It must scrutinise payments, ensure the surrogate has given free consent and be content that the order will safeguard the lifelong welfare of the child.

As an advocate for progressive reform, I want the UK process to be streamlined so that children are recognised in the right families from birth without delay. There is some suggestion in the Law Commission’s 2019 law reform proposals that in the UK, we may get automatic recognition of some international surrogacy arrangements and parenthood from birth without a court process in some domestic cases. As I understand it, however, Ireland is a step behind without any current system for properly recognising children as the legal children of both their parents. Automatic recognition would be the most progressive remedy but failing that, Ireland could adopt post-birth parentage applications, similar to the UK, or even pre-birth applications.

Whatever the route, legal parenthood must be Ireland's first and most urgent priority. It should apply to all family forms and all children, whether born in Ireland or overseas, and it should be retrospective so that no children are left behind. By way of comparison, each time the UK has extended eligibility for the parental order to new groups of intended parents, it has provided for a catch-up period in which retrospective applications can be made. The wider and more complex public policy questions are also important but to have any chance of having a real impact, Ireland needs to regulate rather than restrict. It needs to focus not on simplistic questions about whether domestic or altruistic surrogacy is preferable but on the harder and more sophisticated question of how to promote ethical surrogacy practice effectively.

I thank Ms Gamble very much. I call Dr. Horsey to make her opening statement.

Dr. Kirsty Horsey

I wish everyone a good afternoon. I thank the committee inviting me to speak with it today. I am a legal academic based in England at the University of Kent, where I have been conducting research on surrogacy since 1998. I am currently away from the university working a two-year secondment at the London Women’s Clinic on Harley Street as a senior research associate with an expertise in socio-legal aspects of fertility treatments and surrogacy. As part of that, I am currently undertaking a project on surrogacy looking at outcomes of the surrogacy treatments undertaken in our clinics, as well as a more socio-legal focus on the views and experiences of surrogates and intended parents who were treated at London Women’s Clinic via detailed online surveys and follow-up interviews.

As I understand it, the current law in the UK differs from Ireland - even the proposed new domestic legislation currently being considered - in a number of ways. While both recognise the surrogate as the legal mother at birth, in Ireland, only the biological father, whether in a heterosexual or same-sex couple, may acquire legal parenthood following surrogacy, with the other intended parent only being able to acquire guardianship status. In the UK, a couple may jointly apply for a parental order transferring legal parenthood from them to the surrogate and often her spouse or partner, provided some conditions are met, for example, that one of them must be genetically related to the child. A single person using surrogacy may also now apply for a parental order if he or she is genetically related to the child.

The new legislation proposes a kind of parental order system in Ireland but this would be limited to fully domestic, altruistic surrogacy arrangements. In the UK, while the current law states that surrogacy that takes place domestically should be altruistic, parental orders are not limited in this way. Intended parents who access international surrogacy, commercial or otherwise, in overseas jurisdictions may still, and should, apply for a parental order, subject to the requirements laid out in law. If the arrangement was commercial, the court has the power to retrospectively authorise any payments made, including to the surrogate, in the best interests of the child, whose interests are the paramount consideration. Parental orders have been described by the courts as transformative and the correct way to determine a child’s or family’s identity.

The new legislation does not provide for a way for intended parents of children already born through surrogacy, international or otherwise, to have a means of acquiring joint legal parenthood. In the UK, though the legislation stipulates that parental orders should be applied for within six months of the birth of the child, it has been known for many years that this limit is ineffective and contrary to children’s bests interests. A recent case awarded a parental order in respect of an adult born via surrogacy.

Each time there have been changes to the list of who is eligible to apply for an order, there has been a retrospective window in which those with children already born could apply, for example, the extension of eligibility to same-sex couples and those in enduring relationships in 2008 and to single applicants in 2019.

In addition, the law in the UK is currently under review by the Law Commission of England and Wales and the Scottish Law Commission. They published their joint surrogacy law reform proposals in June 2019 followed by a public consultation that ran until October 2019. They are now in the policy development stage considering those responses. Their final report is expected this autumn and will recommend new stand-alone surrogacy legislation and present the Government with a draft Bill. This is likely to modernise and liberalise the law on surrogacy in the UK further.

In particular, key proposals in the original consultation document include a new pathway to parenthood whereby intending parents who follow a particular route to surrogacy would automatically acquire legal parenthood at birth, subject to the surrogate’s right to object for a period specified in law. Safeguards built into the pathway include the parties getting independent legal advice and counselling before a written agreement is entered into, having the agreement overseen by a recognised surrogacy organisation or licensed clinic, medical and criminal record checks being undertaken and an assessment of the welfare of the potential child. All of these should occur before conception is attempted.

For those who do not fit the proposed pathway, the parental order route would remain. This would include international surrogacy arrangements, whether commercial or altruistic, and do-it-yourself, DIY, arrangements.

This would mean that the court would scrutinise the arrangements, presumably including checks by the Children and Family Court Advisory and Support Service, CAFCASS, that the child's best interests are being met. It is also proposed that a national surrogacy register be created, where information about the intended parents, surrogate and any egg or sperm donors, both on the pathway and parental order route, is collated. Similar to donor conception in the UK, children born through surrogacy could have access to non-identifying information at the age of 16 and to identifying information at the age of 18.

In terms of regulating international surrogacy, problematic aspects of international surrogacy, as identified by the law commissions, include aspects of nationality or citizenship, especially where there is a conflict of law, immigration, depending on the country of birth, and legal parenthood, which in the UK is determined by the Human Fertilisation and Embryology Act 2008, notwithstanding where the child was born. As previously indicated, international surrogacy arrangements would fall outside of the proposed new pathway. However, the Law Commissions also provisionally proposed that the law should provide the ability to recognise the status of legal parenthood acquired by intended parents in other countries automatically, without the need to apply for a parental order. This should be "on an individual "country by country" basis when it has been established by the government that the laws and practices of the country in question provide protection for the welfare of the child, and against the exploitation of the surrogate".

There have been some proposals to try to regulate surrogacy internationally, though given the disparity of approaches to surrogacy in nations around the world, it would seem unlikely that this could ever be achieved. Thus, it seems better to try to seek a way for national law to do the best it can in respect of overseas arrangements, for example, as proposed earlier, alongside supporting best-practice surrogacy domestically, so as to encourage fewer people to go overseas.

While I am not pretending that the law in the UK is perfect, it is the case that international surrogacy arrangements are currently accommodated. Proposals made by the Law Commissions may have the effect of giving intended parents more confidence in undertaking domestic surrogacy, thus reducing the number of people seeking surrogacy overseas. However, it is unlikely to be the case that all overseas surrogacy ceases, but building in a mechanism to automatically recognise legal parenthood for intended parents who travel to countries where surrogacy services protect the best interests of women and children may help, by encouraging people to seek out these destinations over less ethically-sound ones. It strikes me that Ireland could consider similar proposals, as well as stand-alone legislation on surrogacy, so as not to delay the remainder of the assisted human reproduction, AHR, Bill further. Within my own research I have encountered intended parents from Ireland who have entered arrangements with surrogates in the UK. It would seem strange if this, at least, was not a route Irish intended parents were able to take.

I thank both witnesses for their contributions. I now invite members to ask questions. We have a speaking rota and each member has seven minutes both for their questions and the responses of the witnesses. I expect we will get to have a second round if people have additional questions to ask.

I thank both witnesses very much for their statements. Regarding pre-birth and post-birth systems of transferring parentage rights from the surrogate mother to the intending parents, can best balance be provided to protect the rights of the intending parents and of the surrogate mother? Does either system have particular benefits with regard to protecting the rights of children born through surrogacy?

Ms Gamble noted in her statement that it can be difficult to find UK surrogates. There are four non-profit matching organisations that have considerably long waiting lists. Could she elaborate on the point that it is incredibly rare for the surrogate to change her mind? It does happen. What makes surrogacy ethical? That is the question we want to get our heads around.

She also said that the UK law is not perfect and it has evolved to work in practice, perhaps through judicial flexibility around criteria that could have been interpreted restrictively, but this has muddied the rules with case law significantly varying what the legislation appears to say. There is also significant delay in recognising children's identity, leaving them living with a family of which they are not legally a member for up to one year following their birth. She said in considering a similar judicial recognition of surrogacies, it would be sensible for the Irish Government to consider a prompt, ideally, pre-birth process, and to ensure the criteria are not too restrictive. What way would she see that working in Ireland?

