1
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Kennedy S. Ectogenesis and the value of gestational ties. Bioethics 2024. [PMID: 38183623 DOI: 10.1111/bioe.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/26/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
Ectogenesis technology would make it possible to support the complete gestational development of a human being outside the female body. Proponents argue that this technology offers a welcome opportunity to expand reproductive options for those unable or unwilling to gestate. However, by completely bypassing pregnancy, the use of ectogenesis prevents the formation of gestational family ties. Consequently, it has faced criticism for perpetuating a patriarchal view of the family that undermines the moral significance of gestation. The concern is that the introduction of this technology might result in the loss of reproductive autonomy for those who desire to experience pregnancy, as they face pressures to opt for ectogenesis instead. Existing accounts of family values define parents' rights to rear a child, but they fail to establish a right to gestate that can protect an individual's interest in bearing a child. To provide a more comprehensive account of family values, I argue that pregnancy involves a unique quality of intimacy and can make distinct contributions to one's flourishing. Based on this premise, I defend a fundamental moral right to gestate that can help safeguard the option of pregnancy for those who desire it. In conclusion, I consider how a prospective gestator need not provide optimal conditions for fetal development in the way that ectogenesis promises in order for their choice of pregnancy to be justified.
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Affiliation(s)
- Susan Kennedy
- Philosophy Department, Santa Clara University, Santa Clara, California, USA
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2
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Kendal E. Whose (germ) line is it anyway? Reproductive technologies and kinship. Bioethics 2023. [PMID: 38105607 DOI: 10.1111/bioe.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Reproductive biotechnologies can separate concepts of parenthood into genetic, gestational and social dimensions, often leading to a fragmentation of heteronormative kinship models and posing a challenge to historical methods of establishing legal and/or moral parenthood. Using fictional cases, this article will demonstrate that the issues surrounding the intersection of current and emerging reproductive biotechnologies with definitions of parenthood are already leading to confusion regarding social and legal family ties for offspring, which is only expected to increase as new technologies develop. Rather than opposing these new technologies to reassert traditional concepts of the family, however, this article will explore the opportunities that these technologies represent for re-imagining various culturally cherished values of family-making in a way that is inclusive of diverse genders, sexualities and cultures. It will consider IVF, gametogenesis, mitochondrial donation, surrogacy, artificial gestation, CRISPR-Cas9 gene editing, foster care and adoption as some of many possible pathways to parenthood, including for members of the LGBTIAUQ+ community.
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Affiliation(s)
- Evie Kendal
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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3
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Bulletti FM, Sciorio R, Palagiano A, Bulletti C. The artificial uterus: on the way to ectogenesis. ZYGOTE 2023; 31:457-467. [PMID: 37357356 DOI: 10.1017/s0967199423000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
The inability to support the growth and development of a mature fetus up to delivery results in significant human suffering. Current available solutions include adoption, surrogacy, and uterus transplantation. However, these options are subject to several ethical, religious, economic, social, and medical concerns. Ectogenesis is the process in which an embryo develops in an artificial uterus from implantation through to the delivery of a live infant. This current narrative review summarizes the state of recent research focused on human ectogenesis. First, a literature search was performed to identify published reports of previous experiments and devices used for embryo implantation in an extracorporeally perfused human uterus. Furthermore, studies fitting that aim were selected and critically evaluated. Results were synthesized, interpreted, and used to design a prospective strategy for future research. Therefore, this study suggests that full ectogenesis might be obtained using a computer-controlled system with extracorporeal blood perfusion provided by a digitally controlled heart-lung-kidney system. From a clinical perspective, patients who will derive significant benefits from this technology are mainly those women diagnosed with anatomical abnormalities of the uterus and those who have undergone previous hysterectomies, numerous abortions, and experienced premature birth. Ectogenesis is the complete development of an embryo in an artificial uterus. It represents the solutions for millions of women suffering from premature deliveries, and the inability to supply growth and development of embryos/fetuses in the womb. In the future, ectogenesis might replace uterine transplantation and surrogacy.
