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Surrogate

A surrogate is a woman who carries and gives birth to a child on behalf of intended parents who are biologically unable or unwilling to do so themselves, typically through assisted reproductive technologies such as in vitro fertilization (IVF).^[1] In gestational surrogacy, the predominant form today, the surrogate has no genetic relation to the child, as the embryo is formed from the intended parents' or donors' gametes; traditional surrogacy, by contrast, uses the surrogate's own egg via artificial insemination, creating a genetic link.^[2] This practice serves individuals facing infertility, single parents, or same-sex couples, with gestational arrangements comprising the vast majority of cases due to reduced legal and emotional complications from genetic disconnection.^[1] Surrogacy arrangements vary globally in legality and structure, with altruistic (non-compensated beyond expenses) forms permitted in places like the United Kingdom and Canada, while commercial surrogacy—where the surrogate receives payment—is allowed in select U.S. states, Ukraine, and Georgia but prohibited in much of Europe, Asia, and Australia over concerns of commodification.^[3] Empirical studies indicate that many surrogates and intended parents report positive experiences, with surrogates often citing financial incentives or altruism, and children from surrogacy families showing no significant developmental differences from naturally conceived peers in short-term assessments.^[1] However, long-term data remains limited, and satisfaction rates do not preclude systemic risks.^[4] Central controversies surround exploitation, particularly in commercial and transnational surrogacy, where socioeconomic imbalances between typically affluent intended parents and surrogates from lower-income backgrounds can foster coercion or undue pressure, akin to labor vulnerabilities in global supply chains.^[5] Critics highlight the commodification of women's bodies and children, with evidence from developing countries showing surrogates facing health risks, inadequate protections, and post-birth attachment challenges without commensurate safeguards.^[6]^[1] These issues have prompted bans or strict regulations in numerous jurisdictions, underscoring debates over whether surrogacy empowers or undermines human dignity through market-driven reproduction.^[3]

Surrogacy in human reproduction

Definition and types

Surrogacy is an arrangement in which a woman, referred to as the surrogate mother, carries and gives birth to a child on behalf of intended parents who are biologically unable or unwilling to gestate. This practice typically arises from infertility, medical conditions preventing pregnancy, same-sex relationships, or personal choice, with the surrogate relinquishing parental rights post-birth to the intended parents via legal agreements.^[1]^[2] The process relies on assisted reproductive technologies, distinguishing it from adoption, as the child is not the surrogate's biological offspring in all cases.^[7] The two main types of surrogacy are traditional surrogacy and gestational surrogacy, differentiated primarily by the surrogate's genetic connection to the child. In traditional surrogacy, also known as genetic or partial surrogacy, the surrogate provides her own ovum, which is fertilized via artificial insemination with sperm from the intended father or a donor, making her the biological mother.^[1]^[8] This method, less common today due to emotional and legal complexities arising from the genetic link, was more prevalent before advancements in in vitro fertilization (IVF).^[9] Gestational surrogacy, the predominant form since the 1980s, involves implanting an embryo created through IVF—using gametes from the intended parents or donors—into the surrogate's uterus, ensuring no genetic relation between her and the child.^[10]^[9] The American Society for Reproductive Medicine defines a gestational carrier as an individual who gestates without contributing gametes, emphasizing the separation of gestation from genetic parenthood.^[7] This type allows for greater flexibility, such as using donor eggs or embryos from prior IVF cycles, but requires precise medical screening and legal contracts to establish parentage.^[8] Additionally, surrogacy arrangements may be classified as altruistic, where the surrogate receives only reimbursement for medical and related expenses, or compensated, involving payment for her services beyond costs, though the latter faces varying legal restrictions globally.^[11]

Historical origins and evolution

The earliest recorded instances of surrogacy-like arrangements date to approximately 2000 BC in the Hebrew Bible's Book of Genesis, where Sarah, unable to bear children, arranged for her servant Hagar to conceive with Abraham, resulting in the birth of Ishmael; this traditional surrogacy involved the surrogate providing both egg and gestation.^[12] Similar practices appear in Babylonian law codes, which permitted surrogacy to avoid divorce for infertility, as evidenced by cuneiform texts allowing a husband to designate a surrogate if his wife could not conceive.^[13] In ancient Greece, infertile couples reportedly enlisted female relatives, such as sisters, to act as surrogates, with the resulting child raised by the commissioning parents, though documentation remains limited to mythological and anecdotal accounts rather than widespread legal codification. References to surrogacy also exist in other ancient cultures, including Mesopotamian customs where surrogates were integrated into family structures to ensure lineage continuity, and Hindu mythology, such as the case of Balarama, born to surrogate Rohini but attributed to Devaki's lineage.^[14]^[1] These early practices were invariably traditional surrogacy, entailing a genetic connection between the surrogate and child via artificial insemination or natural means, driven by social imperatives for heirs rather than medical infertility treatments; empirical evidence is sparse, relying on religious texts and archaeological inscriptions rather than systematic records. Historical gaps persist from antiquity through the medieval and early modern periods, with few documented cases, likely due to religious prohibitions—such as Catholic doctrine viewing surrogacy as adulterous—and societal emphasis on natural procreation within marriage. Modern surrogacy emerged in the mid-20th century amid advances in reproductive medicine, with the first formal U.S. surrogacy contract drafted in 1976 by attorney Noel Keane, facilitating traditional surrogacy via artificial insemination without initial compensation mandates.^[15] The 1978 birth of Louise Brown, the world's first IVF baby in the UK, laid groundwork for gestational surrogacy by decoupling gestation from genetic origins, enabling embryos from intended parents to be implanted in a surrogate.^[1] By 1980, the first compensated traditional surrogacy occurred in the U.S., with surrogate Elizabeth Kane receiving $10,000, marking a shift toward commercial arrangements.^[16] The pivotal 1985 U.S. case of the first successful gestational surrogacy involved a surrogate carrying an embryo from unrelated donors, eliminating the surrogate's genetic tie and reducing legal disputes over parentage.^[17] This evolution accelerated in the 1980s with cases like Baby M (1986), where traditional surrogate Mary Beth Whitehead refused to relinquish the child, prompting U.S. courts to scrutinize contracts and affirm intended parents' rights in some jurisdictions while highlighting risks of emotional attachment in traditional models.^[15] Subsequent refinements, including preimplantation genetic testing and international commercialization, have favored gestational over traditional surrogacy, with global procedures rising from isolated events to thousands annually by the 2000s, supported by fertility clinic data showing improved success rates via IVF protocols.^[1]

