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Abstract

Ectogenesis (reproduction outside the human body) engages bioethical questions from a variety of perspectives. Some suggest that ectogenesis would offer a welcome liberation from the burdens of childbearing, and others regard it as a sinister encroachment on the natural processes of reproduction. This entry discusses the progress of scientiﬁc research in this area and outlines the key bioethical responses to the prospect of ectogenesis, including its effects on women, implications for the status of the embryo/fetus, and broader social and political ramiﬁcations.

Introduction

The term “ectogenesis” is derived from the Greek “ecto,” meaning outside, and “genesis”– origin or beginning. The term is usually used to denote reproduction outside the mother’s body, e.g., in an artiﬁcial uterus. Strictly speaking, partial ectogenesis is relatively commonplace: conception (genesis) outside the human body, followed by in vitro cultivation of embryos for several days, is a routine aspect of IVF. At the other end of the spectrum, fetuses can be kept alive at increasingly early stages of gestation, with appropriate medical and technological intervention. Thus, the period during which the fetus must be within the mother’s body is shrinking.

At the same time, science tells us more and more about what is happening to the fetus during this essential gestational phase: whether and how fast it is growing, what sex it is, and whether it is likely to suffer from disease or disability. And we are gaining more understanding about how the uterine environment affects the fetus. Maternal diet, lifestyle, exercise, and stress all have an impact. As well as being able to track fetal development, in recent decades, it has become possible to intervene surgically on fetuses in the womb, for example, to remove tumors or repair cleft palates. These innovations provide a powerful impetus to further the state of knowledge and the efﬁcacy of operations carried out on gestating fetuses. While the fetus is necessarily in the maternal womb, the furtherance of this knowledge and the development of interventions remain a contentious issue. The more we know, the greater the degree of pressure to which the gestating mother is subjected. Monitoring and/or controlling her activities while pregnant and working through her body to access the fetus present doctors with a complex ethical and technical challenge (Smajdor 2012).

Despite the advances of science in understanding and intervening in the gestational world of the fetus, the ability to bring a human fetus to term entirely independently of a human body remains a feat beyond the scope of our current technological accomplishments at the time of writing. Even so, many researchers view ectogenesis as scientiﬁcally feasible, if not inevitable. The ongoing drive to save prematurely born fetuses will continue to push back the threshold at which we can sustain neonates outside the womb until we may ﬁnd one day that gestation is no longer an absolute necessity (Simonstein and Mashiach-Eizenberg 2009).

It should be noted, however, that the relevance of ectogenesis to bioethics is not necessarily dependent on its scientiﬁc feasibility. The use of ectogenesis in thought experiments can in itself be a fruitful means of exposing and exploring ethical assumptions related to gestation and childbirth.

Bioethicists have advanced a number of reasons why the development of ectogenesis might be desirable:

To keep very premature fetuses alive
To enable fetuses/embryos to be “aborted” without killing them
To spare women the medical burdens of gestation and childbirth
To avoid the need for surrogacy with its associated ethical problems
To achieve better equality between the sexes
To enable better understanding and control of fetal development

However, the likelihood that ectogenesis would actually yield these beneﬁts is disputed, and this constitutes one of the key areas of bioethical debate.

Scientific, Historical, And Literary Background

JBS Haldane famously predicted the development of ectogenesis; indeed, it was he who ﬁrst used the word to describe reproduction outside the body. He regarded ectogenesis as desirable primarily for eugenic purposes, to enable the careful selection of characteristics for offspring and hence an incremental improvement in each generation of human beings. Moreover, Haldane believed that the potential of ectogenesis to bring about the separation of reproduction and sexual love would enable people to be “free in an altogether new sense” (Haldane 1923). Ectogenesis also famously plays an important part in Aldous Huxley’s Brave New World. Again, in Huxley’s vision, the primary purpose of ectogenesis is to allow for the control and modiﬁcation of offsprings’ characteristics. However, Huxley’s version differs from that of Haldane in its clearly dystopian outlook (Huxley 1973).

