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#16 Teresa Baron: The Artificial Womb on Trial
40 Plays1 month ago
Philosopher Teresa Baron joins us to discuss her book The Artificial Womb on Trial. As artificial womb technology edges closer to reality, Baron asks a different question: not just what ectogenesis means for society, but how we ethically get there. From human subject trials to questions of consent, regulation, and reproductive justice, this episode puts the development process itself under the bioethical microscope.
For more info, visit ethicscircle.org.
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Transcript
Introduction: Teresa Barron on Reproductive Ethics
00:00:16
Speaker
Hi, welcome to the iTech Podcast. This episode is with philosopher Teresa Barron on her new book, The Artificial Womb on Trial from Cambridge University Press. She specializes in reproductive ethics and the philosophy of parenthood.
00:00:28
Speaker
The book is open access free online, so be sure to check it out. Hope you enjoy the episode. Thanks for coming on, Teresa. Thanks for the invite. Great to be here. Your book is about ectogenesis, which is kind of like a science fiction-y idea.
00:00:43
Speaker
of developing a human embryo or maybe ah just the whole baby outside of a human womb. Yeah, so I mean, I guess, could you just tell us a little bit about, yeah, what is ectogenesis?
Historical Origins of Ectogenesis
00:00:56
Speaker
Well, i I guess you kind of got this the soundbite summary already by saying that it's ah development of the the human being outside of the womb from from start to finish.
00:01:07
Speaker
um And in terms of the history of this idea, We can as far back as Paracelsus, who i off the top of my head, I think was a sixteenth century writer.
00:01:19
Speaker
ah polymath. That's what we call people who who do everything. One of the things that he dabbled in was kind of biological theories. And he had this hypothesis that if you buried human sperm in a clay jar full of horse manure and fed it human blood, it would develop into this little homunculus.
00:01:42
Speaker
um And of course, you know, it's it's all hypothesis and there's no results. So I... It turns out that's not true. Yeah. Turns out that that that's not true, I guess. Well, I mean we don't know if he tried it or not, but probably not true. Yeah. So that's the kind of the earliest mention that we might find of something like ectogenesis in and of the literature.
00:02:05
Speaker
um But in terms of ectogenesis as a kind of more concrete scientific idea, it's something that we might see more of in the last couple hundred years and mostly in the realm of science fiction.
Ectogenesis: Mid-20th Century to Present
00:02:20
Speaker
um And it's only been since about the 1950s that scientists have actually been making genuine attempts to keep the fetus alive outside the womb. So the 50s saw and kind of the very earliest perfusion experiments, the kind of thing that you read and think, oh my God, research ethics really didn't exist back then. um And then, you know, this has been a very steady development over the last 70 years or so, leading to what we now have in terms of ah the ability to keep an existing fetus alive outside the womb.
00:02:55
Speaker
looking, of course, only at animal trials um when it comes to gestational development. But of course, the preterm baby we've managed to keep alive outside the womb for decades now and yeah with ah greater and greater success and sophistication at earlier and earlier stages of of gestation.
00:03:13
Speaker
So the key thing for ectogenesis is that it's the continued gestational development rather than mere survival. outside the womb. So without this transition to neonatal physiology that we have in premature delivery.
00:03:27
Speaker
um So in terms of where we're at with ectogenesis, we kind of have to split the picture into work at the end of gestation and at the beginning of gestation. We haven't kind of married those two together in the middle yet.
00:03:42
Speaker
um And one of the reasons for that is that most countries have very strict regulations on how long you can keep a human embryo in culture. ah So in a lot of countries, that limit is 14 days. You just can't keep it alive artificially ah longer than that.
00:03:57
Speaker
So at that point, you kind of have to stop baking your your cake. ah So the the much more extensive progress has been at the end of ah gestation, looking at how early scientists and and medics can intervene in a gestation to keep that fetus baking.
Partial vs. Full Ectogenesis
00:04:17
Speaker
the crucial like difference between like full, maybe, and partial ectogenesis. so like you know Somebody right now with, I guess, IVF technology could take an egg and a sperm and sort of artificially join them and they become zygote.
00:04:40
Speaker
And um so that's like the the really early stage and they can kind of do that artificially right now. They're capable of that first stage, I guess, artificially. but Yeah, i mean, i be it's been around for for the best part of a half century.
00:04:57
Speaker
yeah Yeah, this isn't this is the basic. Yeah, and so that would be like a kind of partial ectogenesis, I guess. Is that right? I mean, you wouldn't call that... Obviously, it's not full because it's not as though...
00:05:12
Speaker
It's going all nine months outside of a womb. But anyway, is that is that the right way of using the word partial ectogenesis or would that not even be be partial? So probably you wouldn't consider the process of conception to be part of...
00:05:26
Speaker
ectogenesis, at least not on on most people's accounts. And the reason for that is just that um most of the time when we talk about ectogenesis, we're talking about embryonic and fetal development. So we're assuming that there is already something that exists as a single entity that can be described as as developing. And when we talk about ectogenesis in this kind of context, we're talking about mammals where development outside the womb would be this you crazy and exciting thing. But of course, ectogenesis as a concept of development outside the body already exists across myriad species in reptiles and and fish and anything that develops in an egg.
00:06:04
Speaker
So, you know, if ah a reptile or a bird is developing in an egg, you know, we would think of that as, as ectogenesis, but that means that you need the egg. um you need the kind of the entity. but But to go back to your question about this partial versus full distinction, when we talk about full or complete exogenesis, what people usually have in mind is this idea that we could take an embryo, put it in an artificial womb system of some kind and develop it all the way to a full term baby, just you know basically the entire and complete process
00:06:37
Speaker
of embryo to to baby all outside of the womb. When we talk about partial ectogenesis or ectogestation, depending on which end of the gestational development spectrum we're looking at, we're talking about just a ah bit of that process.
