Outer Origin: A Discourse on Ectogenesis and the Value of Human Experience

By Laura Johnson Dahlke

Outer Origin examines the individual, social, and spiritual implications of ectogenesis, also known as artificial womb technology. Formerly considered the topic of science fiction, such devices are currently being developed and will soon be a medical reality. This book offers readers information on the status of this technology and considers the ways in which it may one day fully replace human gestation. Ectogenesis has previously been assessed with the future child in mind, but this book, instead, envisions what it might mean for women. It explores the value of pregnancy and childbirth in the twenty-first century and questions the notion that artificial wombs will lead to full equality of the sexes. Outer Origin seeks to elevate the maternal experience by reflecting on the meaning of reproductive technology in our lives. People everywhere must ponder the significance of what has heretofore been their most common link--shared natality and birth. If not, Homo sapiens will enter a deep dive into the unknown--that of not being of woman born.

• Language: English
• Publisher: Pickwick Publications
• Release date: Apr 25, 2024
• ISBN: 9781666772111

Laura Johnson Dahlke

Laura Johnson Dahlke is a graduate of Salve Regina University in Newport, Rhode Island. Her publications are in the fields of pregnancy, childbirth, and maternity care. She specializes in the intersection of the human-technology relationship and reproduction.

Book preview

Introduction

Imagine it is the year 2050. For the first time in human history, a baby has grown from embryo to infant entirely outside of a woman’s body in an artificial womb. Reports abound, much like those of the Louise Brown’s birth on April 25, 1978, the world’s first test-tube baby.¹ Headlines read: Child ‘excellent’ after removal from device. Meet Lenina,² the World’s First Ectogenetic Arrival: SUPERBABE. And here she is . . . THE LOVELY LENINA. Grown Safe—The World’s First Baby in a Bottle Weighs in at 5 lbs 12 oz.³ She is the baby of the century."⁴

Just like Louise’s birth, Lenina’s decanting⁵ sparks worldwide controversy about using a synthetic device to produce a baby. Religious leaders call her arrival a moral abomination⁶ and some politicians identify ectogenesis as the biggest threat since weapons of mass destruction.⁷ Many feminists praise the technology as liberating—a necessary step toward equality. They tout, If any man objects to ectogenesis, let him start a research program aimed at getting men pregnant! If he dares! Lenina’s parents are in their fifties. They decide to start a family after satisfying work careers and building a large savings. This technology, along with induced stem-cell advances, genetic screening of embryos, advanced artificial intelligence (AI), and others have made their biologic clocks irrelevant.⁸ They receive millions of messages—equal parts congratulations and scorn—from around the world.⁹ Even amidst the controversy, the scientists who developed the artificial womb win the Nobel Prize in Medicine and the procedure is soon readily available and widely accepted by the masses.

While this fictitious example might seem implausible to many, ectogenesis is swiftly becoming a medical reality. As French biologist Henri Atlan said, "After the contraceptive pill, artificial insemination, in vitro fertilization, the next step will be ectogenesis, that is to say the artificial uterus."¹⁰ This third era or zenith¹¹ of human reproduction is advancing rapidly and an artificial placenta is set to be tested in human trials.¹² In fact, Alan W. Flake, renowned pediatric and fetal surgeon from the Children’s Hospital of Philadelphia, presented an update on the status of his and his colleagues’ extra-uterine system¹³ at The Pregnancy Meeting of the Society for Maternal Fetal Medicine Conference in San Francisco, February 2023. In the near future, his research group anticipates submission for an investigational device exemption (IDE). This is the initial step required by the Food and Drug Administration (FDA) allowing its use in a clinical study to collect safety and effectiveness data.¹⁴ Human trials for EXTEND may begin as soon as June of 2024 according to Flake’s oral presentation given at the 20th World Congress in Fetal Medicine conference on June 25, 2023.¹⁵ In an interview with Ozge Ozkaya, he said, Ultimately, it is for the FDA to decide,¹⁶ and on September 19–20, 2023, the Food and Drug Administration did consider clinical trials of the system.¹⁷ Extra-uterine systems for human use are becoming reality.

