Legal principles and essential surrogacy cases every practitioner should know
2020; Elsevier BV; Volume: 113; Issue: 5 Linguagem: Inglês
10.1016/j.fertnstert.2020.03.015
ISSN1556-5653
AutoresSusan L. Crockin, Meagan A. Edmonds, Amy B. Altman,
Tópico(s)Reproductive Health and Technologies
ResumoGestational surrogacy, made possible with the introduction of in vitro fertilization, has expanded family building options while introducing novel challenges to established legal principles involving constitutional, contract, and family law as well as duty of care and negligence. Both legislatures and courts have grappled with how to apply these sometimes-competing areas of law to protect participants and professionals, and to create legally secure families. This article explores the following: the Constitutionally protected rights of privacy and reproductive autonomy of gestational surrogates; Contract Law principles that govern surrogacy contracts; the varied ways states have extended Family Law to establish legally recognized parent−child relationships between intended parents and children born to gestational surrogates; and the legal duties of care medical professionals owe to their patients. Gestational surrogacy, made possible with the introduction of in vitro fertilization, has expanded family building options while introducing novel challenges to established legal principles involving constitutional, contract, and family law as well as duty of care and negligence. Both legislatures and courts have grappled with how to apply these sometimes-competing areas of law to protect participants and professionals, and to create legally secure families. This article explores the following: the Constitutionally protected rights of privacy and reproductive autonomy of gestational surrogates; Contract Law principles that govern surrogacy contracts; the varied ways states have extended Family Law to establish legally recognized parent−child relationships between intended parents and children born to gestational surrogates; and the legal duties of care medical professionals owe to their patients. Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/61468-30003 Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/61468-30003 Although the Book of Genesis is often cited to illustrate that surrogacy has been a part of family building since Sarah's servant Hagar carried and birthed a child for her and Abraham, gestational surrogacy—today's most prevalent form of surrogacy—became possible only with the advent of in vitro fertilization (IVF). By moving fertilization out of a woman's body and into a laboratory, genetics could be separated from gestation, challenging longstanding presumptions of motherhood based on pregnancy. Today, gestational surrogacy has expanded parentage options not only to women who cannot carry a pregnancy, but to single men and male couples, all accompanied by legal challenges for the individuals and professionals involved in—and the children resulting from—these arrangements. Most recent statistics report 6,291 gestational carrier cycles for 2017 (preliminary data) (1Society for Assisted Reproductive TechnologyIVF Success: 2017 preliminary national data.https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2017Date accessed: February 20, 2020Google Scholar) and 5,526 in 2016, accounting for almost 4% of all transfers (2Centers for Disease Control and PreventionAssisted reproductive technology national summary report.https://www.cdc.gov/art/pdf/2016-report/ART-2016-National-Summary-Report.pdfDate: 2016Date accessed: February 20, 2020Google Scholar). Between 1999 and 2013, 16% of gestational surrogacy cycles reportedly involved international intended parents (3Centers for Disease Control and PreventionART and gestational carriers.https://www.cdc.gov/art/key-findings/gestational-carriers.htmlDate accessed: February 20, 2020Google Scholar). This article reviews the fundamental legal aspects and seminal case law that surround and guide gestational surrogacy practices today. Issues regarding ASRM's Ethics and Practice Committees' guidance, as well as international surrogacy practices, are addressed elsewhere in this volume and are largely beyond the scope of this article. As a starting point, lawyers know that words matter, and medical and legal professionals need a shared understanding of the meanings of a number of terms in this intertwined field of law and medicine. "Gestational surrogacy," or "gestational carrier arrangements," refers to a surrogate arrangement whereby a woman has agreed, in advance, to carry a pregnancy for intended parents that is not formed with her egg: any resulting child is neither her genetic nor her intended child. This pregnancy may result from the transfer of an embryo formed from the sperm and egg of two intended parents, any combination of donated and intended parent gametes, or a donated embryo. A "gestational carrier" (also referred to as a "gestational surrogate") may be