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The Perfect Womb: Promoting Equality of (Fetal) Opportunity

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The Perfect Womb: Promoting Equality of (Fetal) Opportunity The perfect womb: promoting equality of (fetal) opportunity Citation of the final article: Kendal, Evie 2017, The perfect womb: promoting equality of (fetal) opportunity, Journal of bioethical inquiry, vol. 14, no. 2. DOI: 10.1007/s11673-017-9775-z This is the accepted manuscript. © 2017, Journal of Bioethical Inquiry Reprinted with permission. Downloaded from DRO: http://hdl.handle.net/10536/DRO/DU:30108812 DRO Deakin Research Online, Deakin University’s Research Repository Deakin University CRICOS Provider Code: 00113B 1 [issue] 14(2) [category] Symposium: [title] The Perfect Womb: Promoting Equality of (Fetal) Opportunity [subtitle] [authors] Evie Kendal [author details] E. Kendal School of Public Health and Preventive Medicine, Monash University, Alfred Centre Level 5, 99 Commercial Rd, Melbourne, 3000, AUSTRALIA e-mail: [email protected] Abstract This paper aims to address how artificial gestation might affect equality of opportunity for the unborn and any resultant generation of “ectogenetic” babies. It will first explore the current legal obstacles preventing the development of ectogenesis, before looking at the benefits of allowing this technology to control fetal growth and development. This will open up a discussion of the treatment/enhancement divide regarding the use of reproductive technologies, a topic featured in various bioethical debates on the subject. Using current maternity practices in Western society as a comparator, this paper will conclude that neither naturally nor artificially gestated fetuses have interests that can conflict with those of potential parents who might want to use this technology to control fetal development. Such control may include selective implantation of embryos of a desired gender, deliberate choice of genetic traits, or maintenance of an ideal incubation environment to avoid fetal damage. Objections on the basis of disability as well as concerns regarding eugenics will be addressed. The paper will conclude that none of these objections are compelling grounds to prevent the development and use of ectogenesis technologies for the purpose of achieving specific reproductive goals, particularly when compared to current practices in pre-implantation genetic diagnosis and selective abortion on the grounds of undesired traits. As such, when deciding whether to support ectogenesis research, the enduring interests of parents must be the primary consideration, with societal concerns regarding potential misuse the only valid secondary consideration. 2 Keywords Ectogenesis; Reproductive biotechnology; Eugenics This paper aims to address how artificial gestation might affect equality of opportunity for the unborn and any resultant generation of “ectogenetic” babies. Ectogenesis is the scientific term used to describe the gestation of a fetus in an artificial environment. Full ectogenesis refers to a hypothetical scenario in which artificial incubation follows immediately from in vitro fertilization (IVF), without the need for a human womb at any stage of fetal development (Warren 1986). What could be classified as “partial ectogenesis” is already routinely practiced in neonatology through the use of sophisticated humidicribs and other technologies designed to save fetuses born increasingly premature (Cannold 1995). There are various reasons why ectogenesis might represent a desirable alternative to biological gestation for many women and couples, including promoting sexual equality in reproductive endeavours, providing for women who do not have a functional uterus (including women who have undergone a hysterectomy and male-to-female transsexuals), creating gestational alternatives for women expected to experience high-risk pregnancies (including transplant patients and those undergoing chemotherapy), and providing options for women who for social reasons do not wish to be pregnant (including those whose careers would be adversely affected by pregnancy, such as models and elite athletes) (Murphy 1989). Ectogenesis also carries the unique benefits of allowing gay male couples to reproduce without the need for a surrogate, and providing a much-needed third option for women experiencing an unwanted pregnancy who are morally opposed to abortion. However, while there are clearly grounds to support ectogenesis in terms of maternal/parental interests, this paper will explore whether future offspring might be worse off if this technology is developed and released. In this paper I will argue that while there may be valid concerns regarding the use of biotechnology to achieve certain reproductive goals, ectogenesis does not in itself threaten equality of opportunity for fetuses and future children. This