Three Quiet Cheers for Uterine Transplants

Charles Foster’s post over at Practical Ethics about the news of the womb-transplant surgery that’s slated to take place in the near future is on the money in many respects.  Foster points out that

[p]redictably the newspapers loved it. And, equally predictably, clever people from the world’s great universities queued up to be eloquently wise about the ethics of the proposal.

But if ethics are [sic] concerned with what we should do, there was really nothing worthwhile to be said about Eva Ottosson’s altruism (bar the usual uninteresting caveats about dangerousness and resource allocation), except: ‘Fantastic’.

Of course it is possible to think of things to say. Anyone who has dabbled in philosophy or law could churn out a few thousand words of commentary. When I heard the facts I reflexively began to draft a mental essay plan. But (if one excludes insane religious objections) the bottom line is inescapable.

I shared the impulse to come up with an outline for a paper (and what I’d say if Newsnight felt the urge to talk to a gobby incompetent like me), before coming to the same sort of conclusion: there really isn’t all that much interesting to say about this transplant.  This in itself is remarkable: the media are normally quite good at rooting out someone to object to whatever-it-is-that’s-just-been-announced, but seem to have drawn a blank this time.  Nair et al published a more serious paper on the subject a few years ago, but that strikes me as saying just about all that there is to say (and, to be frank, a bit more; I wonder whether the rationale for writing the paper was along the lines that someone ought to, and someone probably would, so it might as well be them).  There might be something a bit more interesting to be said if the recipient of the transplant happened to be male – but, even there, the interest would (I suspect) be more anthropological and legal than ethical.

Still: while I agree with Foster’s implied conclusion that there is no sane reason to think that uterine transplants ought not to happen, I’m not quite as enthusiastic about them as he.  There’s a couple of reasons for this. One has to do with a slight concern that the procedure’s importance relies on buying into a non-social model of parenthood.  It’s not obvious to me that genetics are important in establishing parenthood; nor is it obvious to me that gestational location is the clincher.  Of course, gestation is morally important – but there’s a perfectly viable model of parenthood that says that gestating a child isn’t what makes someone its parent in the right, morally important, sense.  Fathers know that.  This being the case, surrogacy looks like it would be an option when it comes to the potential womb-recipient becoming a parent (and I’m taking it as read that being a parent is what this is, in the end, all about: merely having a functioning uterus doesn’t seem like it’s all that important if you’ve no intention of growing a baby inside it – that’d be a bit like decorating the spare bedroom and never inviting guests over).  Viable eggs could be transplanted into a surrogate, rather than a viable womb being transplanted.  The former procedure is much less complicated and much safer: it’s almost workaday.

One thing we have to consider in this context, though, is whether there might be a difference between being a parent and being a mother.  If motherhood is a special category of parenthood, then the point about surrogacy could potentially be moot: one might be able to become a parent by means of surrogacy, but still not be able to become a mother.  (Of course, many real-life women who’ve had children via surrogates might object to this – but their objections might be ill-founded.)  What, then, might make motherhood special?  Well, it might have to do with actually gestating the child.  This might tell us why giving a woman (or a man, but let’s not go there for the moment) the capacity to gestate is so important that a womb transplant is in order.  Still, it’d remain to be shown that motherhood is a uniquely special status, and that it’s because of gestation – which would be as much as to say that “mothers” who adopt or use a surrogate are not mothers in this important sense after all.  If, though, we think that women who adopt are actual mothers after all, having carried the child cannot be what makes them so.  And if what makes you a mother is different from gestating the child, then it’s not obvious why it’s so important that a woman without a womb should have one transplanted.  On this basis, we don’t even have to worry about whether the “specialness” of motherhood is real or illusory; a woman’d be able to play this putatively special role even without gestating.  Finally, since there is no obvious reason to deny that women who adopt or use a surrogate are mothers in the morally important sense, there’s no obvious reason to suppose that a womb transplant is the only way to achieve something of great importance.

Again: presumably, the whole point of having the transplant is to enable motherhood or parenthood; but if motherhood can be achieved without it, then the transplant looks to be de trop.

There’s also a legitimate worry, I think, that there might be pressure put on the daughter to have a child post-op.  Suppose the transplant goes ahead, but the daughter decides (for some reason) that she doesn’t want to gestate a child after all.  To what extent might there be a feeling of moral obligation to have one anyway?  The donor in this case is the mother, and she is a live donor.  It’s not implausible to imagine that a live donor would feel that the recipient ought to get pregnant in order to vindicate having taken the risks involved in donating – which is no small procedure.  You don’t get that pressure from a cadaveric donor.  You might not get it in this particular case, either; and even if you do, a feeling of obligation held by either donor or recipient isn’t enough to establish an actual obligation (and nor is an actual obligation necessarily all that powerful: it might easily be overridden by appeals to procreative autonomy).  But a feeling of obligation, even if it is misplaced, is of potential moral import.  It might contribute to a worry about any subsequent pregnancy being coerced.

None of these worries is fatal to the permissibility of the procedure; none of them means it shouldn’t go ahead.  I might even join Foster in his applause.  But my clapping is a touch more muted; my cheers lacking in enthusiasm.  It’s a celebration of an impressive piece of medical engineering, rather than the celebration of having achieved anything of any great import.

UPDATE: Christian Munthe covers similar ground, and provides some useful links, here.  I ought to have linked earlier, and meant to – but, er, forgot.  Sorry!