Public and private adoption agencies consider a number of factors when determining whether a couple or individual is fit to be an adoptive parent. One of the factors is the health of prospective adoptive parents. Health is relevant because agencies want to provide permancy for a young person and to be sure that a health condition does not interfere with the adoptive parent's ability to parent.

Because of the federal Americans With Disabilities Act (ADA), decisions in the U.S. about whether to permit adoption by a person with a health history must be made on an individualized basis based on actual risks and the use of reasonable judgment. If a person is rejected because of health reasons, the ADA requires that the rejection must be justifiable. (For more information about the ADA and adoption, click here.)

Following are the eight steps to take to maximize your chances of an adoption going through. 

• Step 1. Review your financial situation. 
  • An adoption agency will likely consider whether you have adequate health insurance or other financial means to meet what may be substantial medical bills while financially supporting a child. (To help assess your situation, see: Budget. To help improve your financial condition, see Financial Planning).
  • Can your economic entity reasonably afford to raise a child? Consider costs of clothing, food, medical care, education
• Step 2. Let both your primary care doctor and your specialist who treats or treated your health condition know that you are considering adoption. Ask his or her opinion about the question whether you are physically and psychologically able to meet the needs of a child from infancy to adulthood.
• Step 3. Obtain a letter from the specialist who treated or continues to treat your health condition. The letter should include the following:
  • A description of your health history, including diagnosis (in general terms).
  • The date of completion of treatment and the result.
  • An assessment of your current health condition.
  • The doctor's opinion about the prospects for your health in the future. If possible, the letter should include documentation for the doctor's opinion, as well as a percentage which reflects the doctor's degree of certainty about his/her opinion concerning the future.
• Step 4. Create a list of family and friends who can help support the child emotionally, physically and financially. Check with each of the people on your list to be sure they agree with your assessment of their ability and of their willingness to participate if necessary.
• Step 5. Think about what your decision would be if you were asked by an agency about your willingness to seek therapy for you and your partner as well as for the child due to the stress and potential effect on the child if your condition becomes terminal.
• Step 6. Examine your home to be sure that it is a child friendly place. If not, take the steps necessary to make it one.
• Step 7. Discuss with your partner, and reach agreement about:
  • Parental motivation and expectations about adoption.
  • Feelings about infertility
  • Parenting styles
• Step 8. Consider meeting with a social worker or a lawyer who specializes in adoption. While you must answer all questions honestly, such a specialist can help you:
  • Decide which adoption agency to approach based on which agency has been most understanding in the past of people with your medical history.
  • Frame how to present medical and financial information.
  • Obtain appropriate documentation.
  • Avoid unnecessary pitfalls. For example, most agencies will inspect your home. You may keep pill bottles in the open as a reminder to take them. To an observer, the bottles may be a sign of an ongoing illness.

For information about finding a social worker who specializes in adoption, click here. For information about a lawyer who specializes in adoption or a local accredited adoption agency, click here.

If you do not qualify for a local adoption, consider an international adoption. 

• U.S. law does not apply to other countries. Prospective adoptive U.S. parents must look to the law of each country to determine whether they can adopt despite a medical history.
• While it is not impossible, it is very difficult to adopt internationally if you have a history of a serious health condition. For information about adoption in foreign countries, including information about the law as well as practical information, see:
  • The "Quick Links" section at: www.adoptivefamilies.com
  • www.karensadoptionlinks.com
  • Adoption specialists will also know about local and international requirements.
• International adoptions tend to be more expensive than domestic adoptions.  In addition to an adoption agency's service fee for the home study, etc., there is a fee established by the sending company plus the costs of traveling to that country to complete the adoption and bring the child home.

KEEP IN MIND:

• You must be honest and open with an adoption agency. That does not mean you are required to volunteer any information. In fact, you are not required to volunteer any information unless it could be harmful to the child. We recommend erring on the side of disclosing any information which could possibly be harmful to the child. Let the professionals decide whether it could be harmful.
• Adoptions take time, no matter how fast the prospective adoptive parents want things to happen. They can also involve a great deal of stress.
• There is a one-time federal tax credit referred to as the "adoption credit."  For information, see: www.irs.gov/taxtopics/tc607.html

NOTE: If you do adopt, you may be eligible to claim a federal adoption tax credit for qualified adoption expenses for an eligible child. The amount of the credit varies from year to year. For information about the tax credit, click here .