compensated or noncompensated. Compensated surrogacies usually arise from arrangements made through surrogacy recruiting or coordinating programs (also referred to by some as "brokers" and "agencies") but may also be privately arranged between strangers, friends, or relatives, all ideally with the assistance of experienced legal and mental health professionals. In contrast, in "traditional" or, more recently termed, "genetic" surrogacy a woman is inseminated with a man's sperm with a prior agreement that she has no intent to parent the resulting child, regardless of her direct, genetic connection. The linguistic shift reflects that after 30 years of surrogacy arrangements, "gestational" and "genetic" more accurately describe the distinctions between the two types of practices. To avoid confusion, this article will use the term "traditional, genetic" surrogacy. The language change comes from the 2017 revisions to the model Uniform Parentage Act ("UPA 2017"), a set of model rules to establish parentage drafted by the Uniform Conference of Commissioners of Uniform State Laws, a national legal commission formed in 1892 to provide guidance through model laws that state legislatures can adopt in whole or in part (4Uniform Law CommissionUniform Parentage Act (2017) with prefatory note and comments.https://www.uniformlaws.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=1a489a1f-ec9a-ee72-7dbc-10f6d43943b5Date accessed: February 20, 2020Google Scholar). To date, UPA 2017 has been enacted in three states (California, Washington, and Vermont) and introduced in three others (Pennsylvania, Maine, and Massachusetts) (5Uniform Law CommissionParentage Act enactment map.https://www.uniformlaws.org/committees/community-home?CommunityKey=c4f37d2d-4d20-4be0-8256-22dd73af068fDate: 2017Date accessed: February 20, 2020Google Scholar). On a substantive level, UPA 2017 also recognized that, as surrogacy flourished, the 2002 surrogacy provisions of the model act needed to be updated "to make them more consistent with current surrogacy practice" (4Uniform Law CommissionUniform Parentage Act (2017) with prefatory note and comments.https://www.uniformlaws.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=1a489a1f-ec9a-ee72-7dbc-10f6d43943b5Date accessed: February 20, 2020Google Scholar). In the interim, a number of states had created legal frameworks for surrogacy through statutes or court decisions ("case law"), applicable only in that particular state. Although the drafters of UPA 2017 also chose to recognize the legality of traditional, genetic surrogacy as a more affordable and accessible option than gestational surrogacy, it "imposes additional requirements or safeguards on genetic surrogacy agreements. Among other things, UPA 2017 allows a genetic surrogate to withdraw her consent (to relinquish any legal parentage rights) up until 72 hours after birth" (4Uniform Law CommissionUniform Parentage Act (2017) with prefatory note and comments.https://www.uniformlaws.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=1a489a1f-ec9a-ee72-7dbc-10f6d43943b5Date accessed: February 20, 2020Google Scholar). Legally, traditional, genetic surrogacy has long been seen to parallel adoption because, despite asserting her prior intent not to be a mother, a traditional, genetic surrogate and birth mother share the same biological relationship to the child. Thus, adoption laws and protections built into them to protect birth mothers—including, in virtually every state, the essential right to wait to decide whether to relinquish a child until a period of time after the birth, and prohibitions against paying birth parents as a form of baby buying, have frequently been applied and created a tension with the rising phenomenon of surrogacy. In contrast, as discussed below, the law has increasingly come to a consensus that gestational carriers or gestational surrogates—in almost all circumstances—are not legal mothers. From a legal perspective, in any type of surrogacy arrangement, it is imperative to clarify in all consent forms and legal agreements that the surrogate does not intend to be a legal mother and that all intended, genetic parents are not "donors," as legally, gamete or embryo donors have no parental rights, responsibilities, or expectations. Surrogacy has always raised issues over maternity status, potential undue financial or other pressure, and women's constitutional rights over their reproductive choices and bodily autonomy, especially with respect to decisions regarding pregnancy management, termination, and selective reduction. Surrogacy case law has addressed four key topics to date: balancing constitutional privacy and reproductive rights with state public policy interests; enforceability of surrogacy contracts; safeguards and professional duties of care owed in surrogacy arrangements; and establishment and disputed parentage issues of children born through surrogacy. In Re Baby M (1988), the earliest reported