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Ectogenesis Offers Multiple Unique Benefits
Evie Kendal   Nov 3, 2015   Ethhical Technology  

The recent news that womb transplants will be trialled in the UK has sparked much debate regarding the desirability of this and other future infertility interventions.  Perhaps unsurprisingly, the idea of artificial wombs has been brought into this discussion, complete with the usual concerns about women’s reproductive liberty.

Eleanor Robertson writes for The Guardian that the advent of ectogenesis technology would inevitably challenge abortion rights, a common argument relying on the severance theory justification for terminating fetal life with the intention of promoting a woman’s right to bodily autonomy. As the argument goes, a woman’s “right to choose” termination of an unwanted pregnancy only permits the death of the fetus on the basis of necessity; that is, since the established goal cannot be achieved except through the latter consequence this “unfortunate” side effect must be tolerated.

In her article, “Women, Ectogenesis and Ethical Theory,” Leslie Cannold notes that ectogenesis poses a challenge to the accepted wisdom that abortion is “synonymous with fetal death” as it provides the potential to continue gestation in an artificial womb after physiological pregnancy has been interrupted. This issue is at the crux of many feminist objections to the emerging technology. A secondary concern focuses on the legal and moral status of the ectogenetic fetus.

While there are some unique ethical and legal issues at stake regarding artificial gestation, most of the concerns regarding abortion and fetal rights are resolvable through existing ethical models dealing with human life on the boundaries of existence. This can be best illustrated by separating fetal life into two stages: pre-independent viability and post-independent viability. For the purposes of this discussion “independent” will be used to refer to a fetus with the ability to survive outside the womb without technological assistance.

Pre-independent viability

At present, countries that permit abortion “on demand” only do so until the point of viability – an often ill-defined or arbitrary gestational cut off point believed to demonstrate when the State might acquire an interest in preserving fetal life. Fetuses are not generally considered to have legal personhood until they are born alive, so for as long as their biological existence entirely depends on another person, its continuation is subject to the willingness of that person to sustain them.

Introducing ectogenesis into this paradigm need not be problematic, as assuming the present justification for abortion is sound, and assuming the method of fetal extraction for transfer into an artificial womb would differ from the method of pregnancy termination otherwise chosen, the need for informed and voluntary consent from the woman for the procedure would preclude anyone being forced into fetal transfer rather than abortion. Ectogenesis could, however, provide a welcome alternative for women whose wanted pregnancies spontaneously abort, although the practical limitations involved limit the potential benefit achievable here.

For fetuses gestated entirely outside the womb, concerns tend to focus on establishing legal guardianship and guidelines for when it might be ethically acceptable to terminate artificial gestation (e.g. following the discovery of a serious genetic disorder). While the first issue can look to surrogacy arrangements for answers, the second is possibly better handled by looking at end-of-life care. It is common for medical interventions, including life support, to be withheld or withdrawn from terminally ill patients on the basis that it is not in their interest to have their lives extended under the circumstances.

Once treatment has been judged futile and technological prolongation of existence to be antithetical to human dignity, such interventions can cease without it being considered killing. In a similar way, technological prolongation of existence could be abandoned for a non-viable ectogenetic fetus. Since human adults with full legal personhood cannot demand a “right” to unlimited life support, it would seem implausible to bestow such a right on an early stage fetus.

Post-independent viability

Once the ectogenetic fetus has developed to the point that it could survive outside of the artificial womb, the same restrictions on termination might reasonably be extended as in the case of a physiologically gestated fetus. Further, if a terminated fetus shows signs of life this might justify transfer to an artificial womb, much as it does for babies born very prematurely who are transferred into humidicribs.

One of the major benefits of ectogenesis would be the ability to bridge the gap between premature infants that are given a chance at life, and those that are not. This is particularly relevant when considering that “viability” is not a moral distinction, but a practical one that is heavily influenced by circumstances, e.g. distance to a hospital at the onset of labour, availability of high-technology care, hospital policies on transferring infants to neo-natal ICU, etc.  

Having discussed the most common concerns regarding ectogenesis it is now beneficial to consider the unique advantages of embracing this technology. For women who have lost their womb to injury or cancer, ectogenesis might represent the next best thing to physiological pregnancy while simultaneously avoiding the need to engage a surrogate. The same argument applies to women who were born without a womb (including transgender women), and to gay couples.

