Womb Transplantation: A Procedure in Need of Defense?

Baylor Medical Center in Dallas recently announced a first in the US: a woman gave birth to a baby from a transplanted uterus. The procedure currently has a staggering price tag: $200,000 to $250,000.  It’s cheaper to hire a gestational surrogate to carry a baby, though still very expensive.  So it seems uterus transplantation forces women to defend their desire to give birth, as opposed to leaving the birthing to someone else.  But then, hiring a surrogate is much more expensive than adopting.  So perhaps the woman who opts for a uterus transplant also has to defend her determination to procreate instead of adopting.  In an Axios article on the “complicated ethics of uterus transplantation,” the fact that adoption is not pursued by the transplant patient is one of the main issues raised.

The demand for these defenses arises because of a trick-of-the-eye. A case of birth-after-transplant makes us think of surrogacy as the alternative.  A case of using a surrogate makes us think of adoption as the alternative. Meanwhile, there are people who buy yachts. We don’t ask them why they don’t, instead, fund maternity hospitals. We don’t ask single people who take expensive vacations why they don’t, instead, pay for the upkeep of a foster child. It’s unfair to demand a defense of choosing A just because options A and B happen to enter people’s minds at the same time.

Alright, but maybe the right thing to do is not to stop pressing the transplant patient for a defense, but to start also pressing the yacht consumer and the carefree single traveler.  So though it’s certainly unfair to single out the transplant patient, let’s go ahead and ask about the preference for giving birth over paying a surrogate and the preference for procreation over adoption.

Is it puzzling that someone should prefer giving birth to paying a surrogate? Not at all. Carrying and giving birth to a child is one of the very cool (technical term!) capacities most women have, and it’s understandable that many women look forward to exercising it. A mother is inevitably less intimately involved with the gestation and birth of her child when a surrogate is involved. In fact, she’s likely to be less involved than a father typically is when his partner is pregnant.

Perhaps, though, it’s the contrast between assisted reproduction and adoption that particularly energizes critics.  People typically use assisted reproduction—including surrogacy, IVF, and gamete donation—so that at least one parent can be biologically related to the child.  But why do they prioritize that connection instead of adopting one of the (roughly) 100,000 foster children in America who need parents?

The preference for a biological connection is slammed by many writers.  That preference comes about due to an irrational “blood bias,” according to Elizabeth Bartholet, author of several books on adoption, and an adoptive parent. The focus on “natural parenthood” is tantamount to all sorts of other silly appeals to “the natural”—natural slavery, natural male superiority—according to Peter Conn, author of Adoption: A Brief Cultural and Social History, and also an adoptive parent. People who care about having biologically related children are “essentialists,” according to the psychologist Susan Gelman; they believe that the related child has some important inner property lacking in the unrelated child.

In The Philosophical Parent, my new book on parenthood, I defend the wish to have a biologically-related child as a perfectly respectable one. There is something particularly self-like to me about a child who comes from me in all the ways that a biological child comes from me.  So said Aristotle, insightfully, in The Nicomachean Ethics. The sheer fact of coming from me, not the child’s specific genes or attributes, tends to make me love the child as “a sort of other self, but separate.”  I don’t have to be fixated on particular “essential” traits, naturalness, or blood to find it significant that this child, not that child, comes from me.

There are other thoughts that often undergird the attachment of adoptive parents to their children.  A very common element of adoption narratives is the thought that a certain child is “meant for me.”  “Meant for me” casts the same spell as “comes from me,” but perhaps not for everyone.  We can’t castigate the person determined to procreate, not adopt, if she is not convinced she could form family bonds through adoption. And those worried about “blood bias” and the like should note that “meant for me” is not a particularly logical or benign notion. Did another woman really undergo all the travails that lead her to relinquish her child because you were meant to be that child’s parent?

We should not expect everyone to be able to arrive at a parental state of mind in the absence of the thought that a particular child “comes from me,” but we should be glad when people can—and thankfully, many can.