00:06:53
Speaker
um So, for example, culturing an embryo in a Petri dish up to, you know, 11, 12, 13 days, that would be partial ectogenesis.
00:07:05
Speaker
um And then the kind of experiments ah being done using fetal sheep and goats to develop artificial womb and artificial amniac placenta systems. This is also partial ectogenesis or what I refer to as ectogestation, following some of the other scholars working with this vocabulary.
00:07:23
Speaker
um Okay, great. So um
Ethical and Societal Implications of Ectogenesis
00:07:25
Speaker
that's helpful. Okay. So now, I mean, let's just kind of get more into the philosophy side of things, right? So like what kind of philosophical questions, generally speaking, does ectogenesis bring up? And then, you know, maybe you can tell us more specifically about like what kind of philosophical question is kind of animating your ah particular book.
00:07:44
Speaker
Sure. Thank you. Uh, so in the kind of ah existing literature, uh, a lot of work on ectogenesis is, is occupied with the ethics of, uh, of using ectogenesis, uh, of how that kind of thing might be integrated into society of what norms and expectations might surround it.
00:08:05
Speaker
Um, and some of this literature, uh, particularly some ah literature from the 1970s where, ah you know, that this IVF had just been created. And so people's minds were really spiraling with the what reproductive technology might do next.
00:08:21
Speaker
um We can look at now and go, oh wow, well, that was a little bit... um out of left field. So for example, some ethicists hypothesizing, um and I have Singer and Wells in mind here, that we could potentially use ectogenesis to create a supply of um transplantable organs um by basically making fetuses with no brain stem so that we could harvest their organs and then, you know,
00:08:48
Speaker
bump them on to the next thing. um That's not been a popular idea really since then, but other other things, you know, other topics such as the impact of ectogenesis on abortion access, for example, on ah pressures on women, whether, you know, kind of positive or negative.
00:09:08
Speaker
Some people are arguing that ectogenesis would be the the real ah final blow to patriarchy, freeing women from the this unequal reproductive burden. Others saying, well, no, ectogenesis would just create even heavier pressures. We'd end up with ah the policing of women who choose to get pregnant and give birth naturally.
00:09:29
Speaker
um that there's you know These ideas have been explored in a lot of different directions. What struck me, though, and what kind of led me to ah develop the ideas in this book was that a lot of this literature really assumed a starting point of ectogenesis will be developed.
00:09:46
Speaker
And then what will we do with it? What ethical questions come out of that? What are the socio-political issues? What are the kind of issues for feminism? What would this do for medicine? Does it exacerbate the already unjust distribution of medical resources, etc.?
00:10:00
Speaker
But there was kind of this gap of, well, but we we aren't there yet. It has to be developed first. What are the ethical qualms and quandaries that come out of that? And there has been a little bit of work on that in the last sort of five years or so, ah maybe 10, but it's still been a question that falls very much below the rad radar for most people. um Partly, I guess, because...
00:10:27
Speaker
given the way in which reproductive technology and these kinds of interventions have progressed over the last 70 years or so, i guess since the birth of Louise Brown, we've just seen innovation after innovation after innovation. And the assumption perhaps is that's just going to keep going.
00:10:48
Speaker
ah why Why worry about the details of how it will be developed? Let's worry about what we should do to regulate it and make it safe and make sure that it doesn't exacerbate political inequalities and and so on.
00:11:00
Speaker
Perfect. Yeah. So you're kind of, yeah, you're thinking less about, okay, what are the ethical issues that arise once we have established, ectogenesis, complete ectogenesis, and you're thinking, actually, okay, there's a lot of ethical questions that come up when you're thinking about the actual development, the perfection of the technology that would be needed in order to do a complete ectogenesis. That basically... Exactly. right Okay, cool.
00:11:29
Speaker
Can you tell us what the convergence argument is and then maybe you know briefly your criticism of it? Yeah. Yeah, absolutely. So the convergence argument is the name, the shorthand that I gave to a group of ah hypotheses that I've seen put forward by maybe seven or eight ethicists working on ah this idea of of complete ectogenesis.
00:11:58
Speaker
And the thing that motivates the convergence argument, just to kind of take a step back a second, is this essentially... but generally accepted view that trying to just put an embryo in a prototype artificial womb and bake it all the way from start to finish to see what would come out and hope that it works would be unethical. This idea of creating kind of experimental children just for the purposes of scientific research
The Convergence Argument in Ectogenesis
00:12:24
Speaker
would not be okay.
00:12:26
Speaker
No one is trying to justify that, but then we need a workaround. So this convergence argument, which I've seen kind of repeated in different guises ah throughout the literature, is this idea, okay, well, we have current scientific research on the creation and development of embryos in vitro.
00:12:47
Speaker
Great. We already have independent ethical justifications for that. We also already have a relatively substantial ah research program in various countries working on creating artificial wombs for exogestation that would allow ah pregnancies in trouble to be essentially rescued. So the... the successor to the neonatal incubator would be some form of artificial womb from which, you know, within which a fetus that already exists in ah in a biological pregnancy can sort of continue um until full term.
00:13:25
Speaker
So we have an independent justification for that. We can say, well, that would be in the best interests of that fetus. We're not bringing someone into existence for the sake of scientific research. We are saving an existing person.
00:13:37
Speaker
Great. So an independent justification for that. Now, all we have to do is bridge the gap between those and say, well, we have these two areas of research, both independently ethically justified.