Legal status and regulation

The legal status of surrogacy varies significantly across jurisdictions, with no uniform international framework governing the practice. In many countries, surrogacy is either prohibited outright or restricted to altruistic arrangements where the surrogate receives no compensation beyond reasonable expenses, reflecting concerns over the potential commodification of human reproduction and exploitation of vulnerable women. Commercial surrogacy, involving payments for the gestational service, is permitted in a smaller number of locations, often with stringent regulatory oversight on contracts, medical procedures, and parental rights transfer.^[18]^[19] In Europe, surrogacy is banned in several nations, including France, Germany, Italy, and Spain, where legislation deems it contrary to principles of human dignity and the indivisibility of motherhood. These prohibitions extend to both traditional (genetically related) and gestational surrogacy, with penalties for facilitation or advertisement; for instance, Italy enacted a law in October 2024 criminalizing travel abroad for surrogacy purposes, imposing fines up to €1 million and potential imprisonment. Altruistic surrogacy is allowed under regulated conditions in countries like the United Kingdom, where the Human Fertilisation and Embryology Act 2008 permits non-commercial arrangements but voids paid contracts and requires independent legal advice for all parties. Greece legalized gestational surrogacy for heterosexual couples in 2002, expanding access in 2023 to include single women and same-sex couples under judicial oversight, though commercial elements remain prohibited.^[20]^[19]^[21] In the United States, surrogacy lacks federal regulation, resulting in state-level disparities; as of 2025, compensated gestational surrogacy is enforceable in states such as California, where Uniform Parentage Act precedents since the 1990s affirm intended parents' rights via pre-birth orders, and Illinois, under the Gestational Surrogacy Act of 2005 requiring court-approved contracts. Recent reforms have expanded access: Michigan's surrogacy ban, in place since 1988, was lifted with a new statute effective April 1, 2025, allowing enforceable agreements with medical and psychological screenings; Massachusetts followed suit via the Parentage Act effective January 1, 2025. Restrictions persist in Louisiana, where only altruistic surrogacy is viable for certain configurations due to prohibitions on compensated contracts, and Nebraska, which voids surrogacy agreements but permits parentage establishment post-birth. Regulations typically mandate written contracts detailing compensation (often $30,000–$50,000 plus expenses), independent counsel, and health clearances to mitigate disputes over custody or enforcement.^[22]^[23]^[24] Elsewhere, commercial surrogacy thrives in select jurisdictions appealing to international intended parents, such as Ukraine (legal since 2002 for non-residents, with automatic parental rights transfer) and Georgia (permitted since 1997, though recent 2024 proposals seek tighter foreign access controls amid exploitation concerns). In Asia, Iran uniquely allows both altruistic and commercial surrogacy under Shia Islamic jurisprudence since 2004, framing it as a charitable act with court oversight. Bans prevail in China (prohibited since 2001 to preserve traditional family structures) and India (commercial surrogacy outlawed for foreigners since 2015, with the 2021 Surrogacy Act limiting it to altruistic domestic arrangements). Cross-border surrogacy faces additional hurdles, including citizenship recognition denials and Hague Convention gaps, prompting calls for multilateral agreements to address parentage verification and prevent child statelessness.^[25]^[21]^[26]

Medical procedures and health outcomes

Gestational surrogacy, the primary method used in modern reproductive arrangements, entails the creation of embryos through in vitro fertilization (IVF) for transfer into the surrogate's uterus. The process commences with ovarian hyperstimulation of the intended mother or egg donor using gonadotropins to produce multiple oocytes, followed by transvaginal ultrasound-guided oocyte retrieval. Sperm from the intended father or donor is then used to fertilize the oocytes via intracytoplasmic sperm injection or standard insemination, yielding embryos that may undergo preimplantation genetic testing before cryopreservation or immediate use.^[2] The surrogate, screened for medical fitness including prior uncomplicated pregnancies and absence of uterine anomalies, receives estrogen and progesterone supplementation to prepare the endometrium, typically for 2-4 weeks, mimicking a natural cycle. Embryo transfer occurs via a transcervical catheter under abdominal ultrasound, often with a single embryo to minimize multiples, confirming implantation through serum beta-hCG levels 10-14 days later. Subsequent prenatal care mirrors protocols for IVF pregnancies, with heightened monitoring for complications due to assisted reproductive technology (ART).^[2] Obstetric outcomes for gestational carriers align closely with autologous IVF pregnancies rather than natural conceptions, reflecting shared ART factors like embryo quality and maternal age disparities. Meta-analysis of over 28,000 carrier pregnancies indicates no significant differences in preterm birth (adjusted odds ratio [aOR] 0.82, 95% CI 0.68-1.00) or low birth weight (aOR 0.79, 95% CI 0.50-1.26) compared to IVF controls, though preeclampsia risk is elevated versus general populations (aOR 1.44, 95% CI 1.13-1.84). Hypertensive disorders occur in 3.2-10% of carriers per case series, with additional reports of postpartum hemorrhage and gestational diabetes exceeding natural pregnancy rates but comparable to ART baselines.^[27]^[28]^[29] Perinatal outcomes for children born via surrogacy show no substantial deviations from IVF norms, encompassing modestly higher preterm delivery and low birth weight risks attributable to ART rather than surrogacy-specific factors. Systematic reviews find carrier pregnancies yield live birth rates akin to IVF (up to 60% per cycle in screened cohorts), with rare severe morbidity and no excess congenital anomalies beyond genetic screening yields. Limitations in evidence include moderate study biases and underrepresentation of long-term data, underscoring needs for rigorous selection to mitigate ART-inherent risks like placental insufficiency.^[30]^[27] Gestational surrogates exhibit elevated risks of new-onset mental illness during and after pregnancy compared to women with unassisted conceptions, with incidence rates of 7.5 per 100 person-years versus 5.2, according to a 2025 population-based cohort study in Ontario, Canada, analyzing over 5,000 carriers.^[31] ^[32] Surrogates also report higher depression levels during pregnancy and lower prenatal emotional bonding to the fetus, though many experience relief and positive closure post-delivery.^[33] Longitudinal data from the UK indicate sustained psychological well-being among surrogates 10 years post-birth, with most viewing the experience positively and minimal regret.^[34] However, these findings contrast with earlier assumptions of inherent psychological vulnerability, highlighting the need for rigorous screening and support to mitigate transient distress from separation.^[35] Intended parents often navigate anxiety, guilt, and grief over not gestating the child themselves, compounded by uncertainties in medical and legal processes.^[36] Post-birth, they typically report high satisfaction and strong parent-child bonds, with surrogacy families showing comparable adjustment to those formed via other assisted reproduction.^[37] ^[38] Relationships between intended parents and surrogates are frequently positive and ongoing, with 56% of UK surrogacy families maintaining contact in the year following birth, fostering extended family-like networks in some cases.^[38] ^[34] Children born via surrogacy demonstrate psychological outcomes akin to peers from natural or other assisted conceptions, particularly when informed of their origins early, as evidenced by longitudinal studies up to age 14 showing no deficits in adjustment or family functioning.^[39] ^[40] Yet, long-term data remain limited, with scant research on adults raised through surrogacy and potential identity challenges from genetic disconnection or donor origins.^[41] ^[42] Socially, surrogacy families face variable public attitudes influenced by demographics, with opposition higher among those prioritizing traditional family structures, though empirical evidence links open disclosure and stable parenting to resilient child development.^[43] In commercial contexts, especially in developing nations, surrogacy can exacerbate socioeconomic disparities, though self-reports from surrogates indicate high personal wellbeing post-experience.^[6] ^[44]

