#1222 Teresa Baron: The Artificial Womb on Trial

00:00 Ricardo Lopes: Hello everyone. Welcome to a new episode of The Dissenter. I'm your host, as always, Ricardo Lopes, and today I'm joined by Doctor Teresa Barron. She's assistant professor at Nottingham University working on reproductive ethics and philosophy of parenthood. And today we're going to talk about her book, The Artificial W Womb on Trial. So Doctor Barron, welcome to the show. It's a pleasure to everyone. Thanks very much for having me here. So let's start perhaps with just a definition here just also for people who might not be familiar with it to understand what we're going to talk about here. What is artificial womb technology?

00:43 Teresa Baron: Uh, WELL, so artificial womb technology in the way that we might conceive it and the way that it's been presented in science fiction doesn't exist yet. This is the kind of pod that we might imagine in which a human fetus grows outside of the human womb, the biological womb. I, I say human, but of course this could apply for any mammal. What does exist at the moment is, uh, uh, Sort of, uh, scientific research project into ways in which we might support late stage, uh, fetuses. Uh, FOR example, when a pregnancy gets into trouble or when there's a maternal fetal conflict outside of the womb, but we're talking about. Moving fetuses from an established in utero pregnancy into a kind of support system. So the kind of um brave new world image of an artificial womb uh is not on the radar yet, but it's something that of course comes up a lot in the ethical literature when we talk about the way in which this kind of scientific work might progress.

01:49 Ricardo Lopes: But is this kind of technology being developed at all? I mean, and if so, how, how developed is it?

01:58 Teresa Baron: There are, um, OK, so maybe we need to break this down into two strands of research that are relevant to this. So artificial womb technology, when you again, when we think about the the kind of sci-fi concept and the idea that we might one day be able to move procreation completely out of the body and into uh independent scientific technologies. That requires us to be able to, uh, implant an embryo into some kind of artificial environment and get it to start developing there. That's one sort of end of the research spectrum there. And that's something that currently we are able to implant or we are able to maintain and develop human embryos in artificial environments, but only up to a certain time point. In most countries, that's 14 days, at which point there is a legal cutoff. You cannot do any further work there. So we have this kind of very short stage in which we can support the embryo outside the body at one end. Uh, AND then at the other end, we have different kinds of support technologies. Uh, YOU know, the, the neonatal incubator could in some ways be seen as something akin to an artificial womb, depending on how we, we define that. But the more, uh, kind of something we might more closely, uh, describe as as artificial womb technology is something that is being developed currently in 4 different countries. Around the world, and this is a system that would allow support of the developing fetus while maintaining fetal physiology rather than the transition to breathing air and the transition to neonatal physiology. So when we think of a standard neonatal intensive care unit and the incubators that are used to support premature babies when they're born too soon and are very fragile and very dependent. They are still, they are neonates, they have switched over to breathing air and we are supporting them in that physiology. So the kind of technologies that I'm talking about that are being developed in only a few projects around the world are technologies that would allow the fetus to continue essentially gestationally developing, but outside the body. So maintaining uh oxygenation via fluid, um, and continuing to develop as if it were in the womb. These are obviously incredibly difficult and expensive research projects. Um, THERE are 2, located in the US, one a joint project between Japan and Australia, and one, currently being run in the Netherlands. Uh, VERY costly, very difficult, and, um, nowhere at the level ready for, um, human subject trials yet. So the trials that are being currently conducted with these technologies are being done using animal fetuses, mostly sheep and goats, sometimes pigs, uh, but nowhere humans just yet.

04:50 Ricardo Lopes: And what kinds of philosophical questions does do artificial wombs raise?

