An entry from the Journal of Theoretical Medicine and Bioethics is prompting outrage from women on social media after theorizing that the bodies of vegetative or braindead female patients could be utilized as “whole body gestational” surrogates.
The article, originally published in November of 2022, is titled Whole Body Gestational Donation, and floats the concept of utilizing vegetative women’s entire bodies as surrogates for “prospective parents who wish to have children but cannot, or prefer not to, gestate.”
Written by Anna Smajdor, a Professor of Practical Philosophy at the University of Oslo, Norway, the article proposes that it may be viable to utilize the donated bodies of women for gestational purposes in the same manner as donated organs are used.
“I suggest if we are happy to accept organ donation in general, the issues raised by whole-body gestational donation are differences of degree rather than substantive new concerns,” Smajdor writes in her abstract.
“As with many surrogacy arrangements, commissioning parents may prefer to create an embryo for implantation using their own gametes or those of donors. Thus, impregnation could be a surgical affair, preceded and followed by appropriate hormonal therapy to ensure maximal chance of success.”
Referencing previous theories by Israeli medical professor Rosalie Ber, Smajdor considers that the bodies of female patients in persistent vegetative states (PVS), or those who have experienced brain death, could be used as “whole body” incubators for surrogate children.
“[Ber] proposed that female patients in a persistent vegetative state who had given prior written consent, could function as surrogates: embryos would be placed in the woman’s uterus and gestated to term,” Smajdor says.
PVS is a state where patients exhibit no signs of perception and communication or awareness of self. Because the brainstem is not impacted, those in PVS may still be able to breathe on their own and demonstrate some forms of consciousness, including opening their eyes, experiencing sleep-wake cycles, or making facial expressions. Patients may recover from a vegetative state, but it is classified as persistent or permanent after a window of time has passed.
Brain death, however, is the loss of all neurologic functions following a serious trauma or injury. According to the National Kidney Foundation, patients diagnosed as braindead have no brain reflexes and are unable to breathe on their own. Brain death is considered “legal” death.
In Smajdor’s theory, the women impacted by PVS or brain death would be kept functionally “alive” as long as they are gestating, but she compares this to traditional organ donation.
“Prolonging ventilation and somatic survival in brain-dead patients is undoubtedly a disturbing prospect. [Whole body gestational donation] involves treating the patient’s dead body as a means to an end, rather than as an end in itself. The patient moves from being the focus of medical concern, to being a repository of tissues that can be used to benefit others. The prolongation of the ventilation period exacerbates our awareness of this,” she writes. “Yet this is already a part of our organ donation process. Organ donors are almost invariably patients who are already being ventilated, as part of their medical treatment. If the patient is deemed to be a suitable organ donor, ventilation will be continued along with other interventions to ensure that the organs will be maintained for transplant in optimal condition. Thus, we already prolong ventilation in order to facilitate organ donation.”
Smajdor similarly theorizes that the bodies of braindead males could potentially be used to gestate surrogate embryos as well.
“I suggest that brain stem dead men would also have the potential to gestate, meaning that the pool of potential donors is further increased – and that certain feminist concerns might thus be assuaged … The prospect of male pregnancy is not, as many would imagine, fanciful, or a piece of science fiction,” Smajdor says, adding that “the liver is a promising implantation site, because of its excellent blood supply.”
Smajdor concludes the article by claiming that the concepts outlined in her journal entry could only be seen as “outrageous” if traditional cadaveric organ donation process is also called into question.
The entry has caused an uproar on social media, especially amongst women’s rights advocates who already challenge the ethical implications of surrogacy.
Tom Farr, a UK-based lawyer who specializes in combatting sexual exploitation, called the theory “horrifying, dystopian, and signifying as total societal moral collapse.”
This is not Anna Smajdor’s first foray into medical ethics controversy.
In 2013, Smajdor came to international attention after she argued that “compassion” was not a necessary component of healthcare.
“One can remove an appendix without caring about the person it is taken from, empty a bedpan without caring about the patient who has filled it, or provide food without caring about the person who will eat it,” Smajdor said. “Unless we regard healthcare professionals as saints, we cannot demand that they guarantee an unlimited flow of compassion for each patient. Indeed, it is not only unfair, but dangerous to do so.”
The year prior, she had proposed an “artificial wombs” theory which would see babies gestated in mechanical environments in order to advance “equality.”
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