00:13:48
Speaker
And all we need to do is just expand the edges until they meet in the middle you know, go that 14-day limit ah to somewhere closer to maybe 12, 16, 20 weeks while pushing back on the border of viability using developments in ectogestation,
00:14:07
Speaker
And eventually they'll meet in the middle and voila, we will have complete ectogenesis. We'll have a way to ah take ah an embryo to two full term, entirely artificially outside the womb.
00:14:19
Speaker
Good for us, job well done. And we skipped that sticky ethical conundrum of experimental children. We're going to kind of get more into your criticism of it, but like like you said, you know it's supposed to be avoid the problem of creating human being just to test if they or survive and experimentation that way.
00:14:41
Speaker
It's supposed to avoid that problem. um I don't know if we want to, maybe we could talk about that, but people are normally just not ethically comfortable, um which is good with just, you know, taking an embryo and trying to do an artificial wound outside of it.
00:14:56
Speaker
And um it's kind of like intuitively plausible that it's totally wrong to do that because they would most likely not, these embryos would not survive, but, you know, at least initially, because we don't really have the technology worked out.
00:15:12
Speaker
And so if you're like a Kantian, you maybe you'd say like you're treating those initial embryos that are very unlikely to work out as like a means to learning something.
00:15:24
Speaker
You're not treating them as a end. So anyway, I mean, can you just talk a little bit about like basically why it's ethically wrong to... Absolutely. i I mean, I think it is striking that so the almost all of the scholars who have advocated for some version or other of the convergence argument don't even go into developing why it would be wrong or kind of ethically problematic to just shove an embryo into an artificial womb and see what happens. it it's it's almost so intuitive that they feel they don't need to explain why it's wrong. But I think instrumental instrumentalization plays a major role. It's this kind of idea. We know that when we try out new things scientifically, it never comes out perfect the first time. That's just not how scientific research works. These things take a long time to develop and be perfected.
00:16:13
Speaker
Even if you're really, really lucky and your methodology is spot on, you're almost, you know, it's almost impossible, but you will nail it the first time. So we would be going into this knowing that those first few embryos that were tested in this way would probably come out, you know, ah damaged in some way, might not survive to the full term, might suffer in various ways.
00:16:39
Speaker
And those would then be people brought into being, you know, for the sake of scientific progress rather than for their own sake or for the sake of parents you know, families trying to procreate. And unlike in is has been kind of the um get out clause for some forms of reproductive ah technology development, we can't appeal to the non-identity problem because we could in theory say, well, that embryo could have existed as a completely healthy fetus if developed in a biological womb.
00:17:10
Speaker
um And so the existence of that person doesn't depend on them being developed in ectogenic prototype. They, you know, that they um the harms that they're experiencing can't be explained away by appeal to non-identity.
00:17:25
Speaker
um Unlike, for example, and you know when when people talk about genetic modification or mitochondrial DNA donation, if we have an identity fixing intervention, um which you most interventions in DNA at the germline level are are pre supposed to be.
00:17:44
Speaker
then we can appeal to to non-identity and say that person could not have existed under other circumstances. So even if they experience certain kinds of harm as a result of their survival, then as long as their life is worth living, then they haven't been harmed.
00:17:59
Speaker
um Yeah. ah the the The problem for ah convergence argument proponents and the reason why we see these versions of the convergence argument is that we can't appeal to that.
00:18:11
Speaker
It just would be bringing an embryo to term under, you know, fully informed that we would be doing it under less than optimal conditions. And of course, you know, no, no biological pregnancy can be optimal either, but you know what I mean? You know, conditions that would be quite clearly, ah severely suboptimal for the sake of research.
00:18:36
Speaker
And if you take like maybe like a ah rights-based approach, you could even think maybe you know the the the embryo, if it were to be developed, it would never consent to being subjected to that kind of super unlikely.
00:18:51
Speaker
adam Yeah, I mean, this is this is the other problem. We already have incredibly strict ethical regulations for ah any kind of medical trial involving minors, involving children who can't consent to their participation in that research.
00:19:07
Speaker
um And this is on a you even a ah greater level. We're not just subjecting an existing person to research that they can't consent to, but we are bringing someone into existence under these conditions.
00:19:20
Speaker
um without, of course, being able to get that consent. Right. And then just, I mean, this might be obvious, but it may be worth mentioning that like, when it comes to the development, the perfection of, um, artificial wound technology, you know, some of that, um, is coming by the attempt to save preterm, uh, baby. So, you know, let's say, a baby is born at 32 weeks. Well, um,
00:19:51
Speaker
Obviously, if you put it in an artificial womb, I don't know about the technology, how good it is, but maybe that's unlikely for the preterm to survive if it's at 32 weeks in an artificial womb. But there, it's like you're trying to save it's clearly a medical intervention.
00:20:08
Speaker
it's clearly a medical intervention intervention the the the yeah, the baby already exists basically, and you're trying to save it at that point. And so the similar ethical problems, they don't rise, right?
00:20:24
Speaker
Well, at that point, so ah but first I'll pull the the context back a little bit.
Advancements in Neonatal Care
00:20:30
Speaker
32-week babies, absolutely no problem in the NICU these days. In a developed country, we're now looking at the the kind of the periviability zone, that this kind of gray zone where things get really sticky. We're actually looking at more like 22 to 26 weeks.
00:20:43
Speaker
We can save really, really teeny preterm babies now ah in some of the particularly advanced ah neonatal intensive care units in, for example, Germany, Japan, ah some in the US.
00:20:57
Speaker
ah We're looking at ah up to 50% survival rates for babies born as young as 20 weeks. And of course, ah that survival does come in something like a third to one half of cases with substantial comorbidities, but we can save their lives. you know this is this is We have come a long way since the first incubators.