The other sections of this document, contain the following information:

• Prospective Adoptive Parents With Cancer
• Prospective Adoptive Parents With HIV/AIDS
• Examinations To Expect Before Approval As An Adoptive Parent
• How To Find An Accredited Adoption Agency
• For More Information About Adoption

Under the Americans With Disabilities Act (ADA), public and private adoption agencies cannot discriminate against a person with a disability who wants to adopt a child.

The prohibition applies to all adoption agencies, regardless of whether the agency is public or private and regardless of size.

"Disability" for purposes of the ADA doesn't have to be what you might think of as a disability, such as someone in a wheelchair. The statute defines "disability" in a way that can arguably include a life changing diagnosis. (The ADA likely encompasses your diagnosis because of the effects of your health history or because people may perceive you as disabled because of a history of a serious health condition. If you want to learn more about the law, see: ADA).

For our purposes, the ADA requires that every prospective adoptive parent with a medical history be given an equal opportunity to participate. Simply put, this means that the ADA requires people with a disability be given an opportunity that is the same as the opportunity extended to applicants who are not disabled. It does not guarantee individuals with disabilities an unquestioned right to adopt.

An adoption agency that rejects a disabled person as a prospective adoptive parent must either:

• Establish that the disability was not the reason for the applicant's rejection OR
• If the disability was the basis for the decision, the rejection was justified based on current medical knowledge or on the best available objective evidence in determining the risks involved and the actual abilities and disabilities of the individual.

As a general matter, when an adoption agency asks health questions may be relevant in helping to determine whether the agency discriminates on the basis of health or not.

• If an agency asks health questions up front, it may have a discriminatory policy. 
• On the other hand, questions about physical health and possibly even a medical examination may be okay after initial screening. It is appropriate for an agency to look at whether you are physically able to take care of a child. The agency may not look at "why."  

If you feel that you have been discriminated against, you have a right to file a complaint with the Department of Justice and/or file a private lawsuit. In the lawsuit, you can seek injunctive relief, money damages, and reasonable attorneys' fees. For advice about the best manner for you to proceed, contact an adoption lawyer in your area. (See below.)

The Americans With Disabilities Act (ADA) prohibits discrimination based on HIV infection. There is no need for recognizable symptoms associated with HIV or with full-blown AIDS.

As a general rule, people with cancer cannot adopt until after completion of treatment. Many states also have a five year rule which requires that five years pass fafter the date of diagnosis becuase adotpion will be permitted.

The longer a person is cancer free after treatment, the more likely the diagnosis will not prevent becoming an adoptive parent.

Sometimes people with advanced illness get approval to be adoptive parents when their condition is stable. In this event, it is likely the agency will pay particular attention to the role the other prospective adoptive parent will be able to play in supporting and caring for the child, as well as the support that is available from extended family and friends. The agency may also consider the community resources that can be mobilized to ensure that the child remains safe, well cared for, and appropriately supervised.

For advice and support after adoption, look at the on-line bulletin board at Yahoo, "Adoption after Cancer ."  

The adoption home study is required in all adoptions. The examination, which is usually conducted by a social worker, includes:

• A review of the marriage and family relationships.
• Parental motivation and expectations about adoption.
• Feelings about infertility.
• Parenting styles.
• Physical and health history of the applicants.
• Parental education.
• Parental employment.
• Finances.
• References.
• A criminal background clearance.

Legal adoption agencies receive a license from the state to perform adoption services.

Adoption agencies which are accredited by the Council on Accreditation are held to the highest standards.

To find an accredited adoption agency in your community, see:

• www.adoptivefamilies.com/search/agencies.php
• www.adoptioncouncil.org   Click on "For Families" to find organizations that are members of National Council for Adoption.
• Oncofertility Consortium at Northwestern University provides a list of adoption agencies that are willing to work with couples with a cancer history. For information, go to www.oncofertility.northwestern.edu . Type "adoption agencies" in the search box.

You can find a social worker who specializes in adoption through a social worker with which you work or through the National Social Worker Finder: www.helpstartshere.org/common/Search/Default.asp. . 

Ask for personal recommendations from friends and doctors. Then ask for credentials and references from the professionals you contact.
Also visit:

• The website of the American Academy of Adoption Attorneys: www.adoptionattorneys.org
• The Adoption Families': www.theadoptionguide.com/process/finding-an-attorney

Websites to consider for more information include the following:

• www.adoption.com
• www.adoptivefamilies.com
• www.breastcancer.org/adoption.html
• www.fertilehope.org
• http://naic.acf.hhs.gov

Information reviewed by volunteer:

Susan Watson

Director of Domestic Adoption

www.spence-chapin.org