Does the Senator wish anyone in particular to respond?

There is one question for Ms Gamble and the question on the transfer of pre-birth and post-birth parental rights is for Dr. Horsey.

Ms Natalie Gamble

There are a few questions in there. The Senator asked about shortages of surrogates in the UK and waiting lists at the non-profit organisations. It is one of the big things that does encourage parents from the UK to go overseas, because there is a real lack of certainty about when they might find a match with a surrogate. There is definitely a disparity in the number of surrogates when the parents are looking for them, so that is one of the big drivers for parents going overseas.

In terms of the question about surrogates changing their minds, it is incredibly rare. Bearing in mind that I am a lawyer who practices in this area, so if people do have those sorts of problems, I am the first person that they call, but we have only had a very tiny handful of cases where that has happened. I am talking about possibly four or five cases out of thousands of domestic UK surrogacy arrangements over several decades. The cases where that does happen tend to be situations in which people have rushed into things, not taken their time, very often met on Facebook groups and not gone through the proper process of thinking through all the implications of what they are doing. When the communication between the parties breaks down during the pregnancy, that can lead to difficulties, but it is exceptionally rare for that to happen. When it does, the way that the law works in the UK is that the family court will make a determination about who the child should live with on the basis of what is in their best interests. Every case is fact-specific; it is not a question of the surrogate having a right to keep the baby. It would depend on what is best for the child. The four or five cases there have been, have been split fairly evenly in terms of outcome.

The Senator asked the very important question of what makes surrogacy ethical. In my mind, it is very easy to silo different types of surrogacy and say we want it to be domestic, we want it to be altruistic and say that all of those arrangements are ethical if they fall in that category, but I do not think it is as simple as that. I think constantly every day about the ethics of the surrogacy arrangements that we are involved in. For me, it has a number of different components. It is about having a strong relationship that is direct between the parents and the surrogate so that they are going into this with informed consent. They are wanting to help each other. Everybody is doing this as adults who know what they are doing. It is important to look at the role of the third-party intermediaries. Where those intermediaries operate well, they apply screening. They make sure that people are suitable, that they are well informed and that they have been through psychological assessments, counselling, legal advice, etc. That can be a very positive influence on making sure that the arrangements are ethical. That is less so where there is not a fair balance of power. In some jurisdictions we see those third parties have a very controlling influence and keep the parents and the surrogates at a distance from each other. That is less ethical and more fraught with problems.

The child's welfare being at the heart of things is key for an ethical surrogacy arrangement. What does that mean? That means that the child should be recognised in the right family promptly, but it also means that there should be openness and transparency and that information should be kept for the child in the long-term future, so that the child has a positive story and has access to information to answer any questions they may have as they grow older.

The last question was about pre-birth and post-birth orders. We deal with parents from the UK going to all the different surrogacy destinations overseas. I have seen all the different models. There are some where there is a court process even before conception, there are some where there is a court process during the pregnancy and there are some where there is no court process and there is recognition from birth.

There are also post-birth application processes. The ones that work the smoothest are those seen in some US states where there are stipulations that people should have legal advice, counselling and so on, they should enter into a written agreement and, during the pregnancy, there is a judicial process to ensure that has been done properly so that, when the child is born, a determination has already been made that all of the safeguards have been put in place and, therefore, the child belongs in the right family from the moment of birth. These arrangements seem to work the smoothest and best.

The problem with post-birth recognition is that there is an inevitable delay, meaning that the children are in limbo and without status. Sometimes, they are even stateless, which can be significant when crossing borders. There is a problem with recognising arrangements too early as well. In South Africa, for example, people go through a court process before they even conceive, but that is onerous when they do not know whether they will even be able to conceive.

Does this answer all of the Senator's questions?

Yes. May I speak again?

We have to keep it within time, but I will allow Dr. Horsey to respond.

Dr. Kirsty Horsey

The Senator asked me whether the pre-birth or post-birth model was better. I agree with Ms Gamble that a pre-birth determination, albeit not too early, would be in the best interests of the child. Research bears that out. It helps with the recognition of the autonomy of all the parties, it can deal with the issue of the parties receiving proper informed consent, and it can deal with the screenings, checks and balances that need to take place prior to the birth of the child. As she stated, it also means that, at birth, the children are born into the right family. This has practical implications. For example, if consent needs to be given in hospital for medical treatment, then the intended parents, who are usually the ones looking after the child, would be able to give that consent to the hospital. Difficulties like this in the period immediately after birth have been raised in my interviews and surveys time and again. It is one of the issues that could be solved.

A pre-birth determination means that the child is not born into a legal limbo and has an identity from the point of birth within the right family. The surrogates and intended parents I have spoken to would prefer everything to be put in place before birth. Of course they would. At the point of birth, there is a newborn baby. Someone is looking after that child and does not want to be filling out forms and worrying about court processes. It seems that many intended parents worry, unjustly in many cases, about that court process because it is a court process, there are forms to be filled in correctly, there are hearings to be had, the surrogate has to be brought back, etc. It increases stress at a time there should be happiness. That comes up a great deal in many of the interviews I have done.

In a nutshell, I agree with Ms Gamble on all of that.

I wish to remark on how Ms Gamble said that what mattered to children was "not the number or gender of their parents but the quality of their parental attachments". I agree. We have many different family dynamics in our modern society. I liked her comment.

I wish to ask about the pre-birth and post-birth models, which arose in our discussions last week. Some of this discussion has been covered. Ms Gamble spoke about safeguards being put in place. She would agree that a pre-birth model is best and in the best interests of children. I am picking that up from some of her answers, but she might speak on it further.

Ms Natalie Gamble

Children having the right status from the point of birth is important. I will tell the committee a story from 2008 of the first international surrogacy case that we dealt with and that highlighted these issues. A British couple had gone to Ukraine and conceived twins. Under UK law, since their surrogate was married, the surrogate and her husband were the parents and the British parents were not, which meant the children were not born British. Under Ukrainian law, though, the surrogate and her husband were not the parents and, instead, the British parents were. Each system of law said that its people were not the parents. As a result, the children were born into a black hole where they had no nationality anywhere in the world and no legal parents responsible for them. The judge described them as having been marooned stateless and parentless. The situation was resolved by the court making a parental order to make the intended parents the legal parents, but it illustrates how stark these issues are for children. If they do not have recognition from birth in the right family, it can have significant consequences.

I agree. It is an interesting point. Last week, we heard that approximately 85% of health professionals dealing with the issue in Ireland agreed with the pre-birth model and that it avoided questions over who could make a decision where there were complications and medical intervention was needed when a baby was born. Obviously, the intended parents are the appropriate people to make such decisions. I appreciate Ms Gamble's reply.

Is Dr. Horsey in the middle of her research? That research would be of interest to us as a committee, so if it was concluded soon, it would be great. Is there anything she can tell us about it? Perhaps she cannot if she is in the middle of it.

Similar to my question on pre-birth as opposed to post-birth, Dr. Horsey stated: "subject to the surrogate's right to object for a period specified in law." Did she mean that the surrogate should have the right to object to the intended parents becoming parents or did she mean something else? She might elaborate on this point.

Dr. Kirsty Horsey

I have done research in the past that informs some of my statements and opinions, but I hope that the research that I am doing currently will be published soon. There was nothing in its early findings that surprised me; it all seemed to validate or back up previous research that had been undertaken and it told us many of the same things. This is a cohort of people who have undergone surrogacy treatments via the London Women's Clinic. We are looking at their views on surrogacy and the processes. There are aspects of the clinical processes that we are asking them about, including their birth experiences. We are also looking at their understanding of the law and their views on the potential legal reforms that I hope will be made when the law commissions make their final recommendations. That aspect of the research is yet to be published but should be published soon.

I could share with the committee some data if there was something it wanted to know specifically, but it should be recognised that this is a cohort of surrogates being treated at one particular set of private clinics in the UK context, and although it is probably representative, it is not necessarily wholly representative and does not include anyone undertaking international surrogacy.

Dr. Horsey stated: "subject to the surrogate's right to object for a period specified in law."

