Surrogacy in Japan: Gray areas reflect human nature

(Image courtesy of Visual China)

According to Japan's "Oriental New News" report, the surrogacy abandonment incident of China's popular actress Zheng Shuang has triggered a wave of hot discussion among the melon-eating masses in China, making the sensitive topic of "surrogacy" break into the public eye again. In fact, as early as 2003, female artistSaki Xiangjing and her husband Nobuhiko Takada announced that the two had obtained a pair of twin sons through surrogacy in the United States, making the topic of celebrity surrogacy the focus of Japanese society. Today, 18 years later, "surrogacy" is still an ambiguous topic in Japan that is neither illegal nor allowed. Affection, dedication, greed, ruthlessness and other human natures are vividly presented in this gray area.

"I was born to my grandmother"

"I was born to my grandmother!" HaiDou, a young boy born in 2009, once proudly told his teachers and classmates in an English cram school.

Haidou's mother, Natsumi, was 1 year old and had to undergo uterine removal surgery due to illness, and has since lost her fertility. This has always been a problem for Natsumi's mother, Haidou Grandma Yoko, "If I can be willing to conceive and give birth to a child for Natsumi, just like when the child is sick (all mothers) will think that if I can get sick for the child, it will be the same mood."

At first, Natsumi didn't think it was a big deal that she couldn't have children, but after entering the childbearing age and watching her friends around her have children, she still began to feel pain. Coupled with the mother's repeated "nagging" in her ear, Natsumi and her husband Da also began to think seriously about it. But the high cost of overseas surrogacy has squandered the young couple. It wasn't until they saw a press conference on television one day that Nezu Hachihiro, the only doctor in Japan who undertook the surrogacy business, did they know that they didn't have to go abroad to perform surrogacy surgery in Japan.

So they tried to write a letter to Dr. Nezu. Eventually, at Dr. Nezu's private clinic on the shores of Lake Suwa, Natsumi's mother, Yoko, as a surrogate mother, gave birth to a healthy and lively son, Kaidou, for Natsumi and his wife. On The advice of Dr. Nezu, they never hid the surrogacy from those around them and From Haidou himself. They will show the video of the decision to have surrogacy surgery for the child, and they will always try to make the child understand that this is not a shameful thing, there is no need to hide, you are just different from others. Everyone has something different from others, it's your own business. The little sea bucket grows up healthily under the care of mom and dad. Natsumi and Tatsuya's marriage has also become happier and happier with the arrival of Kaidou.

"I used to think that surrogacy is something that celebrities and rich people can do overseas, but it is not. I sincerely hope that in the near future, such a thing can become a more natural thing. HaiDou's father, Da, also sighed. But this good wish of his was not easy to fulfill. Dr. Nezu, who is 79 years old this year, is still the only doctor in Japan who has dared to openly undertake the surrogacy business. As a result, he became one of the most controversial figures in Japanese medicine.

"The Physician Who Intervenes in God's Affairs"

Nezu Hachihiro pioneered the "three firsts" in japanese medical circles: Japan's first fetal reduction surgery in 1986 (surgery to reduce the number of fetuses to ensure the safety of mothers and babies), Japan's first non-conjugal in vitro fertilization in 1998, and Japan's first surrogacy case in 2001. Either one was once the default behavior of the Japanese medical community as "self-censorship". But with the belief of being responsible for patients, Nezu Yahiro boldly pioneered the ethos. Among them, fetal reduction surgery and non-spousal in vitro fertilization have been widely recognized in Japan under his impetus, and many medical institutions have followed suit. Only surrogacy is still a "forbidden area" in the Japanese medical community. As a result, Nezu Yasu also attracted suspicions such as "seeking huge profits" and "selling fame and reputation", and some even accused him of "interfering in God's affairs".

In fact, Nezu Yasu is a strong opponent of "surrogacy commercialization". He has a strict set of screening criteria when performing surrogacy surgery on patients: the couple entrusting the surrogacy must be a person who cannot conceive alone because of the wife's uterus removal or congenital uterus loss; the surrogate mother must be a person who is willing to help free of charge; the surrogate mother must undergo sophisticated medical examinations to ensure that her health is suitable for pregnancy and childbirth; the couple who entrust the surrogacy must accept the condition of "prioritizing the rescue of the pregnant woman if there is a danger to life" in advance, and so on.

As of 2018, he has provided medical assistance for surrogacy to 21 couples, of which 14 surrogate mothers have successfully given birth to 16 children. In the face of the world's accusations that he "promoted surrogacy", NezuHachi argued: I am not promoting surrogacy. I am also very supportive of adopting children. I just hope that democracies can provide more options for those with fertility barriers on the basis that the law explicitly prohibits the commercialization of surrogacy.

