{"id":4370,"date":"2023-02-07T18:12:19","date_gmt":"2023-02-07T17:12:19","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4370"},"modified":"2024-12-11T09:04:53","modified_gmt":"2024-12-11T08:04:53","slug":"whats-the-big-deal-with-whole-body-gestational-donation-on-defending-bioethics","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2023\/02\/07\/whats-the-big-deal-with-whole-body-gestational-donation-on-defending-bioethics\/","title":{"rendered":"What\u2019s the big deal with ‘whole body gestational donation\u2019? On defending bioethics"},"content":{"rendered":"

By J. Y. Lee.<\/p>\n

Over the past week, a flurry of articles on the internet (for example: 1<\/a>, 2<\/a>, 3<\/a>) sensationalized the contents of a journal article published by philosopher Anna Smadjor, on what she calls \u00a0\u201cWhole body gestational donation\u201d<\/a> \u2013 with discussants on social media largely condemning the proposed concept, and implying that \u201cbioethics” itself is a corrupt field rife with repugnant ideas.<\/p>\n

Smajdor\u2019s work builds upon on an earlier paper by Rosalie Ber, who suggested that one way to avoid moral issues raised by gestational surrogacy might be to use female patients in a persistent vegetative state (PVS) \u2013 who had given prior consent\u00a0<\/em>\u2013 as surrogates. While Ber did not articulate a term for this concept, Anna Smajdor names this idea\u00a0whole body gestational donation<\/em> (WBGD).<\/p>\n

Smajdor points out, quite plausibly, that just as some people would be prepared to donate parts of their bodies for organ donation, some may also plausibly be prepared to donate their whole bodies for gestational purposes. She suggests that states and health services \u2013 wherever organ donation is legal \u2013 might adapt their policies so as to allow for WBGD, as one option among other organ donation options. This means that people, just as they may elect and consent to donate some of their organs in case of their eventual death, might likewise consent to donate their whole bodies for gestational purposes in advance \u2013 or so her claim goes. On this framework, WBGD could theoretically be enacted in eligible brain-stem dead patients. WBGD would of course be \u201cqualitatively different in that entails ventilation over an extended period,\u201d in addition to the fact that it is not life-saving in the way people often understand organ donation to be. Rather, WBGD is proposed as a potential way to benefit aspiring mothers (or parents) who wish to avoid the risks and burdens of gestating with their own bodies.<\/p>\n

Make no mistake \u2013 many ethical issues warrant continued discussion in this case. Smajdor fully acknowledges that \u201cprolonging ventilation and somatic survival in brain-dead patients is undoubtedly a disturbing prospect,\u201d given that WGBD would make salient the way a patient\u2019s body can be completely instrumentalized for other people\u2019s benefit. However, she believes \u2013 rightly so \u2013 that many of the ethical concerns which might follow WBGD have a similar structure to the concerns raised for other areas of reproductive medicine and organ donation. Thus, the fact that WBGD is riddled with various (though, in the end, standard) ethical concerns \u2013 like many other areas of medical practice \u2013 is obviously not itself a reason to shy away from raising the idea.<\/p>\n

While I make no comment as to whether WBGD is a good idea overall, or whether it is something that I believe people in general might (or should) somehow come to accept morally, much of the reaction to Smajdor\u2019s work, and the accompanying reaction to bioethics as a field, strikes me as misconstrued. One online article<\/a> claims that \u201cthe body, even in death, still demands respect, and Smajdor\u2019s proposal is not only disrespectful, but also dehumanizing and exploitative.\u201d These are certainly ongoing concerns echoed in both the realms of organ donation as well as surrogacy, where ongoing bioethical debate offer rationales from different sides. Yet debates about what is or isn\u2019t dignified, respect-worthy, exploitative, and so forth, are by no means settled. Smajdor\u2019s justificatory scheme for WBGD is no different to the justificatory schemes that might be used in support of allowing commercial surrogacy, for instance. I myself have written critically about the objectionable ways that people overtly moralize commercial surrogacy<\/a> (and in an accompanying JME blog post<\/a>).<\/p>\n

