Charting a Brave New World: The Ethics of Abortion in Light of Ectogenesis

The world around us is progressing, a feat that not only involves looking to the future but also examining our past. As technologies emerge many times we are forced to consider new ethical standpoints and assess them accordingly. But how will new technology make us reexamine our ethical judgments on past issues? In early 2017, researchers at the Children’s Hospital of Philadelphia revealed that they had developed an artificial womb sustaining a premature baby lamb for 22-24 weeks. We define this using the term ectogenesis, the development of embryos in artificial conditions outside the uterus. Ectogenesis has a bright future in abating the current premature infant mortality and medical complications. But like any medical innovation, ectogenesis bears certain consequences and raises ethical concerns for the future. A primary concern is how ectogenesis will affect viability, outlined by the United States federal law as the point at which a fetus is no longer eligible to be aborted, and consequently the ethicality and regulation of abortion in the United States. Along with viability, abortion laws have been decided based on the autonomy of a woman, therefore we must determine to what extent will ectogenesis remove a woman’s body from this equation. This paper will discuss the possible dismantling of a long-debated law regulated by the current idea of viability. It will examine the long-established ethical ideas of autonomy, beneficence, and privacyrevolving around medical tissue proprietorship which have been presented from the beginning of the abortion debate and are still applicable even with emerging technological advancement. Most would say that we consider the constitution a living document, to be interpreted in light of the moral and ethical climate of the time, so must we also give the same consideration to our ethical values in the face of medical innovation and ectogenesis?


In April 2017, Researchers at the Children’s Hospital of Philadelphia revealed that they had developed an artificial womb sustaining a baby lamb for 22-24 weeks using ectogenesis technology. Recent advances in the past years, the largest development being just last year, have brought ectogenesis technology to life, seemingly metastasizing out of a science fiction novel. The term “ectogenesis,” coined by the British scientist J.B.S. Haldane, was used to describe the technology that would one day metamorphosize gestation, a process once driven by a woman’s body, to an external mechanical process that could bring an embryo to full term (Rosen). As it is in our nature, we are dependent on reproduction for the purposes of populating our Earth and expanding the family unit. The vitality of reproduction to our survival as well as several of our social frameworks have led to developments of reproductive innovation and technology. They have impacted societal views and ethical perceptions on a variety of areas such as proprietorship of reproductive materials, the family unit, the mother-fetal relationship, and women’s rights. It can be expected that ectogenesis too will have a noteworthy impact on how we view the many facets of reproduction on an individual, societal, and ethical scale. But with this emerging technology, as with any other, comes the Daedalus effect; a metaphor for aspects of the scientific process through the ethical perspective. When a problem is solved it often raises others, and when these, in turn, are solved they generate additional questions. Currently, the artificial womb will remedy the shortcomings of incubation technology that has not changed significantly over the past decade. It will do this by gestating a fetus or a premature embryo earlier than expected survival benchmark of 27 weeks, which would ordinarily have a 90% survival rate. But we cannot disregard the potential for ectogenesis to be used for purposes other than its current tested use, as technology in medical innovation follows a pattern, going from novel, to ordinary, to expected.

This paper will focus on the near future use of ectogenesis for the development of fetuses outside the human womb. The growing possibility of an artificial womb is already changing the stances of some on the current American abortion doctrine to see it as moot. Others remain unsure of the consequences regarding abortion laws as well as the implications on the concept of “my body, my choice.”  This raises the question, should the technology of the artificial womb change our considerations of abortion of an early stage embryo considering whether or not there is a “right to a dead fetus?” This question will be examined within the parameters of what is now considered the early stage fetus and can be legally aborted. The late-stage fetus is protected by law as only terminatable in the instance that the life or health of the mother is at risk. I will also evaluate ectogenesis as a “solution” to the abortion debate.

The main ethical issues that this paper will discuss and focus on are; the autonomy of women who are seeking abortion and her right to give consent to a medical procedure that involves her body, the privacy of a woman to control when to beget a child as well as what happens to her reproductive product (in this case the embryo), and the duty of beneficence that physician has to his or her patient in the context of medical operation concerning the fetus. Taking into consideration abortion is already a legal practice federally and considered ethical in numerous circles, in this paper I will not be defending abortion. I will also not be discussing the ethical considerations regarding ectogenesis as a reproductive option in bringing one’s own embryo to term. The ethical values will take into account both sides from their respective positions, but will ultimately lead to the contention that women who are seeking an abortion should not be forced to gestate their child in an artificial womb. The choice of gestating a child in an artificial womb should be the decision of a consenting, competent woman.

