In March 1986, Mary Beth Whitehead and her husband went to a New Jersey hospital and kidnapped a baby girl. She had given birth to the girl three days earlier. They took the infant to Florida, launching the first case examining the legitimacy of surrogate motherhood in America. Four decades later, surrogacy is so out of control that it risks being banned in the U.S. and around the world.

Whitehead had signed an agreement with William and Elizabeth Stern. She agreed to be artificially inseminated with William’s sperm, using her own eggs, carry any pregnancy to term, and then relinquish her parental rights to the Sterns. She was to be paid $10,000. When the baby was born, she changed her mind and decided to keep the girl — thus the escape to Florida.

The custody case went all the way to the New Jersey Supreme Court. In 1988 it ruled that surrogacy contracts were invalid in the state while returning the question of parenting to the family court. That court awarded custody to the Sterns, arguing that the baby would be better off with the Sterns as parents.

Forty years after the birth of Baby M, surrogacy remains an unregulated, troubling ethical mess. The current case of McKenna West makes clear we have not come very far.

A California couple, Omar Ahmed and Nausheen Gilkar, hired West, a nurse and single mother of two living in Alaska, through a for-profit agency to carry their embryo to birth. West was to receive pay and financial benefits for medical fees, travel, and living expenses.

The battle over this surrogate arrangement began when, at close to 20 weeks, the fetus was diagnosed with a rare, life-threatening heart defect. West says that once the condition was known, the Los Angeles couple demanded she abort the pregnancy.

West was horrified and decided to break the surrogacy contract, which required abortion in the case of a massive fetal defect. She left Alaska and flew to Dallas, knowing that abortion is basically illegal in Texas. There she sought and received support from local anti-abortion groups and politicians.

She delivered the baby at Children’s Medical Center of Dallas on Aug. 12. She named the baby Gabriel. The couple who hired her and whose embryo was used named her Rumi. A Dallas judge has issued a temporary restraining order, keeping the newborn hospitalized in Texas pending a key court hearing on custody of the baby, which will involve authorities in Alaska, California, and Texas.

Everything about the West case shows how miserably surrogacy has been managed in America. Surrogacy is a big business in which wealthy people use expensive lawyers and agencies to hire less wealthy people to bear their kids. There are no legal limits on who can hire a surrogate, be a surrogate, or how many surrogates can be hired at the same time by the same intended parents. Concurrent surrogacy is used to increase the odds of having a child — in some instances, for rich, single men to create as many of their biological offspring as their egos demand.

When disputes break out — when a surrogate changes her mind or puts the pregnancy in danger; a serious birth defect occurs; payments are not made; and the intended parents die, divorce, or become unexpectedly bankrupt or even arrested — no laws exist to resolve what is best for all parties, especially babies. Surrogates cross state lines; some flee overseas, making a complete shambles of legal jurisdiction. As with West, surrogates try to flee to states where they think they will get a more favorable reception for their wishes.

The lack of any rules or governance has led many — including the Vatican, Southern Baptists, various U.N. agencies, the Heritage Foundation, and many feminist advocacy groups — to call for a total ban on surrogacy.

Custody disputes triggered by surrogacy don’t end at birth. As the West case and other stories make clear, crucial decisions will have to be made about trying to save the baby’s life. Surgeries to correct a seriously malformed heart like Gabriel/Rumi’s are risky. Heart transplantation may be required but is a long shot given the scarcity of donated infant hearts. So who gets custody in the West case will be crucial to what, where, and whether expensive, high-tech medical care is done.

Do cases like Whitehead, West, and many other heated disputes show that prohibition is the only answer? I don’t think so. Instituting eight principles through state laws (since states generally oversee surrogacy) would greatly help provide basic order to this Wild West.

1. Every surrogate should have her own independent lawyer paid for by the agency that recruits her.

2. Surrogates control their pregnancies; they cannot be forced to get an abortion or even remain drug-free during a pregnancy. Persuasion, sure, but no one can sign away fundamental rights for a fee.

3. Biological parents who create embryos are presumed to be the parents in any dispute. They could lose that status through misconduct or illness, but that is the presumption.

4. The jurisdiction for resolving any potential disputes that arise must be named in the contract.

5. Surrogacy contracts and laws should make it clear that people hiring surrogates cannot abandon the surrogate or the fetus financially or the child after birth. They must accept, raise, and provide all care regardless of disability.

6. All contracts must use all means available, including counseling to ensure surrogates comprehend them.

7. Only medical reasons can be used in justifying concurrent surrogacy, and a qualified physician must attest to them in writing.

8. Finally, the guiding principle in surrogacy will be what is in the child’s long-term best interest.

Perhaps counterintuitively, 40 years of wrangling point not toward banning surrogacy, but to the steps needed to regulate it. Allowing people to use technology to have a family is a moral good. Failing to act legislatively to protect the interests of all parties involved is not.

Arthur Caplan is professor emeritus at NYU Grossman School of Medicine.