The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial (...) womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis. (shrink)

In this commentary, I will consider the implications of the argument made by Christopher Stratman (2020) in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, that virtually everything we already know about unintended pregnancies, abortion and adoption does not (...) prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion then there is unlikely to be any radical transformation of the practice of abortion. Second, abortion is already associated with stigma and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the fetus to the human subject of the artificial womb—the gestateling. Therefore, creating a new category of killing—gestaticide—and this would only reorient the debate rather than end it. (shrink)

Ectogestation involves the gestation of a fetus in an ex utero environment. The possibility of this technology raises a significant question for the abortion debate: Does a woman’s right to end her pregnancy entail that she has a right to the death of the fetus when ectogestation is possible? Some have argued that it does not Mathison & Davis. Others claim that, while a woman alone does not possess an individual right to the death of the fetus, the genetic parents (...) have a collective right to its death Räsänen. In this paper, I argue that the possibility of ectogestation will radically transform the problem of abortion. The argument that I defend purports to show that, even if it is not a person, there is no right to the death of a fetus that could be safely removed from a human womb and gestated in an artificial womb, because there are competent people who are willing to care for and raise the fetus as it grows into a person. Thus, given the possibility of ectogestation, the moral status of the fetus plays no substantial role in determining whether there is a right to its death. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Recently, I argued that subjects inside of artificial wombs—termed ‘gestatelings’ by Romanis—share the same legal and moral status as newborns (neonates). Gestatelings, on my view, are persons in both a legal and moral sense. Kingma challenges these claims. Specifically, Kingma argues that my previous argument is invalid, as it equivocates on the term ‘newborn’. Kingma concludes that questions about the legal and moral status of gestatelings remain ‘unanswered’. I am grateful to Kingma for raising potential concerns with the view I (...) have presented. In this essay, however, I argue that (most) of Kingma’s objections are unpersuasive. First, my original argument does not equivocate on terms like ‘newborn’ or ‘neonate’. The terms denote human beings that have been born recently; that is what matters to the argument. Charges of equivocation, I suspect, rest on a confusion between the denotation and connotations of ‘newborn’ (or ‘neonate’). Next, I show that, contra Kingma, it is clear that—under current law in the USA and UK—gestatelings would count as legal persons. Moral personhood is more difficult. On that subject, Kingma’s criticisms have merit. In response, however, I show that my original claim—that gestatelings should count as moral persons—remains true on several (common) philosophical accounts of personhood. Regarding those accounts that imply gestatelings are not moral persons, I argue that advocates face a troubling dilemma. I conclude that regardless of which view of moral personhood one adopts, questions about the moral status of gestatelings are not ‘unanswered’. (shrink)

Recently, I argued that human subjects in artificial wombs (AWs) “share the same moral status as newborns” and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: (A) “Subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns,” and (B) “Subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns.” In response, Elizabeth Chloe Romanis argued that the subject in an AW is (...) “a unique human entity…rather than a fetus or a newborn.” She provides four lines of response to my essay. First, she argues that I have “misconstrued” what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos (existing in vivo) “would also be ‘born.’” But that is absurd. Third, she claims I fail to “meaningfully respond” to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticizes my essay for focusing on subjects of AWs rather than focusing on pregnant persons (who should be at the “centre” of debates over AWs). I respond to each of these charges. In doing so, I reaffirm that (contra Romanis) some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

Recently, I argued that human subjects in artificial wombs ‘share the same moral status as newborns’ and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns and subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns. In response, Elizabeth Chloe Romanis argued that the subject in an AW is ‘a unique human (...) entity…rather than a fetus or a newborn’. She provides four lines of response to my essay. First, she argues that I have ‘misconstrued’ what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos ‘would also be “born”’. But that is absurd. Third, she claims I fail to ‘meaningfully respond’ to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticises my essay for focusing on subjects of AWs rather than focusing on pregnant persons. I respond to each of these charges. In doing so, I reaffirm that some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

Catholic thinkers generally agree that artificial womb technology (AWT) would be permissible in cases of partial ectogenesis to assist severely premature infants, but there is substantially more debate concerning whether AWT could be used to save frozen embryos, which are the result of in vitro fertilization (IVF). In many cases, these embryos have been abandoned and left in a permanently cryogenic state, which is an affront to their human dignity. While AWT would allow people to adopt these embryos and give (...) them an opportunity to develop, it gives rise to serious concerns over the possibility of scandal and the potential for cooperation in evil. Therefore, the author argues that even though AWT may one day represent a solution to this tragedy, it is currently not a morally licit answer, given the widespread use and approval of IVF in our culture. (shrink)

