Wednesday, March 5, 2014

Occupy Womb

By Naomi Scheinerman

Sweden is the first and only country to complete not just one, but nine, uterine transplants. The women were either born without a uterus or had it removed because of cervical cancer and received wombs donated from relatives. The ultimate goal, of course, is to become pregnant and now four of those women have also had embryos transferred into their new wombs (through IVF). The womb transplants are meant to be temporary i.e. they will be removed after birth. The discussions surrounding these procedures invoke a number of important ethical and philosophical questions related to the goals of medicine, resource allocation, and procreation.

One of the main concerns surrounds the ethicality of purposeful risk to the wombs’ donors, recipients, and occupants (the fetuses). In other words, absent a valid medical reason, can risk ever be ethically permissible? Further, are these procedures legitimate uses of medical resources in light of the risks? The recipients must take drugs and be monitored closely throughout their pregnancy to ensure that their bodies do not reject the uterus. It is also relatively unknown how a fetus will fare in a transplanted womb and in its future life.

Calculations of risk entail weighing the relevant options. In the case of medicine, risky surgeries are usually only conducted if the alternative (not having the surgery) is even riskier (such as a bone marrow transplant for a cancer patient). Thus, in the case of a well-functioning, decently healthy individual (such as the women in Sweden), engaging in a significant surgery, and putting relatives through an intensive surgery as well, seems to carry avoidable risks.

Another way to frame this concern: are womb transplants medically necessary or enhancing? Medically necessary procedures are those that save the individual’s life, such as a heart transplant or a blood transfusion. Medical enhancements are not crucial to an individual’s life but make it better, such as a cochlear device for a deaf person or LASIK eye surgery to correct imperfect vision. However, the distinction between a medical necessity and enhancement is often difficult to defend and can crumble upon further scrutiny. Often, procedures we think of as enhancing dramatically “save” one’s emotional life which itself is morally significant enough to legitimize the procedure. For example, a face transplant for a burn victim is not medically necessary in the sense that the burn victim could survive without it, but can be socially necessary for future happiness and success. The implications of this distinction are important because we tend to allocate our scarce medical resources for medical necessities and view enhancements as illegitimate uses of these resources. And yet, we can concurrently make the case that enhancements do some significant medical good. For a woman who desperately wants to be pregnant the distinction between necessity and enhancement begins to collapse.

My final concern, which most powerfully objects to womb transplantation, is whether it is a healthy model of procreation in today’s society. In a world filled with opportunities for sperm and egg donation, surrogacy, and now womb transplants, I worry that there is an undo emphasis placed on the desire for a genetic connection with one’s offspring. I have no doubt that it is a miraculous thing to be pregnant and create a new life using one’s own genetic material, and perhaps also the genetic material of one’s partner. However, I worry when that is the most important desire for a family. Instead we should focus on building healthy relationships with one’s child and finding a home for children worldwide. I worry that womb transplants and IVF can and do detract from what’s important about procreation and place undo emphasis on carrying to term and having a genetic relationship with one’s child.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.


  1. Regarding the possible objections to this procedure on the grounds that it is not medically necessary, the same logic could be used against the process of IVF (although it does carry very little risk comparatively). We could be concerned with IVF because it too places emphasis on genetic offspring instead of finding a home for children worldwide.

    Another consideration could be the emotional and mental state of the woman. No doubt, couples who pursue a treatment like this must have considered the option of adoption, but they want a genetically similar child so strongly that they are willing to bear financial and medical costs for that result. These women are presumably very determined. Could we argue that not giving them this chance could be detrimental to their mental health?

    1. Absolutely, and I tried to articulate as much in the piece. Using the same logic coudl also eliminate pregnancy altogether, with or without IVF. The problem with the medical necessity v. enhancement debate is that it crumbles when we start evaluating the emotional significance of things that we deem "nonmedical" to an individual's welfare and well-being. I would put child bearing in that category, which is why I think that that argument does little to challenge IVF, and even womb transplantation.

      My main concern comes in the last paragraph, regarding the undo emphasis to genetic connection - there's something disconcerting about it to me. I find it morally strange for reasons to have a child - the reasons being wanting someone you're genetically related to. However, I don't think it's a freedom that should be taken away by the government.

  2. Does it make a difference to your argument that adoption is often expensive (a google search suggests as much as $30k), difficult, and not guaranteed? Many couples looking to adopt have difficulty being approved for a child, often for unfair reasons (for instance, if they are a same-sex couple). It may be easier to adopt if one is open to taking in an older child. But would-be parents may not feel capable of taking on the emotional challenges that sometimes haunt children whose first few years of life have been chaotic and, potentially, without adequate love and care. In this analysis, concerns about adoption have nothing to do with an overweening attachment to one's own genetic material, but with some very real barriers to adoption.

    1. It doesn't really make a difference because often times IVF and especially womb transplants are easily just as much as that and way more risky in terms of health. Also, I have yet to see a conclusive study that suggests that adopted children have significantly more problems with life and difficulty at home than others.