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Some women affected by breast cancer elect to adopt as an alternative
means to parenthood. If you and your family decide to do so, you
face many decisions. Do you adopt domestically or internationally,
through a public agency or a private source? Do you want a newborn,
an older child, a child of a different race or ethnic background?
How do you balance issues around length of survival and the best
interests of the child?
Adoption can be conducted in a variety of ways, and the laws that regulate
adoption differ in each state and country involved. An important
first step is learning about your options.
Children can be adopted through the public or private adoption systems. In
public adoptions, children typically come from foster homes and
are under the care and protection of the state. Children enter the
system at different ages and for different reasons. Foster children
who are eligible for adoption cross a wide range of ages. Adoptive
parents are especially needed for children over age six and children
with special needs.
Private adoptions can be done domestically or internationally; they offer
the best opportunity for those seeking a newborn or child under
18 months old. Domestic adoptions must comply with state law. Depending
on your particular state's requirements, you may use private agencies,
attorneys or facilitators to identify a child and conduct the process
required to complete an adoption. Other resources include physicians,
counselors, pastors and organizations specializing in finding newborns,
older children or special-needs children.
In domestic adoptions, some sensationalized stories in the news media
have resulted in some prospective parents having fears about birth
parents who may return to reclaim children after the adoption. Generally,
these fears are unfounded. Each state has different laws regarding
the voluntary surrender or termination of birth parents' rights.
Using competent professional services and following appropriate
procedures ensure that the legal rights of birth parents will be
addressed in a clear and secure manner. In addition, more recent
practices of openness in adoption have reinforced that the voluntary
placement of a child for adoption is a fundamentally cooperative
process between the birth and adoptive parents. Typically, in domestic
infant adoption, babies come home to the adoptive parents upon release
from the hospital or shortly thereafter.
International adoptions are regulated by the child's country of origin, and most
are legally finalized in those countries. They are growing in popularity
because more people want infants and young children than are available
domestically. Some international adoptions are done privately by
individuals, but most are conducted by agencies and professional
services. The federal government will soon begin regulating international
adoptions.
Price is another factor. Typically, there are no fees associated with
adopting children from the public system. Private domestic adoption
costs range from $15,000 to $35,000 and may include agency services,
legal fees and travel costs. You also may encounter advertising
fees in states that allow families to run ads in print or online
to connect with a pregnant woman interested in making an adoption
placement for her child. International adoptions range from $10,000
to $30,000. Costs may include legal fees, translations, agency services,
document processing fees, the services of foreign facilitators,
travel and incidentals and sometimes a donation to an orphanage
or other facility that cares for children.
Whichever route you choose, you are entitled to a “statement of fees” that
lays out the costs associated with the adoption process. Most likely
you will be eligible for an Adoption Tax Credit of up to $10,160.
Knowing the facts is just the beginning. Allison Rosen, PhD, a psychologist
and breast cancer survivor, says women affected by breast cancer
share common concerns, including fear of discrimination and uncertainty
about sharing their cancer history. She wrote about these issues
in “Third Party Reproduction and Adoption in Cancer Patients,” a
study she recently presented at the Parenthood After Cancer Conference,
held at the MD Anderson Cancer Center.
“Most regulatory structures in adoption are very broad,” says Peter Gibbs,
MA, LMFT, director of the Center for Adoption Research at the University
of Massachusetts. “The statutes are general regarding the prospective
parents, including evaluations of their fitness and ability to provide
care and a stable, nurturing environment for the child. The determination
of who can adopt is based on the decision of the professionals who
conduct the home study process.”
In the home study, a social worker meets with the prospective adoptive
parents and makes a home visit over a period of time to ensure you
have the basic capabilities to meet the needs of a child. Home study
workers also explain the adoption process, answer your questions,
discuss the realities of the experience and review your personal
and health history. Home studies are required in all adoptions.
Many people do not realize they can choose
their home study worker, Rosen says. Because home studies have no
set rules, she advises families to pre-interview workers and gage
their attitudes toward cancer before moving forward. “Once you start
the process, it's harder to shift agencies and social workers,”
she says.
To prepare for these interviews, Gibbs suggests your family discuss
some of the difficult issues you may face as a parent and cancer
survivor. Among them are:
* Your motivation for adopting
* How you would handle parenting and communication with your child should you be rediagnosed
* How your partner would handle raising your child alone
Make specific plans for various contingencies. Once you make them, think
them through again and explore their effect on a child. If you became
very ill, how would you manage?