Ethical controversies and viewpoints

Surrogacy arrangements, particularly commercial ones, have sparked debates over the potential exploitation of gestational carriers, many of whom come from economically disadvantaged backgrounds. Critics argue that financial incentives coerce vulnerable women into bearing children for others, treating their bodies as commodifiable resources akin to labor rental, with documented cases in countries like India—once a surrogacy hub—revealing inadequate protections, poor living conditions during pregnancy, and power imbalances favoring intended parents and agencies.^[45] ^[5] Empirical evidence from global practices shows higher risks of mistreatment in cross-border commercial surrogacy, where carriers in low-income nations serve wealthier clients from permissive jurisdictions, exacerbating inequalities without robust oversight.^[3] ^[6] Consent in surrogacy raises further ethical concerns, as true voluntariness is questioned when poverty drives participation; studies indicate that while surrogates may report satisfaction post-delivery, pre-contract pressures and limited alternatives undermine informed autonomy, especially in unregulated markets.^[4] Altruistic surrogacy, involving no payment beyond expenses, is viewed by some ethicists as less prone to exploitation, yet even here, relational dynamics—such as family or friendship ties—can blur boundaries and impose emotional burdens.^[46] Proponents counter that surrogacy empowers women through reproductive choice and aids infertile couples, aligning with bodily autonomy principles, but detractors, including bioethicists, contend this overlooks systemic vulnerabilities and the inherent asymmetry in contracts that sever maternal bonds.^[47] ^[48] From a child's rights perspective, surrogacy commodifies offspring by prioritizing intended parents' desires over the newborn's interests, potentially denying knowledge of genetic origins and risking identity fragmentation; international frameworks like the UN Convention on the Rights of the Child emphasize parentage clarity, yet surrogacy often obscures this, with evidence of statelessness or custody disputes in cross-border cases.^[49] ^[50] Ethicists highlight that commissioning children treats them as products, contravening principles against child trafficking analogs, and longitudinal data on surrogacy-born children is sparse but suggests psychological challenges from non-traditional parentage.^[51] ^[52] Feminist viewpoints diverge sharply: radical and Marxist feminists decry surrogacy as patriarchal exploitation that reinforces women's reproductive subordination and class divides, viewing paid gestation as womb rental that devalues female labor.^[53] ^[54] Liberal feminists, conversely, defend it as an exercise of agency, enabling economic independence and challenging pronatalist norms, though critiques note that such autonomy claims often ignore coercive contexts in global south practices.^[55] ^[56] Religious perspectives vary: Christianity, particularly evangelical strains, frequently opposes surrogacy for disrupting natural procreation, likening it to adultery or slavery through contractual separation of conception and gestation.^[57] ^[58] Judaism and Hinduism generally permit it to alleviate infertility, provided no harm occurs, emphasizing family continuity over strict biological ties.^[59] Catholicism rejects third-party involvement outright, prioritizing the unity of marital reproduction and human dignity.^[60] Overall, these controversies underscore calls for international regulation to mitigate harms, though enforcement remains elusive amid differing national stances.^[61]

Economic markets and incentives

The global surrogacy market, encompassing commercial and altruistic arrangements, was valued at approximately USD 22.4 billion in 2024 and is projected to reach USD 27.9 billion in 2025, driven by rising infertility rates, delayed childbearing, and demand from same-sex couples and single parents.^[62] Growth projections vary, with estimates reaching USD 195-200 billion by 2034, reflecting expanding access in permissive jurisdictions and technological advancements in assisted reproduction.^[63] These figures include agency fees, medical procedures, legal services, and surrogate compensation, though data from market research firms may overestimate due to inclusion of ancillary services and unverified international transactions.^[64] In the United States, where commercial surrogacy is permitted in most states, total costs for intended parents typically range from USD 100,000 to USD 200,000 per surrogacy cycle as of 2025, varying by location, surrogate experience, and complications such as multiple births or cesareans.^[65] Breakdowns include surrogate base compensation of USD 40,000 to USD 70,000 for first-time gestational carriers, rising to USD 60,000 to USD 90,000 for experienced ones, plus additional reimbursements for maternity clothing (USD 500-1,000 monthly), lost wages, and medical expenses.^[66] ^[67] Agency matching fees account for USD 15,000 to USD 30,000, legal contracts USD 5,000 to USD 15,000, and IVF/embryo transfer USD 20,000 to USD 40,000, creating high barriers to entry that favor affluent clients and concentrate supply among agencies in states like California and Texas.^[68] Economic incentives for surrogates primarily involve financial compensation supplementing prosocial motivations, with studies of U.S. and international gestational carriers indicating medium socioeconomic status and above-average household incomes among participants, where payments enable debt reduction, home improvements, or family support without constituting the sole driver.^[44] In commercial markets, higher payments correlate with greater supply: first-time surrogates earn total packages of USD 55,000 to USD 90,000, incentivizing repeat participation as experienced carriers command premiums up to USD 110,000.^[67] However, non-contractible efforts like prenatal care investments may underperform due to incomplete enforceability, as economic models predict underinvestment by surrogates when outcomes depend on unobservable actions.^[69] Regulatory environments shape market dynamics: permissive commercial systems in the U.S., Georgia, Colombia, and Mexico foster industries with surrogate payments of USD 20,000 to USD 50,000, attracting cross-border demand and boosting local economies through medical tourism, whereas bans in countries like India (since 2022) and much of Europe shift activity to gray markets or emigration, inflating costs by 20-50% for international arrangements and risking exploitation via unregulated brokers.^[70] ^[71] Prohibitions on payments in altruistic-only regimes, such as the UK and Canada, limit supply to volunteers, resulting in waitlists exceeding two years and effective rationing that disadvantages lower-income intended parents, while commercial legalization correlates with 10-20% annual market expansion by aligning incentives with demand.^[3] These disparities highlight how legal restrictions create arbitrage opportunities, with wealthier clients traveling to low-regulation destinations for surrogates earning USD 10,000-30,000, often from economically vulnerable populations.^[72]

Political surrogates

Definition and functions

A political surrogate is an individual who acts as a stand-in for a candidate or elected official by publicly advocating their positions, policies, or candidacy, often through speeches, media appearances, or events.^[73]^[74] This role leverages the surrogate's credibility, fame, or expertise to extend the principal's reach without the candidate's direct involvement, functioning as a deputy in persuasive communication.^[75] Surrogates are distinct from official campaign staff, as they typically operate independently or semi-independently, drawing on personal networks or public profiles to amplify messages.^[76] Key functions include promoting the candidate's agenda to targeted demographics or regions the principal cannot personally access, such as during multi-state tours where time constraints limit direct participation.^[77] Surrogates defend against criticisms by countering opponents' narratives, providing rebuttals that maintain the candidate's focus on positive messaging.^[73] They also mobilize voter turnout by endorsing the candidate at rallies or fundraisers, leveraging endorsements from celebrities, former officials, or influencers to signal broad support and influence undecided voters.^[76]^[78] In practice, surrogates enable strategic delegation: for instance, high-profile figures like former presidents or billionaires can draw crowds and media attention in battleground states, as seen in the 2024 U.S. presidential race where both major campaigns deployed them in Pennsylvania to reinforce local messaging.^[78] This approach mitigates risks, allowing controversial statements to be attributed to the surrogate rather than the candidate, while testing policy emphases through observed audience reactions.^[76] Overall, surrogates enhance campaign efficiency by distributing advocacy labor, particularly in resource-intensive elections where direct candidate exposure must be rationed.^[79]

