Abstract
The concept of ectogenesis, the growth of a life form in an artificial environment, is an old one. The growth and development of fetuses outside the human female body has been fantasized in landmark science fiction books, immortalized on film and opined upon by scientists, ethicists, theologists and feminists alike.
With research being conducted all over the world, we are nearing a realization of ectogenesis in the form of an artificial womb. The goal is to create a device that simulates a uterine system and supports the growth of a human from embryo to neonate. The venture is still in its infancy, with studies limited to lambs and mice, but the dedication to its achievement is steady. Since this technology will change the way humans are brought into the world, it will affect everyone and change the familial fabric of society. Owing to the drastic change it will bring, legal, social and ethical discussions about the technology need to be held a considerable time before its advent.
I. Introduction
Ectogenesis, the concept of the growth of an organism in a man-made and controlled environment, was first coined by the British scientist JBS Haldane. 1 In his 1924 book (based on his lecture given to the Heretics Society of the University of Cambridge) titled ‘Daedalus; or, Science and the Future’, Haldane anticipates the invention of in-vitro fertilization and the possibilities of artificial reproduction. He credits these technological developments as departures from mankind’s “former instinctive cycle”. Not only were Haldane’s ideas and writings controversial, they were influential enough to propagate.
In 1925, Dora Russell, wife to Bertrand Russell and avid campaigner for contraception, built upon Haldane’s essay, making a feminist case for technologies that would emancipate the feminine burden of bearing children. 2 Not long after, Aldous Huxley’s seminal work ‘Brave New World’ was published in 1932. Heavily influenced by Haldane’s concept of ectogenesis, the book explored a future where humans are entirely removed from the process of natural reproduction. 3 In this world, reproduction is strictly controlled and sanctioned by the World State. The novel went on to become one of the most controversial and important works of science fiction, being frequently banned from publication since its release.
In the 1970 book by radical feminist Shulamith Firestone, Haldane’s concept of ectogenesis - which had since been lost to the noise of World War II, was picked up once again. Firestone posited reproductive functions as the source of inequality between the sexes. She was of the opinion that an artificial womb would emancipate "women from the tyranny of their reproductive biology.” 4
Almost a 100 years have passed since Haldane’s pioneering lecture, and the realization of his work is nigh. With the help of modern technology an artificial womb will be a medical device that makes the concept of ‘ectogenesis’ a reality. It will introduce an entirely new path for the creation of a human, from conception to “birth”, possible outside of a live female body. At this point in time, we have a good opportunity to stop and ask ourselves whether this is a venture worth pursuing. Is it our moral imperative to free women of their reproductive duties? Or are we challenging God and treating technology like a toy?
In this paper, we will be arguing whether we should develop this technology or not. We will also be reviewing the current advancements and directions in the field. The paper will discuss the social and legal implications of this technology and examine the ethical minefield that it presents. The ethical examination will include the framework set forth by the Markkula Center for Applied Ethics and other traditional ethical frameworks.
II. Problems
Declining Fertility Rates
In a 2009 paper warning about declining fertility rates and calling for a “radical policy re-think” regarding reproduction in developed countries, Dr. Nargund was prescient in both her diagnosis and prognosis. 5 As the President of the International Society for Mild Approaches in Assisted Reproduction (ISMAAR) she implored governments to “protect human fertility” and advised the use of assistive reproductive technologies (ART). The situation has only gotten worse. According to the CDC, the birth rate has fallen a considerable 22% between 2007 and 2022. 6 In 2022, Japan’s birth rate hit a record low, with only 800,000 babies being born in the year. 7
Decades of World Bank data unveil global trends in relation to fertility rates. 8 The world fertility rate, denoting the number of children per woman, has been on a steady decline since the 1970s, reaching 2.3 in 2020—slightly above the replacement rate of 2.1. However, this global average masks significant differences among countries. As per the United Nations, approximately 66% of the global population resides in areas where the fertility rate falls below the crucial threshold of 2.1. 9 All of the top 30 countries, except Afghanistan, are in Africa. While Africa is expected to add 2.5 billion people by 2100, other continents are anticipating population stagnation. 10 In contrast, South Korea holds the lowest fertility rate at 0.84.
The global decline in fertility rates is influenced by several factors, including improved access to contraception, expanded opportunities for women beyond childbearing, and robust healthcare reducing child mortality. Historically, a higher number of children acted as insurance against high infant mortality rates, and societal restrictions confined women to roles centered around childbearing. 1
Furthermore, not only are women in the United States choosing to have lesser children, they are also choosing to start having children later in life. 11 This gives them a lesser reproductive timeframe, with egg quality and natural fertility declining rapidly after the age of 30. 12 This is an entirely preventable modern tragedy afflicting those who may want to have more children, but cannot.