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Affiliation(s)
| | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, Royal Infirmary of Edinburgh, EdinburghEH16 4SA, UK
| | - Antonio Palagiano
- Reproductive Science Pioneer, Assisted Fertilization Center (CFA), Naples, Italy
| | - Carlo Bulletti
- Extra Omnes, Assisted Reproductive Technology (ART), Center in Cattolica, Italy, and Associate Adjunct Professor, Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, Connecticut, USA
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4
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Lavazza A, Reichlin M. Human Brain Organoids: Why There Can Be Moral Concerns If They Grow Up in the Lab and Are Transplanted or Destroyed. Camb Q Healthc Ethics 2023:1-15. [PMID: 37288491 DOI: 10.1017/s096318012300021x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Human brain organoids (HBOs) are three-dimensional biological entities grown in the laboratory in order to recapitulate the structure and functions of the adult human brain. They can be taken to be novel living entities for their specific features and uses. As a contribution to the ongoing discussion on the use of HBOs, the authors identify three sets of reasons for moral concern. The first set of reasons regards the potential emergence of sentience/consciousness in HBOs that would endow them with a moral status whose perimeter should be established. The second set of moral concerns has to do with an analogy with artificial womb technology. The technical realization of processes that are typically connected to the physiology of the human body can create a manipulatory and instrumental attitude that can undermine the protection of what is human. The third set concerns the new frontiers of biocomputing and the creation of chimeras. As far as the new frontier of organoid intelligence is concerned, it is the close relationship of humans with new interfaces having biological components capable of mimicking memory and cognition that raises ethical issues. As far as chimeras are concerned, it is the humanization of nonhuman animals that is worthy of close moral scrutiny. A detailed description of these ethical issues is provided to contribute to the construction of a regulative framework that can guide decisions when considering research in the field of HBOs.
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Affiliation(s)
- Andrea Lavazza
- University of Pavia, Pavia, Italy
- Centro Universitario Internazionale, Arezzo, Italy
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5
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Battisti D. Attitudes, intentions and procreative responsibility in current and future assisted reproduction. Bioethics 2023; 37:449-461. [PMID: 36916879 DOI: 10.1111/bioe.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 11/30/2022] [Accepted: 02/07/2023] [Indexed: 05/20/2023]
Abstract
Procreative obligations are often discussed by evaluating only the consequences of reproductive actions or omissions; less attention is paid to the moral role of intentions and attitudes. In this paper, I assess whether intentions and attitudes can contribute to defining our moral obligations with regard to assisted reproductive technologies already available, such as preimplantation genetic diagnosis (PGD), and those that may be available in future, such as reproductive genome editing and ectogenesis, in a way compatible with person-affecting constraints. I propose the parent-child relationship argument, which is based on the moral distinction between creating and parenting a child. Hence, I first argue that intentions and attitudes can play a role in defining our moral obligations in reproductive decisions involving PGD. Second, I maintain that if we accept this and recognize reproductive genome editing and ectogenesis as person-affecting procedures, we should be committed to arguing that prospective parents may have moral reasons to prefer reproduction via such techniques than via sexual intercourse. In both cases, I observe an extension of our procreative responsibility beyond what is proposed by the consequentialist person-affecting morality.
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Affiliation(s)
- Davide Battisti
- Department of Law, University of Bergamo, Bergamo, Italy
- IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
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6
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Kendal ES. Form, Function, Perception, and Reception: Visual Bioethics and the Artificial Womb. Yale J Biol Med 2022; 95:371-377. [PMID: 36187409 PMCID: PMC9511943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Artificial wombs are already in development that have the potential to radically alter how we perceive the developing fetus and the role of pregnancy in society. That this technology would allow greater visibility of gestation than ever before also highlights the risk that artificial wombs will be used to further restrict women's reproductive liberty and access to abortion. This article uses Paul Lauritzen's theory of "visual bioethics" to explore the ethical significance of images of the developing fetus and how artificial wombs might best be visually designed and integrated into society.
