Who Gets to Decide? Race, Surrogacy and Bodily Autonomy

That is what makes the unfolding case of McKenna West so important. It is more than a disagreement about abortion or a dispute over a surrogacy contract. It asks whether an agreement signed before a pregnancy can become authority over a medical decision made months later, after the circumstances have changed.

West, a Black nurse and gestational surrogate, was carrying a baby for intended parents when, at approximately 20 weeks, the fetus was diagnosed with hypoplastic left heart syndrome, or HLHS — a critical congenital heart defect in which the left side of the heart is severely underdeveloped.

HLHS is neither hopeless nor curable. A baby born with it generally requires three staged heart surgeries beginning shortly after birth. Those surgeries reconstruct the circulation but do not create a normal heart. Survivors may experience lifelong complications and, in some cases, eventually need a transplant. Still, children with HLHS do survive. Some reach adolescence and adulthood.

According to court filings, the intended parents decided to terminate the pregnancy after consulting medical professionals. They say West initially agreed and made the...