ACOG RECOMMENDATIONS ON SURROGACY
Surrogacy is fraught with legal risks. (See Chapter 24.) Medical opinion on
surrogate parenting ranges from outright advocacy to harsh condemnation. As a
legal matter, physicians have no duty to participate in surrogacy arrangements
and may violate the law by doing so in some states. ACOG has published a
thoughtful guide to physician participation in surrogacy arrangements. The core recommendations from this guide
are reproduced here. Physicians who choose to participate in surrogacy should
carefully consider these recommendations. If they choose to deviate from them,
the reason for this deviation should be discussed in the medical record. While
ACOG carefully declines to call these standards of care, it is clear that the
courts will not be so reticent.
The ACOG recommendations first deal with decision making for the pregnant
woman's medical care:
- In the committee's view, the genetic link between the commissioning
parent(s) and the resulting infant, while important, is less weighty than the
link between surrogate mother and fetus or infant that is created through
gestation and birth. Thus, in the analysis and recommendations that follow no
distinction will be drawn between the usual pattern of surrogate parenting and
surrogate gestational motherhood.
This recommendation is at odds with many who advocate that pregnant women
have a right to contract away their authority over their own medical decision
making. It also accepts the legal notion that paternity is determined by
societal convention rather than being rigidly bound to genetics. We support the
treatment of the pregnant woman as the sole medical decision maker as being
ethically and legally sound. To allow a woman to contract away the right to
control her own health would be to institute contractual slavery. Preventing
binding contracts to give up the infant after birth only reiterates the
adoption laws in most states.
ACOG Committee Opinion 88: Ethical
Issues in Surrogate Motherhood. Committee on Ethics, November 1990.
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