Still Giving Nature a Helping Hand? Surrogacy: ADebate About Technology and Society

Marilyn Strathern

William Wyse Professor of Social Anthropology, Department of Social Anthropology, University of Cambridge, FreeSchool Lane, Cambridge CB2 3RF, UK

The last five years

Numerous developments mark the five yearssince this paper was first given.1 Among non-scien-tists, one has been the emergence of commentaryon the explosion of ethics committees and ethicalprotocols across Europe which accompany appli-cations of new science, especially in the medicalfield. It is as though we had suddenly becomeaware of the fact that scrutiny of interventions inmedical contexts (ethics committees of the kindfound in hospitals) has become a paradigm fordiverse multidisciplinary reviews dealing withpublic reactions to science (commissions ofenquiry, governmental working parties, expertconsultations).2 This is all part of a wider phenom-enon of scientific accountability.3 But whileproliferation of occasions and bodies concernedwith the application of science has been goingon for several years, for some at least the reali-sation that these forms of governance are a forcein their own right has taken time to surface.

It is a truism of present concerns with techno-logical innovation that science and technologyrace ahead while society and its views lag behind,never quite catching up. We can think of manyways in which this is true. But in one profoundsense it is untrue. To a social scientist, andespecially to an anthropologist, science and tech-nology are part of modern society, and socialviews are already embedded or sedimented inthem. Nor is science a special case, as the exampleI have just given shows. My comment was onthe interpretation of extra-scientific activities, theproliferation of ethics committees in forumswhere scientists meet non-scientists. Changes inthe ethical terrain within which science operateshave been going on all the time, until we suddenlyseem to find ourselves on a new social map thatneeds interpretation. We are already there, thesocial innovation has already happened: it is thecommentary that lags behind.

It is important to take commentary for theactivity it is. Whether in meetings of specialists,or more widely in hybrid forums4 or the agorato which Nowotny, Scott & Gibbons refer,5 the

communication of findings and issues is meant toengage different segments of society. What isinvolved is a process of translation across domainsof knowledge: society interrogating itself. Thepresent exercise and the lecture series on which itis based are a beautiful example. Usually we arenot aware of social innovations until they becomethe focus of such commentaryin the media orwhateverso that the innovation that has alreadytaken place becomes the innovation that is nowsubject for comment. One cannot independentlysee that prior process of change. However, thereare moments that afford glimpses of it. Theseinclude moments when public discussion findsitself up against issues that already seem to havebeen resolved and, refusing to be dislodged further,point to changes that have already happened.

I wish to go back to a past moment of discussionand trace one such process. It was already in thepast when I talked about it five years ago. But itoffers a salutary example for how we might under-stand future commentaries, for future ways inwhich science will find itself in perhaps unex-pected ethical terrains. It happens, incidentally, tobe both evidence of the process of commentaryand to address it directly in addressing the role ofinterpretation in social life.

There is another reason for revisiting thismaterial. When social scientists contribute todebates of public concern over new technologiesthey help heat up already hot situations,6

which may or may not be a desirable thing to do.Some argue that the scholars job is to negotiateand thus further stir epistemological turmoil.7

But social science also has concerns of its own.Suppose the object of interest were not the tech-nology but the society. The new technologies canbe approached for the light they throw on moregeneral social formations.

Description and interpretation

In 1995, the Chairman of the Norwegian NaturalScience Research Council and a professor ofmathematical logic addressed himself to the topic

0022-2836/02/$ - see front matter q 2002 Elsevier Science Ltd. All rights reserved

doi:10.1016/S0022-2836(02)00352-2 available online at http://www.idealibrary.com onBw

J. Mol. Biol. (2002) 319, 985993

of the relationship between the social and naturalsciences. He chose economics and anthropology ashis paradigmatic social sciences. There is commonground, he argued, between the natural and socialsciences in their search for structure and explanation.However, he observed of social anthropology that:8

When one describes the dynamics of a pro-cess, one must bear in mind that an act canbe both described (externally observable) andunderstood (carry an intentionality or mean-ing). Neither dimension can be reduced tothe other (my emphasis).

I would just add that an act can be understood inthe sense of carrying an intentionality or meaningwhich is communicated to others, that is, it enters adiscourse shared by the actor and other persons inhis or her social field. And if neither dimensioncan be reduced to the other, each also implicatesthe other. A commentator describes (observes) theact and understands (interprets) the intention atthe same time. The converse also holds: thusanthropologists try both to understand the act inthe context of other acts and observe how theactors understand what they are doing. They areinterested in peoples interpretations. Fensteadgoes on: an act, he says, may have materialconsequences independent of the actors intentionor meanings. This is the point at which the anthro-pologist will talk of the social or cultural contoursof discourse. Such discourse offers a languagewhich people in turn use in making their owninterpretations.

Needless to say, the language is likely to beedited. This was striking in the case of the two bio-logical fathers reported in the Los Angeles Times in1998. Under the title Gay parenting gets a hi-techhelping hand, we are told:

Thanks to in vitro technology, a West Holly-wood couple is due to become parents of theworlds first two-father child. [The clinician]expects the one-mother, two-father child tobe entirely healthy. We have done all thenecessary animal testing. It works in mice, itworks in rhesus (monkeys), and its workingnow with [the child]. Every new advance isscary to some people, but look at the benefits.There is no way under heaven this couplecould have a child together otherwise. [Thetwo men] concurred. Gay couples havealways wanted to be parentsreal biologicalparents.