In fact, I can think of many other hard ethical cases up for debate which have not seemed to stir up the same condemnatory responses online. For example, many women with AUFI (absolute uterine factor infertility) find it acceptable to gestate their own child by receiving a uterus donation<\/a> from living relatives (like one\u2019s mother, aunt, or sister) or unrelated strangers willing to give up their uterus. This is despite the fact that a uterus transplant is not a \u2018life-saving\u2019 organ transplant, despite medical risks to both donor and recipient being widely acknowledged, and in spite of adoption and surrogacy being possible alternatives. The moral consensus when it comes to uterus transplantation, however, seems to be one of general excitement and continued endeavours to innovate. This is evidenced by the fact that, since the world\u2019s first live birth via uterus transplantation in Gothenburg (Sweden) in 2014, research teams around the world have followed in Sweden\u2019s footsteps. In the past couple years alone, many new countries have sought approval over their own uterus transplantation clinical trials \u2013 for example, in Australia<\/a> and Japan<\/a>. News headlines on this topic suggest that uterus transplants are \u2018an amazing gift\u2019<\/a>, a stark contrast to the reaction borne by Smajdor\u2019s suggestion to make it possible for people to donate their whole bodies for gestational purposes, despite there being clear parallels in terms of potential ethical worries.<\/p>\n

While I am not suggesting that uterus donation is morally equivalent to whole body gestational donation, plausibly we might recognize that similar ethical concerns apply in both cases: we can question the conditions under which consent to be a donor\/recipient for such a procedure might be legitimately given, we might anticipate the serious harms that might befall either party, contemplate the potential for emotional coercion and exploitation, and so on and so forth. Is it really, on balance, morally better to allow living uterus donors to undertake a risky, medically non-necessary, and non-life-saving procedure for people who wish to gestate, than to allow people to donate their bodies for gestational purposes in the event of their brain stem death? Of course, we might in the end find that the standard conditions proposed for uterus donation turns out to be more ethically acceptable on the whole relative to WBGD. But even if this were the case, such a result still does not speak in favour of taking the view that WBGD is a uniquely abhorrent or reprehensible proposal.<\/p>\n

To point out another example, an article<\/a> written by Didde B. Andersen in 2021 on vital organ donation makes a philosophical case for a radically permissive type of organ donation. Andersen argues that people \u2013 even people who are not imminently dying for other reasons \u2013 ought to be permitted to become living,\u00a0vital<\/em>\u00a0organ donors. She says this may be permissible even when the donor risks incurring \u201cnon-trivial and irreversible harm (as is the case when he or she is not about to die for other reasons),\u201d focusing on scenarios where the potential donors may voluntarily and autonomously wish to sacrifice themselves for others.<\/p>\n

She calls this concept\u00a0living vital organ donation<\/em>\u00a0(LVOD). Andersen\u2019s LVOD is, in many ways, much more radical than Smajdor\u2019s WBGD; for one, in the case of LVOD we are talking about patients who would\u00a0still be alive<\/em>\u00a0at the time of donation but who would be killed in the process of the sacrifice. I think what the existence of this literature shows, however, is that bioethics, while it may sometimes be a platform for ideas we personally find repugnant, indeed remains an important field precisely because it is poised to debate a range of ethically difficult and complex matters. While some of these topics \u2013 and the mere fact of them put up for discussion in the first place \u2013 may strike many as completely alien to individual moral sensibility or gut instinct, it seems entirely reasonable, as well as valuable, for us to continue talking about issues for which people\u2019s autonomy and welfare are at stake, and to reflect on why<\/em> exactly we ought to approve or disapprove morally of both ongoing and prospective medical practices.<\/p>\n

Author:<\/strong>\u00a0J. Y. Lee<\/p>\n

Affiliations<\/strong>: University of Copenhagen<\/p>\n

Competing interests<\/strong>: None declared<\/p>\n

Social media accounts of post author:<\/strong><\/p>\n

Twitter \u2013\u00a0https:\/\/twitter.com\/jyleephilosophy<\/a><\/p>\n

Webpage \u2013\u00a0https:\/\/www.jyleephilosophy.com<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By J. Y. Lee. Over the past week, a flurry of articles on the internet (for example: 1, 2, 3) sensationalized the contents of a journal article published by philosopher Anna Smadjor, on what she calls \u00a0\u201cWhole body gestational donation\u201d \u2013 with discussants on social media largely condemning the proposed concept, and implying that \u201cbioethics” […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":4504,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8057,2022],"tags":[],"class_list":["post-4370","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-ethics","category-reproduction"],"yoast_head":"\nWhat\u2019s the big deal with 'whole body gestational donation\u2019? 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