00:21:19
Speaker
So just to contextualise, when we're talking about ectogestation, the kind of target clinical population would be super preemie babies at, you know, somewhere between 21 to 25 weeks estimated gestational age. So like 500 grams, you looking at a bag of sugar, basically might be even smaller than that.
00:21:41
Speaker
Um, And of course, yeah, you put it exactly right. This is a population where interventions at this point can be justified on the basis of a concrete individual's interests.
00:21:52
Speaker
And not just that baby's interest, of course, but there are in these situations existing parents who are you know desperate to save their um their child's life.
00:22:04
Speaker
So rather than bringing someone to into existence for the purpose of science, in theory, these interventions would be attempting to save a specific fetus slash neonate for the purpose of that fetus or neonate's life and of course their parents' and interests as well.
00:22:23
Speaker
So it's ah it's a massive kind of asymmetry in terms of justification for that experimental intervention. Perfect. Awesome. Okay, great. So now, um maybe before we get into the details of your kind of criticism of the convergence argument, um which again, it's this the attempt of the convergence argument is this is to show a way we can achieve full ectogenesis.
00:22:51
Speaker
but bypass the ethical problems related to exogenesis, especially the whole problem of like what you call like the experimental child problem, basically. Um, and, um,
00:23:03
Speaker
Anyway, so yeah, that' that's the idea of confirmed argument. So before we get to your like kind of some of the details of your criticism of that, you might want to talk about why would it be good, potentially? What are some reasons to be um excited by the prospect of ah ectogenesis? Why would it potentially be a good thing if we had full ectogenesis? And so one narrative you bring up is, or one line of thinking you bring up is like,
00:23:33
Speaker
you know Some people are kind of like, well, you know pregnancy and childbirth, it it's it's it's ah its <unk> a ah it can be a difficult experience, includes suffering for sure. And so um if we had artificial wombs, this would you know potentially reduce the amount of like suffering in the world, something like that. So anyway, can you kind of just like get into a little bit of that whole line of thinking? Sure.
00:23:58
Speaker
yeah Yeah, So, I mean, going back to, yeah complete etiogenesis. So this idea that we could just from start to finish create new humans entirely outside of the the biological womb, purely lab-based babies.
00:24:12
Speaker
Of course, one appeal of this idea for a lot of people is the idea that we we would never have to deal with pregnancy, childbirth, any of these associated things.
00:24:23
Speaker
uh, phenomena, including, you know, the ones that can last for your entire lifetime, ah ever again. we And when I say we, you know, of course we can imagine that the first rollout of exogenesis would probably not be to the entire world. It would probably be to some wealthy and quite privileged minority, but we can maybe imagine a world in which eventually, exogenesis could be available to everyone and no, no one would have to deal with the the kind of burdens involved in in pregnancy, childbirth, breastfeeding, anything like that ever again.
00:25:00
Speaker
and of course for for advocates for um this idea that the reproductive burden is a form of injustice or that it is a root cause of inequality, of ah ah patriarchy and so on, it's a really appealing idea. we can you solve all of the problems of the gender wage gap and and discrimination against women and all this kind of thing by just outsourcing the entire problem to machines.
00:25:29
Speaker
and And i can i can see the appeal, but the the the main problem I see with it is that unless we at the same time implement some kind of program where everyone has their gametes harvested at puberty and is then sterilized, we're still going to have pregnancies. In in some countries, we have ah nearly 50% of all pregnancies being unintentional, which is not to say that they're all unwanted accidents, but this does happen accidentally really quite a lot.
00:25:58
Speaker
so having access to complete ectogenesis wouldn't get rid of biological pregnancy and childbirth. And so the risk of leaning into ectogenesis as the kind of the cure for these systemic injustices or or kind of problems of patriarchy and misogyny is that we then just focus on creating ectogenesis and don't deal with those socio socio-political problems, which means that for the, you know, to be expected proportion of of people who still end up having babies the biological way, they will keep getting hammered by exactly those same problems in those systems.
00:26:35
Speaker
Uh, you know, not just talking about things like discrimination in the workplace, but widespread obstetric violence, uh, lack of access to to proper maternity care in in a lot of communities, the kind of things that make childbirth itself incredibly difficult unnecessarily.
00:26:52
Speaker
So I don't want to call this pie in the sky thinking, but it's certainly not the kind of solution that I would want people to be focusing on when it comes to, you know, the reproductive burden, the problem of patriarchy, all that kind of, all that jazz.
00:27:08
Speaker
Yeah. Okay. Yeah. and And so it seems like if you're really thinking this is going to solve like really large social problems, it seems like
00:27:23
Speaker
Uh, it would need to be more widespread and you're kind of saying like, in other words, the access to the complete ectogenesis would have to be like almost universal. And you're saying that is a really unlikely scenario. So that's kind of, that's kind of a, would you say that's a kind of key point?
00:27:39
Speaker
Um, Absolutely. Problem one would be access to ectogenesis and problem two would be that just having access to ectogenesis doesn't erase the problem of biological or quote unquote problem of biological pregnancy. And a lot of people would argue but that biological pregnancy and childbirth are not inherently problematic either. And that it's our kind of social approach to these phenomena that is the real root cause of inequalities and injustices.
00:28:09
Speaker
Okay, great. Here, one second. I'm going to pause. ah Okay, cool. and I mean, one thought I had was like, seems to me there's a whole problem with determining whether or not a dreadful or kind of negative experience is something that is ultimately expendable or you would want to expend. I guess what I'm thinking is that there there are a lot of cases where you'll have like a really difficult experience that includes suffering and you initially think like, gosh, I wish I just didn't have to do that.