In this context the ideas are ones already inplace: the intending parents use an analogy withthe heterosexual couple who has a natural childsame vocabulary, same sentimentsin order tocreate an image of real biological parents. Yet theimage of biological parenting is rather startling forwhat it edits out: it ignores the original logic ofjoining, which in heterosexual coupling is the join-

ing of opposites,9 and ignores the fact that withtwo eggs required for separate fertilisation beforebeing fused the mothers contribution is a kind ofreverse twinning.10

It would be trite to say that new technologiesstimulate new social phenomena and vice versathe child with one genetic mother (from twomaternal eggs) and two genetic fathers (combiningin one complement of chromosomes), along withthe evident desire of the gay couple to be parents.But novelty is measured against what is allowedto pass as unchanged. There is very little conten-tion over what is old in this case, namely continu-ing to use the term father for the male parent.Innovation is revealed precisely because a new ver-sion (the gay parent) has been made out of an oldphenomenon (the father). The completely newphenomenon (the process of parental division andfusion) is not brought into the image of what par-enting is to mean. Relegated to the technology,it leaves the notion of biology intact.

Contained in the interpretation of this event isa vision of future possibilities. One purchase wehave on the future is how in the past people havedealt with new possibilities and new technologies,how the once new has had an impact. I go back toevents that took place in the late 1980s/early1990ssignificant in Britain as a time of publicdebate surrounding the Human Fertilisation andEmbryology Act, 1990,11 which set the legislativetone of regulation in the field and has been some-thing of a model for legislation elsewhere inEurope.12 They involved the possibility of fertilisedeggs (embryos) living outside the womb leadingto improved implantation procedures so that theegg may be returned not to the woman who hasovulated but to another woman altogether.Maternal surrogacy emerged as a newarrangement13 which took advantage of thistechnological innovation, and there is somethingto be learned from its reception.

But I wish to derive another lesson. I use the caseof maternal surrogacy as a folk model for the role ofcommentary itself. Forcefully, it depicts a relation-ship between two kinds of factorsthose whichare evidently dependent on others and those whichappear to have their own autonomous trajectory.The difference is between what calls for under-standing, and thus interpretation, and what seemsself-evident, and therefore a matter of observationor description.14 In the eyes of policy makers thatbecomes the difference between what requires regu-lation and what must be taken as a given fact of life.For the two sides of Fensteads act can also be takenas two sides of the phenomenal world. That is whatsome of the debate over surrogacy shows us.15

A 15-year-old debate: surrogacy

Early techniques in assisted conception, pro-cedures such as in vitro fertilisation and embryotransfer, made it possible to separate the pro-creation of an embryo from its gestation. This

986 A Debate About Technology and Society

gave rise to all kinds of possibilities for infertilecouples. It included the possibility of finding substi-tutes not just for parental genetic material but alsofor the womb. The nub of surrogacy agreements,as they came to be called, was the intention of awoman gestating an embryo/foetus to hand thechild when it was born over to other persons, pre-ferably a couple. The commissioning couple weretypically the intending parents of the child to be.

For a period there was considerable termino-logical fluidity around the designations of thevarious parties, and differences within Englishbetween British and American usage. Early on acontrast was established between partial and fullsurrogacy, between the woman who bore the childcontributing both uterus and egg and contributingthe uterus alone.16 In the USA, the former wasalso called traditional surrogacy, and the latterhost or gestational surrogacy.17 With techno-logical improvements and increasing demand,gestational surrogacy became more widespread,and the designation became common usage inEnglish.18 Gestational surrogacy is the arrangementI deal with here, but with a rather different part ofthe epistemological turmoil.

Perhaps we should not be surprised that TheNew Dictionary of Medical Ethics19 defines thesurrogate as follows: the use of a third party toassist a couple in conceiving and bearing a childwhen the commissioning woman is either lackinga uterus or is unable to use her own uterus formedical reasons. However, if we go back to whensurrogacy was being debated in the British parlia-ment, when it was one among a tangled skein ofhot issues at the time, we find a specialist inhealth-care law noting just the opposite definition:20

By surrogacy I mean an understanding oragreement by which a womanthe surrogatemotheragrees to bear a child for anotherperson or couple. Of course this popularunderstanding immediately encounters theobjection that it is the person who takesand rears the child rather than she who givesbirth who is properly the surrogate. Thewoman giving birth is the mother (myemphasis; authors emphasis removed).

The objection came from those who wished todefend the legal understanding that the mother ofa child is the one who gives birth to it. In theEnglish law of the period, the woman who borethe child was the childs legal mother, and her hus-band the childs legal father. (Intending parentscould make a case for adoption if, among otherconditions, the child were genetically related toat least one of them.) The objection was that inpopular understandings parenthood had becomedefined as genetic and was ignoring the authen-ticity of the gestational and therefore birth mother.Contemporary OED definitions of the Englishterm mother (woman who has given birth) andsurrogate (one who acts in the place of another)

supported the complaint. The surrogate would bethe woman who subsequently acquires a child towhich another has given birth. But the reverseview, which the dictionary encoded, wasentrenched popular usage. For popular usage wasdetermined to have it the other way round. Itwas the term surrogate that became irrevocablyand stubbornly tied to the woman who in thesecircumstances bears the child. I am going tosuggest that beyond the genetic issue there wereother interesting reasons for that stubbornness.Classification had already taken place. Alreadysedimented in public discourse, public usageshowed an openness to new possibilities long beforethey became overtly debated.