While ectogenesis is an ongoing source of inspiration for science ﬁction writers and ﬁlmmakers, some progress has been made in real-world scientiﬁc developments. Chavatte-Palmer et al. note that preimplantation culture of embryos in vitro in both animals and humans is well established (Chavatte-Palmer et al. 2012). Likewise, advances have been made in sustaining premature babies at increasingly early stages of gestation. Looking at these two ends of the spectrum, it is clear that the middle stage identiﬁed by Chavatte-Palmer et al. – that at which the embryo/ fetus is attached to the uterus while the organs are developing and while it is unable to survive outside the mother’s body – represents the greatest challenge to scientists working in this ﬁeld. Creating an environment into which the embryo can implant outside the body is a necessary prerequisite to further progress, but implantation is a highly complex biological process and is very difﬁcult to bring about in an entirely artiﬁcial medium.

Ectogenetic implantation has, however, been achieved in human uteruses obtained from women who had undergone hysterectomies. The organs were kept perfused (supplied with oxygen and nutrients) in a similar way to organs for transplant. Embryos injected into the uterus were found to have implanted successfully and began to develop along the expected lines. However, these experiments were discontinued because of ethical concerns.

Scientists have also explored the possibility of creating an artiﬁcial uterus using endometrial cells cultured on a biodegradable structure, as carried out by Hung-Ching Liu at Cornell University, and techniques developed in Japan to create an artiﬁcial placenta and uterus that succeeded in keeping goat fetuses alive ectogenetically for several weeks (Chavatte-Palmer et al. 2012).

Ectogenesis might be effected in a number of different ways, using:

Perfused extracorporeal human uteruses
Artiﬁcial wombs, created with endometrial cells on a biodegradable structure
Man-made artifacts such as incubators or tanks
Perfused extracorporeal nonhuman uteruses
“Surrogates” of other species, e.g., genetically modiﬁed pigs
Human bodies other than those of living women, e.g., men or brain-dead women

The Bioethical Analysis Of Ectogenesis

Animal Research

The vast majority of commentators have focused exclusively on bioethical concerns relating to human beings. Yet there are clearly some ethical questions to be asked about the highly invasive animal research that has taken place so far in the pursuit of ectogenesis and which is likely to play a signiﬁcant part in improving the technique’s efﬁcacy and safety. Experiments have been carried out on a number of animal species, in the course of research into ectogenesis, involving trauma to the mother animals whose pregnancies were surgically removed and damage to the fetuses themselves. The goats whose fetuses were removed for ectogenetic research underwent cesareans, while the fetuses themselves died during or shortly after the process. It might be hoped that once ectogenesis is perfected, the use of animals in ectogenetic research would cease. However, the routine use of animals for the purpose of ectogenesis has also been suggested and if so would raise many of the same ethical concerns as xenotransplantation.

Ectogenesis As Neonatal Rescue

Partial ectogenesis as a replacement or substitute for the uterine environment is already in use for very premature babies. Because of this, its ongoing improvement and development is likely to continue on the same trajectory, toward neonatal rescue at earlier and earlier gestational ages. While complete ectogenesis is not the explicit aim of research and innovation in this area, it may be a logical endpoint of developments in neonatal care (Simonstein and Mashiach Eizenberg 2009). Each last-resort intervention gives rise to the possibility of learning more about fetal development and improving the techniques being used, giving researchers and doctors additional motivations to push the boundaries at which it is possible to sustain life.

From an ethical perspective, empirical studies show that the prospect of ectogenesis for purposes of neonatal rescue is much more acceptable to the general public than ectogenesis for other reasons (Simonstein and Mashiach-Eizenberg 2009). The medical emergency framing for ectogenesis seems at ﬁrst sight to situate it in a reassuringly familiar context: the use of technology to address a speciﬁc and urgent need. However, even in this apparently benign context, there may be slippage in the delineation of the criteria that justify ectogenesis. It is easy to foresee that in jurisdictions where “irresponsible” mothers – those who take drugs during pregnancy, for example – are incarcerated or subjected to forced cesareans, “rescuing” the fetus from its mother’s body before birth might come to be seen as an acceptable course of action (Langford 2008).

