For-profit surrogacy has been in the hot seat recently. While it can look like the only way out for some couples feeling trapped by infertility, the industry has sparked a number of conversations around ethics, often in light of fertility clinics manipulating or outright lying to women, or for preying on low-income women who feel they have no choice but to rent out their wombs to make rent. Now, some bioethicists are proposing an even thornier setup: using the still-living bodies of brain-dead women for the purpose of surrogacy.
If you can donate whole organs, you might as well donate your reproductive abilities to “prospective parents who wish to have children but cannot, or prefer not to, gestate,” or so the logic goes, saying anything less is just a waste. “What about all those brain-stem dead female bodies in hospital beds?” proponents argue, “Why should their wombs be going to waste?”
Stranger Than Fiction
Is this even possible? Medically, yes. We already know that in the tragic case of mothers experiencing brain death, they’re often able to carry out their pregnancies successfully as long as there aren’t other confounding health factors. Although it’s not a common occurrence, careful care for brain-dead women has saved their babies’ lives. Women also don’t have to be conscious to conceive and give birth, a factor that was central to a high-profile sexual abuse case involving a woman in a coma back in 2019.
The proposal of “whole body gestational donation,” however, is fundamentally different. In the viral paper exploring the practice, Norwegian bioethicist Anna Smajdor explores initiating pregnancy in brain-dead women, who would then be kept alive using ventilators until the baby is born. Though Smajdor is certainly the most famous for her paper, she’s not the first ethicist to propose this or similar practices. Previous bioethics papers have proposed using women in “persistent vegetative states,” or comas, as surrogates to help alleviate the moral issues that come with commercial surrogacy. Though Smajdor admits that she finds the idea of using dying or unconscious women to gestate babies “deeply disturbing,” she says that “discomfort alone doesn’t make [gestational donation] unethical.”
Using brain-dead women as incubators cannot be made ethical with a consent form.
Men haven’t been spared from the brain-dead fertility craze either. To help make the proposal more gender equal, Smajdor mused that brain-dead men could also be used, citing womb transplants and the potential for gestation in their livers. Bioethicists have also long explored “perimortem sperm harvesting,” which extracts the biological material from brain-dead men. Unlike whole body gestational donation, this one was actually tried last year. A 20-year-old in the United Kingdom suffered a stroke while playing sports. While he lay brain dead, his parents went to court for the right to collect and store his sperm, arguing that he had wanted kids and therefore “consented.” The court ruled against his parents, saying that there wasn’t enough evidence that their son would have consented, but their lawyer emphasized that the only thing wrong was not getting permission in writing: “If you would like your partner or parents to have the opportunity to use your gametes after death, or if you wouldn’t, tell them now and record those wishes in writing.”
Bodies and Biopolitics
Is the only issue here consent? Smajdor and others argue that if we preserve bodily autonomy, then just about anything, from harvesting your son’s sperm to using brain-dead and vegetative women’s uteruses, can be ethical with rigorous enough consent guidelines. She’s right, just not for the reasons she thinks. Bodily autonomy is a necessary but insufficient basis for thinking about bioethics, and treating consent as the only moral value results in a culture that doesn’t even have a vocabulary to call out other moral evils.
Using brain-dead women as incubators cannot be made ethical with a consent form. First, we can’t treat our bodies as somehow separate from us while we’re living in them. There’s a big push right now to talk about people as though they’re just inhabiting bodies rather than part of them. Talk of “fat bodies” instead of “fat people” or “black and brown bodies” instead of “black and brown people” has become common in social justice circles, and stems from a concept in philosophy called “biopower,” which sees optimizing bodies as being part of political power. The concept is usually used to argue against things like abortion, which is seen as the government exercising power over physical bodies, or to make biological sex sound more arbitrary, as in the statement “the person happened to be born in a male body.” While it might seem like semantics, it’s the tip of an iceberg with huge implications for how we think about fertility, reproduction, and human rights. Biopolitics opens the door for dehumanizing and objectifying humans, because we don’t just have bodies, we are bodies. No human has ever existed without one.
Biopolitics opens the door for dehumanizing and objectifying humans, because we don’t just have bodies, we are bodies.
This brings us to the second reason there’s more to bioethics than just consent: If human bodies matter, we shouldn’t be treating them like scrap material. While organ donation, both in life and at the time of death, saves lives and preserves the dignity of the donor, this doesn’t mean that it’s ethical to use people’s bodies as a means to an end, like in the case of gestational donation. Another example: Recently, a Massachusetts bill was proposed that would allow prisoners to trade their organs to buy their freedom, making the organs they donate a means to decrease their sentences, not to save lives. Prisoners consenting wouldn’t make it moral to turn kidneys into currency.
Philosophy aside, there’s also a practical reason we shouldn’t see “gestational donation” as donation: Surrogacy, egg, and sperm donation are already primarily for-profit businesses. Egg donation clinics tell college students the life-threatening process is easy money, surrogacy is increasingly preying on migrant women and those in developing countries, and sperm donation wouldn’t have so many repeat donors if it were just about altruism. The reality is that whole body gestational donation is equally likely to become a for-profit enterprise, leaving the door open for countries to calculate it into their healthcare cost analyses the way Canada does with medical euthanasia, or for the patient to personally feel like she needs to allow her womb to be sold to give her family financial padding.
Not to mention, advocates for gestational donation want this to be a default. Similarly to the way that some countries and states have opt-out organ donation consent, Smajdor argues we should consider everyone to be consenting as a default. “If WBGD is viewed as a straightforward means of facilitating safer reproduction, and avoiding the moral problems of surrogacy,” she says, “we should be ready to embrace it as a logical and beneficial extension of activities that we already treat as being morally unproblematic.”
We’re not going to solve the ethical issues of surrogacy by dehumanizing women even further. If your bioethics lead you to propose using women as “fetal containers,” the correct thing to do is to re-examine where your morals broke along the way, not explore how to make dehumanization gender equal. This proposal should be a wake-up call. It’s a symptom of a society with a broken conscience from treating consent as the only bodily ethic. We need to rethink how we value human life, because women are worth more than the sum of their body parts.
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