Historical and contemporary examples

In the nineteenth century, U.S. presidential candidates often avoided personal campaigning to preserve the perceived dignity of the office, relying instead on party surrogates—such as allies, newspaper editors, and local leaders—to mobilize voters through rallies, pamphlets, and public debates. During the 1840 election, Whig surrogates transformed William Henry Harrison's image into that of a humble log-cabin hero via widespread torchlight parades, songs like "Tippecanoe and Tyler Too," and grassroots events organized by figures including Daniel Webster, contrasting him with incumbent Martin Van Buren's supposed elitism. In Abraham Lincoln's 1860 campaign, surrogates like Republican Party operatives and orators such as William Seward conducted extensive tours in Northern states, distributing biographies and speeches to counter Democratic attacks without Lincoln himself stumping, as he remained in Springfield, Illinois.^[80] By the early twentieth century, as candidates like William Jennings Bryan began personal whistle-stop tours in 1896, surrogates evolved to include family members and prominent endorsers handling targeted outreach. In the 2004 election, spouses served as strategic surrogates: Teresa Heinz Kerry appeared at 37 events for John Kerry, focusing on women's issues in battleground states, while Laura Bush conducted 52 appearances for George W. Bush, emphasizing family values and security to complement her husband's schedule.^[81] Contemporary examples highlight surrogates' role in reaching niche audiences amid packed candidate schedules and media fragmentation. In the 2016 U.S. presidential race, Hillary Clinton deployed celebrity surrogates including Beyoncé, who performed at a Cleveland rally on November 4 drawing over 13,000 attendees to boost turnout among young and minority voters, alongside political figures like Bill Clinton for 100+ events in Rust Belt states.^[82] Donald Trump's surrogates included Ben Carson, whose appearances aimed to soften the candidate's image among moderates but occasionally backfired, such as Carson's March 2016 claim likening Trump critics to child abusers, prompting disavowals.^[83] In the 2024 cycle, Kamala Harris's campaign utilized high-profile surrogates like Barack Obama, who joined her at multiple swing-state events including a November 3 rally in Madison, Wisconsin, to energize Democratic bases, and Bill Clinton, who stumped in battlegrounds to appeal to working-class voters.^[84] Trump's team countered with Elon Musk, who hosted town halls and donated over $75 million to pro-Trump PACs by October 2024 to target tech-savvy and libertarian-leaning demographics, and Tulsi Gabbard, who campaigned in Native American communities alongside Sen. Markwayne Mullin to court non-traditional Republican voters.^[85]^[86] These deployments underscore surrogates' utility in amplifying messages while allowing candidates to focus on core constituencies, though risks of off-script remarks persist across eras.^[76]

Strategic uses in campaigns

Political campaigns deploy surrogates to extend geographic reach and logistical capacity, allowing candidates to focus on high-priority events while surrogates address secondary markets or demographics. For instance, in the 2024 U.S. presidential election, Vice President Kamala Harris's campaign utilized surrogates like former President Barack Obama and former Representative Liz Cheney to target undecided voters in swing states such as Pennsylvania, compensating for the candidate's limited schedule.^[87] Similarly, former President Donald Trump's team employed high-profile figures to appeal to women voters, softening his image amid criticisms on related issues.^[88] Surrogates enable targeted messaging to niche voter groups, leveraging their personal credibility or shared identities to convey authenticity that candidates may lack. Spousal surrogates, in particular, have been strategically scheduled in competitive states where the candidate underperforms; analysis of the 2004 election showed presidential and vice-presidential candidates' wives appearing more frequently in battleground areas to bolster turnout among women and families.^[81] Celebrity or partisan surrogates amplify visibility and enthusiasm, as seen when Harris featured performers like Usher in Georgia to energize youth and minority bases, though empirical studies indicate such endorsements yield modest vote shifts, often confined to low-information voters.^[89] In constrained scenarios, surrogates serve as proxies for delivering attacks or defenses, preserving the candidate's resources. During Trump's 2023 legal proceedings, allies like Republican senators conducted rallies in his stead, framing narratives around judicial bias to maintain momentum without direct candidate involvement.^[90] Campaigns also use surrogates to test policy phrasing or counter opponents indirectly; in 2016, former President Bill Clinton's 69 visits to Rust Belt states aimed to reinforce Hillary Clinton's economic appeals, though post-election analyses attributed limited causal impact to these efforts amid broader turnout failures.^[91] Overall, surrogate strategies prioritize efficiency over direct persuasion, with data from multiple cycles showing they correlate with higher event density but not guaranteed electoral gains, as gaffes by surrogates can backfire and alienate moderates.^[76]

Scientific and technical surrogates

Surrogate models in computation

Surrogate models in computation refer to simplified mathematical approximations constructed to emulate the input-output behavior of complex, computationally intensive simulations or physical processes, enabling faster evaluations during optimization, uncertainty analysis, or design exploration. These models are built from a limited set of high-fidelity simulation data points, reducing the need for repeated expensive computations while preserving essential system dynamics. The approach addresses scenarios where direct modeling is prohibitive due to high-dimensionality, nonlinearity, or resource demands, as seen in fields like engineering design and scientific computing.^[92]^[93] Common techniques for constructing surrogate models include Gaussian process regression (Kriging), which provides probabilistic predictions with uncertainty estimates suitable for sparse data; radial basis function networks, effective for interpolation in multidimensional spaces; and polynomial response surfaces, which offer interpretable low-order approximations for smoother functions. More advanced methods incorporate machine learning, such as neural networks or support vector regression, to handle nonlinearities and larger datasets, though they require careful validation to avoid overfitting. Selection of a technique depends on data availability, dimensionality, and required fidelity, with hybrid approaches often combining statistical and physics-informed elements for improved accuracy.^[94]^[95]^[96] In computational applications, surrogate models facilitate global optimization by replacing objective function evaluations in algorithms like genetic or Bayesian methods, accelerating convergence in problems such as aerodynamic shape design or material parameter tuning. They are also integral to uncertainty quantification, where Monte Carlo sampling on surrogates estimates variability in system responses without exhaustive simulations. For instance, in groundwater flow modeling, surrogates emulate finite element solvers to support real-time decision-making under hydrological uncertainties. Limitations include potential loss of fine-scale details if training data is insufficient, necessitating adaptive sampling strategies like sequential design to refine approximations iteratively. Empirical validation against full models is essential, as surrogate error can propagate in downstream analyses.^[97]^[96]^[98]