Ectogenesis As An Alternative To Abortion

Ectogenesis may have an impact on a variety of arguments related to abortion, including severance-type approaches and those based on personhood. Advocates of the severance position have hitherto had the advantage of not having to specify their view on whether the fetus is or is not a person. However, if it is possible to “sever” the fetus from the mother without killing it, the question of personhood becomes more pressing: if the fetus is a person, there can be little justiﬁcation for killing it after removing it from the body. If not, there may be little reason to expend resources and technological investment on preserving its life (Gelfand 2006).

From a pro-choice perspective, this calls into question the scope of women’s right to abortion: should a woman have the right to expel the fetus from her body and to end its life? Judith Jarvis Thomson’s famous “violinist” analogy was designed to show that the question of personhood was not determinative of the morality acceptability of abortion. On her analysis, a woman may not have a moral obligation to allow her body to be used by other entities, even if they are persons, but there is no corresponding reason to suppose that a woman has a moral right to destroy an entity who has used her body but is no longer doing so (Jarvis Thomson 1971).

Ectogenesis also calls into question the way that viability is deﬁned, and this in turn may affect access to abortion. In many jurisdictions where abortion is permitted, it is limited to the point at which the fetus is deemed viable (i.e., the point at which there is a possibility of keeping it alive outside the mother’s body). Before this stage, the removal of the fetus results inevitably in its death. Abortions carried out after viability do not necessarily result in the death of the fetus and might thus require an additional procedure of feticide as well as the actual removal from the mother’s body.

Advances in medical technology have shifted the boundaries of viability, and in some countries, this has resulted in changes to abortion laws. For example, in the UK, the upper limit for abortion was changed from 28 to 24 weeks in 1990 partly on the basis that the threshold of viability had moved. With the development of ectogenesis, it has been suggested that there will no longer be a threshold of viability at all: any embryo or fetus removed from the maternal womb could be saved if transferred to an effective alternative gestational environment. Thus, all embryos and fetuses might be deemed to have a right to life. The role that viability currently plays, therefore, in determining access to abortion would dramatically alter.

Coerced Interventions

Offering ectogenesis as an alternative to abortion that preserves the fetus’ life might disadvantage women, in perpetuating the idea that the embryo or fetus has interests independently of the gestational mother and by implication that these interests could be prioritized over those of the mother. With ectogenesis, there is no need to differentiate between the moral status of embryos, fetuses, and infants, but this running together of moral categories may be problematic and implicitly threatening to women’s rights and interests (Langford 2008).

Many writers who advocate ectogenesis as an alternative to abortion do not consider the physical means by which a fetus might be translocated from the womb to the ectogenetic medium. Certainly, the likelihood that such translocation might be dangerous or difﬁcult is not often addressed. However in practice, it is difﬁcult to see how a fetus or embryo could be removed from a woman’s body without an invasive surgical procedure, involving a degree of risk both to the woman and fetus (Langford 2008). Currently, it is possible to terminate a pregnancy pharmaceutically in the early stages of gestation with no need for surgery. But if ectogenesis were to replace abortion, pharmaceutical termination might not be permitted to women. Pregnancies might be terminated only by means of procedures that are more risky and invasive for the woman, but less risky for the fetus (Brassington 2009).

Langford suggests that a society that provides ectogenesis as the only legal way of ending an unwanted pregnancy could inadvertently generate a resurgence of backstreet abortions, as women seek to prevent themselves becoming mothers rather than to prevent themselves being pregnant – an eventuality that is not circumvented through ectogenesis. At the very least, it seems likely that with the development of ectogenesis, a woman’s “right” to choose the mode of termination might be limited by factors beyond her control (Langford 2008). Because of this, ectogenesis fails to offer a straightforward answer to maternal/ fetal conﬂict and could indeed reinforce the tendency to prioritize the life and/or interests of the fetus against those of the mother. US courts, for example, have enforced a cesarean on a dying woman because the fetus was deemed viable. With ectogenesis, since every fetus is viable, such imperatives for coerced intervention might grow more, rather than less, commonplace.

