What are the Key Ethical Issues in Adoption?
Moderators: Reuben Pannor, M.S., Pacific Palisades, CA & Annette Baran, M.S.W., A.C.S.W., L.C.S.W., Santa Monica, CA
Adoption is currently in crisis in that bad practice is becoming institutionalized; we are losing sight of standards; children have become commodities; many infants become available for adoption in this country today not because their families want to relinquish them, but because they are living in poverty; and there are many attorneys who have turned adoption into a high profit business.
I. Infant Adoption
Joyce Maguire Pavao, Ph.D., Center for Family Connections, Cambridge, MA
When discussing ethics, whose ethics are we talking about - particularly when our perceptions of what is ethical may change depending on what stage of development we are in and what field we are working in? In adoption, in order to determine what is ethical, the focus must be on the child.
Issues affecting the adoptee:
While birth is a traumatic event for all humans, it may be even more stressful for infants who are adopted because they are taken away from the familiar sounds, smells and tastes of their mothers.
The adoptee may question who he or she might have been had he/she been named and raised by his/her birthparents.
The adoptee experiences a sense of loss at wondering who his/her birthmother is and the reasons for relinquishment.
Often, individuals such as file clerks, social workers and nurses are permitted to know more about the adoptee's life and origins than the adoptee him/herself.
Many adoptees need to know about their beginnings in order to have a complete sense of themselves and to feel connected to the world both genetically and environmentally.
Adoptees are the only Americans who do not have the legal right to access certain information about themselves.
"The adult adopted person is a seeker of the truth or (may be) damaged by exclusion from it."
II. International Adoption
Susan Soon-Keum Cox, Holt International Children's Services, Eugene, OR
Children are separated from their families due to poverty, illness, death, lack of social support, cultural stigmas and barriers. World-wide, 200,000 children have been adopted internationally, half of whom have been adopted in the U.S. In 1998, approximately 16,000 of these children were adopted by U.S. citizens.
"Intercountry adoption should never be the first line of defense for children. It is not intended to be a solution to world poverty, civil unrest, or urban migration." For many children, however, international adoption is their only option to have a family. It is preferred that every child be raised by the families who give birth to them. When this is not possible, the best alternative is for them to be placed with a family in their countries of origin. "Unfortunately, in many developing countries, where turning cradles and orphanages are the social safety net for abandoned children, that is not their reality. The routine practice of abandonment eliminates the preferred priority of staying with or being reunited with the child's birth family." Decisions which affect the lives of these children should be made quickly, examining both the short and long-term consequences and taking into account the fact that each child is an individual with a unique set of circumstances. Decisions should also be made bearing in mind the life-long impact that these decisions will have on their lives - Children do grow up.
Intercountry adoption is a privilege, not a right, and requires that respect for the dignity of both the child and the child's birth country be a priority. When sending countries first establish policies for the adoption of their children, the system may be overly bureaucratic, cumbersome and inefficient. Deliberate and genuine efforts must be made by "receiving countries" to work constructively toward improving the system rather than attempting to circumvent the system. Working against the system risks the opportunity to assist other children from that country who would benefit from intercountry adoption in the future. Adoption should be an unfaltering commitment to providing families for children, rather than children for families. This is particularly true for children who are adopted internationally. "The simplistic assumption that a poor child in a developing country will have a preferred life with a family in a ėrich' country is misguided, imperialistic, and overlooks the sacrifice and loss - not only to the sending country, but to the child."
Intercountry adoption, originally established to help children in other countries, has been tarnished by unethical practices. The harshest critics of intercountry adoption consider it a "rape of a country's most precious and valuable human resource, a rape of a child's culture and ethnicity. And children are undeniably a nation's greatest resource. However, absent any investment in their lives, they also become a nations' greatest liability."
Issues of Race, Culture, and National Origin
The modern history of international adoption began after the Korean War in the 1950s. Children of Korean mothers and American G.I. fathers - referred to as having "mixed-blood" - were ostracized by their communities. The adoption of these children by American and European families produced mixed reactions. Some people thought of it as a "crazy social experiment." Others worried about how growing up with parents of a different race would affect these children in adulthood.
In the U.S., early practice included "Americanizing" children as soon as possible. Assimilating into American culture was considered a necessary priority as the ability of a child to transplant from one culture to another demonstrated that the adoption was a success. This practice changed in the 1970s as the first generation of Korean adoptees grew up and began to express their concerns about their racial identities.
"As intercountry adoption evolved and matured, there was less fear and anxiety surrounding the necessity of proving its appropriateness. More attention and concern began to focus on educating and preparing families to embrace the child's birth country and ethnicity as valued and necessary to the well being of the adopted child."