04:56 Teresa Baron: Oh my goodness, so many, so many, uh, part of the, the kind of philosophical conundrum, uh, focuses on the actual research ethics of the science being done now. So this is where my book really focuses. Um, AND this is the kind of research questions that we might apply not only to animal trials, but also to potentially humans. TRIALS. How would we, for example, ensure genuine morally transformative informed consent from parents participating in this kind of trial? You can just imagine that the only suitable candidates for this kind of trial might be parents who have just been informed that their pregnancy is at risk of extremely premature birth. Uh, THAT'S a state of we can imagine severe distress and, and, and fear and confusion and uncertainty. Are we going to ask them to enroll in a very experimental technological trial? That's, that's one area. So we've got the kind of the medical research ethics, but there are also bigger philosophical questions that we might ask about artificial womb technology in general that focus not just on the research ethics of the science happening now and you know, in the near future, but also. Focusing on the longer term project of developing an artificial womb that could genuinely remove procreation from the biological body and from from this this whole process. And some of those questions are, for example, more political philosophy questions about uh the equality of men and women. Would the artificial womb, for example, um, remove the biological barrier to equality that uh some. Feminist philosophers have have argued, you know, the artificial womb is necessary for women's true liberation, or would this be imposing essentially the male, uh, life form and life cycle on everyone in a, you know, the worst possible blow to equality for the sexes. So, uh, that's another area of um. Of thinking that's kind of being being developed around these questions. Another one is, for example, the ethics of abortion. Uh, SO some philosophers have raised the concern that if we have the possibility to move any pregnancy into an artificial womb, will that develop a slippery slope from not just pregnancies that are in trouble, for example, because of a maternal fetal conflict. I mean we can imagine. Um, A pregnant woman who needs chemotherapy, we could remove the fetus and allow it to develop healthily and safely without being adversely affected by by that process and you know, save, save both organisms. Um, BUT would there be a slippery slope from that kind of situation to a situation in which any woman who wants to have an abortion because she doesn't want to carry the pregnancy at all? IS essentially forced to have that fetus moved into an artificial womb. What would that do for for paternity rights as well? Would men have any kind of claim or rights or responsibility for a fetus that develops in an artificial womb, regardless of their their role in the kind of broader decision making around that. So there's a lot of very difficult, uh, very interesting, very difficult ethical and political questions that come out of this territory. Um, AND finally, there's, there's metaphysical questions we have to ask ourselves, uh, questions about what it means to create human life, well, any kind of life, but most of the time we're interested in human life in in this kind of field. Um, AT what point do we, uh, think of an embryo, for example, as a person, uh, the calls that have been made to extend the 14 day limit that I mentioned earlier on embryo research, uh, in vitro. That brings up all these kind of questions about at what point that embryo should be considered a human subject. So at the moment embryos sit in this very unique, uh, niche in research ethics and regulation that's kind of been carved out for the embryo. They're not, uh, human tissue, but they're also not human subjects. They have a very special little. Uh, NICHE that's been written for that purpose. But at what point do we move them? And can we just keep expanding that niche? Or at what point do we have to see this as, um, you know, the beginning of a person in a way that might slide into human subject research ethics regulation?

09:22 Ricardo Lopes: Right. Yeah, yeah, I understand. So what are the strongest or what would you say are the strongest moral, scientific, and political arguments for developing and using artificial womb technology?

09:40 Teresa Baron: Uh, THERE, I think it really depends on what kind of artificial womb technology we're looking at. So we, we might want to focus just on the kind of neonatal and fetal support technologies that are currently being developed, um, in which case, I think the very strong arguments are, are for developing those technologies are the ones that are currently motivating that research, you know, the ability to save the lives of wanted, uh, babies when they are born very premature. And this is a field in which medical science has been advancing, uh, you know, leaps and bounds over the last century. Essentially, you know, it used to be that being born at 30 weeks was a death sentence. Uh, BABIES can now survive earlier and earlier and earlier. Um, AND of course the push to develop these kinds of support systems are not only aimed at saving the lives of these very premature. FETUSES slash neonates, but also to reduce morbidities because now we can save the lives of often 22 or 23 week estimated gestational age neonates if they're born very premature, but there is a very high risk of quite severe morbidities if you're born that premature. So developing this kind of technology is motivated by I think very compelling drives for, uh, not only reducing, uh, mortality, but also morbidity. If we look at the kind of broader question of whether we should be trying to move from that ground from that foundation and to develop artificial wombs in the more kind of brave new world, uh, Huxley sense where we could just outsource procreation entirely to machines. I think there are there are some arguments that maybe are more compelling and some that I find incredibly uncompelling. So, uh, so for example, some of the arguments that have been put forward about, for example, the need for artificial technology to liberate, uh, female body people, uh, from, uh, sex inequality. I find, uh, very unconvincing, partly for the reason that. When we look at sex inequality, this is a global phenomenon. Um, WE can just we can very easily imagine that if artificial womb technology were developed, uh, rolled out safely for for use by, uh, by citizens of whichever country got to it first, this would only be accessible to the very well off, uh, those with the resources to to utilize that technology. This is not something that would. Lift, uh, the entire, uh, female half of the population of the world out of, uh, sex-based inequality overnight. It's something that most, most people, probably 99% of uh of people would never have access to, um, at least not in any kind of foreseeable future. The other problem is that of course, Unless you couple the rollout of artificial womb technology with sterilization of the entire population, there will still be pregnancies. There will still be people who, whether deliberately or unintentionally get pregnant and having artificial wombs available doesn't prevent that, uh, that kind of issue. So we still have the the the looming specter of um. Pregnancy based or childbirth based discrimination. Um, AND so I I find this kind of idea that the artificial womb will free us all from this kind of discrimination, this kind of inequality, the burdens involved in childbirth, um, and early child rearing and so on, very unconvincing.

13:21 Ricardo Lopes: Uh, AND on the other hand, what kinds of adverse outcomes have people been warning about and what are the strongest arguments against developing this kind of technology?