Ectogenesis as a “solution” to abortion does not solve the problem of unwanted pregnancy happening in the ﬁrst place, nor does it necessarily improve the standing of women in society (Langford 2008). Certainly, even if ectogenesis were widely available, it seems that women would still have good reason to avoid unwanted pregnancies, and their ability to do this would still be a matter of feminist concern. Moreover, ectogenesis as an alternative to abortion might have a signiﬁcantly negative impact on women’s choices. Rather than broadening women’s options, ectogenesis – if developed and offered within a patriarchal framework – might generate additional burdens for women and increase their vulnerability to coerced interventions (Langford 2008).

Empirical Work: What Do Real Women Think Of Ectogenesis As An Alternative To Abortion?

Singer and Wells argue that there could be scope for a rapprochement between the two sides of the abortion debate, if women could countenance allowing their aborted fetuses to live and if pro-life campaigners could countenance the removal of unwanted fetuses from women’s bodies, followed by ectogenesis (Singer and Wells 1984). However, this prospect has been regarded with skepticism by researchers who have carried out empirical work in this area. Although there is limited data on this subject to date, the studies that have been carried out suggest that women would not after all consider ectogenesis as a feasible alternative to abortion, irrespective of their pro-life or pro-choice leanings.

Leslie Cannold observes that the moral framework which real women apply to abortion is substantially different from that applied by philosophers (Cannold 1995). The reluctance of pro-choice women to sanction the idea of ectogenesis shows that their pro-choice commitments are not based on the kind of moral theory that focuses on women’s right to bodily autonomy. Women who consider abortion apply a set of moral convictions based on ideas of maternal responsibility, rather than bodily autonomy per se. Because of this, removing the fetus to an alternative gestational environment is unsatisfactory since the maternal link still exists and will not be severed unless the fetus’ life is ended (Cannold 1995).

The pro-choice women whom Cannold interviewed thus did NOT see the death of the aborted fetus as an unfortunate but unavoidable result of its removal. Rather, they speciﬁcally sought the death of the fetus as a way of ending a situation where they perceived themselves to have maternal responsibilities that they could not fulﬁll. One of Cannold’s participants explains this as “termination for the child’s sake” (Cannold 1995). The women involved in Cannold’s research were primarily concerned to be good mothers or not to be mothers at all. Thus, odd as it may seem, abortion – including the death of the fetus – was construed as an aspect of morally responsible motherhood.

Similar reasoning may explain the fact that so many women faced with unwanted pregnancies do in fact choose abortion rather than adoption. The prospect of “abandoning” their offspring can be morally problematic for women – whatever the stage of gestation (Cannold 1995). Adoption and ectogenesis will fail to meet the pregnant woman’s needs, if these needs are not conﬁned to their bodily integrity, but are linked to their willingness to assume the responsibility of motherhood (Langford 2008).

Later empirical work seems to conﬁrm Cannold’s ﬁndings with regard to ectogenesis as an alternative to abortion. In 2009, a study was published detailing interviews with 216 participants (Simonstein and Mashiach-Eizenberg 2009). Some respondents thought ectogenesis should not be developed in any circumstances. Most were not supportive of ectogenesis as an alternative to abortion. However, participants were far more favorable to ectogenesis when framed as a medical emergency: 70 % said they would use ectogenesis to save a very premature fetus. Unlike Cannold, Simonstein included men in her research. Interestingly, she found that men and single women were much more positive toward ectogenesis in general, as were those without religious convictions and those with higher educational attainment.

While Simonstein’s ﬁndings are more varied than Cannold’s, the overall picture is similar.

Ectogenesis is not widely viewed as an attractive alternative to abortion partly because many women perceive the mother role as inalienable except through the death of the fetus. The child would still be their responsibility whether it were adopted or gestated externally. On this view, once conception has taken place, for pro-lifers, there is no morally acceptable way of escaping this responsibility; for pro-choicers, the destruction of the embryo is the only route. Ectogenesis was rejected by women of both persuasions because it is perceived to be at odds with being a good woman/good mother: mothers should gestate and rear their children (Cannold 1995).