Factual Background on Ectogenesis

The artificial womb device, called a biobag, consists of a clear plastic bag filled with synthetic amniotic fluid. The fluid flows in and out of the bag just like it would in a uterus, removing waste, shielding the infant from infection, and keeping the fetus’s developing lungs filled with fluid. To substitute the provision nutrition and oxygen to the blood and to remove carbon dioxide that the mother provides through blood blow to the baby and back, scientists connect the fetus’ umbilical blood vessels to a pumpless circulatory system that provides just enough pressure– as a an external pump can damage the fetus’ heart– that moves blood smoothly through the system. The process is smooth enough, in fact, that the fetus’ heartbeat is sufficient to power blood flow without another pump (Becker).

The experiment was tested for up to four weeks on eight fetal lambs that were 105 to 120 days into pregnancy — about the equivalent to human infants at 22 to 24 weeks of gestation—  the full term gestation of a sheep being at 138 to 159 days. After the four weeks, the lambs were switched onto a regular ventilator like a premature baby in a neonatal intensive care unit (NICU). On the ventilator, the lamb’s health appeared to be nearly as healthy as a lamb of the same age gestated naturally and delivered by cesarean section. Later upon examination of their lungs and brain, the organ systems most vulnerable to damage in prematurity were uninjured and developed as the naturally gestated counterparts.  Despite these findings, certain aspects such as brain functionality, differing in lambs and humans, are not measurable to the same standards as a human and therefore we cannot rely on animal testing alone (Becker).

At this point scientists have only gotten as far as testing on lambs. However the lead author of the study, Alan Flake, is confident in the ability for testing on human fetuses in three years. To the concern of many, there is a question of whether or not conducting trials of the artificial womb on a human fetus would be considered unethical human experimentation. But there is consideration for this despite the caveat of whether a fetus is considered human affects how technology can be tested on the fetuses. Because the focus of the proposed research is for life support measures for saving premature infants, there are opportunities for doctors to experiment with new methods such as the artificial womb. These opportunities are presented if a fetus is certain to die without intervention. In this case researchers can attempt even an untested technique to try and preserve its life. This will lead to the distinction between a fetus and baby as well as the current viability standing. Through these criteria and measures a new technology may become tested. Thus, scientists as of now do not face great obligations with initiating human trials of artificial womb gestation. However, moving forwardparticularly when the fetus becomes of age to be protected by the state there must be ethical consideration as to how they are handled and the methods used by scientists.  

It is important to clarify that in no way have there been formal scientific advances in ectogenesis technology with the explicit purpose of decreasing the time between conception and the point at which a fetus is deserving of personhood. Alan Flake has blatantly expressed, “It’s certainly not our goal to extend the limits of viability. Our goal is to improve survival for extremely premature infants.” However, the nature of ethics is not only to consider the present or near future of medical innovation, but to also contemplate the potential future and the consequences and ethical contentions. Despite its initial proposed use to improve premature infant survival; ectogenesis has been considered for other uses; reproduction, the gestation of cryopreserved embryos, and altering viability are the primary uses being considered in the ethical community. Artificial womb technology will be very beneficial in the support and medical care of premature infants who are now typically supported through incubation technology, most of which have not changed in the past 30 years. An infant delivered before 37 weeks is considered premature. In the U.S., about 30,000 infants are born younger than 26 weeks old every year., accounting for 1 out of every 10 infants born in the year 2016. Even still, 95% of extremely premature babies are born with major complications such as lung disease, infections, brain hemorrhaging, heart problems or failure, liver failure, blood conditions, learning and motor disabilities, hearing or vision loss, or in some circumstances death (“Reproductive Health”).

The non-traditional reproductive options of today compared to fifty years ago have become numerous and although not yet tested for this purpose, ectogenesis could be used as an offshoot of IVF. Whether this would be a more affordable or more expensive alternative to most current alternative conception methods is unknown, but assuming it could be used in the situation of an woman who cannot gestate a embryo, it could be an alternative to domestic and international surrogacy which is extremely expensive, not strictly regulated in several places including the United States, and can become exploitative of women (particularly those of a lower socioeconomic class). Following along the lines of ectogenesis as a proposed use for reproduction is the ability to gestate cryopreserved, or frozen, embryos in an artificial womb to bring them to term.  This would serve as another reproduction option that is not dependent on the ability of a woman to gestate the embryo which is dependent on a variety of factors such as health, age, and gestation or birthing ability. Although it will not be explored in this paper, ectogenesis as a reproductive option is additionally an issue of ethical concern.

Ectogenesis technology has come a long way from nearly one hundred years ago when the idea was first proposed, to now when the technology is three years away from being developed and tested on human embryos. Whilst the technology is still in an experimental phase, its probable future in ameliorating survival and quality of life for premature infants as well as the use as a reproductive option, is foreseeable. Despite ethical concern about the use of human embryos in testing of ectogenesis, trials are likely to continue due to the intended purpose for the sustainment of premature infants. But, arguably one of the most impactful possible use of ectogenesis, with significant ethical questions, will be the use of artificial wombs as an alternative or complete legal replacement to abortion.

