Artificial Womb Technology: A Roadmap to a changing Medico-Legal Landscape

Sampa Karmakar  Singh; Aditi  Dey; Shrayoshree  Putatunda; Manoj Kumar  Singh

doi:10.18006/2022.10(1).201.210

Authors

Sampa Karmakar Singh The West Bengal National University of Juridical Sciences, Dr. Ambedkar Bhavan-12, LB Block, Sector III, Salt Lake City, Kolkata, India– 700098
Aditi Dey Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, India- 700126
Shrayoshree Putatunda Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, India- 700126
Manoj Kumar Singh Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, India- 700126

DOI:

https://doi.org/10.18006/2022.10(1).201.210

Keywords:

Artificial Womb technology, Bioethical Issues, Ectogenesis, In-vitro fertilization, Assisted Reproductive Technology

Abstract

Scientists worldwide have tried to replicate birth processes for years, which have resulted in many new infertility solutions like in vitro fertilization (IVF) or surrogacy, but Artificial Womb Technology (AWT) is the most advanced and unique. AWT proposes an alternative to conventional pregnancy and childbirth. Presently, there is no prototype of an artificial womb for people. The innovation is particularly in its early stages. However, we do have to think about the scientific moral, and legal issues before racing into this innovation. We also need to deal with social, religious economic, and health issues. Here in this paper, we have specifically done a critical analysis of the bioethical issues concerning this upcoming technology. A transdisciplinary approach encompassing both the legal and scientific viewpoints, concerns, and suggestions related to this new technology has been discussed. We strongly suggest a worldwide discussion and be ready with a strong framework before we practice AWT, a venture whose outcomes are yet awaited.

References

Alexander, D. P., Britton, H. G., & Nixon, D. A. (1968). Maintenance of sheep fetuses by an extracorporeal circuit for periods up to 24 hours. American Journal of Obstetrics and Gynecology, 102(7), 969–975. DOI: https://doi.org/10.1016/0002-9378(68)90457-2

Alghrani, A., & Brazier, M. (2011). What is it? Whose it? Re-positioning the fetus in the context of research? The Cambridge Law Journal, 70(1), 51-82. DOI: https://doi.org/10.1017/S0008197311000171

Brado, L., Tippmann, S., Schreiner, D., et al. (2021). Patterns of safety incidents in a neonatal intensive care unit. Frontiers in Pediatrics, 9. 548. DOI: https://doi.org/10.3389/fped.2021.664524

Bulletti, C., de Ziegler, D., Flamigni, C., Giacomucci, E., et al. (1997). Targeted drug delivery in gynaecology: the first uterine pass effect. Human Reproduction (Oxford, England), 12(5), 1073–1079. DOI: https://doi.org/10.1093/humrep/12.5.1073

Bulletti, C., Jasonni, V. M., Ciotti, P. M., et al. (1988a). Extraction of estrogens by human perfused uterus. Effects of membrane permeability and binding by serum proteins on differential influx into endometrium and myometrium. American Journal of Obstetrics and Gynecology, 159(2), 509–515. DOI: https://doi.org/10.1016/S0002-9378(88)80119-4

Bulletti, C., Jasonni, V. M., Lubicz, S., Flamigni, C., & Gurpide, E. (1986). Extracorporeal perfusion of the human uterus. American Journal of Obstetrics and Gynecology, 154(3), 683–688. DOI: https://doi.org/10.1016/0002-9378(86)90630-7

Bulletti, C., Jasonni, V. M., Tabanelli, S., et al. (1988b). Early human pregnancy in vitro utilizing an artificially perfused uterus. Fertility and Sterility, 49(6), 991–996. DOI: https://doi.org/10.1016/S0015-0282(16)59949-X

Bulletti, C., Palagiano, A., Pace, C., et al. (2011). The artificial womb. Annals of the New York Academy of Sciences, 1221, 124–128. DOI: https://doi.org/10.1111/j.1749-6632.2011.05999.x

Buss, C., Davis, E., Shahbaba, B., et al. (2012). Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proceedings of the National Academy of Sciences of the United States of America, 109(20), E1312–E1319. DOI: https://doi.org/10.1073/pnas.1201295109

Callaghan, J.C., Angeles, J., Boracchia, B., Fisk, L., & Hallgren, R. (1963) Studies of the first successful delivery of an unborn lamb after 40 minutes in the artificial placenta. Canadian Journal of Surgery, 6, 199–206.