Interpretation in context

The reasons why the term surrogate will go onbeing used for the woman who carries a child onbehalf of another lie beyond the immediate debatesthemselves. They have a cultural purchase that isnot directly affected by the course of the debates.In brief, the term draws attention to the role ofinterpretation in explanations of human life.21

Two dimensions of the broader context arecrucial here, Euro-American in cultural terms,enlightenment in historical reference and moder-nist in epoch. I relate them as axioms.

(1) Society is built both on and after the facts ofNature: it exploits, moulds and imitatesNature all at once. At the same time: (1.1)Nature has its own self-regulatory trajectory,and Society therefore both regulates and isregulated by circumstances beyond itself;(1.2) Societys own systems of communicationare self-regulatory and natural to itself.

(2) Such bifurcations lead to perceptions ofdifferent orders of reality. (2.1) Interpretationimplies the ability to see relationshipsbetween orders of reality, so that one set ofphenomena can be related to another. (2.2)This perception itself exists in a dialecticalrelationship with what is accepted as a self-signifying condition requiring or allowing nointerpretation.

To expand: much is invested in seeking the con-text and reasons for social institutions. Whether inthe realm of natural or social affairs, peopleaim to make explicit the conditions of existence. IfEuro-Americans thus presuppose that humanactivity includes efforts to interpret and hencerepresent the world, then language, symbolism,and the way people express themselves all createorders of reality built on and after other orders ofreality. Indeed signification is held to afford infinitepossibilities in the further relationship it createsbetween what is given and what is subject tohuman intervention. So Euro-Americans createmeaning by dividing phenomena into those whosemeaning is self-evident or self-signifying and

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those whose meaning has to be made explicit byreference to what is being signified, and here theybecome conscious of the act of interpretation itself.

The figure of the surrogate mother (in gestationalsurrogacy arrangements) makes explicit therelationship between gestation and other factors inchildbirth. The meaning of surrogacy is thus estab-lished by reference to those other factors and tothose circumstances where gestation is part of aself-evident maternity. It isamong other thingsan act of signification. Now gestation on the partof the birth mother may be interpreted as moreor less biological and as more or less indica-tive of authentic motherhood, depending on thecontext. It itself is not diagnostic of surrogacy. Thediagnostic issue is that one woman is perceived tobe carrying a child for another woman22and this isa specific representational strategy. In acting onbehalf of another woman, she represents a facet ofmotherhood but is not otherwise the mother. Sheis a stand-in, occupying the place of the motherfor a while, discharging an important function,but always in reference to another person who byimplication is the eventual parent. It is preciselybecause she stands in for that element that other-wise defines motherhood that she is the surrogate.Popular English-speaking usage was immediatelyclear on this.

In short, this is the folk model. It borrows fromthe law in the sense that the arrangements dependon the agreement of the gestational surrogate tobear the child for the commissioning couple, notfor the commissioning couple to rear the child forthe birth mother. To the ordinary person, the inten-tions underlying the relationship are clear. Contestonly arises when the relationship between the surro-gate and the woman on whose behalf she isbearing the child breaks down. (I refer to the factof relationship, not to its conduct.) The relationshipin question is at once social, between persons, andconceptual, between different significations ofwhat the persons are doing. When gestation isclaimed to be definitive of her own motherhood,the surrogate is no longer a surrogate.

However, it is my interpretation of the folkmodel. This is not how people generally talkabout surrogacy. They cut through the potentialturmoil with a very simple device: making a dis-tinction between the mothers. The surrogate isnot, by definition, the real mother. The debateover who is the real mother seems to have beenwon before it was ever argued. And that is becauseof her counterpart: what was certain was that thesurrogate could not be the real mother. This piece ofinstant popular wisdom was not to be given upeasily. It remained a point of clarity amid all thequestions that continued to be asked about theapparent doubling of the maternal contribution.

The enigma of the real

Everything about reality, including its ownconcrete-sounding imagery, would suggest that

the surrogate is a byproduct of what we know inadvance as real. The observer/interpreter (anthro-pologist) would, we have seen, put it the otherway round. In terms of popular categorisations ofthese issues, the surrogate role is quite straight-forward: one person stands in for another. Thedesignation points to or signifies the fact that thereal mother must be another person than herself.But on what grounds is the other person a mother?The enigmatic role turns out to be that of the realparent. That is, when one has to explain andinterpret what is real, one opens the self-signifyingup to signification. It is how to determine what isreal that becomes open to doubt.

The enigma was already there in the objectionMorgan brought up. Surrogacy does not seem tolead to agonising scrutiny of what makes awoman intend to act on anothers behalf; the ques-tion of who might be the real mother may well doso. The definition of surrogacy belongs to theworld of agreements and contracts betweenpersons;23 the real mother, by contrast, is estab-lished by an appeal to some inherent characteristic,for example, the wish or intention, the biologicaldrive, to be a parent. In short, the objection notedby Morgan arose not from ambiguity surroundingthe definition of surrogate, but from ambiguity inrespect of the real or natural mother.

This was acted out in case of legal disputes at thetime where, and they have been much publicised,24

a woman who has agreed to act as a gestationalsurrogate then wishes to claim the child as hers,that is, makes a claim to be the real mother. Inother words, the stand-in claims she is not astand-in after all. One claim to reality substitutesfor another.