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Affiliation(s)
- Evie S. Kendal
- To whom all correspondence should be addressed:
Dr. Evie Kendal, Swinburne University of Technology, John Street, Hawthorn,
Victoria, Australia;
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7
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Anifandis G, Sutovsky P, Turek PJ, Chavez SL, Kunej T, Messini CI, Schon SB, Mavroforou A, Adashi EY, Krawetz SA. Bioethics in human embryology: the double-edged sword of embryo research. Syst Biol Reprod Med 2022; 68:169-179. [PMID: 35380489 DOI: 10.1080/19396368.2022.2052771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There has been a significant increase in the use of assisted reproductive therapies (ARTs) over the past several decades, allowing many couples with infertility to conceive. Despite the achievements in this field, a mounting body of evidence concerning the epigenetic risks associated with ART interventions such as ovarian hormonal stimulation, intracytoplasmic sperm injection (ICSI), and in vitro culture (IVC) of oocytes and embryos has also emerged. Induced development of multiple follicles, the IVC media itself, and extended culture may alter the epigenome of both gametes and embryos, resulting in yet to be fully understood developmental, postnatal, and adult life health consequences. Investigators have attempted to decipher the molecular mechanisms mediating ART-induced epigenetic changes using either human samples or animal models with some success. As research in this field continues to expand, the ethical responsibilities of embryologists and researchers have become critically important. Here, we briefly discuss the ethical aspects of ART research, concentrating on the constraints arising from the perceived 'unnaturalness' of many of these procedures. Secondly, we focus on the bioethics and morality of human embryo research in general and how ethically acceptable model systems may be used to mimic early human embryogenesis. Lastly, we review the 14-day culture limit of human embryos and the notion that this rule could be considered of taken into account using new technologies and cues from animal models. The 'black box' of early post-implantation embryogenesis might be revealed using embryo models. As long as this distinct moral line has been drawn and closely followed, we should not fear scientific growth in embryo research. Although in vitro fertilization (IVF) is ethically acceptable, research with human embryos to improve its success raises serious ethical concerns that are in need of constant revisiting.Glossary index: Moral status: the ascription of obligations and rights to embryos on the basis of sentience; Sentience: the capacity of the developing embryo to experience feelings and sensations, such as the awareness of pain; Ectogenesis: the growth of the embryo in an artificial environment outside the mother's body.
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Affiliation(s)
- George Anifandis
- Department of Obstetrics and Gynecology, ART Unit, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Peter Sutovsky
- Division of Animal Sciences and the Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | | | - Shawn L Chavez
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Departments of Obstetrics & Gynecology, Molecular & Medical Genetics, and Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Tanja Kunej
- Biotechnical Faculty, Department of Animal Science, University of Ljubljana, Domzale, Slovenia
| | - Christina I Messini
- Department of Obstetrics and Gynecology, ART Unit, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Samantha B Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Mavroforou
- School of Health Sciences, Faculty of Nursing, University of Thessaly, Larisa, Greece
| | - Eli Y Adashi
- Center for Prisoner Health and Human Rights, The Warren Alpert Medical School, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology, Molecular Medicine & Genetics, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
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8
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Abstract
This paper argues that uterine transplants are a potentially dangerous distraction from the development of alternative methods of providing reproductive options for women with absolute uterine factor infertility (AUFI). We consider two alternatives in particular: the bioengineering of wombs using stem cells (which would carry fewer risks than uterine transplants) and ectogenesis (which would not require surgical intervention for either the prospective mother with AUFI or a womb donor). Whether biologically or mechanically engineered, these womb replacements could provide a way for women to have children, including genetically related offspring for those who would value this possibility. Most importantly, this alternative would avoid the challenge of sourcing wombs for transplant, a practice that we argue would likely be exploitative and unethical. Continued research into bioengineering and ectogenesis will therefore remain morally important despite the recent development of uterine transplantation, even if the procedure reaches routine clinical application.
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9
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Abstract
Most existing literature on the ethics of full ectogenesis has proceeded under the presupposition that science will at some point produce sophisticated technologies for full-term gestation (from embryo to infant) outside the human womb, delivering neonate health outcomes comparable with (or even superior to) biological gestation. However, the development of this technology-as opposed to the support systems currently being advanced-would require human subject experiments in embryo-onwards development using ectogenic prototypes. Literature on ectogenic research ethics has so far focused on 'backwards' development of partial ectogenesis: incubation and ectogestation technologies that would allow the support of earlier and earlier neonates and foetuses. However, little has been said about the ethics of 'forwards' development of (partial or full) ectogenesis, involving the development of embryos and foetuses in prototype environments. Such a prototype might allow us to produce a gestateling or live neonate from a human embryo, but with poorer expected development and health outcomes than from biological gestation; it might also produce only gestatelings (healthy or otherwise) before the technology was developed to a stage where full-term gestation was achievable. This paper explicates some of the ethical issues that this raises for the development of 'full' ectogenesis, and presents prima facie reasons to consider this research problematic and therefore to require extensive further argument in its defence.