traditional, genetic surrogacy dispute in the United States, has long been held up as a cautionary tale for surrogacy and has had a significant impact in restricting both traditional, genetic surrogacy in many states and compensated surrogacy of any type in a few states (6In re Baby M, 537 A.2d 1227 (N.J. 1988).Google Scholar). The case involved New Jersey residents. The intended parents were Elizabeth Stern, a pediatrician, and her husband, William Stern, a biochemist. The traditional, genetic surrogate, Mary Beth Whitehead, was a stay-at-home mother recruited by a surrogacy program run by Noel Keane. Whitehead received only minimal psychological counseling or screening, which nonetheless revealed concerns that were not passed on to her or the intended parents. In an attempt to avoid any New Jersey prohibitions on baby buying and selling and adoption laws that did not allow a birth mother to commit to placing her child prior to birth, the surrogacy contract was between only the intended father and Whitehead as the biological and legal mother (in gestational surrogacy cases, typically both intended parents are parties to the contract). When Whitehead ultimately changed her mind, offered to return the $10,000 payment, and attempted to keep the baby after the child's birth, the case ended up in court, raising then-novel legal questions of contract enforceability, maternity rights, and a custody determination. The case reached the New Jersey Supreme Court, where the court ruled the contract illegal as a violation of public policy, rejecting the proposition that a surrogate could contractually agree in advance or be forced by contract to terminate her parental rights. Instead it applied a "best interest" standard to decide who should have legal and physical custody of the child. Class differences were noted throughout the litigation, with a guardian ad litem appointed to evaluate the parenting capabilities of each of the parties. Ultimately, the New Jersey court ruled that the Sterns would be the better parents and should have physical custody of the child, with Mary Beth Whitehead remaining as the legal mother with visitation rights (6In re Baby M, 537 A.2d 1227 (N.J. 1988).Google Scholar). Elizabeth Stern was ultimately allowed to adopt the child, a necessary step to secure her maternal rights. Other early and more recent cases also reject the enforceability of contracts that require traditional, genetic surrogates to relinquish their maternity rights in advance. In a 1998 case from Massachusetts, R.R. v. M.H., that state's highest court refused to enforce the contract against a traditional, genetic surrogate who did not want to hand over a child in exchange for $10,000, finding that she was essentially a birth mother, protected by adoption laws, and that any custody determination must be based on the child's best interest after birth (7R.R. v. M.H., 689 N.E.2d 790 (Mass. 1998).Google Scholar). The R.R. court explicitly acknowledged that gestational surrogacy presented "considerations different from those in the case before us…," accepting the arguments of "Amicus" (Latin for "friend of the court") briefs (including one filed by this author) that, given the absence of a genetic connection, the adoption laws did not apply to gestational surrogates. In a 2013 traditional, genetic surrogacy dispute from Wisconsin, Rosecky v. Schissel, discussed in more detail below, that state's highest court also upheld a surrogacy contract with the significant exception of the legal maternity rights of the surrogate (8Rosecky v. Schissel, 833 N.W.2d 634 (Wis. 2013).Google Scholar). The legal uncertainty as to maternity status and the potential applicability of adoption and baby-selling laws identified in traditional, genetic surrogacy cases, coupled with the introduction of IVF, prompted an increase in gestational surrogacy arrangements whereby the surrogate's lack of a genetic connection makes her more easily distinguishable from a legal mother. In 2018, New Jersey enacted surrogacy legislation allowing compensated gestational (but not genetic) surrogacy (9New Jersey Gestational Carrier Agreement Act, N.J. Stat. §§ 9:17-60—68 (current through 28th Second Annual Sess.).Google Scholar), leaving only New York and Michigan currently disallowing the practice (10Legal Professionals Group of the American Society for Reproductive MedicineSurrogacy laws by state.https://connect.asrm.org/lpg/resources/surrogacy-by-state?ssopc=1Date accessed: February 25, 2020Google Scholar). Since 2007, New York has repeatedly introduced legislation supporting compensated gestational surrogacy; the bill came close to passage in 2019 and is being reintroduced in 2020 (11Clark D.M. Cuomo plans renewed effort to legalize gestational surrogacy in NY in upcoming session.New York Law Journal. 