Empirical work carried out by Sheryl de Lacey, on women’s decisions as to the fate of their “spare” embryos, reveals a similar pattern. Interestingly, de Lacey shows that before undergoing successful IVF, women were open to the idea of allowing their spare embryos to be “adopted” by other couples. However, once they had had a child, their perspective changed. Where previously they had regarded the embryos as merely potential offspring, they now identiﬁed themselves as mothers and regarded the “abandonment” of the embryos for adoption as an unacceptable dereliction of maternal duty. Instead, they chose to donate them for research or have them destroyed (de Lacey 2005).

Cannold accuses moral theorists of failing to accommodate real women’s moral reasoning. The weight that real women give to maternal responsibility as a reason for destroying embryos or fetuses does not map neatly onto the moral concepts or frameworks that have been developed by philosophers to show why abortion might be justiﬁable. Perhaps we should not be surprised to ﬁnd a dichotomy between the moral perspectives of women whose lives and bodies are impacted by motherhood and moral theorists who are in many cases evaluating these questions from a purely abstractive perspective.

However, the fact that there is a discrepancy between these two ways of looking at the issue does not necessarily tell us which is to be preferred. A person’s sincerely held belief that she/he has a moral obligation to end a fetus’ life is not sufﬁcient to demonstrate that she/he does in fact have such an obligation. Some moral theorists might argue that the women Cannold described were swayed by self-interest or that their reasoning was ﬂawed. Alternatively, it might be that real women’s way of interpreting the moral responsibilities associated with pregnancy, and motherhood is the product of a pathologically gendered society that leads women to overidentify with the maternal role (Firestone 1970). Either way, while the data lends an additional angle to the debate, it does not provide a simple solution to questions about the morality of ectogenesis.

The Pro-life Perspective

Singer and Wells assume that pro-life advocates and perhaps Catholic doctrine might support ectogenesis as a means of saving embryos and fetuses that would otherwise perish through abortion. If so, this would bolster the optimistic view of ectogenesis as a means of resolving disputes in “happy harmony” (Singer and Wells 1984). However, the pro-life women who participated in Cannold’s research were also unhappy with the prospect of ectogenesis. For them, it was an unacceptable abrogation of maternal responsibility – although the fetus could be kept alive, it was felt to be morally wrong that the mother should seek to abandon it.

A signiﬁcant feature of the Catholic position is its emphasis on integrity and dignity in reproduction: “[I]ntentionally fragmenting parenthood” is wrong (Tonti-Filippini 2003). Ectogenesis can certainly be construed as a fragmentation of parenthood, in which case, whether or not it is used as an alternative to abortion, it would be viewed as wrong. This would be especially true if one accepts the idea of motherhood as an inalienable status from the moment of conception.

However, if the alternative is the death of the embryo/fetus, the wrong of ectogenesis in terms of fragmenting parenthood might be the lesser of two evils, as Singer and Wells suggest. But this kind of utilitarian weighing up of wrongs may not be acceptable from a Catholic perspective, even if the alternative is the death of the fetus. TontiFilippini argues that “[t]here is an obligation to save life, but not an obligation to save life by means that are themselves immoral.” Thus, if ectogenesis is deemed an immoral means of rescue, the fact that it can save a fetus’ life might not be enough to justify its use as an alternative to abortion (Tonti-Filippini 2003).

Part of the reason for this is the idea that as soon as a pregnancy is initiated, the woman has undergone an “ontological change” and her role is not just that of a life-support system for the embryo, but she is now a mother, which is a profound and identity-changing alteration in her life and cannot be thrown off or transferred (Tonti-Filippini 2003). Thus, there is a striking resonance between the empirical data presented in Cannold’s research and the Catholic perspective put forward by Tonti-Filippini. In both cases, there is an emphasis on the idea that motherhood is a moral status that is not transferrable or replaceable by purely physical interventions, nor can it be overriden by shifting the embryo/fetus from one location to another.

