Department of Philosophy and Moral Sciences, Bioethics Institute Ghent, Ghent University, Blandijnberg 2, 9000, Ghent, Belgium.
BMC Med Ethics. 2021 May 13;22(1):59. doi: 10.1186/s12910-021-00630-6.
Breakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation.
This paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis' subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus.
The development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy.
动物研究的突破使得人类应用外生性技术用于医疗和非医疗目的的话题比以往任何时候都更加相关。虽然目前的数据尚未显示出很快就能有合理的临床获益预期，但有几个研究小组正在研究人工子宫用于体外人类妊娠的可行性。
本文首次全面而及时地讨论了外生性技术在临床应用方面最重要的利弊，并探讨了继续研究和临床转化外生性技术所引发的关键伦理（和法律）问题。预期的益处包括推进产前医学、改善新生儿重症监护、为生物父母身份提供新途径。这带来了重要的未来挑战。在应用于人类之前，必须考虑有关转化研究、人类胎儿的实验使用和适当的安全测试的重要问题。需要确定关于外生性技术主体风险的关键问题，以及当需要从子宫转移到人工子宫时对孕妇的身体影响。必须考虑到相称性的关键问题，包括平等获得的机会，相对于外生性技术的预期应用。外生性技术的出现也带来了围绕堕胎、延长胎儿存活能力和胎儿道德地位的关键问题。
外生性技术的发展将对临床实践产生众多影响。在进行人体试验之前，应仔细考虑是否（以及如何）将外生性技术作为现有新生儿护理的延续引入，同时要充分考虑到对胎儿的安全风险以及对孕妇进行实验性和/或侵入性程序的压力。同样重要的是，社会应该就外生性技术的可接受应用以及如何优先考虑这些应用进行辩论。应该预料到，外生性技术的临床可用性，可能首先是为了挽救极早产儿，可能会引发对非医疗目的的需求，如避免怀孕的身体和社会负担。
