How would you feel about using brain-dead people as surrogates?
How would you feel about using brain-dead people as surrogates?
If your first reaction is disgust, you’re not alone.
Whole-body gestational donation (WBGD) is a term coined by bioethicist Anna Smajdor in 2022. Smajdor defines it as the use of a brain-dead person’s body to gestate a foetus—that is, a person on an artificial life support machine who no longer has any brain functions. She argues that the practice is both medically possible and ethically permissible. Expounding the latter concern, she contests that if we are happy to accept the principles of organ donation, then whole-body gestational donation is theoretically only a difference of degree.
She too finds this idea uncomfortable. Yet she believes that her work as a bioethicist necessitates taking discomfort head-on.
Many babies have been brought to term by people who have suffered tragic accidents resulting in brain death. Sarah Armstrong and Roshan Fernando’s research concludes that there is no known upper limit for the amount of time that a patient can be kept alive in this state. Furthermore, we know that people in permanent vegetative states can become pregnant; Smajdor notes at least two cases of this happening after the patient was raped.
Smajdor is building on the work of Rosalie Ber, who posited that this technology could be life-changing for those without uteruses or those for whom pregnancy is considered too high-risk. Smajdor points out that, technically speaking, pregnancy is high-risk for everybody. The World Health Organisation estimates that in 2020, 800 women a day died during childbirth, and 95% of those deaths occurred in lower-income countries. Of the “wealthy nations”, the US has the highest rates of maternal deaths and black women are three times as likely to die as white women. It is also known that brain death is more likely during pregnancy, given how higher blood pressure increases the chance of a stroke.
Reflecting on the high stakes associated with pregnancy, Smajdor notes that “we cannot yet forgo the uterus altogether for the reproduction of our species, but we can transfer the risks of gestation to those who are no longer harmed by them”.
Smajdor also proposes that WBGD may not require a uterus. She cites Robert Winston, who told journalists in 1999 that it is perfectly possible to gestate a baby outside of the uterus; the liver is a good contender due to its rich blood supply. Complications arise with the delivery of a baby, which can be dangerous or even fatal for the pregnant person. However, Smajdor imagines this to be of less concern, should the gestator be legally considered dead.
Upon publication, the biologist was labeled a Nazi, a misogynist, an evil scientist, and more. Mary Harrington, the author of ‘Feminism Against Progress’ and the substack, ‘Reactionary Feminist’, was a prominent voice amongst the outrage. Harrington claims that the suggestion of WBGD reinforces a violent patriarchy that wants to turn women into “dehumanized ‘breeders’”. I would argue that this violence more appropriately describes a society that refuses to seek alternatives to allowing those with uteruses to shoulder the burden of gestation.
“The real violence”, Harrington goes on to add, “is grounded in the claim that what and who we are has nothing to do with how we are embodied.” Harrington is against any form of reproductive innovation, and she believes that it’s a short leap from students selling their eggs to pay tuition fees to a state of “full transhumanism”, where “wombs are harvested” to be implanted into trans women. It is here that we understand the logical framework underpinning her objection. She and her chorus want to police the boundaries of ‘natural reproduction’, and, with it, gender. To put it plainly, Harrington is a TERF (Trans Exclusionary Radical Feminist).
Gender-critical objections aside, there are further considerations that we must take seriously. Whilst it might be medically possible to implant a foetus into the liver of anyone, I am under no illusion that the first people to be experimented on for this procedure will be those with uteruses, and more specifically, amongst the most marginalised in society. The situation was well explained by Angela Davis when speaking about surrogacy in the 1990s. Davis posits that whilst the technology isn’t inherently oppressive, “the socio-economic conditions within which reproductive technologies are being developed, applied, and rendered accessible or inaccessible manoeuvre them in directions that most often maintain or deepen misogynist, anti-working-class, and racist marginalization.”
The core objections to surrogacy don’t extend to WBGD, since it is difficult to exploit someone who is both consenting and brain dead. But under the current economic conditions, such a process would only benefit the very wealthy. WBGD may do little more than turn the brain-dead bodies of the majority world into business opportunities for the top 1%, extending the global baby farm for the rich without the inconvenience of having to consider the rights of the surrogate.
This likely outcome may be inevitable. But refusing to engage with technological advancements on the grounds that they might reinforce racial, class, and gender marginalisation renders this a self-fulfilling prophecy.
Helpfully, whole-body gestational donation does not yet exist. It’s currently no more than science fiction. Ursula Le Guin, the priestess of the genre, considers the value of science fiction to lie not in its predictive or even speculative power but in its use as a thought experiment. A thought experiment that considers the implications of transferring the load of child-bearing from the minority of our population who are fertile, partly onto the shoulders of those who are no longer vulnerable to its negative side effects. By extension, we can probe how this technology might serve to disrupt the biologically essentialist ideals of parenthood and even unsettle the nuclear family.
The Xenofeminism manifesto boldly explored this very idea. The polemic, compiled by Laboria Cuboniks, demands that technology be employed in projects of liberation. Furious at this potential being suffocated by the market, it reminds us that “the ultimate task lies in engineering technologies to combat unequal access to reproductive and pharmacological tools, environmental cataclysm, economic instability, as well as dangerous forms of unpaid/underpaid labour” .
This belief in the revolutionary power of reproductive technology dates back to the 1970s, when Shulamith Firestone first proposed mechanical wombs. She wanted to destroy the primary biological distinction, as she saw it, between men and women. Firestone believed that if we liberated people from gestation transferring the process to machines, society would be able to properly embark on a project of gender equality.
For true gender liberation, the umbilical cord linking gestation and gender must be cut.
Here, I return to Angela Davis, who argues that for the liberationary power of such reproductive technology to be realised, we must first uproot the “bourgeois individualism” of the nuclear family. Davis calls on us to conceptualise the family and reproductive rights in “terms that move from the private to the public, from the individual to the social.” Such a world would necessitate good social care, the provision of universal basic services, and the democratic access to reproductive technologies. The gestational labour would be undertaken by mechanical wombs, and children would be raised communally. The resulting society would be built on the foundation of stronger webs of caring relationships, freed from the gender matrix and the governing structures of the nuclear family.
It is for the time between now and “tomorrow’s extra-corporal gestation technology”, that Rosalie Ber and Anna Smajdor would like to offer up whole-body gestational donation as part of the journey towards this possible world.
