Deeper Concerns with Ectogenesis

This post over on Bioedge pointed me towards a couple of essays published in the current edition of the Cambridge Quarterly of Healthcare Ethics on the subject of ‘Ectogensis’ or ‘Extra Corporeal Gestation’ (ExCG). The first, by Murphy, is a critique of an earlier paper by Smajdor. The second is her response. 

The arguments they present do not, as Bioedge’s title a little misleadingly suggests, concern the ethical status of pregnancy per se. Rather they concern whether we have a moral motivation to develop a technology that would relieve women of the burden of pregnancy given the basic facts of human reproductive biology and the prima facie inequality between the sexes it presents. This is Smajdor’s argument and her approach is a Dworkinesque (and Rawlsian) approach. In the final flourish of her initial paper, she asks us to consider if, from behind a veil of ignorance, 

“Would you prefer to be born into society A, where women bear all the risks and burdens of gestation and childbirth, as they do now, or society B, where ectogenesis has been perfected and is routinely used”?

There is a lot one could say about these papers and the way in which the argument is conceived, presented and developed. As evidenced by the veil of ignorance approach, behind which we are supposedly rendered gender neutral but are in fact constructed according to a masculine schema, Smajdor's conception of gender and sexual equality is one where female difference is neutralised. It is, therefore, one in which women are rendered equal to men rather than gaining equality on their own terms. Rendering women equal to men by reconstructing them as men has obvious implications, already articulated within feminist discourse, for the way in which we understand gender and gender neutrality. One might respond that, in this case, we are dealing with the 'brute facts' of reproductive biology however I do not think that, particularly in this case, sex and gender are as fully distinct as we might think.

Neither Murphy nor Smajdor gives much thought to the idea that pregnancy might be an end in itself and not jut a means to some other end, i.e. a child. They both seem to assume that people can, do and should plan how and when to have a child. However many people do not make such decisions but rather take life as it comes. Often this amounts to making an implicit decision by becoming lax about using contraception for example. Nevertheless this is how people choose to lead their lives and it is not clear how ExCG will fit in with or alter the way in which we reproduce. It is these eventualities that interest me and they are rarely considered within bioethical discourse.

Whilst the question Smajdor ask us to consider from behind a veil of ignorance starkly contrasts our current society where women get pregnant and one in which ExCG is a reality, we can assume that the second society is one where women can choose to become pregnant or to make use of ExCG technology. We might then question how society will organise itself around this choice. Will ExCG be something that couples, or women, will have to pay for? Will it be a luxury unavailable to a majority or a minority? Or will we come to see a choice to have a normal pregnancy as an alternate or 'lifestyle' choice and the medical costs of this will become something women will have to bear the costs of directly? Perhaps we will see maternity rights cut because, after all, if women are no longer needed to gestate their children are they really needed during nine months of a baby’s life? 

ExCG will not, of course, relieve women of all differential reproductive burdens. Harvesting gametes from women is much more difficulty and risky than retrieving them from men. Furthermore if women wish to avoid pregnancy but also wish to breastfeed then this will have to be induced in some, presumably biochemical, way. It is here that we can begin to see that one’s physical being, sex, and one’s social nature, gender, are inextricably intertwined. When becoming parents both men and women enter a state of parenthood however this is not to say that motherhood and fatherhood are essentially the same. Elsewhere Savulescu and Sandberg have suggested that love drugs might be used to maintain sexual relationships. Given the physical and biochemical events that occur during pregnancy and the role of hormones in our emotional lives perhaps women will be under pressure to take similar drugs when they are finally in receipt of their child. 

Whilst it is the case that not all mothers either gestate or breastfeed their children doing so is a big part of our cultural ideal of being a mother. Women who do not do so are not lesser mothers but if we moved to state where few women gestated or breastfed their children we would alter our conception of motherhood and we might suggest that, in so doing, we would be rendering it more like fatherhood. Again this would be to contribute the erasure of gender difference by, once more, erasing things labelled feminine and central to women's experience in favour of gender neutrality that is in fact masculine. 

Furthermore such technology will move the locus of reproductive control out of the bedroom and into biomedical hands. IVF is the most obvious example of this. When it was first approved it was unavailable to single women and lesbian couples. However rather than imagine the governance of ExCG technology to be like that historically and currently surrounding IVF it may be that it will be more comparable to the governance of adoption. Here there are extensive checks on potential adoptees’ suitability before they are given a child to look after. Perhaps access to ExCG technology will introduce similar demands on those who would reproduce. It is almost certain that there will be an additional battery of genetic and development tests introduced as part of the process that cannot be considered morally neutral. Some might argue that this is to be concerned with the moral implementation of a technology rather than with the morality of the technology per se. However the argument is not about the morality of ExCP per se but whether there is a moral imperative to produce and implement such a technology. Whether we are ready to handle such a technology in an ethical manner should be central to the bioethical debate.