What do I mean by substitute? We might say thatthe real world created by the possibilities of newreproductive technology inevitably substitutes fora real world whose possibilities were tied to othermeans. In the same way new knowledge substi-tutes for old: it constitutes an order of reality in itsown right. This taking the place of another, isdifferent from standing in for another. It is thedifference between what is seen to requireinterpretation by reference to another person ororder of reality (surrogacy), and the supplantingof one by another (substitution). In the case ofsurrogacy, there is always an interpretative move(the one mother makes sense in reference to theother), while in the case of substitution, no furtherinterpretation is necessary. The difference is nomore nor less than the visibility of the relationshipbetween them (that is, the two women). The surro-gate mother is a surrogate as long as her relation-ship with the other mother is intact; should sheclaim the child to be hers, however, she then sub-stitutes for that other woman. For to desire to be amother is generally taken as requiring no furtherjustification or interpretation.

The logic is supported by attendant substi-tutions. Compare the altruism of surrogacy withthat of ovum donation. In making a gift the donor

988 A Debate About Technology and Society

alienates her rights to the eggs; the eggs may stillcarry her identity, but she cannot dispose of themfurther, and in popular parlance neither donor norrecipient is a surrogate. Rather, donated eggssubstitute for the commissioning mothers eggs.25

And, in Euro-American cultures, a gift-giving is acomplete act that requires no further interpre-tation. The act of giftingculturally understood asaltruismis self-signifying; it points to itself.When the surrogate substitutes her own maternalimpulse (to have a child) for altruism (to bear achild for another) this is understandable; indeedthe generosity is generally approved. Surrogatemother, real altruist.

However, the same self-signifying logic, that is,action which requires no interpretation, occurs inanother social domain which brings emphaticdisapproval.26 Here the real meaning of her actionsmay be thrown into doubt. For her very willing-ness to act as a surrogate may already carry asubstitutive possibility of another kind. In theplace of a desire to help there may instead be adesire for money. When the surrogate substitutes acommercial impulse for a maternal one, it too maybe understandable but is invariably put into nega-tive light. For there is nothing surrogate aboutcommerce. Profit is thought to contain its ownrationale: acting for profit in and of itself needrequire no interpretation. Indeed the market is anend as well as a means, for it is regarded as apolitical regulator in its own right. I suspect thatthe equivocations surrounding the commercialpossibilities of surrogacy arrangements turn inpart on the substitutive and thus displacementeffect that money introduces. Surrogate mother,real profiteer.

The British Human Fertilisation and EmbryologyBill (1990) was intended to set up, as it did, alicensing authority for certain treatments of infer-tility and associated embryo research. While thegovernments position was that both treatmentand research should be encouraged with multiplebenefits in view, it drew back from allowing themarket to intervene as a mechanism for regulatingsupply and demand. An explicit provision in theAct debarred the donors of gametes from beingable to profit from the donation (S12(e)), and per-sons who wished to seek an order to be treated asparents of a child from either donated gametes ora surrogacy arrangement could not do so if moneyhad changed hands (S30(7)). The commerciali-sation of surrogacy by third parties alreadyinvolved a criminal offence. Whatever the range ofneeds, market-led possibilities were rejected infavour of only permitting surrogacy arrangementson a private basis. In the background was the ideathat only such a context would sustain the valueof altruism that made the agreement betweensurrogate and commissioning mother sociallyacceptable. In seeking money, of course, it wasassumed that the surrogate was primarily inter-ested in that and not in the relationship betweenherself and the other mother.

It would seem that the altruism (if only mini-mally the altruism sealed in a contract) that other-wise justified surrogacy could be displaced byother orders of phenomena which then appearedas the real thing. That might be either maternityor commerce.

Foundations

But if the impulse to motherhood appears torequire no interpretation, why should the realmother appear the more enigmatic of the two? Byitself motherhood is not enigmatic. But preciselybecause its rationale is ordinarily taken forgranted, a given, motherhood appears problematicat the moment when it becomes the subject ofquestioning. When disputes arise as to who is thereal mother, the category is thrown open to poten-tially endless interpretation. In such circumstancesappeal is frequently made to further givens, thatis, further taken for granted and unquestionedgrounds which will bulwark the once unques-tioned grounds now being contested. The formermay appear as foundations for the latter.

In popular parlance, real motherhood has itsfoundations both in biology and in the social recog-nition of biology, so the real mother always haseither nature or society on her side; by the sametoken, when a surrogate acts on behalf of a realmother it is because the real mothers claims arealready there. Thus a commissioning mother canbe considered a real mother, whether by nature(some commissioning parties can also claim agenetic tie; all can claim the natural desire to be aparent), or society (through seeking legal supportfor their claims or demonstrating they can providethe child with everything that defines good parent-ing). So where is the enigma? The enigma rests inthe very necessity to conserve the foundations onwhich the real thing is established. Competingfoundations take away their own axiomatic (andthus foundational) status. Here the foundationsbeing propped up are the authority of society andnature.

I touch briefly on two conserving strategies,27 thefirst to do with the evidence that nature producesof and about itself, and the second with theregulating role of society. As sketched earlier,Euro-Americans take societys capacity to organiseand regulate the social world as its own self-evident foundation in the same way as nature isknown by its self-regulating properties. Part ofthat regulatory activity involves making explicitthe relationship between these different orders ofreality.

