June 5, 2024

Singapore will need to confront ethical and moral dilemmas with artificial womb technology

We are facing a brave new world with artificial womb technology (AWT). This refers to bioengineered systems for the gestation of human offspring outside the human body (technically known as ectogenesis or ectogestation), which promises to be a life-saving technology for extremely premature new-born babies.

At the current stage of its development, artificial womb technology cannot support a foetus from conception to birth. It is intended for infants born between 20 to 28 weeks of pregnancy, which is considered extreme prematurity.

It was recently reported that the US Food and Drug Administration (FDA) will approve human clinical trials of this new technology within the United States in the near future.

This would certainly be of interest to Singapore, which has increasingly leveraged new assisted reproduction technologies to overcome its dismal fertility rate that hit a new low in 2022.

While certainly useful for saving the health and lives of extremely premature babies born before 28 weeks, which is considered the threshold for requiring artificial womb technology rather than warding in neonatal intensive care units; there are two major ethical issues with this new technology platform.

What about disability?

The first relates to the cost-benefit assessment related to saving the lives of extremely premature new-born babies at all costs, even with increased risks of disability and lifelong health problems.

New technology platforms are often deficient. It can take several years for them to be optimized. The risk is that artificial womb technology at a sub-optimal level might place undue pressure on parents to utilize this new technology platform to save the lives of extremely premature newborns – a kind of emotional or moral blackmail.

The development of the offspring may be compromised even though its life is being saved. Particularly vulnerable are the developing lungs and brain of the extremely premature new-born baby.

This could result in severe disabilities and lifelong health problems, imposing heavy financial and care-giving burdens on parents. It might even cause much greater psychological and financial distress than simply losing a child.

Under such circumstances, the use of artificial womb technology would replace one harm with another, possibly worse.

Given that fewer than 1% of babies are born extremely premature, this new technology platform will not boost Singapore’s low birth rate.

Hence, even based only on a cost-benefit-harm assessment, the question that arises is whether it is worthwhile for Singapore to invest in it. Would it not be wiser to wait for this technology to be further developed, optimized and perfected in other countries, before introducing it into Singapore?

Moreover, in a Confucian society like Singapore, congenital disability is stigmatized, and disabled children are regarded as a shame for their families and as a burden on society.

Hence, parents would have to be carefully counseled on the risks of congenital disability, before electing to place their extremely premature new-born babies on life-support with artificial womb technology.

Rescuing foetuses for adoption

The second issue relates to the use of artificial womb technology to rescue late-term electively aborted fetuses for adoption. According the the latest statistics, there have been around 6,000 to 7,000 abortions annually for the past five years in Singapore. At the same time, there are about 400 infant adoptions taking place annually in Singapore, with the majority of these being inter-country adoptions.

Why not, some argue, permit the use of artificial womb technology to rescue and gestate late-term aborted fetuses at between 20 to 24 weeks of pregnancy, and make them available for adoption?

Under Singapore law, abortions cannot be carried out after more than 24 weeks of pregnancy, unless it is done to protect the life or health of the pregnant woman. At the same time, current artificial womb technology cannot be used on human fetuses less than 20 weeks old, because blood vessel development is not mature enough to allow transition to an artificial womb environment, which could severely compromise development of the fetal heart.

Very often, women considering elective abortion of an otherwise healthy fetus due to personal circumstances (i.e. unmarried mothers) often feel guilt. Could they possibly be persuaded to sustain the life of their late-term aborted fetuses in an artificial womb environment, and subsequently give it up for adoption?

The question that arises is: who picks up the tab? Perhaps the hefty medical bills could initially be borne by government funding, which would be reimbursed by the adoptive parents. After all, adoptive parents typically spend a hefty sum of S$25,000 to S$35,000 with a local adoption agency. Would not the money be better spent on rescuing late-term abortions?

In this case, the Government has to be extra careful that the number of infants rescued from abortion by artificial womb technology does not exceed the number of available adoptive families on the waiting list, or else the others would end up in state-run orphanages. Moreover, there is also a risk that some of the rescued infants might be disabled. This would certainly turn off many prospective adoptive parents.

Exploiting the technology

In the future, when artificial womb technology has advanced sufficiently to support all nine months of gestation, governments will have to confront novel ethical issues.

For example, affluent career women might use ectogenesis to escape the burdens of pregnancy and childbirth. This might lead pathologizing pregnancy and childbirth.

Still worse, knowing that women have the option of gestating their children in an artificial womb, employers might pressure them to avoiding taking maternity leave. Large multinational corporations might offer the technology to high-value female employees in senior management.

Yet another controversial issue is gestating children for gay couples, as an alternative to surrogacy. This could be combined with in vitro gametogenesis (IVG) technology to produce a child with two fathers and no mother.

The Singapore government should adopt an extremely cautious approach to this new technology platform, and rigorously scrutinize its ethical implications. 

Alexis Heng