The purpose of this book is to present a discussion on ectogenesis before the headlines report a child arriving by this technology. It will analyze the individual, cultural, and spiritual elements of gestation and childbirth in relationship to ectogenesis, but from the often-diminished woman’s point-of-view. Instead of focusing on the implications for neonates and future children, it aims to address what it will mean for women or those who gestate and give birth. The book seeks to answer this question: What are the implications, especially for women, if human beings are no longer ‘of woman born’? It is based on the prediction that ectogenesis is inevitable and will become available and safe for children grown in the artificial environment. It is a sincere attempt to grapple with the reality of full ectogenesis—the development of embryos in artificial conditions outside of a women’s body from beginning to end.

The technology of ectogenesis has been the subject of fascination for scholars and scientists for several hundred years. It was Paracelsus who in the sixteenth century provided a formula to create a homunculus—a man with no soul, in an artificial womb¹⁸ outside of a woman’s body. In 1924, J. B. S. Haldane coined the term ectogenesis, meaning outer origin, (hence, the title of this book) in his essay Daedalus, or Science and the Future and believed it would be one of the greatest inventions ever made. Aldous Huxley’s social science fiction novel, Brave New World, additionally offers an in-depth account of ectogenesis and its theoretical impact on society. Today, extra-uterine systems already exist and have been tested on animals to study their efficacy with the intent to decrease the morbidity and mortality of extremely premature infants born before twenty-eight weeks gestation. The next logical extension of this technology, however, is that it expands to improve infertility and decrease maternal complications of pregnancy. Eventually, it may be viewed as a more optimal and ethical choice for both mother and baby by avoiding the complications of organic pregnancy and childbirth. It appears plausible that the technology could progress rapidly through the ethical framework of impermissible-permissible-obligatory (I-P-O),¹⁹ quickly becoming obligatory for both.

The inevitability of the technology being developed from both sides, from infertility to neonatology, was forecasted more than thirty-five years ago by bioethicists Peter Singer and Deane Wells. In their book Making Babies: The New Science and Ethics of Conception, they conclude that ectogenesis is ethically permissible so long as fetuses can be grown without harm. Their most astute observation, however, is that the period necessary for the human fetus to be in its mother’s womb is shrinking from both sides and that the time necessary for fetal growth in a natural womb is being reduced and may end up being eliminated altogether.²⁰ Because of the capability to start embryonic life in a petri dish and extend the life of extremely premature infants, they believe medicine will stumble upon ectogenesis almost by accident.²¹

An assessment of ectogenesis is incomplete unless society fully appreciates how modern obstetrical practices contribute to its development. Obstetrical procedures, like other forms of modern medicine, convey to women the technocratic core values of American society—the superiority of technology over nature.²² Such practices generally view the birthing process as machine-like, orderable and time dependent, and therefore readily alter it through surveillance, pharmacology, or surgery. This has had a profound impact on the way both women and men think about women’s bodies, and the perception of their ability to give birth. Modern maternity care perfectly situates humanity for the acceptance and use of an ultimate reproductive model—an artificial womb.

Because of this fundamental belief of modernity, it remains difficult to contextualize birth outside of the confines of technological dominance, making it highly probable that ectogenesis would eventually be widely used. While women once might have been celebrated for their ability to gestate and bear life, childbirth is now more often characterized in Western society as a medical process with little value apart from the arrival of a child. Practitioners who help women give birth deliver them. Subsumed in this terminology is the idea that women need to be delivered or set free from pregnancy and childbirth. Ectogenesis is the ultimate form of such deliverance. This study argues that society must reevaluate the meaning of pregnancy and childbirth as a valuable experience with the power to impart profound wisdom and insight.

Chapter 1, Into Existence: The History, Myths, and Future of Human Intervention in Reproduction, offers a historical overview of the human propensity to control and manipulate reproduction. The chapter considers at least four possible foundational reasons why people both past and present might desire the ability to create offspring outside the body. It argues that just as with other aspects of life, Homo sapiens have sought technological advantages for reproduction. It exhibits how such a desire, especially in the Western world, has led to outcome-altering tools such as contraception, forceps, cesarean delivery, and anesthesia. Following this trajectory, the third and final wave of reproductive technology, ectogenesis, will be achieved by removing women’s bodies completely from the reproductive process, thus gaining total control of the process.