“People who have had cancer are in a position to consider those things,
whereas those who haven't can't even imagine it,” Gibbs says. “But
all parents have an obligation to think about these possibilities. On the positive
side, someone who has considered all of these significant, powerful
possibilities may be very well prepared to parent.”
Another area of concern is the requirement that prospective parents submit
health information, usually in the form of a doctor's letter. This
letter is a critical piece of the information-gathering process,
and its language should be carefully articulated. No set standards
exist, but the letter may describe your diagnosis and treatment,
current medical status, and issues of future medical risk and length
of survival. It can aid in an open discussion of the implications
of a possible loss and the challenges in attachment for the child.
The letter also provides an opportunity to educate your home study worker,
who will explore your current health status, prognosis and issues
related to your experience with cancer, Gibbs says. You may need
to get information from medical specialists to help them understand
the implications of your history with cancer.
“Breast cancer is a complicated illness—it's not one illness—and not all
adoption professionals will understand this,” Gibbs says. “They
will need the help of qualified medical professionals to understand
the issues.”
In a domestic or private adoption the doctor's letter may impact the
decision of the birth parents regarding a prospective parent with
cancer. And legally, no single diagnosis is exclusionary. Says Gibbs:
“There isn't a one-size-fits-all here. People's circumstances should
be evaluated on an individual basis.”
However, foreign authorities or agencies that conduct international adoptions
may have more rigid and exclusionary standards regarding the health
status of prospective adoptive parents. International children usually
have been living in orphanages where attachments to caregivers and
other children may make them more vulnerable to loss than other
children. This phenomenon, known as “attachment disorder,” is more
common in children adopted internationally, Rosen says.
In Rosen's study of six adoption agencies, she found agencies differed
in their openness toward cancer survivors. Between .5 and 10 percent
of the agencies' clients were cancer survivors. “No agency wanted
to discriminate, but they view their primary client as the adopted
child and are protective of the countries they work with,” she says.
Perseverance is important, says Gibbs. For the three women profiled in this article,
perseverance helped them adopt after breast cancer.
For Janet*, 40, one of the biggest challenges of the adoption process
was finding a reliable resource for information. “Selecting the
right agency for a foreign adoption and obtaining word-of-mouth
recommendations from other adoptive parents—from someone else with
breast cancer—helped us find the solution,” Janet says. “You have
to place your complete trust in the agency and all the people you
work with along the way. It's blind faith.”
Diagnosed with breast cancer at age 33, Janet had a two-year-old daughter
and plans for another child. Her treatment comprised a lumpectomy,
chemotherapy and radiation therapy. Because her tumor was estrogen-receptor
positive, she went on tamoxifen.
“I began to feel cautious about getting pregnant again and began to
consider adoption,” says Janet. So at age 36 she consulted an adoption
counselor recommended by her radiation oncologist. “I was afraid
of misinformation and aware that adoption is time consuming. Our
counselor described the process, walked us through domestic and
foreign situations, and explained that relinquishment of parental
rights was different in different states.”
Janet and her husband had no initial preference for domestic versus foreign
adoption. “The focus of our concern was our daughter, who was four
at the time, and how her life was about to change,” Janet says.
“If an adoption did not come to fruition and we had to start over
again, what would be the impact on our daughter? She was an integral
part of the process. Foreign adoption seemed to alleviate some of
the uncertainty, and that's how we decided.”
Leela, 33, recently adopted two children from Russia. Diagnosed two years
ago with stage II breast cancer with lymph node involvement, she
underwent a bilateral mastectomy, chemotherapy and radiation therapy.
“I did a tremendous amount of research into the adoption process
throughout the nine months of my treatment,” says Leela. “I wrote
to and interviewed different social workers and located an agency
I felt comfortable with. It helped me focus on the future.”
At the time, Leela and her husband had a 12-year-old daughter and wanted
a larger family. “Knowing we didn't want a newborn made the option
of foreign adoption our first choice,” says Leela. “The hardest
thing about adopting from Russia is finding an agency that isn't
closed off from considering a woman with breast cancer. The social
worker's personal opinions about cancer do come into play. It's
her interpretation of the home study results that reflect your current
and future health to the agency. The agency we finally settled on
barely mentioned my medical condition in the home study.”