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Affiliation(s)
- Teresa Baron
- Institute of Philosophy, Czech Academy of Sciences, Praha, Czech Republic
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10
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Verweij EJ, De Proost L, van Laar JOEH, Frank L, Obermann-Borstn SA, Vermeulen MJ, van Baalen S, van der Hout-van der Jagt MB, Kingma E. Ethical Development of Artificial Amniotic Sac and Placenta Technology: A Roadmap. Front Pediatr 2021; 9:793308. [PMID: 34956991 PMCID: PMC8694243 DOI: 10.3389/fped.2021.793308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
In this paper we present an initial roadmap for the ethical development and eventual implementation of artificial amniotic sac and placenta technology in clinical practice. We consider four elements of attention: (1) framing and societal dialogue; (2) value sensitive design, (3) research ethics and (4) ethical and legal research resulting in the development of an adequate moral and legal framework. Attention to all elements is a necessary requirement for ethically responsible development of this technology. The first element concerns the importance of framing and societal dialogue. This should involve all relevant stakeholders as well as the general public. We also identify the need to consider carefully the use of terminology and how this influences the understanding of the technology. Second, we elaborate on value sensitive design: the technology should be designed based upon the principles and values that emerge in the first step: societal dialogue. Third, research ethics deserves attention: for proceeding with first-in-human research with the technology, the process of recruiting and counseling eventual study participants and assuring their informed consent deserves careful attention. Fourth, ethical and legal research should concern the status of the subject in the AAPT. An eventual robust moral and legal framework for developing and implementing the technology in a research setting should combine all previous elements. With this roadmap, we emphasize the importance of stakeholder engagement throughout the process of developing and implementing the technology; this will contribute to ethically and responsibly innovating health care.
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Affiliation(s)
- E J Verweij
- Division of Fetal Therapy, Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - Lien De Proost
- Department of Obstetrics and Gynaecology, Erasmus Medical Center (MC), Rotterdam, Netherlands.,Department of Neonatology, Erasmus Medical Center (MC), Rotterdam, Netherlands.,Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center (MC), Rotterdam, Netherlands
| | - Judith O E H van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands.,Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Lily Frank
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - Marijn J Vermeulen
- Department of Neonatology, Erasmus Medical Center (MC), Rotterdam, Netherlands.,Care4Neo, Rotterdam, Netherlands
| | | | - M Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands.,Faculty of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Elselijn Kingma
- Department of Philosophy, King's College London, London, United Kingdom
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11
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Kendal E. Unique benefits of ectogenesis outweigh potential harms. Emerg Top Life Sci 2019; 3:719-22. [PMID: 32915221 DOI: 10.1042/ETLS20190112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Abstract
This article will consider some of the ethical issues concerning ectogenesis technology, including possible misuse, social harms and safety risks. The article discusses three common objections to ectogenesis, namely that artificial gestation transgresses nature, risks promoting cloning and genetic engineering of offspring, and would lead to the commodification of children. Counterbalancing these concerns are an appeal to women's rights, reproductive autonomy, and the rights of the infertile to access appropriate assisted reproductive technologies. The article concludes that the unique benefits of promoting the development of ectogenesis technology to prospective parents and children, outweigh any potential harms.
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12
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Cavaliere G. Ectogenesis and gender-based oppression: Resisting the ideal of assimilation. Bioethics 2020; 34:727-734. [PMID: 32696504 DOI: 10.1111/bioe.12789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
In a recent article in this journal, Kathryn MacKay advances a defence of ectogenesis that is grounded in this technology's potential to end-or at least mitigate the effects of-gender-based oppression. MacKay raises important issues concerning the socialization of women as 'mothers', and the harms that this socialization causes. She also considers ectogenesis as an ethically preferable alternative to gestational surrogacy and uterine transplantation, one that is less harmful to women and less subject to being co-opted to further oppressive ends. In this article, I challenge some of the assumptions that underlie MacKay's case in favour of ectogenesis by questioning whether the relationship between women's capacity to gestate and birth children and gender-based oppression is as strong as MacKay makes it out to be. I subsequently argue that-even if MacKay's reading of this relationship is accurate-ectogenesis is not a desirable means to end gender-based oppression. It embodies a strategy that could be used to pursue liberating projects that follow what Iris Marion Young defines as 'the ideal of assimilation', but that must be resisted. I then concur with MacKay's contention that ectogenesis is better than gestational surrogacy and uterine transplantation. My argument is that many of the problematic issues that MacKay herself sees as features of these practices will not disappear with ectogenesis. Finally, I conclude that MacKay's narrow focus on women's biology and ectogenesis as a solution to gender-based oppression results in the overlooking of broader systemic issues that contribute to the upholding of oppressive norms.
