Abstract
A human fetus developing outside of a uterus may seem like science fiction at first, but artificial wombs are quickly becoming a reality. They’ve already been tested successfully on lambs, and some researchers predict they’ll be ready for human use in less than a decade. Despite criticism from opponents who see artificial wombs as “unnatural” or believe they will be harnessed to create genetically modified “designer babies,” this paper argues that the technology, once proven safe, is wholly ethical – and in certain cases, it may even be unethical not to use it.
Artificial Wombs – Science Fiction No Longer
Imagine a human fetus developing outside of a human uterus – it may seem like science fiction at first, but artificial wombs are quickly becoming a reality. An underdeveloped fetus could be placed inside an artificial womb, which would allow the fetus to grow until it could survive outside of the womb on its own. In 2017, for instance, researchers at the Children’s Hospital in Philadelphia successfully developed eight prematurely born lambs by putting them into artificial wombs for four weeks [1]. The artificial womb, known as the “Biobag,” is a large plastic bag filled with an electrolyte solution similar to amniotic fluid which encloses the fetus [1]. A prematurely born lamb can continue to develop inside the Biobag, allowing it to grow its brain and lungs, wiggle around, grow wool, and even open its eyes [1].
Although these artificial wombs have only been tested on lambs thus far, some scientists believe that the technology could be used with human fetuses soon. In fact, researchers from the Netherlands predict that the first human artificial womb would be ready for use in less than ten years [2]. It’s not a matter of if artificial wombs for humans will become available; it’s a matter of when.
Although the notion of developing a human fetus outside of the womb may seem unnatural at first, artificial wombs for humans are ethical. In fact, it would be unethical not to use them in certain circumstances. Not only does the technology satisfy the four principles of bioethics (autonomy, beneficence, nonmaleficence, and justice), but by saving the lives of premature babies and by making the human reproduction process more equitable, artificial womb technology will greatly benefit society.
Saving the Prematurely Born
One of the key benefits of artificial wombs is the ability to develop prematurely born babies inside an artificial womb until they can survive outside of the womb. In the United States, the Center for Disease Control and Prevention reports that one in ten babies born within the United States is born prematurely [3]. Premature babies often have breathing difficulties, heart defects, immune deficiencies, and other health problems, so it’s no wonder that premature babies account for 17% of all infant deaths [3, 4]. Furthermore, even if a prematurely born baby survives into childhood, they often face chronic health issues such as cerebral palsy, visual and hearing problems, and behavioral disorders [4].
But imagine that a premature baby, instead of having to enter an incubator or survive on its own, could be placed inside an artificial womb such as the Biobag. The baby could continue to develop inside the bag, which could prevent it from suffering the health issues associated with premature birth. It would be unethical to deny the use of this technology to prematurely born children.
Giving Women Greater Freedom
It’s clear that one biological sex faces a greater burden in the reproduction process: women. During their pregnancies, women often face complications including anemia, or lower amounts of red blood cells; higher blood pressure; and mental health problems such as depression [5]. Some of these complications, such as viral infections, can be deadly for both mother and baby [5]. In fact, 700 people die every year in the United States due to pregnancy or delivery complications [6].
In addition, many report a “pregnancy penalty.” According to the Harvard Business Review, studies have shown that visibly pregnant women are often “judged as less committed to their jobs, less dependable, and less authoritative, but warmer, more emotional, and more irrational” compared to other women [7].
Although artificial wombs won’t fix every problem caused by sexism, the technology, which could allow women to develop a child without becoming pregnant, could lift the burden of reproduction from women. Artificial wombs could allow the birth of a child without risking the potential health and career hazards that come with being pregnant. They could also help a woman compete on a more level playing field in a sexist world that discriminates against pregnant women.
Greater Equity in Reproduction
In addition to providing greater freedom in the reproductive process, artificial wombs can offer greater freedom for people who cannot biologically reproduce themselves. With artificial womb technology, same-sex couples, transwomen, and women whose uteruses had to be removed for health reasons could have a child without adoption or surrogacy.
The adoption and surrogacy process can be incredibly complicated, expensive, and time-consuming. Surrogacy can cost anywhere between $75,000 to $125,000, with most of the cost dependent on the surrogate’s medical costs during pregnancy [8]. The process can also take one to two years to complete, given that any potential surrogate must be screened [8]. Adoption, although cheaper than surrogacy, is no less complicated, with parents having to face the uncertainty that the birth mother might not give up her child for adoption in the end [8]. These costs and complications could turn some potential parents away from expanding their family through adoption or surrogacy.
