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By Anna Nelson.
Prompted by a sensationalist headline in the Daily Mail, there has been a furore on social media around an article published last year by bioethicist Anna Smajdor in which she defends ‘Whole Bodily Gestational Donation’ (WBGD). Put simply WBGD means that, with prior consent, the bodies of women in a permanent vegetative state could be used to gestate pregnancies on behalf of others.
The purpose of this blog is not to engage with the ethics of this proposal, nor is it to suggest that the paper on WBGD ought not to have been published (on this latter point, see J.Y. Lee). Rather, this blog reflects upon the widespread public response to the media reports on Smajdor’s article, and suggests that some of this anger could be more usefully focussed on present day challenges which threaten the rights and safety of women and birthing people.
Understandably, many of the concerns raised by social media users in response to WBGD were explicitly feminist in nature and highlighted worries about potential harm to women – physical harm to the bodies of the donor, harm to reproductive and bodily autonomy where coercion or lack of information undermines consent to such procedures, and broader, socio-cultural harm attached to the risk of WBGD compounding and perceptions of women as foetal environments.
I am not looking to address the legitimacy of such concerns, nor do I question people’s right to express these. Rather, I question why a theoretical exploration of a speculative aspect of reproductive science has attracted so much more attention and outrage – both by those in the media, and by those responding on social media – than the very real and very present way that women and birthing people are being harmed by the current under-investment in maternity services. I argue that those of us who are rightly worried about the way that future scientific developments could interact with society and medical institutions to sustain and perpetuate harm to women, need to have (at least) equal concern for that which is happening right now.
The disparity in outrage was powerfully illustrated by the fact that, only four days after WBGD came to widespread public attention, a shocking and heart-breaking story was published on BBC News, outlining how delays in post-birth treatment and poor interpretation services may have contributed to the post-partum death of a woman in Gloucester. While it would be inaccurate to suggest that this story went unnoticed, it received only a fraction of the attention that was prompted by Smajdor’s theoretical paper – both from the media and from the wider public.
This incident was not an isolated tragedy. Last year saw the publication of the final Ockenden Report on the independent investigation into maternity services at Shrewsbury and Telford Hospital NHS Trust, and the Kirkup Report on the independent investigation into maternity and neonatal services in East Kent. In both instances it was concluded that serious failings had resulted in avoidable harm to birthing women, their babies and their families.
Particularly shocking was the evidence laid out in the Kirkup Report about the “basic lack of kindness, care and understanding” being shown to “women and their families” (p48) and the failure to “ensure or preserve women’s dignity or meet their basic needs” (p50). Alongside this, both the campaign group FIVExMORE and the charity Birthrights published damning reports which highlighted the physical and psychological harm caused by systemic racism within the maternity services:
“There was one point in my labour right near the end where I remember looking at [my Partner] and saying, I’m going to be a Black statistic. I was so scared, and the epidural hadn’t come so I felt like people weren’t listening to me, it had been days…’
These reports clearly demonstrate that feminists are right to worry about the harms faced by women in the reproductive sphere – be those harms to physical safety, to bodily autonomy, to dignity or to psychological wellbeing. Yet, none of these issues attracted nearly as much attention or widespread public outrage as the theoretical discussion of WBGD. This, I suggest, illustrates that the groundswell of anger which was seen on social media following news coverage of Smajdor’s paper was somewhat misplaced; as reports about the ongoing, harmful experiences of women and others who birth within the current system do not attract the same levels of attention and public comment.
Of course, we should debate future scientific developments before they come to pass, and of course it is vital that we parse the potential intended and unintended consequences thereof (as someone whose PhD looked at partial ectogenesis, a speculative reproductive development, it would be incredibly hypocritical of me to suggest otherwise!). However, it is imperative that the same scrutiny is applied to the less sensational but arguably more materially significant harms which are experienced by women and birthing people, and their families, every day as a result of a maternity system which is underfunded, understaffed and undervalued.