Dr. Kirsty Horsey

That is something that is in thelLaw commissions' provisional proposals. Although they are proposing an automatic legal parenthood at birth for the intended parents if all of the pathway has been followed and the checks and balances taken in the pre-birth process have been met, there is a co-proposal that that should be subject to the surrogate retaining the right to object for a period. This co-proposal is yet to be fully recognised, but the commissions have suggested a period of two weeks during which she would have to state publicly that she did not give her consent to the intended parents becoming the parents. It would not necessarily be the case that she wants to keep the child, only that she does not believe that the intended parents should be the parents.

I thank the witnesses.

I thank the witnesses for their contributions and answers to the questions. They have been really informative. Many of my questions have been answered. I am drawn to the potential new pathway to parenthood and what is laid out about ensuring something is ethical. Most of us want a regulated, ethical framework. The route for intended parents in the new pathway to parenthood stands out to me. Are there any discussions about groups that are left out of that structure to access surrogacy when criminal record checks arise? Does that rule out people who may have a criminal record that has nothing to do with their ability to parent? Does that end up creating something unethical by restricting a cohort of people, whether due to social class or other reasons, from accessing pathways to parenthood? Are discussions about such matters happening?

Ms Natalie Gamble

That discussion is yet to be had. The model that is being looked at is a regulated system of surrogacy. The agencies and organisations that facilitate matching would have a responsibility to conduct screening. That would be under licence from the Human Fertilisation and Embryology Authority. The second stage would be for the authority to determine what that screening looks like and what its consequences are. If it is required to conduct criminal records checks, is that to exclude certain people from being eligible to become parents or to make sure that everybody is aware of all the issues and backgrounds, and that there is openness and transparency? In adoption law in the UK, there are a limited number of specified offences that prevent people from applying to be matched with a child for adoption, including offences against children and very serious offences. That may carry over into surrogacy, but that will be a matter for the regulator to decide.

I would be concerned about class bias when the regulator is deciding that. Restrictions make sense in a limited number of circumstances, such as if somebody is a danger to a child, but that does not necessarily incorporate all things that might come up in a criminal record. It just stood out to me. I want to make sure that all groups, regardless of their background, have access to a legal, ethical framework. I have one more question for Ms Gamble. She said legal parenthood should be a priority and to regulate and not restrict. We could get bogged down in considering which system is more preferable and then neglect getting into what is ethical and how we regulate it. Will she speak more to what happens if we ignore the regulation and decide to have restrictions instead?

Ms Natalie Gamble

It is about separating clearly in one's mind what the status of the children is and whether they have recognition in the right families from a separate question, which is how we can encourage intended parents and surrogates to go to good jurisdictions overseas, or not to go overseas, and so on. It is a mistake to use parentage, which affects children, as a tool to affect behaviour. It should not matter what the circumstances of children's conception are. They have a right to belong to the right family. On restriction or regulation, the policies that encourage parents to do things in the best possible way are important. Those include how friendly the environment at home is. If it is as liberal as possible and as supportive of parents and surrogacy as possible, including safeguards such as pre-conception checks, sensible advice, counselling and so on, and if that is facilitated at home, it will encourage more people to stay. If it is restricted and can only happen at a specific type of clinic in Ireland and if people are certain types of parents, that will drive people overseas to places where Irish law has no jurisdiction to control what happens. It is necessary to be realistic about what can be achieved, rather than stating that we do not like commercial surrogacy in some jurisdictions, so we will not recognise children as having status if they are born there, because that conflates two separate issues.

Basically, restrictions result in refusing rights and protections to children who will be born anyway. Regulation is much more ethical, whether one believes in surrogacy or not.

Ms Natalie Gamble

Yes.

I thank Ms Gamble.

I thank the witnesses for their contributions. They are helpful and confusing; each time I have a question. Our main goal is to ensure that pathways to parenthood, which the witnesses speak about, is something that this committee looks at to ensure that we have family protections, both existing ones and for the future. Some of my questions have been asked. If there was an immediate acknowledgement of parenthood, is there a process for that pathway to be revoked? What happens if it is deemed after the fact that it was unethical? What happens to that baby if the surrogate says that she is just the surrogate and the baby is not hers? Regarding ethical international surrogacy and surrogacy in general, while it is maybe a naive word to use, is there a checklist of general requirements to ensure that all parties are taken care of in the partnership? Is there a checklist for a judge to make a parental order?

Dr. Kirsty Horsey

In response to the first question, if the intended parents acquired automatic legal parenthood at birth and then subsequently something was found to be unethical or wrong in the arrangement, they have legal parenthood. If the surrogate is past the window of opportunity where she has the right to withdraw her consent for them to have legal parenthood, then they would be parents in the same way as anyone else who becomes a parent or parents. We have a Children Act in the UK that protects the welfare of children. Decisions would be made on that basis if a question was raised about the child's welfare. The welfare of children falls within a different area of law to the question of who the child's parent is at the moment of birth.

On the other point, the Senator may be conflating the parental order route and the proposed pathway to parenthood. The proposed pathway to parenthood would only apply to domestic arrangements in the UK, as long as what is currently proposed by the Law Commission includes counselling, criminal records checks, legal advice and all the other things put in place prior to birth. Those parents would automatically become the legal parents at birth, subject to having a genetic link, if that is retained.

For overseas arrangements, which will inevitably still happen, then the pathway would not come into play and it would be a parental order process, in which case you are looking at post-birth checks and balances carried out by a judge on the basis of the parental order application. Thus, there is a different timing of the checks depending on where and how the child is born. Does that make sense?

Yes. What we are trying to do here is ensure we have ethical international surrogacy. Dr. Horsey said it is up to the judge to decide whether it was ethical. Is there guidance for that judge? Is there a list of things parents, agencies and everyone must adhere to during the process in order for that judge to make the parental order? Alternatively, is it solely in the judge's hands? What guidance does the judge look to?

Dr. Kirsty Horsey

We should note that judges are already doing this. Whether there is a written checklist rather than just common law principles is more something Ms Gamble could answer.

Ms Natalie Gamble

Yes. Essentially, whether it is pre-birth or post-birth, there is a checklist. It is a question of who is overseeing that and at what stage. With the proposed pathway Dr. Horsey was talking about it is regulated surrogacy organisations that must ensure these steps are taken and then they certify that has happened. That is what then enables the parents to be recognised as the legal parents from birth. With the current system and the system that will remain for international surrogacy cases, it is about a judge looking at the criteria set out in the legislation. Some of those criteria relate to the eligibility of the parents. They must have a genetic link, one of them must be domiciled in the UK, they must be aged over 18, etc. Another criterion is the surrogate must have given her full, free and unconditional consent more than six weeks after the birth. I deal with these applications every day and judges take that requirement for consent very seriously. They want to see surrogates participate in the process. They want to ensure documents are properly translated if English is not a surrogate's first language and that they are notarised, signed by the right person, etc. If there are any concerns about consent then that will be investigated very rigorously.

The court will then look at the payments. This is when the ethical exploitation stuff comes in because where the court is authorising payments of more than expenses, it will want a clear breakdown of the financial transactions that took place. It will be down to the penny and cover everything that was paid and what it was for. It will also want to understand the context around that, namely, who the surrogate is, whether there is any suggestion she is being exploited or taken advantage of, whether the parents have acted in good faith or whether there has been anything illegal or immoral. The court will inquire into all those issues and want to be satisfied about them.

Ultimately, if there are issues or problems or something that has happened that the court feels is not in the best possible way, which is very rare in my experience, but if there is a question about the ethics of it the court will then balance that public policy against the welfare of the child. It will do an exercise of measuring if this is such a serious breach of public policy it should withhold a parental order or is the child's welfare the paramount consideration and should it outweigh that? There has not been a case where a parental order has been refused so the compulsion of the judges to safeguard the welfare of the child is quite rightly very strong but that does not mean the ethical issues are just irrelevant. People will get a very hard time. They will have to produce a lot of evidence. There will be questions about what they have done, why and how and what happened and so on. It helps nudge people in the right direction. If I do legal advice meetings with parents at the beginning of a surrogacy journey I will tell them if they want to make the court process as straightforward as possible, they need to show they have taken care of their surrogate, asked about the screening, that they have a relationship with her, that they have ensured things were done properly and that no one is being taken advantage of. Thus, the way the court inquires into these issues actually has quite a positive effect in changing the environment in which people are conducting surrogacy internationally.

