Navigating the Ethical Landscape of the Artificial Placenta: A Systematic Review

Abstract

Abstract Objective: To present the ethical debate on the artificial placenta (AP) by identifying, distinguishing, and organizing the different ethical arguments described in the existing literature. Method: We conducted a systematic review of the AP ethical literature. Articles were selected based on predefined inclusion criteria: discussing ethical arguments, on AP, written in English. QUAGOL methodology was used for analysis. Results: Forty-five articles were included. We identified three main themes. First, foundational-ethical issues. There is substantial disagreement on whether the AP subject should be considered an infant or a new moral entity. While physiologically it stays a fetus, it sits outside the womb. Second, reproductive ethics issues. Few authors believed that the AP would increase reproductive choices. However, the majority warned that the AP could limit reproductive choices by creating pressure to use it in healthy pregnancies or as an alternative to abortion. Third, research ethics issues. Publications mostly focused on selection of the in-human trial participants. Conclusions: AP ethical literature focuses mostly on the potential use of AP as an alternative to abortion or healthy pregnancies rather than on the intended use as treatment after extremely premature birth. Furthermore, all but one article originated from high-income western countries, and no article discuss the AP from a global health perspective. We conclude, therefore, that the current ethical literature on AP is imbalanced: it leans more towards science fiction than actual clinical and technological reality, and important perspectives like global health are currently missing from the existing body of literature.