While advances in reproductive science and technology do carry the potential to create new harms, it is more likely that they will serve to compound and magnify existing problems. Therefore, when we are thinking about these developments it is important not to lose sight of the forest for the trees. In order to truly protect women (and others who gestate), it would be helpful to direct some of the very vocal anger which was whipped up by Smajdor’s paper towards the very present and pressing fight to fund and sustain a maternity system which centres the dignity and safety of all who birth.
Author: Anna Nelson
Affiliation: Centre for Social Ethics and Policy, Department of Law, University of Manchester
Competing interests: None declared
Social media account of post author: @Anna_Nelson95
The post The furore around whole bodily gestational donation: a tale of misplaced anger? appeared first on Journal of Medical Ethics blog.
By J. Y. Lee.
Over the past week, a flurry of articles on the internet (for example: 1, 2, 3) sensationalized the contents of a journal article published by philosopher Anna Smadjor, on what she calls “Whole body gestational donation” – with discussants on social media largely condemning the proposed concept, and implying that “bioethics” itself is a corrupt field rife with repugnant ideas.
Smajdor’s work builds upon on an earlier paper by Rosalie Ber, who suggested that one way to avoid moral issues raised by gestational surrogacy might be to use female patients in a persistent vegetative state (PVS) – who had given prior consent – as surrogates. While Ber did not articulate a term for this concept, Anna Smajdor names this idea whole body gestational donation (WBGD).
Smajdor points out, quite plausibly, that just as some people would be prepared to donate parts of their bodies for organ donation, some may also plausibly be prepared to donate their whole bodies for gestational purposes. She suggests that states and health services – wherever organ donation is legal – might adapt their policies so as to allow for WBGD, as one option among other organ donation options. This means that people, just as they may elect and consent to donate some of their organs in case of their eventual death, might likewise consent to donate their whole bodies for gestational purposes in advance – or so her claim goes. On this framework, WBGD could theoretically be enacted in eligible brain-stem dead patients. WBGD would of course be “qualitatively different in that entails ventilation over an extended period,” in addition to the fact that it is not life-saving in the way people often understand organ donation to be. Rather, WBGD is proposed as a potential way to benefit aspiring mothers (or parents) who wish to avoid the risks and burdens of gestating with their own bodies.
Make no mistake – many ethical issues warrant continued discussion in this case. Smajdor fully acknowledges that “prolonging ventilation and somatic survival in brain-dead patients is undoubtedly a disturbing prospect,” given that WGBD would make salient the way a patient’s body can be completely instrumentalized for other people’s benefit. However, she believes – rightly so – that many of the ethical concerns which might follow WBGD have a similar structure to the concerns raised for other areas of reproductive medicine and organ donation. Thus, the fact that WBGD is riddled with various (though, in the end, standard) ethical concerns – like many other areas of medical practice – is obviously not itself a reason to shy away from raising the idea.
While I make no comment as to whether WBGD is a good idea overall, or whether it is something that I believe people in general might (or should) somehow come to accept morally, much of the reaction to Smajdor’s work, and the accompanying reaction to bioethics as a field, strikes me as misconstrued. One online article claims that “the body, even in death, still demands respect, and Smajdor’s proposal is not only disrespectful, but also dehumanizing and exploitative.” These are certainly ongoing concerns echoed in both the realms of organ donation as well as surrogacy, where ongoing bioethical debate offer rationales from different sides. Yet debates about what is or isn’t dignified, respect-worthy, exploitative, and so forth, are by no means settled. Smajdor’s justificatory scheme for WBGD is no different to the justificatory schemes that might be used in support of allowing commercial surrogacy, for instance. I myself have written critically about the objectionable ways that people overtly moralize commercial surrogacy (and in an accompanying JME blog post).
