A surrogacy case that has captured national attention is now being considered by the U.S. Supreme Court, raising complex questions about the meaning of parenthood. McKenna West entered a surrogacy agreement with Nausheen Gilkar and Omar Ahmed, in which she agreed to carry their genetically created child. The contract specified that she would terminate the pregnancy if the fetus had a serious birth defect and the intended parents requested an abortion. Around 20 weeks into the pregnancy, the couple discovered the fetus had a severe heart defect. They asked West to terminate the pregnancy, but she refused and moved to Texas, where the baby was born. After undergoing complex heart surgery in mid-August, the child remains in critical condition. West, supported by anti-abortion groups, is now seeking custody of the child. She has asked the Supreme Court to intervene, arguing that the parents should not have the right to control the child’s medical care while she pursues custody in Texas courts. The case highlights a deep conflict between two important principles: a woman's right to control her own body during pregnancy and the rights of the people who are legally and biologically the child’s parents after birth. This is not the first time such a conflict has arisen. In 2011, Crystal Kelley signed a surrogacy contract with a couple in Connecticut, agreeing to terminate a pregnancy if serious birth defects were discovered. When the fetus was diagnosed with multiple defects, the couple asked Kelley to end the pregnancy and offered her $10,000. Instead, she fled to Michigan, where surrogacy contracts are not enforceable, gave birth, and was listed as the mother on the birth certificate. The child was later adopted by another couple and lived with them until her death at age eight. These cases reveal the difficult tensions at the heart of surrogacy. A surrogate plays a crucial role in a child’s development and bears the physical risks of pregnancy. Some feminists argue that women cannot fully consent to surrogacy agreements because they may develop emotional bonds with the fetus during pregnancy. However, these factors do not necessarily make the surrogate the child’s legal parent. The cases also raise questions about the rights of intended parents to make decisions for their biological child before birth and whether such decisions should be governed by enforceable contracts. In 2020, New York passed the Child-Parent Security Act, which included the nation’s first Surrogates’ Bill of Rights. This law recognizes a surrogate’s right to make healthcare decisions for herself and the pregnancy, including whether to terminate it. However, it also establishes clear boundaries: a surrogate cannot use her own egg to create the embryo and thus cannot be the biological mother of the child. The law ensures that the intended parents retain full legal rights over the child after birth. This balance recognizes a surrogate’s autonomy while preserving the legal parenthood of the intended parents. West is asking the Supreme Court to adopt a different approach, arguing that intended parents could lose their parental rights simply by requesting an abortion. That argument is problematic. The purpose of a surrogacy agreement is for the surrogate to carry the child for the intended parents, who entrust their genetic material to her. Even if a parent cannot force an abortion in the case of a life-threatening condition, that does not change who the child’s parents are after birth. The courts should not allow a dispute over reproductive decisions to undermine the legal rights of the parents. West agreed to be a gestational surrogate, meaning she did not provide the genetic material. The agreement was based on the understanding that Gilkar and Ahmed would be the child’s legal parents. Once the child was born, their parental rights should not depend on West’s approval of medical decisions or her desire for custody. The courts should preserve this distinction, ensuring that the difficult, deeply personal choices surrounding pregnancy do not erase the parents’ legal rights after the child is born.