We may soon be able to make artificial wombs. For many, that prospect evokes images of fetuses developing in transparent chambers. Imagine a world where excited parents-to-be post images of their developing babies on social media sites. Today's ultrasound images would look primitive in comparison. To make it all happen, we just need to take a few more steps down the pathway to ectogenesis -- motherless pregnancy, maintenance of gestation outside the mother.
But how would this capability affect the societal and policy debates that currently surround human reproduction and our growing ability to control what used to be the realm of fertility gods? How will it play out between religious forces and the rapidly secularizing societies of the countries where the technology will first be used?
The answer is sure to be complex. But there's little reason to think our society won't struggle to find common ground on reproductive policies in the coming decades, just as it does today. It's a debate that's certain to be shaped by our world's religions, which lack a unified voice on the subject.
State of the technology
Current guidelines and rules over human embryo research are on a collision course with our expanding scientific capabilities -- specifically the ability to sustain a human embryo in vitro. A dozen nations, including the UK and Canada, forbid research on embryos older than 14 days of gestation, while others, including the US, have similar scientific guidelines. For decades, opposition to the rule was rendered moot by the fact that scientists had difficulty keeping an embryo alive for more than nine days. But that's changed, with researchers now pushing up against the 14-day limit.
These embryology developments may soon come into direct contact with other developments in the area of premature births, as researchers move slowly toward an artificial womb that would push the boundaries of viability outside the mother's body. A conflict seems inevitable between conservative religious groups and those who see these scientific advances as a way to further our understanding of medicine and human health.
In a groundbreaking paper in Nature Communications, researchers at the Children's Hospital of Philadelphia described their success in supporting fetal lambs for several weeks in a bag-like artificial womb. The limit on prematurity for the lambs in this system corresponds to a human fetus leaving the biological womb weeks before any human premature infant has ever survived. This is possible because the fetal lungs are bypassed, removing the need for critical ventilation. While not the intent of the research, the work has the potential to change the respiratory viability paradigm underlying policies connected with neonatal intervention, abortion and other issues related to pregnancy.
"Our goal is not to extend the current limits of viability, but rather to offer the potential for improved outcomes for those infants who are already being routinely resuscitated and cared for in neonatal intensive care units," the researchers wrote.
But just as incremental progress in neonatal ventilators effectively pushed back viability by a few weeks since the US Supreme Court's 1973 Roe v. Wade decision, the new technology could push viability even further. Ultimately, we appear to be headed toward a real artificial womb, enabling ectogenesis. And that could change how religious groups and other segments of society approach abortion rights and other matters related to human development.
On paper, an artificial womb appears ideal for resolving the abortion conflict. But even if we gain the ability to transfer and grow babies outside the maternal womb, there's no guarantee that some powerful religions would accept it as an option.
Speaking for the Catholic Church, Rev. Tadeusz Pacholczyk said he sees no major ethical concerns in the use of an artificial womb to treat a fetus delivered early because of medical necessity. When it's a matter of choice, the picture changes.
"An artificial womb, technically speaking, appears to constitute little more than a sophisticated incubator. However, in the absence of a proportionately serious threat to [the mother's] physical health, or the health of her unborn child, insisting on such a removal, even with the possibility of an artificial uterus to house the child afterwards, would be morally unjustifiable," Pacholczyk wrote in an email interview.
Pacholczyk, director of education at the The National Catholic Bioethics Center in Philadelphia, is a priest who also holds a Ph.D. in neuroscience from Yale University and has worked in molecular biology at Harvard Medical School. His objections to elective transfer of a fetus to an artificial womb are based partly on a expectation that it would likely be riskier to develop a fetus outside the mother. The discussion did not expand to the question of risky maternal behavior, such as smoking and drinking, and how that might make a machine mother the safer option.
Pacholczyk speaks for the Catholic view, but some conservative objections to the technology are certain to be based on religious beliefs centered around the idea that the embryo has the moral status of a person. There are many intermediate positions. Some Christian groups, for instance, generally discourage abortion and oppose creation of embryos specifically for research and treatments, but say "full speed ahead" when it comes to utilizing cryopreserved human embryos that were created in fertility clinics, and are either not viable or otherwise destined to be discarded. The part dealing with newly-created versus surplus embryos currently dominates policy in North America and other high-tech areas of the planet, where embryo research is underway
Some religions frame their embryo ethics discussions around the timing of "ensoulement" --infusion of an organism with a non-material entity called a soul. A gestational age of 14 days can be significant for those religions, because an embryo younger than 14 days can twin (split into two or more normal embryos) and thus become more than one person, while more than one embryo in that early period can fuse into one chimera. Twinning and fusion are not problematic for any religion that makes ensoulement the basis of personhood, yet also imagines ensoulment occurring many weeks, or months, into pregnancy. From such a standpoint, the period up to 14 days looks like a safe zone.
It is clear that Catholics, and least those who follow Church rulings, cannot be expected to change positions on abortion rights, even given the prospect of maintaining the fetus in an artificial womb after being removed. This prediction is based not only on how Catholic bioethics scholars, such as Pacholczyk, treat this issue specifically, but also on the overall attitude regarding reproduction, even extending to the treatment of gametes (eggs and sperm).
"Freezing [sic] embryonic humans is an objectively evil act, whether for space travel or for any other purposes," Pacholczyk said, when asked about the sci-fi idea of using an artificial womb to carry cryopreserved human embryos for space exploration. Nor would making gametes, rather than conceived embryos, the target of cryopreservation (meaning vitrification, solidification without crystal formation) change his position. "Freezing [sic] gametes for purposes of later doing in vitro fertilization [IVF] is also morally unacceptable," he said.
But he admitted that most other religions do not go as far. "The Catholic Church remains probably the lone voice in our world today stressing that IVF is always and without exception unethical as a freely chosen human activity."
Sensitivity to religious views often dominates discussions and stories bioethics. But given the potential of embryo technologies to conquer disease and improve neonatal viability, is society too concerned with the opinions of religious groups? Moreover, does honoring the beliefs of social conservatives effectively dismiss the beliefs of secular people and other religions who may be willing to accept an extension of the embryo research window in the pursuit of medical breakthroughs?
Perhaps, it is time to look primarily outside of religion for moral guidance.
Countering the views of of Catholicism and certain other branches of Christianity, is a secular-based ethical outlook that author and neuroscientist Sam Harris explained many years ago during a lecture at the Salk Institute:
It’s morally indefensible, given that these notions really are prolonging the scarcely endurable misery of tens of millions of human beings, and because of the respect we accord religious faith --not even just people of faith; even advocates of stem cell research accord this faith respect-- we can’t have this dialogue in the way that we should. I submit to you that if you think the interests of a blastocyst just may trump the interests of a little girl with spinal cord injuries, or a person with full-body burns, your moral intuitions have been obscured by religious metaphysics. And this is a kind of blindness that is very well subscribed in our society, and it's a blindness that goes by name of religious faith, and we have been cowed into respecting it.
It's not only a critique of the most conservative elements of our society, but also those in the middle. Presented with a chance to confront disease in a major way, the middle people could be the key to society warming up to embryo research. Religious groups hold great sway in our world. But when it comes to embryo research, we may be reaching a point where the majority opinion is effectively a secular one. There are enough religious people that view a human embryo -- be it 14 days old, 28 days, or older -- the same way that secular people views it, and this is the kind of trend that can lead society to embrace the artificial womb, when the technology is ready.