From the maternal uterus to the "uterus device"? Ethical and scientific considerations on partial ectogenesis.

The article aims to elaborate the progress made in partial ectogenesis research on sheep as well as human embryos. Since the ban on embryos experimentation after the 14-day window is a major roadblock in terms of partial ectogenesis research, the authors have weighed the possibility that such a ban could be reconsidered. In favor of easing such a restriction, it may be argued that: (a) unlike the Catholic approach, prevalent ethics precepts hold that the embryo's interest ought to be balanced against the interests of the other parties involved; (b) an extension of the 14-day deadline would no longer make ethically untenable practices acceptable; hence, the "slippery slope" argument, although generally worthy, would not conclusively apply to partial ectogenesis; (c) in mainstream embryo research efforts, there is a conflict between the lives of embryos and the health of individuals already born; as for partial ectogenesis, however, such a conflict would be between the lives of embryos and the lives of fetuses which would not survive otherwise. Still, in light of the embryo's status as a human being, the authors conclude that such research practices should only be allowed on supernumerary embryos.

De onde vêm os bebês?: Útero artificial, bioética e direito:os possíveis impactos da ectogênese no campo da filiação - Uma análise a partir do contexto jurídico brasileiro / Where do babies come from?: Artificial womb, bioethics and law: the possible impacts of ectogenesis in the field of filiation - An analysis of the Brazilian legal context

Nos últimos tempos, os avanços biotecnológicos no campo da reprodução humana, sem dúvidas, acarretaram diversas alternativas procriativas para aqueles que buscam desempenhar um projeto parental através das chamadas técnicas de reprodução assistida. Desse modo, também nesse seguimento, pesquisas recentes vêm debruçando-se sobre o desenvolvimento da tecnologia do útero artificial, objetivando viabilizar a ectogênese, ou seja, o desenvolvimento de gestações extracorpóreas. Em razão disso, o presente artigo visou revisar, a partir do panorama jurídico brasileiro, os possíveis impactos que o desenvolvimento efetivo de tal ferramenta possa vir a causar na atribuição da filiação civil. Para tanto, a pesquisa pautou-se na técnica da revisão bibliográfica, no intuito de investigar quais seriam os parâmetros para estipulação dos vínculos filiatórios (AU)

En los últimos tiempos, los avances biotecnológicos en el campo de la reproducción humana han conducido a varias alternativas de procreación para aquellos que buscan iniciar un proyecto parental a través de las llamadas técnicas de reproducción asistida. En esta área, la investigación reciente se ha centrado en el desarrollo de la tecnología del útero artificial, con el objetivo de hacer viable la ectogénesis, es decir, el desarrollo de embarazos extracorpóreos. Como resultado, este artículo busca revisar, desde la perspectiva jurídica brasileña, los posibles impactos que el desarrollo efectivo de dicha herramienta puede causar en la atribución de filiación civil. Para este propósito, se realizó una investigación documental, a fin de recopilar información ya existente sobre el tema del establecimiento de la relación de filiación (AU)

In recent times, biotechnological advances in the field of human reproduction have led to several procreation alternatives for those seeking to initiate a parental project through so-called assisted reproductive techniques. In this area, recent research has focused on the development of artificial womb technology, with the aim of making ectogenesis viable, that is, the development of extracorporeal pregnancies. As a result, this article seeks to review, from the Brazilian legal perspective, the possible impacts that the effective development of this tool may have on the attribution of civil filiation. For this purpose, a bibliographic review was carried out in order to determine which would be the parameters for the assignment of filiation relationship (AU)

En els últims temps, els avanços biotecnològics en el camp de la reproducció humana han conduït a diverses alternatives de procreació per a aquells que busquen iniciar un projecte parental a través de les anomenades tècniques de reproducció assistida. En aquesta àrea, la recerca recent s'ha centrat en el desenvolupament de la tecnologia de l'úter artificial, amb l'objectiu de fer viable la ectogènesi, és a dir, el desenvolupament d'embarassos extracorporis. Com a resultat, aquest article busca revisar, des de la perspectiva jurídica brasilera, els possibles impactes que el desenvolupament efectiu d'aquesta eina pot causar en l'atribució de filiació civil. Per a aquest propòsit, es va realitzar una recerca documental, a fi de recopilar informació ja existent sobre el tema de l'establiment de la relació de filiació (AU)

Pregnant people, inseminators and tissues of human origin: how ectogenesis challenges the concept of abortion.