Chapter 2, Industrialized Reproduction: How Heidegger’s Thought on the Technological Age Is Reflected by Maternity Care and the Development of Ectogenesis, establishes Martin Heidegger’s basic framework for modern technology. The chapter further presents the concept of extra-uterine destining, a novel term coined here suggesting that the long and varied manipulation of reproduction has put humanity on a path toward synthetic womb usage. The concept of extra-uterine destining not only aims to recognize industrialized patterns in modern maternity care but also raises awareness about how this promotes ectogenesis. Artificial wombs should not be seen, then, as a technological outlier but as the final step in the long march toward complete commodification and industrialization of reproduction. It encourages, as Heidegger did more broadly, serious questioning and contemplation of synthetic womb usage.

Chapter 3, On the Importance of Individuation and Uniqueness, explores how and why people seek differentiation and strive to be unique. It contextualizes these concepts in relationship to standardized maternity care and the development of ectogenesis. It further enlists Dana S. Belu’s concept of reproductive enframing²³ to highlight the conflicts that can arise when parturient women are treated as fungible raw material²⁴ awaiting optimization.²⁵ This chapter aims to show how ectogenesis de-individuates in various ways. Additionally, it offers Huxley’s Brave New World as a literary precedent exhibiting the potential danger of technological interventions that have the power to change what it means to be human.

Chapter 4, A More Certain Machine: Social, Political, and Medical Considerations of Ectogenesis, discusses the main reasons why society may embrace ectogenesis, most specifically, to mitigate uncertainty. When combined with gene-editing biotechnologies such as CRISPR,²⁶ synthetic wombs will increase control and certainty of reproduction. What was once impermissible may soon be seen as obligatory. It is likely that it will be seen as more ethical or advantageous to employ such technologies rather than rely on natural pregnancies with their potential risks and uncertainties. This chapter also details several feminist arguments both for and against artificial wombs and presents the potential medical indications for ectogenesis, especially those relating to maternal health. Lastly, due to predicted drops in worldwide populations, ectogenesis may be accepted as a way for societies to mitigate such declines.²⁷ This prediction is based on several social factors such as economic concerns, climate change fears, or women’s greater access to education. If correct, ectogenesis may be viewed as the solution to optimize the workforce and restore numbers.

Chapter 5, Awe in Childbirth, enlists the concept of awe to elucidate the childbirth experience, a consistent and powerful conveyer of awe. It shows that the act of giving birth, apart from the arrival of a child, has its own moral, spiritual, and aesthetic value.²⁸ Ectogenesis would eliminate the experience of pregnancy and birth and thus remove this primary, shared element of humanity. In so doing, artificial wombs may diminish women’s access to awe, which generally happens only a few times in any given life. In fact, attention to women’s desires and experiences during pregnancy and delivery may be the best defense humanity has against extra-uterine destining.

If ectogenesis becomes widely used and accepted as this book argues it will, there will be a cost to humanity. Maternal experiences are foundational to humankind and provide all people a common link—shared natality and birth. It is incumbent on us to address the reality of artificial womb technology. If not, Homo sapiens will likely enter the ultimate unknown—that of not being of woman born. Human procreation, perhaps more precisely, reproduction, will begin in an outer origin.

1

. Jasanoff, Ethics of Invention,

130

. Louise Brown was born via in vitro fertilization (IVF) but because it involved using glass vessels, it was called test-tube by the public.

2

. The name Lenina is taken from Aldous Huxley’s character in Brave New World.

3

. These fictitious news headlines are variations of those published in

1978

after Louise Brown’s birth.

4

. Metzl, "Louise Brown at

40

!" Metzl is referencing Brown’s birth, not ectogenesis. The wording is being used fictitiously.

5

. Wording taken from Huxley’s Brave New World.

6

. Metzl, "Louise Brown at

40

!"

7

. Metzl, "Louise Brown at

40

!" IVF used for Louise’s birth was compared to a threat like the atom bomb.

8

. Metzl, Hacking Darwin,

70

–

88

.

9

. Metzl, "Louise Brown at

40

!"

10

. Abecassis, epigraph in Artificial Wombs,

3

.

11

. Abecassis, Artificial Wombs,

3

.

12

. Horn, Ectogenesis at Home?

