The story of Maria Tomasa is deeply moving. Tommy went through a difficult process to find support in her wish to have a child. Then she risked her health in this pregnancy. Finally, she accepted that her story be told and commented on by strangers. All three steps show admirable courage. The authors must also be commended for publishing a case highlighting several issues on which reasonable people may disagree. Without attempting definitive answers, we comment on a few points illustrated by this story.