The evidence nature produces of and aboutitself: there is of course a history to be traced inthe sequence that has turned nature intobiology and biology into genetics. What isenigmatic is how one should understand (inter-pret) the real thing. Disputes over carryingand birth motherhood show the point at whichbiology ceases to be an axiomatic foundation for

A Debate About Technology and Society 989

motherhoodnot because social motherhood isopposed to biological motherhood, but becausewhat is biological about biological motherhood has tobe made explicit. This is what makes the claims ofthe real mother enigmatic. How will the real thingshow itself? On what will it be founded? Is itstill biology, and what do we mean by that? Isthe desire to have a child as much a biologicalfunction as the ability to bear one? Or the abilityfor mothering in the same sense as fathering(begetting)? If the foundation for biogenetickinship is taken to be the genetic tie, the appeal tobiology may be understood as an appeal to geneticconnection. The foundation of all life in genesseems to need no further interpretation. Indeed ifpopular usage is stubborn on the issue of who isthe surrogate, it is also stubborn on the significanceof genes. The UK Clothier Report,28 which fol-lowed closely on the HFE Act, opened with thisstatement: Genes are the essence of life: theycarry the coded messages that are stored in everyliving cell, telling it how to function and multiplyand when to do so (1.1).

There is an important sense in which technologyis self-signifying: when it operates as an enablingprocess. When we ask how it is sustained as self-signifying, thenas in the case of motherhoodwe start looking for and thus querying its foun-dational rationale. I return to this in a moment.Here I remark that it can enable another self-signifying process. Procedures which assist gesta-tional surrogacy allow an intending couple whohave no uterus to claim the evident value ofgenetic parentage. Writing a decade ago, Sir DavidWeatherall envisaged a new question.29 Ethicalproblems could be seen on the horizon: as webecome more efficient at predicting the geneticmake-up of individuals, how far will we bejustified in offering parental choice? What kindof choice, he asks, should a parent have to bring adefective child into the world? That choice is ofcourse subsumed in the prior choice by whichparenthood is in the first place claimed on a geneticbasis. Do we glimpse a dimension that begins tomake the genetic tie enigmatic? Insofar as thegenetic (biological) tie takes precedence only byhaving been actively sought out, it is no longer agiven of parentage; it has been selected as oneamong other possible routes. The case of the twofathers would bear that out.

Note that Weatheralls warning about the longterm, that future developments in molecularbiology might raise fundamentally new ethicalissues, already drew together scientific and non-scientific (ethical) factors. This leads us intosociety as an object whose foundations must alsobe conserved, and into the second strategy.

When surrogacy cases are debated in terms of acontrast between the genetic and the gestationaltie, asymmetry is assumed; one or other musttake precedence. Indeed, if surrogacy alwaysimplies such an asymmetry (it points to thereal thing elsewhere), this is also true in the

relationship between technology and biologywhere technology simply assists biological process.At the same time technology is regarded as in arelationship of sorts with society. Technology isseen to be built on and derived from the samematerials that nature uses (it assists biology) butwith the further input of human ingenuity andhuman intentions for it, which are geared to socialpurposes. Here its foundational rationale belongsto society.

For as long as social ends remain stable, techno-logical innovation does not, in this Euro-American(modernist) view, have to mean social innovation.On the contrary, as in the promotion of the nuclearfamily, new procedures may fulfil old goals: theapplication of technology is taken to have a foun-dation in social values it leaves unchallenged.Certainly in a society that values individual well-being, it is considered morally proper for tech-nology to be turned to the ends of medical welfare.This is largely the basis on which developments ingene therapy, for instance, were justified. At thetime when, in early 1990s Britain, the legitimacy ofsurrogacy arrangements was being debated, genetherapy pinpointed further possibilities in themedical applications of genetic knowledge. Pro-vided the (old) social foundations remained stable,however, genetic technology could continue on its(new) trajectory.

Weatheralls warning came from Science andPublic Affairs, a joint publication of the BritishAssociation for the Advancement of Science andthe (British) Royal Society. In 1991 the magazinepublished a multidisciplinary discussion30

intended to allay anxiety by clearing away con-fused thinking. His opening paper pointed outthat it was difficult to predict long-term outcomes,and this was the context of his warning; in theshort term, however, the position seemed clear:31

Our new-found ability to manipulate ourgenes is giving rise to a certain amount ofpublic concern. In fact the application ofhuman recombinant DNA technology doesnot raise any fundamentally new ethical issues,at least not yet. Genetic screening andprenatal diagnosis have been accepted pro-cedures for many years; our new technologywill simply increase the number of diseasesthat can be avoided in this way Organtransplantation is quite acceptable; replacingdefective genes is, in essence, no different toreplacing whole organs (my emphasis).

New technology, then, but old practices. Newpossibilities for human health but no new ethicalissues because the kinds of decisions individualshave to face have already been encountered inclinical medicine. The new field simply highlightsexisting issues. The discussion was attended bymembers from the Committee on the Ethics ofGene therapy which presented its report to theBritish Parliament the following year.32

990 A Debate About Technology and Society

The report was requested precisely because,among other things, it was acknowledged thatgene therapy may introduce new and possiblyfar-reaching ethical issues which have not pre-viously had to be considered (1.11). The presump-tion of the report was that before gene therapywas introduced into medical practice it must beethically acceptable; for instance, such therapymust stand the tests of safety and effectiveness inrelation to other treatments (1.12). However, itsgeneral finding was that the basis for an ethicalposition already exists. It offers the tentative viewthat gene therapy should initially be regarded asresearch involving human subjects (8.3). Somaticcell therapy was directed to the specific individualwith a disorder, and the conditions for such anapplication of genetic knowledge were met byalready established guidelines for research withmedical patients (such as preserving the subjectsrights and carrying out procedures with respect tothe subjects well-being).