13:34 Teresa Baron: Um, I think there's a few different ways in which people have gone and kind of warning against developing this technology. One of those I think is a fear about, uh, commodification more broadly. So a fear that if we remove the, uh, biological process or remove that process from our own bodies, procreation becomes so detached that people think of children in a in a in a new way that we might not be prepared for. Um, AND that. You know that that fear has been expressed in various different ways, uh, from the kind of lower we might say lower level of fear that people will not bond with their children uh in the same way. I'm not very convinced by that argument because of course we know that stepparents, foster parents, adoptive parents, um, many parents develop incredibly loving and and close relationships with their children without any kind of biological bond, whether that's gestational or genetic. Other kinds of fears that I think are potentially more, uh, legitimate concerns that have been expressed are the ideas that, um, as we've seen in some surrogacy cases, for example, cases in which, uh, Commissioning parents have changed their minds about wanting the child halfway through a surrogate's pregnancy has been completed. There's been a couple of high profile, quite scandalous cases, um, in the last decade or so that have shown this this sort of attitude, um, which of course, you know, is not widespread, but uh it's the kind of thing that especially if it gets. Into enough newspapers, people will will worry about people might worry that the same kind of of consequence could arise with artificial womb technology that, you know, you could put your order in, uh, for your artificially gestated baby and somewhere in the process of gestation, go, ah, you know what, actually, we've changed our minds about this. Um These fears and these debates are often rolled into uh or rolled up with artificial womb technology and also, uh, other ethical debates about, for example, uh, prenatal genetic diagnosis, um, the idea that we might and and also separately, the idea that we might at some point be able to create designer babies by modifying the germline. Different, uh, different issues, but that end up packaged up together in this broader fear around what might happen if we let procreation get too technical and too personalizable. Um, SO I think this is this is definitely a uh a larger category of ethical debate that I think is is more legitimate to be concerned about than the idea that if we don't gestate our babies personally, we won't love them.

16:24 Ricardo Lopes: And that would be a form of eugenics, correct.

16:28 Teresa Baron: So the, the worry about eugenic motivations is one that definitely comes up a lot in these uh arguments about, um, not just artificial womb technology, but things like CRISPR and the possibility that of course, at the minute, uh, again, the scientific research is focusing on, uh, for example, eradicating. Uh, SPECIFIC heritable diseases, but people look at that and go, oh, but what if one day we can use that technology to choose our babies eye colors, IQ, uh, sporting, uh, ambitions and abilities. Uh, OF course, when you can select for that kind of thing, the, the, the word eugenics comes up immediately.

17:11 Ricardo Lopes: Yeah, because I would imagine that if we were trying to eliminate something like cystic fibrosis, probably not many people would oppose it, but when we get into the realm of trying to improve or Increase IQ and selecting for particular kinds of physical traits, that's more controversial,

17:36 Teresa Baron: right? Absolutely. And of course we are nowhere near. I keep saying we as if I am a scientist. The the brilliant scientific teams that are working on these uh different lines of research are nowhere near the the stage at which you would be able to select your baby's IQ, uh, even if I'm not sure that's even a genetically linked trait, maybe it is, but um we're we're nowhere near that stage in the same way that we are nowhere near the stage of having. Um, YOU know, full, um, complete ectogenesis in the sense we could have artificial wombs that gestate from embryo to to full term. That's just not anywhere near us on the horizon. But something that we do need to consider is that medical ethics is not always completely ahead of scientific innovation. So it is important to have these debates and to to to think where might we translate this into policy into regulation. As far ahead as we can, um, as long as we're not, you know. Sliding down into uh into insane hypotheticals that may or may not be divorced from the scientific reality.

18:46 Ricardo Lopes: Of course. So in the book you talk about the convergence argument. What is it and how does it suggest that we avoid some of the ethical problems associated with the development of complete ectogenesis?

19:03 Teresa Baron: Yeah, thank you. Um, THIS is. Uh, THE convergence argument is the general name I've given to a shape of argument that comes up. I think I found it at least 6 times in different. Bioethical works, uh, from the 80s to, you know, last year, uh, that focus on how we might get around some of the ethical conundru, the, the ethical sticking points that would be presented by trying to develop an artificial womb from scratch. So imagine that you've got your your artificial womb prototype, you want to test this with human subjects. The only way to do that. Uh, AND the only way to kind of see that it works or find out what doesn't work and develop it further would be to insert a human embryo and try and gestate that as long as possible, ideally to full term, uh, to show that it works. The problem with this, uh, that most ethicists see immediately is that this, this would involve. Producing, uh, people for the purposes of scientific experimentation and and also knowing that because we almost never get it right the first time, we would be developing, uh, developing people in the knowledge that their outcomes would not be as good as if they had been gestated in in a in a biological womb. Um, So that's the kind of the the sticky point. We can't make people, um, just for the instrumentally to show that our science either works or doesn't work. So how can we avoid that? Well, uh, these different bioethicists have In different forms, uh, but mostly kind of dancing to the same tune, argued that we can avoid this by converging two branches of independently justifiable scientific research. So we can take our, our work, uh, in which we Maintain human embryos, uh, and I guess eventually if that 14 day limit were to be extended early fetuses outside the womb, um, and just keep increasing that length of time in which we in which we maintain them outside the biological womb. And at the same time at the other end of of gestation, work back the age at which we can support an extremely premature fetus uh from an existing pregnancy. Outside the womb. So basically intervening in that procreative process, uh. Later and later from one end and earlier and earlier from the other end. And the idea would be that at some point they will just naturally converge. Uh, AND we can use that overlap, um, to essentially go, oh, well, look, we have accidentally created an artificial womb that can get you from embryo to full term baby. And we never had to go through this messy process of instrumentally creating people for the purposes of research. Um, THE problem with this convergence argument is that, well, actually there's a few problems with it, um, as I explain in the book, but one of the biggest problems is that it does not account for the fact that this overlap. Is itself, uh, representing a research process. So the idea that we could, you know, develop an embryo outside the womb up to this point and that we could intervene to rescue a late, uh, late stage mid-stage fetus from this point, uh, into our, uh, support system. Transitioning from one to the other would itself be experimental. So we don't actually eradicate, uh, new experimental research by having this kind of convergence because getting from one to the other would still be experimental. You would still be placing, uh, that embryo or that fetus. In a certain kind of risky situation, in order to see that it works. We don't have the same kind of moral justification for taking that leap that we do when there is a fetus in an existing pregnancy. To whose interests we can appeal in using experimental or innovative procedures. We can go, look, it is in the fetus' interests to survive, and of course in the parents' interests to save their baby, um, when it's a wanted pregnancy. So we can appeal to an existing set of interests. But when we're just bringing that embryo or fetus into existence as part of a scientific procedure, that there is no preexisting person to whose interests we can appeal to justify the risks that we impose. Um, BECAUSE of course, these are not, uh, research subjects who can consent. If you bring someone into existence through, uh, experimental ectogenesis, you can't ask them beforehand if they consent to the risks that that might involve.

