Unique benefits of outweigh potential harms

Citation of the final article: Kendal, Evie 2019, Unique benefits of ectogenesis outweigh potential harms, Emerging Topics in Life Sciences, vol. 3, no. 6, pp. 719-722.

Published in its final form at https://doi.org/10.1042/etls20190112.

This is the accepted manuscript.

© 2019, The Author

Reprinted with permission.

Downloaded from DRO: http://hdl.handle.net/10536/DRO/DU:30131603

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Unique benefits of ectogenesis outweigh potential harms.

Author details

Dr Evie Kendal Lecturer of and Health Humanities Deakin University, School of Medicine Waurn Ponds, Victoria, Australia [email protected]

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 and 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.

Introduction

Full ectogenesis refers to the artificial gestation of human embryos until independent viability, without the need for a woman’s womb at any stage.1 It represents the closing of a gap between existing artificial reproductive technologies, including (IVF) and humidicrib incubation, to cover the entire development period. While only speculative at this time, many scientists working in this field believe the technology could become a reality with sufficient practical and legal support.2

Ethical and social concerns about ectogenesis abound. Chief among them are concerns of “playing god” or transgressing the bounds of nature in reproduction. Similar accusations were levelled at the scientists involved in achieving the first IVF birth.3 Other potential fears include that ectogenesis will be used to create human clones, genetically modify human infants, or create mass‐market baby farms. This article will consider each of these issues in turn, before establishing why the unique benefits of promoting the development of ectogenesis technology outweigh any potential harms. This argument will rest on a defence of reproductive autonomy, women’s health and liberty, and promoting the needs of prospective parents currently unable to achieve their goal of making a family.

Objections to ectogenesis

Playing god and transgressing nature

The first objection to ectogenesis is that artificial gestation represents inappropriate human interference into natural pregnancy and is therefore immoral. Such a view has its historical roots in Catholic dogma, and forms the basis of the Church’s opposition to IVF and most of modern fertility medicine, due to its potential to disturb the “natural” and “sanctified” processes of human reproduction.4 Options for countering this objection either appeal to consistency, e.g. accepting this characterisation would necessitate rejection of treatments already well‐established, such as IVF, or rejecting the premise that such interference would be in conflict with Catholic ideals. The latter has been used to suggest ectogenesis might find some support among religious groups due to its ability to prevent loss of fetal life through abortion or prematurity,5 whereas the former argues that without also opposing partial ectogenesis processes, including incubation of prematurely born infants, this objection lacks strength. Full ectogenesis would merely improve the efficacy and extend the period for which artificial gestation were possible, it would not in itself represent a wholly new form of fetal development ex utero. Furthermore, religious objections to human interference in reproduction imply that chance or fate should play a major role in these processes, a perspective that is difficult to justify when considering the many risks to women and that could be avoided through artificial gestation in a controlled environment.6 Especially in cases where the use of IVF and/or ectogenesis could prevent significant harm or disease, the suggestion it would be more moral to forego such preventive measures because they transgress certain notions of naturalness is problematic.

Human reproductive cloning and genetic engineering

For reasons that are not intuitively obvious, opponents of ectogenesis sometimes conflate the issues surrounding this future technology with that of two entirely different processes – human reproductive cloning and genetic engineering.7 A recent example can be seen in the debate between Joona Räsänen and Christopher Kaczor (and others) where the right not to become a genetic parent, e.g. by means of stolen genetic material used to artificially incubate offspring, was considered using the example of a clone of the “wronged” person.8 As both reproductive cloning and genetic engineering involve embryonic, rather than fetal, manipulation, neither requires the use of sophisticated or prolonged artificial gestation. Thus, ectogenesis would not represent a vital methodological step in either of these ethically challenging processes, so even if they were to be banned on moral grounds, this need not justify the continued ban on research into ectogenesis present in many countries.9 At most, ectogenesis might exacerbate existing concerns about cloning and genetic engineering by means of providing a method to mass produce such infants, without the need to engage surrogates to gestate and birth them. However, such a situation could be avoided through regulation of ectogenesis services and limitations to use.