00:28:46
Speaker
And then it turns out to be formative later. So like really dumb example that doesn't really compare to, uh, having a child of course is like, I was thinking of like, uh, with like working out or like with, um,
00:29:00
Speaker
Like for me, like, you know, with football, you had two a days. And so think these are like this really like arduous, difficult, like tons of practice and you and you feel terrible as it's happening. And if you asked me if I wanted to be in it, I would say no. But then like looking back, you're like, oh, that's actually like a really formative thing. And it was helpful. And I, and so I was thinking, you know, it's, I guess I don't know, like, I'm sure there's a lot of women who would elect you know, to, um, to do complete ectogenesis if they could.
00:29:35
Speaker
But I guess my thought is like, i guess, so yeah, I guess I kind of wonder about like some of them might after having going through a normal reproductive process might actually like have valued the experience, even though it included suffering. I don't know. Does this make some sense? What i'm trying to say here is like- I can see where you're coming from, but I would jump in and say that the range of childbirth experiences can go from, you know, something being painful and and hard work and a bit grueling, but ultimately forgotten.
00:30:13
Speaker
ah Because of course, many people have to forget the pain of childbirth in order to consider having another one. you that end of the spectrum all up to you know, seriously traumatic experiences at the other end. And there's a lot of things that can contribute to ah trauma in childbirth. Some of those things are, you know, the the actual ah pain and fear associated with the physiological experience, but a lot of it can also come down to phenomena like um violations of informed consent, obstetric abuse, bullying by healthcare providers, this kind of thing.
00:30:46
Speaker
um And just to put all of this in perspective, in low risk groups, we see up to four to five percent rates of PTSD postpartum ah in in women who've given birth and up to 18 percent ah ah rates of PTSD in high risk groups.
00:31:08
Speaker
um So, yeah. To compare, that you know depending on which country you look at, um veterans of the armed forces have 8% to sometimes 20% rates of PTSD, depending on you where where they were stationed and whether they saw active combat.
00:31:26
Speaker
I'm not sure that I would consider... PTSD from um active duty ah in Iraq or Afghanistan to be something that I'd call oh a transformative experience that you really benefit from. And I'd say the same about a you really traumatic childbirth experience.
00:31:43
Speaker
So I'm not sure that it's something I would say, oh but, you know, if women just experienced it, they would learn to appreciate the value of of that kind of epistemically transformative experience.
00:31:55
Speaker
yeah um But on the other hand, I think that if we look at it in terms of um, the kind of experiences that women report as, as really positive to them through pregnancy and childbirth are, for example, feeling that they create a bond with their child, that they feel the beginning of the parent-child relationship through gestation and the kind of intimacy involved in childbirth. I think that you we can find positive aspects of those experiences that could be lost ah if we moved to ah complete ectogenesis system. So I'm not sure I agree with where you went with that, but I think there's something to to that premise that there is something in natural ah pregnancy and childbirth that potentially we could lose by yeah giving this robots. Yeah. re book
00:32:42
Speaker
Yeah, I mean, it's tricky because, yeah, obviously it's like if you know in advance that this person's about to have the the the intensely traumatic version of the suffering, then, yeah, that that's one where you're like less likely to be like, okay, maybe it's transforming. Maybe there's like an ultimate value in it.
00:33:01
Speaker
Yeah. But yeah, was, but I mean, but it seems like there's going to be a lot of cases where there is suffering involved and it is painful, in, but, uh, maybe it's not to the level of, um, um, where it's so traumatic that it no longer has the potential for like a transformative or a formative, um,
00:33:25
Speaker
dimension to it. Um, but anyway anyway, yeah, that, that, I mean, that makes it makes total sense. and So it's really important to keep in mind just the degree of suffering and difficulty and pain that can, and potential trauma that can go along with, um, of the, the gestation, um, the normal, the form of development. Um, now, um, you know, another rationale you kind of bring up for ectogenesis, um,
00:33:53
Speaker
is that it could also, I mean, I guess this is already kind of connected to the last one, but like kind of reducing burdens associated with reproduction in a sort of patriarchal context. Do you want to comment on that as well, potentially? Sure. Yeah, this has definitely been something that's been raised by some proponents of complete ectogestation, not just in terms of reducing the uh, general inequality between men and women, but also by reducing inequalities, uh, across different kinds of, uh, pairings, you know, between, ah gay men, lesbian couples, uh, single people trying to have a baby there. There's ah a vast range of different potential family configurations and a vast disparity between the ways in which those couples can access
00:34:43
Speaker
reproduction So it's been argued, for example, that ah complete ectogenesis would open up new opportunities for ah gay male couples, ah single men, gay you know, ah other other gendered couples in which neither party have a womb or where, you know the person with a womb has a fertility problem and can't carry to term.
00:35:06
Speaker
These are, you know, family orientations that currently are limited to adoption or surrogacy if they want to start a family and surrogacy in most countries is either...
00:35:20
Speaker
deeply legally sticky, ethically problematic, or just completely financially inaccessible to the vast majority of people. So there's a lot of constraints currently on who can start a family and in what way. And of course, even though there has been a lot of criticism of the kind of biological imperative and the idea that genetic reproduction or biological reproduction should be the gold standard for family making, there is still a very deeply entrenched cultural drive towards biological reproduction as the kind of ultimate and and gold standard form of family making. So it has been argued that complete ectogenesis would
00:35:59
Speaker
level the playing field in this sense by allowing everyone equal access to but potentially a genetically related child, but without needing recourse to either a partner with a womb or, ah you know, the availability to outsource ah to um a surrogate.
