Artificial wombs (ectogenesis)
Published November 2016
Partial ectogenesis (PE) would involve the use of an artificial womb (or aspects of a womb, such as an artificial endometrium and placenta) for part of the reproductive process, and could also be used to further human embryo research. This may lead in the future to full ectogenesis (FE) which would involve the entire reproductive process (from fertilisation to birth) occurring outside of the female human body in an artificial womb.
Are there recent scientific, legal or social developments?
The focus of research is now twofold: firstly extending the length of time embryos can be kept alive prior to implantation in the mother, with a recent study achieving 13 days; and secondly being able to keep extremely premature babies (< 22 weeks) alive, using an artificial womb. Both of these areas would contribute to PE (and potentially FE), although the former is mainly being developed for human embryo research, and the latter is at the stage of research in animals, such as a study that kept premature lambs alive with an artificial placenta for one week.
Are there complex ethical issues?
There may be a concern that research into and the use of PE for both embryo research and assisted reproduction is an unjustifiable use of limited resources, as infertility is not a life-threatening or primary concern. There are other options for infertile individuals, such as adoption, which arguably have more social benefits. However, some claim that there is a fundamental desire for your own genetic children, which society may have a duty to help citizens fulfil. If fully developed and available, PE may be regarded as safer and better, as an artificial womb is a controlled environment. Questions concerning whether all women should use PE, or whether certain ‘higher risk’ women (e.g. those who would drink and take drugs during pregnancy) should be compelled to use PE will arise, as well as the idea of fetal rights, and the best interest of the child. This may also lead to ‘natural’ pregnancy and birth being considered as risky and stigmatised (for further discussion on concept of ‘naturalness’, see the Council’s recent project.) On the other hand, the mother’s bodily autonomy is important, and PE may affect the mother-child bond that is thought to begin in the womb, although the bonds that fathers and adoptive parents build with their children downplays the strength of this point. PE may also further gender equality and reproductive autonomy, as it provides women with another option. However, using a medical solution to tackle a social issue raises its own questions. PE is also relevant to the abortion debate, as it potentially enables both a pregnant woman’s right to choose abortion and the fetus’ right to life to be satisfied, by providing an alternative womb for the fetus to develop in, making the fetus ‘viable’ earlier. Questions concerning whether this creates a duty to use PE, or whether a pregnant woman also has as a right the death of the fetus have been raised. FE generates further issues. The cited benefits include: enabling people who currently cannot have children to have children without needing a surrogate; eradicating the risk of pregnancy for women and minimising the risk for the fetus; removing women as the sole bearers of the risks and burdens of pregnancy, and potentially achieving gender equality. However, FE brings new possibilities for controlling reproduction. Some may be beneficial, enabling us to ensure that the fetus is in the best possible environment for it to develop. Others may be more ethically complex, such as the ability to control which fetuses are eligible for FE, and which people can become parents. The likely high cost of FE will also raise issues of equal accessibility.
Is there a potential policy impact?
As research into PE advances, policy makers need to (re)consider regulations and guidelines pertaining to research, in particular, the acceptability of testing artificial wombs on human premature babies, and the potential extension of the 14 day rule (the topic of a current council workshop) for human embryo research. The implications of FE will also need to be considered. If/when artificial wombs are available for clinical use, specific legislation, regulation and guidelines detailing when, who and in what circumstances they can be used (especially as growing organs for transplant in humans may be possible at that time), and who is responsible for the fetus will be required. The impact on existing policy, such as that regarding abortion, and the legal understanding of parenthood or motherhood, also need to be considered.
Is it a subject of public concern?
It appears that the public is not widely aware of either PE or FE as a real possibility, although there are some articles available from specialist media outlets such as the Genetic Literacy Project, and it has been addressed in a 2015 Guardian article. Reproduction, infertility and abortion are however topics of public concern, as is the possibility of keeping younger premature babies alive, and the existence of technology that has the potential to vastly change our biological and social lives.
Is consideration timely?
Scientific research in the field is advancing, and it has been suggested that some new technology (in particular artificial placentas) may be ready for clinical use within five years, highlighting the need to initiate discussions soon to enable legislation and regulation to be in place.
Can the Council offer a distinctive contribution?
The Council could offer a platform to initiate discussions with policy makers and medical professionals, regarding the unique ethical issues surrounding clinical use of PE and FE, and how this relates to current regulation, such as abortion laws.
Possible future work topics
This is one of the topics that have been suggested as possible project areas for further investigation by the Council. These topic summaries do not aim for comprehensiveness; rather, they are intended to sign-post some of the key considerations and to provide a starting point for discussion. Each summary includes links to relevant publications on the topic.