2019 Dec 30; (Available at:)https://www.law.com/newyorklawjournal/2019/12/30/cuomo-plans-renewed-effort-to-legalize-gestational-surrogacy-in-ny-in-upcoming-session/?slreturn=20200125141054Date accessed: February 20, 2020Google Scholar). In contrast, in February 2020, South Dakota introduced legislation to ban compensation to surrogates (12South Dakota House passes ban on commercial surrogacy. Dakota News Now, 2020 Feb 6https://www.dakotanewsnow.com/content/news/South-Dakota-House-passes-surrogacy-567633961.htmlDate accessed: February 20, 2020Google Scholar). Although the New Jersey Supreme Court's decision in Baby M was a significant legal setback for surrogacy, with the advent of IVF, gestational surrogacy has flourished in many states, prompting new statutory and case law guidance as to parentage, contract enforceability, and professional duties and liabilities. Surrogacy arrangements involve balancing a woman's constitutional right to privacy and her right to contract away private reproductive choices. A foundational principle arising from the 1973 United States Supreme Court's seminal decision in Roe v. Wade is a woman's constitutional right to privacy and reproductive autonomy (13Roe v. Wade, 410 U.S. 113 (1973), holding modified by Planned Parenthood of Se. Pennsylvania v. Casey, 505 U.S. 833 (1992).Google Scholar). Although not unlimited, Roe's protection of reproductive privacy and autonomy unequivocally supports the widely accepted view, also expressly incorporated into some state surrogacy laws, that intended parents cannot interfere with or overrule a surrogate's reproductive rights by the terms of a legal contract. This can become a critical issue if a surrogate—traditional, genetic or gestational—refuses to terminate or to selectively reduce at the request of the intended parents, even if she has previously agreed to do so in the contract. One state has recently introduced explicit legislation barring intended parents from forcing a surrogate to abort a pregnancy or to selectively reduce a multiple pregnancy (14Mauroni A. Virginia senate approves bill to prevent surrogates from being forced to abort multiples.2020 Feb 5https://www.jurist.org/news/2020/02/virginia-senate-approves-bill-to-prevent-surrogates-from-being-forced-to-abort-multiples/Date accessed: February 20, 2020Google Scholar). ASRM's 2018 Ethics Committee opinion also recognizes this legal principle ("[g]estational carriers are the sole source of consent regarding their medical care…" ) (15Ethics Committee of the American Society of Reproductive MedicineConsideration of the gestational carrier: an Ethics Committee opinion.Fertil Steril. 2018; 110: 1017-1021Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar). A contract between the intended parent(s) and gestational surrogate (and any spouse or partner) is an essential part of any surrogacy arrangement, and should be drafted and negotiated by separate, independent legal counsel experienced in reproductive law. Having separate, independent legal counsel protects each of the respective parties or couples, helps avoid conflicts of interest, and is not only a generally applicable ethical rule for legal representation but uniformly recommended or required for surrogacy arrangements by ASRM (16Practice Committee of the American Society of Reproductive MedicinePractice Committee of the Society for Assisted Reproductive Technology. Recommendations for practices utilizing gestational carriers: a committee opinion.Fertil Steril. 2017; 107: e3-e10Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar), the American College of Obstetricians and Gynecologists (17Committee on Ethics of the American College of Obstetricians and GynecologistsCommittee opinion no. 660. Obstet Gynecol 2016;127:e97–103.https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Ethics/Family-Building-Through-Gestational-Surrogacy?IsMobileSet=falseDate accessed: February 20, 2020Google Scholar), the American Bar Association (18American Bar AssociationModel act governing assisted reproduction.https://www.americanbar.org/content/dam/aba/administrative/family_law/committees/art/resolution-111.pdfDate: 2019Date accessed: February 20, 2020Google Scholar), and the Academy of Adoption & Assisted Reproductive Technology Attorneys (19Code of Ethics of the Academy of Adoption and Assisted Reproduction Attorneys.https://adoptionart.org/wp-content/uploads/2018/06/Ethics_Code_April2018.pdfDate accessed: February 20, 2020Google Scholar). Albeit beyond the scope of this article, there also may be a question of conflict of interest or potential conflict of interest whereby an attorney simultaneously represents (or owns) a recruiting program and represents a participant to the surrogacy arrangement, as the Stiver and Huddleston courts discuss (20Crockin S.L. Debele G.A. Ethical issues in assisted reproduction: a primer for family law attorneys.J Am Acad Matrim Law. 2015; 27: 289-357Google Scholar). Gestational carrier agreements should contain several essential elements. Although contract elements are beyond the scope of this article and too numerous to comprehensively list, among the major ones are: