In Sweden right now four women are recovering from major surgery -- all part of the search for the ideal of motherhood.
The two older of the women are the mothers of the two younger ones. Each daughter has been surgically given the same uterus from which she herself was born -- and from which she hopes to give birth to her own children.
I am here to add another: Troubling.
The history of all transplants is one of weighing risk against reward. The risks are many -- there is risk from surgery itself, particularly the anesthesia; from infection and complications after surgery, from years of anti-rejection drugs, all of which have side-effects; from the rejection of the organ if the drugs fail.
When deciding to transplant something life-saving, like a heart, liver or lung, the reward, by definition, justifies the risk. When the "organ" is a hand or a face, as has been made possible much more recently, the reward becomes quality of life, and while this equation is less clear, ethicists have generally approved this new line.
But when the reward is the ability to carry a baby? Is this a value statement we, as a society, really want to make?
Arthur Caplan, head of medical ethics at Langone NYU Medical Center thinks not. "There are dangers here," he told me over the phone. "And too few answers."
Caplan began researching those dangers about a decade ago, after news of a failed uterine transplant in Saudi Arabia, the first attempt in the world. (The uterus had to be removed after 99 days because of circulatory complications.) Caplan, who was then with the Hastings Center, an ethical think tank, was one author on a 2007 report called"Moving the Womb" that listed the unique questions raised by transplanting this particular organ.
In addition to the usual risks of transplant, his report explained, the fact that a uterus is life-giving but not life-saving brings knotty complications. How will families view a child born in such a way -- as that of the donor, or the recipient? In a world that is still struggling with the rights of egg donors, sperm donors, birth parents and gestational surrogates, can we responsibly add uterine donor to that list?
What, in turn. are the long-term psychological implications to that child? The long-term health implications? What is the possibility of rupture to a uterus that has undergone a transplant? While advocates have correctly said that the risks here are less daunting because the organ can easily be removed if the transplant fails, what if it contains an embryo or a fetus when that happens?
All good questions. But none get at the heart of what I feel is the most important , overarching, unstated but deeply ingrained, problem here -- our essential view of motherhood.
The reason a woman would request a transplanted uterus is because she doesn't have one. Of the two Swedish recipients, one lost hers to cancer and the other was born without. Only one half of one percent of infertility in women is caused by a lack of a uterus, which translates to between 2000 and 3000 women in Sweden who might be surgically given one.
And why would they want one? To have a baby? No. There are other ways to do that, including gestational surrogacy, through which one can potentially have a biological child. (At least in those states where it is legal and those cultures which allow it.) The real reason for uterine transplants, then, is to grant a mother the experience of carrying and giving birth to a child.
Is that worth the risk?
To some women -- starting with the two anonymous patients in Sweden -- clearly it is. And how I want to assure them that they are wrong.
"Motherhood and the defining elements of being a mom have been romanticized," during this age of technology, Caplan says. "There is a tendency to expand the definition to include the experience of pregnancy, the naturalness of pregnancy, the non-medicalization of pregnancy." Uterine transplants, he says, are the end game of the thinking that giving birth is "an empowering female experience and the defining moment for a mother."
Let's forget for now the irony that giving birth post-transplant is the epitome of medicalized and unnatural, and look instead at the core of the belief that you need to carry a child to mother one. That dismisses the bonds between adoptive parents and children. It also dismisses the role of fathers. And it burdens far too many mothers, in that it takes us one step further along the spectrum that has women feeling "less-than" because they had a C-section or asked for an epidural. What technology should be giving us instead is affirmation of the fact that there are countless ways to have a baby, and that all of them are essentially irrelevant to actually becoming a parent. What makes you a mother, a parent, is loving and raising a child.
Are birth and pregnancy magical and transformative? Yes. For some people.
Are they worth four abdominal surgeries (the two that have already occurred in each donor-recipient pair, the C-section that will be necessary to deliver children from the transplanted uterus, and the one that will eventually remove the organs for good so the recipient need not take immunosuppressants for life)? I don't think so.
When we are drawing ethical lines, do we want to cross the one that declares "it is worth measurable risk to life to accept the skewed definition of a 'real' mother? I hope not.
I wish these two women happy pregnancies and healthy children. And I wish we lived in a world where no woman felt defined by how -- and whether -- she gave birth.
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