paper will first explore the current legal obstacles preventing the development of ectogenesis, before looking at the benefits of allowing this technology to control fetal growth and development. This will open up a discussion of the treatment/enhancement divide regarding the use of reproductive technologies, a topic featured in various bioethical debates on the subject. Using current maternity practices in Western society as a comparator, this paper will conclude that neither 3 naturally nor artificially gestated fetuses have interests that can conflict with those of potential parents who might want to use this technology to control fetal development. Legal Obstacles and Objections to Developing Ectogenesis In her 1970s manifesto The Dialectic of Sex, Shulamith Firestone defended the development of “artificial reproduction” on the grounds that it would promote sexual equality (Firestone 1970, 12). At this time the possibility of ectogenesis must have seemed remote, for although humidicribs had existed for almost a century, successful clinical trials of surfactant to overcome the issue of lung under-development in preterm infants did not occur until the 1980s (Halliday 2008). On the other end of the gestational spectrum, in vitro fertilization (IVF) would not achieve a live human birth until 1978. Despite a sustained interest in artificial wombs among scientists since at least the 1950s, significant advances have only been made in recent years (Johnstone 2010). Anna Smajdor’s 2007 article “The Moral Imperative for Ectogenesis,” expands on Firestone’s argument about the unjust burden women face in reproductive endeavours, claiming that “legal and ethical cut-off points” are now impeding the development of the technology “rather than technical problems” (Smajdor 2007, 339). There have been several noteworthy technological advances since the time of Smajdor’s writing, including the development of miniaturized oxygenators in 2011, described by their creators as “one step on the way to the clinical application of the artificial placenta,” and the successful artificial incubation of several animal species (Arens et al. 2011, 1000). Most recently, a species preservation project in Australia in 2012 developed an acrylic tank to gestate late-stage shark embryos, resulting in healthy offspring. Although the lead scientist, Dr Nick Otway, notes his system could be adapted for use in other species, including humans, he says he has no plans to pursue this avenue of research due to “the ethical issues” (Binns 2009, 34; Otway and Ellis 2012). This statement seems to validate Smajdor’s assertion that the science behind ectogenesis may soon cease to be the major limiting factor in its development and release. Despite the potential benefits of developing ectogenesis technology, laws based on outdated reports hamper ectogenesis research in many countries. In 1979 the United States national ethics advisory board restricted IVF development to fourteen days; the Waller Commission in Australia and the Warnock Report in the United Kingdom both followed suit in 1984 (American Congress of Obstetricians and Gynecologists 1994). 4 The United States has also banned the use of federal funds for ectogenesis research, while Canada has explicitly banned ectogenesis research itself (Pence 2006; Simonstein and Mashiach-Eizenberg 2009). In Australia the Regulation of Human Embryo Research Amendment Act of 2006 lists as an offense “developing a human embryo outside the body of a woman for more than 14 days” and “creating an embryo for a purpose other than achieving a pregnancy in a woman” (Bayne and Kolers 2003; Parliament of Australia 2006, 10–11, emphasis added). The rationale behind drawing the 14-day limit is that up until this point in embryonic development, division and recombination can still occur, while at fourteen days post-conception the primitive streak has formed and twinning is no longer possible (Silver 1998). The argument is that when this milestone is reached, the pre-embryonic stage is complete and the conceptus is committed to developing into a single, unique human being. However, imposing a fourteen day restriction on embryo development ex vivo effectively prohibits research into technological alternatives to physical gestation. This is particularly difficult to justify in countries where abortion laws permit the termination of a pregnancy well beyond this point. Just last month, British scientists succeeded in cultivating IVF embryos in a petri dish for thirteen days, but had to discontinue their research before trespassing the fourteen day boundary (Deglincerti et al. 2016). Researchers involved in the project have told the media it would be beneficial if the ban were loosened, even if only by a few days (Knapton 2016). In response to the research, the Nuffield Council on Bioethics in the United Kingdom released
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