The first part of the Children and Family Relationships Act (parts two and three) was commenced a few days ago. It deals with IVF, among other things, but it did not include any law relating to surrogacy.
This is an arrangement whereby a woman, known as the surrogate, agrees to carry a child for another. At birth, the other person becomes the parent. The intended parent may be a woman, man or a couple.
It is strange that this troubling area of reproduction was avoided, since many other countries have tackled it, despite the controversy surrounding it.
Two types of surrogacy exist. The traditional method uses the woman's own egg for conception, making her the biological mother of the baby. It is overwhelmingly achieved with donor sperm, usually from the father of the intended parents.
The second, more recent, and also by far the more common, is gestational surrogacy. The refers to pregnancy using an embryo conceived in a petri dish and implanted by IVF.
Most surrogacy is commercial and the fees vary according to the country in which it takes place. The clinics handle all the financial and medical arrangements. Costs range from €30,000 to €150,000.
For this reason, many regard surrogacy as a rent-a-womb business, accessible only to the rich. Names like Kim Kardashian and Elton John spring to mind, with both of them having children born to surrogates. Occasionally, arrangements are made that do not involve any financial transaction with the surrogate apart from expenses. This is known as altruistic surrogacy. The surrogate is usually a close relative, who carries the baby to term.
Traditional surrogacy has been practised for centuries and was mentioned in the 'Bible'. In the book of Genesis, Abraham and his wife Sarah were childless, and his wife gave her servant Hagar to Abraham, and said "sleep with my maid servant; perhaps I can build a family through her".
Many countries have now banned all surrogacy. These include Sweden, Italy, Spain, Germany and France, to name but a few. Belgium, Denmark, the UK, the Netherlands and Ireland allow altruistic surrogacy, where the surrogate is not paid or is only paid reasonable expenses.
In this country, it is not underpinned by any law. India, once known as a rent-a-womb haven, banned commercial surrogacy in 2016 and only allows altruistic surrogacy under very strict conditions. The Netherlands have also established a strict law that severely limits altruistic surrogacy.
Countries that allow commercial surrogacy include Russia, Ukraine, Mexico, Nepal and many states in the US.
California is the most surrogacy-friendly place on the planet, with clinics now advertising "social surrogacy" for women without any fertility problems who want children but simply do not wish to be pregnant or to jeopardise their careers by taking time out. And for those wanting to dupe others into thinking they are pregnant, fake "baby bumps" are available for the different stages of gestation.
The issues raised by surrogacy are profoundly ethically and legally complex. The knee-jerk reaction is to suggest that surrogacy presents a compassionate and progressive solution for those unable to have children; it's just another type of modern family, encompassing those with certain fertility problems or who cannot biologically carry a baby, such as gay men. But this view is questioned not only by the so-called "right" and religious, but also by feminists and human rights groups. The arguments against surrogacy are based on its exploitative nature, since it is invariably poor women who turn to this as a means of procuring money.
Reproduction of this nature has been outsourced to poorer nations and Ukraine is now a favoured destination. Supporters argue that this is mutually beneficial and that it is engaged in by both parties for a good end. Yet many women are coerced into this by husbands and much of the money is gobbled up by the middle-man in the fertility clinic.
The surrogate also runs the risk of health problems associated with any pregnancy. The most profound argument, however, is the commodification of human life inherent in surrogacy - choosing the egg of an attractive woman or the sperm of a man with film-star good looks from a brochure, not to mention selecting their sex and skin colour, is utterly utilitarian. A baby should never be regarded as a faulty product if it fails to meet the specifications of the parents, yet this is what surrogacy enables. A troubling legal case around this in 2014 resulted in the near-total ban on surrogacy in Thailand.
But some will say, what about altruistic surrogacy? If a relative wishes to assist a family member, what's so wrong about that? As Kajsa Ekis Ekman wrote in the 'Guardian' in 2016 "(the woman) is still used as a vessel, even if told she is an angel. The only thing she gets is the halo of altruism which is a very low price for the effort and can only be attractive in a society where women are valued for how much they sacrifice, not what they achieve". This is still exploitation.
Countries as diverse and India and Germany have banned all surrogacy. We should have the courage to join them. Ultimately, the means do not justify the end, where human lives are concerned.
Patricia Casey is consultant psychiatrist in the Mater Hospital and Emeritus Professor of Psychiatry at UCD