This issue of Christian Bioethics explores theological, metaphysical, and ethical questions surrounding emerging reproductive technologies. Narratives concerning such technologies are often manipulated via “language games.” Language games involve toying with language to ensure that one’s vision of the good gains or retains political prominence. Such games are common in academic discussions of “artificial womb” technologies. Abortion proponents, for example, are already using language to dehumanize subjects within “artificial wombs.” This is unsurprising. Were relevant subjects considered persons, then abortion access (and (...) other forms of “reproductive autonomy”) might be curtailed. Here, I show that abortion proponents’ language games often depend on dubious metaphysical claims. Second, I argue that Christians should oppose dehumanizing language games, since those games undermine “neighbor-love,” which Christians are commanded to show others. I also highlight how discussions of other technologies—such as medication abortion—are affected by confused (or manipulative) language. Ultimately, the language games I critique aim to preserve and expand the “rights” of the powerful to dehumanize, control, and kill vulnerable human beings. Since neighbor-love commands Christians to provide for “the least of these,” however, Christians must expose these manipulative language games, refute them, and resist the corrupt ideologies from which they flow. (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)

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)

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)

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)

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)

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)

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)

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)