While artificial wombs will soon be tested in humans, ethicists are wondering about the status to be given to the fetus which will be transferred from the pregnant woman to this external technological pocket. What protection should be given to this “human entity”? What care will she be entitled to? What will be the obligations of health professionals towards it? What voice will maternal or even parental authority have? What decision-making freedom will each have? All these questions are the subject of debate.
“For the moment, we have no answers to these questions, because both the moral status and the legal status of the human entity [foetus] in artificial uterus (AU) remain undetermined in Canada,” indicated from the outset the doctoral student in bioethics at the University of Montreal, Frédérique Drouin. She looked into this problem and presented a proposed response during a conference entitled Consider the entity in the artificial uterus as a patient to ethically guide its medical treatment which she presented this week at the congress of the Association francophone pour le savoir Acfas.
The UA prototypes that several countries, including Canada, are developing with the aim of improving the medical care of extremely premature babies — with a gestational age of 22 to 25 weeks — in whom mortality and morbidity rates are high is making great strides. “The United States is the most advanced and the most ready to begin clinical trials in humans, which could begin in 2024,” she said. Children’s Hospital of Philadelphia has already conducted more than 300 successful trials, including lambs that had completed sufficient development to allow them to live outside of the DU.
A UA consists of a plastic bag that is filled with synthetic amniotic fluid. During the transfer of the fetus, we maintain its umbilical cord which will be connected to a machine, “because it is through this that the nutrients and oxygen will be delivered to it and that the elimination functions will be carried out” .
The attitude to adopt towards the “AU entity” gives rise to lively debates in the literature, underlined the researcher. Some authors believe that “UA would support a process more closely resembling the continuation of a pregnancy.” In doing so, the AU entity should be treated in the same way as a fetus.” Others are more of the opinion that “the UA is simply a more sophisticated extension of the incubator. For this reason, the entity in UA would deserve the same legal protections as the newborn in the incubator.”
Essentially, the question is whether the entity in AU is a newborn or a fetus. “It is important to know which category it will fall into because the way we consider it will determine the treatment that we will be able to administer to it,” explains M.me Drouin before recalling that in Canada, the embryo and the fetus in the human uterus do not have the right to life, which allows recourse to an abortion throughout the gestation. On the other hand, after a live and viable birth, the fetus becomes a newborn, which acquires legal personality, as well as the right to life. “We can therefore no longer end our existence, otherwise it would be considered murder. Treatment can only be stopped when the care is considered futile and disproportionate. »
Mme Drouin presented an avenue which circumvents this debate and which is inspired by the proposal formulated by Frank Chervenak and Laurence McCullough in 2017 in an article entitled Ethical dimensions of the fetus as a patient. These authors, who were of course discussing a fetus in a human uterus, and not in an UA, specified that the fetus could be considered a patient under two conditions: “the first being that the pregnant person must present their fetus to the medical profession , the second being that there are medical interventions beneficial for the fetus. When we transpose these conditions into the UA context, we see that the UA entity respects these two conditions because the pregnant person, to transfer their fetus to a UA, will first have to present it to the medical profession. Then, once UA has proven its effectiveness, it will become a beneficial medical intervention for the entity within a UA,” argued the researcher.
Chervenak and McCullough also asserted that to be considered and treated as a patient, it is not necessary to hold an independent moral status, that is, to be a person with all the rights that one is granted. And that the simple fact of having a reasonable potential to obtain an independent moral status, that is to say of becoming a child, is enough, emphasized the bioethicist.
However, according to Chervenak and McCullough, the medical profession is required to protect and promote the interests of all their patients, and therefore has beneficent obligations towards the fetus-patient. “If we transpose this to the context of UA, as the entity in UA can be considered as a patient, it would therefore benefit from the same moral obligations of beneficence on the part of the medical profession, which would protect it from certain medical and parental harms , even if she is not recognized legally or morally as a “complete person”. Thus, we do not need to know whether the entity in AU is a fetus or a newborn. We are leaving this debate and we still have protections,” noted M.me Drouin who advocates this approach.