The womb and reproductive technologies

Medical advances have led to the possibility of a uterus transplant, but is it ethical ?

Jennifer Kimball

Classical and theological discourse has always held a unique and deeply significant respect for the womb. Indeed, it’s the place where the human person first experiences communion with another, where the child is nourished and grows under the care of maternal union, where the developing person is most vulnerable and depends upon another in all things.

There’s a cultural norm in Catholic morality which implies a regard for the womb, but this norm has yet to be fully articulated in Church teaching. Its absence can be understood when looking at the Church’s early understanding of human embryology. In the 13th century, Thomas Aquinas thought that human life began only from the man’s sperm, his “seed.” The woman’s participation in conception was thought to be passive. It’s interesting to note, however, that the woman’s “seed” is mentioned much earlier (Gen 3:15).

The womb, or uterus, is part of the female reproductive system, yet outside of the generative capacity of the system itself. The womb doesn’t participate in conception, but it’s where a new life grows and develops.

By design, the womb doesn’t serve the physical integrity of the woman, such as the kidney or liver, but exists to serve another — actually drawing, to a small degree, from the physical good of the woman, demanding her gift of self.

Given that the womb exists for another and bears a deeper relational significance not yet fully articulated by the Church, Catholic bioethicists may need to address future issues such as womb donation and the gestation of embryos in artificial/mechanical wombs. In delving into these questions, we contribute significantly to current debates such as early embryonic transplants to save the life of the fetus. Are artificial wombs intrinsically wrong? Suppose a pregnant woman needs radiation therapy to prevent her death from cancer (and the unborn baby’s death as well). Would it be immoral to move the unborn child from the mother’s womb to an artificial uterus to protect its life?

In 2006, the review board for New York’s Downtown Hospital granted approval for Dr. Giuseppe Del Priore to perform the United States’ first human uterus transplant. The first known attempt was performed in Saudi Arabia in 2000. It was removed after 99 days due to clotting of the blood, even after two successful menstrual cycles. Upon hearing of the N.Y. board’s approval, barren women were lining up to receive a new uterus. With many cases of endometriosis and scarring of the uterus, conception can still occur in the fallopian tubes and travel the four to six days to the uterus. The problem with these illnesses, however, is not necessarily the lack of conception, but that the womb becomes inhospitable to the embryo, causing a failed attachment and the resultant death of the embryo. Given that medicine has sought a nonconventional therapy in the form of transplants, we must ask if it’s ethical.

The Church teaches that “ethically, not all organs can be donated. The brain and the gonads may not be transplanted because they ensure the personal and procreative identity respectively. These are organs which embody the characteristic uniqueness of the person, which medicine is bound to protect” (Pontifical Council for Pastoral Assistance, Charter for Health Care Workers, 1995, #88).

The uterus, though part of the reproductive system, does not comprise generational or personal identity of the donor such as with the ovaries, testes or brain. This may suggest that to donate this organ for the sake of another’s conceived children may be licit in Church teaching, though the need for such a transplant may only be realized as a result of advances in reproductive medicine and technology.

With a uteral transplant, a woman’s uterus is removed and then placed in another woman’s body in the hope that the woman and her husband may conceive a child. In formulating an ethical regard for transferring a heterologous (foreign) uterus into the body of another woman, will we need to consider marital or sexual ethics?

A child gestating in the donated womb within its biological mother is not foreign to the father nor is it generated without his participation. It also seems reasonable to say that the transplantation of the uterus, though part of the reproductive system, is not a sexual act in any fashion. It’s a medical procedure that provides an actual good for both the fulfillment of the marriage and the gestation of their children.

A woman’s becoming pregnant after such a transfer remains to be established as a result of the natural marital union. The gestation of the couple’s child, however, comes about through the gift of another though it remains personal to the mother and to her body.

I believe that, as technology progresses, the Church may rule that it’s permissible to transplant a womb in order to save another — and to gestate and nurture a human life.

Jennifer Kimball is executive director of the Culture of Life Foundation, a non-profit policy think tank based in Washington, D.C. She earned a bachelor’s degree and a Licentiate in Bioethics from the Pontifical Athenaeum Regina Apostolorum School of Bioethics in Rome.