23:48 Ricardo Lopes: So tell us about the proof of principle trials using mid to late gestational stage animal fetuses that have been carried out in different countries. I mean, how are they done and what results have people been getting?

24:06 Teresa Baron: Yeah, um, so these are trials that have been carried out, uh, mostly in, um, in the US and, uh, in the project that's being run between Australia and Japan. Um, AND again, mostly using fetal sheep and goats. There have been a few trials using, um, miniature pigs. The key facts, I guess to lay out about these trials is that they, uh, involve taking a fetal animal from, uh, a pregnant sheep or goat, uh, or pig and moving that fetal animal into, um, the, uh, ecto gestational support system. And this is a system that maintains, uh, oxygenation via the lungs, so preventing the animal from starting to breathe. Um, AND seeing whether basically whether that animal can survive, whether, uh, the fetal animal survives inside that system. That's one crucial element. Seeing whether it can survive being removed from that system, that's another crucial element, and seeing whether gestation within that kind of artificial environment has any, uh, substantial adverse effects on, uh, brain development, for example, or organ development. And this is a uh. An area of research that is Gosh, nearly 70 years old now, and some of the early trials done in, in uh, in the 50s and 60s in this area are uh interesting but shocking to read. You look at that and go, man, there was just no research ethics then at all. Uh, PEOPLE could just do whatever they wanted. Now, of course, there is a much tightly, a much more tightly regulated research ethics process. Um, AND, and of course, uh, much, much more robust peer review system. But, but I want to emphasize this is a long running. Uh, RESEARCH field Um, and The last decade has, I think, seen the most promising results in that area. So there are, uh, you know, trials which have demonstrated that fetal animals can be kept alive and kept kind of gestationally developing in these artificial environments, uh, for days or even weeks, um, and that they can be weaned from the artificial environment to standard, um, sort of neonatal incubation, um, without. Too many adverse effects, but there has to be a caveat, it's important to know that fetal animals, uh, that are being used in these trials. Uh You know, they they might be representative of human fetuses in in certain ways that makes the science worth doing. Of course, there have to be some similarities, but they are very different from human fetuses of the relevant gestational age in many ways. And one of the key ways in which they are different is that they are bigger at the the kind of relative gestational age that we're looking at. A fetal sheep is bigger, it has, it has greater mass, its arteries are wider and therefore easier to cannulate. So the question of, oh, well, you know, the animal trials worked, great, we can switch over to human trials is it's absolutely not that straightforward. There is a much more difficult trans translation process from human trials to uh from animal trials to human trials than we might expect.

27:28 Ricardo Lopes: Has complete ectogenesis already been achieved?

27:33 Teresa Baron: Uh, NOT in the way that we might think. Um, NOW, complete ectogenesis is what I was describing earlier, where we go from embryo to full term, or at least, you know, as near to full term as we can get all outside the body. Um, WE cannot do that with humans. We cannot do that with large mammals. We have gotten relatively close to doing that with, uh, some. Uh, SOME other species. Um, SO I say relatively close, of course, uh, I don't mean that we can actually genuinely, uh, gestate, uh, an animal from embryo to full term. But, um, we, the, there have been, uh, trials done using, for example, embryonic and fetal mice that really push the boundary of, of the, the limit of how long we can maintain an organism, uh, in kind of gestational development outside the body. Um, AND you know, even with mice, we're not off the top of my head, we're not even looking at halfway through full term development, but the fact that we can. Create synthetic environments in which an embryo, uh, and early stage fetus can begin to develop and we can begin to see early organogenesis, um, is incredibly impressive and of course very useful for scientists to be able to do. But the kind of broader question of can we go from, uh, embryo to baby, uh, we can't do that in any mammalian species yet. It's something that birds and lizards have been doing for millennia, though, uh, you know, we have outside of the body development in many, many non-mammalian species. And, um, you know, this is something that When we look at the very earliest descriptions of, uh, ideas of ectogenesis, uh, you know, going back even hundreds or thousands of years when, when, um, people were pondering this question of whether, whether we could develop outside the body, they're taking their inspiration from, from other species that developing in eggs outside the body. Mhm.