 

Legal Considerations and Terms

In examining the potential for ectogenesis to change current viability and therefore abortion regulation, there must be a consideration of the maternal-fetal relationship. This starts with the distinction between a fetus and a baby from the already established constitutional law regarding the difference. From the outset, the status of the fetus is a peripheral issue from the pro-choice standpoint and imperative to the anti-abortion argument.  The argument that a fetus is or is not a person seems subjective and at times unscientific considering that biology, medicine, law, philosophy, and theology have no consensus on the issue, and neither does society as a whole. However, this terminology will be based on the current legal definitions of fetus and of a baby as they are what currently determine our laws and proceedings on matters of abortion.

In the 1973 abortion rights case of Roe v. Wade, in upholding a woman’s right to an abortion, the High Court ruled that the fetus up to 22 weeks is not a human being and does not have a person’s full range of constitutional protections. In making its decision, the Court ruled that a fetus is not a person under the terms of the Fourteenth Amendment to the U.S. Constitution. However, the Court also maintained that the state has an interest in protecting the life of a fetus after viability—that is, after the point at which the fetus is capable of living outside the womb. As a result, states were permitted to outlaw abortion in the third trimester of pregnancy except when the procedure is necessary to preserve the life of the mother. It is important to note that while there are a wide variety of laws throughout the world written specifically to protect “born human beings” and their property, there is virtually no legal precedent for applying such laws to fetuses. Even when abortion was illegal, it had a lesser punishment than for murder, and was often just a misdemeanor (Arthur).

A fetus is certainly alive, but this reasoning can apply to any living thing, including the most basic life forms like bacteria. To consider a fetus alive is different from considering it a “human being.” “The words ‘person’, ‘human being’, ‘child’, and ‘individual’, include every infant member of the species homo sapiens who is born alive at any stage of development (1 U.S. Code § 8).” The Cornell Legal Information Institute defines a baby as being “born alive”:

The term “born alive”, with respect to a member of the species homo sapiens, means the complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.

Because a baby is considered a “human being” or person it is afforded the same rights as a child and the legal protections of a human being provided under the Constitution. These protections also extend to the right to life.

Fetuses are uniquely different from born human beings in major ways, which strongly disputes the claim that they can be classified as human beings. The most fundamental difference is that a fetus is totally dependent on a woman’s body to survive. Although a claim can be made that born human beings are too dependent on other people, the crucial difference is that they are not dependent on one specific person to the exclusion of all others, which is the case when a fetus inhabits a single woman’s body for sustainment. Anybody can take care of a newborn infant, but only that pregnant woman can nurture her fetus. Another key difference is that a fetus doesn’t just depend on a woman’s body for survival, it actually resides inside her body. Human beings must, by definition, be separate individuals and fully exit the woman’s body and be able to exist independently of the woman.

The distinction between baby and fetus is important because they are given different rights and protections under the law based on the classification of being “born alive.” But from an objective standpoint, there are key highlighted differences between a fetus and a baby as an individual “human being” based on their biological dependence on the mother’s body.  Because of the perspicuous differences between the fetus and the baby I will not be using these terms interchangeably as they have different denotations.

 

Viability

Viability, established by the monumental case of Roe v. Wade in 1973, is currently defined by the Supreme Court as the potential of the fetus to survive outside the uterus after birth, natural or induced, when supported by up-to-date medicine. In Planned Parenthood v. Casey in 1992, the Court purported to reaffirm the viability rule citing that, “no changes of fact have rendered viability more or less appropriate as the point at which the balance of interests tips” (qtd. in Messner). Nevertheless, the Supreme Court has failed to explain why the capacity to survive outside the womb should be required as a constitutional matter before a state can protect the life of a second-trimester fetus. Viability is a concept still considered equivocal by many. In his statement on the 1979 Colautti v. Franklin case about physician determination of viability prior to performing an abortion, Professor Randy Beck states, “The probability of any particular fetus’ obtaining meaningful life outside the womb can be determined only with difficulty… Different physicians equate viability with different probabilities of survival, and some physicians refuse to equate viability with any numerical probability at all” (qtd. in Messner). Most importantly, viability is relative to the level of medical technology available at the time. It is a moving time window with an ending that is moving closer to its beginning, becoming shorter as technology improves. In light of recent technology, specifically ectogenesis, viability will occur before the 20-week mark in a large percentage of cases. “Due to the advances in neonatal care, the state may be able to protect a fetus from abortion today when, just a few years before, it would have been constitutionally disabled from protecting an identical fetus” (Beck qtd. In Messner). This provides an obstacle for abortion because viability is contingent on technological advancement and therefore will be dictated by the artificial womb. Currently we define a fetus’ status as a person protected by the state not based on when we consider them to be a person, but when technology is able to “make” them one. From this, a greater issue arises of letting technology determine what makes us human and at what point this occurs.

