McKenna West Surrogacy Case Raises Questions About 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 appointment before changing her mind. They deny trying to force her to have an abortion. West says she felt pressured and ultimately refused.

When West entered the surrogacy agreement, she could not have known that the fetus would later be diagnosed with HLHS. The contract may have anticipated the possibility of a congenital anomaly in the abstract, but agreeing beforehand to a hypothetical course of action is not the same as giving informed consent after receiving a specific diagnosis, prognosis and proposed medical procedure. The circumstances had changed, and West was entitled to reconsider.

A person does not lose the right to say no simply because she once said yes.

A contract is not consent

I am pro-surrogacy.

I have known surrogates and, as a nurse, cared for women laboring with babies they were carrying for other families. I have seen how generous, complicated and deeply human surrogacy can be.

Surrogacy contracts matter. They establish expectations, compensation, expenses, medical responsibilities and parental rights. A surrogate may breach an agreement, and a court may determine the consequences.

But a contractual promise is not present medical consent.

Informed consent is not merely a signature on a form. It is an ongoing process in which the patient must understand the procedure, its risks, its benefits and its alternatives. Most importantly, the decision must remain voluntary.

An abortion is performed on the pregnant person. It is her body that undergoes the procedure and bears its risks. Her body does not cease to belong to her because money changed hands.

California law confronted part of this tension in Johnson v. Calvert, a landmark 1993 surrogacy case. Although one provision purported to give the intended parents authority over abortion, the agreement also acknowledged that a pregnant woman had the absolute right to abort or refuse to abort and that any promise to the contrary was unenforceable.

The court decided the case on parentage and did not resolve whether a contract could deprive a gestational carrier of control over an abortion. But the distinction remains instructive: a contract may establish who will parent a child without transferring ownership of the pregnant woman’s body.

West may ultimately be found to have violated parts of her agreement. Whether she owes money or breached other obligations belongs in court.

Whether she consented to an abortion belonged to West.

She can be wrong about custody, and right about her body.

West did not simply refuse the abortion and continue the pregnancy in Alaska. She traveled to Texas to deliver the baby.

According to a filing by the State of Alaska, no Alaska hospital was prepared to provide the specialized treatment the baby would need immediately after birth. West said she chose Texas to be near physicians experienced in treating HLHS.

But medical access was not the only issue. Texas also offered West a potentially more favorable legal forum for claiming parental rights as the woman who gave birth. The intended parents had already been recognized as the child’s legal parents in California and said they had arranged specialized cardiac care there. They argued that West’s move disrupted their plans, complicated continuity of care and interfered with their parental rights.

West then sought recognition in Texas as the child’s mother and attempted to gain authority over his medical care.

Those actions deserve scrutiny. Traveling to obtain a more favorable legal position may be viewed as forum shopping, and a court may find that West violated her contract or interfered with the intended parents’ rights.

But those questions must remain separate from the abortion decision.

West called the baby Gabriel. His intended parents call him Rumi. After his birth, they were recognized as his legal parents and assumed authority over his medical care.

That does not necessarily make them hypocrites. Seeking an abortion during pregnancy and caring for a child after birth are not contradictory positions. Once Rumi was born, he became a separate patient, and his parents had the right and responsibility to make decisions about his treatment.

West’s control over her body during pregnancy did not automatically entitle her to custody after birth. The intended parents’ authority after birth did not retroactively give them control over West’s body during pregnancy.

She can be wrong about custody and still be right about medical consent.

Yet people have called West an incubator and argued that accepting compensation reduced her to reproductive equipment. There is no such thing as renting a womb without the woman attached to it. Money can create obligations. It cannot erase personhood.

The hardest version of the question

HLHS is severe, but it is not uniformly fatal. Children can survive with treatment.

Now consider the hardest version of the bodily-autonomy question.

What if prenatal testing had instead revealed anencephaly — a fatal condition in which major portions of the brain and skull do not develop? Almost all babies born with anencephaly die shortly after birth, and there is no cure.

In that circumstance, termination might appear to many people not merely understandable but compassionate. The intended parents’ request would carry profoundly different medical and emotional weight.

But the prognosis would not change whose body must undergo the procedure.

Compelling reasons for an abortion are not the same as authority to compel one.

Bodily autonomy does not require us to agree with every decision. It requires us to recognize that the person undergoing the procedure remains the person whose consent is necessary.