Somatic cell gene therapy will be a new kindof treatment, but it does not represent amajor departure from established medicalpractice, nor does it, in our view, pose newethical challenges (8.8).

The foundational status of Societys regulatorycapacity was conserved.33

This returns me to a point made at the begin-ning. Current medical ethics presumably provideda foundation for ethics in the area of gene therapybecause it already embodied the values of societythrashed out through much deliberation and dis-cussion. So the finding of no new ethical issueswas based on already established practice. Likepopular usages of the term surrogate, perhaps weglimpse here another absorption of new ideas intoa form (no new ethical issues) that was alreadysedimented in discourse.

Technology and society

In the field of assisted reproduction, therelationship between technology and natureorbiologyseems for all the world like the twocomponents of maternity that have now enteredpopular parlance, the social and the biological;this in turn is like the two components of biologicalmotherhood made explicit in surrogacy, geneticand gestational.

Reproductive technologies are regarded as facili-tating biological process, above all as assistingconception.34 (They do not assist nurture or thoseafter-birth body processes some have regarded asequally biological in nature.) Insofar as techniquesfocus on conception, they focus on the fertileunion of male and female gametes and on the via-bility of the embryo. In this, artificial insemination,in vitro fertilisation or other practices such as GIFT(gamete intra-fallopian transfer) simply stand in,so the justification goes, for natural body processes.

Not themselves natural, they make up for naturalimpairment in the same way as the woman whoacts on behalf of anothers motherhood is a surro-gate for her capacity to bear a child. We couldconsider them surrogate processes.

What makes a surrogate mother like a motheryet not the real mother is the fact that she assiststhe real mother to overcome a particular impair-ment. While her gestation of the child is a completesubstitute for the commissioning mothers role ingestation, by itself it is an incomplete act that onlymakes (interpretative) sense when seen as part ofthe total social process by which the real mother iscreated. (If there were no real mother to receivethe child, her act by itself would be meaningless.)In the same way, medical technology is like thenatural processes it assists yet is not the naturalprocess itself. Again, technological interventionattends to some particular bit of the wholedevelopmental sequence that creates a child; eachact of assistance as such is only given meaning,however, by a successful outcome that is simul-taneously a natural onean egg is fertilised, achild is born. (If there were no encompassingnatural process, the interventions would haveno outcome.)

This commentary on the two conservationstrategies brings an interesting realisation. It is notjust that technology can appear now an adjunct ofnature, now an adjunct of society, but assistingnature is also assisting society. In the epoch ofwhich I talk, each could appear foundational tothe other.35

The folk model of surrogacy enables us to clarifycertain aspects of the science/society debate as ithas appeared in the recent past. Specifically, Ihave drawn a parallel with how technology givesbirth, with what kind of mother it is. Surrogacyoffers a depiction of a relationship between factorswhich are evidently dependent on others, andfactors which appear to have their own trajectory.If the surrogate who keeps her agreement is anuncontested surrogate, so, too, technology. As longas technology is simply giving nature a helpinghand,36 then it appears akin to natural resourceswhich can be put to the benefit of society. As onespeaker in the debates surrounding the passage ofthe British Human Fertilisation and EmbryologyBill said: research and experimentation are anatural part of the development of the humancondition.37 But the discourse faces both ways.By the same token, technology (and pari passuscience) appears to be fuelling a runaway worldwhen its aims are presented as a substitute forsocietys, and it seems to be the only real thingthere is.

References

1. This is a version of Reproducing the future, a talkgiven to the European Molecular Biology Laboratory,Heidelberg, November 1998, in the Science and Society

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Lecture Series. The case draws on Strathern, M. (1998).Surrogates and substitutes: new practices for old?In The Politics of Postmodernity (Good, J. & Velody,I., eds), Cambridge University Press, Cambridge,which offers a rather different context, and repeatsmaterial found there. [That touches on Americandata, but with some small exceptions here I restrictmy comments to developments in the UK. When Irefer to Euro-American I mean that my remarksapply to cultural continuities broadly identifiableacross Europe and North America.]

2. For example Siegler, M. (1999). Ethics committees:decisions by bureaucracy. In Bioethics: An Anthology(Kuhse, H. & Singer, P., eds), Blackwell Publishers,Oxford on the US experience. For a wider contextin the UK see Rose, N. (1999). Powers of Freedom:Reframing Political Thought, Cambridge UniversityPress, Cambridge. For an anthropological glance.(2000). Audit Cultures: Anthropological Studies inAccountability, Ethics and the Academy (Strathern, M.,ed.), Routledge, London. Medical ethics committeesare not the only antecedents. The Warnock andGlover Reports (Warnock, M. (1985). A Question ofLife: The Warnock Report on Human Fertilisation andEmbryology. Blackwell, Basil, Oxford; Glover, J.(1989). Fertility and the Family, The Glover Report tothe European Commission on Reproductive Technologies,Fourth Estate, London) are classic examples comingout of parliamentary and quasi-parliamentary pro-cedure.