Adhering to the previous statement made in the introduction about the consideration of how ectogenesis could possibly mandate the end of abortions and the ethicality and implications of this possibility, this paper will stay within the limits of the termination of an early stage fetus and not of a late stage fetus. Previous statements find reasons for the currently defined “viability” as unjustifiable by science, undeterminable by technology because of the subjectivity to further advancement, as well as not rooted in fundamental ethical theory. A alterable timeline of potential life outside of the womb does not assign moral status or personhood, it merely is a reflection of our technological advancements instead of the unchangeable point that we consider a fetus deserving of life and the rights of an individual (as long as it does not impede on the life/health/ability to life of the mother). A more distinct and idealistic prioritization of life is based on the “graduated” view of embryonic and fetal status. Margaret Little in Abortion and the Margins of Personhood, finds a distinction of the rights provided to the fetus and to the mother at certain stages, stating  “Even at early stages of pregnancy, developing human life has an important value worthy of respect [but not of more respect and consideration than that of the woman]; its status grows as it does, increasingly gradually until, at some point late in pregnancy, the fetus is deserving of the very strong moral protection due newborns.” Granted, this “point late in pregnancy” can be considered as ambiguous as the aforementioned viability and even to some degree arbitrary. But the reasoning behind this is that the fully matured fetus  has the same level of moral considerability as a newborn because birth itself does not mark a change in intrinsic moral status (Little). As for the exact point itself, it is not arbitrary. In fact it’s contingency lies on fetal sentience, a stronger basis for the determination of the point when a fetus is deserving of personhood. Fetal sentience, which is the capacity to feel, perceive, and experience objectively, occurs around the same time as viability at about 24 weeks (Steinbock).The choice between sentience and viability as the benchmark for the time frame in which abortion justifiable is important because it changes our view on whether or not the point of protection of the fetus is subject to change based on technology. After this period of fetal maturity, the factors affecting the woman’s decision about the pregnancy change and there is now a future child to consider. However, that does not mean that in the event of a late term pregnancy that an abortion should be denied, instead there are different ethical considerations particularly in the case of preserving a woman’s own life or health.

In the face of ectogenesis, the Supreme Court’s’ determination of viability proves to be vague and unjustifiable both ethically and scientifically. Instead, it currently sits upon a timeline determined by recent technological advancement, which in the delicate scenario of determining a point of personhood and human protection, is an inapposite application. A more appropriate judgement and determination of viability  can be made in favor of the parameters of moral status laid out by Margaret Little. She defines the early stage fetus and late stage fetus as both deserving of respect, but with full development as well as the development of sentiende the fetus past about 24 weeks is deserving of the same level of moral considerability as a newborn. This moral considerability when conflicting with the life and health of the mother does not take precedent. This designation of the point of viability what determines the moral status of a fetus will guide the ethical considerations of this paper.

Ectogenesis Aligned With Ethical Values

In answering the ultimate question; should ectogenesis technology change current abortion regulation, we must consider if the artificial womb changes if and when we consider a fetus as an individual deserving rights and most importantly the right to live. This question is posed in regards to the current determination of viability, not the one based on moral status as proposed by Margaret Little. According to the contemporary definition of viability the artificial womb could alter the time frame of viability to even earlier in pregnancy and for a shorter amount of time, possibly to the point where viability is essentially from the point of conception. In this case, when viability is earlier in development of the fetus, this would mean a fetus would therefore be recognized as deserving protection from the state and to a more drastic point, personhood and moral status. To this point, many consider maintaining abortion in spite of ectogenesis would be demanding the “human right to a dead baby” rather than the right to a dead fetus (Thompson qtd. in Overall). This idea will be addressed later in this paper, but a caveat of this argument is that it fails to acknowledge the maternal-fetal relationship. In this situation the stakeholder is not only the fetus, there is also the mother to consider as she has an indisputably important biological and social role in relation to the fetus.  “To regard the fetus during gestation, as being isolated from and independent of the woman is therefore an ontological and moral error” (Overall). This then begs the question if we should separate the woman from the fetus as two individuals deserving equal rights. Treating the fetus as it had independent moral status while still in a woman’s womb could result in failure to recognize a woman’s moral status and autonomy. It would violate a woman’s bodily autonomy by making the female body an instrument to be used by a fetus. A fetus is part of the woman’s body, inside the woman’s body, and sustained by the woman’s body. If fetus is not independent of a woman’s body, then it does not have independent moral status. Mary Anne Warren, a well known pro-choice writer, concludes, “It is impossible to treat fetuses in utero as if they were persons without treating women as if they were something less than persons. The extension of equal rights to sentient fetuses would inevitably license severe violations of the women’s basic rights to personal autonomy and physical security” (qtd. in Overall)