If bodily autonomy protects only choices other people approve of, it is not autonomy.

It is permission.

A principle that cuts both ways

West’s case is not unfolding in a political vacuum.

Live Action, an anti-abortion organization, reportedly paid for her travel to Texas. Alliance Defending Freedom, a conservative Christian legal organization with a long history of opposing abortion, represents her. Texas Attorney General Ken Paxton also intervened, framing the dispute around protecting the unborn child and ensuring medical treatment after birth.

Their involvement raises a legitimate question: Is West’s individual claim being used to advance fetal personhood, restrict surrogacy or create another pathway for limiting abortion?

Perhaps.

But legal principles do not always travel in the direction their architects expect.

If a court rules that West could refuse the abortion because the fetus possessed an independent right not to be aborted, that reasoning could strengthen the anti-abortion movement and weaken reproductive autonomy.

But if the court rules that West could refuse because she remained the patient and no contract could override her medical consent, the principle points somewhere different. It would affirm that a pregnant person retains authority over her body even when other people have powerful emotional, financial or parental interests in the pregnancy.

That principle cannot logically apply only when the answer is no to abortion.

The same bodily autonomy that protects one woman’s decision to continue a pregnancy also protects another woman’s decision to end one. Pro-life advocates may believe this case belongs to them. It may ultimately give them something they did not intend: a powerful argument that reproductive decisions belong to the pregnant person — not the state, the intended parents or a contract.

Black women’s bodies have been here before

West is a Black woman.

That does not make every criticism of her racist or mean that race explains every aspect of this dispute. Her conduct involving custody, communication and the child’s medical planning can be questioned without reducing every disagreement to racial prejudice.

But language matters.

People should examine how easily words such as incubator, rented womb and reproductive equipment are applied to a Black woman whose body was carrying someone else’s child.

Black women’s bodies have long been battlegrounds for other people’s ideas about medicine, reproduction and consent.

Anarcha, Lucy and Betsey — the enslaved women now remembered as the Mothers of Gynecology — were subjected to experimental gynecologic procedures in the 1840s. Enslavement made meaningful consent impossible. Their bodies helped advance medicine while their autonomy was denied.

In 2025, Adriana Smith, a Black nurse in Georgia, was declared brain-dead while approximately eight weeks pregnant. Her family said they were told her body had to remain medically supported so the pregnancy could continue; state officials later disputed that Georgia law required it. Even in death, Smith’s body became a jurisdiction. Her son, Chance, was delivered extremely prematurely by emergency C-section. Smith was then removed from life support.

The loss of authority did not end with Smith. In March 2026, two Black doulas said security and police removed them from a Georgia hospital while their unidentified client, a Black woman in active labor, pleaded for them to stay. She had declined a recommended C-section for a breech baby and wanted pain relief while considering her options. The doulas said the hospital withheld an epidural until they left. Afterward, the woman delivered by C-section and said she felt her birth had been taken from her. The hospital cited privacy and declined comment.

In separate Florida cases, the courtroom entered the delivery room directly. ProPublica reported in March 2026 that hospitals brought two Black women before judges while they were in labor after they declined C-sections. In 2023, a judge ordered Brianna Bennett to undergo surgery that lasted two and a half hours and left her with a T-shaped incision requiring a wound vacuum. In 2024, a judge authorized doctors to operate on Cherise Doyley without her consent if they declared an emergency. Hours later, doctors performed the C-section after reporting a seven-minute drop in her baby’s heart rate. Doyley was herself a professional birth doula.

One woman was stripped of her chosen advocates. Two others lost final authority over surgery. Smith, already dead, had no voice at all. The circumstances are not identical, but the echo is: who is permitted to exercise authority over a Black woman’s body?

These cases are medically and legally different. The connection is not identical circumstances but the recurring question of who is permitted to exercise authority over a Black woman’s body.

Black women should not have to keep teaching America lessons about medical consent with our bodies.

We have paid that tuition already.

Where the contract ends

The West case may become an important test of surrogacy law, contract enforcement, medical consent and legal parentage across state lines.

West may lose her custody claims. She may be found financially responsible for breaching portions of the agreement. The intended parents may be confirmed as the child’s only legal parents.

None of those outcomes would erase the boundary exposed by this case.

Parentage is not ownership of the pregnant person.

A contractual promise is not permanent medical consent.

And bodily autonomy does not disappear when someone makes a decision we would not have made.

The contract ends where her body begins.