If you’re looking for a surrogate mother to have your baby, please don’t approach it the way Rep. Trent Franks did.

Virtually everything about how the Arizona Republican broached the sensitive and complicated topic of surrogacy — both according to his own recounting and the allegations of former aides — strikes some very strange chords considering the legal standards, biological realities and ethical questions underpinning the process.

The eight-term congressman abruptly resigned on Friday, after the House Ethics Committee said it was investigating him for potential sexual harassment concerning his conversations surrounding surrogacy with two female staffers. Franks’s own news release, in which he admitted to making the aides uncomfortable but insists he never solicited sex, is one of the stranger resignation announcements we’ve read when it comes to lawmakers.

It gets even weirder when you consider that Franks is one of the most prominent antiabortion members of Congress, sponsor of many bills aimed at restricting abortion, including a 20-week ban the House has passed multiple times. Surrogacy is an issue that makes many abortion opponents uncomfortable because it typically results in the creation and destruction of multiple embryos. (For more about this, read my colleague Sarah Pulliam Bailey.)

Franks and his wife have twins through surrogacy, but have sought additional children since. Let’s take a look at some of the oddest aspects of how Franks allegedly broached the topic.

1. Surrogacy is technically illegal in Franks’s home state of Arizona.

A half-dozen states strongly encourage surrogacy by upholding contracts between donor parents and surrogate mothers. Another half-dozen frown upon it either by banning such contracts or prohibiting compensation. The rest fall somewhere in between on a complicated legal smorgasbord of laws and court rulings ascribing varying levels of rights to donor parents and surrogates.

Arizona is on the less-friendly end of the spectrum. The state technically outlaws such arrangements, but there is legal precedent allowing two parties to go to court to determine parentage. To have their twins via surrogacy, the Franks would presumably have had to take legal risks within their own state or contract with a surrogate elsewhere. They haven't clarified exactly how their twins were born.

“It could work in Arizona, but it would be a legal nightmare because they don’t enforce contracts,” Arthur Caplan, professor of bioethics at New York University, told me.

2. The market rate for paying surrogates is $20,000 to $55,000 (that's in addition to their medical expenses) — not anywhere close to the $5 million Franks allegedly offered a former aide to bear his child.

Yes, Franks is among the richest members of Congress — his net worth is estimated at nearly $33 million, mostly from oil and gas investments. But that makes it no less odd that Franks would offer such an extravagant figure to a potential surrogate for his child.

“During my time there, I was asked a few times to look over a ‘contract’ to carry his child, and if I would conceive his child, I would be given $5 million,” one former aide told the Associated Press.

That aide — and another Franks had also approached about surrogacy — said they weren’t sure whether he was referring to impregnating them through sexual intercourse or through in vitro fertilization, according to a report by Politico. Yet the term “surrogacy” always refers to a medical procedure, experts say.

“This notion that the baby would be conceived via sexual contact is very much out of the norm when it comes to the way surrogacy works in this country,” said Valerie Gutmann Koch, director of law and ethics at the University of Chicago’s MacLean Center for Clinical Medical Ethics.

Business Insider senior editor Josh Barrow:

And the question of compensation highlights a serious divide between those who embrace surrogacy and those opposed to it.

“There’s a real split,” Leslie Francis, a philosophy professor and bioethicist at the University of Utah, told me. “There are some feminists who are utterly opposed to the practice, thinking of it as commercializing reproduction and exploiting the woman.”

Others view surrogacy as a charitable act by the woman, even if she’s also paid — or at least as a reasonable financial decision if the woman understands the details of the arrangement in advance and gives her full consent.

3. It’s unusual and difficult to create only a limited number of embryos, as Franks claimed to have done with the birth of his twins. 

In his resignation announcement, Franks said that his twins were conceived through “a pro-life approach that did not discard or throw away any embryos.” That’s theoretically possible but difficult, experts say.

