Like a Virgin (31 page)

Brännström has had successes with some early operations, conducted in sheep. He and his team were able to remove the wombs of five ewes, keep the tissues alive outside of the body for
a couple of hours, and then replace the wombs in the original animals, reconnecting the blood supply and the vagina successfully. And four of the five ewes subsequently became pregnant.
Brännström and his colleagues have also performed the procedure on mice, rats, and baboons, with two out of five baboons that underwent the surgery resuming regular menstruation
afterwards. These are small, incremental steps, but transplantation in humans is the end goal.

Of course, even if Brännström succeeds, womb transplants may not be a viable option for everyone – think of a woman who has already had an invasive hysterectomy
in order to remove cancer then choosing to undertake a series of transplant operations, with all of the medical risks that would entail. A safer, more desirable course of action might be to turn to
a womb outside of your own body. Though today the technology is quite limited, researchers in the field are right to believe that a fully functional artificial womb will come to exist in the next
decade or so.

There is obviously a complicated relationship between
an embryo in the womb and its mother, in terms of how a developing baby develops an immune system and takes on board
a range of environmental cues while in a mother’s body. Indeed, there are many issues that are still not understood, about epigenetics and more. Yet, much has been learned about the
underpinnings of disease in the last couple of decades, and that knowledge is breaking open the last remaining barriers to an artificial womb for humans. An artificial womb, after all, will
primarily be used to bridge the gap between the fertilization of an egg in a test tube and the movement of the developing embryo into an incubator – since Amillia Taylor’s birth a
period approaching a brief twenty weeks. And it could help to save pregnancies, whether their origins are in vitro or in vivo, in which the embryo is not yet able to survive with current incubator
technology – including many ectopic pregnancies that could endanger the life of the carrying parent.

But an artificial womb could also offer solutions, much as IVF did, both for those with clinical need (which would include gay men if you consider that neither partner will have a womb of their
own, and will clinically need one if they want to have a child) and for those who opt for it for various other reasons. For many women who use IVF to become pregnant, the time, pain and expense are
wasted when their babies fail to implant in their own wombs. The reasons why this happens are currently not clear, but having access to another womb in a controlled environment certainly sounds
like a helpful option for them. During labour, the birth canal is sometimes a treacherous place for babies and the ordeal can lead to death – a scenario that would be avoided if gestation
were not inside the woman’s body. And because, of course, a woman would not technically have to carry her child, and as pregnancy poses a risk to the mother – in particular, it can
genuinely endanger the health of an older mother – this is one advantage, and a use of the technology that
becomes very tricky to argue against.

But if you remove a foetus’s development from the context of the ‘natural’ womb, an idea that some opponents say is like putting a foetus in a box for forty weeks, will you
also remove the ‘special bond’ that forms between a mother and her child? To all intents and purposes, however, this question is a red herring: carrying a baby has never been a
prerequisite for loving one’s baby or being able to bond with it – otherwise the same issues would be an argument against adoptive parents, mothers who use surrogates, and even fathers.
In fact, being able to watch, in plain sight, the fragile, doll-like foetus as it develops and grows may encourage a new and special bond. Over the past thirty years, sonograms and other scans have
become a regular part of prenatal care, and this ability to view the foetus, as an independent being, is thought to contribute to a maternal–foetal relationship forming much earlier in
development – weeks earlier than a mother is usually able to feel kicks and other movements. If it is also the case that bonding is proportionate to the degree to which a child is wanted,
parents who have put themselves through any of the gruelling aspects of assisted reproduction – including the artificial womb of the future – may see their great desire to bring their
child into the world translate into a great bond with their child, no matter the womb it developed in.

Not all babies are wanted, of course, which means that an artificial womb or a transplant into a ‘willing womb’ raises other thorny issues. Such as, if a baby could
be made viable from day one using some newfangled contraption, where would that leave the abortion debate?

When a woman has an abortion, she is exercising her right
to remove an unwanted pregnancy from her body, and quite a number of women exercise this right every year. In
2009, there were 189,100 abortions in England and Wales; in 2005, 820,151 were reported in the US. Around forty percent of terminated pregnancies are aborted for medical reasons related to the
developing foetus, including the risk of potentially serious disabilities, for example, of damage to the nervous system or Down syndrome. (An estimated ninety-two percent of all women who receive a
prenatal diagnosis of Down syndrome choose to terminate the pregnancy.) The remaining sixty percent of abortions are chosen for reasons related to the mother – her own physical or emotional
health or her relationship to the father, among many other factors. It should be stated that a woman’s right to an abortion does not give her the right to kill a child; rather, the aim is to
end a pregnancy. This is why, under the law, we consider the foetus to be a collection of cells, not a baby, until some demarcated point when the cells could live on their own outside the womb.

