Bioethics @ TIU

Uterine Transplantation Redux: Another Boundary Issue in Medicine

Posted January 23rd, 2016 by Susan Haack

Speaking of boundaries…which I spoke about in my last blog
It was one and half years ago, in September of 2014 that the first baby was born following a successful uterine transplantation in Sweden. While the baby was apparently healthy, Dr. Mats Brannstrom, the pioneering physician in Sweden said, “The principal concern for me is if the baby will get enough nourishment from the placenta and if the blood flow is good enough.”

In November 2015, uterine transplantation hit the news again when the Cleveland Clinic announced plans to begin a clinical trial of “highly experimental” uterine transplantation using cadaveric organs—for reasons of “safety.” The experimental procedure is lauded by many as “open(ing) the door to an innovative and promising advancement within reproductive medicine.” Dr. Alan Lichtin, chairman of the Cleveland Clinic’s ethics board, further justified the procedure by noting that the committee’s initial impression was, “This is really pushing the envelope. But this is the way human progress occurs.” There it is again: the god of progress for which we will sacrifice not only lives, but all boundaries.

Uterine transplantation, in fact, pushes the envelope both medically and ethically It is the first transplant procedure involving a non-vital organ, and the first considered “ephemeral” because of its temporary nature—it is removed after one or two children have been produced to avoid the ongoing risks of immunosuppressive drugs.

The defining concern in uterine transplantation, however, is its motivation: this is not an issue of health, but of experience, one that is being dubiously linked to health care by labeling it a “quality of life” issue. It does not treat a disease but provides the opportunity for an experience—an attempt to give a woman, not a child to raise, (which can be accomplished by safer, less costly means), but the experience of pregnancy. Understood from that perspective and in that context, it is a very costly procedure that poses grave threats to a woman’s health and even greater threats to the life and health of any child born in such an experimental situation. Add to this the enormous financial costs associated with a minimum of 5 required surgical procedures and it becomes clear—even judging by the utilitarian standards that govern much of our society, much less the cardinal principles, if you will, of autonomy, beneficence, non-maleficence and justice–that the ends do not justify the means. Moreover, such procedures that in fact treat no health condition fly in the face of justice. In a country—and world—where so many lack even basic health care, this is an irresponsible use of our limited resources. But where reproduction is concerned, such arguments carry little weight.

Furthermore, within days of publishing the news that such trials would begin for women with uterine factor infertility, another boundary issue was raised: could uteri be transplanted into men? And of course the answer is “yes”—probably within 5-10 years. Men lack the “support systems”—vasculature, ligaments, hormones—to maintain a uterus and pregnancy, but none of these are believed to be impossible to create. The most insurmountable obstacle is felt to be economic. “We can’t even begin to guess how much a uterus transplant will cost if the surgery makes it out of the research phase, and chances are slim that insurance companies will pay for it.” But that comment is out of touch with the reality of our society: if Medicaid will pay for sex reassignment surgery for an inmate serving a life term, on what grounds could they deny uterine transplantation? In reality, it may be more likely that there will be insurance coverage for transgender uterine transplants than for treatment of uterine factor infertility in non-transgender women.

From the very beginning, humankind has disdained boundaries. Now being enslaved to technology we repeatedly demonstrate our inability to set moral or ethical boundaries for its use. Therefore transplanting uteri into novel subjects, like men, and upsetting all natural boundaries—because we can—is a given. It is as if we are sneering in the face of our Creator, while proclaiming our freedom from His patronizingly imposed boundaries and limitations on our lives. Have we no respect?

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