clearly setting out both the parties' parentage-related intentions and the legal process to establish legal parentage for the intended parents and not the gestational surrogate; setting out agreements on prenatal, pregnancy-related, labor, and delivery issues—including recognizing constitutional limits and reproductive autonomy; the consequences of various types of breaches of the agreement; escrowing all agreed upon compensations and fees prior to medical treatment; clarifying that compensation is for time, effort, and inconvenience (not for a live birth or transfer of legal custody); addressing both life and disability insurance; and addressing assumptions of the risks. There are many other important, if less central, issues, including restricting travel, alcohol, drugs, and social media postings; and addressing ancillary expenses including child-care, lost wages, and potential loss of reproductive organs. Before any medical procedures can begin, the IVF physician and clinic will want to know that the negotiated legal agreement is in place and should require a written affirmation from legal counsel for one of the participants in the form of a legal clearance letter (Table 1). Clearance letters typically include representations as to the agreed-upon number of transfer attempts and timeframe, the maximum number of embryos per transfer, and an affirmation that the intended parents and gestational surrogate have each had separate legal representation. Without such a letter, the clinic should not begin any medical procedures. There is no legal requirement (unless a specific state should enact one), and likely no benefit, for an IVF physician or medical clinic to receive a copy of the actual legal agreement for their own files, as medical management of any planned pregnancy should follow standards of care for all patients and is not subject to any private contract between individuals seeking treatment.Table 1A legal clearance letter should typically include:•Confirmation that intended parents (IPs) and gestational carrier (GC) and her spouse, if married, each have independent legal representation, including the names of each attorney.•Confirmation that the final legal agreement has been negotiated, signed by each of the participants, and returned to each attorney.▪If there is applicable statutory law, affirm compliance with that statute and include any specific information required by it.•The maximum number of embryos agreed to be transferred per cycle (typically one embryo, there may be some exceptions for two), subject to both the in vitro fertilization physician's recommendation and approval by GC and IPs.•The maximum number of embryo transfer attempts, typically three (excluding cancelled cycles) if needed for GC to become pregnant.▪May be subject to any of the following:○Necessity for IPs to create additional embryos○Any decision by IPs or GC to discontinue and terminate legal agreement after any transfer that did not result in a viable pregnancy○If no pregnancy results after agreed number of transfers, IPs and GC may mutually agree to additional transfer attempts•Any relevant time period for all agreed transfers to occur within (typically 12 or 18 months). Open table in a new tab As noted earlier, a central principle of contract law is that a contract (or part of a contract) that is found to be against "public policy" will not be upheld. Both the Rosecky and Baby M cases involving traditional, genetic surrogates highlight these contract principles. Although the Baby M court found the entire surrogacy agreement void as against public policy, the Rosecky court voided the agreement to sever maternal rights by contract as against public policy and upheld the rest of the contract as enforceable. Both cases yielded the same result: the traditional, genetic surrogate could not be required to terminate her parental rights despite a contractual agreement to do so, but the surrogacy-born child was placed in the custody of the intended parents under a best interest of the child test determination. Elizabeth Stern was ultimately able to adopt her child, whereas Marcia Rosecky was not, nor was she ever recognized as the legal mother before her death. In addition, under contract law, breaches of certain types of contractual terms cannot be enforced through "specific performance" (forcing someone to physically perform a contractually agreed-upon action or nonaction). Contractual terms involving pregnancy management, termination, and selective reduction—whether for a traditional, genetic or gestational surrogate—will all fall within those types of breaches. Instead, money or "liquidated" damages may be allowed for such breaches as long as the breached term is not found to be against "public policy." Independent experienced legal counsel for each of the participants will increase the likelihood that a contract will be found equitable and enforceable. Legal liability in negligence or malpractice cases depends on whether