Artificial wombs: a shift in approach to neonatal intensive care and beyond

By Elizabeth Chloe Romanis

What if there was no such thing as being born too premature to survive? Today babies born on the viability threshold (around 24 weeks) have little chance at life, or of a life without serious long-term health problems. Neonatal intensive care can only do so much for babies born with an undeveloped capacity for life. Artificial wombs, however, could change these odds by taking over the process of gestation after a pregnancy does not go to plan.

Last year a successful animal trial of a device termed the ‘biobag’ made global headlines. The biobag was designed as an alternative to current intensive care and marks a significant shift in the approach to treating premature babies. Rather than providing mechanical assistance to perform bodily functions (e.g. using a ventilator to support the lungs), the biobag attempts to replicate the environment and function of the human uterus.

The biobag seals its subject in amniotic fluid, just like a foetus during pregnancy. The subject is attached to a cannula, mimicking the umbilical cord/placenta by providing all essential nutrients – again, just like during pregnancy. The biobag is an early artificial womb prototype that allows gestation to continue. And, the scientists behind it anticipate that testing on human subjects could be just years away.

As a consequence, we must consider what happens when biobags or other alternative artificial womb prototypes become a regular feature of neonatal intensive care. Biobags would be a life-changing development for parent/s who could be spared the heartbreak so often the result of premature birth. However, I am concerned about two issues that often go ignored, and have not yet been fully explored.

First, I am concerned that artificial wombs will be treated like just another form of intensive care because they have been designed to replace routine treatment for premature babies. This does not seem quite right. An artificial womb is just not the same as an incubator.  For starters, we are clueless about how well it works or what the long-term implications will be. In my paper, ‘Artificial Wombs and the frontiers of human reproduction: conceptual differences and potential implications,’ I explore the important differences between the technologies, and between the baby in intensive care and the subject (baby/foetus?) of a biobag.

Artificial wombs have implications far beyond intensive care. Inevitably they will, unlike current technology, keep pushing back the viability threshold, ensuring even younger ‘babies’ are supported outside a pregnancy. This will have profound implications for our perception of viability with important consequences; for example, by changing norms about when we should treat newborns with experimental treatments, and influencing how we talk about, or even allow access to, abortion.

Recognising that artificial wombs are different is important for considering whether additional regulation is necessary to oversee its introduction into clinical settings.  It is important to ensure that parent/s willing to consent to the use of the experimental device understand what it is and what it does. It is important to ensure adequate protection for the vulnerable subject of experimental treatment.  It is important to ensure the broader societal consequences of artificial wombs are not ignored when biobags are used.

Second, I question what we should call the human being developing in an artificial womb. Terms usually used to describe developing human beings – ‘foetus’ or ‘baby’ – do not fit. How can it be a foetus when it is not located inside a pregnant woman’s uterus? How can it be a baby when it is likely to be more similar in all its features and behaviour to a foetus? How can it be described as a newborn when it is still undergoing gestation as if it hadn’t been born?

I argue that the developing human being in the artificial womb is novel and unique. This is why existing terms cannot be used to accurately describe it. Finding a new word will allow us to discuss it clearly, and avoid language that often carries underlying emotional connotations. To resolve the issue, I have named the human being undergoing gestation outside a human uterus the ‘gestateling.’ Avoiding other misleading or morally loaded words means we can start having important conversations about the gestateling and how it should be treated.

 

Author: Elizabeth Chloe Romanis

Affiliation: Centre for Social Ethics and Policy, School of LawUniversity of ManchesterManchester, UK

Paper: Artificial womb technology and the frontiers of human reproduction: conceptual differences and potential implications

Competing Interests: None declared

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