Segers Seppe, Romanis Elizabeth Chloe
Department of Health, Ethics, and Society, Research Institutes GROW and CAPHRI, Maastricht University, Maastricht, the Netherlands.
Edmond & Lily Safra Center for Ethics and Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard University, Cambridge, MA, USA.
Risk Manag Healthc Policy. 2022 Nov 24;15:2207-2220. doi: 10.2147/RMHP.S358553. eCollection 2022.
Increasing numbers of research teams are investigating the feasibility of developing artificial amnion and placenta technology (AAPT), commonly referred to as "artificial womb technology". This technology, aimed at supporting ex vivo gestation, has not yet been tested in humans, but it has been stated that we are closer to clinical application than ever before as breakthroughs in animal studies demonstrate good proof of principle. With these proof-of-concept models, further dissemination of AAPT as a research modality is expected. In this review article, we consider the ethical implications of the most imminent anticipated applications for AAPT. We focus specifically on the specific ethical complications regarding the improvements this technology may offer to conventional neonatal intensive care, its potential utility in facilitating prenatal interventions, and some of the broader socio-legal implications such as the debates about abortion access and reproductive and gestational choices. We discuss translational and societal questions when it comes to designing and developing this technology, like commitments to value-sensitive design, along with an examination of the legal and moral status of the entity gestating ex utero, which will be relevant for how it ought to be treated in the context of these various applications. From these perspectives, this review identifies the ethical questions that we believe to be most pressing in the development and potential introduction of AAPT, with due attention to their manifestation as translational and legal issues.
越来越多的研究团队正在研究开发人工羊膜和胎盘技术(AAPT)的可行性,该技术通常被称为“人造子宫技术”。这项旨在支持体外妊娠的技术尚未在人体上进行测试,但据称,由于动物研究取得突破,证明了其原理的可行性,我们比以往任何时候都更接近临床应用。基于这些概念验证模型,预计AAPT作为一种研究方式将得到进一步推广。在这篇综述文章中,我们考虑了AAPT最紧迫的预期应用所涉及的伦理问题。我们特别关注这项技术可能为传统新生儿重症监护带来的改善所引发的具体伦理复杂性、其在促进产前干预方面的潜在效用,以及一些更广泛的社会法律影响,比如关于堕胎权利以及生殖和妊娠选择的争论。在设计和开发这项技术时,我们讨论了一些转化和社会问题,比如对价值敏感设计的承诺,同时审视了体外孕育实体的法律和道德地位,这对于在这些不同应用背景下应如何对待它至关重要。从这些角度来看,本综述确定了我们认为在AAPT的开发和潜在引入过程中最为紧迫的伦理问题,并适当关注了它们作为转化和法律问题的表现形式。