29:39 Ricardo Lopes: Uh, HAS it been tried with human fetuses?

29:43 Teresa Baron: No, uh, there are two teams, um, off the top of my head that are getting ready to launch human subject trials, but they have not yet had approval. So, um, the Children's Hospital of Philadelphia, um, if I remember correctly, applied for FDA approval. Um, THE year before last, um, to launch human subject trials, they have not had that approval yet, but it's not been a straight up rejection. It's been a please go away and think about these, these other things. We're not completely convinced, but you know, come back, come back. Um, IT'S something that I think we can imagine seeing in the next 5 to 10 years. Uh, WHETHER we will be ready for that is a different thing. I think that one of the key issues. For this field and actually a lot of fields of, um, medical research, biomedical research is when you have a small number of teams across the world working on one thing, uh, and sort of racing to be the ones who do it first. Um, IT is easy to imagine that there are conflicts of interest involved. Um, EVERYONE wants a Nobel Prize. So I, you know, when I say we might see this in the next 5 to 10 years, I don't mean that necessarily as a good thing. I think there is a risk, and this is something that I'm working on in in my, uh, ethical writing. Uh THERE is a risk that we push or that these research teams push a little too fast, too soon. Not just out of the kind of scientific motivation, but because they are racing each other, you know, when when you have so few uh scientific teams working on the same thing, I imagine actually, if there's even more scientific teams, it might still feel like a race, but there are further um incentives that might color that picture.

31:33 Ricardo Lopes: What practical and ethical questions does it raise? I mean to try to do it with human fetuses.

31:42 Teresa Baron: There's quite a few different ones. One of them is the one that I mentioned before about informed consent. This is something that is absolutely fundamental to medical research, um, and experimental medicine to, um, separate fields. Um, BUT they both require a very high kind of standards of informed consent. The question is whether parents who were asked to enroll their fetuses in these kind of trials would have the capacity to give that informed consent, given the circumstances under which they might be presented with the option to enroll in this kind of trial. Um, AND the other is whether they would be able to give kind of informed consent, like even if they were not in this situation of, of, um, fear, distress and uncertainty when you just find out that your, your pregnancy is at risk of extreme, extremely premature birth. You might think, all right, well, even if they aren't feeling distressed and and and afraid. Would parents in those situations be able to understand any kind of Robust level, what the distinction is between the experimental option and the existing neonatal incubation option, um, that would allow them to make an informed decision. How would these options be presented? Um, IS are there again vested interests that would encourage, for example, the promotion of one option over another. Um, THESE are all things that would have to be handled incredibly difficult, uh, um, incredibly carefully. Um, THEY would be difficult. They would require a lot of independent scrutiny to make sure that those processes are as as ethical as possible. And that's something that of course comes up in in all kinds of medical research. But I think here, um, you know, we're talking about decisions having to be made very fast, um, and in a in the face of distress and extreme uncertainty. So I think that's 11 ethical issue. Another is, uh, as I kind of follow on from what I was saying before about animal trials, knowing when to translate from animal subject trials to human soldier trials. At what point can we say that we have enough evidence that this would be a viable option in order for us to present parents with uh. Eo gestation as an option for treatment for an extremely premature baby, we would have to have enough evidence that this is at least as good an option in terms of the likely outcomes for the baby. Um, AS the existing treatment, which would be in, uh, the neonatal intensive care unit. But how can we have the question is how do we get that kind of evidence from the animal trials? Um, SO there are, there are a lot of very difficult problems to be untangled here and some of them. The ethics and the science are are really intertwined. We can't necessarily know what the ethical solution is without knowing what the scientific data show us, which is why I think in this area, as with many areas of medical ethics, it's really crucial for ethicists engaging with these questions to be as well versed with the science as possible.

34:51 Ricardo Lopes: Mhm. How does partial ectogenesis differ from complete ectogenesis in terms of how it is approached philosophically?

