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August 13, 2003

Fake uterus

TNR has a subscription-only article on the development of an artificial uterus. It is discussed in the context of abortion rights, which I found rather uninteresting, but check this out:

But Liu has said she hopes to "create complete artificial wombs using these techniques in a few years"--although, given current IVF and stem-cell laws, it is not yet clear whether she will be able to continue her work in the United States.

I wonder what country Dr. Liu will continue the research in. The article gives 5 years as a possible date when artificial wombs become viable.

(Full article below)

Fetal Position
by Sacha Zimmerman
Post date: 08.13.03
Issue date: 08.18.03

ack in January, the abortion rights group naral Pro-Choice America held a dinner in Washington to commemorate the thirtieth anniversary of the Roe v. Wade Supreme Court decision. But the event was far from celebratory, with speaker after speaker warning that a woman's right to choose was in grave danger. "For the first time since Roe v. Wade, anti-choice politicians control the presidency and both houses of Congress," naral Pro-Choice America President Kate Michelman warned in a typical speech. "The Supreme Court is one vote away from dismantling the right to choose." At a rally the next day, the group's legal director, Elizabeth Cavendish, declared, "A woman's right to choose is imperiled."

But, however serious the political threat to Roe, Michelman and Cavendish are missing a technological threat that could be greater still: ectogenesis. Better known as the artificial womb, ectogenesis is the process by which a fetus gestates in an environment external to the mother. And, while it may sound like the stuff of science fiction--evoking images of the "decanted infants" in Aldous Huxley's Brave New World--researchers estimate that ectogenesis could be a reality within five years.

If and when that happens, the legal and philosophical premises underpinning Roe could be completely dismantled. Which is why some pro-lifers are eagerly awaiting that day. And why it is so surprising that pro-choice activists appear to have given little or no thought to the brave new world that could be right around the corner.

ctogenesis is close to becoming a reality because scientists are steadily advancing reproductive technology at both ends of gestation. At one end, to help women who are having difficulty conceiving or who have defective wombs, Cornell University's Dr. Hung-Ching Liu has taken steps toward developing an artificial womb by removing cells from the lining of a woman's womb and then, using hormones, growing layers of these cells on a model of a uterus. The model eventually dissolves, leaving a new, artificial womb that continues to thrive. What's more, Liu's team found that, within days of being placed in the new womb, embryos will attach themselves to its walls and begin to grow. At that point, scientists must end the experiment to comply with in-vitro fertilization (IVF) laws, so researchers do not yet know how long after the beginning stages of gestation this artificial womb would be viable. But Liu has said she hopes to "create complete artificial wombs using these techniques in a few years"--although, given current IVF and stem-cell laws, it is not yet clear whether she will be able to continue her work in the United States.

Meanwhile, at the other end of gestation, Temple University's Dr. Thomas Schaffer is trying to save premature babies by using a synthetic amniotic fluid. He developed a breathable liquid made of perfluorocarbons--liquids that carry more oxygen than air--and has successfully tested the fluid on premature lamb fetuses not yet capable of breathing air. Schaffer says that the only reason he isn't using the technique on human beings right now is a lack of funding. "We have babies that are six hundred grams [21.9 ounces], born on a toilet, brought to a nicu [neonatal intensive care unit], and survive," he says. "Now [with perfluorocarbons] we can take care of these children."

In Japan, Dr. Yoshinori Kuwabara, a professor of obstetrics at Juntendo University, has actually created an artificial womb, using an acrylic tank filled with a fluid similar to Schaffer's amniotic fluid and attached to a machine that acts as a placenta to bring oxygen and nutrients to the fetus. Kuwabara has successfully delivered goats from this artificial womb after just three weeks of gestation--the equivalent of one human trimester. Kuwabara says that, with enough funding, his ectogenetic chamber could be ready to use on a human fetus within five years.

While these scientists have no political agenda, the same can't be said for one of the earliest advocates of ectogenesis, Dr. William Cooper. In 1993, Cooper, then head of the Christian Fertility Institute, patented a "placental chamber," in which the fetus would gestate at the bottom of a tank and the placenta would rest on a shelf at the top. Cooper's invention went nowhere--today's advances toward ectogenesis owe nothing to the "placental chamber"--but his motivations for devising it are instructive: He hoped it would undermine Roe v. Wade.

Roe v. Wade, after all, is predicated on two basic ideas: a woman's right to privacy (including the right not to be pregnant) and the viability of the fetus--defined as the ability to survive outside the mother's womb, currently placed at 24 weeks of gestation. Complete ectogenesis could dismantle both of these premises. First, it could make Roe's viability issue moot, since with ectogenesis a fetus could be technically viable outside the mother's womb from the moment of conception.

