Neonatology’s brave new world       

By Phillip Wozniak, Ashley Fernandes

Could a live baby outside its mother’s womb remain “unborn?”

On its face, it seems like an absurd question, but scientific advancement in the field of neonatology has made answering this question a priority. In 2017, Dr. Emily Partridge and her colleagues at the Children’s Hospital of Philadelphia published the results of their artificial womb animal trials. This artificial womb, nicknamed the “Biobag,” replicates the natural womb’s physiology, supplying nutrition and oxygen to a fetal lamb via the umbilical cord. In doing so, the fetal lamb is spared the need for invasive respiratory support in order to live. Human trials of these artificial wombs are fast-approaching. If successful, it would represent a seismic change in the field of neonatology. By closely replicating the natural womb, preterm infants could be spared the most devastating consequences of premature birth: chronic lung disease and neurodevelopmental impairment.

The publication of Dr. Partridge’s successful trials of the Biobag caused quite a stir among medical ethicists. The most pressing question to be answered: is the human being inside a Biobag an unborn fetus or a newborn baby in need of medical attention? The moral significance of this question cannot be overstated. If it is a newborn baby, then it is entitled to all of the rights and privileges of any other human person. If it is an unborn fetus, then it remains subject to the regulations surrounding abortion access.

The most prolific scholar currently working to resolve this conundrum is Dr. Elizabeth Romanis. In her papers on this topic, she attempts to find an “Option C.” She proposes treating a neonate sustained in a Biobag as neither properly born nor still dependent on its mother’s womb for survival. She dubs the neonate occupying this middle state of existence a “gestateling,” and assigns it more rights vis-à-vis a fetus in the natural womb, but less rights and protections than a neonate in a traditional incubator in the neonatal intensive care unit (NICU). We believe this view is both medically and philosophically flawed. Creating the term “gestateling” seems to be a convenient pretext questioning the moral value of a neonate receiving oxygen via a Biobag instead of a ventilator.

As clinicians, we offer a physiologically based rebuttal to the arguments Dr. Romanis puts forward. Contrary to her view that the Biobag challenges the bright lines between born and unborn, we believe that the Biobag represents the natural progression of neonatal research and medical technology. As ethicists, we note that the moral value of a neonate existing independently outside its mother’s womb should be an inviolable principle as the medical field prepares to contend with the ethical debate surrounding the advent of artificial wombs.


Paper title: Conventional revolution: the ethical implications of the natural progress of neonatal intensive care to artificial wombs

Author(s) (do not include qualifications): Phillip S. Wozniak1, Ashley K. Fernandes1,2


1 College of Medicine, The Ohio State University, Columbus, Ohio, USA

2 Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA

Competing interests: none

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