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The Upcoming Discovery of Ectogenesis

644920

Northwest Nazarene University

PHIL 3600 Clinical Ethics

Professor Chamberlain

May 3rd, 2023

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The Upcoming Discovery of Ectogenesis

Every day around the globe, around 385,000 babies are born a day. According to the

World Health Organization (WHO), around 15 million babies are born prematurely worldwide

yearly. These numbers alone are challenging to comprehend but also eye-opening to how

relevant and crucial the field of obstetrics is in the healthcare field around the world. A new and

upcoming discovery that could radically change the way the world creates and fosters human life

is Ectogenesis. Ectogenesis is the research and study of the development of embryos in artificial

conditions outside the uterus. This type of technology has not been suitable or even considered

until recently. New scientific discoveries regarding ectogenesis have started the discussion of

what this means for our existence worldwide if this method of gestational growth and delivery

works on humans. This paper aims to discuss the known and unknown risks, known and

unknown benefits, the ethical and legal implications of ectogenesis, and whether this discovery is

ethically sound.

The major discovery that made healthcare professionals shift their focus toward this topic

came after an experiment at the Children’s Hospital of Philadelphia in 2017. The researchers

created an external womb called a “biobag,” which simulates the uterus as closely as possible.

The circulatory system is designed like the womb, where the blood circulates from the umbilical

cord through the system’s low-resistance external oxygenator that substitutes for the mother’s

placenta in exchanging oxygen and carbon dioxide (CHOP, 2017). Fetal Physiologist Marcus G.

Davey, Ph.D. described the design of the amniotic fluid within the Biobag when he said, “Fetal

lungs are designed to function in fluid, and we simulate that environment here, allowing the

lungs and other organs to develop, while supplying nutrients and growth factors” (2017). What

makes this system superior to other designs is its pumplessness. CHOP, Children’s Hospital of
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Philadelphia, describes why this pumpless system had much better outcomes compared to other

styles when they said,

“Previous researchers have investigated versions of an artificial placenta in animal models, but
pumpless systems have achieved a maximum duration of 60 hours, and the animals have
sustained brain damage. The new system, in contrast, has operated up to 670 hours (28 days)
with some animals, which remained healthy. The lambs showed normal breathing and
swallowing, opened their eyes, grew wool, became more active, and had normal growth,
neurological function, and organ maturation” (2017).

This description and evidence from these experiments demonstrate how effective and

successful possible partial or complete ectogenesis could be beyond animal tests. Neonatologists

and Fetal Surgeons have been excited about the possibility of this form of gestation becoming a

reality.

Although this research looks promising, there are several possible risks related to

ectogenesis being performed on humans. It is difficult to find literature that outlines the risks

related to partial or complete ectogenesis since the research has not been done on humans, and

many researchers don’t carry true equipoise when it comes to comparing the risks and benefits.

Many prospects are unknown as researchers have not conducted studies on human subjects;

however, the possible risks are worth discussing. First, there are several possible dangers to the

fetus. The potential for pain and suffering with partial ectogenesis is difficult to measure and

study. According to the University of Gloucestershire, “It is uncertain how much pain fetuses

feel in utero, so the transfer from a female uterus to an artificial uterus may cause significant

pain, distress and suffering, as might the period of artificial gestation” (pg. 9, 2018). Since fetal

pain in utero is already difficult to assess, trying to evaluate the possible pain and suffering

surrounding the transfer of the fetus or the time spent in an artificial womb is an ethical dilemma.

These considerations may prevent ethical approval to conduct such research demonstrating the

principle of non-maleficence. Any researcher or ethical committee taking a non-maleficent

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stance would choose not to act and try partial ectogenesis on humans because of the potential to

harm the fetus. Another unknown impact of ectogenesis relates to maternal-fetal bonding since

the fetus will be removed from the womb prematurely. Especially with complete ectogenesis, the

physical act of having a fetus inside a woman’s uterus creates a fetal-maternal bond that could be

damaged if the fetus is developed completely outside the uterus. The University of

Gloucestershire quoted Teiu, who made a valid point about maternal bonding which said,

“'Therefore, at the very least, one ought to be concerned with any process that disrupts the

important bonding between mother and child which begins during gestation and continues after

birth'” (pg.15, 2018). His perspective demonstrates how the complete development of a fetus

outside a mother’s uterus can impact bonding. There is not extensive research relating to this

lack of bonding which makes this risk unknown; however, the lack of bonding can lead to other

issues like fetal rejection and avoidance of the baby leading to possible neglect.