David, T. R. (2010). The Morality of Artificial Womb Technology. The National Catholic Bioethics Quarterly 10, 515-527. DOI: https://doi.org/10.5840/ncbq201010332

Davis, N. (2019). Artificial womb: Dutch researchers given€ 2.9 m to develop prototype. The Guardian, 8. Retrieved from https://www.theguardian.com/society/2019/oct/08/artificial-womb-dutch-researchers-given-2.9m-to-develop-prototype

Don, K. (2015). The High-Tech Future of the Uterus. The Atlantic. Retrieved from https://www.theatlantic.com/health/archive/2015/ 01/the-high-tech-future-of-the-uterus/383232/

Donum vitae. (1987). Congregation for the Doctrine of the Faith, n. 6, original emphasis. Retrieved from https://www.vatican.va/ roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

Greenberg, E. M. (1955). Artificial uterus, Patent No. 2723660, 1955 . Retrieved from https://patents.google.com/patent/ US2723660A/en

Guller, S., Bulletti, C., Biener, A., & Gurpide, E. (1984). Relative distribution of estrone, estradiol and estriol between fetal and maternal perfusates during perfusions of human term placentas with labelled C19 precursors. Journal of Steroid Biochemistry, 20(4B), 975–979. DOI: https://doi.org/10.1016/0022-4731(84)90007-4

Hedesan, G. D. (2014). Paracelsian medicine and theory of generation in ‘exterior homo’, a manuscript probably authored by Jan Baptist Van Helmont (1579–1644). Medical History, 58(3), 375-396. DOI: https://doi.org/10.1017/mdh.2014.29

Horn, C., & Romanis, E. C. (2020). Establishing boundaries for speculation about artificial wombs, ectogenesis, gender, and the gestating body. In Dietz, C., Travis, M., & Thomson, M. (Eds.), A jurisprudence of the body (pp. 227-254). The Palgrave Socio-Legal Studies series, Palgrave Macmillan Ltd. DOI: https://doi.org/10.1007/978-3-030-42200-4_10

Huxley, A. (1932). Brave New World: Chatto &Windus Publication, United Kingdom.

Indian Penal Code. (1860). Legislative Department, Government of India. Retrieved from https://legislative.gov.in/sites/default/ files/A1860-45.pdf

Jennifer, B. (2006). 'Immaculate Conception? How will Ectogenesis Change Current Paradigms of Social Relationships and Values?'. In Gelfand, S., Shook, J.R. (Eds.), Ectogenesis: Artificial Womb Technology and the Future of Human Reproduction (pp. 149-157). Rodopi, B.V. Retreived from https://philpapers.org/rec/GELEAW DOI: https://doi.org/10.1163/9789401203456_014

Kaczor, C. (Ed.). (2010). The Ethics of Abortion: Women's Rights, Human Life, and the Question of Justice (1st ed.). New York, Routledge.

Kalra, B., Baruah, M. P., & Kalra, S. (2016). The Mahabharata and reproductive endocrinology. Indian Journal of Endocrinology and Metabolism, 20(3), 404–407. DOI: https://doi.org/10.4103/2230-8210.180004

Kuwabara, Y., Okai, T., Kozuma, S., et al. (1989). Artificial placenta: long-term extrauterine incubation of isolated goat fetuses. Artificial Organs, 13(6), 527–531. DOI: https://doi.org/10.1111/j.1525-1594.1989.tb01574.x

LaFee, S. (2004). Spare womb. Will artificial wombs mean the end of pregnancy?. The San Diego Union Tribune, 25. Retrieved from https://www.ivf1.com/pdf/san_diego_tribune_artificial_womb.pdf

Liu, H., Mele, C. A., Alpert, A., & Rosenwaks, Z. (2001). Tissue engineering of human endometrial cells using a biodegradable polymer. Fertility and Sterility, 76(3), S23. DOI: https://doi.org/10.1016/S0015-0282(01)02091-X

Miura, Y., Saito, M., Usuda, H., et al. (2015). Ex-vivo uterine environment (EVE) therapy induced limited fetal inflammation in a premature lamb model. PloS One, 10(10), e0140701. DOI: https://doi.org/10.1371/journal.pone.0140701

Moon, C., Lagercrantz, H., & Kuhl, P. K. (2013). Language experienced in utero affects vowel perception after birth: A two‐country study. Acta Paediatrica, 102(2), 156-160. DOI: https://doi.org/10.1111/apa.12098

MTP ACT. (1971). The Medical Termination of Pregnancy Act, 1971 (Act No. 34 of 1971) (10th August 1971), Ministry of Health and Family Welfare, Department of Health and Family Welfare, Government of India Retrieved from https://main.mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-1971