I thank our guests for their opening statements and contributions and I thank Ms Gamble for the briefing document, which I appreciated. There are more than 67 million people residing in the UK. Much of the argument for the need for international surrogacy in Ireland comes down to population and the fact there would not be the same availability of people willing to be surrogate mothers here. When I consider the population of the UK, I wonder why people are travelling. I would appreciate our guests' input on that matter.

Ms Natalie Gamble

We did some research in 2018 with Cambridge University to look at the reasons people were going overseas because this was a group of parents that was very hidden in policy and research. We found the main drivers for UK parents going overseas for surrogacy was, first, the lack of access to professional matching services and certainty around when they would find a surrogate; second, the shortage of surrogates; and, third, the lack of legal certainty in the UK. That was really important. Parents going overseas very often want to access a place where they will be recognised as their child's legal parents from birth. I hear repeatedly from parents who are at the stage of choosing how to do this that they understand the risks of a surrogacy going wrong in the UK are very small but this is their child and they cannot afford to take any risk. They want to be recognised as legal parents from birth. This comes back to how if the environment is made restrictive at home, this is just going to be driven overseas, so it is much better to make it more liberal at home and make it possible for people. That will encourage more people to stay. However, international surrogacy is not going to go away. People will continue to go overseas both from the UK and I am sure from Ireland as well.

Okay. I thank Ms Gamble. Does Dr. Horsey have anything to add?

Dr. Kirsty Horsey

It was exactly the same in surveys we did in 2015 and 2018. The people who went overseas cited certainty of the processes over there and the ability to be recognised on a birth certificate as the legal parents as the main reasons that were taking them over there. Similarly, there is the uncertainty at home. It is a combination of both, as Ms Gamble said.

Okay. That is great. That brings us to the countries people would go to. We are hoping to have an assisted human reproduction authority here. My hope is that would be a place of knowledge and experience about what has happened or about surrogacy and even within Ireland about recommended clinics, licensed clinics abroad, and maybe recommended countries and clinics within that country so we would have some repository of all that information.

That brings us to how to examine a country. I practise privacy law professionally. Article 45 of the GDPR supplies the criteria that are looked at for adequacy decisions on allowing the transfer of personal data abroad. These look at issues such as human rights and the rule of law in a country. Article 45.2 specifically sets out the criteria that are to be looked at when an adequacy decision about a country is made at an EU level. What we put into our law could be analogous to that. We could have criteria such as ensuring there is independent legal advice, recourse to the courts - and that must be easy access to the courts - rule of law and professional medical and legal standards. Do our guests have any suggestions for what could go on such a list to advise people to travel to particular countries, or more importantly to advise them against travelling to specific countries, to avail of surrogacy?

Ms Natalie Gamble

I guess the starting point would be what the law is in the country and what it requires of people who are going through surrogacy arrangements. If we look at the world map of surrogacy, as it were, there are those countries where there is specific legal regulation that states that if it is done in a certain way and particular steps are followed, then legal parentage is recognised. It is very easy to see, in those jurisdictions, what steps are being taken. We then have those countries where there is no legal regulation of surrogacy, but it happens. This was the case in India before it was closed down, and we have seen it in Thailand. I am referring to the countries where surrogacy keeps moving. Surrogacy happens there for a while and then the government clamps down and stops it, and then it moves somewhere else. With those countries it is much more difficult to see what those standards would be, because there is no uniformity or legal regulation of it. We would be relying on the regulation of professional bodies, doctors and so on. It would be much harder to see what is really going on in those places. That is probably the easiest way to draw a clear distinction between countries where there is specific law and regulation around this, and countries where there is not.

My third question concerns the definition of commercial surrogacy, and the fact that there is not a recognised definition of it. We have everything from compensated surrogacy, as in the Canadian model, all the way through to absolute exploitation and criminal behaviour. I think the term "commercial surrogacy" can be weaponised in the hands of those who do not want surrogacy. They will draw attention only to the extremity of criminal behaviour, rather than understanding what it is. In Ms Gamble's experience, when UK judges look at a situation where money has exchanged hands, how do they discriminate between commercial and compensated surrogacy, and where is that permissible line drawn?

Ms Natalie Gamble

I think the Senator is right. These things are weaponised. It is really important to be very factual and clear about what we are actually talking about. For most people, the public consciousness of commercial surrogacy is that the surrogates themselves can be compensated beyond their expenses. Actually, there are other elements to what might be called commercial surrogacy. It is about the intermediaries being able to make a profit out of arranging the surrogacy, and whether contracts are enforceable between a parent and surrogate without other things around those agreements being in place to ensure safeguarding. There are lots of different elements of it.

I think we need to look at those individual things. In terms of compensation to surrogates, it is all about the context. What we see, for example, with American surrogacy arrangements, is that surrogates are paid compensation in a very open and transparent way. They have legal advice, screening, psychological evaluations and a lot of support via professional agencies. The relationships between parents and surrogates feel very balanced, fair and ethical. The fact that the surrogates are being paid does not harm the ethical nature of the surrogacy. In other jurisdictions, there is much more risk of an imbalance of power between the parents and the surrogates, particularly where there is a wealth imbalance, where there is a language barrier, and most importantly of all, where there are profit-making intermediaries who are controlling the arrangement and not allowing that direct relationship between the parents and the surrogate.

Just talking about commercial surrogacy as an evil of itself is a really naive way of looking at things, because it misses all of that nuance. It is about looking at whether compensation is being paid to the surrogates for what they are doing, and if so, if there is a context around that to make sure that they are giving informed consent and that there is a balanced relationship. It is also about looking at the role of the intermediaries and whether they are playing a positive role, supporting everybody, carrying out screening, being belt and braces and making sure that everybody is safe, or whether they are carrying out a role where they are keeping people apart and managing the situation in a very controlling way. Those are the questions to ask. That is why I said in my opening statement that we need to really drill down into what makes surrogacy ethical, rather than just saying that if it is commercial, it is unethical, and it if it altruistic, it is ethical.

On the other side of the fence, altruistic arrangements can be unethical. For example, there could be an arrangement between siblings, where, let us say, one is not being paid, but feels under enormous pressure to be a surrogate when it is not something she really wants to do. The involvement of money is not in itself a determinant of whether something is ethical or not. What we are really asking is whether there is exploitation, whether one side it taking advantage of the other, and whether there is informed consent. Those are the questions we should be asking.

Some of my questions have been answered already, so I am reformulating some of my thoughts here. The criteria that was mentioned by Senator Seery Kearney and the checklist that was spoken about, is an interesting aspect. One of the things that comes to mind, certainly, from our own experience in this country, is intercountry adoption, where countries have been approved for intercountry adoption, have lost that approval and have managed to regain it. I do not know if we are engaging with the Adoption Authority of Ireland. Perhaps a comparative paper about its experience of regulating intercountry adoption, or even an issues paper around it, could be very useful - if we have time, admittedly. There was mention of the checklist that the judges are using in relation to parental orders. I was very curious about parental orders and whether any were denied. I am hearing that none were denied, which is interesting. Is the checklist that judges are using informal and coming from these NGOs or Government agencies, or is it grounded in any sort of legislation, statutory instruments or regulations? Where does that checklist come from? What does it look like? I think that would be a very useful thing to know in terms of those criteria. I have a few other questions after that.

Ms Natalie Gamble

The checklist is section 54 of the Human Fertilisation and Embryology Act 2008. If the Deputy has a look at my briefing paper, it summarises what those requirements are. Yes, it is set out in law and legislation. It is also expanded upon by case law. Over a number of years, we have had many cases where people have not quite ticked the boxes for various reasons, but the judges have wanted to get to the end result of awarding parentage to the right people. Some of those requirements have been stretched by the case law. One starts with the legislation, but one would also need to understand all the case law around it. For example, I know that Dr. Horsey mentioned earlier that the legislation states that parents must apply for parentage within six months of the birth, but we now have case law wherein judges have stated that it is such an important order for the child that parliament did not really mean "must", and must have intended to allow the judges some discretion. The court now can give permission for people to make applications beyond six months. I would recommend starting with section 54, but it should be borne in mind that it has been expanded a little by real case decisions.

Dr. Kirsty Horsey

Can I just add to that that when Ms Gamble said that no parental order had ever been refused before, she was talking in the context of payments overseas. There have been refusals to make parental orders. To my knowledge, and Ms Gamble will correct me if I am wrong, all of those cases were about consent, where the surrogate either could not be found or did not or would not give consent. Of the checklist in section 54, that is the one criterion that seems to be absolutely holding its own. There have been no deviations around that other that what is already built into the law itself.