Next, there are several possible risks to the pregnant woman. Since partial ectogenesis

involves the transfer of the fetus to the artificial uterus, this procedure involves making the

pregnant mom a patient and performing a C-section which carries its own hazard. Performing a

C-section includes the risk of infection, hemorrhage, reaction to anesthesia, blood clots, and

surgical injury. Seppe Segers from the Bioethics Institute Ghent mentions the issue related to this

surgery when he states, “Despite an expected better fetal accessibility, possible concerns for the

pregnant woman’s well being remain in the case of the surgical removal and physical

translocation of the fetus to an artificial womb” (pg. 367, 2019). Even though partial ectogenesis

could produce positive results for the fetus, the impact of the surgery on the mother needs to be

explored and considered before making a definitive statement about the safety of the transfer of

the fetus. The principle of beneficence is a major relevant theme related to this aspect of
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ectogenesis. Segers also comments on our awareness of the relevant beneficence related to

partial ectogenesis when he said, “The relatively common and dominant

Chervenak–McCullough account of in utero maternal–fetal treatment maintains that

beneficence-based obligations to the fetal patient must in all cases be balanced against both

beneficence-based and autonomy-based obligations to the pregnant patient” (pg. 366-367, 2019).

The researchers who argue for ectogenesis need to view the beneficence of the fetus and mother,

not just the fetus.

There are also many benefits to the possibility of ectogenesis both for the mother and

fetus. One possible advantage includes better patient outcomes for the fetus and longevity of life.

When the fetus is prematurely removed from the uterus, they are sent to Neonatal Intensive Care

(NIC), where nurses and doctors help them develop and survive. However, being in the NIC is

not as optimal for survival and proper development as if they were to stay in the uterus longer.

Therefore, the possibility of transporting the premature fetus to an artificial uterus to further

development until they reach gestation could help increase positive fetal outcomes. One quote

from a Medical Law review made the statement about how artificial wombs could change the

obstetric perspective forever when they said, “Used as an alternative to conventional methods of

NIC, AWs have the potential to produce better and more consistent outcomes for developing

human entities removed from the uterus before 37 weeks” (Romanis, 2019). There are high

hopes that artificial wombs can be the saving grace for premature infants who just need more

time in the womb to progress and grow. Developing artificial wombs with this perspective in

mind is an act of beneficence for the fetus. Another benefit of an artificial womb for the fetus

relates to the physician’s ability to easily access the fetus for utero-fetal treatments and surgical

procedures. Currently, if a fetus needs surgery or treatment to fix a deformity, the fetus undergoes
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uteral-fetal treatment, which can produce complications for the mother. An artificial uterus

would allow for easier access to the fetus for physicians to perform surgeries or treat the fetus.

Seppe Seggers from the Bioethics Institute of Ghent said, “Pence, for instance, has given the

example of how ectogenesis could make surgery for hydrocephaly or cleft palate ‘much safer’

than doing it in utero. While ectogenesis is not a prerequisite for fetal treatment, it is thought that

interventions would be easier on an extrauterine fetal patient” (pg.366, 2019). Being able to

perform these surgeries on the infant outside of the mother will avoid producing complications,

like a ruptured uterus, for the mom. Another quote from the Medical Law talks about how

artificial wombs can have beneficence and an autonomy shift for pregnant women. Elizabeth

Romanis said, “AWs, however, could eliminate much of the concern over the risks of

prematurity, and the limited success of NIC. This could enable a new kind of decision-making in

obstetric practice, shifting the focus to the woman’s experience of pregnancy, rather than the

‘fetus’s interests’ in not being removed from the uterus prematurely” (Romanis, 2019). Having

artificial wombs could enhance the woman’s autonomy to make better decisions about her and

her baby’s health without sacrificing one life or the other. Having artificial wombs can enable

reduced pressure on women in terms of forcing them to make difficult decisions about

termination.

