Abortion and the Artificial Womb

This past week, scientists have shared that they have created the most successful artificial womb yet. Lambs have been born healthily after spending up to half of their gestation in a simulated uterus.  

For now, this technology is proving to be intriguingly successful in lambs. To keep hormones, temperature, oxygen, and other life-sustaining factors stable for humans will be quite a hurdle, but scientists and spectators are already hypothesizing about what this could mean farther down the line (specialists estimate testing this technology on humans would be about three years in the future). Artificial wombs could be of help not just with premature births on the cusp of viability, but perhaps even earlier. Perhaps, artificial wombs can be of use soon after conception, or are the next stage of development for so-called test tube babies. In that case, we could develop children without the need of a woman’s uterus altogether!

Putting aside this last thought, the possibility of relying on artificial means to bring fetuses to full viability raises direct questions in the debate about the morality of terminating pregnancies.

A major intuition behind the morality of abortion is that it would not be justified to terminate if the being in question would likely survive on its own outside of the womb. At some point, it makes more sense to extract or deliver rather than terminate, all things being equal to the woman’s body. This medical development is pushing earlier the point at which this assumption may make sense.

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In 1971, Judith Jarvis Thomson changed the debate surrounding abortion from attempting to articulate when human life gains the rights we typically grant adults with full capacities. Instead, she frames the question in terms of the rights and responsibilities of the person bearing the burden of pregnancy. In a series of thought experiments, she grants for argument’s sake that the fetus has the right to life, and presses on whether this should solve the debate over whether it is impermissible to terminate a pregnancy.

For example, would it be moral if we force you to remain medically “hooked up” to someone for nine months against your will?  If you were to wake up in bed with tubes going from your major organs to another person and were told it would be this way for nine months or the person would die, would it be impermissible for you to unplug yourself? Surely, remaining plugged in would be generous and kind, but it is less clear that it would be impermissible to refuse aid to this stranger.

In short, it isn’t clear that we are obligated to do everything in our power to ensure that others remain alive. Your right to bodily autonomy and to decide how your life goes is often seen as a moral trump card; the value of your autonomy is more important than the duties of beneficence towards others. If someone a plane ride away were to die if you did not lay your hand upon their shoulder, do they have a right to you hopping a plane and placing your hand upon their shoulder? It is a morally good thing to do, surely, to provide aid when you are in a special position to do so. But just when such moral goods translate to obligations is a thorny area.

Our intuitions about the morality of unplugging yourself in the above example may shift as the onerousness of the demand lessens. If, in order to save someone’s life, I need to dedicate nine months of my time and energy, it seems reasonable that my own demands trump such a commitment. However, if five minutes of my day is all that is needed to save someone’s life, relying on the relative strength of the principles of autonomy and beneficence can seem callous.

The possibility of an artificial womb may be just this sort of prospect, in theory – lessening the burden on the autonomy of the women in question. It will be more difficult to justify terminating pregnancies at earlier stages, because medicine can intervene and bring the pregnancy to term.

Considering just these moral values – the right of the woman to make choices about her body and her life, versus the moral demand of beneficence to help others – the artificial womb changes the stakes attached to each of these values.

It is important to note that 90% of terminations occur at 13 weeks of pregnancy or before, and currently the technology is aimed at 22-24 week premature fetuses, so it would take a great leap in technology to significantly change the burdens discussed here. Viability is not the standard in play for most terminations in practice. However, imagining what the debate would look like if the demands on the pregnant party’s autonomy were significantly lessened highlights the broader picture of reproductive morality.

Viability is intuitive as a cutoff because the fetus could exist outside of the womb, and so moral appeals to the right to bodily autonomy cease to have impact. One could say, just remove the pregnancy and attempt to bypass the thorny questions of when a fetus qualifies for the rights we grant adults with full capacities. (Does the developing human have value in virtue of the potential to become such an adult? Is it in virtue of species membership that the developing human has rights? Is there a biological marker like heartbeat, brain development, sensatory mark, etc. that it will gain rights? Problems abound with attempts to articulate such standards.)

Developments in medicine like this one put pressure on the rest of the picture behind terminating pregnancies – the rights and responsibilities involved in bringing more humans into the world. Unless the problem in question with avoiding having a child truly was a case of avoiding the pregnancy itself (as in medical complications with pregnancy, or tokophobia, say), artificial gestation doesn’t solve the problem with terminating pregnancy: the person who would be in charge of this creature is attempting to not have it. Medicine being able to bring in into the world anyways now opens up more questions, perhaps, but is a clear and helpful answer only when the parents are wanting to solve their parenting problems, as in the case of premature birth.

Keep in mind this isn’t a problem for those who consider terminating pregnancies to be morally unproblematic, who do not share Thomson’s argument’s assumption that all human life should be granted the rights we share with adults. However, if we maintain this assumption, as a significant portion of our society tends to believe, the possibility of technology that minimizes the burdens of pregnancy reshapes the morality of reproduction.

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If gestating humans have the moral standing of adults with full capacities, and pregnant women who would terminate upon finding out they were pregnant now could get the pregnancy “delivered” to a biobag for the same burden, where does that leave us?

There is a distinction between terminating and delivering to a biobag, even if both are equally physically demanding on the pregnant woman. In terminating, the woman has made a decision that is being carried out, whereas delivering to a biobag creates a prima facie obligation to rear a child. In our society, if you bear a child, it is assumed that you will bear the burdens of care for the child until it reaches adulthood. Of course, you can give up this obligation by withdrawing your guardianship and putting the child up for adoption, but by delivering, the person is put in the position to choose. An obligation is created that must be discharged either by raising a child or establishing alternative care by putting the delivered embryo/fetus up for adoption. It seems that the woman can be worse off by being put in that position.

With our current system, children are put up for adoption, most frequently during their early infancy. This medical development would open the possibility of giving up guardianship even earlier, and thus may increase the adoptable population. It also passes on a burden of medical care to bring the embryo or fetus to a point where it can exist on its own in the world.

The expense of bringing all terminated pregnancies to full-term, and the practicality of establishing alternative guardianship, would establish interesting norms were the technology to develop so that we could create an artificial environment into the first trimester, when 90% of terminations take place.

Our moral obligation to provide biobags to developing humans (under the Thomson assumption) would be the same obligation we have to provide life-saving medical care to other humans that have medical needs. Perhaps this isn’t a strong obligation – it could be a burden of beneficence, or it could be stronger – say, a matter of justice that the government owes its citizens.

With the development of medical technology so that the burdens of pregnancy may not have to be born by any individual person, it seems likely that the pressure to discuss what rights a developing human has will increase. The intuitiveness of what I have been calling the Thomson assumption – that unborn humans should be granted the rights we typically grant adults with full capacities – may break down when we consider the implications for the care or support this may obligate us to provide for embryos in the hypothetical future biobags. Or, perhaps this may seem like the natural thing to do for the next generation, and the complications that result in terms of expense and guardianship may be practical upshots of nevertheless moral demands.

With such practical questions at stake, more and more people may be asking why such energy and attention would be paid at different stages of development – what justifies granting standing to developing humans? The changing stages of viability thus puts pressure on us to establish, rather than allowing us to bypass the question of, standards for rights of developing humans.