The potential benefits of an alternative to physical gestation are numerous. These include providing reproductive options for prospective parents who are unable to establish or maintain a physiological pregnancy, and saving the lives of some infants born prematurely. Ectogenesis could also promote sexual equality in reproduction, and represents a necessary option for women experiencing an unwanted pregnancy who are morally opposed to abortion. Despite these broad, and in some cases unique benefits, one major ethical concern is the potential impact of this emerging technology on abortion rights. This article will argue that ectogenesis poses a challenge to many common arguments in favour of a pregnant woman's right to choose, but only insomuch as it highlights that their underlying justifications for abortion are based on flawed conceptions of what the foetus and pregnancy actually are. By interrogating the various interests and relationships involved in a pregnancy, this article will demonstrate that the emergence of artificial gestation need not impact existing abortion rights or legislation, nor definitions of independent viability or moral status.

Neonatal incubator or artificial womb? Distinguishing ectogestation and ectogenesis using the metaphysics of pregnancy.

A 2017 Nature report was widely touted as hailing the arrival of the artificial womb. But the scientists involved claim their technology is merely an improvement in neonatal care. This raises an under-considered question: what differentiates neonatal incubation from artificial womb technology? Considering the nature of gestation-or metaphysics of pregnancy-(a) identifies more profound differences between fetuses and neonates/babies than their location (in or outside the maternal body) alone: fetuses and neonates have different physiological and physical characteristics; (b) characterizes birth as a physiological, mereological and topological transformation as well as a (morally relevant) change of location; and (c) delivers a clear distinction between neonatal incubation and ectogestation: the former supports neonatal physiology; the latter preserves fetal physiology. This allows a detailed conceptual classification of ectogenetive and ectogestative technologies according to which the 2017 system is not just improved neonatal incubation, but genuine ectogestation. But it is not an artificial womb, which is a term that is better put to rest. The analysis reveals that any ethical discussion involving ectogestation must always involve considerations of possible risks to the mother as well as her autonomy and rights. It also adds a third and potentially important dimension to debates in reproductive ethics: the physiological transition from fetus/gestateling to baby/neonate.

Equitable access to ectogenesis for sexual and gender minorities.

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual- or gender-minority groups who likewise seek to pursue parenthood. We examine the history of access to current family-building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual- or gender-minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice.

The ethics of ectogenesis-aided foetal treatment.

In this paper, we aim to stimulate ethical debate about the morally relevant connection between ectogenesis and the foetus as a potential beneficiary of treatment. Ectogenesis could facilitate foetal interventions by treating the foetus independently of the pregnant woman and provide easier access to the foetus if interventions are required. The moral relevance hereof derives from the observation that, together with other developments in genetic technology and prenatal treatment, this may catalyse the allocation of a patient status to the foetus. The topic of foetal medicine is of growing interest to clinicians, and it also deserves due attention from an ethical perspective. To the extent that these developments contribute to the allocation of a patient status to the foetus (and to its respective interests for medical treatment), normative questions arise about how moral responsibilities towards foetal interests should be balanced against the interests of the pregnant woman. We conclude that, even if ectogenesis could facilitate foetal therapy, it is important to remain sensitive to the fact that it would not circumvent the key ethical concerns that come with in utero foetal treatment and that it may even exacerbate potential conflicts between directive treatment recommendations and the pregnant woman's autonomous decision to the contrary.

Procreation machines: Ectogenesis as reproductive enhancement, proper medicine or a step towards posthumanism?