Harvesting eggs from the donor mother is an arduous process that most women don’t want to undergo more than once. So doctors typically collect many eggs at once and immediately fertilize them, because frozen embryos are much more stable than frozen eggs.

If the goal is to only create as many embryos as can be implanted into a surrogate, a doctor would probably have to harvest eggs multiple times or wait to fertilize them. Few surrogates would probably be willing to have more than a few embryos implanted inside them because of the risk of triplets, quadruplets or even more.

“Finding a surrogate willing to take more than two or three embryos would be quite a task,” Caplan said.

And freezing embryos doesn’t necessarily solve the ethical problem for those who consider it morally wrong to destroy one of them — even if they might, in time, be adopted by other people desiring children.

“Just freezing them doesn’t settle the issue — why are you freezing people?” Caplan said. “You’re getting up pretty close to what I would consider inconsistent practices and beliefs.”

Playwright Catherine Castellani:

TPM editor Josh Marshall:

4. Franks allegedly approached two of his staffers — directly — to request their services as surrogates.

Franks’s aides said their boss approached them directly to raise the idea of bearing his child. Now, it wouldn’t be so strange to directly approach a potential surrogate in what’s known as a traditional contract surrogacy — in which the surrogate mother is genetically related to the fetus. This was the first type of surrogacy generally practiced, with a couple seeking out a family member to be artificially inseminated because the woman can’t bear a child for one reason or another.

But Franks crossed all kinds of workplace and ethical lines by approaching his staffers. It’s unclear whether Franks was referring to a traditional surrogacy or a gestational surrogacy, where his wife’s egg would be used. In a gestational surrogacy, prospective parents often engage legal counsel, since their relationship with a surrogate is so nuanced and sensitive.

Bottom line: Franks essentially committed some major blunders in the way he went about seeking a surrogate in his apparent quest for more children.

“How much he was willing to spend, the fact he was unable to clarify whether this was a gestational surrogacy and the fact that these are his subordinates — those are the big red flags,” Koch said.


AHH: California adults who are 21 and older may now use pot recreationally. But will that make it harder to keep youth from using it?

"The legalization of recreational marijuana for adults in California and other states poses an added challenge for drug education and prevention programs," The Post's Anna Gorman reports. "Teachers are trying to explain the risks of marijuana just as stores are preparing to open and marketers are planning campaigns. Medical marijuana has been legal in California for more than 20 years, but experts say the new law on recreational marijuana could prompt more youths to believe that the drug is safe."

Educators in California say legalization has prompted questions and confusion among young people, who may be getting misinformation — and peer pressure — through social media. While medical marijuana can help ease chronic pain, use of the drug is also linked to poor respiratory health, increased car accidents and can undermine the cognitive and mental health of teens.

"Recent studies show that teens who use marijuana frequently exhibit lower cognitive performance and brain function than those who don’t," Anna writes. "They also perform worse in school. Despite that, teen perception of the harms of marijuana has dropped over time, and many think it’s safer than alcohol...Currently, more than half of 10th- and 12th-graders believe that smoking marijuana isn’t dangerous, according to a recent Rand report."

OOF: An estimated one in five American children have a diagnosable mental, emotional or behavioral disorder in a given year, NBC reports, highlighting a Centers for Disease Control and Prevention report released in August. And these kids largely aren't getting the help they need; only 20 percent are ever diagnosed and get treated. The report also indicated that increasing numbers of teen girls are experiencing serious depression; their suicide rate reached a 40-year high in 2015.

"There is an acute health crisis happening among members of the youngest generation of Americans, with critical implications for the country's future," Kate Snow and Cynthia McFadden write. "Teens are known for their moodiness, and adolescence — a particularly turbulent time of life — is one of the most vulnerable periods to develop anxiety and depression."

"Child and adolescent mental health disorders are the most common illnesses that children will experience under the age of 18. It's pretty amazing, because the number's so large that I think it's hard to wrap our heads around it," Harold Koplewicz, founding president of The Child Mind Institute, a nonprofit children's mental health advocacy group, told NBC.