Furthermore, some feminist activists, such as Gloria Steinem, claim that surrogacy is unethical, seeing it as “patriarchal, exploitative and even akin to slavery” [9]. They also worry about the implication of male purchasing power over the bodies of women [9]. Other activists, such as the feminist theorist Sophie Lewis, worry more about the class aspect of surrogacy, or how the process of wealthy people paying a poorer woman to carry their child could lead to exploitation [9]. Given these ethical concerns, artificial wombs are a potential solution that would not require paying a woman to carry a baby to term.
Ethical Principles
We can also review the ethics of artificial wombs by looking at the four principles of bioethics. These four principles were first developed in 1979 by researchers Tom Beauchamp and James Childress to help doctors and biomedical engineers make ethical decisions [10].
The first principle is autonomy, which states that a patient must provide informed consent for any medical treatment [10]. Artificial wombs fulfill this principle because the use of artificial wombs will depend on the consent of the patient. If artificial wombs were developed, no transfer of a fetus from a uterus to an artificial womb would take place without permission. Just as other medical procedures such as abortion do not take place without consent, the same would be true for transferring a fetus to an artificial womb.
The second principle, that of nonmaleficence, states that doctors should not intentionally harm a patient [10]. Transferring a human fetus from a uterus to an artificial womb could pose a health risk for the parent and for the fetus. However, if artificial womb technology develops enough such that this transfer could be done safely, then artificial wombs satisfy this principle.
The third principle, beneficence, states that any treatment should benefit the health of the patient [10]. Artificial wombs embody this principle. Many cannot continue a pregnancy due to health complications. For instance, if a patient were to get cancer while pregnant, undergoing chemotherapy or radiation treatment could harm the fetus [11]. However, if artificial wombs were an option, the patient could safely transfer that fetus to one before undergoing those cancer treatments. This option could also help those suffering from drug addiction or other health conditions that could negatively affect a fetus’ health. The key is that with artificial wombs, there would be no need to choose between the health of the parent and the health of their baby.
Finally, the fourth principle, justice, states that any healthcare treatment should be distributed fairly within a society [10]. One concern regarding artificial wombs is that they could be a very expensive technology and only available to the wealthiest in society. Such an issue is not specific to the technology of artificial wombs, as any expensive treatment could be seen as a healthcare luxury. However, a universal healthcare system could help bring the artificial womb technology to the people who need it the most – including those whose health could be put in danger because of a pregnancy.
Addressing Possible Ethical Issues
Critics worry that artificial wombs would make it easier to create “designer babies.” With this technology, what is stopping a person from artificially creating a human embryo and growing it in an artificial womb? Such a possibility is not far-fetched.In 2016, researchers from Cambridge University successfully grew human embryos for 13 days, almost hitting the legal limit of 14 days [12]. If scientists combined that technology with gene editing and artificial wombs, it’s very possible that a world similar to what Aldous Huxley describes in his dystopian novel Brave New World – where humans are grown in test tubes – could become a reality.
However, this possibility should not disqualify scientists from continuing to develop artificial wombs. The ethics of gene editing and “designer babies” is different from the ethics of artificial wombs. Artificial wombs do not imply that all babies developed outside of a human uterus are going to be genetically modified. Even if ethicists deem gene editing and “designer babies” unethical, that does not imply that artificial wombs are unethical, as their functions include a much larger range of scenarios.
Critics also call artificial wombs unethical because of the unnaturalness of developing a baby outside of a woman’s uterus. However, whether something is “natural” or “unnatural” does not translate to it being “good” or “bad.” Just because artificial wombs are not the “natural” way that humans reproduce, that doesn’t mean that they aren’t a positive innovation. Vaccines, for instance, are not “natural,” yet they save millions of lives from deadly diseases.
Such a criticism echoes the uproar over in vitro fertilization, or IVF. When researchers Robert Geoffery Edwards and Patrick Steptoe first started researching the technology in the late 1960s, their technology immediately generated controversy [13]. Many contemporary ethicists did not believe that infertility should be something that should be “solved,” and worried about “the normality” of the children born using IVF [13]. Today, such criticisms seem laughable, as millions of parents depend on IVF to enable them to reproduce [13]. Thus, while it’s of course important that artificial wombs are heavily tested before their widespread use, such technology should not be dismissed simply on the grounds that it is “unnatural.”