a recognized "duty of care" has been breached. Given the multiple participants and potential child (or children) involved, surrogacy presents unique issues and obligations for professionals. Two significant cases from the 1990s each identified a heightened duty of care owed by both medical and nonmedical professionals to all of the participants, and to the anticipated child, in surrogacy arrangements. Two additional, more recent, cases discussed here also raise issues of responsibility or liability for medical, legal, and mental health professionals' screening, representation, and care of a prospective surrogate. In Stiver v. Parker, Judith Stiver, a traditional, genetic surrogate and her husband sued surrogacy broker Noel Keane, her assigned lawyer, and the four participating doctors for negligence after the child she delivered was born with cytomegalovirus, presumably contracted from Alexander Malahoff, the intended father whose semen was not tested (20Crockin S.L. Debele G.A. Ethical issues in assisted reproduction: a primer for family law attorneys.J Am Acad Matrim Law. 2015; 27: 289-357Google Scholar, 21Stiver v. Parker, 975 F.2d 261 (6th Cir. 1992).Google Scholar). Keane, a lawyer, ran a surrogacy business in which he recruited surrogates, acted as the prospective father's lawyer, drafted the surrogacy agreement, and organized the rest of the surrogacy program including arranging the psychiatrist and doctors, and providing a lawyer for the surrogate whom she first met at the time that she was shown and signed the agreement (21Stiver v. Parker, 975 F.2d 261 (6th Cir. 1992).Google Scholar). The court held that Keane and each of the other professionals owed an affirmative duty of protection and heightened diligence (21Stiver v. Parker, 975 F.2d 261 (6th Cir. 1992).Google Scholar):…Keane assumed a task and role as a surrogacy broker, and the other professionals participated in the program Keane designed. The group were in this sense joint venturers … They are entrepreneurs pioneering in a new field. Keane, as well as the doctors and the lawyer, expected to profit from their roles in the program …We conclude that Keane, the surrogacy business designer and broker, and the other defendant professionals who profited from the program, owed affirmative duties to the Stivers and to Malahoff, the surrogacy program beneficiaries. This duty, an affirmative duty of protection, marked by a heightened diligence, arises out of a special relationship because the defendants engaged in the surrogacy business and expected to profit thereby. Keane owed a duty to design and administer a program to protect the parties, including a requirement for appropriate testing (21Stiver v. Parker, 975 F.2d 261 (6th Cir. 1992).Google Scholar). The second case identifying this same heightened duty of care involved another surrogacy arranged by Noel Keane, Huddleston v. Infertility Center of America (22Huddleston v. Infertility Center of America, 700 A.2d 453 (Pa. Super. Ct. 1997).Google Scholar). As operator of the Infertility Center of America (ICA), Keane matched Phyllis Huddleston as a traditional, genetic surrogate with a single, intended father, James Austin. After being artificially inseminated with Austin's sperm, Huddleston gave birth to a baby boy and gave physical custody to Austin. The baby died at 5 weeks of age, after Austin repeatedly abused the baby, resulting in severe head and brain injuries (22Huddleston v. Infertility Center of America, 700 A.2d 453 (Pa. Super. Ct. 1997).Google Scholar). Reportedly, Austin had no childcare experience, no psychological counseling, and his mother had died shortly before the surrogacy (23Lewin T. Man accused of killing son borne by a surrogate mother. New York Times, January 19, 1995https://www.nytimes.com/1995/01/19/us/man-accused-of-killing-son-borne-by-a-surrogate-mother.htmlDate accessed: February 20, 2020Google Scholar). In Huddleston's civil suit against the ICA for wrongful death and survival actions, Keane attempted to argue that his program had no duty to the surrogate over harm to the baby, since she had relinquished legal custody. The court, citing Stiver, disagreed and held that the ICA "must be held accountable for the foreseeable risks of the surrogacy undertaking" because of the special relationship between the surrogacy business, parties to the surrogacy, and the resulting child (22Huddleston v. Infertility Center of America, 700 A.2d 453 (Pa. Super. Ct. 1997).Google Scholar). Austin was also criminally charged and convicted in his infant son's death. Stiver and Huddleston strongly support an affirmative duty of care owed by surrogacy recruiters, physicians, and other involved professionals to the surrogate, the intended parents, and the resulting child. For reproductive endocrinologists (REIs), duty of care over screening and pregnancy management issues will include reviewing a prospective surrogate's medical records
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