00:36:18
Speaker
um There are, of course, kind of responses to that that appeal to exactly the criticism I just mentioned of this idea that this just fuels additionally and reinforces existing geneticism and pronatalism at the expense of fostering and adoption, that it potentially will also kind of and create ah an increased market problem in terms of ah supply and demand for ah biological surrogacy.
00:36:53
Speaker
It's even been posited that as soon as ectogenesis became accessible and available to enough people, that it was you know the option for the masses, that demand for biological organic surrogacy would come back into fashion for wealthy elites, that we would end up with this bizarre circular system in which ah norms of reproduction also had fashionable sort of trends that cycled backwards and forwards, ah leaving everyone still sort of at the mercy of these
00:37:24
Speaker
bizarre market forces um and the push to try and break away from norms governing what counts as a family what counts as family making should also drive us to be at the very least skeptical of these motivations for complete ectogenesis great okay awesome so um i don't know if you unless there's any other um justification or reason you want to put down, I mean I guess we can kind of move more toward the kind of key ah point of your book, um really the really exciting part of it, which is the criticism of the convergent argument that we mentioned earlier.
00:38:08
Speaker
And so, I mean, just in general, it seems like people have been focusing on the potential application. We talked about this earlier, but the people have been focusing about potential applications of um, ectogenesis and they've been a little bit less to focus on the ethics associated with the development of the technology. And, um, and, and so you're kind of going to focus on that side of the development and, and you kind of point out that the convergence argument, which again, is that the idea that we're going to get complete ectogenesis by the convergence of different research areas. So like the, the, I guess the kind of more like IVF early, um,
00:38:49
Speaker
early stage research and then the later stage research that's kind of coming from, ah helping preterm, uh, babies. And we're going convergence of that and then ultimately get the perfected, uh, technology. And, and you kind of point out that this argument has like three ah various assumptions built into it Maybe we could go through those. Um, um,
00:39:14
Speaker
And I mean, I think the first one is that, you know, we are able to grow embryos outside the body up to a certain age. But any anyway, yeah, do you want to kind of delve into this idea of the different presuppositions built into the convergence argument. Sure. I mean, one of them is just the the very...
00:39:33
Speaker
ah basic biological or scientific presupposition that we will be able get both strands of research to a point where they could comfortably converge and either that means that we bring interventions in existing pregnancies back you know to to the point of mere weeks into pregnancy you know to say that we would be saving existing fetuses uh at earlier and earlier and earlier gestational ages on the kind of ectogestation end, or that we would be developing embryos and eventually fetuses in vitro,
00:40:10
Speaker
later and later and later. And even if we were to meet those in the middle, that would still mean either that we are developing embryos slash fetuses way past the point we currently think is ethically acceptable or is even legal in most countries, or that we would for some reason be removing fetuses from the womb and placing them in ectogestation systems well be like before the point we would have a biological reason to do so. We're well before the point where we would, for example, be able to screen for abnormalities or consider the the pregnancy to be in danger.
00:40:49
Speaker
ah so one of the, one of these directions at the very least is very suspect in terms of the, the scientific presuppositions involved.
00:41:01
Speaker
um and um sorry Oh, sorry. Yeah, I was just, yeah, that's, so it's like they need there to be a bridge between these kind of two sides. They need the, bridge there needs to be a bridge between the embryo research and the preterm fetus research.
00:41:18
Speaker
And the thing is that, ah yeah, like can you talk a little bit about the whole point, the point you just made where it's like the the medical justification of removing a fetus.
00:41:33
Speaker
um You know, maybe you might remove it in virtue of perceiving abnormalities or predicting abnormalities. I'm not sure exactly, but That perception, the knowledge of, okay, there's there's there's medical reason to take the fetus out and to put it in an artificial womb.
00:41:54
Speaker
That perception or that knowledge can only be gained at a later stage than would be necessary. Could you go kind of go into that? really brief I'm sorry. I hope I... Yeah, of course. So just to kind of clarify this a little, currently, you know, this clinical population that would be targets for human trials of ectogestation are preterm baby or or fetuses at risk of extremely preterm ah delivery.
00:42:23
Speaker
And some of the indications for that ah that preterm delivery might be a condition in the mother, um, placenta previa, for example, or, um, very high blood pressure, preeclampsia, um, or the need for her to take certain kinds of medication for her own treatment and and wellbeing.
00:42:44
Speaker
Um, or it might be, ah you know, a problem with the the fetus sudden, uh, you know, dropping of heart rate, for example, or, you know, or potentially the kind of, uh,
00:42:59
Speaker
disability that would be fixable or could ah be attempted to be fixable with fetal surgery. And you know one of the arguments for ectogestation is that it would allow access to the fetus for this kind of surgery ah without having to then use the mother's body as a kind of post-operative environment for the fetus. So this kind of range of of different reasons, we might think, okay, this fetus is a candidate for experimental ectogestation.
00:43:29
Speaker
um We're not going to see many of those reasons in the vast majority of pregnancies before the 20-week scan. um And it's incredibly unlikely that at the 12-week scan, you would be able to see ah clear indication that this pregnancy is at risk of extremely pre-term delivery.
00:43:48
Speaker
In some cases, maybe, but in most cases, almost certainly not. And this is even assuming that we would be able to support a 12-week fetus on an ectogestation system, which, as I kind of explain in in a bit more detail in the book, just is ah beyond impossible with the current systems and resources available to us in terms of and the size of catheters that we can use um to to um and to cannulate the umbilical vein, for example, we we're talking incredibly, incredibly tiny veins in ah in a fetus that small. So, you know, even assuming that we could identify a reason to think, okay, this fetus is at risk, there's no saying that we could actually support that fetus outside the womb. So another reason to think that just going backwards increasingly to the point where we can converge with embryonic research is a bizarre pipe dream.