This essay explores the theological and anthropological significance of birth, in order to discern what might be lost with the adoption of complete ectogestation (“artificial wombs”). Specifically, it considers both Saint Augustine and Karl Barth’s respective accounts of humanity’s whence—that is, their theological answer to the question of the nature and significance of our origins as individuals. I suggest that Augustine’s account of his origins emphasizes both his epistemic and biological dependency on his mother and nurses, while Barth’s stresses the (...) individual’s immediate derivation from God. Those disparate answers affect how they construe the relationships of parents and children and work themselves throughout their theological visions and imaginations. I conclude that careful consideration of humanity’s whence cannot answer whether we ought to pursue ectogestation; but it does help us account for how our understanding of God and ourselves might be altered if we gestate human life outside the womb. (shrink)

The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of (...) pregnancy and childbirth is criticised for its impact on the relationship between doctors and pregnant women and the way in which doctors treat fetuses. It is argued that ectogenesis may cause more imbalance in the doctor and intended parent relationship and may result in an increased lack of clarity regarding a doctor’s duty to the fetus. This paper finds that extensive guidance and revised legislation will be necessary to minimise the impact of ectogenesis on the existing issues caused by the medicalisation of reproduction. (shrink)

Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine support for extremely premature neonates, numerous ethicists have debated the potential implications of such a device. Some have argued that the Biobag represents a natural evolution of traditional newborn intensive care, while others believe that the Biobag would create a new class of being for the patients housed within. Kingma and Finn argued inBioethicsfor making a categorical distinction between fetuses, newborns and ‘gestatelings’ in a Biobag on (...) the basis of a conceptual distinction between ectogenesis versus ectogestation. Applying their arguments to the clinical realities of newborn intensive care, however, demonstrates the inapplicability of their ideas to the practice of medicine. Here, I present three clinical examples of the difficulty and confusion their argument would create for clinicians and offer a possible remedy: namely, discarding the term ‘artificial womb’ in favour of ‘Biobag’. (shrink)

De Bie et al. (2023) propose an organizing framework for different stages of human gestational development from conception to the viable premature. They also identify ethical considerations and con...

BackgroundBreakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation.Main textThis paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial (...) ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis’ subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus.ConclusionsThe development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy. (shrink)

A few decades from now, it might become possible to gestate fetuses in artificial wombs. Ectogestation as this is called, raises major legal and ethical issues, especially for abortion rights. In countries allowing abortion, regulation often revolves around the viability threshold—the point in fetal development after which the fetus can survive outside the womb. How should viability be understood—and abortion thus regulated—after ectogestation? Should we ban, allow or require the use of artificial wombs as an alternative to standard abortions? Drawing (...) on Cohen, I evaluate three possible positions for the post-ectogestative abortion laws: restrictive, conservative and liberal. While the restrictive position appears untenable, I argue that the liberal and conservative positions can be combined to form a legally and morally coherent basis for post-ectogestative abortion legislation, offering an improvement from the point of both prolife and prochoice positions. (shrink)

De Bie et al. posit thatthe best way to describe the person who would receive current AWT is as a “fetal neonate” or fetonate. Neonatal pertains to the fact that the subject is removed from the wom...

Throughout most of human history women have been defined by their biological role in reproduction, seen first and foremost as gestators, which has led to the reproductive system being subjected to outside interference. The womb was perceived as dangerous and an object which husbands, doctors and the state had a legitimate interest in controlling. In this article, we consider how notions of conflict surrounding the womb have endured over time. We demonstrate how concerns seemingly generated by the invisibility of reproduction (...) and the inaccessibility of the womb have translated into similar arguments for controlling women, as technology increases the accessibility of the female body and the womb. Developments in reproductive medicine, from in vitro fertilisation to surrogacy, have enabled women and men who would otherwise have been childless to become parents. Uterus transplants and ‘artificial wombs’ could provide additional alternatives to natural gestation. An era of ‘womb technology’ dawns. Some argue that such technology providing an alternative to ‘natural’ gestation could be a source of liberation for female persons because reproduction will no longer be something necessarily confined to the female body. ‘Womb technology’, however, also has the potential to exacerbate the labelling of the female body as a source of danger and an ‘imperfect’ site of gestation, thus replaying rudimentary and regressive arguments about controlling female behaviour. We argue that pernicious narratives about control, conflict and the womb must be addressed in the face of these technological developments. (shrink)

In a recent publication, I argued that there is a conceptual difference between artificial womb (AW) technology, capable of facilitating gestation ex utero, and neonatal intensive care, providing incubation to neonates born prematurely. One of the reasons I provided for this distinction was that the subjects of each process are different entities. The subject of the process of gestation ex utero is a unique human entity: a ‘gestateling’, rather than a fetus or a newborn preterm neonate. Nick Colgrove wrote a (...) response to my paper, claiming that my distinction between the subject of an AW and a newborn (in intensive care) was false. He claims that I have not accounted for the proper definition of ‘birth’ and that gestatelings are not a distinct product of human reproduction. Further, Colgrove posits that even if I can successfully distinguish gestatelings from preterms, such a distinction is morally irrelevant because the entities would have the same moral status. In this paper, I address the three challenges raised and defend the claim that gestatelings are unique entities. Moreover, I argue that moral status should not be considered ipso facto determinative in the debate about AWs. (shrink)