Ectogenesis As A Complete Alternative To Pregnancy

In addition to its potential as an alternative to abortion or an emergency measure to sustain premature fetuses, ectogenesis could function as a complete replacement for pregnancy. In this scenario, women would not need to undergo fetal removal: offspring could be conceived in vitro and brought to term without ever inhabiting a woman’s body. Widespread ectogenesis as an alternative to pregnancy and childbirth could beneﬁt women both physically and socioeconomically, as they would be freed of the unequal burdens of reproduction and of the negative impact of these burdens on other areas of their lives (Smajdor 2007).

However, when no longer construed as a lifesaving measure (as neonatal rescue or alternative to abortion), the potential harm to offspring associated with ectogenesis may assume a greater signiﬁcance. Ectogenesis also allows for state control and/or intervention in reproduction to a greater degree than hitherto and increases the potential for ecto-fetuses to be regarded as commodities or property. Additionally, the development of ectogenesis as an alternative to pregnancy might disadvantage those women who do wish to gestate and give birth to their own children.

Health And Gender Equality

Pregnancy and childbirth take a heavy toll on women. The necessary physical connection between women’s bodies and reproduction puts them at a disadvantage in comparison to men, who are able to reproduce without going through the risks and discomforts of childbirth. It also perpetuates a social expectation of women as the primary caregivers of offspring. Gender inequalities, such as the susceptibility to pregnancy, can be construed as natural injustices that might merit restitution in the way that blindness or disability does. Smajdor, for example, argues that ectogenesis should be prioritized as a means of rectifying the unequal distribution of health burdens that pregnancy and childbirth entail for women, since men can have genetically related children without undergoing the same risks (Smajdor 2007).

Ectogenesis has, however, been construed by some thinkers as an antifeminist prospect.

It might be feared that such beneﬁts as ectogenesis brings are of a speciﬁcally masculine sort: that in seeking ectogenesis as a means of equality, women would be in some senses seeking to become male, thus implicitly repudiating the intrinsic value of womanhood and of pregnancy and childbirth themselves. Alternatively, if gestation no longer required women’s bodies, perhaps women themselves would become obsolete, especially if ectogenesis is developed in an already patriarchal society. Another challenging prospect for advocates of speciﬁcally female interests in reproduction is the possibility of using ectogenetic techniques to initiate male pregnancies, either ectopically – on the liver, for example – or through womb transplants. This blurring of reproductive gender boundaries in reproduction is regarded as a threat by some feminists, who characterize it as the loss of a female domain to male control (Langford 2008).

Singer and Wells regard the idea that the value of women in society rests on their capacity to gestate children as unconvincing (Singer and Wells 1984). Nevertheless, once gestation and birth are dissociated from the female body, it seems likely that the balance between women’s and men’s reproductive power may shift in ways that could diminish rather than augmenting women’s reproductive autonomy. In the event of a dispute between prospective parents as to the destiny of an ecto-fetus, the woman would have no grounds on which to claim a greater interest. With ectogenesis, both genetic parents could be thought of as “fathers” and their rights over the ecto-fetus as equal (Brassington 2009). Carrying embryos or fetuses in her body gives a woman power that is lost when they are contained externally, meaning that in the case of a dispute, her wishes may be overridden. Yet if the primary goal is equality, this loss of one source of female power may be construed as acceptable collateral damage in the pursuit of gender-neutral reproduction.

Another concern is women’s ability to choose their preferred mode of reproduction in a society where ectogenesis is in common use. Singer and Wells argue that ectogenesis need not be compulsory and that individual women could determine whether or not it is appropriate for them. However, if ectogenesis were to become widely accepted, it might become unusual or even unacceptable for women to choose to gestate their own children. Employers would have an incentive to pressure female staff to use ectogenesis, since natural pregnancy would be far more costly in terms of maternity leave and possible health and medical problems (Gelfand 2006).

Risks To Offspring

Most of those who have written on the subject agree that ectogenesis should not be used until it has been shown to be reasonably safe. The experimental and uncertain nature of the technique means that offspring might lack some essential chemical or emotional requirement, and it would seem reckless to embark on ectogenetic projects before it is fully understood and its safety established (Singer and Wells 1984). Even if ectogenesis is achieved successfully in animals, there will be some uncertainty as to how it would work in humans. The ﬁrst attempts will be highly experimental, and although major anomalies may be obvious from the outset, it may take many years to establish whether lower-level and longer-term harm is associated with the technique.