00:44:46
Speaker
Yeah, yeah. Especially given the fact that there's the 14-day limit, 14-day rule ah for embryo embryo research. Could you maybe to talk a little bit about that for those who aren't?
00:45:00
Speaker
Yeah, absolutely. um This is a limit on how long and a human embryo can be cultured outside of the womb for the purpose of scientific research.
00:45:10
Speaker
And at the time at which this limit was put in place, ah you know science was nowhere near being able to culture embryos to 14 days. So it's only in ah the last few years that scientists have actually reached that that point, you know just just short of the limit coming just to the wire and going, okay, well, maybe we could go longer, but we legally aren't allowed to. And and as a result, some people are saying, well, we should revisit the limit.
00:45:35
Speaker
We just put it there because we didn't think anyone would get to that point. um Of course, that's not the entire reason it was set at 14 days. But one of the the the reasons for this ah ah contributing factor certainly is that no one thought we would get there anytime soon. But we are there now. And the question is, do we extend this?
00:45:55
Speaker
just because now science can do this? Is that a weird way to to change the limits on scientific research? This is very much an ongoing debate. And since most countries that have a limit on embryonic research have set it at that same point, it's very much a global debate.
00:46:14
Speaker
Right. Now, um I guess there's like, occurs to me, like, you know, someone, there might be, what, are there any, is there anyone who's like, yeah, you know, that's right, the 14-day is in place and maybe it's very unlikely that it will be removed.
00:46:29
Speaker
But ah there is anyone who says, you know, but I actually think that it would be ethical, it wouldn't be unethical to violate the 14-day rule? I guess my question is like, do you think it's... um ethically wrong to go past the 14-day rule, not just in terms of a legal sense, but just let's suppose it wasn't a legal rule.
00:46:49
Speaker
ah Would you say, yeah, just ethically speaking, researching beyond that is ethically ah wrong? I guess that's that's kind of more. Yeah, I see what you mean.
00:47:00
Speaker
Personally, I'm not from an ethical standpoint, wedded to 14 days. I don't think that there's any ethical reason for it to be specifically 14 days rather than 13 or 15 or 16. One of the reasons that's been cited as a kind of ah justification for 14 days specifically is because this is the point at which gastrulation occurs, which is the point beyond which the embryo cannot split into twins. And so it's been sized by some as the the point at which the embryo becomes a numerically ah it it achieves numerical identity, becomes an entity that can't become more entities.
00:47:41
Speaker
um But from biological standpoint, gastrulation is as crucial as any other stage of development. There's no reason specifically to say this one is crucial for this ah fetus to develop more ah more significant than any other stage.
00:47:55
Speaker
The thing that I would sort of appeal to in terms of ah ethical reasons to set a limit somewhere and maybe to to guide where that limit should be set is that in order to have ethical research on humans, including ah human materials,
00:48:15
Speaker
um you need to have a really good reason for doing that. We have much higher standards for ah scientific research on human embryos than we do for on mo mouse embryos or dog embryos.
00:48:28
Speaker
um And it's not because embryos are people per se, but just because we have a very strong... ah ethical stance shared by society, politicians, the scientific community, that this is special in some way, if for no other reason than that it's actually really difficult to get eggs to make these embryos. It's a very laborious process for women to donate their eggs to science. And so we should respect that.
00:48:54
Speaker
and if if for noah And of course, there are other reasons also to to respect ah human embryos in scientific research. So we need a good reason to use them. And the question is, what are we learning if we can culture embryos in in vitro for a a longer time? What are we learning about them? What can that tell us about human development?
00:49:15
Speaker
And what can it tell us about human development that is actually applicable to gestational development? Because of course, we can't always expect embryos to behave in a petri dish the way that they're going to behave in a womb. So there's already, you know, the longer we culture embryos in vitro, the less Potentially, there is that we can generalize that you can create knowledge that is useful for, for example, ah treating the causes of early miscarriage, for example.
00:49:42
Speaker
The other issue is that without a synthetic placenta, eventually you're not you're not going to have um any structure for that embryo to develop on. it can't stay alive in a petri dish and definitely that's not the environment in which an embryo will develop.
00:49:59
Speaker
um And, you know, this becomes even more complicated when we are talking about the early fetus, which, again, you know, are we going to create a synthetic placenta and amniotic sac and, you know, all of the other biological infrastructure that ah of an early fetus normally would have around it and and be developing within and through in the womb? um the These are all kind of questions that From a practical and an ethical perspective, I think we would need to answer, you know, what is the point of extending this kind of research further and further? You know, the convergence argument advocates assume that we will have an ethical justification for continuing that research and expanding it to the point of convergence. But actually, I think this is the kind of research where you're not always going have the same
00:50:47
Speaker
ethical justification ah all the way through. i don't think that the same justifications, for example, will apply to culturing an embryo to study it from days eight 10, as you might to say, all right, well, we just want to see if we can keep it alive to week four.
00:51:05
Speaker
This is a different kind of science, a different kind of aim. And so I think it would need to be really carefully scrutinized at each point to see, you know, it's not just about an arbitrary dateline, but about the reason behind the research and what it is that we can actually learn from Right. um Do you want to comment maybe more about the placenta problem? It seems like, I don't know, is this right to say that like when it comes to artificial, you know, full ectogenesis, creation of an artificial placenta is maybe one of the primary obstacles? Is that correct? like Is that one of the more difficult?
00:51:44
Speaker
I'd say it's a pretty substantial one. Yeah, absolutely. Especially because the kinds of systems that are being developed, at the other end of of gestation. So artificial womb and artificial amnion and placenta.