Which would surely impact the other idea underpinning Roe: a woman's right to privacy. With ectogenesis, an unwanted fetus, rather than being aborted, could be removed from a woman and placed in an ectogenetic chamber to be adopted later; the woman's right to privacy would arguably not be invaded, since removal of the fetus for implantation in an artificial womb need not be any more invasive than the abortion she was originally seeking. As bioethicists Peter Singer and Deane Wells write of ectogenesis in their book Making Babies: The New Science and Ethics of Conception, "Freedom to choose what is to happen to one's body is one thing; freedom to insist on the death of a being that is capable of living outside of one's body is another."

Although many right-to-lifers are skeptical of reproductive technology in general and view ectogenesis as an unnatural and dehumanizing possibility, others recognize that it could radically alter the abortion debate. "Roe v. Wade should be repealed anyway," says Dr. W. David Hager, an obstetrician-gynecologist and professor at the University of Kentucky School of Medicine who currently serves as head of the Bush administration's Reproductive Health Drugs Advisory Committee. "But, if we had the technology to be able to placentize or incubate in a placental environment, then I would say that would be an argument in favor of repeal."

Other pro-life activists believe ectogenesis could change public attitudes about abortion in much the way The Silent Scream--the film, taken with a sonogram, that graphically documents the abortion process from extraction to destruction--did after its 1984 release. In his book, The Hand of God, Dr. Bernard Nathanson, the former abortion doctor turned pro-life activist who filmed The Silent Scream, writes of the "enormous threat to abortion forces" that the film precipitated due to its powerful imagery. Nathanson hopes that an acrylic ectogenetic chamber, containing a month-old fetus, could act as a similar visual aid. "If [the fetus is] viable from ten weeks on," he says, "you've destroyed Roe v. Wade. It collapses."

ut, while some pro-lifers have begun grappling with this possibility, not one of the five major pro-choice organizations I contacted--Planned Parenthood, the Center for Reproductive Rights, the National Organization for Women, naral Pro-Choice America, and the Feminist Majority Foundation--has a position on ectogenesis. "For naral it's really important not to get distracted," legal director Cavendish told me. "We have to keep an eye on the prize of electing officials devoted to keeping Roe v. Wade. We can't pay too much attention to every potential tactic pro-life may use to distract us from our goal--which remains the same, notwithstanding new technological developments."

Yet, while the pro-choice mainstream remains silent on ectogenesis, more radical voices have filled the vacuum. Writing about ectogenesis in her book Human Reproduction: Principles, Practices, Policies, feminist philosopher Christine Overall argues that abortion is about the right not to procreate, not simply the right not to be pregnant. Overall claims that fetal extinction--not just extraction--is the aim of women seeking abortions and that forcing a woman to submit to a fetal extraction is like forcing her to donate organs against her will. The pregnant woman, Overall writes, is the "most appropriate person--perhaps the only one--to decide the disposition of the fetus." Extraction, extinction, disposition: Is this how the pro-choice movement wants their side of the debate to be framed in a post-ectogenesis world?

Surely there are more sophisticated arguments to be made for abortion rights in the face of ectogenesis: women who might raise their children in poverty rather than use an ectogenesis-adoption solution and face the emotional turmoil of knowing that someone else is raising their child; pregnancies resulting from rape that might be better terminated than saved; changes that could occur in the scope of fathers' rights vis vis mothers. But you won't hear these arguments from mainstream pro-choice groups. Nor will you hear the alternative: that ectogenesis could lead to an agreement with the pro-life side that transcends the abortion debate altogether.

For now, the pro-choice movement is ignoring the prospect of ectogenesis at its own peril. If and when ectogenesis becomes a reality, it will redefine the abortion debate. Just consider the issue of viability: 41 states ban abortion after viability; if ectogenesis is achieved, will abortion then become illegal in each of those states? Many pro-lifers will certainly be prepared to argue yes. Isn't it about time pro-choicers start thinking of what they will say in response?

Sacha Zimmerman is the assistant managing editor at TNR.

Posted by razib at 11:11 AM

I suspect the more practical (and also more readily accepted) advances will come in the form of treatments for extremely premature infants, which will gradually come to approximate an artificial womb. But I think it will be a long time before it is ethical to deliberately move a fetus from a healthy mother to such a facility, because prenatal development and the natural womb environment are much more complex than the article would lead you to believe. Creating an environment in which a fetus can survive is much easier than creating one that will lead to normal, healthy development. Current treatments for extremely premature infants often result in survival, but with severe handicaps and/or mental retardation. If techniques are developed to allow survival of ever-smaller infants then the smallest/ most premature cohort will probably continue to be developmentally abnormal.

Posted by: bbartlog at August 13, 2003 01:49 PM

Is there a big womb shortage? They seem to be all over the place.

Posted by: zizka at August 13, 2003 04:46 PM