Ms Natalie Gamble

There are two of the criteria where parental orders have been refused. One is consent, and the other is domicile. The court has to have the jurisdiction. The parents have to have enough connection with the UK. I think there have been two cases where orders have been refused because parents did not meet that criterion. The court has then gone on to consider what else it can do instead. It does not mean it is necessarily the end of the road. In terms of consent, there has been a key case in the UK, which I am sure Dr. Horsey is alluding to, where a surrogate gave birth, gave the baby to the intended parents, but then there was a disagreement and she spitefully refused consent to the parental order not because she wanted to care for the child, but just because she was being very difficult. The judge essentially said that the law bound their hands and they wanted to make a parental order but could not do it. As a result of that case, one of the recommendations in the Law Commission's proposals is that going forward, the court should be able to waive the requirement for consent if it is in the child's best interests. In the future, if that situation were to arise again, the court would be able to make a parental order in those circumstances.

That is a very difficult case. The truism of bad cases making bad laws is a very complicated issue.

I was curious about one other matter. We had the discussion last week and earlier today about pre-birth versus post-birth recognition of parentage and parentage orders. With regard to the child arriving in the jurisdiction, how does that work in terms of the UK's courts and immigration? Can intending parents get recognition? Can Ms Gamble talk about the difficulties around immigration status for international surrogacy?

Ms Natalie Gamble

Yes. The parental order process is quite a lengthy one and it does to some extent require the parents to be in the UK. What happens in international surrogacy arrangements is that a person must deal with the immigration side of things while he or she is in that limbo point before he or she has got secure parenthood. It is, therefore, incredibly complicated. It depends on the jurisdiction, who has got what kind of British nationality and whether the surrogate is married or not. Essentially, there needs to be an immigration plan in each case.

With American cases, typically, parents will apply for an American passport and use that to travel into the UK. They then get the parental order and then once the parental order has been granted, they will apply for the British passport. In places like Ukraine and Georgia, people do not get a local passport so they have to apply for the British passport. That often means children are stuck overseas, sometimes for three or four months, while those immigration processes are sorted. The passport has to go through this very complex process of trying to work out whether this child is actually British or not, and, if he or she is not, granting British nationality in order that the parents can come home to complete the parental order application. One of the reasons we are advocating for some kind of pre-birth model for international cases is because this is just so complicated and difficult. It is to the detriment of newborn children that their parents are stuck in a jurisdiction where they do not have support networks or access to healthcare and the NHS and all the rest of it. The way the two things interact are really complicated.

There was much talk about the dangers of children falling into the gaps and the best welfare of children being the paramount concern. My time is almost up so I will leave it there.

I thank the Deputy very much. I have a couple of questions, the first of which is with regard to the fact that there is currently no regulation in Ireland dealing with this. Many children have already been born, whether domestically or internationally. What are the witnesses' recommendations for us to retrospectively deal with those children to ensure that they are not disadvantaged by the fact that Ireland had not grasped how to manage surrogacy? That is the first question.

The second refers to when the witnesses said they do not pretend the law in the UK is perfect. I do not think any jurisdiction would probably have perfect laws. It is a very complex issue. I doubt any jurisdiction has any perfect regulation or laws. Which model and jurisdiction do the witnesses think meets the correct balance between protecting the rights and welfare of the children, the surrogates and also the intending parents? Is there any jurisdiction that stands out in that regard?

Dr. Kirsty Horsey

I will take the second question first - no, not really. Like the Chairman said, I do not think anywhere is perfect. There have been attempts to make things better or get closer to how it probably should be. Some of the aspects of the Law Commission's recommendations would improve the UK law. Similar things are happening in New Zealand and there are various discussions. I cannot think of anywhere that is perfect, however. The model of pre-birth operation that goes on in Greece is quite interesting but that has its flaws as well because so many people are excluded from the processes. Obviously, that is an entirely different system from the UK anyway so it does not map on. It is, therefore, hard to say where one jurisdiction would be anything like perfect compared to us. We probably have to aim to make our own law better to act to safeguard the children and families that are being created this way. Would Ms Gamble agree?

Ms Natalie Gamble

I do not think the Greek model works very well on the ground at all. It is one of those places where a person needs a court process before he or she can even see. It is just too onerous to work in practice. The models that work best, and it is slightly different in different states, are the US models whereby everybody has screening, legal advice, counselling, psychological evaluation and enters into an agreement. The law will recognise intention, therefore, it will recognise the people who intend to be the legal parents as being the legal parents. There is then some degree of oversight, however, that those kinds of safeguarding checks and so on have happened pre-conception, whether that is a judicial process during the pregnancy, or, as in the state of Illinois, it is an administrative process where a person simply has to file papers with the local department of health. Having some oversight to make sure the steps happen around the agreement and make sure everything is done properly at that stage, which then enables everyone's intention to be ratified and honoured at the point of birth, is the most efficient and effective way of ensuring ethical surrogacy. Those are the models that stand out to me having seen it work in many different places.

In answer to the Chairman's question about not leaving children behind that have already been born, and Dr. Horsey mentioned this earlier, we have dealt with this quite a few times under UK law. The parental orders came into UK law in 1994 and at the time, people had to be a heterosexual married couple to apply. The law has since been expanded in stages. In 2010, same sex couples and partners who were living together but not married became eligible to apply for a parental order. The new law that was coming in said that if a person either had a child who had been born within the last six months or had a child of any age for the first six months of that law coming into force, he or she could make an application. The same thing happened in 2019 when they expanded it to single parents. Whatever system Ireland decides to go for, whether that is automatic or administrative recognition or a judicial process or whatever, allowing some form of opt-in for a period of time for the parents who have until this point been excluded is a very easy way of fixing that retrospectively.

I thank Ms Gamble very much. We have some time so we can go around for another round of questions. We might limit it to five minutes each to make sure we get around. I call Senator Keogan.

Some 400 paternal orders are made each year through the English court system. This is with regard to Ms Gamble's statement, in which she said half of those are through UK surrogacy agreements and the other half are through international agreements. Further on then she said that 69% are international surrogacy arrangements. I want Ms Gamble to correct the actual figure on that. Is it 50% or is it 69%? The international surrogacy arrangement parental order extinguishes the motherhood of the overseas surrogate and transfers it to the intended parents. The UK birth certificate, therefore, reflects the intending parent and legal guardian. How does she believe that is in the best interest of the child? How does she believe it is even ethical to erase the birth mother from the process? That is the first issue.

Is Ms Gamble familiar with the Spanish case? There was a court case in Spain on 10 April that ruled that commercial surrogacy constitutes unacceptable exploitation of both the child and biological mother. The case involved a Spanish woman who made a contract with a surrogate in Mexico in 2015 to bear a child through a surrogacy agency. The court declared that adoption was the better option for protecting the best interests of the child. What is Ms Gamble's view on adoption being a better option rather than surrogacy? With regard to international surrogacy being ethical, basically, what we are saying is that it is okay to give a green light to women in the USA or Ukraine, and exploit the women there but not here in Ireland. This is a double standard. No feminist woman would be happy to stand over that at all. To exploit women anywhere in our world for commercial reasons is wrong, so-----

I think Senator Keogan needs to qualify what she means by exploitation instead of just throwing it out. She is not giving examples; it is not thought out. If she is talking about exploitation, where and what is that exploitation?

Is Senator Ruane familiar with the Ukraine system?

She is familiar, okay. She knows how much that industry is worth in the UK.

What is the Senator's point?

We are running short of time so I suggest we ask the witnesses to comment.

I am addressing the witnesses. I thank the Chairman. I will rest there and let them comment.

Ms Natalie Gamble

I will take these in turn and deal with the statistics first. I apologise but I do not have my briefing paper in front of me. I think the 69% figure relates to the numbers of parents who reported choosing to go overseas because of the lack of professional availability of surrogacy matching in the UK. With the statistics around parental orders, they are approximate but for the past few years we have seen around 400 parental orders made each year, with around half of those relating to UK surrogacy and half relating to international surrogacy. I do not think the 69% figure came from that. I hope that clarifies the matter.