Challenges in Creating an Artificial Placenta
00:51:57
Speaker
um These are not, despite the name, they're not actually creating an artificial placenta.
00:52:02
Speaker
They're creating ah different kinds of closed fluid systems that would allow the fetus to kind of stay ah with the lungs submerged in fluid and that would use ah various different kinds of techniques to oxygenate the blood and and keep it moving properly.
00:52:20
Speaker
through the fetal body. Um, and of course there are all sorts of concomitant problems, like the fact that, uh, the, the kinds of cannulas that we might be using in that kind of system will not grow naturally as the fetus grows. That's a, that's a whole other issue. But the thing is, if we were to kind of keep going backwards with this kind of system and then converge with whatever is coming up the other side, ah what's coming up the other side would presumably for it to get far enough up, up the other side of the hill to converge with ectogestation research would have to, at some point have developed an artificial placenta for the fetus to grow in and through.
00:53:02
Speaker
and the, the biological placenta is something that is grown out of the both fetal tissue and maternal tissue is a completely shared organ. um and so when ah When you give birth, it literally leaves a wound that that organ kind of rips apart and and or rips away from from the womb and leaves a big old hole there, um which is why the the womb has to contract very, very fast after you birth so you don't bleed to death.
00:53:32
Speaker
um if we're saying, okay, well, we've managed to construct something synthetic that the fetus can can sort of latch into and grow its half of the placenta into that so that it can develop normally, what are we going to do when we get up the hill?
00:53:47
Speaker
Are we going to detach the fetus from that placenta to hook it up then to... the ectogestation system, or are we going to try and somehow design that placenta in a way that it can be transferred into the system?
00:53:59
Speaker
We have this, you know, it's now a two placenta problem, one artificial placenta and one very, very artificial placenta with no means of kind of combining them or ethically detaching one to hook it up to the other. If we were to bring ah that kind of early fetal research up the hill towards convergence on this artificial placenta,
00:54:22
Speaker
The only purpose behind that kind of research would be to try and get it to the convergence stage, which would already be the first step towards exactly the problem the convergence argument is meant to avoid, which is the experimental child.
00:54:35
Speaker
Right, and that that's the basic kind of... would I be correct to basically describe, you know, your criticism is that there's no way for the convergence argument to really escape the experimental child problem.
00:54:47
Speaker
Uh, when you really get into the scientific kind of details, uh, you realize that there's just not a plausible route by which it could converge, uh, without, um, running into the experimental child problem, which is, I guess it's just the problem of, uh, uh,
00:55:06
Speaker
working with embryos for the sake of just advancing the science? Is that basically like, we're just we're just doing this to to learn more, to to to to increase our scientific knowledge? Is that... um Yeah, essentially, not well not so much working with embryos, because that would, of course, exclude all of the early embryonic research that is currently now, but this idea of ah bringing an embryo to full gestational development to show that we can. Yeah, right.
00:55:38
Speaker
Okay, good. And so just real quick, could you just talk about why like someone might think, oh, but what about like maybe we do some stuff with animals, other animals besides humans, and ah we improve the technology that way, and we kind of like then apply it to humans? what's the What's the issue with that kind of angle?
00:55:56
Speaker
Yeah. Yeah, well, so that is the approach that's currently being taken. um And, you know, there are completely separate issues for ectogestation science and whether we will be able to, but say we, whether scientists working on these research programs will be able to safely and ethically translate the animal trials that are taking place to human subject trials at some point, maybe in the next five, 10 years.
00:56:22
Speaker
There are questions there about how, at what point do we know whether the animal trial data provides a genuine clinical basis for experimental ectogestation How would we identify an appropriate ah experimental population? These would be the fetuses of parents who had just been told that their ah pregnancy is a ah high risk of ah preterm delivery and yeah offered, well, we can either try the NICU or this experimental technology.
00:56:51
Speaker
This is probably not ideal conditions for informed consent and so on and so on. So there's there's already some kind of ethical questions that need to be addressed there. But regardless of what we manage to do with animal systems and how that might set us up to achieve human exogestation at this kind of the the back end of of pregnancy, it still doesn't resolve the issue of how we then converge.
00:57:13
Speaker
how How do we bridge that gap from one kind of research to a completely different kind of research unless we orient both sets of of both both of those research programs with the design in mind that they will be you know at some point converging, that they will be trying transferable, that we can make them meet in the middle, at which point we have to admit that we weren't just coincidentally converging on independent lines of research, but that the whole time we were trying to create complete ectogenesis.
00:57:45
Speaker
Do you want to make any last comments on your criticism here of the convergence argument? and mean Oh, well, if I give you too many comments, then people might not read the book. So instead, I'm just going to say, please read the book. It's available open access for free from the Cambridge University Press website. so please download yourself a PDF today.
00:58:05
Speaker
Yeah, absolutely. Yeah, I highly recommend the book. yeah It's a really, it's very well written as well. I have to say, ah not only the argument, is I think is really strong, ah but yeah, also very well written and in So just to close off the discussion, would you mind telling anything you're working on now? I'm just kind of curious like what you're up to now in terms of your philosophy and that stuff.
00:58:28
Speaker
Sure, absolutely. i ah Partly because of the kinds of literature that I came across while I was writing this artificial womb on trial, um I have really been delving into the periviability literature and the kind of ethics of decision making for extremely preterm babies, and you know this time focusing really on the NICU and the obstetrics ward rather than the kind of potential near future, near far, we don't know, sci-fi future of experimental ectogestation, but now really the more day-to-day, very current dilemmas faced by parents and healthcare care providers when trying to make decisions in the face of chronic uncertainty over how a really preemie baby is going to cope with different kinds of treatments.