Is It Acceptable To Use Brain-Dead Women As Surrogates?

My answer is no, not even if it's the woman's own baby

May 27, 2025

swan and a baby — Image by Sarah Richter from Pixabay

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Are you aware of the horrific and deeply traumatic case of Adriana Smith from Georgia? In February, Adriana Smith took ill, was rushed to the hospital, but on arrival was pronounced brain dead.

Devastatingly, her family are not allowed to grieve. You see, Adriana Smith is being kept on life support because she is pregnant. The inhumane abortion laws in Georgia resemble policies extracted directly from the fictional country of Gilead in The Handmaid's Tale.

Adriana was only nine weeks pregnant when she was rendered brain-dead. So the state plans to keep her hooked up to machines, using her body as a vessel, for potentially almost seven months.

There is so much grotesquely wrong with this situation that I can’t find the words to express my horror. Yes, we have a right to life, but we should also have a right to death. Depriving Adriana of a dignified death is not only abhorrently disrespectful to her first and foremost, but also harrowingly traumatic for her loved ones, who watch on helplessly, unable to grieve.

And what of the poor baby? What will happen to them?

I can’t help but feel this situation is similar(ish) to the idea of whole body gestational donation (WBGD), which I wrote over a year ago. Yes, Adriana was already pregnant when rendered brain-dead, but there are similarities.

In light of what is happening to Adriana Smith and her family, I think it’s time to dig out that old piece of writing on brain-dead surrogacy and share it here.

Are you sitting comfortably? Let’s begin.

I have tokophobia, which is a pathological fear of pregnancy.

This phobia, coupled with the fact that I don’t want children, means I meet intrusive inquiries about my baby-making plans with a scoff and a retort of “over my dead body.”

I didn’t expect science to take this as a challenge.

Whole body gestational donation (WBGD) is the name given to offering up your entire body in the rare case of being rendered brain-dead.

I believe in organ donation; after all, it saves lives. But I’m somewhere between grossed out and freaked out about WBGD, which creates lives.

The fact is women are often objectified for their sexual or reproductive functions. But I can’t even fathom the idea of this objectification carrying over into death.

Scientific advances mean I could have pregnancy inflicted upon me in death.

My whole nervous system prickles and recoils at the mere thought of WBGD.

I admit I was quick to label WBGD as immoral and unethical, not to mention a backward step for women’s rights. Terror fueled my initial reaction, and I struggled to find objectivity and balance.

I have looked one of my greatest fears in the eyes, and I’m still petrified. But in doing so, I have forced myself to ponder and examine this scientific advancement from different angles.

Sure, there may be positives derived from WBGD, but I can’t help but think that just because something can be done doesn’t mean it should be done.

Who even thought up WBGD?

In 2000, Rosalie Ber wrote a report titled Ethical Issues In Gestational Surrogacy; in this, she mooted the notion of using patients in a persistent vegetative state (PVS) as an option for bypassing the moral and legal controversies that come with surrogacy.

To date, no jurisdictions around the world have implemented Ber’s suggestions. This is where Smajdor comes in.

Smajdor’s 2022 report called Whole Body Gestational Donation, published in Theoretical Medicine and Bioethics, takes Ber’s work and expands on it. This expansion stakes a claim that a host body via WBGD is a superior alternative to a host body in a PVS.

This report created an online furore at the time of publishing, perhaps inflamed by sensationalist tabloid articles.

More recently, an article was published in Health News exploring the ethical dilemmas of Smajdor’s report. And believe me, it is an ethical minefield.

Many may wonder whether WBGD is possible. Based on Smajdor’s report, we are encouraged to take it as prima facia that it is. However, the Health News article suggests otherwise.

The first perplexing and somewhat discombobulating concept to grasp is that WBGD requires the host body to be dead.

The NHS clarifies that if a person is brain-dead, they are legally and clinically dead. They will never regain consciousness.

Brain-dead people rely on life-support machines to breathe and circulate blood. But the rise and fall of the chest in a brain-dead patient is actually an illusion of life. They are not breathing by their own accord; rather, this is a mechanical function.

I’m no stranger to death and dead bodies. In my previous job as a police officer, dealing with death was integral to my job. Perhaps this is why I struggle to comprehend logically that brain-dead patients are dead.

To me, a dead body is pale, cold, and riddled with rigor mortis. Cadavers are the epitome of death. Within just a few days of life expiring, deceased bodies start to decompose. And don’t even get me started on the smell.

But a brain-dead patient is warm. They still have blood circulating in their body. They emanate a glow of “life”. They don’t excrete a pungent, vomit-inducing odour.

I suspect families of brain-dead patients also struggle to accept the classification as “dead.”

Exploring the differences between organ donation and WBGD

Organ donation has become a standard and acceptable procedure.

In her report, Smajdor argues that, in technical terms, WBGD is the same process as organ donation. Both require the host bodies to be ventilated to “preserve” the donated body parts.

But come on, the difference here is not just a few days; it’s months and months. I mean, I’m no expert, but I believe it’s nine months to be exact.

I am comfortable with my body being mutilated and harvested to give others some of my working parts. If my death could save lives or enhance the quality of someone’s life, I’m all in. Cut me open and fill up your pick-n-mix cup with what you need.

But the idea of having pregnancy inflicted on me in death haunts me.

What about consent?

Ok, I admit, my initial catastrophising had me painting a dystopian landscape of medical units full to the brim of dead women with growing bellies.

I have a vivid imagination, and although intelligence and common sense tell me the embryo would be inserted into the host body by a medical procedure, my mind conjures up images of necrophilia. For the more curious of you, the impregnation process is similar to that of IVF; the fertilised egg is placed into the host's womb in a clinical manner.

My concerns about consent, however, remain a fundamental criticism of WBGD.