13

. As detailed in Partridge et al, Extra-Uterine System to Physiologically. See also chapter

1

.

14

. Flake, Artificial Placenta (Feb

8, 2023

).

15

. Flake, Artificial Placenta: Time Line.

16

. Ozkaya, Artificial Placenta Could Be Tested.

17

. Kozlov, Human Trials of Artificial Wombs.

18

. Paracelsus, Concerning the Nature of Things,

124

. See also chapter

1

.

19

. Mercurio and Cummings, Critical Decision-Making,

173

.

20

. Singer and Wells, Making Babies,

117

. See also chapters

1

and

4

.

21

. Singer and Wells, Making Babies,

118

.

22

. Davis-Floyd, Birth as an American Rite,

2

.

23

. Belu, Heidegger, Reproductive Technology,

3

.

24

. Belu, Heidegger, Reproductive Technology,

24

.

25

. Belu, Heidegger, Reproductive Technology,

5

.

26

. CRISPR is an acronym for clustered regularly interspaced short palindromic repeats

27

. Bricker and Ibbitson, Empty Planet,

2

.

28

. Keltner and Haidt, Approaching Awe, a Moral, Spiritual,

297

.

1

Into Existence

Ectogenesis and the History, Myths, and Future of Human Intervention in Reproduction

JASON: What we poor males really need

is a way of having babies on our own—

no females, please.

Then the world would be

completely trouble free.

—Euripides, Medea, 431 BCE

Before beginning a discussion about how ectogenesis is ultimately a direct result of reproductive enframing,

¹

will disconnect humanity from the shared experience of being biologically gestated and born, and fail to be an equalizing force for women, the first objective is to raise a question: Why would people want to create human life through artificial means in the first place? Though obstacles may arise in the process from conception to birth, the human body is generally well equipped to procreate. Thanks in large part to humans’ innate sex drive and functioning fertility, more than seven billion people live on the planet right now.

²

Sexual reproduction remains the central focus of our species. Creating more human lives is an a priori motivation of people everywhere and throughout all of history, a desire often transpiring without much thought or questioning. So, why would intervening in procreation be appealing? There are at least four possible foundational and historical reasons why people both past and present might desire the ability to create offspring outside the body:

1. Myths and stories prime the human psyche for generation outside of biology.

2. Human beings are creators of tools who use them to manipulate or enhance nature, of which reproduction is a part.

3. The female body has been cast as deficient, inferior, fragile, and in need of deliverance.

4. Biological constraints have largely been overcome by machines and technology making ectogenesis inevitable.

This chapter aims to deconstruct these underlying motivations and then discuss the advancing technology of synthetic wombs.

Myths and Stories

Creatio ex nihilo. Creating something out of nothing. This Latin phrase communicates what is the most long standing and widely accepted Christian belief of initial creation—that God created the universe out of nothing. Darkness into light. This belief has also been incorporated into Jewish and Muslim theologies.

³

Notable theologians such as Augustine, Thomas Aquinas, Martin Luther, John Calvin, and John Wesley all believed that God created the world from nothing, as do many today. Thomas Jay Oord notes that the apostle Paul wrote that God calls into being things that were not and the psalmist says, by the word of Lord the heavens were made.

⁴

Though some contemporary theologians do not "affirm creatio ex nihilo—pointing to passages that compare God’s creating as the work of a potter using clay, or from God’s own self, chaos, the deep, matter, or even possibilities"—the concept of creatio ex nihilo has persisted.

⁵

Looking further back in history, the Greek story of creation has similar themes. In the beginning there was Chaos, a yawning nothingness and from this void emerged Gaia, the earth.

⁶

This darkness also produced Eros (love), the Abyss (part of the underworld), and Erebus (the unknowable place where death dwells)

⁷

.. Like the creation story, things emerged from nothing, chaos, or a void. Gaia spontaneously then provided a firm foundation for Mount Olympus and the gods who would live there,

⁸

akin to mother earth. Without assistance (analogous to a virgin birth), Gaia then gave birth to Uranus (the sky) with whom she conceived the Titans

⁹

—six sons and six daughters. The last of the sons, Cronos, fathered Zeus, who would later fight Cronos to be king of the gods. Zeus and his siblings, the Olympians, were victorious, and began their domination.