Surrogate endpoints in research

Surrogate endpoints, also known as surrogate markers, refer to measurable biomarkers or intermediate clinical outcomes that are used in clinical trials as proxies for definitive clinical endpoints, such as patient survival, symptom relief, or functional improvement.^[99] These endpoints are intended to predict the therapeutic effect on the true clinical outcome, enabling inferences about efficacy without awaiting long-term data.^[100] For instance, in cardiovascular trials, reductions in low-density lipoprotein cholesterol levels have been employed as surrogates for decreased risk of coronary heart disease events.^[100] The primary rationale for adopting surrogate endpoints lies in their potential to expedite drug development and regulatory approval, particularly for conditions with high unmet needs. Trials relying on surrogates can be shorter in duration, smaller in sample size, and less costly than those measuring direct clinical benefits, which often require years to observe rare events like mortality.^[101] The U.S. Food and Drug Administration (FDA) has leveraged this approach through mechanisms like accelerated approval, granting provisional licensure based on surrogates deemed "reasonably likely" to predict clinical benefit, as seen in approvals for oncology drugs using progression-free survival (PFS) in lieu of overall survival (OS).^[102] By July 2025, the FDA's table documented numerous such cases, including antivirals for HIV where viral load suppression served as a surrogate for immune recovery and survival.^[102] This framework facilitates faster access to potentially life-saving therapies, as evidenced by the approval of drugs for rare diseases or pandemics where traditional endpoints would delay intervention unacceptably.^[103] Validation of surrogate endpoints demands rigorous statistical and causal assessment to ensure they reliably reflect the intervention's effect on the true endpoint, rather than mere correlation. Frameworks rooted in causal inference, such as principal stratification or trial-level meta-analyses, evaluate whether the surrogate captures the full causal pathway, accounting for potential confounders like off-target effects.^[104] For example, Prentice's criteria require that the surrogate fully mediates the treatment effect and is unaffected by non-causal factors.^[105] Peer-reviewed evaluations, including those using failure-time models, have confirmed surrogates like CD4 cell count increases in HIV trials as valid predictors of survival benefits from antiretrovirals.^[106] Conversely, incomplete validation risks misleading conclusions; causal realism underscores that surrogates must mechanistically link to the outcome via first-principles biological pathways, not just empirical associations.^[105] Despite these benefits, surrogate endpoints carry inherent limitations and have led to notable failures, highlighting the need for empirical scrutiny over optimistic assumptions. In some instances, improvements in surrogates fail to translate to clinical gains, as observed in oncology trials where PFS advancements did not consistently reduce mortality, potentially due to subsequent treatment crossovers or toxicity masking effects.^[107] Historical examples include anti-arrhythmic drugs like flecainide, which lowered arrhythmia surrogates but increased overall mortality in the 1989 Cardiac Arrhythmia Suppression Trial, demonstrating how surrogates may overlook adverse causal pathways.^[108] Similarly, in heart failure studies, surrogates such as ejection fraction improvements have underperformed in predicting hospitalization or death rates.^[108] Regulatory bodies like the FDA mandate post-approval confirmatory trials to verify surrogates, yet delays or failures in these validations—such as withdrawals of drugs approved on unconfirmed surrogates—underscore systemic risks of premature reliance.^[101] Meta-analyses of randomized trials reveal that only a subset of proposed surrogates, around 50-70% in validated cases like colorectal cancer OS surrogates, achieve reliable predictive power, emphasizing the imperative for trial-specific validation over generalized acceptance.^[103]^[107]

Applications in engineering and AI

Surrogate models in engineering approximate computationally intensive simulations, such as finite element analysis or computational fluid dynamics, to support design optimization, reliability assessment, and uncertainty propagation. Techniques like Kriging (Gaussian process regression), radial basis functions, and neural networks construct these approximations from limited high-fidelity data points, reducing evaluation costs from potentially millions of CPU hours to seconds per query. In structural engineering, data-driven surrogates enable structural health monitoring by predicting anomalies and optimizing maintenance strategies based on sensor data, as demonstrated in applications for bridge and building integrity assessments.^[109] In aerospace, surrogate models facilitate multidisciplinary design optimization by emulating aerodynamic and thermal responses, allowing engineers to iterate rapidly on configurations like wing shapes or rocket nozzles without exhaustive simulations.^[110] In AI and machine learning, surrogate models primarily address interpretability challenges in black-box systems by training transparent approximations—such as linear regressions, decision trees, or rule-based models—to replicate the input-output behavior of opaque neural networks or ensemble methods. Global surrogates provide overarching explanations of model logic across the feature space, revealing patterns like feature interactions or decision thresholds, while local surrogates, as in the Local Interpretable Model-agnostic Explanations (LIME) framework introduced in 2016, generate instance-specific approximations to highlight influential variables for individual predictions.^[111]^[112] These approaches maintain high fidelity to the original model, with metrics like mean absolute error often below 5% in benchmark tests on datasets such as UCI repositories, though they trade off some predictive accuracy for human-readable insights. Surrogates also integrate AI techniques to enhance engineering simulations, using physics-informed machine learning to create hybrid models that embed domain constraints into neural approximations for faster forward predictions in tasks like material microstructure analysis or process optimization. For example, convolutional neural network-based surrogates have accelerated property predictions in manufacturing by orders of magnitude compared to traditional solvers, enabling real-time control in additive manufacturing processes. In black-box optimization within AI pipelines, such as hyperparameter tuning for deep learning models, evolutionary algorithms augmented with surrogates minimize expensive fitness evaluations, converging solutions in fewer iterations—typically 10-50% reductions in standard test functions like those from the BBOB suite.^[113]^[114] This synergy underscores surrogates' role in scaling AI-assisted engineering, though accuracy depends on training data quality and model mismatch risks persist without validation against physical experiments.^[115]

Legal and administrative surrogates

Role in probate and estates

In jurisdictions such as New York and New Jersey, a surrogate serves as the elected judicial officer presiding over the Surrogate's Court, a specialized tribunal dedicated to matters involving decedents' estates, including probate proceedings.^[116]^[117] The term "surrogate" derives from its etymological root meaning "substitute," reflecting the officer's role in acting on behalf of the deceased to ensure orderly estate resolution.^[117] This court maintains exclusive original jurisdiction over the probate of wills, the administration of estates, and related actions such as guardianships for minors or incapacitated individuals who stand to inherit.^[116]^[118] The surrogate's core duties in probate encompass validating and admitting wills to probate, appointing qualified executors for testate estates or administrators for intestate ones, and issuing letters testamentary or of administration to authorize asset management.^[119]^[120] During estate administration, the surrogate oversees the inventory of assets, payment of debts and taxes, distribution to heirs or beneficiaries, and resolution of any contests or disputes over will validity, such as claims of undue influence or forgery.^[116]^[121] For estates involving minors, the surrogate appoints guardians to manage inheritances, supervises trust funds, and ensures compliance with fiduciary standards until beneficiaries reach majority.^[120]^[122] In New Jersey counties, surrogates additionally function as deputy clerks of the Superior Court, Chancery Division, Probate Part, handling filings for adoptions and maintaining archival records of probated estates dating back centuries.^[123]^[118] Surrogates exercise discretionary authority in approving estate accounts and settlements, often requiring court orders for asset sales or creditor claims to prevent mismanagement.^[119] While primarily administrative, surrogates adjudicate contested matters, such as will interpretations or heirship determinations, with appeals possible to higher courts.^[117] This specialized role streamlines probate efficiency compared to general civil courts, though procedural requirements—such as filing deadlines and bond postings—vary by jurisdiction; for instance, New York mandates probate petitions within prescribed timelines under Surrogate's Court Procedure Act provisions.^[116] Outside New York and New Jersey, equivalent functions fall under probate courts or divisions, without the "surrogate" designation.^[124]