3. Nowotny, H., Scott, P. & Gibbons, M. (2001). Re-think-ing Science: Knowledge and the Public in an Age ofUncertainty, Polity, Oxford.

4. Callon, M. (1998). An essay on framing andoverflowing: economic externalities revisited bysociology. In The Laws of the Market; The SociologicalReview (Callon, M., ed.), p. 260, Blackwell Publishers,Oxford.

5. Agora (after the Greek) describes the new publicspace where science and society, the market and poli-tics, co-mingle (Nowotny, Scott & Gibbons, see no.3, p. 203); the participants they have in mind arelargely the articulate products of an enlightenededucational system.

6. Callon, M. (1998). See no. 4, pp. 260261.7. Barnett, R. (2000). Realizing the University in An Age of

Supercomplexity, SRHE [Society for Research intoHigher Education] and Open University Press,Buckingham.

8. Fenstead, J. E. (1995). Relationships between thesocial and natural sciences. Eur. Rev. 3, 63.

9. In the short-lived virgin birth furore (Silman, R.,ed.) (1993). In Virgin Birth, Academic Unit ofObstetrics and Gynaecology, Whitechapel: WFTPress, London) women who sought fertilisation out-side the context of any kind of sexual relations witha man were excoriated not just for wanting to createfatherless children but for ignoring the symbolismof cross-sex union.

10. Several eggs were obtained from the woman whowas to carry the child; they were fertilised by spermfrom both men. Two female embryos, each thusfathered by one of the men, were then fused,forming a combined embryo, in which cellsfathered by the two men were intermingled (LosAngeles Times 1 April, 1998).

11. Morgan, D. & Lee, R. (1991). Blackstones Guide to theHuman Fertilisation and Embryology Act, 1990: Abortion

and Embryo Research: The New Law, Blackstone PressLtd, London.

12. Forvargue, S., Brazier, M. & Fox, M. (2001). Reproduc-tive Choice and Control of Fertility, Report to EuropeanCommission, DG XII Concerted Action Programmeon Biomedical Ethics. Centre for Social Ethics andPolicy, Manchester University, Manchester.

13. An old concept (one woman having a child foranother) re-made anew through technology.

14. I use description in the general sense intended byFenstead; it can of course contain the same contrastwithin itself. The distinction (between descriptionand interpretation) is itself part of a Euro-Americanmodel of knowledge, but rather than unpacking it Ihere run with it. (The same could obviously besaid of the distinctions and elisions of nature/tech-nology/biology/society.).

15. I should make it clear that almost all of what I say isby way of cultural commentary. It may require mespeaking as though I were giving an opinion orstating a norm, but the speaker is not meI amdescribing opinions and norms which arise in Euro-American discussions about the assisted reproduc-tion techniques. Part of the anthropologists concernis to describe the contexts or domains in whichideas flourish (the culture). Culture we may con-sider as a field in which ideas, concepts, practices,values are recognisable and thus replicated acrossdomains. When they become unrecognisable to oneanother, we are in a new cultural field.

16. Full surrogacy did not mean that the birth motherwas more a mother but that she was more a surro-gate. Haimes, E. (1992). Gamete donation and thesocial management of genetic origins. In ChangingHuman Reproduction: Social Science Perspective (Stacey,M., ed.), Sage, London, pp. 120122, laid out thenumber of relational permutations thatin the early1990scould be derived from gestatory and geneticparentage.

17. Ragone, H. (1994). Surrogate Motherhood: Conceptionin the Heart, Westview Press, Boulder, p. 73. Ragoneretrospectively applies the term gestationalsurrogate to both the UK Warnock Report on HumanFertilisation and Embryology (1985) and the Report forthe European Commission on Reproductive Technologies(1989), though neither used the vocabulary at thetime (see no. 2).

18. See Cook, R. & Sclater, S. D. (forthcoming). SurrogateMotherhood: International Perspectives, CambridgeUniversity Press, Cambridge for an up to date,multidisciplinary, overview.

19. Boyd, K., Higgs, R. & Pinching, A. (1997). The NewDictionary of Medical Ethics, BMJ Publishing Group,London.

20. Morgan, D. (1989). Surrogacy: an introductory essay.In Birthrights: Law and Ethics at the Beginnings ofLife (Lee, R. & Morgan, D., eds), p. 56, Routledge,London.

21. In so doing the term makes explicit a mode of under-standing the world which I take as wider thansimply English-language usage: it is more generallycharacteristic of twentieth-century Euro-Americancultures: Wagner, R. (1975). The Invention of Culture,Prentice-Hall, New Jersey is one of the classicstatements in anthropology.

22. The Glover Report (1989, see no. 2., p. 67) captures it:The term surrogate implies that one womanreplaces another in her role as mother, although aswe shall see there is a critical difference between

992 A Debate About Technology and Society

two modes of replacement. Note that the WarnockReport (1985, see no. 2, p. 42) was also clear (Surro-gacy is the practice whereby one woman carriesa child for another with the intention that thechild should be handed over after birth) untilthe possibility of the carrying mother not being thegenetic mother arose. This could lead to argumentas to whether the genetic mother or the carryingmother ought in truth to be regarded as the motherof the child (Warnock Report, 1985, see no. 2, p. 44,my emphasis). The popular view supported the defi-nition adopted in the 1985 Surrogacy ArrangementsAct, which banned commercial surrogacy (Surro-gate mother means a woman who carries a childin pursuance with an arrangement [S1]), the onepiece of legislation stemming immediately from theReport.