In fact, I can think of many other hard ethical cases up for debate which have not seemed to stir up the same condemnatory responses online. For example, many women with AUFI (absolute uterine factor infertility) find it acceptable to gestate their own child by receiving a uterus donation from living relatives (like one’s mother, aunt, or sister) or unrelated strangers willing to give up their uterus. This is despite the fact that a uterus transplant is not a ‘life-saving’ organ transplant, despite medical risks to both donor and recipient being widely acknowledged, and in spite of adoption and surrogacy being possible alternatives. The moral consensus when it comes to uterus transplantation, however, seems to be one of general excitement and continued endeavours to innovate. This is evidenced by the fact that, since the world’s first live birth via uterus transplantation in Gothenburg (Sweden) in 2014, research teams around the world have followed in Sweden’s footsteps. In the past couple years alone, many new countries have sought approval over their own uterus transplantation clinical trials – for example, in Australia and Japan. News headlines on this topic suggest that uterus transplants are ‘an amazing gift’, a stark contrast to the reaction borne by Smajdor’s suggestion to make it possible for people to donate their whole bodies for gestational purposes, despite there being clear parallels in terms of potential ethical worries.
While I am not suggesting that uterus donation is morally equivalent to whole body gestational donation, plausibly we might recognize that similar ethical concerns apply in both cases: we can question the conditions under which consent to be a donor/recipient for such a procedure might be legitimately given, we might anticipate the serious harms that might befall either party, contemplate the potential for emotional coercion and exploitation, and so on and so forth. Is it really, on balance, morally better to allow living uterus donors to undertake a risky, medically non-necessary, and non-life-saving procedure for people who wish to gestate, than to allow people to donate their bodies for gestational purposes in the event of their brain stem death? Of course, we might in the end find that the standard conditions proposed for uterus donation turns out to be more ethically acceptable on the whole relative to WBGD. But even if this were the case, such a result still does not speak in favour of taking the view that WBGD is a uniquely abhorrent or reprehensible proposal.
To point out another example, an article written by Didde B. Andersen in 2021 on vital organ donation makes a philosophical case for a radically permissive type of organ donation. Andersen argues that people – even people who are not imminently dying for other reasons – ought to be permitted to become living, vital organ donors. She says this may be permissible even when the donor risks incurring “non-trivial and irreversible harm (as is the case when he or she is not about to die for other reasons),” focusing on scenarios where the potential donors may voluntarily and autonomously wish to sacrifice themselves for others.
She calls this concept living vital organ donation (LVOD). Andersen’s LVOD is, in many ways, much more radical than Smajdor’s WBGD; for one, in the case of LVOD we are talking about patients who would still be alive at the time of donation but who would be killed in the process of the sacrifice. I think what the existence of this literature shows, however, is that bioethics, while it may sometimes be a platform for ideas we personally find repugnant, indeed remains an important field precisely because it is poised to debate a range of ethically difficult and complex matters. While some of these topics – and the mere fact of them put up for discussion in the first place – may strike many as completely alien to individual moral sensibility or gut instinct, it seems entirely reasonable, as well as valuable, for us to continue talking about issues for which people’s autonomy and welfare are at stake, and to reflect on why exactly we ought to approve or disapprove morally of both ongoing and prospective medical practices.
Author: J. Y. Lee
Affiliations: University of Copenhagen
Competing interests: None declared
Social media accounts of post author:
Twitter – https://twitter.com/jyleephilosophy
Webpage – https://www.jyleephilosophy.com
The post What’s the big deal with ‘whole body gestational donation’? On defending bioethics appeared first on Journal of Medical Ethics blog.
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Red squirrels that gamble at the game of reproduction outperform their counterparts, even if it costs them in the short term, research finds.
Imagine overhearing the Powerball lottery winning numbers, but you didn’t know when those numbers would be called—just that at some point in the next 10 years or so, they would be. Despite the financial cost of playing those numbers daily for that period, the payoff is big enough to make it worthwhile.