Full ectogenesis as the complete externalization of human reproduction by bypassing the bodily processes of gestation and childbirth can be considered the culmination of genetic and reproductive technologies. Despite its still being a hypothetical scenario, it has been discussed for decades as the ultimate means to liberate women from their reproductive tasks in society and hence finally end fundamental gender injustices generally. In the debate about the application of artificial wombs to achieve gender equality, one aspect is barely mentioned but is of crucial relevance from a medical-ethical perspective: whether and how could full ectogenesis be justified as a proper use of medicine? After characterizing the technology as a special form of human enhancement and as an extension of medical practice that goes beyond the traditional field of medicine, this paper critically assesses the theoretical possibilities of legitimizing this extension. We identify two ways of justification: either one argues that ectogenesis fulfils a proper goal of medicine (a justification we call pathologization), or one argues that the application of ectogenesis achieves a non-medical goal (which we call medicalization). Because it is important from a medical-ethical point of view to avoid an inappropriate instrumentalization or misuse of medicine and thus an undue medicalization of non-medical problems, a set of necessary conditions has to be met. It is doubtful whether full ectogenesis for non-medical purposes could fulfil these conditions. Rather, its comprehensive usage could be seen as a revolutionary modification of what it means to be human.

Abortion and Ectogenesis: Moral Compromise.

The contemporary philosophical literature on abortion primarily revolves around three seemingly intractable debates, concerning the (1) moral status of the fetus, (2) scope of women's rights and (3) moral relevance of the killing/letting die distinction. The possibility of ectogenesis-technology that would allow a fetus to develop outside of a gestational mother's womb-presents a unique opportunity for moral compromise. Here, I argue those opposed to abortion have a prima facie moral obligation to pursue ectogenesis technology and provide ectogenesis for disconnected fetuses as part of a moral compromise.

Gestation, equality and freedom: ectogenesis as a political perspective.

The benefits of full ectogenesis, that is, the gestation of human fetuses outside the maternal womb, for women ground many contemporary authors' arguments on the ethical desirability of this practice. In this paper, I present and assess two sets of arguments advanced in favour of ectogenesis: arguments stressing ectogenesis' equality-promoting potential and arguments stressing its freedom-promoting potential. I argue that although successfully grounding a positive case for ectogenesis, these arguments have limitations in terms of their reach and scope. Concerning their limited reach, I contend that ectogenesis will likely benefit a small subset of women and, arguably, not the group who most need to achieve equality and freedom. Concerning their limited scope, I contend that these defences do not pay sufficient attention to the context in which ectogenesis would be developed and that, as a result, they risk leaving the status quo unchanged. After providing examples of these limitations, I move to my proposal concerning the role of ectogenesis in promoting women's equality and freedom. This proposal builds on Silvia Federici's, Mariarosa Dalla Costa's and Selma James' readings of the international feminist campaign 'Wages for Housework'. It maintains that the political perspective and provocation that ectogenesis can advance should be considered and defended.

Ectogestation ethics: The implications of artificially extending gestation for viability, newborn resuscitation and abortion.

Recent animal research suggests that it may soon be possible to support the human fetus in an artificial uterine environment for part of a pregnancy. A technique of extending gestation in this way ("ectogestation") could be offered to parents of extremely premature infants (EPIs) to improve outcomes for their child. The use of artificial uteruses for ectogestation could generate ethical questions because of the technology's potential impact on the point of "viability"-loosely defined as the stage of pregnancy beyond which the fetus may survive external to the womb. Several medical decisions during the perinatal period are based on the gestation at which infants are considered viable, for example decisions about newborn resuscitation and abortion, and ectogestation has the potential to impact on these. Despite these possible implications, there is little existing evidence or analysis of how this technology would affect medical practice. In this paper, we combine empirical data with ethical analysis. We report a survey of 91 practicing Australian obstetricians and neonatologists; we aimed to assess their conceptual understanding of "viability," and what ethical consequences they envisage arising from improved survival of EPIs. We also assess what the ethical implications of extending gestation should be for newborn and obstetric care. We analyze the concept of viability and argue that while ectogestation might have implications for the permissibility of neonatal life-prolonging treatment at extremely early gestation, it should not necessarily have implications for abortion policy. We compare our ethical findings with the results of the survey.