While declining fertility rates signify positive socioeconomic and gender equality development, they also present challenges such as shrinking populations and an aging demographic. The worldwide impact of shrinking populations of the developed world, stands as an unprecedented challenge for humanity.
Pregnancy, Birth and the Fight With Death
It is accepted across cultures that pregnancy is a battle with death. This is as true today as it was a millenia ago. According to the WHO, maternal mortality rates are “unacceptably high”, with a reported maternal death (death of the mother due to any pregnancy related cause) taking place every two minutes in 2020. 13 Obstetric causes make up to 75% of maternal deaths across the globe. The number one cause amongst these being hemorrhage (severe bleeding), responsible for over half of maternal deaths worldwide. 14
According to the CDC, maternal mortality rates increase with age. 15 As aforementioned, more women are having children later in life, leading to a steady increase in maternal mortality in the United States. As mentioned earlier, an escalating number of women are giving birth at later stages of life, contributing to a gradual rise in maternal mortality rates in the United States. In 2021, the rate stood at 32.9 deaths per 100,000 live births, up from 23.8 in 2020 and 20.1 in 2019.
On the other side of the birth equation, infant mortality rate (IMR) - characterized as the count of infants who pass away before reaching one year per 1,000 live births - remains a significant challenge. Only last month, the New York Times reported a notable 3 percent rise in IMR in the past year. 16 The CDC reports that the primary contributors to infant mortality include congenital anomalies, premature birth, and low birth weight. 17 Other sources single out preterm birth as the leading cause of death in infants. 18, 19 These are unfortunate and untimely deaths that are entirely preventable.
The perils of traditional pregnancy and the associated mortality rates are, in my opinion, a roadblock easily removable on the path to sustainable fertility rates. These are challenges faced by people who have the will to build families but are thwarted by the current state of reproductive technologies. Addressing and aggressively mitigating these challenges should be at the forefront of every developed country’s national strategy.
III. Artificial Womb Technology
With the first Cesarean section began the story of ART. Although the timing of the first procedure is controversial, with each major civilization having its own due date, the first successful operation to be written down in history took place in Switzerland, in the year 1500. 20 It is worth noting that, from Sanskrit texts to the Talmud, this technology has been honored with a mention in religious books spanning a wide range of history and cultures. 21 Perhaps the ancients, too, felt a moral imperative to assist the creation of life.
The second major development in ART would be the invention of in-vitro fertilization (IVF), a process where an egg is combined in-vitro with a sperm. The first baby born through this technology was a baby girl named Louise Brown in 1978. 22 The procedure took place in England, leading to the awarding of the Nobel Prize in Physiology or Medicine in 2010 to physiologist Robert G. Edwards, one of the co-developers of the treatment. 23
Fast forward to 2016, the University of Eindhoven in the Netherlands, has been working on developing an artificial womb technology (AWT) called the Perinatal Life Support (PLS) system. 24, 25 The focus of this project is on preventing health complications in premature babies; this involves a manikin for testing, advanced monitoring, and computational modeling. The university has been awarded with a recent grant of 3 million euros and an additional 10 million in progress. Researchers at the Children’s Hospital of Philadelphia managed to keep a premature lamb alive for a month in a “biobag” filled with artificial amniotic fluid, in 2017. 26 The researchers hope to extend these developments to human babies within the next three to five years. The most recent advancement in the field of AWT comes from Israel, where two subsequent studies from 2021 and 2022 have demonstrated viable synthetic mouse embryos outside the natural ureteric system. 27 The Weizmann Institute of Science constructed a mechanical womb to cultivate mouse embryos and then used the same apparatus to support mouse stem cells for more than a week.
These technologies are not only exciting but also offer an alleviation to many of the troubles mentioned in the ‘Problems’ section of the paper. AWT offers a relief to women who want to have children but are limited by their biology. It also offers an alternative to couples struggling with infertility. AWT will not only lengthen reproductive time frames but make the process of pregnancy and childbirth much less risky. The high level of control and oversight made possible with this technology will be a forever cure to the tragedy of maternal and infant death. Furthermore, reproductive autonomy takes center stage with AWT, offering the gift of true gender equality.
IV. Legal Perspectives
The road to AWT is paved with legal considerations. Most notably, the 14 day rule (Human Fertilization and Embryology Act 1990, Chapter 37, 1990). This rule prohibits the development of embryos outside of a human body for more than 14 days. 28 The rule was introduced shortly after the birth of the first IVF baby Louise Brown and serves as a regulatory balance between scientific advancement and the sanctity of human life. 2021 saw the first relaxation of the rule since its inception when the International Society for Stem Cell Research made modifications in order to permit researchers to apply for extended studies beyond this timeframe. 29
Not all societies feel the same. Despite a general societal reluctance to grant legal status to embryos, China has incorporated bioethics into its national strategic goals, following a "People-Centered" approach. 28 In my view, America needs to catch up and make considerations well before the arrival of the first babies born through AWTs. Such deliberations are essential for shaping not only the trajectory of AWT, but also of solidifying America as the leader of future human creation.
