Primum non nocere - First, do no harm

(Written & Posted Originally in April 2013 - Reposted today in honor of National Adoption Month, November 2015)


'Primum non nocere', perhaps you've heard that phrase? If so, you've likely heard this as one of the principle precepts of medical ethics. I'm not writing about medical ethics today. I'm writing about adoption ethics, but the same precept applies. 

First, do no harm.

I wholeheartedly believe most prospective adoptive parents set out to 'do no harm'. 

To each person considering adoption and to each person who has already completed an adoption, I share the following out of a deep concern for birth-mothers and first families. I share it as an adoptive mother, from a place of sorrow and regret.

Manno & his Papa

Recently I wrote this: I have intensely complicated thoughts about everything related to poverty, orphans, orphanages, and international adoption. Some of my thoughts are developed thoughts and others I am wrestling with as I wonder about the roles I have played in the system and as I watch injustice and unbalanced power all around me. 

For months I've been in utter and complete turmoil over many things related to international adoption. We first adopted more than 10 years ago. My turmoil has to do with my son, Isaac. It has to do with his first family. (I plan to share that story in a follow-up to this post soon.)  It has to do with the system and its multiple pitfalls. It has to do with doing harm.

The more I learn living in Haiti, the more research I do, the more convinced of the appalling issues I become. The more involved I've been with our children's first families the more I've been forced to face some difficult realities about international adoption. I recognize that I too have been part of the problem. I recognize that "do no harm" requires so much more understanding, awareness, and education than we had. 

Ketia & Julianna

In part because of my sister, who was a first-mom that placed her daughter for adoption as an infant, and in part due to my own international adoption experiences, I find myself predisposed to fight for first mothers and their rights. 

Having spent a number of years in Haiti, I have had an opportunity to slowly build relationships with many women and that has allowed me a unique peek into their lives and their reality. I've witnessed troubling exploitation of birth-mothers in Haiti. From all that I've learned, I have come to care intensely about the needs and rights of first mothers and fathers. 

"Exploitation" is perhaps an intangible term for some. When I say exploitation, I am casting a large net that refers to multiple things. As one example, I refer to a system that rarely tries to help a first mom through a difficult time but has no problem having her sign paperwork she doesn't understand and taking her child off of her hands, for good. If the child is an infant, that can easily be referred for adoption, he or she is received even faster. 

I desire reform in the area of ethical practices that go above and beyond to protect vulnerable, materially poor, marginalized, and often times uneducated first mothers/families. Even if we cannot agree how that reform should be fleshed out, I hope we can agree reform that protects poor first families is needed and overdue. 

Dieumatha & her little one

It occurs to me that our western culture of capitalism, materialism, and consumerism all play a large role in our attitude toward and approach to international adoption. Due to our wealth and ability to provide, sometimes without even realizing it we begin to believe that our material wealth makes us better suited to parent the child of a poor mother. What began as noble and pure and loving can fairly easily begin to look a lot more like ethnocentrism and entitlement. 

Prospective adoptive parents presented with proof that a healthy and able birth-mother exists rarely ask questions about why she relinquished her child. We want to be trusting people and we believe the story offered by their agency and never look back. Sadly, many later learn that nothing was as it appeared. 

(And of course, sometimes -for dozens of reasons First-mothers choose, without force or manipulation, to relinquish their child for adoption out of great need and pure motives. There are absolutely situations where babies and older children are legitimately relinquished.) 

Additionally, adoption is being marketed to us by our churches now. The cry from the pulpit to address the "orphan crisis" oftentimes creates pressure to adopt rather than a calling to adopt. I am not at all against a fact-based movement encouraging openness to exploring a new idea. I am against using guilt to propel people into uninformed or reckless action.  (Adoption as a way of solving the "orphan crisis" is marketed with sketchy numbers and without delineating "true orphan" from "poverty orphan" - which I find dishonest. Perhaps this is an entirely different blog post for another day.)  

I think most adoptive families (choosing to adopt internationally especially) enter into the process thinking they will be helping a child that desperately needs a family. Over and over adoption is marketed as- "Giving a child what they deserve:  A family."  My struggle is, most of these kids have that family before we arrive. We've not done enough to help their families have other options. We've not invested enough time in educating the birth families; first families frequently don't fully understand what they signed up for, nor do they understand what they can expect in the future. 