Before birth, the rights of babies – that is, foetuses – are not protected; under current UK, Canadian, and US law, foetuses have no rights at all. In a handful of cases, however,
American mothers have been charged with child abuse for behaving in ways that allegedly harmed the foetus they were carrying. If an artificial womb were created in which a healthy foetus scheduled
for abortion could survive to term, the issue of whether it should be nurtured there would become a matter for politicians and public policy to decide. Ninety-one percent of the abortions performed
in the UK in 2009 were conducted when the foetuses were at thirteen or fewer weeks gestation – too early for today’s incubators. If they could conceivably be kept alive, would medical
staff have an obligation to resuscitate them and place them in an artificial womb? Would it be better for society if these pregnancies were not aborted, if the embryos survived
to become people with inalienable human rights?

Already, the relatively antiquated incubators in modern hospitals have proved to be an ethical minefield when conflicts arise between the desires of premature babies’ parents and the
obligations of medical staff. One such battle began on 21 October 2003, when a baby who had only been in the womb for twenty-six weeks was born in Portsmouth, England. Tiny Charlotte Wyatt was only
12.7 centimetres (five inches) long at birth and weighed 458 grams (sixteen ounces), instead of the average 3.5 to four kilos (approximately 7.5 pounds) for a full-term baby. Charlotte was fragile;
her organs – especially her lungs, heart, and brain – were extremely underdeveloped. She nearly died after delivery. After being resuscitated, Charlotte suffered severe brain damage and
several of her organs failed; she was left blind and deaf, her kidneys were compromised, and her lungs were so severely injured that she required a constant supply of oxygen. The extreme immaturity
of her body also meant that her immune system was unprepared for the world outside the womb, and any small infection could be lethal. There was little hope of her living beyond childhood.

Charlotte’s team of doctors contended that, however long she lived, she would not only need continual medical attention, but would also likely be in constant pain and experience a life of
extremely poor quality. Medical opinion was weighted in favour of no longer resuscitating the child when she next suffered cardiopulmonary failure – as she had on three occasions – and
instead allowing her to die with some measure of comfort. The medical staff argued that with every resuscitation they performed, Charlotte’s lungs became increasingly delicate, and aggressive
treatment was not in the child’s best interests. Prolonging her life, in fact, appeared to constitute an assault of ‘inhumane and degrading treatment’ under Article 3 of the
European Convention on Human Rights, as the potential
long-lasting harms to the person would ultimately exceed the benefits. The doctors argued in favour of palliative care
alone.

Charlotte’s parents disagreed. As committed Christians, the Wyatts believed that their daughter’s life should be preserved at all costs. So when doctors refused to resuscitate
Charlotte for a fourth time, her case was brought to court. The doctors won the legal right to let her die, should her body shut down again. Yet, Charlotte did not die, as expected, and the
‘do not resuscitate’ order was eventually lifted, in 2005, when her parents showed that Charlotte was no longer in constant pain or unable to respond to stimuli.

Over those two years, however, the extreme stress of the situation had led to the breakdown of the Wyatts’ marriage, with the two parents visiting their severely disabled child only
infrequently in the hospital ward. A second series of legal clashes ensued, this time over sustaining care for Charlotte. In the end, the child was placed with foster parents. By 2009, her father
was visiting her monthly, according to an interview with the
Daily Mail
. He reported that, though Charlotte still needed some oxygen every day, she loved to listen to nursery rhymes and
could stand and walk with the help of a walking frame. ‘Going through the courts to keep Charlotte alive totally drained me,’ he said. ‘But now, when I look at her smiling face, I
know it was the best thing I ever did.’

While it is currently feasible to keep the very premature alive, good health and quality of life are by no means guaranteed – and there can be a devastating toll on both child and parents.
An artificial womb that can sustain and continue the development of extremely young foetuses could completely reinvent the parameters of neonatal medicine, helping to give children like Charlotte a
less traumatic life.

Regardless of such gains, a fully functional artificial womb will also present entirely new ethical dilemmas, including some we may not be ready to
negotiate. What if a foetus that would otherwise be aborted could be removed from its mother’s body and gestated artificially? Would that improve the chances of adoption for a child, given
that many couples prefer to adopt a baby rather than an older child? Would each year’s 189,574 aborted pregnancies, as occurred in 2010 in England and Wales, be viewed as the prospect of a
joyful miracle in the tradition of the first test-tube babies, or would they be seen as supplanting the placement of older children needing a home?