Conclusion
As technology progresses, our view of ethics must progress as well. For some future technologies, such as advanced artificial intelligence, gene editing, and robotics, we still have a long way to go in deciding how they should be used ethically. On the other hand, the ethics of artificial wombs are clear. As long as artificial wombs are developed with human safety in mind and are a viable option for parents, then artificial wombs could be of enormous benefit to society. As the Norwegian bioethicist Anna Smajdor declares, “Assuming we could get perfect [artificial womb technology], it seems like a thing we should do, in a fully just society.” [14]
By Timothy Wang, Viterbi School of Engineering, University of Southern California
About the Author
At the time of writing this paper, Timothy was a junior majoring in Computer Science and minoring in Screenwriting. He also served as the treasurer for both the student organizations Queers in Engineering, Science, and Technology and Asian Pacific Cinema Association. He plans on pursuing a Ph.D. in Computer Science after graduation.
References
[1] R. Becker, “An artificial womb successfully grew baby sheep — and humans could be next”, The Verge, 2020. [Online]. Available: https://www.theverge.com/2017/4/25/15421734/artificial-womb-fetus-biobag-uterus-lamb-sheep-birth-premie-preterm-infant. [Accessed: 22- Oct- 2020].
[2] K. Devlin, “The world’s first artificial womb for humans”, Bbc.com, 2020. [Online]. Available: https://www.bbc.com/news/av/health-50056405. [Accessed: 22- Oct- 2020].
[3] S. Stierwalt, “Could Artificial Wombs Be a Reality?”, Scientific American, 2020. [Online]. Available: https://www.scientificamerican.com/article/could-artificial-wombs-be-a-reality/. [Accessed: 22- Oct- 2020].
[4] “Premature birth – Symptoms and causes”, Mayo Clinic, 2020. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730#:~:text=Premature%20babies%20are%20more%20likely%20to%20have%20chronic%20health%20issues,infant%20death%20syndrome%20(SIDS). [Accessed: 22- Oct- 2020].
[5] “Pregnancy Complications”, Reproductive Health. [Online]. Available: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-complications.html. [Accessed: 22- Oct- 2020].
[6] “Pregnancy-Related Deaths”, Reproductive Health. [Online]. Available: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-relatedmortality.htm. [Accessed: 22- Oct- 2020].
[7] G. Lemmon, “The Pregnancy Penalty: How Working Women Pay for Having Kids”, The Atlantic, 2020. [Online]. Available: https://www.theatlantic.com/sexes/archive/2012/12/the-pregnancy-penalty-how-working-women-pay-for-having-kids/266239/. [Accessed: 22- Oct- 2020].
[8] D. Kaufman, “The Fight for Fertility Equality”, Nytimes.com, 2020. [Online]. Available: https://www.nytimes.com/2020/07/22/style/lgbtq-fertility-surrogacy-coverage.html. [Accessed: 10- Nov- 2020].
[9] “Debating Between Adoption and Surrogacy? 5 Questions to Ask Yourself”, American Adoptions Blog, 2020. [Online]. Available: https://www.americanadoptions.com/blog/adoption-or-surrogacy/. [Accessed: 22- Oct- 2020].
[10] T. McCormick, “Principles of Bioethics | UW Department of Bioethics & Humanities”, UW Medicine: Department of Bioethics and Humanities, 2020. [Online]. Available: https://depts.washington.edu/bhdept/ethics-medicine/bioethics-topics/articles/principles-bioethics. [Accessed: 22- Oct- 2020].
[11] “Cancer in Pregnancy: Types, Treatment, Risks, and Outlook”, Healthline Parenthood, 2020. [Online]. Available: https://www.healthline.com/health/cancer-in-pregnancy#treatment. [Accessed: 22- Oct- 2020].
[12] I. Sample, “Researchers break record for keeping lab-grown human embryos alive”, The Guardian, 2020. [Online]. Available: https://www.theguardian.com/science/2016/may/04/scientists-break-record-for-keeping-lab-grown-human-embryos-alive. [Accessed: 22- Oct- 2020].
[13] K. Eschner, “In Vitro Fertilization Was Once As Controversial As Gene Editing is Today”, Smithsonian Magazine, 2020. [Online]. Available: https://www.smithsonianmag.com/smart-news/vitro-fertilization-was-once-controversial-cloning-today-180964989/. [Accessed: 22- Oct- 2020].
[14] J. Kleeman, “‘Parents can look at their foetus in real time’: are artificial wombs the future?”, The Guardian, 2020. [Online]. Available: https://www.theguardian.com/lifeandstyle/2020/jun/27/parents-can-look-foetus-real-time-artificial-wombs-future. [Accessed: 10- Nov- 2020].
Links for Further Reading
https://www.technologyreview.com/2021/03/17/1020969/mouse-embryo-grown-in-a-jar-humans-next/
https://undark.org/2017/09/29/artificial-womb-ectogenesis/
https://www.technologyreview.com/2018/10/22/139478/are-we-designing-inequality-into-our-genes/