Wislene and her precious family

It is not a mystery why some injustice continues unchallenged in the adoption arena. Whenever people have a personal interest they are apt to protect themselves over the greater good.  Many say, "Once our adoption is done, we'll talk about what we saw, what we heard, or what we learned".  So many people that plan to talk "later" get tired or busy with a new family member to acclimate and they never follow through. Meanwhile, every day more children enter institutionalized care and new families turn over their payment and paperwork and the light does not shine on truth. I challenge all adoptive and prospective adoptive parents to refuse to be quiet when things are troubling  - to refuse to be frozen in fear - to refuse to allow the powers that be to manipulate or misinform without consequence.  

“The moment we begin to fear the opinions of others and hesitate to tell the truth that is in us, and from motives of policy are silent when we should speak, the divine floods of light and life no longer flow into our souls.” -Elizabeth Stanton

I imagine a world where a prospective adoptive parent would be every bit as willing to advocate (financially, spiritually, emotionally, and otherwise)  for the rights and justice of the poor first/birth-mother to keep and parent her child, as they are willing to push for their own completed adoption. I don't think anyone starts out wanting to trample on the marginalized but sadly it seems to be happening by default in many countries around the world.

Justice is not only about seeking fairness and equality for those without a voice; at times it is also risking our own personal happiness or gain in order to bring it.  

Those of us in the position to consider an international adoption are the ones with the most power.  Let us use our voice for good. Let us stand with the poor in support of their ability to raise children. Let us demand real and measured transparency.Let us not blindly trust what we're being fed by agencies and those that stand to gain most from the entire process. Let us be about exposing the dark parts of this system (truth telling) and educating ourselves and new adoptive families so we can all avoid hurting and oppressing the poor.      

Because I believe that with very few exceptions, most adoptive parents set out to "do no harm", it seems possible that we might all be willing to look more critically at the gray areas. If you're open to further consideration, here are some links and thoughts you can begin to read and research further:

1.  "In many countries,it can be astonishingly easy to fabricate a history for a young child, and in the process, manufacture an orphan.The birth mothers are often poor, young, unmarried, divorced, or otherwise lacking family protection.The children may be born into a locally despised minority group that is afforded few rights.And for enough money,someone will separate these little ones from their vulnerable families,turning them into "paper orphans" for lucrative export."Source: The Lie We Love, Brandeis University  
2.  PEAR - Parents for Ethical Adoption Reform (on Facebook too)
3. Multiple links regarding fraud/corruption here at Schuster Institute for Investigative Journalism - a.) Proposal for fairer adoption practices here 
4. I recently finished reading an advance copy of this book. My original perception was that it painted Christians with a broad brush, therefore some of it left me slightly defensive - BUT - there are enough/many stories and things that ring 100% true that I hope many adoptive parents will read it for themselves and not take my word for it - simply to be informed of the troubling evidence of coercion and multiple issues that exist within the current system.   
5.  Child Laundering: How the Intercountry Adoption System Legitimizes and Incentivizes the Practices of Buying, Trafficking, Kidnapping, and Stealing Children, by David M. Smolin  (This guy is smart and honest and comes at it objectively.)
6. If you are aware of North Americans using their power and inherent privilege to strong-arm or force an adoption (actually called kidnapping and called trafficking) - please expose them to authorities because every time a child somehow slips out of their birth country in an illegal and unethical way, it hurts others with legitimate and lawful adoptions.

This post does not address many other forms of fraud and deception; it was intended to be just one piece of the puzzle, focused on first families. Please don't read this post as any sort of personal attack or indictment. We are all swimming in ethically gray waters. I've become so troubled that I feel it is important to risk upset  in order to bring attention to the fact that many of our good intentions are inadvertently causing unjust results. Even though there is personal and emotional involvement - I am thankful that some adoptive parents will be moved by the Good that compels them to look harder at the broken system we have been complicit in creating and consider how we can be agents for change.

... God gives out wisdom free, is plainspoken in Knowledge and Understanding. He's a rich mine of Common Sense for those who live well, a personal bodyguard to the candid and sincere ... 

- Proverbs 2  -

~         ~         ~          ~

post script ...

Over the last several years, through the work happening here in Haiti, I've been watching Haitian mothers being offered a bit of encouragement and love. In that time I've watched over 250 women choose to parent (and not relinquish to an orphanage) their babies. Less than 1% have chosen to place for international adoption. Some are very, very poor women; some are middle-class women. With a relatively small amount of emotional support these women are choosing to parent their children. Without the benefit of wealth and material blessing they are doing a fabulous job loving and serving their little ones. 

Jacquline, her mother, and her newborn daughter

(all photos of Haitian families used with permission)