Formula feeding can help illuminate long-term consequences of full ectogenesis.

Breastfeeding is analogous to pregnancy as an experience, in its exclusiveness to women, and in its cost and the effects it has on equitable share of labor. Therefore, the history of formula feeding provides useful insights into the future of full ectogenesis, which could evolve into a more severe version of what formula feeding is today: simplify life for some women and provide couples with a more equitable share of work at the cost of stigma, guilt and a daily diet of studies purporting to show the benefits of natural pregnancy. Making pregnancy an optional route to motherhood would make women's life trajectory more similar to men's and thus put pressure on women to compete with men on the ground shaped by men's preferences. Despite being a treasured experience of many women today, bearing children could become the luxury of the few, the province of the very poor and a choice working women will pay a high price for as women who choose pregnancy become stigmatized as self-indulgent or unprofessional and penalized for it in the workplace. At the same time, scarce societal resources that could be used to support pregnant women and working mothers would instead be directed toward proving to women or even forcing them to gestate children "the right way." While not necessarily threatening on its own, when added to formula feeding, IVF, stem-cell produced ova and sex robots, full ectogenesis could diminish men's stake in women's wellbeing and even existence.

Artificial womb technology and clinical translation: Innovative treatment or medical research?

In 2017 and 2019, two research teams claimed 'proof of principle' for artificial womb technology (AWT). AWT has long been a subject of speculation in bioethical literature, with broad consensus that it is a welcome development. Despite this, little attention is afforded to more immediate ethical problems in the development of AWT, particularly as an alternative to neonatal intensive care. To start this conversation, I consider whether experimental AWT is innovative treatment or medical research. The research-treatment distinction, pervasive in regulation worldwide, is intended to isolate research activities and subject them to a greater degree of oversight. I argue that there is a tendency in the literature to conceptualize AWT for partial ectogenesis as innovative treatment. However, there are sufficiently serious ethical concerns with experimental AWT that mean that it must not be first used on humans on the basis that it is a 'beneficial treatment'. First, I outline the prospects for translation of AWT animal studies into treatment for human preterms. Second, I challenge the conceptualizations of experimental AWT as innovative treatment. It must be considered medical research to reflect the investigatory nature of the process and guarantee sufficient protections for subjects. Identifying that AWT is research is crucial in formulating further ethico-legal questions regarding the experimental use of AWT. Third, I demonstrate that clinical trials will be a necessary part of the clinical translation of AWT because of requirements laid out by regulators. I consider the justification for clinical trials and highlight some of the crucial ethical questions about the conditions under which they should proceed.

Artificial Womb Technology and the Choice to Gestate Ex Utero: Is Partial Ectogenesis the Business of the Criminal Law?

It is frequently claimed that artificial wombs (AWs) could alleviate the burdens placed exclusively on women in reproduction. In this article, I demonstrate how AWs used for the partial gestation of preterm neonates could introduce new choices for women by changing perceptions of tolerable risks in gestation. In light of advancing medical technology, it is necessary to consider whether the current legal framework in England and Wales would support increased choice for women about alternative forms of gestation. I examine the ill-defined offence of 'unlawfully procuring miscarriage' in the Offences Against the Person Act 1861 and demonstrate that different conclusions about the legal significance of ending a pregnancy are evident, depending on the analytical lens adopted in interpreting ambiguities. Furthermore, I demonstrate that the defences available to pregnancy termination under the Abortion Act 1967 are too narrow to support choices about alternative forms of gestation, even if they become physically and medically possible. Therefore, we should decriminalise termination of pregnancy, or, if it is assumed that gestation is the business of the criminal law, specific reforms to the legal framework are necessary. The offence of unlawfully procuring miscarriage is too uncertain and broad, and the defences available are too restrictive.

Artificial womb technology and the significance of birth: why gestatelings are not newborns (or fetuses).