International adoptees, most being of a different race than their adoptive families, are consistently called upon to validate (often to strangers) that their families are indeed real families. The survey of the first generation of Korean adoptees, conducted by the Evan B. Donaldson Adoption Institute, revealed that racial disparity is a reality which affects individuals to varying degrees throughout their lives. Adoptive families must acknowledge and accept this reality, and should view themselves not as Caucasian families with children of color, but as interracial families.
Issues of Money, Accountability, and Regulation
The cost of international adoption ranges from a few thousand dollars to $30,000 or more. There is not always a direct relationship between fees and service delivery. In order to ensure ethical adoption practice, all costs and fees must be fully outlined and be made available for review. There are legitimate expenses associated with the provision of basic services by social workers and agencies. Adoptive families, however, are often required to pay inflated fees to sending countries - fees which sometimes far exceed the average annual incomes of families from those countries and create the appearance of buying and selling children. Adoption practitioners must take responsibility for setting and carrying out ethical standards in order to avoid even the appearance of profiting at the expense of children and families.
Access to Background Information and Informed Decision-making by Prospective Adoptive Parents
Adoptive families must not view intercountry adoption as a way of avoiding birth families ever appearing in their lives. Many internationally adopted children have searched and been successful in finding their birth families.
Intercountry adoption presents unique challenges in securing accurate and truthful background information and history on children. Differences in culture, language, terminology, technology and the competence of medical resources in sending countries all profoundly affect this process. It is the highest priority to make every effort to secure as much information as possible - including establishing relationships with overseas partners - so that prospective adoptive parents and adoptees may receive accurate information. Original records, including hand written notes in the margins and soiled paperwork, are vital and precious to adoptees.
Prospective adoptive parents should never be coerced and must be allowed a reasonable period of time upon receiving a child's information (and it must be truthful information) to make a thoughtful and informed final decision regarding adoption. The future of the child as well as the future of international adoption are dependent on such ethical practices.
Impact of Institutionalization on Children
"The majority of children adopted internationally will have spent some or all of their childhood in an orphanage or institution." It is now understood that institutionalization - including the length of time a child is institutionalized - affects physical, emotional, and psychological development. "According to some medical experts, children who have spent time in an institution must be considered high risk placements or potentially children with special needs."
We must think about children not as "our" children or "their" children, but as THE children.
III. Foster Care and Adoption
Joseph Crumbley, Ph.D., Philadelphia, PA
Established by the federal government as a response to the belief that adoptions were being handled unethically, The Adoption and Safe Families Act (ASFA) regulates how agencies handle adoptions. In order to look at and understand child welfare and ASFA, we need to first examine the ethics and issues related to welfare in general.
- allows families to languish in the system.
- is creating families in which dependency on the system has become a lifestyle which may be passed on from generation to generation.
- negatively affects emotional and mental well-being of families and their members when the dependency is long term.
- negatively affects self-esteem, reliance, worth, confidence, individual development, goals, productivity, attachments, and responsibilities.
- should not be a system. Families should assume primary and long-term responsibility for their own welfare.
- should be comprised of interventions that are short-term, secondary and for emergencies.
- should be long term only when necessary in special needs situations.
- should have incentives built into the system to decrease the number of families dependent on the system.
- should incorporate reasonable efforts to assist families in assuming individual responsibility and self-sufficiency (for example, job-training).
- should involve the termination of a family's right to assistance after a certain period of time or reasonable efforts to provide services have been made.
The values provided by ASFA are that:
- children are languishing too long in foster care.
a disproportionate number of them are children of color.
- foster care has become an institution, an alternative lifestyle for raising children in place of families.
- long-term foster care negatively affects emotional and mental well-being of families, including separation, attachment and loss issues.
- families should assume primary and long-term responsibility for care of their children.
- foster care should be secondary, short-term, and for emergency situations.
- long-term foster care should be needed only under special situations.
- incentives should be provided to increase the number of adoptions.
- reasonable efforts should be provided to families to assume care and return of their children.
- parental rights should be terminated after a period of time and reasonable efforts have been made.
We find ourselves reacting to the ethics, values, and standards provided to us by others. Someone has told us what is the right thing to do. With regard to health and safety, what standard and references are we going to use to define health and safety? Whose standards and values? How do we define the standards with consideration to culture and families, and in what context? It is necessary to identify the differences and find a way of testing and individualizing the criteria because questions will be raised regarding whose safety, culture and context we are addressing. It is necessary to define "reasonable efforts" and decide when enough is enough. Sometimes there is a dilemma which results from differences in what the adoptive parent, the agency, or others may consider to be reasonable efforts. Then, it is necessary to find a way of considering, evaluating and incorporating the definitions of all perspectives.
How do we minimize the appearance of dual loyalties and commitments to plan A or plan B? How do we recognize opposing roles and tasks when we are trying to implement those plans? How do we minimize the client's mistrust of the agency?