The Senator spoke about "erasing" the birth mother. It is important to say surrogates very strongly and universally do not consider themselves mothers of these children. They consider themselves surrogates who are carrying a child for someone else; it is not that the child belongs to anyone but that child is the child of the intended parents, who she is helping.

So the birth mother is inconsequential.

Ms Natalie Gamble

No. Of course she is not inconsequential. She is absolutely integral to the process and it is really important to ensure she goes into it with fully informed consent and she does it with all the right set-up.

The birth certificate does not actually reflect that.

Ms Natalie Gamble

In the UK the current birth certificate records the surrogate as the mother initially and then after the parental order is granted, the original birth certificate is sealed and a new birth certificate is issued that records the intended parents as the legal parents. There is a proposal with the UK Law Commission to maintain a national surrogacy register. It would mean that in future, even if birth certificates are issued initially with the intended parents on them, there would be a record of who had carried the child and given birth so the information is safeguarded for the child in future. This is not about erasing the person who has given birth but reflecting her role as a surrogate but not a mother in the conception of this child and retaining those records for the child for the future. That is entirely appropriate and ethical. Those who are concerned about that not being ethical have not spoken to surrogates.

When we dealt with our response to the Law Commission proposal we spent a considerable amount of time speaking to real surrogates in the UK who were carrying children. They were absolutely adamant that the people who were saying they were mothers and they needed to be protected, safeguarded and have a right to change their minds completely misunderstood what they were doing. There is a kind of misguided feminism around protecting women who are actually well-informed and making considered choices and it must be treated with enormous care.

The Senator asked if adoption would be a better option. Parental orders were explicitly designed in the UK in 1990 when the legislation was going through to be an alternative to adoption. It was recognised that these are children being conceived through assisted reproduction and are biologically connected with at least one of their parents. There is an intention for these people to be the parents from the moment of birth and they will care for the children from the moment of birth. These are not adopted children born into one family, given up and placed into another family. It is very important for children's identity to recognise that.

These are children who belong in the category of children conceived with donors and through IVF, etc. It is absolutely important for children in the long term for information to be kept about any donors and surrogates involved. Their birth story is core to their identities and they should have a right to access that information. This belongs in the category of assisted reproduction and not in the category of adoption.

My supplementary questions are similar to what the Chairman asked around existing children and other models. It is important, when speaking about surrogacy, to note it is very different from other pathways. It is not like adoption, fostering or anything else, and it is really important for that message to go out really strongly from this committee. There is a tendency to compare them but they are not comparable at all. I agree fully with the points made by Ms Gamble about surrogates very much not seeing themselves as mothers. That is the experience of anybody I have dealt with, whether surrogates or intending parents. I thank the witnesses for their contributions and opening statements. I failed to say that in the first round of questions.

I might put this to Dr. Horsey, who has done much talking with surrogates. It would be really interesting to hear her insight on this as well. I should have asked for her comments in reply to the previous question. Does she wish to comment from her own research experience of dealing with surrogates and intending parents?

Dr. Kirsty Horsey

I did research in 2015 and 2018 that involved the largest surveys of surrogates and people involved with surrogacy that, as far as we know, has been undertaken in the UK. Overwhelmingly, surrogates did not see themselves as mothers and did not want the term "mother" to be used. The term "surrogate mother" was disliked by them and it was a point we put to the Law Commission before it started even looking at this. The term "surrogate" is preferred rather than "surrogate mother" throughout the Law Commission process.

As Ms Gamble said, this is not about erasing the birth mother. I agree that as in the case of gamete fertilisation, it is important for records to be kept and for ongoing knowledge and contact even to take place between the parties. My current research and research I have done indicates amazing amounts of ongoing contact between surrogates and the families they helped to create. Surrogates may not see themselves as mothers but the relationships can be enmeshed and there may be a deep friendship or bond formed in many of these arrangements. It is a lifelong bond and most of the children in the studies I have done will grow up knowing exactly who was the surrogate and her involvement. All parties are really open and honest about that. That is to be praised, actually.

It is very important for people to understand the difference between paternalism, feminism and how different they are. I am infuriated at the idea that because of certain demographic qualities, women somehow would not have the ability to consent to what they do with their lives. If we stretched our minds that far, we would realise what feminism really is when it comes to women's capacity to consent to what they do or do not in their lives, regardless of their socioeconomic background. I would like to touch a bit more on what informed consent looks like, regardless of the context of a woman's life, her situation or her circumstances, or whether she does or does not want to be compensated in entering into a surrogacy agreement. Could we discuss what informed consent looks like, the differences between informed consent and assessments of capacity to consent?

Ms Natalie Gamble

It is a really good question. We should not make presumptions about women not being capable of consenting to something just because they live in a certain place or they are from a particular socioeconomic background. As well as being a lawyer I am one of the founders of a surrogacy agency in the UK that operates on a non-profit basis called Brilliant Beginnings.

When we set up Brilliant Beginnings we wanted to create a real best practice model for ethical surrogacy. We have a really detailed process in terms of verifying informed consent for women choosing to come forward and offer themselves as surrogates. That includes a whole process over a series of months where we have in-depth discussions with surrogates about what is involved and what it will mean for families, children and partners. We discuss practicalities and ensure they have private and confidential implications counselling so they can explore their feelings around that. They have a psychological evaluation with a clinical psychologist specialising in this area. They have independent legal advice. We do a home visit.

There are criminal record checks and we take up references. There is a process that goes into making sure these women really understand what the process involves. They know what they are signing up for. They really do want to do it. They are prepared for the process. This is the gold standard of ensuring consent. It is about making sure women have all of this information. Surrogacy takes place in many different contexts. We need to make sure as far as possible that wherever it takes place we get as close to this standard as we can and that the women are given all of the information, they are free of pressure from anyone else and there are independent professionals safeguarding their interests and advising them. These are the best ways to ensure a woman has given informed consent.

Dr. Kirsty Horsey

I agree. As Ms Gamble alluded to earlier, if too much restriction is in place people are driven not only overseas but, for want of a better word, underground. There are some cases we have seen with surrogacy in the UK where it cannot necessarily be said that the surrogate entered into it with what we might call true informed consent but they are not the ones supported by agencies such as Ms Gamble's. They do not have independent people safeguarding their interests or the interests of the children. Although such cases are rare they do happen. It is another consequence of restriction and the misunderstanding of how difficult the process actually is.

The witnesses mentioned the difficult case in England where people were considering how to bypass consent. It is an issue for many people to think this would be allowed for one case, especially if it could be misused by a court at any other stage. What are the conversations around this? What safeguards are in place with regard to the idea that consent would be removed or with regard to giving a judge the ability to remove consent? I imagine this would be very problematic for many people.

Dr. Kirsty Horsey

I believe this is in adoption law. I ask Ms Gamble to tell me whether I am correct that there is a provision for a judge to put aside consent where it is deemed to be unreasonably withheld. Obviously "unreasonably withheld" is a subjective term. There are tests already used in adoption law for this. I presume it would be a very tight test and it would not be just because people think on a whim that a case should go through.

Ms Natalie Gamble

This would be carrying over what already exists in adoption law as Dr. Horsey has mentioned. They are not saying that consent no longer matters and people do not have to get it. What they are saying is that consent is required unless it is withheld and the court determines that it should be dispensed with because it is in the best interests of the child. I trust our family court judges. I work with them all the time. They take an incredibly sensitive approach and an incredibly child-focused approach. They will do the right thing in the circumstances. This is not a question of the surrogate's voice being extinguished or not being heard. It is about having somebody who will be the voice of the child and look at all the issues to determine in what circumstances it is appropriate to dispense with consent. It will happen rarely if never. It will be a very rarely used power but it is very important that the court's hands are not tired. In the case that has been mentioned, the child was living with the parents and the surrogate had agreed to that. It was just about transferring formal parenthood. There is no logical reason it should not happen but the courts did not have the power to do it. These are the sorts of situations where the court will dispense with consent. It is not where there is a more substantive dispute that needs to be looked at differently.

My question is technical. It is a follow-up question on birth certificates and acknowledgement of the surrogate mother on a birth certificate. At present in the UK the birth certificate is rectified. The older birth certificate is put away and there is no record of the surrogate mother on the new birth certificate.

Ms Natalie Gamble

Yes, that is right.

Is there a move towards acknowledging the surrogate mother on the birth certificate? Is there any talk about acknowledging the way the child came into the world on a new type of birth certificate?