Animals that live in highly variable environments play a similar lottery when it comes to their Darwinian fitness, or how well they are able to pass on their genes.
Natural selection favors female squirrels that have large litters in years when food is abundant because they contribute lots of babies to the gene pool, says Lauren Petrullo, lead author of the study and a postdoctoral research fellow in biopsychology at the University of Michigan.
“We were surprised to find that some females have large litters in years when there won’t be enough food for their babies to survive the winter,” she says. “Because it’s biologically expensive to produce offspring, we wanted to know why these females make what appears to be an error in their reproductive strategy.”
The red squirrels studied live in the Canadian Yukon and experience a “mast year,” or boom in their main food source—seeds from the cones of white spruce trees—once every four to seven years. Squirrels forecast the large mast crop of food before it occurs and increase litter sizes in the months prior, ensuring better future survival for their babies and better fitness for themselves.
“There is a constant tug-of-war between the trees and the squirrels at our study site,” Petrullo says, “with each player trying to deceive the other for its own fitness gain.”
Petrullo and Ben Dantzer, associate professor of psychology and of ecology and evolutionary biology, used data collected by the Kluane Red Squirrel Project, a collaborative, 34-year-old field study involving the University of Michigan, the University of Colorado, the University of Alberta, and the University of Saskatchewan.
“This is exciting because it suggests that squirrels are eavesdropping on the trees.”
“Each year, we collect data on how many babies squirrels produce and how many spruce cones the squirrels eat,” Dantzer says.
The scientists quantified the reproduction of female squirrels during both food booms and busts, discovering differences in their fitness whether they gambled with their reproductive strategy or not. While some squirrels played it safe by keeping litter sizes small each year, those that took a “pie in the sky” approach by having large litters even when food was scarce enjoyed greater lifetime fitness if they got to experience a mast year, the research showed.
Unlike the Powerball example, though, squirrels aren’t guaranteed to eventually win.
“In some ways, this strategy of gambling with litter sizes is like playing with fire,” Petrullo says. “Because the average squirrel lifespan is 3.5 years and masts only happen every four to seven, a female could potentially be sabotaging her fitness by having too many babies in low-food years, hoping for a mast when she may die before she ever gets to experience a mast at all. This could be pretty costly.”
Alternatively, for squirrels, the cost of not gambling at all in the game of reproduction can be insurmountable if they end up missing their shot at the jackpot.
“It’s essentially impossible for a female to recuperate the fitness costs of not ramping up reproduction in a mast year, so the stakes are extremely high,” Petrullo says.
Females that increased litter sizes in low-food years did take a short-term hit to their fitness. But they were more likely to increase litter sizes if and when they experienced a mast, taking home the ultimate prize of greater lifetime reproductive success, she says.
The squirrels’ best bet, according to the researchers, is to take their chances and suffer short-term fitness costs in order to avoid the unmatched cost of missing the fitness jackpot completely.
“Determining the relative costs of different types of errors is key to understanding why animals make what look to us like mistakes,” Petrullo says.
Scientists are still unsure exactly how the squirrels are able to forecast future food production. The animals may be eating parts of the spruce trees that affect their physiology and alter the number of babies they produce, Dantzer says.
“This is exciting because it suggests that squirrels are eavesdropping on the trees, but we still have much more to do to solve this puzzle,” he says.
Because many animals use cues about things like food in their environment to make reproductive decisions, and the reliability of these cues is declining due to global climate change, scientists also wonder how the costs of these types of errors will alter what is the best reproductive strategy.
“If the predictability of a food boom is reduced and squirrels can no longer forecast the future, this could impact the number of squirrels out there in the Boreal forest,” Dantzer says. “This could be problematic given that squirrels are prey for many predators.”
The research, which appears in Science, had partial funding from the National Science Foundation and the Natural Sciences and Engineering Research Council of Canada.
Source: University of Michigan
The post Why red squirrel moms gamble on the trees appeared first on Futurity.
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