Substitutes in decision-making authority

In legal and administrative contexts, a surrogate decision-maker serves as a substitute authorized to exercise decision-making authority on behalf of an individual lacking capacity, typically in areas such as healthcare, finances, or personal welfare.^[125]^[126] This role arises when the principal cannot consent due to incapacity, such as from coma, dementia, or minority status, and is distinct from full guardianship, which may involve court oversight for broader estate management.^[127] Authority is limited to specified domains and must align with statutory or directive guidelines to prevent abuse.^[128] Designation of surrogates occurs through explicit mechanisms or defaults. Individuals can nominate a healthcare proxy via advance directives, such as a durable power of attorney for health care, which empowers the surrogate to consent to or refuse treatments like surgery or life-sustaining measures once incapacity is documented by physicians.^[129] Absent such designation, most U.S. states apply a statutory hierarchy for default surrogates, prioritizing spouses, adult children (often by majority agreement), parents, siblings, or close friends, with provisions for judicial intervention if disputes arise.^[130]^[131] For non-medical decisions, such as financial administration, court-appointed conservators or guardians ad litem fill similar roles under probate codes, requiring periodic reporting to ensure fiduciary duty.^[132] Decisions by surrogates follow ethical and legal principles prioritizing patient autonomy. The substituted judgment standard requires surrogates to infer and apply the principal's known values or prior wishes, drawing from conversations, writings, or observed preferences, over a pure best-interests analysis focused on objective medical benefits like prolonged life expectancy.^[133]^[129] If prior wishes are unknowable, best interests prevail, weighing factors like pain relief, quality of life, and treatment burdens, though empirical studies indicate surrogates often deviate toward overtreatment due to emotional bias or incomplete knowledge.^[134]^[135] Courts may override surrogates in cases of clear malfeasance, as seen in statutes mandating good-faith actions and liability for willful neglect.^[136] Jurisdictional variations underscore the framework's adaptability but also its inconsistencies. All 50 U.S. states recognize surrogate authority for healthcare via statute or common law, with 44 explicitly codifying default hierarchies as of 2014, though updates like expanded roles for domestic partners reflect evolving family structures.^[130] In probate and estates, surrogates such as executors derive authority from wills or intestacy laws to manage assets, but decision-making substitutes extend to incapacitated beneficiaries via guardianship proceedings under uniform acts adopted variably.^[137] Internationally, similar constructs exist, such as the UK's Mental Capacity Act 2005, which emphasizes least restrictive interventions, but U.S. models prioritize familial surrogacy to minimize state intervention.^[133] Empirical data from bioethics research highlights risks, including surrogate disagreement rates up to 20% in end-of-life scenarios, prompting calls for clearer directives to reduce litigation.^[138]

Surrogates in arts, culture, and economics

Representations in literature and media

In literature, the concept of surrogacy—particularly gestational surrogacy—has been portrayed as a site of exploitation and loss of agency. Margaret Atwood's 1985 novel The Handmaid's Tale depicts a totalitarian regime in which fertile women, termed Handmaids, are compelled to serve as surrogates for infertile elite couples through ritualized insemination and gestation, underscoring themes of coerced reproduction and subjugation of women's bodies.^[139] This narrative draws parallels to debates on commercial surrogacy, though Atwood has clarified it critiques state-enforced breeding rather than consensual arrangements.^[140] Film representations often extend surrogacy to technological proxies, as in the 2009 science fiction thriller Surrogates, directed by Jonathan Mostow and based on Robert Venditti's graphic novel. In this scenario, most humans operate lifelike robotic surrogates remotely to conduct daily life, avoiding physical risks and vulnerabilities; the plot centers on an FBI investigation into a device that kills operators by destroying their surrogates, exposing societal detachment and the illusion of perfect avatars.^[141] The film critiques overreliance on such intermediaries, portraying a world where authentic human interaction erodes amid virtual enhancements.^[142] Reproductive surrogacy features in both comedic and dramatic cinema, frequently highlighting contractual tensions and emotional bonds. The 2008 comedy Baby Mama follows a career-driven executive (Tina Fey) hiring a working-class surrogate (Amy Poehler), blending humor with explorations of class differences, unexpected attachments, and legal ambiguities in surrogacy agreements.^[143] In Indian cinema, films like Chori Chori Chupke Chupke (2001) depict commercial surrogacy amid societal stigma, portraying surrogates as economically desperate women navigating exploitation in underground arrangements.^[144] Academic analyses identify a "surrogacy thriller" subgenre in recent films, where commercial practices amplify ethical dilemmas like commodification, often reflecting feminist concerns over women's reproductive labor.^[145] Broader surrogate motifs appear as narrative devices, such as author surrogates—fictional characters embodying the writer's views or experiences to convey philosophical or social commentary. For instance, in Philip K. Dick's works like Do Androids Dream of Electric Sheep? (1968), protagonists serve as proxies for exploring human authenticity amid artificial substitutes, influencing adaptations like Blade Runner (1982). These depictions, while speculative, mirror real-world anxieties about delegation and substitution in human relations.^[146]

Surrogate goods and substitution theory

In economics, surrogate goods, also termed substitute goods, refer to products or services that can interchangeably satisfy similar consumer needs, allowing buyers to replace one with another when relative prices or preferences shift.^[147] Examples include butter and margarine, where a rise in butter's price prompts increased margarine demand, or tea and coffee as alternatives for hot beverages.^[147] This substitutability underpins market competition, as cross-price elasticity—measuring demand response to a rival's price change—quantifies the degree; positive values indicate substitutes, with higher elasticities signaling stronger surrogacy.^[148] Substitution theory, a core element of consumer demand analysis, decomposes price-induced consumption changes into substitution and income effects, as formalized by Eugene Slutsky in 1915 and John Hicks in 1939.^[149] The substitution effect isolates the impact of a relative price alteration while holding real purchasing power (utility) constant: when a good's price rises, consumers shift toward cheaper surrogates, reducing quantity demanded of the pricier item along the indifference curve.^[150] For instance, a 10% gasoline price increase might boost public transit usage by 5-15% in urban areas, depending on local elasticities estimated from U.S. Department of Energy data spanning 2000-2020.^[149] This effect reinforces the law of demand, as empirical studies confirm consumers rationally reallocate budgets toward relatively affordable options, absent income adjustments.^[151] The elasticity of substitution extends this framework by measuring responsiveness: it equals the percentage change in factor (or good) ratios divided by the percentage change in their marginal rate of technical substitution (MRTS), often exceeding 1 for flexible markets like consumer electronics, where smartphones readily surrogate landlines.^[152] In production contexts, low elasticities (e.g., below 0.5 for energy in heavy industry, per 2010s OECD estimates) imply rigid input mixes, limiting surrogate viability. Critiques, such as those challenging macro-level applications in inequality models, highlight that assuming constant elasticities overlooks empirical variations; for example, Thomas Piketty's r > g thesis relies on elasticities around 1.5-2, but micro-data from firm-level studies suggest values closer to 0.7 in advanced economies, questioning causal claims of rising capital shares.^[153] Overall, substitution theory empirically drives policy, as seen in antitrust analyses where high surrogacy (e.g., generic drugs substituting brands post-2003 U.S. Medicare reforms) curbs monopolistic pricing.^[154]