Ms Natalie Gamble

We have had a lot of debates on this with regard to donor conception. The trouble with recording it on a birth certificate is that a birth certificate is a public document. It is a document that people potentially have to produce to their school, university or employer. People may not want to disclose to those people the circumstances of their conception. It is important that this is considered when we think about what is recorded on a birth certificate. At the same time we have a register of information in the UK for donor-conceived children who have a right ask for information about the identity of the gamete donor who helps lead to their conception. The proposal of the Law Commission is to have something similar for surrogacy. At present it works because there is an initial birth certificate the child could ultimately ask for in the same way as an adopted child could, for example. In future there will be birth certificates that are immediately issued with the intended parents' names on it. The replacement for the existing provision and access to information will come through the national surrogacy register. Information about the identity of the surrogate will be there and available for the child. It will be a private piece of information rather than something recorded publicly on a document the world will see.

We hear the allegation that domestically we are not allowing exploitation but internationally we are. This is to presuppose women in Ireland can have informed consent and make the decision to enter into a surrogacy agreement but somehow women abroad cannot do so. I want to label this for what it is. It is making an assumption that somehow if people do not live in Ireland they do not have the capacity to make these legal choices around their own bodily autonomy as well as the legal definition of consent. I would appreciate the witnesses dispelling this. I want to reiterate what Senator Ruane very eloquently said. In this there is also a failure to recognise the women who would happily have carried their own babies to full term rather than stand by and watch another woman having to do it for them. In many instances it is their biological baby that another woman is carrying. We need to get this on record because somehow it is being conflated here. The surrogate - or surrogate mother because there is still an attitude in some certain quarters of Ireland if we drop the word "mother" - is not the biological mother of the child she is giving birth to. This needs to be underlined. This is a child that is the biological child of at least one of the intended parents.

Everybody enters into a surrogacy agreement in the knowledge that it is a temporary arrangement. It does not mean that the surrogate mother is not somebody who is held in extraordinarily high esteem by the intended parents. She is so held for the entirety of the life of the child and those parents in a very grateful manner. She is not nothing to them. Lest anybody attempt to put this out there, there is no intended parents who have that attitude to the surrogate mother. I need to clarify this because of some of the inflammatory statements being made in this committee.

In Ireland we have medical infertility and we have social infertility. Coming back to my previous questions, I am concerned about commercial surrogacy.

If we say "No" to commercial surrogacy, we may be excluding same-sex parents from the ability to avail of surrogacy because they must go to the United States or to Canada. We must be very careful about the definition. We had a constitutional convention that dealt with marriage equality. Within that convention we also dealt with the right to parentage and same-sex couples being parents. Interestingly, 79% of the delegates voted for marriage equality and 81% of them voted that same-sex parents were entitled to parentage. Obviously, in many instances this is for gay fathers, and surrogacy is the only route to parentage for them, so it is very important that we have that.

In a way, I am correcting things that have been said and also reiterating things that have been said, especially by Senator Ruane. I welcome Ms Gamble's comment that AHR is the place for surrogacy, not adoption or otherwise, and that it is the right context for it. That was very important and puts the context aptly and correctly. I do not have a question. I want to make sure that the right things are on the record here.

Ms Natalie Gamble

I have worked with thousands of intended parents going through surrogacy and, without exception, they do not do this lightly. For heterosexual parents, it is a last resort. I have never had a case where a woman has said she does not want to be pregnant and will use surrogacy; I have never seen that. These are people who have lost babies, lost pregnancies, been through 15 rounds of IVF, had cancer or were born without a womb. There are incredibly heartbreaking stories. It is incredibly hard for people to have to get to the last resort of doing surrogacy and then to face all the misunderstanding about who they are and what their motives are for doing it. The parents want to do this well and they want to do it ethically. They care about their surrogates. They retain that connection and make sure that their surrogates are well looked after.

It is easy to make ethical choices when one is wealthy. In the US there is a professional structure around it, with so much vetting and so forth. That is great, but it is massively expensive and out of the financial reach of many people. For everybody else, they are making very difficult choices and doing the best they can. We should bear that in mind. These are not people who are out to exploit women or buy babies. They want to start their families. All the people who have children and have not had those difficulties should perhaps ask themselves how far they would go to have a family. It is the most natural thing in the world. People want to do this responsibly and well, and we must help them to do that.

Dr. Horsey, we cannot hear you. You are on mute.

Dr. Kirsty Horsey

I was muted because the primary school near me had screaming kids outside.

I wish to add a couple of comments on that. In the research I am doing currently I have been doing interviews with gay fathers through surrogacy. They have been at pains in many cases to stress that they do not have it as bad as women who cannot have children, who have gone through 15 rounds of IVF or who have had cancer. When we press them on it, we find that they have had their own hardships. They have had discrimination and they have people making comments to them in the street or in the park and the like. It is a different type of difficulty that they are overcoming, rather than one of a medical last resort nature. The gay fathers are not doing it lightly either. They are coming into it having to have their eyes wide open about what it is going to mean to people around them and how they are going to be treated.

I have come across couples of gay fathers who have come from Ireland and who have worked with a surrogate who is being treated in England. That is not going overseas for a commercial arrangement. It is a nipping over the Irish Sea type of thing. That is something that can happen. If one is paying for private IVF it does not matter necessarily where one starts off with that. When the surrogate gives birth in the UK that is covered by the NHS. It then tips into the legal parenthood thing afterwards.

I wish to mention something else. This is not going to be included, as far as I understand it, in the new Irish legislation. In the UK, surrogates can use their own egg, and the parental order process is the same for that. Most surrogates I have spoken to who have done that consider themselves both an egg donor and a surrogate. They see themselves in a way whereby they are doing two things in one. One of them even said to me that she could have done the two things separately, she could have donated her eggs, walked away from the clinic and then come back six months later and used that as an embryo transferred in surrogacy, but why add to the expense? I know that is not proposed in Ireland, but even where that does happen surrogates are still able to make informed decisions about what they do with their own body. Otherwise, we would not let people donate eggs in the first place.

I will eventually get to a few questions, but, like others, I want to put it on the record that I reject the idea that we are setting up a double standard. Ms Gamble spoke at the beginning about assuming all domestic surrogacy is kosher whereas international surrogacy is nothing but evil and about how that assumption is deeply wrong. Saying that we are simply rubber-stamping a double standard is prejudging the work of this committee. This committee and its members in their contributions have acknowledged there is a range of experiences and arrangements that go from the altruistic to the exploitative at the far end. Our job here is to prevent that double standard and to find a way to put in safeguards in regulations and legislation for mothers, intended parents, surrogate mothers and for the children at the heart of it, so that people who enter into this process, often after very difficult personal circumstances as have been described, can know that they are not engaging in an unethical process and that they, due to the work we are doing here, can take some comfort from that and know that their children's rights are respected. To simply dismiss it as a double standard ignores the work we are trying to do here and undermines the committee as a whole.

With regard to the birth certificates, the special rapporteur on children here spoke about the ECHR right to identity, and the role of the knowledge and identity of the surrogate and the importance of that. Perhaps that is something we must examine here in terms of the birth certificates and how that looks practically.

I have a question for Dr. Horsey. She referred to the interesting research on the surrogates' experiences and her interviews with them. It would be good if she could send the committee a copy of that research as I am sure we all would love to read it. Is she aware of any other international studies in other jurisdictions in the EU or globally doing similar research on the experience of surrogates in other countries?

Dr. Kirsty Horsey

I am aware of a relatively recent Canadian study on the experiences of surrogates going through surrogacy. I believe there was a study in Israel as well. I can dig those out and send them to the committee as well, if it wishes.

That would be great.

Dr. Kirsty Horsey

That is about the experiences of surrogates as they go through the surrogacy process. There is a study in the UK about post surrogacy, how surrogates feel about it then and their well-being. I can send that to the committee too.

We have a lot of reading material, so Dr. Horsey may as well throw as much as she wants to us. I thank her for that.

How is maternity leave and maternity benefit dealt with?

We have more time, so we can go around again. A question has been asked about maternity benefit and how it is dealt with in the UK.

I was asking about both maternity leave and maternity benefit.