When analyzing this new discovery, there are several ethical terms that can be related to

the scenario. Looking at this topic through the lens of utilitarianism, a person would want the

result to bring the most beneficial balance of good over bad consequences for everyone involved.

Through this view, you need to weigh the risks and benefits between mother and baby and

rationalize which action brings the most benefit. Someone with a deontological obligation to

protect and further life could see the artificial womb as an advantage to both the fetus’s and the
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mother’s health. However, if the artificial womb does more harm than good, a deontologist

would stick to their principle of maintaining life and would not favor the artificial womb.

My decision on whether or not this new discovery is ethically sound depends on whether

we are looking at partial or complete ectogenesis. I believe that partial ectogenesis can be

ethically sound because it takes the fetus that has been partially grown in a mother’s uterus and

transports the fetus to an artificial womb to help the fetus grow and develop to term. I can see

partial ectogenesis being significantly beneficial both for the mother and fetus if the fetus has to

be delivered prematurely, and it needs more time in the womb to grow. According to the current

research and the positive outcomes they have seen with growing lambs in artificial wombs, I

think the research is promising to help premature fetuses grow and develop properly. However, I

have more of a problem regarding complete ectogenesis. Complete ectogenesis is the process of

doing in-vitro fertilization and having the fetus grow in the artificial womb throughout the

entirety of its life. There isn’t much research on this type of ectogenesis yet; however, this seems

very risky and irrational to take the mother out of the picture entirely. No one knows the possible

birth defects or congenital abnormalities arising from this form of development. This also seems

like a slippery slope because who can access complete ectogenesis? All people? Or will it only

be offered to those with the money to afford the procedure? Also, whoever owns this artificial

womb could potentially use it in a non-beneficial way. It would be concerning to have this be the

new way of creating humans when they have the power to create life in this manner. There would

need to be several laws put into place that protect people’s rights and legal repercussions if this

form of creating life became discriminatory. I can see there being a risk of eugenics if they can

only offer this form of producing life to certain people groups, certain countries, or those with

the money to pay for it. Whereas I can see partial ectogenesis being used strictly for the purpose
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of helping premature fetuses grow and being implemented in the NIC, where they are used for

medical purposes only. Rather than for leisure and the convenience of being able to produce a

human without the natural way we were designed to reproduce.

In conclusion, the rise of ectogenesis is an intriguing and challenging topic to cover and

discuss. There are several unknown and known risks and benefits to this form of reproduction.

Ethically viewing this topic can be difficult because there is no black-or-white answer. There are

several factors to consider, and this discussion amongst ethicists should not be taken lightly. The

discovery of ectogenesis can impact the obstetric field forever, depending on the research and

outcomes of future trials. Even though this exploration is exciting and promising, researchers and

ethicists need to be cognitive of the risks and proceed with caution since this could impact the

lives of many people to come.

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Sources

Orcid, N. (n.d.). Retrieved April 28, 2023, from

https://eprints.glos.ac.uk/6495/1/6495%20Hammond-Browning%20(2018)%20A%20Ne

w%20Dawn.pdf

Romanis, E. C. (2019). Artificial Womb Technology and the Choice to Gestate Ex Utero: is

Partial Ectogenesis the Business of the Criminal Law? Medical Law Review.

https://doi.org/10.1093/medlaw/fwz037

Segers, S., Pennings, G., & Mertes, H. (2020). The ethics of ectogenesis‐aided foetal treatment.

Bioethics, 34(4), 364–370. https://doi.org/10.1111/bioe.12715

The. (2017, February 28). A Unique Womb-Like Device Could Reduce Mortality and Disability

for Extremely Premature Babies | Children’s Hospital of Philadelphia. Chop.edu.

https://www.chop.edu/news/unique-womb-device-could-reduce-mortality-and-disability-

extremely-premature-babies