Because the fetus can not be thought of as an individual deserving rights that come into conflict with the women’s own rights, essentially the status of the fetus revolves around its relationship with the mother. The fetus’s moral status before the point of sentience and full development is deserving of respect and ethical consideration but is dependent on the relational properties it has to the mother, whether it is considered a child or an occupier, because it is within her and of her. For example, a happily pregnant woman may feel love for her fetus as a special and unique human being, a welcome and highly anticipated member of her family. Consequently, she can feel an early miscarriage as the equivalent to the profound loss of a child although it has not yet developed a moral status defined by the development of sentience, not is it “born alive.” But an unhappily pregnant woman may view her fetus with utter dismay, bordering on revulsion. She cannot bring herself to refer to it as a human being and is desperate to relinquish the role of a biological and social mother to this fetus. Both of these reactions to a fetus, and all reactions in between, are perfectly valid and natural. Both may even occur in the same woman, years apart. And throughout all stages of development the fetus is demanding of ethical respect and consideration. But the moral status of the fetus before reaching the point of sentience or full development (late stage) is dependent on the relational properties it has to the mother. Therefore, during this early stage when abortion is an option, the woman who is entitled to human rights and autonomy over her body as well as procreative choices, can decide to terminate the pregnancy based on her relationship with the fetus..

One of the more popular views of the artificial womb is the prospect of it as a “solution” to the abortion debate. Viability in itself could become moot, since with ectogenesis a fetus could become viable right after conception and therefore from that point a human being. Consequentially the right to not be pregnant can also become a moot point. Instead of having an abortion the fetus can be removed from the woman’s body and gestated in an artificial womb to be adopted later. Moving forward these this paper will explore how these views impede on the autonomy of a woman; her right to give informed-consent; and the autonomous right of a woman to decide when a child biologically related to her is born, which further extends to her procreative control and her right to refuse to accept the biological and social obligations/expectations of motherhood. From there the value of privacy will be examined, which will further support the unethicality of the removing a biological product without consent. And to conclude, the further dismantling of these ideas based on the obligation of the medical community to do good under the principle of beneficence.

Autonomy

As ectogenesis comes into fruition we will subsequently become faced with two very different options of giving women the choice to continue pregnancy in an artificial womb versus requiring that every unwanted pregnancy be completed in an artificial womb rather than terminated through and abortion. In the situation of forced gestation in an artificial womb a woman would have to go through a non-consensual procedure of termination by cesarean or induced labor. This would be considered assault as women would be required to undergo, without her consent, a procedure that is not in her best interest but in the interests aimed at the survival of the fetus. Historically there has been an ethical precedent set that one of the most fundamental rights afforded to humans, the right to autonomy over one’s body and medical decisions, cannot be violated in the context of medicine and treatment in the case of a fully competent patient.

This ethical conclusion was demonstrated in the 1987 D.C. Circuit reproductive rights case, In Re A.C. In this case Angela Carder as a woman who during cancer remission became pregnant (qtd. in Thornton). During the pregnancy she emphasized that she did not want her own health to be compromised by her own health. She was later diagnosed with lung cancer and her health was in serious decline to a point where she was in a coma, the only course of action to “intervene and save” the fetus’ life was to perform a Cesarean section which her husband was opposed to. The operation was performed and  the fetus died within two hours. Two days later, she died, never having received the cancer treatment she requested. On April 26, 1990 the D.C. Court of Appeals en banc in In Re A.C. vacated the court-ordered Caesarean and held that Angela Carder had the right to make health care decisions for herself and her fetus. The decision found the judge had failed to properly balance the rights of Carder not to consent to the procedure and the interests of the state. In a statement later made by the court they affirmed that, “it would be an extraordinary case indeed in which a court might ever be justified in overriding the patient’s wishes and authorizing a major surgical procedure such as a caesarean section” (qtd. in Thornton).

Many would consider the transfer of a fetus from an human womb to an artificial womb as invasive as the process of abortion itself. Though that might be true, the legal practice of abortion requires the informed-consent of the woman, as it is a medical procedure. If carried out without her consent this would be considered a violation of her ethical and right to autonomy. This concept is also applicable to a gestational transfer. If made a legally mandatory alternative to abortion, the process itself still remains a medical procedure still requiring informed-consent because a woman’s autonomy is still to be respected. It has already been determined that although deserving of respect and consideration during its early stage, a fetus has no moral status and therefore the autonomy of the woman takes greater precedent in the event that she no longer wants to gestate the child.

One of the most prominent arguments that remain against abortion in the case of developed artificial wombs is the defense that there is no human right to a dead baby. Judith Jarvis, most famous for her violin player analogy in support of abortion, uses the same analogy in the scenario of a technology mimicking the end product of the artificial womb:

I have argued that you are not morally required to spend nine months in bed, sustaining the life of the violinist; but to say this is by no means to say that if, when you unplug yourself, there is a miracle and he survives, you then have a right to turn around and slit his throat. (qtd. in Cannold)

But this parallel is an oversimplification of all the nuances and implications that gestational transfer into an artificial womb carries. It fails to regard the maternal-fetal relationship and it does not address the concern for the woman’s reproductive rights, nor does it confront the aspect of giving a child up for adoption that would be a part of this process.

