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 organising the different ethical arguments described in the literature. Method: We conducted a systematic review of the ethical literature. We selected articles based on the following predefined inclusion criteria: presenting fully elaborated ethical arguments, on artificial placenta/partial ectogenesis, English-language. We followed the QUAGOL methodology for the analysis. Results: Forty articles were included. We identified three main themes. First, foundational-ethical issues. There is substantial disagreement on whether the subject is an infant or a new moral entity because it has the physiology of a foetus, but it sits outside the womb. Second, clinical-ethical 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 first in-human trial participants, e.g., only parents who have been adequately counselled and for whom a caesarean is medically indicated. Conclusions: The focus of the existing AP ethical literature AP is mostly its potential use as an alternative to abortion or healthy pregnancies rather than on treatment of preterm infants, who will bear the risks of the first AP trial and implementation. Furthermore, all but one article originated from high-income western countries, and no articles discuss the global health perspective. We conclude, therefore, that the current ethical literature on AP is imbalanced: it leans more towards science fiction scenarios than actual clinical and technological reality and it lacks a global ethics perspective.