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Affiliation(s)
- Giulia Cavaliere
- Lancaster Medical School, Faculty of Health & Medicine, Furness College, Lancaster University, Lancaster, United Kingdom of Great Britain and Northern Ireland
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13
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Kingma E, Finn S. Neonatal incubator or artificial womb? Distinguishing ectogestation and ectogenesis using the metaphysics of pregnancy. Bioethics 2020; 34:354-363. [PMID: 32249443 DOI: 10.1111/bioe.12717] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/25/2019] [Accepted: 11/08/2019] [Indexed: 06/11/2023]
Abstract
A 2017 Nature report was widely touted as hailing the arrival of the artificial womb. But the scientists involved claim their technology is merely an improvement in neonatal care. This raises an under-considered question: what differentiates neonatal incubation from artificial womb technology? Considering the nature of gestation-or metaphysics of pregnancy-(a) identifies more profound differences between fetuses and neonates/babies than their location (in or outside the maternal body) alone: fetuses and neonates have different physiological and physical characteristics; (b) characterizes birth as a physiological, mereological and topological transformation as well as a (morally relevant) change of location; and (c) delivers a clear distinction between neonatal incubation and ectogestation: the former supports neonatal physiology; the latter preserves fetal physiology. This allows a detailed conceptual classification of ectogenetive and ectogestative technologies according to which the 2017 system is not just improved neonatal incubation, but genuine ectogestation. But it is not an artificial womb, which is a term that is better put to rest. The analysis reveals that any ethical discussion involving ectogestation must always involve considerations of possible risks to the mother as well as her autonomy and rights. It also adds a third and potentially important dimension to debates in reproductive ethics: the physiological transition from fetus/gestateling to baby/neonate.
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Affiliation(s)
- Elselijn Kingma
- Faculty of Humanities, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Suki Finn
- Faculty of Humanities, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
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14
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Eichinger J, Eichinger T. Procreation machines: Ectogenesis as reproductive enhancement, proper medicine or a step towards posthumanism? Bioethics 2020; 34:385-391. [PMID: 31943287 DOI: 10.1111/bioe.12708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/08/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
Full ectogenesis as the complete externalization of human reproduction by bypassing the bodily processes of gestation and childbirth can be considered the culmination of genetic and reproductive technologies. Despite its still being a hypothetical scenario, it has been discussed for decades as the ultimate means to liberate women from their reproductive tasks in society and hence finally end fundamental gender injustices generally. In the debate about the application of artificial wombs to achieve gender equality, one aspect is barely mentioned but is of crucial relevance from a medical-ethical perspective: whether and how could full ectogenesis be justified as a proper use of medicine? After characterizing the technology as a special form of human enhancement and as an extension of medical practice that goes beyond the traditional field of medicine, this paper critically assesses the theoretical possibilities of legitimizing this extension. We identify two ways of justification: either one argues that ectogenesis fulfils a proper goal of medicine (a justification we call pathologization), or one argues that the application of ectogenesis achieves a non-medical goal (which we call medicalization). Because it is important from a medical-ethical point of view to avoid an inappropriate instrumentalization or misuse of medicine and thus an undue medicalization of non-medical problems, a set of necessary conditions has to be met. It is doubtful whether full ectogenesis for non-medical purposes could fulfil these conditions. Rather, its comprehensive usage could be seen as a revolutionary modification of what it means to be human.
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Affiliation(s)
- Johanna Eichinger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tobias Eichinger
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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15
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Kimberly LL, Sutter ME, Quinn GP. Equitable access to ectogenesis for sexual and gender minorities. Bioethics 2020; 34:338-345. [PMID: 32050295 DOI: 10.1111/bioe.12723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
Abstract
As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual- or gender-minority groups who likewise seek to pursue parenthood. We examine the history of access to current family-building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual- or gender-minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice.