In revisiting the idea of maintaining abortion despite the public availability to gestate in an artificial womb as the “right to a dead baby,” we must first examine the intent and reasoning behind abortion itself. Under the logic of those who claim “no right to a dead baby,” abortion is seen as an act of malicious intent directed at the fetus rather than an only option or last resort. In actuality, to secure the death of a preborn child is a woman’s exercising of autonomy in reproductive decision making, the right to choose when or when not to beget a child. Those who seek abortion might not want a child biologically related to her to be raised by someone else. “Residual moral responsibilities toward the fetus, child, and adult who develops, and the fact of dereliction of the central maternal duty of care, will be ineradicable and significant moral facts of the two related lives” (Reader qtd. in Overall). To belittle the decision making and ethical consideration of whether or not to give up the child for abortion also undermines the idea of this “residual moral responsibility” felt by the biological mother to the child even after the child is given up for adoption. This idea of moral responsibility can be best understood through the comparison and contrasting of the diverging of the severance and preformationist theory in application to ectogenesis as a replacement for abortion. The severance theory is rooted in the idea that abortion is moral because of a woman’s right to autonomy and control over her own body which overrides the fetus’ right to life. Contrarily is the preformationist theory that rests on the premise that from conception an individual human being is formed and is therefore deserving of the rights of personhood. The preformationist theory positions the abortion debate as a “fundamental conflict of interest between two individuals” (Hendricks).

In Leslie Cannold’s, Women, Ectogenesis and Ethical Theory, she conducts a study of 45 Australian women, half of whom supported abortion rights and the severance theory and the other half were anti-abortionists who were in support of the preformationist theory. Both groups of women were asked if they considered a required gestational transfer into an artificial womb as opposed to an abortion ethical. The severance theorists believed that if a woman is unable to assume the roles of a social mother and the significant responsibilities of motherhood they have the ethical right to acquit themselves of these responsibilities through terminating the life of the fetus. This ethically permissible because it prioritizes the life of the woman. Her life is encompassing of her physical, emotional, and mental capabilities during the time of pregnancy, allowing her to make the decision of whether or not to physically carry the child. Her biological ties and biological children are also a part of this life, her ability to decide whether or not to terminate the life of a fetus for the purpose of relinquishing and biological, societal, and legal responsibilities she might have to this child is a life decision on her part. We cannot prevent a woman from having control over her life. The alternative would be for her to sacrifice this choice, sacrifice her ability to dictate her life and her future in favor of a fetus that is not yet a life along with the preservation of life is a preservation of maternal responsibility.

There is also an undeniable responsibility that comes with putting someone on this planet. You have started a life, and even if you relinquish a direct role in that life you will always be a part and contributor to their life. That is a thought that is daunting, there is the question of “if this child is not protected, not loved, not cared for in the way that is deserving of all children, who is accountable?” One of the severance theorists in the study states, “I imagine that my decisions would affect my child in a more humane manner, because I’ve got my child’s interest at heart. And that’s why I’d decide to terminate, for that child’s sake. If you give it away to technology, you don’t know what you’re doing.” On the other hand, we cannot ethically hold a woman accountable if the child they gave up for adoption does not have a childhood or life of quality. But they are ethically accountable for the action of bringing that child into the world and giving it up, an action that will affect the child’s life both directly and indirectly. You may not be responsible for what the world does and holds for that life after you give it up, but you are responsible for the life. Therefore it could be seen as ethically irresponsible to bring a child into the world were they are unable to care for it or be a parent.

Looking at the issue from the antithetical viewpoint, women who were anti-abortionists and believed in the preformationist theory believed that there was “no morally acceptable way for a woman to escape her responsibility to gestate and raise her fetus/child once conception takes place” (Cannold). Women opposed to abortion rights reject termination because it terminates the life of the fetus and because they believe it is the responsibility of a woman to gestate and raise all fetuses/children they conceive. Therefore, they see the result of relinquishing a child that would otherwise be aborted to an artificial womb as the same as an abandonment of this responsibility and role. They also reject ectogenesis as an immoral solution to an unwanted pregnancy because the abandonment of the role of a social mother by the biological mother is rejecting the moral responsibility to raise her own child as well as the responsibility to gestate her own child. “A good mother values her role, or potential role, as a mother beyond all other aspects of life, placing her children, and potential children, above her on interests, ambitions and goals as an autonomous human being” (Cannold).