The uterus is clearly priced, and the baby is reduced to "medical waste"

Although Yoshimura Yasunori, who served as chairman of the Japan Society of Obstetrics and Gynecology from 2007 to 2011, also believes that Dr. Nezu Hachihiro did not pursue the business of surrogacy not to make himself famous or make money, but out of the belief that he would do his best to help patients, he still unabashedly opposed Dr. Nezu's behavior: surrogacy and receiving sperm or egg donations from a third party and conceiving and giving birth on his own are completely different things. As a doctor, you should understand the high risks of pregnancy and childbirth. Should the act of leaving one's own genes and exposing others to additional physical burdens and life risks really be promoted?

The Japanese Society of Obstetrics and Gynecology, as a professional organization with strong influence in the Japanese medical community, banned medical institutions from carrying out "surrogacy" business in the form of a "public announcement" in 2003. This is why surrogacy is not prohibited by law but cannot be widely practiced in Japan. The society has issued serious warnings to Nezu Hachiren on several occasions.

Due to the opposition of the Japanese Society of Obstetrics and Gynecology, for most Japanese couples who have fertility barriers and cannot conceive on their own and want to get a child with their own genes, overseas surrogacy is the only option to fulfill their wishes. However, at present, only some states in the United States and very few countries and regions such as Russia and Ukraine are allowed to provide surrogacy services for foreigners, and the cost is very high. For example, the intermediary fee for entrusting surrogacy in Russia is about 6.9 million yen, and the United States is twice as much as in Russia. Therefore, overseas surrogacy is regarded as a privilege exclusive to the rich in Japan.

But even if you have money, you can't guarantee that everything will go as people want. There was once a Japanese couple who traveled to India for surrogacy, but the two were divorced by the time the child was born. Under the laws of their respective countries, both Japan and India refuse to recognize the nationality of their children. In cases where both the entrusting mother and the surrogate mother refuse to accept the baby, the entrusting father is willing to claim the child. Indian law does not allow single men to claim baby girls...

In order to meet the needs of the client and improve the fertility rate, the general surrogate mother will be required to implant more than two fertilized eggs. This creates a higher rate of preterm birth and the likelihood of physical defects for surrogate babies. In the face of an inadequate baby, not all clients can accept it calmly. Parents who treat babies as commodities and choose to "return" are also very large. Most of the surrogate mothers who choose to "rent out their womb" are engaged in this high-risk industry out of poverty, simply unable to raise their abandoned babies by their clients. This has led to the death of a large number of abandoned surrogate babies and their eventual disposal as "medical waste".

Japan's more sensational surrogacy incident is undoubtedly the explosive news that the 24-year-old "rich second generation" Shigeta Mitsushi gave birth to 21 children through surrogacy in Thailand. Shigeta allegedly planned to have 5 to 10 children a year, with the ultimate goal of having 1,000 children so that he could help manage the family business in the future. The women who provided him with eggs came from China, Spain, Australia, the United States and other countries. Although after a four-year trial, the Thai Family Court finally ruled that Shigeta was granted custody of all the children, Thailand used this as an opportunity to enact a new law to permanently close the door to surrogacy for foreigners.

Japanese legislation is looming

Saitama University Faculty of Medicine, Faculty of Obstetrics and Gynecology, believes that the composition of the family is becoming more and more diverse from a worldwide perspective. In contrast, Japan's legal system building is undoubtedly seriously lagging behind. The surname of husband and wife, which originally did not exist at all, can be seen in Japan, which does not work. From the perspective of the diversification of family forms, surrogacy can hardly be said to be an absolutely unacceptable behavior, but it must be strictly regulated and strictly managed in medicine.

Surrogacy and in vitro fertilization of sperm or eggs provided by a third party are medically known as "reproductive assisted medicine" (PPD). In fact, Japan's Liberal Democratic Party, the ruling party, has long begun to draft bills in this area. Shunji Furukawa, a member of the Liberal Democratic Party (LDP) who graduated from the Faculty of Medicine at Keio University, was specifically in charge of drafting the bill. He said the bill was delayed because in principle laws relating to bioethics must be legislated by lawmakers and unanimously approved by the ruling and opposition plenums. At present, the plenary has not yet reached an agreement on the bill. Although this bill is primarily aimed at in vitro fertilization that is more demanding than surrogacy, Furukawa pointed out that once passed, the surrogacy act could be partially legalized in Japan. (Original title: Surrogacy in Japan: Gray Area Refracts Human Nature)