OUCH: We've written a lot on these pages about the growing practice of mixing fentanyl with heroin to create an even more potent drug. But here's another way to use the highly addictive synthetic painkiller -- to execute prisoners. Nevada and Nebraska are pushing to have the nation’s first fentanyl-assisted executions, our colleagues William Wan and Mark Berman report, but some doctors and opponents of the death penalty warn that untested use of the drug could lead to botched executions.

The efforts come as states are having a hard time getting long-used drugs for executions, as drug companies are refusing to supply them, William and Mark report. As a result, some states are turning to different drug combinations, and other states are using old methods such as firing squads and electric chairs. There are 31 states where capital punishment is legal that are searching for options beyond legal injection.

Why use fentanyl? The obvious reason is potency, Mark and William write. Fentanyl is 50 times more powerful than heroin and 100 times more powerful than morphine. Another reason is easier access. The synthetic drug is commonly used by doctors to anesthetize patients or treat severe pain. Still, prisons in both Nevada and Nebraska declined to explain why they chose fentanyl, our colleagues write. States often keep the procedures secret to minimize legal challenges. 


--Sen. Lisa Murkowski (R-Alaska) has posted a question-and-answer video on her YouTube page where she defends her vote for the GOP tax plan -- and its repeal of the individual mandate -- saying opponents are using "scare tactics" in criticizing the effort.

“I think it’s important that people really look to what is included in this bill when it relates to the Affordable Care Act and to get beyond the scare tactics and the rhetoric that is designed to just instill fear and paranoia in people,” Murkowski said, answering a question about people who say the bill will take health coverage away from Americans.

Murkowski pushed back on the idea that she was undermining the ACA by backing the tax plan, noting the only part of the health-care law to be repealed is the individual mandate -- not its insurance subsidies nor its Medicaid expansion. Over the summer, the senator voted against multiple versions of Obamacare repeal because they would have taken away health benefits from millions of Americans, she said.

“What this bill does is says if you can’t afford health-care coverage, or if you don’t see that value in it, we’re not going to fine you,” she said. “It doesn’t impact the ACA in any other way. If you receive a subsidy for your health-care insurance before this tax bill passes you will still be able to receive a subsidy after.”

--A few more good reads from The Post and beyond:

Health & Science
A good death in familiar surroundings can happen with planning and hospice care.
Andrew MacPherson and Ravi B. Parikh
Advocacy groups and the F.D.A. have warned that companies are capitalizing on the epidemic by offering unproven remedies.
New York Times
Margaret Leatherwood has eight choices for health insurance next year but no good options. The cheapest individual coverage available in her market would eat up nearly a quarter of the income her husband brings home from the oilfields.
Ascension and Providence St. Joseph would combine into a 191-hospital national system.

​​​​​​​Coming Up

  • The Senate Judiciary Committee holds hearing on “Oversight of the Ensuring Patient Access and Effective Drug Enforcement Act” on Tuesday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the cost of prescription drugs on Tuesday.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on “Examining Concerns of Patient Brokering and Addiction Treatment Fraud” on Tuesday.
  • The Brookings Institution holds a webinar on impact bonds of health on Tuesday.
  • The House Natural Resources Subcommittee on Energy and Mineral Resources holds an oversight hearing on "Examining Consequences of America's Growing Dependence on Foreign Minerals" on Tuesday.
  • The Kaiser Family Foundation holds an event on “Living in an Immigrant Family in America: How Fear and Toxic Stress Are Affecting Daily Life, Well-Being, and Health” on Wednesday.
  • The Senate Health, Education, Labor and Pensions Committee has a hearing on “Implementation of the 21st Century Cures Act: Responding to Mental Health Needs” on Wednesday.
  • The House Energy And Commerce Subcommittee on Health holds a hearing on “Examining the Drug Supply Chain” on Wednesday.

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