Maria, 36, adopted her first son domestically six years ago. Through a
facilitator, she is finalizing the private adoption of her youngest
son, now one year old, who has lived with her family since birth.
Initially diagnosed at age 24, Maria had a lumpectomy, chemotherapy
and radiation therapy. Four years later her cancer recurred, and
she received a bone marrow transplant.
“My husband and I chose to adopt domestically for three reasons,” says
Maria. “We thought it would be easier to understand the adoption
process here rather than abroad, where we'd have to deal with language
and other barriers. We wanted to adopt a Caucasian infant. And I
had a friend who'd successfully adopted domestically and could guide
me through the process.”
The family had adopted their oldest son privately through an attorney.
“A birth mother would contact the attorney, informing him she had
decided to put her child up for adoption, and he would present her
with four or five sets of prospective parents,” Maria explains.
“After much work and time a match was finally made between a birth
mother and us. The second time around we chose to use an adoption
facilitator through a website. The site lists information about
various birth mothers, such as due date, health status and medical
and agency fees. Prospective parents e-mail the site when they locate
a birth mother that interests them, requesting the birth mother's
profile. Either way, the whole process is time consuming and requires
a lot of paperwork, follow-up and patience.”
Although the process took two years, Maria says the experience was wonderful
and she would do it again. “We were prepared for the home visit
and felt nothing was unanswerable or undoable. The social worker
delved through our backgrounds and asked questions about our own
childhoods, our discipline styles and our likes and dislikes. She
wanted to know who we were and that we'd have a safe place to keep
a baby. My husband and I each had to present doctor's letters stating
we were in good health.”
“Both cancer and the adoption process are intrude on our most intimate
space,” says Gibbs. “We have to tell our personal stories and give
information we don't typically have to share. There's also a certain
element of fear of exposure to the judgment of others.”
“We were completely up front about my health history,” says Janet. “Both
of us felt my breast cancer diagnosis is just one part of who I
am and don't view it as a detriment. I believe all the information
and facts from both sides should be on the table, for everyone involved
to be able to make an informed decision—and a decision in the best
interests of the child.
“Now that we have Miranda [from China], we can't imagine our lives without
her. It's a privilege to bring another culture into our family.
My message to someone else with breast cancer is [that] if you want
to adopt, there is no reason why it can't happen.”
Leela was direct in asking the various social workers she interviewed
how to address questions of medical risk and life expectancy. She
got letters from her oncologist, primary care physician, radiation
oncologist and cancer counselor. Each letter described her treatments
and did not directly provide a prognosis.
For the home study Maria and her husband had to provide proof of financial
stability, present life insurance policies and undergo child abuse
and criminal history record checks. “We also had to have physicals
and demonstrate normal life expectancy,” Maria says. “My medical
history disclosed my 1991 diagnosis and follow-up treatment.”
“My philosophy during the process was, ‘if asked, tell the whole
truth,'” says Leela. “I didn't want to distort the facts and end
up with heartache and lost time and effort. I recommend presenting
all the facts. However, after five years [of disease-free survival],
I might never bring it up. For the home study I was ultra prepared
to overcome the social worker's misconceptions around breast cancer.”
“To other women with breast cancer who decide to adopt, I say don't
give up,” Leela says. “If you get a ‘no' at one door, go to the
next. Open the phone book and get on the Internet. Someone will
work with you. Interview the social workers, be selective and don't
be frightened by rejection. Ask them how they conduct the home study
and how they feel about your prognosis. Ask about the agency's policies
and whether you have to mention your cancer history if you are adopting
within the first five years of diagnosis and treatment. Focus on
your current health.”
Maria advises: “Both cancer and adoption are like riding a rollercoaster.
Each is an emotional ride, and the hardest part is the waiting.
Neither is easy, but I am a witness that success can happen.”
* Not her real name. LBBC withheld the women's names upon their request.
Select Resources
* A listserve and resource for people interested in adopting after cancer:
http://groups.yahoo.com/group/adoption-after-cancer
* About state adoption laws:
National Adoption Information Clearinghouse: naic.acf.hhs.gov
Center for Adoption Research: www.centerforadoptionresearch.org
* Nonprofit groups
FertileHOPE: www.fertileHOPE.org
Living Beyond Breast Cancer: www.lbbc.org
Resolve: www.resolve.org
Young Survival Coalition: www.youngsurvival.org
* About the adoption tax credit:
Internal Revenue Service: www.irs.gov/taxtopics/tc607.html
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