Ectogenesis also provides for the needs of women who cannot safely be pregnant or whose lifestyles would not easily accommodate pregnancy. It would also provide a method of terminating an unwanted pregnancy that didn’t also bring about the death of the fetus for those women who are morally opposed to abortion on these grounds. Wanted pregnancies could also be transferred into artificial wombs if a medical condition arises in which standard treatment causes harm to the fetus (e.g. chemotherapy). It is noteworthy that many of these advantages are unique to ectogenesis and cannot be achieved through existing reproductive biotechnologies.

While accepting a womb transplant may remain the preferred option for some women, the risks involved in temporarily transplanting a foreign organ into a woman and trying to establish an IVF pregnancy in it later, indicate this option won’t appeal to all eligible candidates. Ectogenesis might be a more favourable alternative for some, and need not diminish the rights of those who wish to avoid it.

Given the necessary legislative support, research into ectogenesis technology has the potential to cause a dramatic shift in cultural assumptions regarding women’s role in reproduction, and if handled correctly, could promote more equitable distribution of the burdens and benefits of parenthood.

Evie Kendal is a feminist bioethicist and literary critic from Melbourne, Australia. She works as an Assistant Lecturer for the School of Public Health and Preventive Medicine at the Alfred Hospital Centre, teaching into the Bachelor of Health Science and Bachelor of Biomedical Science degree programs. Evie also teaches medical ethics and philosophy at Monash and is a seminar leader at Yale University's Interdisciplinary Center for Bioethics Summer Institute where she teaches a course on bioethics and biotechnology. Evie's research focuses on the representation of ectogenesis and other reproductive biotechnologies in popular culture and the impact this has on public policy and the bioethical debates surrounding these technologies.



COMMENTS

It is hard to see a downside to ectogenesis.  In particular, it is hard to see how it could be a woman’s rights issue, since it only offers more options.

The reason I am writing this is to confront a particularly perplexing issue to me: snowflake babies (a baby born following the transfer of a surplus embryo produced during the in-vitro fertilization of one woman to the womb of another woman who was not a cell donor).

I simply don’t understand how people who claim that they are concerned about the “unborn baby” in women’s wombs can ignore the much larger problem of surplus embryos sitting inside IVF clinic freezers.  Inevitably, the cell donors opt for eventual destruction of those zygotes, instead of paying the perpetual fee for continuing cold storage.

Using the logic of the “pro-life” movement, the flushing down the sink of hundreds of thousands of “unborn babies” each year is a Holocaust beyond measure, and dwarfs the number of abortions performed.

Being a futurist, I foresee a time in the near future where we will start migrating beyond the Earth’s gravity well, and will find useful vast numbers of people to populate the off-world settlements.  Ectogenesis combined with snowflake babies will offer us a miraculous opportunity to enlarge the human population dramatically in a short time.

The issue of surplus embryos is one I hope will be solved soon by perfecting ova freezing techniques (see work by fertility preservation team Levi-Setti et al. here: http://www.ncbi.nlm.nih.gov/pubmed/24794316). Since sperm can already be safely frozen and stored, improving the success rate of ova freezing might negate the need to freeze fertilised eggs at all and thus alleviate some of the concerns noted. Were ectogenesis available, some people with stored embryos might indeed consent for them to be gestated artificially and adopted out in a similar manner as the ‘snowflake’ arrangement.

It is strange that many pro-life organisations are so opposed to the development of technologies like ectogenesis given the potential it has to save fetal life (including saving the lives of infants born extremely premature). Unfortunately I feel that rather than being genuinely pro-life some are in fact simply anti-abortion (or in extreme cases anti-women). A more authentic pro-life stance would surely focus on providing families the means of supporting additional children.

I hadn’t really thought about using ectogenesis to gestate humans off-world, but I would be very curious to know whether in the future it would be possible to extend the 9-month gestation period using such technology. There are a number of theories regarding why human infants are so defenceless compared to other species that focus on the need to be born before the head grows to a size the birth canal cannot accommodate. If this practical constraint could be removed, what then?

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