A Decision Checklist Before Applying

What a pre-application decision record is meant to reveal

turning values, health questions, household capacity, support, autonomy, privacy, finances, and unresolved concerns into a documented go, pause, or decline decision, with clear boundaries between the surrogate’s decision, clinical judgment, program practice, agreement expectations, and location-dependent law. This is not a test of generosity or commitment. It is a way to see the real effect of values and motivations, unresolved health questions, household capacity, and support reliability before an application creates momentum.

Start with the fact that the prospective surrogate is the decision-maker about whether to explore the role. Other people may have legitimate information, workload, safety or legal responsibilities, but their involvement does not erase her agency. The practical task is to make those responsibilities visible early enough for an unpressured choice.

A useful review names both the ordinary plan and the less convenient version. Ask what happens when values and motivations goes as expected, then ask what changes if unresolved health questions becomes harder, household capacity is unavailable, or support reliability cannot be kept private. Specific questions expose assumptions that reassurance alone will miss.

• Include values and motivations in the written review.
• Include unresolved health questions in the written review.
• Include household capacity in the written review.
• Include support reliability in the written review.
• Include bodily boundaries in the written review.

Why this belongs before an application

Readiness can feel like a vague emotional judgment unless unresolved health, household, autonomy, privacy, support, and financial prerequisites are made visible.

Once profiles, records, matching conversations or financial expectations begin, stopping can feel harder even when it remains possible. Early planning protects a genuine no, not only a smoother yes. It also lets the reader distinguish a solvable gap—such as confirming household capacity—from a boundary that makes the role unsuitable now.

Do not measure readiness by how confidently someone speaks. A careful person may have more questions because she has considered bodily boundaries, privacy limits, and financial and work prerequisites. The useful signal is whether she can identify missing facts, ask independently, state limits and tolerate an answer that changes the plan.

• A pause can be a responsible decision, not a failed application.
• Support should expand choices rather than reward compliance.
• New information may legitimately change an earlier preference.

Build the pre-application decision record

Create four lists: confirmed strengths, unanswered questions, non-negotiables and prerequisites. Assign each open question to the right clinician, counsellor, lawyer, program or household member, then choose apply, delay or decline and set a date only if review would help.

Write names and actions, not labels such as “good support” or “we will manage.” For values and motivations, record who supplies information and who decides. For unresolved health questions, record the primary plan and backup. For household capacity, record what must be confirmed before sharing records or accepting a next step.

Use a three-state marker: confirmed, unresolved or unacceptable. Confirmed means the responsible person has agreed and the necessary information exists. Unresolved means a named professional or household conversation is still needed. Unacceptable means the proposal conflicts with a boundary or creates a burden you are not choosing.

• Values and motivations: record owner, backup, evidence and pause point.
• Unresolved health questions: record owner, backup, evidence and pause point.
• Household capacity: record owner, backup, evidence and pause point.
• Support reliability: record owner, backup, evidence and pause point.
• Bodily boundaries: record owner, backup, evidence and pause point.
• Privacy limits: record owner, backup, evidence and pause point.

Keep decision ownership clear

The checklist organizes your decision; it cannot certify medical eligibility, legal safety or psychological readiness. A yes today remains open to revision when screening, matching, agreements or treatment reveal new information.

• Ask who is accountable for the statement.
• Ask whether it is a fact, recommendation, preference, practice or legal rule.
• Ask what happens if the surrogate disagrees or changes her mind.
• Ask where independent advice can be obtained.

Stress-test the plan without predicting the future

Choose one ordinary scenario and one disruption scenario. In the ordinary version, trace values and motivations, unresolved health questions, and household capacity through the people, records and decisions involved. In the disruption version, assume support reliability changes suddenly and examine the effect on bodily boundaries and privacy limits. The purpose is to locate single points of failure, not to estimate a personal probability.

• Values-clarification record: confirm purpose, owner and update point.
• Decisional-conflict questions: confirm purpose, owner and update point.
• Reversible-step map: confirm purpose, owner and update point.
• Prerequisite tracker: confirm purpose, owner and update point.
• Independent-review list: confirm purpose, owner and update point.
• Change-of-mind record: confirm purpose, owner and update point.

Choose a proportionate next step

Choose whether to apply, delay, or decline based on personal values and unresolved prerequisites, without treating application as consent to screening, matching, or treatment.

• Proceed only with the next reversible step you actually choose.
• Delay when a material question lacks an owner or reliable answer.
• Decline when the proposal conflicts with a non-negotiable boundary.
• Reassess whenever material medical, legal, household or financial facts change.

Key takeaways

• Choose whether to apply, delay, or decline based on personal values and unresolved prerequisites, without treating application as consent to screening, matching, or treatment.
• Use a pre-application decision record to expose assumptions and assign unanswered questions to the right person.
• Application is a reversible step, not consent to screening, matching, an agreement or medical treatment.
• A safe plan preserves the option to pause, decline or change direction when material facts change.

Sources and further reading

• AHRQ - The SHARE Approach (reviewed 2026)
• ACOG - Informed Consent and Shared Decision Making (2021)
• ASRM - Recommendations for practices using gestational carriers (2022)
• ASRM Ethics Committee - Consideration of the gestational carrier (2023)
• UK DHSC - Having a child through surrogacy (updated 2025)