Intersections

Evaluating Uterine Transplantation

by: 
Susan M. Haack, MD, MA, MDiv, FACOG

“As long as patients want it, there will be people trying to figure out how to make it safe and effective.”[1]

The desire to have a child of one’s own is a compelling force for many women. This desire drives many of the technological advances in reproductive medicine of which uterine transplantation is a prime example. Its recent development highlights the quagmire of ethical issues arising from technological advancement. When perfected, this procedure would appear to be a promising achievement, providing women who would have had no possibility of reproducing with the hope of having a child of their own.

But are there other ethical implications to consider, particularly in the context of church life and practices? In this post, I will compare taking and keeping with receiving and giving, as a dialectical framework for evaluating complex bioethical issues, a framework I developed in more detail here and here. To view life through the lens of taking and keeping is to live under the illusion that we are in control of our lives and our destinies through our own rational and technological powers. Conversely, in a Kingdom approach of receiving and giving, life (as well as technology) is a gift of God to be received and managed according to God’s purposes—gifts over which we are merely stewards.

The question at hand can be asked in this way: How does one approach the issue of uterine transplantation with an individual woman lacking a uterus, formerly believing that childbearing was not in her future, but who has suddenly been given new hope?

A utilitarian calculus considers costs for society against the good for her (a sort of cost-benefit analysis). Even if this approach is valid, it will be ineffective in the midst of her compelling personal desire to have a child of her own.[2]

Another approach is to explore the deeper meaning of childbearing: What does it mean to have a child? Is having a child a right to be demanded, a good to be pursued at all costs, or a gift to be received?

Rights entail corresponding responsibilities. If having a child is a right, then it falls to others—to society—to secure that right and to bear the costs. But in what sense is bearing a child a “right”? Despite common parlance and beliefs, having a child is not a right but a responsibility. Furthermore, if society is unwilling or unable secure the right or bear the costs in light of other pressing and unmet health needs, needs that are a matter of life and death, women may be angered by being deprived of a right to which they believed they were entitled.

There is no doubt that having a child is a human “good,” one even commanded by God,[3] but is it a good to be pursued at all costs? Today the all-consuming desire to have a child of one’s own often crosses the line from understanding procreation as an inherent good to understanding it as an instrumental good. As an instrumental good, the child (or the “experience” of pregnancy) becomes a means to another’s self-fulfillment rather than an end or a good in itself.

Technology offers many opportunities for women in their pursuit of that inherent human good of childbearing, but from an ethical or theological perspective, is there a line that can (or should) be drawn between techniques that aid realization of an inherent good and those that promote attainment of an instrumental good? Can we identify that line? Is there a point at which a child becomes a commodity to be produced rather than a gift to be received?

Technological progress has been a great benefit to humankind, improving our lives in a myriad of ways. Yet our interaction with technology can easily become distorted into a commitment to a sort of technological imperative—the drive to continually develop new and improved techniques as a good end in itself—which can be understood as an offspring of an attitude of “taking and keeping.” Having lost any sense of stewardship, the “imperative” has no regard for cost and risk and recognizes no limitations. This is illustrated by the Cleveland Clinic, which has suggested that a goal of their 5–year plan is to be able to transplant uteri into men, or rather transgender women,[4] a development that will significantly expand the applicability of the technique.

At what point have we slipped from being stewards and participants into an inappropriate role of co-creator, redesigning ourselves according to our desires? At what point does God’s gift become a matter of human achievement? When does pursuit of the good become a problem? Rather than receiving God’s gift of technology, have we not “taken and kept” it, transforming it into a human achievement? These questions are particularly important for the Church to consider, for we are called to be “salt” in this world, to preserve and enrich humanity. But, just as salt is also used on roads to prevent slippage on icy surfaces, so must we at times be the salt that prevents slippage into inappropriate roles.

Viewed through the lens of “receiving and giving,” technology is indeed a gift of God to be received from His hand, always as stewards, and with the attitude of giving back, whether to Him or to others. While the desire for a child itself is good and failure to realize our desires and dreams can be tremendously disappointing, from the perspective of receiving and giving, a child is neither a right nor a commodity but a gift of God to be received and held lightly. God distributes gifts according to His own purposes and plans, not our wants and desires. Trusting in God who is faithfully working out His good plans for us will lead us to consider what gifts He may have for us that we may be missing because our hands are too filled and our pockets too emptied in our pursuit of our own desires. Uterine transplantation is a tremendous technological achievement but is not without significant costs and ethical implications. Without prayerful consideration, in the process of “valuing life” through uterine transplantation and other reproductive technologies we paradoxically risk devaluing it.


[1] Bridget M. Kuehn, “US Uterus Transplant Trials Under Way,” JAMA 317, no. 10 (2017), doi:10.1001/jama.2016.20735.

[2] The procedure is experimental, complex, and costly. It necessitates all the attendant costs and risks of immunosuppressive therapy, in vitro fertilization, and 3–5 major operations prior to surgical removal of the transplanted organ. The cost of the transplant procedure which is estimated at $60,000 in the UK (a figure that would be more than double in the U.S.  and which insurance is unlikely to cover). See Womb Transplant UK, “Everything You Need to Know about Uterine Transplantation,” September 30, 2015, http://wombtransplantuk.org/everything-you-need-to-know-about-uterine-transplantation (Accessed March 5, 2017). The transplantation risks include retrieval from a donor, which is an eleven hour procedure if a live donor is used; placement in the recipient; and a maximum of two cesarean sections.

[3] The command to “be fruitful and multiply,” while most commonly applied to childbearing, may have nuanced meaning and applications.

[4] Denise Grady, “Will Uterine Transplants Make Male Pregnancy Possible?” New York Times, November 16, 2015, https://www.nytimes.com/2015/11/16/insider/will-uterine-transplants-make-male-pregnancy-possible.html (accessed February 27, 2017).

 

Susan M. Haack, MD, MA, MDiv, FACOG

Susan M. Haack, MD, MA, MDiv, FACOG

Dr. Haack is a board-certified obstetrician gynecologist with an MA in Bioethics and a MDiv from Trinity Evangelical Divinity School. She completed her residency in obstetrics-gynecology at Northwestern University-McGaw Medical Center in Chicago. She has spoken and written on issues pertaining to beginning of life, end of life, professionalism and right of conscience. She currently practices consultative gynecology, and is a former Associate Fellow (2010-2014) of the Academy of Fellows at The Center for Bioethics & Human Dignity.