A large body of literature considers the ethico-legal and regulatory issues surrounding assisted conception. Surrogacy, however, within this body of literature is an odd-fit. It involves a unique demand of another person—a form of reproductive labour—that many other aspects of assisted conception, such as gamete donation do not involve. Surrogacy is a form of assisted gestation. The potential alternatives for individuals who want a genetically related child but who do not have the capacity to gestate are ever increasing: with the (...) advent of uterus transplantation, and the anticipated development of artificial placentas.In this paper, I highlight the pertinent conceptual differences between technologies assisting conception and those assisting gestation to demonstrate that distinct issues arise when assisted gestative technologies are used. I argue that there is utility in considering AGTs as a genus of technologies. These technologies perform the same function from the perspective of putative parents and might exist on a spectrum of alternatives when they become more available. Moreover, since many of the same or very similar ethical, social and legal issues are raised by surrogacy, UTx and ectogestation, analysis of these issues will be better contextualised by considering these technologies together. Many of the matters currently being highlighted for reform in the context of surrogacy will inevitably impact on how other forms of assisted gestation are governed. The conversation should be broadened; we should consider how far other emerging technologies might be accommodated in revised regulatory schemes. (shrink)

In this commentary, I will consider the implications of the argument made by Christopher Stratman in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, I argue that virtually everything we already know about unintended pregnancies, abortion and adoption does (...) not prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion, then there will be no radical transformation of the practice of abortion. Second, abortion is already associated with stigma, and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the foetus to the human subject of the artificial womb—the gestateling, therefore creating a new category of killing—gestaticide. However, this would only reorient the debate rather than end it. (shrink)

The rapid development of artificial womb technologies means that we must consider if and when it is permissible to kill the human subject of ectogestation—recently termed a ‘gestateling’ by Elizabeth Chloe Romanis—prior to ‘birth’. We describe the act of deliberately killing the gestateling as gestaticide, and argue that there are good reasons to maintain that gestaticide is morally equivalent to infanticide, which we consider to be morally impermissible. First, we argue that gestaticide is harder to justify than abortion, primarily because (...) the gestateling is completely independent of its biological parents. Second, we argue that gestaticide is morally equivalent to infanticide. To demonstrate this, we explain that gestatelings are born in a straightforward sense, which entails that killing them is infanticide. However, to strengthen our overall claim, we also show that if gestatelings are not considered to have been born, killing them is still equivalent to killing neonates with congenital anomalies and disabilities, which again is infanticide. We conclude by considering how our discussion of gestaticide has implications for the permissibility of withdrawing life-sustaining treatment from gestatelings. (shrink)

Ectogenesis (artificial wombs) might soon become a reality. This paper will analyse how the development of such technologies will affect Judith Jarvis Thomson’s defence of abortion, and what the potential consequences of this will be for society. Thomson attempts to justify abortion by appealing to the mother’s right to bodily autonomy. We will argue that once these technologies have been developed, the right to abortion can no longer be justified by such appeals. As a result, when justifying abortion, Thomson-style arguments (...) will no longer work, and a very different strategy will have to be adopted by those wishing to justify its permissibility. Anticipating a consequent weaker position of the pro-choice view, we briefly consider some of the practical implications of ectogenesis for society: effects on parental dynamics, governmental expenditure, research, and gender equality. (shrink)

The Journal of Medical Ethics has published a few papers over recent years that explore the ethical implications of ectogenesis.1–4 It is an as yet undeveloped but theoretically possible method by which a fetus can be gestated outside of the womb, and while the prospects of ‘full’ ectogenesis seem some way off, there are techniques that suggest ‘partial’ ectogenesis could be closer. This issue’s Feature Article considers two of the principal arguments that have been developed in favour of ectogenesis being (...) permissible and available.5 Cavaliere observes that the equality and freedom promoting aspects of ectogenesis will only benefit a small number of women, and she argues that it’s the broader political perspective ectogenesis advances that’s valuable. By equality she has in mind the workplace, the burdens of bearing, as well as equality among fertile, infertile, trans and lesbian women. In this context, …. (shrink)

Ectogestation—that is, ‘artificial’ or extramammalian pregnancy—may soon be within technological reach. This confronts us with questions about the correct moral and legal attitude towards the subjects of this technology, which are called ‘gestatelings’. Colgrove argues that gestatelings are a kind of newborn, and consequently should have the same moral and legal protections as newborns. This paper responds that both claims are unsupported by his arguments, which equivocate on two understandings of the term ‘newborn’. Questions about the appropriate moral and legal (...) status of gestatelings are therefore left unanswered, but in the course of attempting to answer them, we are well advised to continue using the term gestateling. (shrink)

De Bie et al. (2023) hold out their paper as an effort “to identify the broad range of ethical concerns and considerations regarding AWT” and to organize them “into a comprehensive framework to org...

In their article, De Bie et al. (2023) provide a scoping review of the ethical and socio-legal issues arising from research into, and the potential, maybe even likely deployment of, artificial womb...

De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...