Symbolic or metaphorical uses

In artistic practice, the concept of surrogacy manifests symbolically through objects or representations that stand in for absent originals, evoking themes of absence, replication, and commodification. Allan McCollum's Plaster Surrogates series, produced between 1982 and 1989, exemplifies this by featuring framed plaster casts mimicking the scale and format of paintings but lacking painted surfaces, thereby serving as metaphorical placeholders that critique the art market's emphasis on reproducibility over unique expression.^[155] Similarly, in self-portraiture, the artwork functions as a surrogate for the artist's physical presence, conveying symbolic insights into identity and persona, as explored in collections where etched or painted self-images negotiate the boundary between creator and representation.^[156] In theoretical discourse on aesthetics, surrogate metaphors arise when explanations of art substitute conceptual frameworks for direct experiential engagement, potentially distorting the immediacy of aesthetic response. Philosopher Arnold Berleant argues that such metaphorical theories act as surrogates, prioritizing ideational meaning—such as historical or interpretive content—over the raw sensory and participatory dimensions of art, thus illustrating how symbolic substitution can mediate but also obscure authentic perception.^[157] This extends to broader cultural practices, where digital surrogates in heritage visualization, such as 3D models of historical sites, symbolically replicate physical artifacts to foster public engagement, though they introduce aesthetic and political tensions regarding fidelity to the original.^[158] Metaphorically, surrogacy frames rhetorical and psychological constructs, as in empirical studies where linguistic metaphors like "mother for rent" evoke reactance against commercial surrogacy by symbolically reducing human gestation to transactional substitution, influencing attitudes toward ethical boundaries.^[159] In nonverbal communication, "surrogate language"—encompassing gestures, music, or signs—operates symbolically to convey meaning in place of verbal forms, enabling cross-sensory understanding, such as deaf individuals interpreting visual cues or blind persons decoding instrumental sounds in literary depictions.^[160] These uses underscore surrogacy's role as a versatile metaphor for mediation, where the substitute not only approximates but also amplifies underlying symbolic layers in human expression.