In a recent publication, I argued that there is a conceptual difference between artificial womb (AW) technology, capable of facilitating gestation ex utero, and neonatal intensive care, providing incubation to neonates born prematurely. One of the reasons I provided for this distinction was that the subjects of each process are different entities. The subject of the process of gestation ex utero is a unique human entity: a 'gestateling', rather than a fetus or a newborn preterm neonate. Nick Colgrove wrote a response to my paper, claiming that my distinction between the subject of an AW and a newborn (in intensive care) was false. He claims that I have not accounted for the proper definition of 'birth' and that gestatelings are not a distinct product of human reproduction. Further, Colgrove posits that even if I can successfully distinguish gestatelings from preterms, such a distinction is morally irrelevant because the entities would have the same moral status. In this paper, I address the three challenges raised and defend the claim that gestatelings are unique entities. Moreover, I argue that moral status should not be considered ipso facto determinative in the debate about AWs.

Subjects of ectogenesis: are 'gestatelings' fetuses, newborns or neither?

Subjects of ectogenesis-human beings that are developing in artificial wombs (AWs)-share the same moral status as newborns. To demonstrate this, I defend two claims. First, subjects of partial ectogenesis-those that develop in utero for a time before being transferred to AWs-are newborns (in the full sense of the word). Second, subjects of complete ectogenesis-those who develop in AWs entirely-share the same moral status as newborns. To defend the first claim, I rely on Elizabeth Chloe Romanis's distinctions between fetuses, newborns and subjects of ectogenesis. For Romanis, the subject of partial ectogenesis 'is neither a fetus nor a baby' but is, instead, a 'new product of human reproduction'. In this essay, I begin by, expanding upon Romanis's argument that subjects of partial ectogenesis are not fetuses while arguing that those subjects are newborns. Next, I show that the distinction that Romanis draws between subjects of partial ectogenesis and newborns needs to be revised. The former is a kind of the latter. This leads us to an argument that shows why different moral statuses cannot be justifiably assigned to subjects of partial ectogenesis and subjects of complete ectogenesis, respectively. As subjects of partial ectogenesis share the same moral status as newborns, it follows that subjects of complete ectogenesis share the same moral status as newborns as well. Iconclude by considering implications that this essay may have for the research and development of AW technology and conceptual links between a subject's moral status and birth.

Ectogenesis and the case against the right to the death of the foetus.

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson's violinist analogy, which argues for a woman's right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson's reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen's analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.

Bioethics and Biopolitics: Presents and Futures of Reproduction.

This Bioethics and Biopolitics: Presents and Futures of Reproduction symposium draws together a series of articles that were each submitted independently by their authors to the JBI and which explore the biopower axis in the externalization of reproduction in four contexts: artificial gestation (ectogenesis), PGD for sex selection, women's (reproductive) rights, and testicular cryopreservation (TCCP). While one contribution explores a "future" of reproduction, the other three explore a "present," or better, explore different "presents." What may counts as "present," and what may count as "future," has dramatically different connotations depending on the geographical declination of the tense.

The Perfect Womb: Promoting Equality of (Fetal) Opportunity.

This paper aims to address how artificial gestation might affect equality of opportunity for the unborn and any resultant generation of "ectogenetic" babies. It will first explore the current legal obstacles preventing the development of ectogenesis, before looking at the benefits of allowing this technology to control fetal growth and development. This will open up a discussion of the treatment/enhancement divide regarding the use of reproductive technologies, a topic featured in various bioethical debates on the subject. Using current maternity practices in Western society as a comparator, this paper will conclude that neither naturally nor artificially gestated fetuses have interests that can conflict with those of potential parents who might want to use this technology to control fetal development. Such control may include selective implantation of embryos of a desired gender, deliberate choice of genetic traits, or maintenance of an ideal incubation environment to avoid fetal damage. Objections on the basis of disability as well as concerns regarding eugenics will be addressed. The paper will conclude that none of these objections are compelling grounds to prevent the development and use of ectogenesis technologies for the purpose of achieving specific reproductive goals, particularly when compared to current practices in pre-implantation genetic diagnosis and selective abortion on the grounds of undesired traits. As such, when deciding whether to support ectogenesis research, the enduring interests of parents must be the primary consideration, with societal concerns regarding potential misuse the only valid secondary consideration.