Baby farms and the commodification of children

At the time of writing, a publication in Nature10 has stirred media interest, with headlines like “Scientists Create a Device That Can Mass‐Produce Human Embryoids” appearing in response to the development of a technology that can rapidly create synthetic analogues for primitive embryos.11 This fear of mass‐producing human life can also be found in debates surrounding ectogenesis, namely, that were the technology realised on a mass scale, it could facilitate the creation of baby farms where prospective parents could simply purchase the baby of their dreams. This would undermine the fundamental social belief that children should not be treated as commodities.12 However, situations in which the wealthy can choose to outsource their gestational labour already exist in commercial surrogacy, where another woman’s body is contracted to gestate the commissioning parents’ offspring. If outsourcing this labour to a machine is considered morally suspect, requiring it of another person must logically be far more so. There is also the practical limitation that full ectogenesis is likely to be very expensive, as even when comparing the costs of gestating a inside the body of a woman on full life support with that of using a humidicrib, physicians have claimed women’s bodies as the “cheapest incubators we have.”13 As such, fears of mass infant production are unlikely to be sustained, but even if they were, this would represent a better option than establishing a mass market of surrogate‐born children, a reality that is already theoretically possible given existing technologies. Put another way, even those who oppose both ectogenesis and surrogacy for their potential role in the commodification of children or gestational labour, might be convinced that the former produces less harm and suffering than the latter.

Support for ectogenesis

Reproductive autonomy and women’s liberty

One of the major arguments in favour of promoting the development of ectogenesis is that it would promote sexual equality in human reproduction and avoid the risks and burdens of pregnancy and childbirth on women. The option of creating biological children without relying on a woman’s body for gestation represents a radical shift in perspective regarding gender roles in society and the family unit.14 Pregnancy carries a number of health risks for women, and no matter how safe it may become, even in the most developed countries women still die in childbirth and from pregnancy‐related complications every year.15 Ectogenesis provides a means to avoid this risk while still achieving the same outcome. Furthermore, providing an alternative to biological gestation enhances reproductive autonomy, both for those who choose to use it and those who do not. At present, most women who “choose” to gestate their biological offspring do so in the absence of a viable alternative, thereby rendering that “choice” redundant. Similarly, women who do not wish to or cannot safely maintain a pregnancy may “choose” to remain childless, but only due to the lack of available substitutes. Thus, even if the predictions of low initial uptake16 prove accurate, the advent of ectogenesis services provides positive choices and increases reproductive autonomy.

Potential risks to women’s liberty, such as recent debates that suggest ectogenesis could be used to undermine abortion rights,17 while concerning, can and should be mitigated by strengthening legislation in this area before any release of this technology. The current threats to abortion rights that already exist in the absence of this technology, including the recent passing of several restrictive laws in the USA,18 provide evidence of a much broader problem that warrants attention independent of any risk that ectogenesis might exacerbate current efforts to undermine women’s reproductive liberty.

Serving the needs of the infertile

Perhaps the strongest justification for promoting the development of ectogenesis is that it would serve the needs of various groups, often in unique ways not currently captured by existing artificial reproductive technologies. These include single men and gay male couples who wish to procreate without the involvement of a surrogate, women born without a (both cis‐ and transgender women), and women who rely on medication or treatment that would be harmful to a fetus or make pregnancy dangerous.19 The needs of these groups are currently not being met, even in jurisdictions where surrogacy or uterine transplant may be available to some. Particularly for women who may have lost their uterus to cancer, infection or injury, ectogenesis represents the only possible method of gestating a biologically related child without further physical trauma, e.g. in the form of transplant surgery, or outsourcing gestation to another woman. As such, the technology yields unique benefits to this group that justify its development and release.

While the focus of this piece has been on women’s health and liberty, concerns about fetal wellbeing can also be answered with reference to the possibility that ectogenesis could be used to provide the optimal growth environment for fetal development, free from common toxins, e.g. tobacco smoke. Furthermore, any errors that might arise in the operation of the technology are likely to have consequences very similar to those occurring in natural pregnancy, but without the added complication of dealing with an in utero fetus. For example, while an ectogenetic fetus is far less likely to be exposed to rubella, were this to occur, diagnosis, possible interventions or termination would be easier than were the same exposure to occur in a biological pregnancy.

