According to an announcement last month by Nagano Prefecture obstetrician Yahiro Nezu, a woman nearly 60 years old has served as a surrogate mother for her daughter. Last spring the woman gave birth to a baby that had been conceived externally using a fertilized egg provided by her daughter and the daughter’s husband. The daughter’s uterus had been removed because of cancer.

Described as a “grandmother giving birth to a grandchild,” the case invites bioethical questions. At least 33 editorial comments on the issue have appeared in Japanese newspapers, including the following:

Sankei Shimbun

It has long been argued that a woman becoming a surrogate mother of a grandchild is medically feasible and that such an event occurring in Japan would not be a surprise. Yet, when it actually happened, we could not help feeling somewhat uncomfortable. Dr. Nezu said, “Anything that happens the first time seems unnatural. But I decided that a mother becoming her daughter’s surrogate would be much better than somebody else performing the duty. I am prepared for any criticism.” His words are not persuasive, however. Shinano Mainichi Shimbun

The woman who gave birth was way past menopause, and was not able to become pregnant until her reproductive functions were revitalized with hormones. That implies the possibility of a serious risk in pregnancy at that age. Even if prior consent had been given by her and family members, doubts remain as to whether such an act is ethically permissible. Mainichi Shimbun

Progress in reproductive technology has opened the way not only to surrogate birth but also to other means of artificially creating parent-child relations. Unless something is done, there is the danger that female bodies will be used as tools, with technological development taking precedence over the health and welfare of mother and baby. Chunichi, Tokyo

In advanced medical science, the fait accompli has been taken for granted more often with assisted reproduction than with any other technology. This is because such technology does not require large-scale facilities. Every precaution is called for in the use of medical skills that touch on human birth. Nihon Keizai Shimbun

Countries like the United States, Britain, Germany and France all have their own consistent policies and philosophies regarding advanced medical science and bioethics: Germany and France have rigid legal provisions; Britain’s are somewhat more flexible; and the U.S. has resisted governmental regulations. It is time for Japan to clarify its position. Asahi Shimbun

Much confusion has spread because rule-making has not kept pace with the rapid progress in reproductive medical science. Still, many babies are being born, and regardless of how they were born, their welfare must be given top priority. Surrogate birth must not be taken lightly. The reality is that there are cases in which that is the only way people can have a child. This method of childbirth may have to be permitted in exceptional cases, although it should be banned in principle. Daily Tohoku

Under the name of medical science, the doctor used the body of a healthy woman as a tool, exposed her to a dangerous and painful experience for a long period, and deprived her of the baby immediately after birth and gave it to somebody else. We do not believe these events are compatible with the basic principle of assisted reproductive technology, which is to maintain human dignity while attaching priority to safety and the welfare of children. Kyoto Shimbun

This matter requires immediate debate nationwide. While the government has started considering extending aid to assisted reproductive technology, perhaps it is necessary to establish a special forum for discussion — like the one that dealt with the question of brain death. Chugoku Shimbun

Rather than calling for an outright ban on surrogate births, thorough discussions must be conducted on rule-making to perhaps permit them in exceptional cases. Kobe Shimbun

For in-depth discussions, voices must be heard from a broad spectrum of citizens. There may be clash of opinions stemming from different positions and values. Yet, a consensus should be reached from the stand point of promoting the welfare of both the mother and the child. Yomiuri Shimbun

Surrogate birth is the only means left for a woman who has lost her uterus and wants to have a baby. The question is whether such means should be recognized, and if so, how to minimize the risks.

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