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Affiliation(s)
- Laura L Kimberly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
- Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Megan E Sutter
- Department of Population Health, New York University School of Medicine, New York, New York
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Gwendolyn P Quinn
- Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, New York
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
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16
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MacKay K. The 'tyranny of reproduction': Could ectogenesis further women's liberation? Bioethics 2020; 34:346-353. [PMID: 31943247 PMCID: PMC7217043 DOI: 10.1111/bioe.12706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/17/2019] [Accepted: 11/13/2019] [Indexed: 05/20/2023]
Abstract
This paper imagines what the liberatory possibilities of (full) ectogenesis are, insofar as it separates woman from female reproductive function. Even before use with human infants, ectogenesis productively disrupts the biological paradigm underlying current gender categories and divisions of labour. I begin by presenting a theory of women's oppression drawn from the radical feminisms of the 1960s, which sees oppression as deeply rooted in biology. On this view, oppressive social meanings are overlaid upon biology and body, as artefacts of culture and history. I then argue that ectogenesis should be pursued to replace two modes of assisted gestation that can be seen as outgrowths of oppressive assumptions about women's function, ectogenesis should be pursued to replace two modes of assisted gestation. These are gestational surrogacy and uterine transplant, which arise partly from gendered, pronatalist, and geneticist norms. These practices are supported by assumptions about women's identity and value. Pursuing technologies such as ectogenesis, which weaken the presumed link between biology and gender, is beneficial to (trans-inclusionary radical) feminist aims, as part of a broad project of challenging dominant power relations resting on and maintaining gender categories. By allowing the conceptual separation of female reproductive function from 'woman', ectogenesis raises questions about how we determine who counts in this gender identity, and also how we value those who claim the identity 'woman'. I conclude that ectogenesis has the potential to challenge traditional patriarchal family structures, and thence all other male-dominated structures (of work, education, cultural production), allowing a reimagining of the family and society in more radical ways than we have yet achieved.
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Di Stefano L, Mills C, Watkins A, Wilkinson D. Ectogestation ethics: The implications of artificially extending gestation for viability, newborn resuscitation and abortion. Bioethics 2020; 34:371-384. [PMID: 31697404 PMCID: PMC7216952 DOI: 10.1111/bioe.12682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 05/20/2023]
Abstract
Recent animal research suggests that it may soon be possible to support the human fetus in an artificial uterine environment for part of a pregnancy. A technique of extending gestation in this way ("ectogestation") could be offered to parents of extremely premature infants (EPIs) to improve outcomes for their child. The use of artificial uteruses for ectogestation could generate ethical questions because of the technology's potential impact on the point of "viability"-loosely defined as the stage of pregnancy beyond which the fetus may survive external to the womb. Several medical decisions during the perinatal period are based on the gestation at which infants are considered viable, for example decisions about newborn resuscitation and abortion, and ectogestation has the potential to impact on these. Despite these possible implications, there is little existing evidence or analysis of how this technology would affect medical practice. In this paper, we combine empirical data with ethical analysis. We report a survey of 91 practicing Australian obstetricians and neonatologists; we aimed to assess their conceptual understanding of "viability," and what ethical consequences they envisage arising from improved survival of EPIs. We also assess what the ethical implications of extending gestation should be for newborn and obstetric care. We analyze the concept of viability and argue that while ectogestation might have implications for the permissibility of neonatal life-prolonging treatment at extremely early gestation, it should not necessarily have implications for abortion policy. We compare our ethical findings with the results of the survey.
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Affiliation(s)
- Lydia Di Stefano
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
- Oxford Uehiro Centre for Practical EthicsFaculty of PhilosophyUniversity of OxfordOxfordUnited Kingdom
| | - Catherine Mills
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneAustralia
| | | | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical EthicsFaculty of PhilosophyUniversity of OxfordOxfordUnited Kingdom
- Newborn CareJohn Radcliffe HospitalOxfordUnited Kingdom
- Murdoch Children’s Research InstituteMelbourneAustralia
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Segers S, Pennings G, Mertes H. The ethics of ectogenesis-aided foetal treatment. Bioethics 2020; 34:364-370. [PMID: 32037564 DOI: 10.1111/bioe.12715] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
In this paper, we aim to stimulate ethical debate about the morally relevant connection between ectogenesis and the foetus as a potential beneficiary of treatment. Ectogenesis could facilitate foetal interventions by treating the foetus independently of the pregnant woman and provide easier access to the foetus if interventions are required. The moral relevance hereof derives from the observation that, together with other developments in genetic technology and prenatal treatment, this may catalyse the allocation of a patient status to the foetus. The topic of foetal medicine is of growing interest to clinicians, and it also deserves due attention from an ethical perspective. To the extent that these developments contribute to the allocation of a patient status to the foetus (and to its respective interests for medical treatment), normative questions arise about how moral responsibilities towards foetal interests should be balanced against the interests of the pregnant woman. We conclude that, even if ectogenesis could facilitate foetal therapy, it is important to remain sensitive to the fact that it would not circumvent the key ethical concerns that come with in utero foetal treatment and that it may even exacerbate potential conflicts between directive treatment recommendations and the pregnant woman's autonomous decision to the contrary.
