Surrogacy Case for A New Medical Student
As a medical student of the First Year, a surprising question was asked.
Reflect on a time when you questioned or challenged a belief or idea.
Describe what prompted your thinking and what was the outcome?
If applicable, expand on how this experience will affect your practice as a future physician.
This was when we came across a case during my first year as a medical student, which was that of a surrogacy case of a patient in the first trimester of her pregnancy. The case was rare in our professors’ obstetric practice. After the involvement in an extensive counseling session, Tracy finally agreed on a surrogate mother for a gay couple. Upon her regular visits, she told all about the surrogacy contract, which included that she would be entitled to compensation for all expenses incurred. And that she will report all prenatal visits, refrain from risky behaviors like drinking alcohol, smoking, and keep an open eye over medical records so that the couple has complete information about the ongoing pregnancy.
One day, during her visit, after regular examination, she was somewhat hesitant in saying something. Upon further inquiry, Tracy said that she thought there would be no trouble in not drinking alcohol when she signed the surrogacy contract, but now she is finding it difficult to give up. After doing some research, she further said that she concluded that alcohol consumption would not harm the baby, and she has started taking a glass or two of wine in a week. She also requested not to put anything about this in the medical record.
Being a medical student, medical ethics holds great importance for us. Patient autonomy is certainly a greater concern where, in this case, Tracy has lost it by entering into the contract. Patients and surrogates are supposed to make their healthcare decisions after informed consent. This will involve discussing risks, options, and benefits to the patient and the decision maker’s invoking elements of their relatively stable value system to choose amongst the available options.
Surrogacy has Raised Several Debates:
Surrogacy has raised several debates in the past. The primary concern raised in the entire system relates to the concern about commodification, exploitation, and/or coercion when women got the money to become pregnant and deliver babies. However, according to my opinion and beliefs, the counter of this can be the right of the woman to enter into a contract; she can make decisions regarding her body. Womb commodification is that process in which the services performed by the female womb are for sale or purchase in the market.
Basically, the market transaction of the female womb renders it to be only a service provider in the market. This arrangement argues whether women have control over their bodies or are exploited for individual body parts. Additionally, usually womb commodification most of the time takes advantage of the willingness of the poor to undertake a task as long as they are earning a wage.
In the current scenario, Tracy should have refrained from such risky behavior. Her willingness to discuss considered an opportunity to appreciate her responsible behavior. Which will further strengthen the relationship to facilitate communication in the future.
A Rare Case in Medical Records:
Being a rare case in my medical record, I have taken this case over to my attending physicians who have claimed this case to be both an ethical and clinical dilemma that is unique to surrogacy pregnancy. He further advised that steps need that helps in placing the health of the women and the child first irrespective of the surrogacy contract. This can be eventually done by the provision of appropriate information about dose-related impacts of alcohol along with encouraging Tracy to avoid unforeseeable events in the future. The advice was to conduct counseling sessions for Tracy so that she clearly understands the impact of alcohol on her health status and that she comes to fulfill the terms of the surrogacy contract.
An honest dialogue with Tracy that medical ethics does not permit to hide medical information; however, an evidence-based discussion with that of the intended parents so as to provide them with a complete picture of the scenario, make proper arrangements for appropriate follow-ups along with offering Tracy additional resources for proper counseling in this aspect can serve as better options. Additionally, I have a strong opinion that a thorough understanding of psychology, medicine, and law related to this particularly important clinical activity is an absolute obligation towards making surrogacy successful.
Handling this case, I have realized that surrogacy does undermine the control of women over their bodies and places them in the position of emotional mercy of the intended parents. However, making the health of the surrogate to be the top priority offers them to be more empowered and given great responsibility. This makes the situation quite complex and involves making decisions that are in the favor of both the surrogate mother and the intended parents. Because Tracy has presented her free consent while entering into a surrogacy contract, she becomes ethically and morally liable to fulfill the contract terms and refrain from any such activity that causes harm to her health or to the fetus during the course of pregnancy.
This eventually calls for the statement that although autonomy is an integral element of a surrogate mother; however, there are still some exceptions that directly relate to the health of the surrogate woman or the fetus in her womb.
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