Who Are Your Patients, and What Happens When They Disagree?

Third-party reproduction carries significant legal and ethical challenges. Although well-intentioned mutual desire typically guides parties entering a gestational surrogacy or egg donation arrangement, the potential for conflict cannot be avoided. Because the physician’s role includes treating both their patient (the intended parent/s) and the “third-party patient” (the egg donor or surrogate), the physician should be aware of potential conflicting desires about medical treatment (i.e., an intended parent may desire a triplet pregnancy, while the surrogate may prefer to reduce). Systematic bias should also be considered, as it may result in favoring one patient’s medical needs over the other. The laws in this area are unsettled and in many situations no definitive legal answers are available. Prior to engaging in third-party reproduction each patient should be fully informed of potential medical risks and consult with mental health professionals and independent lawyers to confirm agreement with respect to the arrangement.