Based on both of these perspectives ectogenesis is not an ethical replacement of a abortion because it is either a preservation of maternal responsibility not wanted by the mother or an unethical abandonment of the responsibility for a mother to gestate their child and raise them socially. In no way will ectogenesis be a “solution” to the abortion debate because it only addresses in the most simplest form, the argument of “my body, my choice,” in regards to a woman’s ability to maintain her bodily autonomy through gestational transfer without have to abort.  But it does not allow a woman to maintain her reproductive autonomy. From this we can draw the implication that woman abort for the purpose of not only terminating pregnancy, but also ending the life of the fetus as justifiable in the case of having procreative control and preventing the ethical responsibility that comes along with having a biological child, whether or not they are given up for adoption. Seeing the mother and fetus as a maternal/fetal-child unit, if a mother believed that her child would be harmed by bringing them into this world through her own assessment, this is an adequate justification of terminating the life of a fetus through abortion. To relinquish this “right to a dead fetus,” and claim that pregnancy termination should not involve fetal death, would unjustifiably override the goals of women and deny them the reproductive freedom that they seek. As a point of clarification, putting up a child for adoption is not unethical. But it does come with its own consequences for both the mother and the child. And in this instance you are still not relinquishing responsibility for the life of the child. Some women are willing to undertake the consequences as well as the remaining responsibility over the life that you have brought into the world and put up for adoption. Some women are not willing to do this for the reason that they don’t want to take the consequences and responsibilities. Either option is ethically permissible, but neither option should be forced because in both instances the woman has the autonomous right to choose the responsibility or not.

From these arguments we can come to the conclusion that a forced gestational transfer into an artificial womb would be inherently unethical because it violates a woman’s right to autonomy. In this proposed situation there is the potential to violate a woman’s bodily autonomy, forcing her into a non-consensual cesarean section or induced labor in order to attain personhood for the fetus. Additionally, based on Cannold’s Australian study it can be concluded that even exceedingly differing ideologies on abortion have found a common ground of ectogenesis as an unethical replacement to abortion. Particularly from the perspective of the  severance theory, ectogenesis as a forced alternative to abortion also impedes on a woman’s right to reproductive autonomy. This reproductive autonomy goes beyond the decision to physical carry the fetus because it is the decision of when and whether or not to beget a child.

The Principle of Beneficence

In applied biomedical ethics the principle of beneficence refers to a normative statement of a “moral obligation to act for the others’ benefit, helping them to further their important and legitimate interests, often by preventing or removing possible harms” (Beauchamp). In the more specific scenario of a physician patient relationship, the principle of beneficence, commonly referred to as the duty of the physician to “do good” is afforded to the patient in order to promote their well being.

In the scenario of a forced transfer of an embryo to an artificial womb it is serving the best interests of the embryo, while the patient in actuality is the woman. Because an embryo is not afforded the rights of an individual they are not considered a patient, and are therefore not given patient rights such as beneficence. This then becomes a slippery slope because this position can further justify the controlling of an individual’s medical actions in order to protect others, stripping them of their consent. Consider a scenario in which a child is born with a rare medical condition that requires a kidney transplant from a donor that is biologically related to them. The only match is the child’s mother. The mother does not want to donate her kidney because she is not financially or emotionally able to take on that responsibility. She is not ethically or legally obligated to donate her kidney although it would be the only thing that would save her child. To force her to do so would impede on her autonomous right to medical consent and would go against the principle of beneficence. To say otherwise would endorse the “suspension of autonomy-protective features of informed consent practices in order to protect the well-being of embryos and fetuses; it holds that beneficence toward embryos and fetuses requires that women’s ability to consent to abortion be less than fully voluntary and informed” (Vandewalker).

The woman is due the principle of beneficence to be afforded to her and therefore a procedure that would not be in the best interests of a woman who does not want it, is a violation of this. Forced transfer of an fetus to an artificial womb is serving the best interests of the fetus, while the patient is the woman. Because an fetus is not afforded the rights of an individual they are not considered a patient, and are therefore not given patient rights such as beneficence. Furthermore, this can lead to the slippery slope of justifying the controlling of an individual’s medical actions to protect others, stripping right to autonomy/informed consent and leading to similar instances which add to the issue.

Privacy

For better or worse, we have irretrievably entered an age that requires examination of our understanding of the ethical considerations and rights regarding the human body and the human cell. While there are no clearly defined regulations regarding the ownership of human tissue specimens and who can control their fate, there have been some models of the past that have set the preliminary stage for ethical parameters of biological tissue proprietorship. First and foremost is taking one’s tissue, body parts, or body products against one’s will or consent. In this situation past cases such as Moore v. Regents of the University of California  have determined the need for consent for the extraction and the use of biological products. The case revolved around John Moore, who was referred to the UCLA Medical Center for treatment of a relatively rare form of blood cancer known as hairy cell leukemia. At the Medical Center he was seen by Dr. Golde, who recommended that Mr. Moore’s spleen be removed, the only known treatment for the disorder. Mr. Moore signed a standard surgical consent form for the therapeutic procedure. This consent form did not include any mention of research being performed on the excised tissue. At the concluding of the proceeding the court found he could not assert a legal claim over the human source of blood and tissue used by others in potentially lucrative medical research. However, the court permitted to proceed with claim that they had failed to obtain informed consent to the excision or removal of these materials, and did not disclose the end uses (Dorney).

