In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity survives the premature ending of the pregnancy. In outlining (...) the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process—and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used. (shrink)

According to Chloe Romanis, it is worth distinguishing interventions such as surrogacy, uterus transplantation (UTx), and potentially artificial placenta technology, as falling under the genus assisted gestative technologies (AGTs) rather than the more general term assisted reproductive technologies (ARTs). The proposed genus of assisted gestative technologies is a helpful first step in the endeavour to distinguish between the different ethico-legal landscapes across various ‘assisted reproductive technologies.’ Yet, if assisted gestative technologies can be considered a genus of assisted reproductive technologies, we (...) might consider surrogacy, uterus transplantation (UTx), and artificial placenta technology their individual species. Between these various species of AGTs, I would argue, there remains enough ethico-legal diversity to warrant independent discussion about the descriptive and normative functions of each AGT and the relationship between gestation, genetic relatedness, and legal/moral parenthood. (shrink)

This paper argues that we ought to distinguish between ‘assisted’ gestation and ‘delegating’ gestation—and that the relevant difference does not depend on whether it is another human or technological system doing the work.1 In the philosophy of action, there is an important theoretical gap between S ‘helping A to φ’ and S ‘φ-ing on behalf of A’: the former is an instance of joint agency while the latter is an individual’s action. This matters because if the latter counts as an (...) intentional action, then only S is being said to have acted intentionally while, if the former is an intentional action, then both S and A have acted intentionally—which might have consequences for responsibility attributions, for example. To put it brutally, it is the difference between Belarus supporting Putin’s invasion and Belarus doing Putin’s dirty work—and you do not have to be a Russian mother to see that these two alternatives will have very different consequences. In another context, the economics of outsourcing is also built around the same theoretical distinction. But does this matter to gestation and reproduction? It does, argues this paper. Insisting on an ‘assisted’ reproduction framework2–8 reinforces patriarchal stereotypes and continues to put undue burdens on prospective mothers both by perpetuating the stereotype of women as needing help and also by implicating them in an action that might genuinely not be theirs. Delegation, on the other hand, empowers parents—who are in charge, rather than needing help. Furthermore, an action-theoretical delegation framework might be better placed to regulate and anticipate future technological developments, …. (shrink)

This July 2022 issue of the JME contains several articles addressing ethical issues related to COVID-19 as well as reproductive ethics—a timely topic, given the leaked U.S. Supreme Court document, anticipating the overturn of Roe v. Wade. On the COVID-19 front, original articles in this issue include an analysis of ethical issues related to sharing research samples and data between low/middle-income countries and high-income countries,1 a retrospective analysis of European scientific societies’ triage policies early in the pandemic,2 an assessment of (...) the fairness of the allocation framework used by the WHO for their COVID-19 Vaccines Global Access Facility,3 balancing physicians’ freedom to express opinions on medical matters with public interest when they run contrary to each other,4 and a survey of Americans’ views on race-based and place-based COVID-19 vaccine prioritisation.5 The articles include a mix of looking back and …. (shrink)

In ‘Assisted Gestative Technologies,’ Romanis argues for the conceptual creation of a new genus of assisted reproductive technologies, in recognition of the unique ethical, legal and social implications assistive gestative technologies raise.1 She argues this taxonomic classification might allow for ethicolegal determinations regarding one AGT to be generalised to other instances of this technology. Romanis correctly identifies a lack of appropriate regulations for dealing with the rapidly developing field of assisted and artificial gestation, noting the current discussion of surrogacy law (...) reform in the UK offers an opportunity to redress this. However, when reading this article what strikes me most is not how AGTs, ARTs or assisted conception are defined, but rather what constitutes a technology. Surrogacy is introduced as assisted gestation, but uterine transplantation as being on the spectrum of AGTs. While both might use assisted conception, for example, in vitro fertilisation, it is unclear what part of uterus donation or transplantation is to be considered technological? This is not to say such processes do not involve technologies—of course they do—but we do not typically describe surgery itself as an instance of technology. This distinction is relevant if the purpose of establishing this genus of AGTs is to group morally relevant characteristics of technologies together or create paradigm cases for casuistical reasoning. Considering the above …. (shrink)

Elizabeth Chloe Romanis argues that surrogacy, uterine transplantation (UTx) and ectogestation belong to a genus of ‘assisted gestative technologies” (“AGTs”).1 These technologies are conceptually distinct from assisted reproductive technologies (ARTs) in that they support gestation rather than conception. Romanis argues that they also raise some overlapping ethical and policy issues that are best appreciated by ‘considering these technologies together’, thus placing the issues that AGT’s share at the forefront of ethical analysis. The neologism ‘AGTs’ picks out a distinctive and important (...) category of technologies, and there is value in considering the ethical parallels between various AGT’s. However, the category of AGTs should provide neither the only nor the main level of ethical analysis. Surrogacy, UTx and ectogestation share important parallels not only with each other but also with other practices; indeed, some of these parallels are stronger than those AGT’s share with each other. Consider ectogestation. One striking implication of ‘artificial placentas’ is that they may make it possible to terminate a pregnancy without causing the death of the fetus. This is noteworthy in part because it threatens to disrupt one influential defence of abortion rights: that they are protected by something like a moral right to bodily integrity. Once fetuses can be transferred to artificial wombs, bodily integrity would no longer support a …. (shrink)

In the paper Assisted Gestative Technologies, Elizabeth Chloe Romanis advocates for the creation of a new category, which includes technological interventions that allow ‘persons who want to reproduce, potentially using their own genetic material, but are unable, or potentially unwilling, to undertake gestation’.1 Romanis conceptualises these technologies as a unified kind, a ‘genus’, and argues that they ‘collectively raise distinct ethical, legal and social issues from those related to assisted conception’.1 As I understand Romanis’ paper, her aims are twofold. The (...) first is conceptual: Romanis construes assisted gestative technologies as a separate kind with shared attributes and purposes, which differ from those of technologies that enable conception. The second is normative: Romanis champions the distinction between AGTs and other technologies as a useful way to tease apart relevant ‘ethical, legal and social issues’ that specifically concern AGTs. The reason for this, according to Romanis, is that gestation is ‘such a unique and demanding form of labour’.1 I agree with Romanis: gestation is indeed a unique and demanding form of labour, one with associated biological, cultural and political specificities with distinctive moral significance. It is for this very same reason that I believe that AGTs should not conceptually be considered as a unified category and should not be morally appraised as such, for relevant political and moral aspects of these technologies would be overlooked in the process. To clarify: Romanis’ use of genealogy to aid normative inquiry is a worthy endeavour. And I concur with the very convincing case she makes for the distinction between conception and gestation. My disagreement with Romanis rather concerns the conceptualisation of technologies such as gestational surrogacy, uterine transplantation and artificial placentas as a unified category, and the normative inquiry grounded in …. (shrink)