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Modern Moral Problems

Abortion & Artificial Wombs

Ji Young Lee and Andrea Bidoli discuss how artificial womb technology will shape the abortion rights discussion.

Abortion is the deliberate termination of a pregnancy. In current practice, this involves the death of the foetus. Consequently, the debate on whether those experiencing an unwanted pregnancy have the right to abortion is usually dichotomized as a matter of pro-choice versus pro-life. Pro-choice advocates maintain that abortion is acceptable under various circumstances. The idea that we ought to respect pregnant people’s rights to choose what to do with their bodies – respect for bodily autonomy – is cited as a major reason for granting them abortion rights. Pro-life advocates, on the other hand, claim that abortion is not acceptable under most circumstances. They argue, typically, that the foetus has a right to life. Recent events, such as Poland’s High Court decision in October 2020 to ban most abortions, and the huge protests and outcries this generated around the world, indicate that the abortion debate is far from resolved.

Cover art for Brave New World by Aldous Huxley (1932)

Artificial Womb Technology

Presently, most research on artificial womb technology is funded to tackle health complications caused by premature birth. But artificial womb technology may one day make gestation outside of human bodies possible. This will have radical implications for the abortion debate.

The notion of gestation within artificial wombs has been termed ‘ectogenesis’, from the Greek ecto (‘outer/outside’) and genesis (‘coming to life’). There are two possible routes of ectogenesis, which would lead to two different challenges for the abortion debate. Partial ectogenesis would involve the transfer of the foetus from a human uterus to an artificial womb at some point in a pregnancy. Full ectogenesis would instead involve the creation of the embryo in vitro and its direct placement in an artificial womb, therefore bypassing a human uterus completely. Research has been promising enough in recent years to expect partial ectogenesis in the relatively near future. Full ectogenesis, by contrast, may be possible only in the unforeseeable or far future. But both types of ectogenesis raise interesting issues worth talking about today.

Let’s first briefly consider what the general impact of ectogenesis might be for the controversies currently surrounding abortion matters. On the surface, the possibility of gestation outside of a human body appears rather promising for the abortion debate. By enabling people to avoid enduring an unwanted pregnancy whilst ensuring that foetuses can grow without having to compete against a person’s bodily rights, ectogenesis appears appealing to both the pro-choice and the pro-life factions of the dispute. Yet it is equally possible that ectogenesis might instead complicate the debate on abortion. The next sections will elaborate on these issues.

Partial Ectogenesis & Abortion Rights

Some claim that partial ectogenesis could resolve the abortion debate. Supporters of this view argue that once artificial gestation becomes technologically possible, the only morally acceptable way to meet abortion requests would be to extract the foetus from the pregnant woman and continue its gestation ex utero regardless of preference(s) of the potential parent(s). However, not everyone would agree that this is a morally satisfactory solution to the abortion issue, on account of the potential parent’s bodily autonomy. For instance, just as we might view a forced abortion as morally abhorrent, under the assumption that people ought not to be forced to have something done to their body that they do not want done, forced extractions would be equally subject to the charge of interfering with bodily autonomy. Thus, although the possibility to resort to artificial womb technology would be a significant addition to the choices offered to people considering an abortion, some may argue that this procedure – like any medical procedure – ought not to be imposed on them.

Even in the case that partial ectogenesis is voluntarily carried out, an interesting dispute arises on whether to class a foetus as born once out of the human womb, as premature babies currently are or whether it’s born only once the gestation (human or artificial) is complete. If the foetus is considered born at the time of the transfer process, it would be almost impossible to request the death of the foetus thereafter, no matter how early the extraction occurs, as it would automatically become a premature child. In this case, it seems that partial ectogenesis would terminate unwanted pregnancies, but fail to avoid bringing to life an unwanted child at any point post-extraction.

Some scholars have introduced alternative conceptualizations of human identity, which might perhaps be necessary in this scenario. In particular, Elizabeth Romanis has proposed that we consider “the subject of the process of gestation ex utero [as] a unique human entity: a ‘gestateling’, rather than a fetus or a newborn preterm neonate” (see ‘Artificial womb technology and the significance of birth: why gestatelings are not newborns (or fetuses)’, Journal of Medical Ethics, 45(11), 2019). Whatever we make of the metaphysical status of the foetus post-extraction in partial ectogenesis, the definitional boundaries – and so the justifiability or permissibility of abortion – remain contentious.

Full Ectogenesis & Abortion Rights

Full ectogenesis would have more radical implications on the abortion debate. This is because the focus would shift away from the issue of the right to bodily autonomy - which has thus far been the basis of many abortion laws - entirely onto the even more ethically controversial right to the death of the foetus.

Full ectogenesis challenges proponents of abortion rights to justify why termination of a foetus would be ethically permissible if the usual routes cited by pro-choice advocates – such as bodily autonomy – are no longer relevant. For instance, in her famous paper ‘A Defence of Abortion’ (1971), the philosopher Judith Jarvis Thomson argued in favour of the right to choose abortion when the issue is related to bodily autonomy, but against “the right to secure the death of the unborn child.” Some might intuitively feel that this question is doubly at issue in the full ectogenesis context, since, unlike in natural conception, full ectogenesis is in principle never accidental, but involves deliberate intent, and poses no health risk to the aspiring parent. Perhaps the most palatable options in the case that the aspiring parent(s) change their mind about having a child, then, is for them to relinquish any legal responsibility or right over the foetus; for the artificial womb to continue to be used to incubate the now legally parentless foetus; and for the resulting child to be put up for adoption once out of the artificial womb.

Although some believe that full ectogenesis would make termination of a foetus ethically unacceptable, others would argue that the boundary of reproductive choice for potential parents also includes the right to terminate the foetus even in this case. It may be therefore that a more comprehensive view of the ‘right to choose’ is called for. We might need to broaden peoples’ rights over their reproductive future in a way that includes the right for every individual to decide whether to become a parent. Such a right would capture the right to decide whether to become a parent at a particular time, with a particular partner, to a particular potential child. This right may be based on one’s rights to control one’s genetic material, or to privacy, for instance.

Suppose such a right to personal control over parenthood could be established. We might still encounter further, novel challenges, such as the need for all partners involved in the child-making process to have a say in termination rights of the foetus in question. It would no longer be the sole prerogative of the pregnant person to decide, since the pregnancy itself has been outsourced to an artificial womb.

On the face of it, this looks like a win for gender equality in reproductive rights: surely aspiring parents, rather than only potential parents, would have equal say in what happens to the foetus in the artificial womb. Yet even allowing this, difficult questions remain. Whose decision should be prioritized in case of disagreement? What ethical models would we use to adjudicate contrasting preferences? Up until what point in gestation should the parents be able to decide whether to terminate the foetus? As our reproductive possibilities and procedures change over time, we must be ready to address these kinds of questions.

Conclusion

The prospect of full ectogenesis may seem far off, the stuff of science fiction. However, the increasing potential of artificial womb technology compels us to consider new ethical terrains for future abortion debates. Ectogenesis can represent a promising new possibility. Yet, even the mere possibility reveals that sensible policies here will be critical to the future of abortion rights, and thereby to the ethical success of this technology. We should therefore rightly reflect on the moral and legal implications of these matters, and do so well before the possibility of ectogenesis becomes a reality.

J.Y. Lee is a postdoctoral researcher at the University of Copenhagen, working on the Velux-funded project ‘The Future of Family Relationships’. Andrea Bidoli is a PhD fellow in Bioethics at the University of Copenhagen. Her PhD project focuses on gender, parenthood and gestation.