Mary-Jane Rubenstein writes that creation stories also have traditionally included a primordial scene or conception of the world before the world

¹⁰

from which all things emerged. She notes that as the stories continue, something then happens to this primordial stuff: the egg breaks; the giant is dismembered; the parents fight, reproduce, or both; the material is stirred up, shaped, or breathed on by a divine agent.

¹¹

In order to create the world, a god or god-like figure acts mightily and potently to bring forth the universe and its inhabitants. From disorder has come order, from chaos the cosmos.

¹²

No matter if one believes the biblical or Greek stories of creation as literal or symbolic, one thing is evident—creating is powerful. This ultimate form of miraculous capabilities, generating something out of nothing, is an example by which all other creative activities are compared.

As these stories unfold, readers learn that human beings are made from clay after the earth has been created. From inanimate dust, humanity emerges with the aid of a god. In the Judeo-Christian story, Adam is formed this way. Genesis 2:7 reads: The Lord God formed man from the topsoil of the fertile land and blew life’s breath into his nostrils. The human came to life. In the Greek version, the Titan Prometheus fashions man out of mud and Athena breathes life into the clay figure. Prometheus then makes man stand upright, like the gods do, and gives them fire (to which Zeus objects). Notably, a woman is created after a man in both stories. Zeus later creates the first woman, Pandora,

¹³

from clay to punish Prometheus. She is given a box that unleashes evil upon the world. In the biblical story, Eve is generated from Adam’s ribs to be his companion: So the Lord God put the human into a deep and heavy sleep, and took one of his ribs and closed up the flesh over it. With the rib taken from the human, the Lord God fashioned a woman and brought her to the human being.

¹⁴

In both stories, Pandora and Eve release or introduce evil or sin into the world and thus initiate disorder to a newly ordered world.

The idea of creating, or generating, is deeply rooted in the human psyche. People understand that creating is just as David DeGrazia says—it is to bring into existence.

¹⁵

Producing something from nothing is how people have come to understand the creative process. Human reproduction, in fact, is one of the closest activities people have to mimic the creation of the cosmos. When humans procreate, they similarly produce offspring as if from nothing, or from the mysterious, microscopic forces of making sperm and egg meet. Leon R. Kass writes that the desire to have a child of one’s own is acknowledged to be a powerful and deep-seated human desire—some have called it instinctive.

¹⁶

Mirroring the creation, generating offspring is a microcosm of the macrocosmic undertaking of spawning the universe.

Not only does reproduction allow the species to continue, it harnesses the power that humans desire—power that exceeds their own limitations through the use of tools and the development of technology. James E. McClellan and Harold Dorn claim that human evolutionary history is grounded in the history of technology and that no human society has ever survived without technology.

¹⁷

Creating more lives is humanity’s mightiest force. While the creation stories offer versions of how people have come to be, science also has put forth evolutionary theories for humankind’s existence and desire to create. Sexual reproduction is a hardwired motivation that is believed to have evolved because it supercharged diversity

¹⁸

which is the essence of life.

¹⁹

Sex drives ensured that our ancestors kept sexually reproducing even if they didn’t understand, at least on the technical level, much of what was happening.

²⁰

Without the urge for sex or creating human life, the human species would be extinct.

In addition to innate sex drives, human beings have become conscious via large brains. Evolutionary theory states that this happened over time, at least in part, because human neonates are born helpless. When compared to other mammals, babies need constant care and feeding, requiring more from their parents than other mammalian offspring. Such care, however, has evolutionary advantages. According to Jamie Metzl, protecting and nurturing babies allowed their brains to keep growing

²¹

and has over many millennia allowed humans to become conscious, inquisitive beings who have survived and thrived by manipulating their environment for the own ends.

Creators of Tools

These large brains have imagined a world in which people could be more god-like. In fact, they have produced a species focused on making and using tools through the cultural transmission of technology.

²²

Homo fabers. Toolmaking and mastery became essential to the human mode of existence and was practiced in all human societies . . . Without tools, humans are a fairly frail species, and no human society has ever survived without technology.

²³

Humans, to this extent, may be considered co-creators or even self-creators.

This manipulation takes many forms. The earliest humans made tools such as axes and spears or