Ms Jones is a 28-year-old woman who has agreed to be a gestational surrogate for a couple who cannot bear children. She presents to your office for prenatal care.
Which of the following is your responsibility as an obstetrician caring for a gestational surrogate?
When a pregnant surrogate seeks medical care for an established pregnancy, the obstetrician should explore with the surrogate her understanding of her legal agreement with the intended parents. She should be cared for as any other obstetrical patient. The obstetrician’s professional obligation is to support the well-being of the pregnant woman and her fetus, and to provide appropriate care regardless of her plans to keep or give up the baby. The pregnant surrogate should be the one to give consent regarding treatment of the pregnancy in the clinic or on labor and delivery. The obstetrician should make treatment decisions that are in the best interest of the surrogate and her fetus, regardless of the agreement between her and the intended parents. Patient confidentiality should be maintained. The patient’s medical information should only be given to the intended parents with the surrogate’s explicit consent. The obstetrician should avoid conflicts of interest and should not facilitate a woman’s becoming a gestational surrogate for a couple for whom the physician is treating.
A 24-year-old patient who you have been seeing for routine gynecological care reports that she is considering becoming a surrogate mother for a couple she knows at work.
As her physician, what is your responsibility to her in preparing her to become a surrogate?
When approached by a patient considering becoming a surrogate mother, the physician should address medical risks and benefits, along with ethical and legal concerns. Recommendations for independent legal counsel and explicit written preconditions and contingency agreements should be made. The physician should not treat the couple for whom the patient will become a surrogate. Referral for mental health counseling should be provided prior to initiation of pregnancy to explore potential psychological risks and effects on the surrogate mother. Compensation to the surrogate should not be determined by the physician or be contingent on the successful delivery of a healthy infant. The physician should receive only usual fees for medical services; other payments for financial gain are inappropriate.
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