Regulating the ‘Brave New World:’ Ethico-Legal Implications of the Quest for Partial Ectogenesis A thesis submitted to the University of Manchester for the degree of Doctor of Philosophy in the Faculty of Humanities School of Social Sciences 2020 Elizabeth Chloe Romanis Department of Law 1 SHORT TABLE OF CONTENTS INTRODUCTION ................................................................................................................... 19 Chapter One – Key Context ..................................................................................................... 25 Chapter Two – Approach ........................................................................................................ 48 Chapter Three – Outline of Papers........................................................................................... 64 PART I – UNDERSTANDING PARTIAL ECTOGENESIS ................................................. 69 Paper One – Artificial Womb Technology and the frontiers of human reproduction: conceptual differences and potential implications ................................................................... 70 Paper Two – Challenging the ‘Born Alive’ Threshold: Foetal Surgery, Artificial Wombs and the English Approach to Legal Personhood............................................................................. 84 Paper Three – Artificial Womb Technology and the Significance of Birth: Why Gestatelings are not Newborns (or Fetuses) ............................................................................................... 122 PART II – REALISING PARTIAL ECTOGENESIS .......................................................... 129 Paper Four – Artificial Womb Technology and Clinical Translation: Innovative Treatment or Medical Research? ................................................................................................................. 130 PART III – IMPLICATIONS OF PARTIAL ECTOGENESIS ........................................... 153 Paper Five – Artificial Womb Technology and the Choice to Gestate Ex Utero: Is Partial Ectogenesis the Business of the Criminal Law? .................................................................... 154 Paper Six – Partial Ectogenesis: Freedom, Equality and Political Perspective ..................... 194 CONCLUSION ...................................................................................................................... 200 BIBLIOGRAPHY .................................................................................................................. 234 APPENDIX ............................................................................................................................ 250 Word Count (including footnotes, excluding front and end matter): 88,507 2 COMPLETE TABLE OF CONTENTS ABSTRACT ............................................................................................................................... 7 DECLARATION ....................................................................................................................... 8 COPYRIGHT STATEMENT .................................................................................................... 8 ACKNOWLEDGEMENTS ....................................................................................................... 9 THE AUTHOR ........................................................................................................................ 11 LIST OF ABBREVIATIONS .................................................................................................. 14 TABLE OF CASES ................................................................................................................. 15 TABLE OF LEGISLATION ................................................................................................... 17 INTRODUCTION ................................................................................................................... 19 CHAPTER ONE – KEY CONTEXT ...................................................................................... 25 Aims and Objectives ............................................................................................................ 25 On Speculation ..................................................................................................................... 25 Scope .................................................................................................................................... 28 Partial ectogenesis ........................................................................................................... 28 The subject of the artificial womb .................................................................................... 35 Moral Status ...................................................................................................................... 36 CHAPTER TWO - APPROACH............................................................................................. 48 Thesis Structure .................................................................................................................... 48 Method and Methodology .................................................................................................... 49 Bioethics, the Law and Science ........................................................................................ 49 Critical Doctrinal Analysis ............................................................................................... 55 Feminist Perspective ......................................................................................................... 58 Notes on Terminology .......................................................................................................... 61 Pregnant People ................................................................................................................ 61 Human Entities ................................................................................................................. 62 Maternal-Foetal Surgery ................................................................................................... 63 CHAPTER THREE – OUTLINE OF PAPERS ...................................................................... 64 PART I – UNDERSTANDING PARTIAL ECTOGENESIS ............................................. 64 PAPER ONE: Artificial Womb Technology and the frontiers of human reproduction: conceptual differences and potential implications (2018) 44 Journal of Medical Ethics 751 .................................................................................................................................... 64 3 PAPER TWO: Challenging the ‘Born Alive’ Threshold: Foetal Surgery, Artificial Wombs and the English Approach to Legal Personhood (2020) 28 Medical Law Review 93 ...................................................................................................................................... 65 PAPER THREE: Artificial Womb Technology and the Significance of Birth: Why Gestatelings are not Newborns (or Fetuses) (2019) 45 Journal of Medical Ethics 727 ... 65 PART II – REALISING PARTIAL ECTOGENESIS ......................................................... 66 PAPER FOUR: Artificial Womb Technology and Clinical Translation: Innovative Treatment or Medical Research? (2020) 34 Bioethics 392 .................................................. 66 PART III – IMPLICATIONS OF PARTIAL ECTOGENESIS ....................................... 67 PAPER FIVE: Artificial Womb Technology and the Choice to Gestate Ex Utero: Is Partial Ectogenesis the Business of the Criminal Law? (2020) 28 Medical Law Review 342 .................................................................................................................................... 67 PAPER SIX: ‘Partial Ectogenesis: Freedom, Equality and Political Perspective (2020) 46 Journal of Medical Ethics 89 ............................................................................................ 67 PART I - UNDERSTANDING PARTIAL ECTOGENESIS .................................................. 69 PAPER ONE: Artificial Womb Technology and the frontiers of human reproduction: conceptual differences and potential implications ................................................................... 70 Artificial Wombs – Where are we? ...................................................................................... 71 Limitations of Neonatal Intensive Care ............................................................................ 72 The Biobag ....................................................................................................................... 73 Subjects in the Biobag .......................................................................................................... 75 Beyond just another form of Neonatal Intensive Care ......................................................... 77 The innate features of AWT ............................................................................................. 78 The subject of partial ectogenesis ..................................................................................... 80 Potential uses of partial ectogenesis ................................................................................. 81 Conclusion ............................................................................................................................ 82 PAPER TWO: Challenging the ‘Born Alive’ Threshold: Fetal Surgery, Artificial Wombs and the English Approach to Legal Personhood............................................................................