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Affiliation(s)
- Seppe Segers
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent, Belgium
| | - Guido Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent, Belgium
| | - Heidi Mertes
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent, Belgium
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Buturovic Z. Formula feeding can help illuminate long-term consequences of full ectogenesis. Bioethics 2020; 34:331-337. [PMID: 31664718 DOI: 10.1111/bioe.12687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/19/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
Breastfeeding is analogous to pregnancy as an experience, in its exclusiveness to women, and in its cost and the effects it has on equitable share of labor. Therefore, the history of formula feeding provides useful insights into the future of full ectogenesis, which could evolve into a more severe version of what formula feeding is today: simplify life for some women and provide couples with a more equitable share of work at the cost of stigma, guilt and a daily diet of studies purporting to show the benefits of natural pregnancy. Making pregnancy an optional route to motherhood would make women's life trajectory more similar to men's and thus put pressure on women to compete with men on the ground shaped by men's preferences. Despite being a treasured experience of many women today, bearing children could become the luxury of the few, the province of the very poor and a choice working women will pay a high price for as women who choose pregnancy become stigmatized as self-indulgent or unprofessional and penalized for it in the workplace. At the same time, scarce societal resources that could be used to support pregnant women and working mothers would instead be directed toward proving to women or even forcing them to gestate children "the right way." While not necessarily threatening on its own, when added to formula feeding, IVF, stem-cell produced ova and sex robots, full ectogenesis could diminish men's stake in women's wellbeing and even existence.
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Cohen IG. Commentary on 'Gestation, Equality and Freedom: Ectogenesis as a Political Perspective'. J Med Ethics 2020; 46:87-88. [PMID: 32015016 DOI: 10.1136/medethics-2019-105958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
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Abstract
The contemporary philosophical literature on abortion primarily revolves around three seemingly intractable debates, concerning the (1) moral status of the fetus, (2) scope of women's rights and (3) moral relevance of the killing/letting die distinction. The possibility of ectogenesis-technology that would allow a fetus to develop outside of a gestational mother's womb-presents a unique opportunity for moral compromise. Here, I argue those opposed to abortion have a prima facie moral obligation to pursue ectogenesis technology and provide ectogenesis for disconnected fetuses as part of a moral compromise.
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Cavaliere G. Gestation, equality and freedom: ectogenesis as a political perspective. J Med Ethics 2020; 46:76-82. [PMID: 31704782 DOI: 10.1136/medethics-2019-105691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/24/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
The benefits of full ectogenesis, that is, the gestation of human fetuses outside the maternal womb, for women ground many contemporary authors' arguments on the ethical desirability of this practice. In this paper, I present and assess two sets of arguments advanced in favour of ectogenesis: arguments stressing ectogenesis' equality-promoting potential and arguments stressing its freedom-promoting potential. I argue that although successfully grounding a positive case for ectogenesis, these arguments have limitations in terms of their reach and scope. Concerning their limited reach, I contend that ectogenesis will likely benefit a small subset of women and, arguably, not the group who most need to achieve equality and freedom. Concerning their limited scope, I contend that these defences do not pay sufficient attention to the context in which ectogenesis would be developed and that, as a result, they risk leaving the status quo unchanged. After providing examples of these limitations, I move to my proposal concerning the role of ectogenesis in promoting women's equality and freedom. This proposal builds on Silvia Federici's, Mariarosa Dalla Costa's and Selma James' readings of the international feminist campaign 'Wages for Housework'. It maintains that the political perspective and provocation that ectogenesis can advance should be considered and defended.
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Blackshaw BP, Rodger D. Ectogenesis and the case against the right to the death of the foetus. Bioethics 2019; 33:76-81. [PMID: 30341923 DOI: 10.1111/bioe.12529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson's violinist analogy, which argues for a woman's right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson's reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen's analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.
