Analysis: scientific advances bring complete ectogenesis closer to reality, but it would give rise to a myriad of ethical, legal, social and practical questions
In December 2022, EctoLife, a concept video, posted to YouTube sparked significant debate about the ethical and legal implications of ectogenesis, the gestation of a fetus outside of the human body in an artificial womb. This fictional concept video imagines a facility where up to 30,000 human babies can be grown in pods, reminiscent of Huxley's dystopian 1932 novel Brave New World. The ideas presented in this concept video sound more akin to science fiction and raise significant ethical issues, however scientific developments mean that ectogenesis could be nearing a scientific possibility.
The term 'ectogenesis' was first coined in a 1923 speech by scientist JBS Haldane in which he imagined a future where humans were routinely gestated in artificial wombs, and such technologies were used to enable the eugenic improvement of humans through the control of their own evolution, which raises significant ethical issues. While such technologies were not possible in 1923, great strides have been made in terms of assisted human reproduction since Haldane's speech a century ago, and the scientific prospect of developing a human outside of the body in future is becoming more plausible given recent scientific studies.
Recently, there have been considerable developments in partial ectogenesis - whereby a fetus is transferred to an artificial womb technology at some point during gestation - in animals. Most notably, the EVE project and Extend design, showed promising results in sustaining premature lambs in artificial wombs, with hopes that this technology could at some point be used to sustain premature human infants. In the Extend design, lambs were removed from the uterus at 105-108 days and 115-120 days gestation, (equivalent to approximately 71-81% of the average gestation period for lambs).
Such developments may also bring the prospect of complete ectogenesis – where a fetus grows outside the body entirely in an artificial womb - closer to reality. Complete ectogenesis of humans is not currently scientifically or legally possible. Currently, the scientific challenges to complete ectogenesis include the complexities of understanding how to gestate a fetus entirely outside the body without the human placenta and womb.
Complete ectogenesis is legally limited by the '14-day rule’ in embryo research. For complete ectogenesis to be possible in humans, it would require human embryos to be created and grown outside of the human body in an artificial womb technology until ‘birth’. The 14-day rule is an international legal and ethical standard which means human embryos cannot be grown outside the body for more than 14 days, as this is widely accepted to be the point when twinning is no longer possible and the embryo thus forms its own unique entity.
Ireland currently has no legislation limiting human embryo research per se, meaning that individual research centres/universities, have had to devise their own ethical guidelines on embryo research. Funding bodies’ policies may also affect this, for example, Science Foundation Ireland does not fund research using human embryonic stem cells, pending the enactment of specific legislation. The proposed General Scheme of Assisted Human Reproduction, published in 2017 but not yet enacted, states that embryos used for research could not be maintained in vitro beyond the 14th day of development after fertilisation and must be destroyed, although this Bill does not explicitly refer to ectogenesis. However, recent changes internationally regarding support for the 14-day rule could influence future legislation.
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Complete ectogenesis, should it become scientifically and legally possible, would give rise to a myriad of legal and practical questions, such as who should be the legal parent(s) of a child born via ectogenesis, who should be allowed access the technology, under what conditions, and costs, and what would be the legal status of a fetus gestated via ectogenesis.
It could also have wide social impacts as it may be used in the assisted human reproduction context to allow people to have biological children who otherwise may be unable to do so without the assistance of a third party (e.g., via surrogacy). Some have argued that ectogenesis could also lead to greater equality between the sexes as women would no longer be required to undergo the physical, mental, social and economic burdens associated with pregnancy and birth. Others have highlighted that it could ensure a safe environment for the fetus – free from potential dangers such as alcohol, tobacco, disease or illness.
However, the long-term mental, physical and/or social effects and ethical implications of human gestation in an artificial womb are not known. The Ectolife video imagines an optional genetic editing package used alongside ectogenesis, which also raises ethical concerns, including around the use of genetic editing in humans and related eugenics issues.
While complete ectogenesis may not be scientifically possible until the distant future, advances in partial ectogenesis in animal studies are developing at pace and may, once the legal and scientific hurdles have been overcome, be available to humans. Thus, it is vital that there is a deeper conversation which considers the legal, ethical, and social issues relating to complete ectogenesis, before such a facility as imagined in the Ectolife video is capable of becoming a reality.
The research conducted in this publication was funded by the Irish Research Council under award number GOIPG/2022/620
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