Ms Natalie Gamble

I can answer that query. It used to be case that parents through surrogacy fell through a gap in respect of leave from work, because they were neither not pregnant, which would have given them an entitlement to maternity leave, and nor were they being matched by an adoption agency, which would have given them an entitlement to adoption leave. We campaigned to have that situation changed, and the British Government added a special provision to the adoption laws in 2015. There is now a form of adoption law for surrogacy, which states that where intended parents intend to apply for a parental order, they will be given rights to leave from work and pay after the birth of their child. Those rights work in a way that allows one of the partners to claim the equivalent of maternity leave, while the other can claim the equivalent of paternity leave. We also have some provisions in UK law for sharing that leave if people wish to do so. That all applies. Essentially, therefore, intended parents have the same rights in respect of time off work as any other new parents. Regarding the surrogate, she is a woman giving birth and, as such, she is entitled to maternity leave as well.

Ms Gamble and Dr. Horsey have been with us for quite a while and we have gained a great deal of useful information from them. We will have some more brief questions. I call Senator Keogan.

Ms Gamble said: "It is easy to make ethical choices when one is wealthy". I suppose this concerns informed consent and the capacity to consent. Does Ms Gamble acknowledge that women could be exploited because of economic circumstances when it comes to-----

That was not the context Ms Gamble was speaking about. She was talking about gay men accessing services. Ms Gamble was talking about something totally different.

It is misrepresentative of the context.

Ms Gamble made that comment.

Not in the context that Senator Keogan is suggesting.

I am sorry, but I am asking the question. Does Ms Gamble acknowledge that women could be exploited because of economic circumstances? If so, has she come across any of those women?

Ms Natalie Gamble

Yes, I do acknowledge that. It is an important consideration in surrogacy to ensure that the women doing this are giving informed consent. All sorts of things may impair that consent. It could be pressure from a partner, or from the intended parent, if he or she is a relative, or it might be financial circumstances. The risk is heightened when we are considering jurisdictions where there is much poverty and therefore an imbalance between the intended parent and the surrogate. This does not mean it happens routinely. In my experience of surrogacy in many jurisdictions, this has not been something that I have seen a great deal of, if at all. The cases which worry me the most in respect of exploitation are those where the parents have limited information about their surrogate. I refer to situations where the intended parents are being matched with a surrogate by an agency. The whole relationship is then with the agency or the clinic and they do not know much about the surrogate.

The worry in those situations concerns the details of the woman who is the surrogate. Has she been given all the required preparation, support and screening and is she undertaking the surrogacy because of economic duress or real duress? We do not know in those cases. I can honestly say I have never seen a case where I have directly seen that kind of exploitation and duress and desperate poor women doing this because they have no other choices. The worry arises that this might be happening in those situations where we do not know much about the surrogate, however, and where there is not a strong direct relationship between the parties. This is one of the reasons I said that one of the core elements of ethical surrogacy is a direct relationship between the intended parents and the surrogate to enable us to see what is going on.

Has Dr. Horsey ever come across such situations?

Dr. Kirsty Horsey

No, nothing I have seen would suggest direct exploitation like that. Obviously, we are aware of some situations from previous studies undertaken in India, for example, where things were less than ideal for some women acting as surrogates. Services in those areas, however, have been closed.

The reason they were closed in 2015 was because the women were being exploited.

Dr. Kirsty Horsey

Not because all women were being exploited.

Not all, but the majority of women were being exploited.

Dr. Kirsty Horsey

I could not speak to that. It was because some of the surrogacy that was taking place in India was less than ideal.

Yes. Can Dr. Horsey elaborate on how that "was less than ideal"?

Dr. Kirsty Horsey

Ms Gamble was going to say something.

Ms Natalie Gamble

I used to deal with many people doing surrogacy in India. The reason it was closed as an option there was because of a decision made by the Indian Government. I do not know if that was based on perception or on specific cases. We should, however, be cautious about assuming that even women in India are incapable of giving informed consent. I remember one Indian surrogacy case I dealt with where the parents were both British. The mum was of Indian origin, and she was able to speak the same language as the surrogate. They formed a positive direct relationship. The surrogate had a business that she ran with her husband, but it had been destroyed by flooding. The surrogacy enabled the family to restart that business and get back on their feet. That woman was incredibly proud that she could do that to help her family. They all supported her and it was a very positive experience. It ended up with the intended parents being invited to go to the wedding of that family's son, and they all stayed in touch in the long run. Therefore, we should be cautious about just assuming that women being from a different culture, speaking a different language or being in a different poverty bracket means they cannot make informed consent decisions. We must, however, take care to ensure that their decisions are made with informed consent. Equally, however, we must be careful about saying that all Indian surrogacy, or all surrogacy in any particular country, is necessarily exploitative because these women are different from us.

Dr. Kirsty Horsey

Absolutely, and I hope Ms Gamble does not think I was saying that.

Ms Natalie Gamble

No, I do not.

Okay. I thank the witnesses.

Would anyone else like to come in? I call Senator Ruane.

To clarify what said regarding people being able to be more ethical when they are wealthier, that was said in response to a question from Senator Seery Kearney concerning gay men's access to surrogacy or being able to travel further afield. It referred to a context where things are more established and regulated, instead of intended parents who are less wealthy being forced into less ideal situations. Ms Gamble was talking about that aspect, rather than about people being able to make ethical decisions about their bodily autonomy. She was referring to the wealthy position of intended parents, rather than to the economic position of the person offering to be a surrogate mother. I ask Ms Gamble to clarify that was the context of the conversation.

Ms Natalie Gamble

Yes, it was. I apologise if I was not clear. The sense I was trying to convey in this regard is that if a great deal of structure is erected around surrogacy, then there are safeguards because everyone must have legal advice, screening, psychological assessments and a third-party agency involved to offer support. That is always going to add to costs. The US is the model that has all that professional support. We can take much comfort from the fact that such arrangements are ethical, that everyone is giving informed consent and that there is openness and transparency. Everyone in that situation has their own professionals in the game, if I can put it that way.

The flip side is that level of structure and support adds significantly to the cost of the process. Therefore, intended parents who have sufficient wealth to enable them to access options such as US surrogacy, can do so with a great degree of assurance that they do not have to worry about the ethics. Less wealthy parents are not able to access those kinds of options in situations where they are looking at other places - in Ukraine, for example, though obviously not now - where there is less professional support and structure available. Intending parents in those situations must be more alive themselves to ensuring the requisite ethics are being followed. They must ensure they meet their surrogate and understand what screening is taking place. In other words, they must ensure they have done their own due diligence. Therefore, when I said it was easier to make ethical choices if one is wealthy, that was what I was describing. I was not alluding to any threat to surrogates.

Ms Gamble was very clear. I was more concerned with making this point because what was said in the contribution was being misrepresented on this side. Therefore, I thought it important to record that Ms Gamble was not talking about the surrogate, but about the economic position of the intended parents, their options and their ability to access these services.

Moving to another topic, and because people want to pull things in the direction of exploitation, does it make obvious logical sense that regulation is what addresses the issue of exploitation and not restriction? If we genuinely care about people being exploited, then we must look at regulation to ensure no one is exploited. Saying outright that it should not happen actually increases the chances of people being exploited.

Ms Natalie Gamble

Yes. Whenever there is an attempt to stop it happening in a particular way, it pops out somewhere else.

There is demand and we live in a world with global reach. Ireland cannot directly regulate what happens in other countries so the choice is how to deal with the consequences of people going overseas and ensure children's welfare is safeguarded or what do we do at home and regulate it here. The choices around regulating this at home will have an impact on the options people have. If it is made as liberal, supportive and well-regulated at home as possible, it will maximise the chances of people doing it within that framework rather than having to look overseas. We are not able to stop people going overseas, however, and if this is made too restrictive at home, more people will be sent overseas.

I will make two absolute points. I thank Ms Gamble for her clarification that in the Indian example, the decision came from the Indian Government and was done in conjunction with a supreme court decision in India that it would not be a destination. That does not mean ethical surrogacies were not entered into in India and given that many children in Ireland were born via surrogacy in India, for anybody to make a sweeping statement about them or the country of India is either racist or going down a route of deliberately stigmatising children for some sort of political points scoring, which is obnoxious. I thank the witnesses.

It has been a really interesting conversation. Speaking with people who have worked for so long and in such depth with people going through this process has been very interesting and informative, so I thank the witnesses again for appearing before us today.

The joint committee adjourned at 3.32 p.m. until 9.30 a.m. on Thursday, 21 April 2022.
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