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Affiliation(s)
- Bruce P Blackshaw
- Department of Philosophy, University of Birmingham, Birmingham, United Kingdom
| | - Daniel Rodger
- Allied Health Sciences, School of Health and Social Care, London South Bank University, London, United Kingdom
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Kaczor C. Ectogenesis and a right to the death of the prenatal human being: A reply to Räsänen. Bioethics 2018; 32:634-638. [PMID: 30252944 DOI: 10.1111/bioe.12512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/02/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
Both many critics of abortion and many defenders of abortion have suggested that artificial wombs could end the abortion debate. If the fetus is removed from the uterus, women have an end to an unwanted pregnancy. If the living fetus is then put in an artificial uterus for ectogenesis, there is no termination of the life of the fetus. Joona Räsänen challenges this view in his article, Ectogenesis, abortion and a right to the death of the fetus. Räsänen provides three arguments for a right to secure the death of the human being in utero, namely the 'right not to become a biological parent argument', the 'right to genetic privacy argument', and the 'right to property argument'. This article critiques these three arguments for a right to the death of the fetus.
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Affiliation(s)
- Christopher Kaczor
- Loyola Marymount University, Bellarmine College of Liberal Arts - Philosophy, Los Angeles, California, United States
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Abstract
Joona Räsänen, in his article 'Ectogenesis, abortion and a right to the death of the fetus' (this journal), has argued for the view that parents have a right to the death of the fetus. In this brief article, I will explicate the three arguments Räsänen defends, and show that two of them have false or unmotivated premises and hence fail, and that the support he offers for his third argument is inconsistent with other views he expresses in his article. Therefore, I conclude that there is no right to the death of the fetus, or, if there is one, Räsänen has not shown it.
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Räsänen J. Ectogenesis, abortion and a right to the death of the fetus. Bioethics 2017; 31:697-702. [PMID: 29044695 DOI: 10.1111/bioe.12404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/10/2017] [Accepted: 08/13/2017] [Indexed: 06/07/2023]
Abstract
Many people believe that the abortion debate will end when at some point in the future it will be possible for fetuses to develop outside the womb. Ectogenesis, as this technology is called, would make possible to reconcile pro-life and pro-choice positions. That is because it is commonly believed that there is no right to the death of the fetus if it can be detached alive and gestated in an artificial womb. Recently Eric Mathison and Jeremy Davis defended this position, by arguing against three common arguments for a right to the death of the fetus. I claim that their arguments are mistaken. I argue that there is a right to the death of the fetus because gestating a fetus in an artificial womb when genetic parents refuse it violates their rights not to become a biological parent, their rights to genetic privacy and their property rights. The right to the death of the fetus, however, is not a woman's right but genetic parents' collective right which only can be used together.
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Abstract
At some point in the future - perhaps within the next few decades - it will be possible for foetuses to develop completely outside the womb. Ectogenesis, as this technology is called, raises substantial issues for the abortion debate. One such issue is that it will become possible for a woman to have an abortion, in the sense of having the foetus removed from her body, but for the foetus to be kept alive. We argue that while there is a right to an abortion, there are reasons to doubt that there is a right to the death of the foetus. Our strategy in this essay is to consider and reject three arguments in favour of this latter right. The first claims that women have a right not to be biological mothers, the second that women have a right to genetic privacy, and the third that a foetus is one's property. Furthermore, we argue that it follows from rejecting the third claim that genetic parents also lack a right to the destruction of cryopreserved embryos used for in vitro fertilization. The conclusion that a woman possesses no right to the death of the foetus builds upon the claims that other pro-choice advocates, such as Judith Jarvis Thomson, have made.
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Abstract
The birth of a child after uterus transplant from a living donor in Sweden in October, 2013 has spurred reproductive and transplant physicians in Europe and North America to investigate whether uterus transplants, from living or cadaveric donors, will be a safe and effective therapy for women with uterine insufficiency. While progress with uterus transplant depends on medical factors, there are also important ethical and legal concerns. Uterus transplant is essential for women without access to surrogacy. It may also be sought by infertile women who dislike surrogacy. This article examines medical, ethical, legal, and policy issues that arise with womb transplant, including the role of surrogacy policies that make them necessary. The conclusion is that there is a clear ethical path for either surrogacy or uterus transplant to be used by women with uterine insufficiency.
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