Sure, Smajdor acknowledges the requirement for explicit informed consent before WBGD is viable. This requires the person providing consent to be of sound mind — and, thus, clearly alive. Yet, even she acknowledges how consent can be malleable.

For instance, in the UK, organ donation used to be an “opt-in” process; now, we have to specifically “opt-out.” Yet this is not widely known.

It is disconcerting to learn that many people donate organs through passive consent instead of informed consent.

If WBGD becomes a thing, how can I be sure my wishes will be honoured?

There is no guarantee that the “opt-in” consent process won’t be manipulated as with organ donation, meaning consent becomes the default position. I shudder in horror.

Note, Adriana Smith never consented to her situation and nor has any of her family.

Women’s rights and male pregnancies

For women to be used as “foetal containers” even in death is a slap in the face to feminism. Smajdor is prepared for this pushback and suggests that men can be used as host bodies, too.

Apparently, pregnancies can come to term outside the uterus. The liver is a particularly viable organ for growing a foetus.

Ordinarily, male pregnancy would be deemed too risky and potentially fatal due to the delivery complications. However, if the host body is already dead, the risk of death is nullified.

If this is the case, I can’t help but wonder why women are the focus of WGBD in the first place. Will we ever stop reverting women to mere baby vessels, whether in life or death?

I am also curious as to how many men would willingly donate their bodies for WBGD. I suspect the ones most unpersuaded are also those who are rigidly anti-abortion.

Is WBGD a realistic alternative to surrogacy?

There’s a reason commercial surrogacy is illegal in many countries. It carries with it moral, ethical, and legal controversies.

Pregnancy is inherently risky. Speaking of the risks of pregnancy, Smajdor says,

“Pregnancy itself should, properly speaking, be medically contraindicated for women generally.”

She goes on to say,

“To expose oneself to risks comparable to pregnancy and childbirth would be deemed foolish and pathological in any other context.”

Women who are paid to be surrogate mothers are risking their lives.

Focusing solely on commercial surrogacy, surrogate mothers are often acting from a place of desperation. A socioeconomic divide comes into play here; these surrogate mothers are usually low-income and carry children for exceptionally wealthy clients. All this so they can feed their own children.

Sure, you could argue that it’s free will and their choice. You can even try to convince me that it’s a simple business deal that benefits everyone.

Is free will really free will when it comes from a place of desperation and being backed into a corner?

The horrors of surrogacy have caused India and Thailand to end commercial surrogacy. Russia used to be a popular destination for surrogacy tourism, but it has recently banned surrogacy services for foreigners. This leaves Ukraine as the leading destination for commercial surrogacy.

I am against surrogacy of any sort, but I also appreciate there’s a sort of irony in my having an opinion on what other people do with their uterus. I myself am an advocate for the childfree and childless, and part of my advocacy is in trying to move the conversation along from focusing on our empty uteruses.

So, what right have I to be outspoken about the ‘choice’ of surrogates to fill their uteruses with other people’s babies?

But my point is valid — babies are not commodities.

If you don’t like what you “ordered,” you can’t just return them. This investigative piece about baby Bridget, a child born with disabilities, highlights the harrowing side of surrogacy that we rarely hear about. I wept as I read of this poor child being rejected and abandoned by her biological parents.

So, if the surrogate host body is dead, are the ethical and moral issues of surrogacy revoked?

I’m not sure where I stand on this. Certainly, with WBGD, the welfare of the surrogate host body is less complex. But I would argue that everyone has a right to respect, even in death.

And let’s not forget the child’s welfare here.

All too often in our pronatalist society, we are so hellbent on reproduction at all costs that we forget to consider whether bringing a child into the world is in the unborn child’s interests.

WGBD is self-serving for the hopeful parents and the fat cat laughing his way to the bank. Any child is a by-product of this process. I am confident that WGBD is not in any child's interest.

We know the importance of bonding with babies in utero. Where does this attachment building come into play with WGBD?

And don't tell me that for nine months, night and day, the biological parents are going to sit by the host body’s bedside, rubbing the expanding belly, playing classical music, and cooing gently. As we all know, that’s utter BS, not to mention impractical.

Is WGBD a realistic option?

In the UK, there are 18 cases of brain-dead patients per million people in the general public.

Even with a robust consent process, finding a host body for WBGD seems slim.

But in the situation where stars align, I still worry that WBGD would elevate the rights of potential life to supersede the rights of the dying or the dead.

Smajdor says WBGD is

“available to anyone who wishes to avoid the risks and burdens of gestating a foetus in their body.”

There are sensitivities here for childless people. Those experiencing fertility issues are in a particularly vulnerable stage of life as it is.

I appreciate some people are advised to avoid pregnancy for medical reasons, and some don’t have children due to infertility or other circumstances.

We already have IVF as one option and adoption as another. Yes, both services have flaws and can not guarantee a baby/child. But even so, is there a need for WBGD? And if so, is this need pandering to pronatalism rather than considering what’s best for the unborn child?

Ultimately, my overarching question is, “Why?”

Keeping a WBGD host body ventilated to be used as a baby vessel is resource-intensive. Surrogacy, as we know it today, is expensive. Therefore, the projected cost for WBGD is incomprehensible.

Clearly, WBGD is a service reserved for the super-rich.

Call me cynical, but I can’t help but see WBGD as a medical gimmick used to exploit the vulnerable while lining the pockets of its purveyor.

Ultimately, WBGD could cause more harm than good.

What do you think?

And on that note, who is paying to keep Adriana Smith ventilated? An eye watering amount of state money I suspect, while living children in poverty are not adequately supported or provided for.

My thoughts go to Adriana Smith’s family at this hauntingly difficult time.

I’d love to hear your thoughts; feel free to drop a comment and add to the conversation.