However, Smajdor argues that the risks and experimental nature of ectogenesis are not sufﬁcient to demonstrate that it should not be pursued. She notes that many women and babies are currently harmed through the processes of natural gestation and childbirth which are not risk-free either. Moreover, she suggests that if ectogenesis were developed, this could beneﬁt fetuses who would otherwise die during complex deliveries or as a result of gestational problems such as preeclampsia. Because of this, from a veil of-ignorance perspective, decision-makers who did not know whether they would be incarnated male or female, or as embryos, fetuses, or adults, might have reason to prioritize ectogenesis despite the risks inherent in its developmental phase and even though they might themselves be subject to those risks as embryos or fetuses (Smajdor 2012).

It is also possible that ectogenesis might eventually be safer or, at any rate, more easily controllable than natural gestation. With a computeroperated ectogenetic environment, the levels of nutrients could be carefully monitored (Simonstein 2009). The fetus’ exposure to toxins and poor diet could be effectively circumvented (Gelfand 2006). Longer-term beneﬁts might follow: for example, the size of the human brain need no longer be constrained by the necessity of squeezing it through a woman’s pelvis at birth.

Yet if ectogenesis did prove safe in clinical terms, it would alter the relationship between mothers and their offspring in a profound way. If motherhood is deemed to start before birth, the gestational period is one in which mother and child are already in communication and are interdependent and during which their bond is already forming (Tonti-Filippini 2003). Even if ectogenesis causes no obvious direct harm, the environment of the ecto-fetus will not be completely identical with that of a naturally gestated fetus. The gestating woman’s movement, her voice, and her daily activity are all part of a normal fetus’ gestational experience (Langford 2008). It may be disturbing to think that a developing fetus is deprived of these experiences or that they are simulated by machinery.

Singer and Wells ask whether a woman who would consciously choose ectogenesis might lack some essential maternal quality. The discomfort, risks, and burdens of pregnancy are often accepted willingly and even welcomed by women as part of the transition to motherhood. Circumventing these necessary processes might in itself demonstrate a woman’s unsuitability to have a child (Singer and Wells 1984). If mother and child do not meet until after the “birth” and the mother has not undergone the physical demands of pregnancy, her role is not substantially different from that of a father.

Fathers can, of course, have close bonds with their children, as can adoptive parents (Smajdor 2007). From some perspectives, ectogenesis might improve maternal/fetal relationships. The burdens and investment involved in gestation can give women a sense of “ownership” of their offspring – a tendency which, it has been suggested, results in a pathologically distorted relationship between mother and child (Firestone 1970). Moreover, gestation itself is not an absolute guarantee of maternal bonding and can be associated with several factors that tend to disrupt mother/child bonding, such as postnatal depression, birth trauma, and stress. Accordingly, it seems that gestation is neither necessary nor sufﬁcient to guarantee parental bonding, though it forms a central part of what we tend to regard as essential to motherhood (Smajdor 2012).

Funding And Equity Issues

It seems likely that ectogenesis would be a complex and costly procedure. For this reason, the routine use of ectogenesis as a default alternative to either abortion or pregnancy would pose signiﬁcant economic challenges. If every fetus currently aborted were to be “saved” ectogenetically, this would impose costs on the state at several levels: ﬁrstly, the resources spent on removing the fetus; then maintaining the ecto-fetus during the gestational period itself; thirdly, providing the necessary care for it during childhood; and, ﬁnally, dealing with the population increase that would ensue.

And while ectogenesis might offer some improvements in gender and health inequalities between men and women, there are questions about how far its beneﬁts would reach across different societies and socioeconomic groups and whether it would be available only to those rich enough to pay large sums of money. Gelfand, however, takes the view that ectogenesis would in fact be cheaper than natural gestation/childbirth because the process of birth would be far simpler. He argues that many of the health costs expended on maternal and neonatal care, especially low birth weight and preterm deliveries, could be avoided if ectogenesis were routinely available. Gelfand’s argument might have some weight in countries with robust economies and sophisticated health services, where resources are available to spend on maternal care and the “rescue” of premature neonates. However, in countries where maternity care is very limited, complex births may be more likely to result in the death of the mother and/or the fetus than to be tackled with expensive healthcare resources. In such circumstances, ectogenesis would not offer any cost savings.