35:02 Teresa Baron: One of the key things I think is this question of interests. So when we look at partial electiogenesis, um, at the kind of late end of pregnancy, um, or at the early of the sorry, the early stage of development, we have two very, very different, uh, Notions of interests, uh, to deal with. When we look at an embryo that is going to be used for research and maintained in vitro, and then disposed of after 14 days, there is no human person there whose interests we have to take into consideration from this kind of ethical standpoint. Legally speaking, the embryo is not a person. And because we know that it is not going to become a person, because it will have to be destroyed at 14 days, uh, it cannot be developed further outside the body. We also know that it's not a future person. So there's there's there's no person and no future person. If there was a future person, then there would be the interests of that future person's interest, uh, interests of that future person to take into account. But there's no interests involved there that are morally relevant to that conversation, at least in the framework that we're using at the moment for that kind of research. At the other end, there is an existing fetus, there is an existing, um, pregnant woman. At least two sets of interests that we can weigh into that moral calculus of, you know, uh, would intervention X be justified? Would intervention Y be justified? Um, WHAT is in the interests of these people? Now, complete ectogenesis. So this idea that you would, you know, do the entire thing in an artificial environment. Is A kind of an interesting metaphysical and ethical conundrum, because at the beginning, there is no person and of course at the end, there is a person. That's something that we're very used to dealing with in the ethics of pregnancy. But of course, with the artificial environment, it all looks a little bit different. At what point do you start to see this as a process that you have to kind of leave running? At what point can you make interventions in the interests of that future person? At what point should you say, oh, well, You know what, this seems to be developing a bit weirdly. Let's terminate the process now. I don't think that we can completely straightforwardly translate abortion ethics onto that kind of debate, especially when we're still in the realm of research. Um, BUT I also don't have a uh a framework in mind for what we should use, uh, in order to answer those kind of questions when it comes to complete ectogenesis.

37:33 Ricardo Lopes: How does this technology, artificial womb technology, compare to the development of technologies such as in vitro fertilization and mitochondrial DNA transfer?

37:46 Teresa Baron: So, yeah, uh, in some ways, they overlap entirely in terms of the metaphysical questions that they require us to to ask and answer. In some ways, um, they're incredibly divergent, especially if we just focus on partial ecto gestation and the the kind of Research currently being done to try and support extremely premature babies. I think that that is entirely removed from the metaphysical and ethical questions that the development of IVF and MTDNA donation call up. But the idea of complete ectogenesis, and also any part of that research process that would require us to, uh, maintain embryos in vitro for a longer and longer period of time. I think definitely call back some of the questions that were asked about IVF during the early days of that research, um, and that have been raised again more recently with the development of mitochondrial DNA donation. And that is the question that we were talking about a little while ago, which is, um, At what point can you create someone for the purposes of research? Um, AT what point can you create a human person in order to show that you can. And when we look at the, uh, the early development of IVF, of course, this is not how, how this was framed by the scientists doing this. They were not creating people to show that they could. They were creating people to allow people to have babies, to, you know, to help with it was very strongly motivated. At least on some level, by the belief that it already was working, that they could do it with animal embryos and that it would work with human embryos. And so I'm sure that it wasn't motivated in this kind of very instrumental way. But in some ways, that is what it was, the very early attempts to, uh, create, uh, IVF, uh, babies. We research projects and these, these, the, uh, embryos that didn't survive were negative outcomes. The children that were born were positive outcomes. All of this. WAS instrumental to showing that the research did work. And I do think that we look at this now and go, well, it's amazing. People benefit so much from IVF. This was a fantastic breakthrough. I think we would look at it very differently if it had not worked. But the way in which people were enrolled in these trials, uh, and the the the efforts that went in, especially with things like, um, egg harvesting, which, you know, even today is not a pleasant process, but, uh, in those early days could have really, uh, quite severe mental and physical health consequences for for women who did it. If if IVF had not been a scientific success. But had failed, I think we would judge those scientists through a very different lens. And I think it's important to kind of be able to look at that independently of the actual success. Um So yeah, I think I think it's obviously we don't I I think there is a part of us that doesn't want to retrospectively. Find, uh, flaws in our scientific history and go, oh, well, actually, maybe it wasn't such a great thing. But I think the possibility that we might retrospectively judge a process or a discovery, um, in a negative light shouldn't stop us from applying that kind of critical scrutiny. Um, AND especially, you know, in comparison. Um, WITH the kind of processes that we're looking at now. Uh, I think it's something that I find, uh, really quite shocking every time I, I think about it is that one of the, uh, one of the pioneers of IVF, um, wrote in a journal article only 8 years, I think before the birth of Louise Brown, um, that, uh, there's the animal, uh, experiments had been a success, but that it would, of course, be unethical. Uh, TO implant, uh, a human embryo, uh, in a human womb, following the same process. So clearly, clearly, he rethought the ethics of it. But we have to ask, did he rethink the ethics of it because he rethought the ethics of it, or because the science started to look like it could work? Um, I think those are two separate questions. Right,

42:18 Ricardo Lopes: but do you think that there are circumstances under which it may be ethically permissible to bring children into the world for the purposes of research?

42:30 Teresa Baron: Personally, I, I don't. Uh, I, I, I've thought about this a lot, um, particularly in the process of writing this book. And I, I struggle more and more, uh, to justify ethically the idea of, of bringing someone into the world to show that a specific scientific procedure works. Um. And I know that that sort of has quite stark ramifications, uh, for a lot of reproductive technologies, a lot of reproductive science. Um, BUT The the kind of core ethical principle um of treating people as ends in themselves rather than as means to ends. I think is completely incompatible with treating, uh, human subjects, uh, including, I guess in this case, hypothetical human subjects. As a means to showing that a research process works. I think one attempt to overcome this problem that uh has been has been made is the distinction between, um, biomedical research and innovative medicine, which are treated quite differently and have different kind of justificatory frameworks attached. But I still I I I have this moral instinct, I suppose that. Bringing someone into the world to show you can is one of the worst possible justifications for bringing someone into the world. And that's within the context of a broader, uh, philosophy that we already bring children into the world far too lightly and that many of the reasons that we do, uh, are not good reasons.