Conclusion

Given the risks associated with developing ectogenesis are either not unique to the technology, manageable through regulation, or are highly unlikely to eventuate, continued opposition to a technology that stands to benefit a number of disadvantaged groups and promote reproductive autonomy is ethically suspect. Ectogenesis requires practical and legal support to fulfil its potential of promoting sexual equality in human reproduction and reproductive autonomy.

Summary points

 Ectogenesis could provide for the needs of individuals and couples who cannot currently achieve their goal of creating a family with existing technologies  Concerns about transgressing nature, human reproductive cloning, genetic engineering and commodification of children fuel opposition to ectogenesis research  Practical and legal support is required for ectogenesis to fulfil its potential of promoting sexual equality in human reproduction

References

1 Warren, Mary Anne, ‘Making Babies: The New Science and Ethics of Conception by Peter Singer; Deane Wells,’ Ethics 97, no. 1 (1986): 288–289. 2 Chavatte‐Palmer, P., R. Lévy and P. Boileau, ‘Une Reproduction Sans Utérus? État des Lieux de L’ectogenèse’ (Reproduction Without a Uterus? State of the Art of Ectogenesis), Gynécologie Obstétrique and Fertilité 40, no. 11 (2012): 695. 3 Edwards, Robert, Life Before Birth: Reflections on the Embryo Debate (London: Hutchinson, 1989), 92. 4 Najera, Olga, ‘Ethical Concerns for Assisted Reproductive Technologies,’ Dialogue & Nexus 3 (2015): 2. 5 Smajdor, Anna, ‘Ectogenesis,’ in: ten Have H. (eds) Encyclopedia of Global Bioethics (Springer, Cham, 2016). 6 Kendal, Evie, ‘The Perfect Womb: Promoting Equality of (Fetal) Opportunity,’ Journal of Bioethical Inquiry 14, no. 2 (2017): 56. 7 Smith, George P. II, ‘Intimations of Immortality: Clones, Cyrons and the Law,’ U.N.S.W. Law Journal 6 (1983): 121. 8 Kaczor Christopher, ‘Ectogenesis and a right to the death of the prenatal human being: A reply to Räsänen,’ Bioethics, 32 (2018): 636. 9 Simonstein, Frida and Michal Mashiach‐Eizenberg, ‘The : A Pilot Study Considering People’s Views on the Artificial Womb and Ectogenesis in Israel,’ Cambridge Quarterly of Healthcare Ethics 18 (2009): 88. 10 Zheng, Yi, et al. ‘Controlled Modelling of Human Epiblast and Amnion Development Using Stem Cells,’ Nature 573 (2019): 421–5. 11 Stein, Rob, ‘Scientists Create A Device That Can Mass‐produce Human Embryoids,” NPR, September 11, 2019. Available at: https://www.npr.org/sections/health‐shots/2019/09/11/757072996/scientists‐create‐a‐ device‐that‐can‐mass‐produce‐synthetic‐human‐embryos 12 Kass, Leon, ‘Preventing a Brave New World: Why We Should Ban Human Cloning Now,’ New Republic 224, no. 21 (2001): 31. 13 Murphy, Julien S., ‘Is Pregnancy Necessary? Feminist Concerns about Ectogenesis.’ Hypatia 4, no. 3 (1989): 69. 14 Farquhar, Dion, ‘(M)other Discourses,’ in The Gendered Cyborg: A Reader, Gill Kirkup, Kathryn Woodward and Fiona Hovenden (eds) (London: Routledge, 2000), 211. 15 Smajdor, Anna, “The Moral Imperative for Ectogenesis,” Cambridge Quarterly Healthcare Ethics 16, no. 3 (2007): 340. 16 Cannold, Leslie, ‘Women, ectogenesis and ethical theory,’ Journal of Applied Philosophy 12, no. 1 (1995): 55–64. 17 Räsänen, Joona, ‘Ectogenesis, Abortion, and the Right to the Death of the Fetus,’ Bioethics 31, no. 9 (2017): 697–702. 18 A summary can be found in this Al Jazeera article from 1 June, 2019: https://www.aljazeera.com/news/2019/05/states‐passed‐abortion‐bans‐190514142646289.html 19 Hendricks, Jennifer S., ‘Not of Woman Born: A Scientific Fantasy,’ Case Western Reserve Law Review 62 (2012): 10.