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)

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 (IVF) 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)

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)

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)

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)

Let me begin by thanking the Journal of Medical Ethics editors and the four commentators for taking time to read, reflect and offer thoughtful comments on my paper. The issues they raise warrant careful attention. Regrettably, I am only able to address some of their key concerns due to space constraints. In my paper, ‘Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’, I outline two sets of critiques of liberal defences of ectogenesis and contend that these defences are limited (...) in their reach and scope. Building on Federici’s,1 and Dalla Costa’s and James’2 readings of the of the international feminist campaign ‘Wages for Housework’, I argue that the value of ectogenesis is to similarly advance a political perspective and a provocation. Framing ectogenesis in these terms enables to critically engage with the physical and social burdens of pregnancy, childbirth and childrearing, which all too often are borne by women. It also allows to demand for better medical and social services for mothers and women more generally, as well as better working and living conditions for these and other disadvantaged groups. Lisa Campo-Engelstein thoughtfully broadens my reading of liberal defences of ectogenesis and contextualises them within the history of ‘reproductive advancements and technologies’.3 She illustrates that …. (shrink)

This paper calls for the development of a method of ectogestation as an emancipatory intervention for women. I argue that ectogestation would have a dual social benefit: first, by providing a gestational alternative to pregnancy, it would create unique conditions to reevaluate one’s reproductive preferences—which, for women, always include gestational considerations—and to satisfy a potential preference not to gestate. Enabling the satisfaction of such a preference is particularly valuable due to the pressures women face to embrace pregnancy as central to (...) their identity, while at the same time being penalised by it. Second, ectogestation would address certain specific negative social implications of gestation and childbirth, which cannot be avoided through social measures as they are caused by the corporeal nature of these phenomena. Finally, I argue that it is unfair to hold ectogestation to a higher standard than other innovations such as modern contraceptives and non-medical egg freezing. (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 article I explore partial ectogenesis through the lens of choice in childbirth, framing it as a mode of delivery. In doing so, I refocus discussion about partial ectogenesis, ensuring that this centers upon the autonomy and rights of the birthing person—as the procedure required to facilitate external gestation will be performed upon their body. By drawing a critical comparison between “delivery by partial ectogenesis” and request cesarean sections, I argue that delivery by partial ectogenesis ought to be available (...) on the basis of the pregnant person’s request alone. (shrink)