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Advances in surrogate based modeling, feasibility analysis, and ...
This paper reviews recent advances in the area of surrogate models for problems in modeling, feasibility analysis, and optimization.Review · Introduction · Surrogate Models
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A review of surrogate models and their application to groundwater ...
Jul 27, 2015 · Surrogate modeling aims to provide a simpler, and hence faster, model which emulates the specified output of a more complex model in function of ...
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[PDF] Surrogate-based Analysis and Optimization
The surrogates are constructed using data drawn from high-fidelity models, and provide fast approximations of the objectives and constraints at new design.
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Surrogate Endpoint Resources for Drug and Biologic Development
Jul 24, 2018 · A surrogate endpoint is a clinical trial endpoint used as a substitute for a direct measure of how a patient feels, functions, or survives.
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Biomarkers and Surrogate Endpoints In Clinical Trials - PMC - NIH
We discuss the definitions of clinically meaningful endpoints and surrogate endpoints, and provide examples from recent clinical trials.
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Validating Surrogate Endpoints to Support FDA Drug Approval
Jul 8, 2025 · In comparison to clinical outcomes, surrogate markers offer an advantage in reducing the duration, size, and total cost of trials. Surrogate ...
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Table of Surrogate Endpoints That Were the Basis of Drug Approval ...
Aug 29, 2025 · FDA's surrogate endpoint table provides valuable information for drug developers on endpoints that may be considered and discussed with FDA ...
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Definitions, acceptability, limitations, and guidance in the use and ...
Jun 26, 2023 · A surrogate end point does not measure the clinical benefit of primary interest in and of itself but rather is expected to predict that clinical ...
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Surrogate Endpoints in Clinical Trials - Annual Reviews
Mar 9, 2023 · I review this work, with a particular focus on approaches that use the causal inference paradigm, as these conceptualize a good marker as one in ...
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A causal framework for surrogate endpoints with semi-competing ...
In this article, we have proposed a simple causal framework for modelling the causal effect of the surrogate endpoint on the true endpoint. The initial goal of ...Missing: peer- reliability
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Statistical evaluation of surrogate endpoints with examples from ...
Feb 12, 2015 · Validation of surrogate endpoints in multiple randomized clinical trials with failure-time endpoints. Journal of the Royal Statistical ...
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Surrogate endpoints in oncology: when are they acceptable for ...
Jul 21, 2017 · It is often argued that treatments that fail to improve OS but do improve surrogate outcomes may still have meaningful clinical benefit, either ...
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The perils of surrogate endpoints - PMC - NIH
May 14, 2015 · ... failed to predict clinical outcome. Thus, although the ... surrogate in heart failure trials. Electrocardiogram. Findings on the ...
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Application of Data-Driven Surrogate Models in Structural Engineering
Jul 13, 2024 · The implementation of surrogate models in SHM systems enables the detection of anomalies, prediction of potential failures, and optimisation of ...
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From Surrogate Modelling to Aerospace Engineering: a NASA Case ...
Aug 15, 2024 · In this blogpost, I will give a general idea of surrogate models, from theory to code. Then, I will describe a specific NASA application of surrogate models.
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25 Surrogate Models – Interpretable Machine Learning
A global surrogate model is an interpretable model that is trained to approximate the predictions of a black box model.
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Interpreting Black-Box Models: A Review on Explainable Artificial ...
Aug 24, 2023 · It can be noted LIME generated surrogate models that have high local fidelity, meaning that they accurately represent the behavior of the black ...
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A generalised deep learning-based surrogate model for ... - Nature
Jun 5, 2023 · The use of surrogate models based on Convolutional Neural Networks (CNN) is increasing significantly in microstructure analysis and property ...
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Review of machine learning-based surrogate models of ...
Dec 1, 2023 · Machine learning-based surrogate models are an effective approach to enhance the efficiency of the numerical models, and have recently attracted ...
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[PDF] Surrogate-based methods for black-box optimization - LIX
The methods we will present are based on the construction of surrogate models to approximate black-box functions and using them to search for (global) optimal ...
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An Overview of Surrogate's Court | NYCOURTS.GOV
The Surrogate's Court in NY handles probate of wills, estate administration, guardianships, and other actions relating to decedents.
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Surrogate's Court | Hunterdon County, NJ
The Surrogate serves as Deputy Clerk of the Superior Court, Chancery Division, Probate Part as well as Judge of the Surrogate's Court. The word Surrogate means ...
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Functions of the Surrogate | Camden County, NJ
The Surrogate's Court maintains records and microfiche of all estates probated in Camden County and all Superior Court proceedings related to the office dating ...
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Surrogate | Somerset County
The Surrogate probates wills, qualifies executors, administrators, and trustees and issues necessary documents for administering estates.Case Information Forms · Probate Process · Welcome Message · E-Probate
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FAQs • What is a Surrogate? - Gloucester County
The Surrogate is responsible for probating Wills and other Estate Matters, supervising minors' trust funds, and serves as the clerk of the court for adoptions, ...
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What Is the Purpose and Function of a Surrogate's Court?
Feb 16, 2022 · The Surrogate's Court oversees probate, handles actions relating to a deceased's estate, and handles will disputes, estate administration, and ...
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About the Surrogate - Cumberland County, New Jersey (NJ)
Today, the Surrogate probates Wills, appoints Administrators, appoints Guardians for minors, handles applications for Adult Incapacitated Persons, ...
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Office of the Surrogate - Ocean County Government
The Surrogate serves as Clerk of the Superior Court, Chancery Division, Probate Part as well as Judge of the Surrogate's Court.
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General Information - Probate Law - Guides at Texas State Law Library
Oct 2, 2025 · Probate is the legal process to distribute a person's property after they die, with court approval, to validate the will, pay debts, and pass ...
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Surrogate Decision-Maker - an overview | ScienceDirect Topics
A surrogate decisions maker, also known as medical or healthcare proxies, is defined as a legally designated representative trusted with making medical ...
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When Can A Family Member Serve As A Surrogate Decision-Maker?
Oct 4, 2024 · A surrogate decision-maker is a person who is authorized to make healthcare decisions on behalf of another person who is unable to make his or her own ...What Is A Surrogate... · Understanding The Role Of A... · What Are The Legal...
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Default Surrogate Decision Making - Fundamentals - Merck Manuals
If a person is incapable of making a decision about CPR, an authorized surrogate may make the decision. A DNR order does not mean "do not treat." Rather, it ...
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Appendix III, Legal Authority to Make Decisions
A surrogate decision maker is authorized to consent to only medical treatment on behalf of the person. Enabling Statute Texas Health and Safety Code §313.002 ( ...
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AMA Code of Medical Ethics' Opinions on Patient Decision-Making ...
Surrogate decision makers should base their decisions on the substituted judgment standard; in other words, they should use their knowledge of the patient's ...Ama Code Of Medical Ethics'... · Decision-Making Capacity And... · More About Surrogate...<|separator|>
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An Overview of Surrogate Consent Laws in the United States
Oct 1, 2014 · Default surrogate consent statutes were enacted to provide legal authority for health care decision-making through a non-judicial rule of law ...
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Locating and Identifying Third-Party Decision-Makers
Mar 1, 2022 · Most states, with the exception of Colorado and Hawaii, impose a hierarchical order among potential surrogates. ... Legislatures have established ...
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[PDF] CHAPTER 3: TYPES OF SUBSTITUTE DECISION-MAKING
Types of substitute decision-makers include natural supports, parents of minors, guardians of the person, guardians of the estate, and representative payees.
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Substituted Judgment: The Limitations of Autonomy in Surrogate ...
Substituted judgment is often invoked as a guide for decision making when a patient lacks decision making capacity and has no advance directive.
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The ethics of surrogate decision making - PMC - NIH
Surrogate decisions should consider patient values, but often use "substituted judgment" and act in best interest. California law requires considering known ...
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[PDF] Perspective - Surrogate Decision Making
Surrogate decisions follow a hierarchy: patient's known wishes, substituted judgments, and best interests. However, research shows divergence from these ...
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[PDF] Legal and Ethical Standards - New York State Unified Court System
The substituted judgment standard is often used when someone has lost the capacity to make treatment decisions, and is most closely aligned with preserving the ...
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Who Decides When a Patient Can't? Statutes on Alternate Decision ...
Apr 13, 2017 · We use “alternate decision maker” to refer to any person participating in decision making for such a patient, regardless of whether he or she ...
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Deciding for Others: Limitations of Advance Directives, Substituted ...
Aug 1, 2009 · The second-line approach is substituted judgment, wherein those who know the patient best carry out the course they think the patient would have ...
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“The Handmaid's Tale” and Modern-Day Surrogacy - Hastings Center
Jul 13, 2017 · While Atwood's handmaids are not called surrogates, some disturbing parallels exist between their experiences and the realities of ...
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What The Handmaid's Tale has taught me about surrogacy | PET
Jul 24, 2017 · The real message is not that surrogacy exploits women; it is that women should always have the right to choose the circumstances in which they conceive and ...
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Surrogates (2009) - Plot - IMDb
The case grows more complicated, however, when several humans are murdered when their surrogates are destroyed, something which is not supposed to happen, as ...Missing: themes | Show results with:themes
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Surrogates (2009) - Moria Reviews
Nov 2, 2009 · FBI agent Tom Greer and his partner Jennifer Peters are called to a scene where two surrogates has been destroyed in an alley outside a nightclub.<|separator|>
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14 Books and Movies that Got Surrogacy Right
Oct 23, 2017 · Some of the easiest ways to find these representations are through surrogacy movies and surrogacy books, which can help you explain the process and spread more ...
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[PDF] The Ethical Quandaries of Commercialized Surrogacy in India and ...
Apart from discussing the Indian social and legal scenario concerning surrogacy, this paper analyzes three famous Bollywood movies, Chori Chori Chupke Chupke, ...
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The Baby Makers: Representing Commercial Surrogacy in Film and ...
Jan 15, 2024 · This essay attempts to define the genre of the surrogacy thriller as a prominent form for recent representations of commercial surrogacy.
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Author Surrogate: Definition and Examples - TCK Publishing
In literature, when an author projects themselves onto a character (whether or not the reader is aware), it's called an author surrogate.
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Types of Economic Goods - Okpedia
Examples include butter and margarine, or olive oil and seed oil. These goods are also known as alternative goods, competing goods, or surrogate goods.
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3.1 Demand | Principles of Economics - Harper College
Substitute goods are goods used instead of one another. iPODs, for example, are likely to be substitutes for CD players. Breakfast cereal is a substitute for ...
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What Is the Substitution Effect? Definition and Causes - Investopedia
The substitution effect is the decrease in a product's sales attributed to consumers switching to cheaper alternatives when its price rises.
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Substitution Effect - Defintion, Example, Slutsky
The substitution effect refers to the change in demand for a good as a result of a change in the relative price of the good compared to that.What is the Substitution Effect? · Graphical Illustration of the...
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Income substitution effect - Economics Help
The substitution effect measures how much the higher price encourages consumers to buy different goods, assuming the same level of income.
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Elasticity of Substitution Definition - INOMICS
Sep 7, 2020 · Elasticity of substitution measures the ease with which one can switch between factors of production. The concept has a broad range of applications.
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[PDF] WORKING PAPER 2014-8 Piketty's Elasticity of Substitution: A Critique
Aug 19, 2014 · However, his elasticity of substitution theory of a rising capital share relying on a “wealth” measure of capital at the macro-level is both ...<|separator|>
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Supply Substitution and Market Definition: Lessons from FTC v. RAG ...
The Federal Trade Commission (FTC) relied on a supply substitution theory to define the relevant market in its challenge of the merger of Evonik and PeroxyChem.
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from Artificial Surrogates to Natural Copies - Allan McCollum
The artificial surrogates, universal signifiers which—while lacking any inherent meaning of their own—designate genres like paintings, photographs, sculpture ...
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Self, Symbol, Surrogate: Artist Portraits… | Grand Rapids Art Museum
Mar 22, 2019 · In self-portraiture, artist and subject are one in the same, giving the viewer insight into the artists' own self-image. An etched self-portrait ...
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Surrogate Theories of Art - Compiler Press
For a metaphorical theory is a surrogate theory, and aesthetic theory with pretensions to truthfulness must forego metaphor and deal with the experience and ...
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Digital surrogacy: politics and aesthetics in visualising the historical ...
Oct 7, 2021 · This case study analyses the city's approaches to displaying and vitalising the model, the role of the built environment as a cultural backdrop,
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Do metaphors make opinions?: An empirical study on the effect of ...
Discussion: The results support the idea that a metaphorical frame can evoke reactance regarding the payment of surrogate mothers. ... use of metaphors to define ...
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[PDF] Linguistic roles of surrogate language in the select literary texts ...
Any nonverbal communication that uses body movement, musical instruments and sign language is tagged in this paper as surrogate language. A lot of meaning is ...