The parallel with the fetus and the artificial womb can seem far fetched but in reality can draw many similarities. The status of the fetus as property of the woman is unclear unlike tissue, although it was previously stated that before sentience the fetus’s moral status is contingent upon the relationship to the mother, but there is no doubt that while in a woman’s body no one else owns or can own the fetus, not even the state. But just as healthcare workers are not entitled, against a woman’s will, to remove blood or organs in order to keep someone else alive, they are not entitled to take advantage of the woman’s body against her by removing what is arguably a part of her, against her will in order to attain independent moral status of the fetus.

 

Conclusion

Moving forward with ectogenesis technology, having the option to gestate a fetus in an artificial womb would be a great contribution to reproductive technology and giving women a choice how they build a family. There should not be a dependency on the technology to bring about social change, but the artificial womb has a future in giving women more reproductive autonomy. Additionally, it has potential to serve homosexual couples and single men as a reproductive option without the need for a surrogate. Although it is not discussed in this paper as the technology comes closer to fruition, there is a need for more research and consideration about the possible emotional and psychological effects that gestating a child in artificial conditions outside of a human body can have.

As we become more advanced in our understanding of science and attaining technology for the purpose of providing opportunities, it has become clear that ethical standards are a sine qua non of our society.  And in examining the ethical standards set by the values of autonomy, privacy, and the principle of beneficence conclude that women who are seeking an abortion should not be forced to gestate their child in an artificial womb. Instead, the choice of gestating a child in an artificial womb should be the decision of a competent woman who gives her consent.

Based on our current definition of viability the question remains; how do we prevent an unethical change in abortion viability in response to ectogenesis? It has already established that viability as it stands currently should not be changed by artificial womb. Instead we must re-examine definition of viability completely. The numerical point of viability should not changed drastically because it is around the same time as sentience is developed. However, the reasoning behind it and its definition should change to better reflect the moral status and the point where a fetus is most deserving of  more human rights rather than technological ability to sustain fetus. This would avoid the threat that ectogenesis poses to abortion, solving the greater issue of when a fetus is deserving of personhood and protection by the state. We must also remember that from the outset, the status of the fetus is a peripheral issue in terms of reality of women who will continue to seek abortions. Regardless of whether a fetus is a human being or has rights, women will have abortions anyway, even if it means breaking the law or risking their lives. Even women who believe that abortion is murder have chosen to get abortions, and will continue to do so. This point further advocates for leaving the decision up to women’s moral conscience and making sure that they are provided with safe, legal, accessible abortions. There should also be a focus on educating women and men about and providing more contraception and preventative methods to avoid unwanted or dangerous pregnancies. The only way that we will see a significant decrease in the need for abortions is in the decrease of unwanted pregnancies.

Ectogenesis and the capabilities of the artificial womb has been seen as having the potential to be a great “equalizer” between men and women by relieving a woman of her biological obligation to carry a fetus during the nine months of gestation. But there is also the common idea that with artificial womb technology women will lose some sort of leverage that comes with their necessary role in the process of begetting a child, risking the possibility of becoming obsolete. In both of these conception of the future of ectogenesis technology we find fault. They are based upon the idea that a woman is and can only be valued by her biological capabilities rather than her equal value to men as fellow human beings. The idea of ridding the woman of the responsibility of pregnancy in order to achieve a form of gender equality is also inherently unethical because it stems from the reasoning that what prevents a woman from being equal to men is her biology and therefore we as a society are not obligated to protect the rights or treat the pregnant woman as an equal. We shouldn’t misconceptualized the real problems of abortion and divert attention from the urgent need for social programs for the woman who decides to carry her child such as; workplace structured to meet the demands of women’s lives and for new patterns of family life not dependent on advancing patriarchal and capitalist interest. The reasoning here is flawed, women should not be expected to play a role that their male counterparts are not expected to, whether it is biological or social, but if they do decide to take on the biological role of gestating a fetus she is still no less of an equal. This is the fundamental basis of a woman’s right to abortion, to give her the autonomy that was not inherently afforded to her because of her biology and the societal views of a woman as deserving less autonomy in her reproductive decision making. If she decides not to gestate an embryo in her body, it is her choice. If she decides not to bear a child biologically related to her, it is her choice. If to be seen as an equalizer, ectogenesis should increase the protection we provide for the ethical rights women deserve,  not decrease these rights by violating her bodily autonomy, her autonomous reproductive decision making, impeding on her privacy, or denying her the physician duty of beneficence owed to her. We cannot become dependent on a technology such as ectogenesis to bring about social change and equity in our society. The only way to reach a desired outcome of equality and a society dictated by ethics is a further development of these ethical rights in practice, not technology that helps us achieve a biological equality.

 

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