44:05 Ricardo Lopes: And I mean, what would be the purpose and goals of doing so?

44:11 Teresa Baron: Of bringing children into the world,

44:13 Ricardo Lopes: into the world for the purposes of uh experiment or research. Yeah,

44:18 Teresa Baron: I mean, one of those reasons is that is part of the scientific process. So in the case of whether we look at IVF or whether we look at, you know, hypothetically at some point in the future, complete ectogenesis, in order to perfect a technological innovation or a new procedure, you have to run experiments, you have to find the The problems, uh, by trying to do the thing that you're trying to do, realizing what does and doesn't work, and, and kind of tweaking it until until it's perfect, until it works. Um, THE only way that you can apply that kind of process in reproductive technologies where the goal is to create a person is to try and create people. Um, AND in with some technologies, there's a lower risk involved that that might end up having negative consequences for the person created in that way. With others, I think the risks involved are much starker, especially in cases where we may not be able to intervene until it's quote unquote, too late.

45:20 Ricardo Lopes: Yeah. And in whose interests would such an experiment be conducted?

45:28 Teresa Baron: Most of the time when we look at things like the development of IVF, uh, the development of, uh, mitochondrial DNA donation, and in some ways of framing the development of complete ectogenesis, the interests most commonly referred to are those of prospective parents. So those who really want to have genetically related children, um. Under specific kinds of conditions. So mitochondrial DNA donation is a great example of this because this is something that Is often described as uh facilitating um or or preventing the uh. The birth of children with severe mitochondrial disease. But of course, we already have ways of preventing that. We have ways of screening embryos to check for these things. We also have, you know, in cases where a woman is a carrier for a mitochondrial disease, we, we cannot use donor eggs. But the thing is that the donor egg procedure won't allow her to have her genetically related child. So MTDNA donation is a procedure that has been developed, not Exclusively to prevent children from being born with mitochondrial disease, but more specifically to allow parents to have genetically related children and avoid passing down these diseases. So there are there are kind of more layers of motivation built in than we often admit. Um, AND I think part of The the role of ethics in this area is to scrutinize all all of those levels of motivation and to go, but why is it so important that you have a genetically related child? Why is that genetic link worth, for example, this risk, this risk, this massive resource, uh, used in in developing these, these technologies. These are, you know, potentially quite uncomfortable questions, but they're ones that ethicists definitely have to dig into.

47:24 Ricardo Lopes: OK, so I, I mean, I have just, uh, an, uh, a last broad question, let's say. I mean, uh, does, do you think that thinking about the development of artificial womb technology also raises broader questions or at least would connect to broader questions in the ethics of procreation, like, for example, what does it mean to bring a new being into the world? What does it mean to decide to perform an Act of procreation, uh, what does it mean to make the decision that life is worth living on behalf of a person who cannot be consulted? I mean, because, uh, I, I've had, uh, people, for example, anti-atalists on the show, and I was just thinking that, um, they would probably use this kind of technology to also. Put forth these kinds of questions. I mean, to what extent it is ethical even for people to procreate.

48:27 Teresa Baron: Yeah. Yeah, it's a big question. But it's a question that I think this, the, the kind of the generation, uh, who are currently in their kind of late 20s, early 30s, um, are now having to ask themselves in a genuine way for possibly the first time as a whole generation. Because the option not to procreate, uh, has is relatively speaking so new. You know, of course, we've had contraceptives that have been relatively reliable for a few generations now. But I think we finally reached a point where the acceptance of the decision not to have children is widespread and well grounded enough that this is now a genuine option. People are having to decide. Not just kind of, oh, when, when will I have children with whom will I have children? But am I going to have children? Do I want to have children? Why do I want to have children? I think this is the first time that um an entire cohort in society is faced with that as a as a very real choice. Um, AND something that therefore has to be dealt with on not just kind of personal levels, but but moral levels, social, political, economical levels. Um. This is, I think, a turning point in the way in which we we think about procreation. And of course, you know, as you mentioned antenatalism, um, uh, there have been, there have been antenatalists, there have been, uh, philosophers who have critically questioned, um, whether and why we should procreate. But I think that is different from the phenomenon that we're currently seeing where suddenly such a vast swathe of society is opening themselves up to this question, uh, in a very real sense. And it and we are seeing the effect that it's having on, uh, for example, birth rates in most developed countries.