Eugenics

The ecto-fetus might become the focus of state interest to a greater degree than naturally gestating fetuses. Indeed, this is the primary reason for Haldane’s enthusiastic advocacy of the technique – and conversely for Huxley’s anxiety (Haldane 1923; Huxley 1973). Because of the necessity for third-party involvement throughout the ecto-gestational period, there is ample scope for the state to play a role in constraining parents’ choices, either through primary legislation or through regulation of clinics and health services. For example, if an ecto-fetus were found to be suffering from a serious disease, its termination could be brought about without infringing on the bodily integrity of any other individual. The balance of parents’ interests, especially those of the mother, would be dramatically altered.

If prospective parents wished to terminate an ecto-fetus, a pronatalist state might intervene to prevent this. Constraints could be placed on prospective parents to stipulate that certain gender ratios must be achieved or that certain modiﬁcations or enhancements must be undertaken. Access to reproduction might become contingent on parents’ willingness to fall in with state requirements. For many, this might seem a sinister prospect. But from the radical feminist perspective, steps toward the dissolution of the parental bond might be welcome, in repositioning offspring as belonging to society in general, rather than to their parents in particular, especially the mother (Firestone 1970).

Commodification Of Embryos And Fetuses

Ectogenesis would open a window into the processes of gestation and fetal development, allowing for new forms of research and intervention. This might change the way we look at fetuses: our relationship with them is profoundly different if they are visible, accessible, and disconnected with the mother’s body. The ability to create embryos outside the human body led to a recognition of their utility as research objects rather than to an urge to save each one as a valuable human life. This has had a signiﬁcant impact on the way that their moral status was perceived. The idea of a “spare” embryo came into being because of the practice of creating multiple embryos for IVF. Not all embryos were destined to be implanted; some were abandoned in clinics by parents with whom contact had been lost, and at the same time, researchers had a keen interest in gaining access to this new source of knowledge, hence the argument that these embryos would be “wasted” if not used for research.

Similarly, if human embryos and fetuses can be created and sustained entirely outside the body, their moral status is likely to come into question. Like the “spare” or “wasted” IVF embryo, the ecto-fetus is dissociated from the human body and its destiny subject to human control. It may seem sensible medically to create several ectofetuses for each reproductive project, in order to give the parents options or to insure against failures or accidents. Alternatively, “parents” of fetuses being gestated ectogenetically may lose interest in their reproductive project or perhaps run out of money to fund it and lose touch with the clinic where their ecto-fetus is being gestated.

It is easy to see the possibility that such ectofetuses would become the focus of research interest and that the same arguments could be applied as in the case of embryo research: if an abandoned fetus is destined for destruction, rather than reproduction, perhaps its potential for other forms of beneﬁt could be exploited. For some, this might seem precisely the kind of dystopian scenario that gives us reason to shun ectogenesis. However, Singer and Wells take an altogether more sanguine approach, suggesting that ecto-fetuses could be created speciﬁcally as commodities for the generation of tissues and organs for transplantation (Singer and Wells 1984).

Conclusion

If and when ectogenesis becomes a reality, it will fragment the biological processes of reproduction and force us to reconsider what we mean by motherhood. We will have to establish whether the fetus outside the body is a different moral entity from that within. Whether these challenges will prove beneﬁcial, either to women, offspring, or society more generally, remains a contentious question. The impact of ectogenesis will be shaped largely by the ethical, social, and political values of the societies in which it is practiced, and these may vary widely. It is therefore a mistake to suppose that the development of ectogenesis will in itself bring about a global revolution in attitudes toward women or toward abortion, for example. Yet the prospect of ectogenesis as a future possibility may help bioethicists and others to reexamine their assumptions about the moral value – if any – of human gestation and childbirth.

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