Monitoring and evaluation feedback and warning systems about clients' ongoing progress need to be established. Clients need to be informed of their standing and the point in which it has been decided that the other system will come into play. Process, activities and outcomes need to be identified in order to determine when a plan will continue. When do we start working on the plans simultaneously?
Termination of Parental Rights
When do we advocate for exceptions? How do we define what is in the best interest of the child? When do we decide that reunification should continue or not continue to be the goal? In terms of timetables, the ethical dilemma is whether the situation of the family allows for reasonable intervention efforts. For example, drug and alcohol rehabilitation rarely occurs successfully within the limited time frames of ASFA.
Placing Children of Color
Is adoption the solution to the problem of disproportionate numbers of children of color in foster care? Is it necessary to address race and culture in adoption of children of color especially in the context of ASFA, The Multi-Ethnic Placement Act (MEPA) and the Interethnic Placement Act (IEPA) - which, again, are all ethics or values which someone developed in response to the belief that the "right" thing was not being done? Many of these plans target older African American males. Questions remain, however, as to whether MEPA and IEPA will result in a higher number of these older children being placed with adoptive families or if only African American infants and younger children will leave the foster care system. It is too early to determine the effects of MEPA and IEPA. In order to ascertain whether these laws are benefitting all African American children in foster care, we must keep track of which children are adopted. If it is determined that these laws are not accomplishing the goals for which they were created, adjustments must be made accordingly.
When should issues of race and culture be determining factors in recommending or finalizing adoptions?
Discussion: Points Raised by Conference Participants
"Adoption should be about finding families for children, not children for families." According to Joyce Maguire Pavao, the homestudy process is unethical and still follows a 1930s and 1940s model (the "white glove test"). All members of the triad are being underserved. Ninety five percent of people who want to be adoptive parents should be approved. If a parent is determined to be unable to meet the needs of one child, he/she may be able to meet the needs of a different child. The homestudy needs to have a component which addresses this.
Intercountry adoption should only be an option for a child if it is the only way for that child to have a family. If that determination is made and a child is adopted internationally, efforts must be made simultaneously to promote adoption in that country. We must realize that these programs will progress slowly and be aware that the development of social practice is slower than economic development. It is unreasonable to expect that centuries of culture are going to change in one or two generations. We must be able to view the situation through the eyes of other cultures. To hold the view that they should change according to Western cultural standards is unethical.
It is never appropriate to falsify information on an application. The homestudy is permanent information. The wishes of sending countries must be respected, even if we do not believe in their policies. Change is possible - an example is China's policy which now allows single parents to adopt. However, change happens slowly.
Foster care is a business. When the numbers of children in foster care began to grow, in addition to the question of how to house these children, there was another agenda which dealt with profits. We need to look at our own practice, the parents coming into the system and the foster care business as it affects the growth of numbers. All three issues must be addressed if we want the numbers to go down.
Everyone agrees on the goal that more children need to get out of foster care. How do we do it? What is the right way? What is in the best interest of the child? A large percentage of the children are of color. Who is going to adopt them? What is the best source of permanency? What about the ethics of incentives? There is a danger in creating another business if we institutionalize something that makes adoption disrupt.
The push for the adoption of children in foster care is happening because agencies are being forced to define permanency as adoption, particularly because most incentives are based on their increased number of adoption placements. The consequence is often that there are more children removed from legal guardians and adoptive parents because of abuse and neglect in the name of speedy permanency planning.
Birthparents will sign surrenders if they think that they will still have contact with the child. It is important that people have a real relationship before any legal action is taken. You can't have open adoption unless you have an agreement for an adoption. The relationship between the families will continue to be adversarial unless there is education and counseling.
A little over half a million children are in out of home care. How do we achieve permanency in an expeditious manner? What are the guidelines for permanency under ASFA?
We talk about the placement as if the child is frozen in time. Adoptees grow up and can contribute to change and are able to provide perspectives. They need to be acknowledged.
Agencies are being co-opted to go into unethical practices. Adoption should be the providence of the social agencies. They are licensed, have rules, practices, accreditation and the potential for doing a good job. Independent adoptions have free reign and should be made illegal.
It is unfortunate that money is involved in adoption, particularly in light of the disparity in "pricetags" and how that knowledge may affect a child. The involvement of money should be limited only to valid expenses.
The ethical framework falls apart when the outcome to good ethical practice means that the child waits a longer time for a same race adoption or is kept too long in the country of origin and has second class status. Money needs to be invested in recruitment to find appropriate families. Culture and identity make a difference, even in same-race adoptions. Placing a child with a family of the same race does not insure a perfect match. A child from an urban area, for example, placed with a family of the same race in a rural area may encounter difficulties with cultural differences in spite of the fact that they are the same race.