V. Social Perspectives
The social perspectives on AWT range between two extremes. There are well placed grievances and time-honored hostilities on both sides of the extremes. It invokes the ire of both sides of the political spectrum. 30, 31
On the one hand, the technology is seen as an offering to feminist Gods, giving humans the opportunity to finally have true reproductive autonomy. AWT would be fulfilling Firestone’s assessment of equalizing the two sexes, as it would nip the source in the bud. This perspective would advocate for an aggressive push to achieving AWT, while ignoring multiple quandaries it may represent.
On the other hand, AWT is seen as a nuking of the familial fabric of society that holds it together. It would not only challenge the writ of God and His plans, but it would also throw into question the concept of lawful marriage and conception. This perspective would call for a halt to any and all progress conducted in the field, ignoring the multiple solutions it offers. It would also fail to recognize how much ART in general and AWT in particular resonate with family values.
VI. Ethical Perspectives
Considering the implications this technology will have on the way human life is conducted, it is no surprise that the ethical landscape of AWT is a minefield. 30, 31 Below is a list of just some of the concerns :
Reproductive Autonomy : is it wise to machinate the closest Godlike ability humans have?
Parental Rights and Responsibilities : how should parental rights and responsibilities be defined in the case of an AWT baby? Should the pregnancy be terminated if one parent wants it?
Long-Term Health and Development : do we know what the health profiles of babies borne of AWT will be like? Is it ethical to be using a nascent technology to experiment with the creation of life?
Access and Equity : who decides who will get this technology? How do we ensure equitable access?
Ethics of Research : is it ever ethical to experiment with embryos and developing fetuses?
Cultural and Religious Perspectives : how can conflicts between science and religion be reconciled in order for AWT and its babies to flourish?
Defining Personhood : when does a baby gestating within an AWT become a person? How and when do we protect the rights of this “person”?
Potential Misuse and Abuse : how can we prevent the misuse of artificial womb technology for unauthorized or unethical purposes, such as forced gestation or coerced reproduction?
Social and Psychological Implications : how can potential challenges addressing the social and psychological wellbeing of both parents and children be addressed?
Regulatory Oversight : how do we ensure robust governance to guarantee responsible and ethical development, deployment, and use of AWT?
Ethical Analyses
The framework set forth by the Markkula Center for Applied Ethics has a lens called ‘Common Good Lens’, according to which, “life in a community is a good in itself, and actions should contribute to the collective well-being”. If AWT is indeed able to help stabilize global fertility rates and drastically reduce infant and maternal mortality, does it not contribute to the collective well being of human civilization? It will also be contributing to the human community by increasing life itself and offering people the opportunity to become parents and have as many children as they want.
The traditional framework of ‘Rule Utilitarianism’ further supports this notion, positing that actions should increase overall happiness. It has been established by medical research that babies increase happiness and life satisfaction. 32 Furthermore, emancipating women of reproductive burdens and lowering mortality rates would cause a dramatic decrease in human tragedy and the pain associated with it. Another traditional framework, the ‘Divine Command’ theory, reveals a convergence of religious teachings encouraging human reproduction. Biblical passages like Genesis 1:28, urging believers to "be fruitful and multiply," highlight the resonance of artificial womb technology with religious precepts. In Judaism, the obligation of procreation stems from one of the earliest and frequently reiterated commands in the Torah, known as 'pru u'rvu,' instructing believers to 'be fruitful and multiply.’ 33 Followers of Hinduism consider parenthood an integral aspect of fulfilling their Dharma, specifically in adhering to the righteous duty of managing a family system, known as Grihasta Ashrama. 34
The final traditional framework I will be employing is that of ‘Subject Relativism’. This framework relies on the notion that ethical judgments are subjective and dependent on individual perspectives. In the realm of AWT, this framework allows for diverse opinions on what is morally acceptable, recognizing the right of individuals to make choices aligned with their own values. To each, their own.
VII. Conclusion
In conclusion, I believe that it is in fact a moral imperative for us to build this technology. It is our moral responsibility to pursue this technology aggressively. Millions of mothers and infants die from preventable causes each year we fail to build this technology, while millions more struggle to create precious life.
After careful ethical consideration, it is clear that not only will AWT be in the greater service of humanity but will also be fulfilling divine purpose. We are nearing towards a great future, painted with much less pain and much more joy. The AWT will be our companion as we navigate it.
References
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Note : I wrote the paper for my Legal-Social-Ethical Biotech class. A month ago, I was awarded the Student Leader award by AthenaDAO for my work.