23. See Dolgin, J. L. (1997). Defining the Family: Law,Technology and Reproduction in An Uneasy Age, NewYork University Press, New York on status andcontract in surrogate motherhood from a USperspective.

24. Primarily in the period up to the 1990 Act, e.g.Morgan (1989, see no. 20); also Wolfram, S. (1989).Surrogacy in the United Kingdom. In New Approachesto Human Reproduction: Social and Ethical Dimensions(Whiteford, L. M. & Poland, M. L., eds), WestviewPress, Boulder. Commentary continued to pour infrom the USA, and particular stories were widelyreported in the British Press (see for example thecases detailed by Dolgin (1997, see no. 23)).

25. In both UK and American usage, when all that is atissue is the donation of ova, the gestational motheris taken to be the natural mother of the child shebears. Thus an intending mother who receives eggsby ovum donation is not called a surrogate, anymore than the egg donor is. (The Warnock Reportrecommended that the birth mother using a donatedegg should be the mother recognised in law.).

26. I am stabilising these ascriptions for purposes ofexposition. The same act can of course be taken nowin a self-signifying mode (figurative) and now in areferential or interpretative (literal) one. The interestis the way the popular usage of the term surrogatehas stabilised this dialectic with respect to gesta-tional surrogacy.

27. And they are also conservative: foundationalismendures in folk models where it is discarded inanalyses and interpretation in the human and socialsciences.

28. Clothier, C. M. (1992). Report of the Committee on theEthics of Gene Therapy, HMSO, London.

29. Weatherall, D. (1991). Manipulating human nature.Science and Public Affairs, The Royal Society, London,BAAS, 2531, p. 29.

30. At a meeting organised by the Royal Society underthe title Embryos and Ethics, a small-scale exampleof a kind of hybrid forum (see above) becomingincreasingly common.

31. Weatherall, D. (1991). See no. 29, p. 28.32. Clothier, C.M. (1992). See no. 28.33. Of course, what appears to be an unequivocal foun-

dation can in turn be open to doubt. The processesof regulation may also be in need of regulation.Thus it is acknowledged (3.8) that different codes ofpractice and means of regulation have evolved tocover different areas that treatment may forcetogether.

34. See, for example, Franklin, S. (1999 [1993]). Makingrepresentations: the parliamentary debate on theHuman Fertilisation and Embryology Act. In Tech-nologies of Procreation: Kinship in the Age of AssistedConception (Edwards, J., et al., ed.), 2nd edit.,pp. 135136, Routledge, London.

35. (But a foundational model separates out Nature andSociety again.) The argument may be pursued inStrathern, M. (1992). After Nature: English Kinship inthe Late Twentieth Century, Cambridge UniversityPress, Cambridge and in Franklin (1999 see no. 34).The realisation is an analytical performative orobviation. Wagner, R. (1986). Symbols that Stand forThemselves, Chicago University Press, Chicago.These chimera (Nature, Society, etc.) are of interesttoday for the lessons they may hold for currentconceptualisations of a biosocial world.

36. Hirsch, E. (1999 [1993]). Negotiated limits: interviewsin south-east England. In Technologies of Procreation:Kinship in the Age of Assisted Conception (Edwards, J.,et al., ed.), 2nd edit., p. 102, Routledge, London.

37. Quoted in Franklin (1999). See no. 34, p. 145.

Marilyn Strathern is William Wyse Professor of Social Anthropology at the University of Cambridge and Mistress ofGirton College, Cambridge. In 2001 she received a DBE for services to social anthropology. A fellow of the BritishAcademy, and Foreign Hon. Member of the American Academy of Arts and Sciences, she sits on the UK NuffieldCouncil of Bioethics. While she is increasingly preoccupied with administration (the edited book, Audit Cultures(2000), subtitled Anthropological studies in accountability, ethics and the academy, touches on the institutionali-sation of good practice), her research remains a lifeline. Starting in 1964, she has carried out fieldwork over severalyears in the Highlands of Papua New Guinea (Melanesia), the most recent field visit being in 1995. Her research inter-ests have for some time been divided between Melanesian and British ethnography. Investigations in gender relationsin PNG (Women in Between, 1972) and kinship in the UK (Kinship at the Core, 1981) together led to a critical appraisal ofongoing models of Melanesian societies (The Gender of the Gift, 1988), and of British consumer culture (After Nature,1992). Debates around legislation following the Warnock Report stimulated an interest in reproductive technologies;a collaborative research project (19901991), which examined some of the issues in the context of kinship waspublished as Technologies of Procreation (Edwards et al., 1993). Property, Substance and Effect (1999) is a collection ofanthropological essays on persons and things, and most recently she has been involved with colleagues, in PNG andthe UK, in another collaborative study, this time of debates over intellectual and cultural property under the generaltitle Property, Transactions and Creations. Common elements in these projects come from an ongoing curiosityabout comparative issues in knowledge, technology and personhood.

(Received and Accepted 11 April 2002)

A Debate About Technology and Society 993

Still Giving Nature a Helping Hand? Surrogacy: A Debate About Technology and&?show [NBsp]; SocietyOutline placeholderThe last five yearsDescription and interpretationA 15-year-old debate: surrogacyInterpretation in contextThe enigma of the realFoundationsTechnology and society

References