50:21 Ricardo Lopes: Yeah, and I mean, I guess that from an ethical perspective it's not good enough for people to just justify procreating by saying something like, oh, it's what everyone does, it's what we've evolved to do. Uh, AND I mean, it's just that people have this impulse to procreate or this impulse to have sex that then results in procreation. I mean that those kinds of justifications are not good enough for ethics,

50:55 Teresa Baron: right. Yes, I think you you you you've hit the nail on the head there. And the instinct. I'm glad you brought up instinct because this is something that comes up. I think exclusively when it comes to uh procreation, that the the instinct, um, is brought up as as a justification in a way that is exclusive to parenthood, and that we wouldn't accept as a justification for any other kind of action. You know, if if if I say If I, if I get in a fight on the street and the police officer says, why did you hit that man? I go, well, I just had the instinct. That's not taken as a justification or an excuse. But people raise quite genuinely this, this, particularly when it comes to scrutinizing women's choices to either have or not have children. This this specter of the maternal instinct. You know, you, you, you say you don't want children, but you'll change your mind when that maternal instinct hits. You kind of think if someone has very kind of in a considered and rational way, looked at her, her life choices and her her her career, her family situation, her friends, her hobbies and gone. Yes, I think I will not have a child. To say to that person, oh, well, all those rational thoughts won't matter when this instinct arrives. You kind of think, well, that's that's kind of ridiculous. Why would we want to be the kind of people who will be swayed by an animal instinct in the face of decisions we've made quite rationally. So I think the instinct thing is I I could talk about that all day. Um, WE, we, we treat that in a very special way when it comes to procreation.

52:25 Ricardo Lopes: Yeah, oh yeah, and I, I mean, I would really love to get more into that. Perhaps we can do another interview just about that, but it falls outside of the purview of this one and the, and your book. So, uh, the book is again the Artificial womb on Trial, and I, of course, will be leaving a link to it in the description of the interview. And Doctor Barron, just before we go, apart from the book, where can people find you on the internet?

52:53 Teresa Baron: Uh, I have a, um, Phil people account. Uh, MY website is TeresaBaron.co.uk. You can find, uh, info about my publications and my current research projects on there. Um, AND you can find me on the University of Nottingham's web pages.

53:08 Ricardo Lopes: Great. I will also be leaving links to that in the description. And thank you so much for taking the time to come on the show. It's been a fascinating conversation.

53:16 Teresa Baron: Thank you. Yeah, it's been a great chat.

53:19 Ricardo Lopes: Hi guys, thank you for watching this interview until the end. If you liked it, please share it, leave a like and hit the subscription button. The show is brought to you by Enlights Learning and Development done differently. Check their website at enlights.com and also please consider supporting the show on Patreon or PayPal. I would also like to give a huge thank you to my main patrons and PayPal supporters, Perergo Larsson, Jerry Muller, Frederick Sundo, Bernard Seyaz Olaf, Alex, Adam Cassel, Matthew Whittingbird, Arnaud Wolff, Tim Hollis, Eric Elena, John Connors, Philip Forst Connolly. Then Dmitri Robert Windegerru Inai Zu Mark Nevs, Colin Holbrookfield, Governor, Michel Stormir, Samuel Andrea, Francis Forti Agnun, Svergoo, and Hal Herzognun, Machael Jonathan Labrarith, John Yardston, and Samuel Curric Hines, Mark Smith, John Ware, Tom Hammel, Sardusran, David Sloan Wilson, Yasilla Dezaraujo Romain Roach, Diego Londono Correa. Yannik Punter DaRosmani, Charlotte Blis Nicole Barbaro, Adam Hunt, Pavlostazevski, Alekbaka Madison, Gary G. Alman, Semov, Zal Adrian Yei Poltonin, John Barboza, Julian Price, Edward Hall, Edin Bronner, Douglas Fry, Franco Bartolati, Gabriel Pancortez or Suliliski, Scott Zachary Fish, Tim Duffy, Sony Smith, and Wisman. Daniel Friedman, William Buckner, Paul Georg Jarno, Luke Lovai, Georgios Theophannus, Chris Williamson, Peter Wolozin, David Williams, Dio Costa, Anton Ericsson, Charles Murray, Alex Shaw, Marie Martinez, Coralli Chevalier, Bangalore atheists, Larry D. Lee Jr. Old Eringbon. Esterri, Michael Bailey, then Spurber, Robert Grassy, Zigoren, Jeff McMahon, Jake Zul, Barnabas Raddix, Mark Kempel, Thomas Dovner, Luke Neeson, Chris Story, Kimberly Johnson, Benjamin Gelbert, Jessica Nowicki, Linda Brendan, Nicholas Carlson, Ismael Bensleyman. George Ekoriati, Valentine Steinmann, Per Crawley, Kate Van Goler, Alexander Obert, Liam Dunaway, BR, Massoud Ali Mohammadi, Perpendicular, Jannaertner, Ursula Guinov, Gregory Hastings, David Pinsov, Sean Nelson, Mike Levin, and Jos Necht. A special thanks to my producers Iar Webb, Jim Frank, Lucas Stink, Tom Vanneden, Bernardine Curtis Dixon, Benedict Mueller, Thomas Trumbull, Catherine and Patrick Tobin, John Carlo Montenegro, Al Nick Cortiz, and Nick Golden, and to my executive producers, Matthew Lavender, Sergio Quadrian, Bogdan Kanis, and Rosie. Thank you for all.