Partridge, E. A., Davey, M. G., Hornick, M. A., et al. (2017). An extra-uterine system to physiologically support the extreme premature lamb. Nature Communications, 8(1), 1-16. DOI: https://doi.org/10.1038/ncomms15794

Patnaik, A. M. M., & Kejriwal, G. S. (2012). A perspective on the PCPNDT Act. Indian Journal of Radiology and Imaging, 22(02), 137-140. DOI: https://doi.org/10.4103/0971-3026.101116

Romanis, E. C. (2020a). Artificial womb technology and clinical translation: Innovative treatment or medical research?. Bioethics, 34(4), 392-402. DOI: https://doi.org/10.1111/bioe.12701

Romanis, E. C. (2020b). Artificial womb technology and the choice to gestate ex utero: is partial ectogenesis the business of the criminal law?. Medical Law Review, 28(2), 342-374. DOI: https://doi.org/10.1093/medlaw/fwz037

Rosen, C. (2003). Why not artificial wombs?. Washington, D.C., The New Atlantis, 3, 67-76.

Salama, M., Isachenko, V., Isachenko, E., et al. (2018). Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). Journal of Assisted Reproduction and Genetics, 35(7), 1277-1288. DOI: https://doi.org/10.1007/s10815-018-1181-x

Sandman, C. A., & Davis, E. P. (2012). Neurobehavioral risk is associated with gestational exposure to stress hormones. Expert Review of Endocrinology & Metabolism, 7(4), 445-459. DOI: https://doi.org/10.1586/eem.12.33

Sandman, C. A., Davis, E. P., & Glynn, L. M. (2012). Psychobiological Stress and Preterm Birth. In Morrison, J.C. (ed) Preterm Birth-Mother and Child. Intech Open.

Shook, J., & Gelfand, S. (Ed.). (2006). Ectogenesis: Artificial Womb Technology and the Future of Human Reproduction. Amsterdam and New York: Editions Rodopi. DOI: https://doi.org/10.1163/9789401203456

Smajdor, A. (2007). The moral imperative for ectogenesis. Cambridge Quarterly of Healthcare Ethics, 16(3), 336-345. DOI: https://doi.org/10.1017/S0963180107070405

Smajdor, A. (2012). In defense of ectogenesis. Cambridge Quarterly of Healthcare Ethics, 21(1), 90-103. DOI: https://doi.org/10.1017/S0963180111000521

The Assisted Reproductive Technology (Regulation) Bill (2020). Govt. of India, Retrieved from http://164.100.47.4/BillsTexts/ LSBillTexts/Asintroduced/97_2020_LS_Eng.pdf

The Constitution of India (As on 9th December, 2020), Ministry of Law and Justice, Govt. of India. Retrieved fromhttps://legislative.gov.in/sites/default/files/COI_1.pdf

The medical termination of pregnancy (amendment) ACT, 2021, ministry of law and justice (legislative department), Govt. of India. Retrieved from https://egazette.nic.in/WriteReadData/2021/226130.pdf

The pre-natal diagnostic techniques (regulation and prevention of misuse) amendment act, 2002, Govt. of India.Retrieved from (https://ncpcr.gov.in/view_file.php?fid=434)

Tom Avril (2017) 'Artificial womb' scientist at CHOP wins Philly Geek award, The Philadelphia Enquirer. Retrieved from https://www.inquirer.com/philly/health/science/artificial-womb-CHOP-preemie-philly-geek-award-20170830.html.

TU/e, News Overview, Eindhoven University of Technology (2020). Artificial womb improves survival rates for the very smallest. Retrieved from https://www.tue.nl/en/news/news-overview/16-06-2020-artificial-womb-improves-survival-rates-for-the-very-smallest/

Usuda, H., Watanabe, S., Saito, M., et al. (2019). Successful use of an artificial placenta to support extremely preterm ovine fetuses at the border of viability. American Journal of Obstetrics and Gynecology, 221(1), 69-e17. DOI: https://doi.org/10.1016/j.ajog.2019.03.001

Viltart, O., & Vanbesien-Mailliot, C. C. (2007). Impact of prenatal stress on neuroendocrine programming. The Scientific World Journal, 7, 1493-1537. DOI: https://doi.org/10.1100/tsw.2007.204

Yuko, E. (2017). Weighing the ethics of Artificial Wombs. The New York Times, 8. Retrieved from: https://www.nytimes.com/ 2017/05/08/health/artificial-wombs-ethics.html