Nicole Fice questions whether feminist objections to the idea of brain-dead individuals as gestational surrogates can be easily dismissed.

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An article titled “Whole Body Gestational Donation” by Anna Smajdor, published in Theoretical Medicine and Bioethics, has garnered recent attention due to its controversial claim that it might be ethical to allow brain-dead patients to gestate as surrogates.

The paper argues we can use the frameworks that justify the permissibility of organ donation to likewise support the view that brain-dead individuals could donate their entire bodies to gestate fetuses to term. These brain-dead bodies would thus act as surrogates for people who might not want to, or might not be able to, gestate themselves.

There are many possible objections to be made against this argument, including ones about whether “whole body donation” is equivalent to organ donation. Here, I want to explore the author’s attempt to anticipate and respond to feminist objections.

Photo Credit: Flickr/Zappys Technology Solutions. Image Description: A photo of the fertilization process with an egg and sperm.

The feminist objection considered in the paper is that whole body gestational donation would reinforce sexist assumptions about the value of women’s bodies as mere vessels for procreation. The author’s response is that this worry could be avoided if brain-dead men could participate in whole body gestational donation as well. Here, Smajdor draws on medical hypotheses that people assigned male at birth could gestate a fetus to term.

This response hardly engages with the main substance of the feminist criticism, which relates to worries about objectification and commodification. Feminists would suggest that if people assigned male at birth could gestate, issues relating to the commodification of bodies for the purposes of reproduction would still hold. Feminists might still think that it is wrong—regardless of the sex or gender of the surrogate—to permit surrogacy, especially when we take into consideration inequities between who accesses surrogacy and who surrogates are. I will return to this point. Overall, the author’s suggestion that feminist objections can be avoided by including men in the category of people eligible for whole body gestational donation does not sufficiently address the crux of feminist worries.

A further issue relates to the medical feasibility of male gestation. As the author notes, there is much that is medically unknown about the possibility of gestation in brain-dead individuals. This kind of medical uncertainty is even more applicable to the possibility of gestation in individuals assigned male at birth. Even if we assume that gestation is possible for people assigned male at birth, it will likely take much more time to develop and perfect as a viable form of surrogacy. If Smajdor is right that we ought to permit whole body gestational donation as a form of organ donation, women’s bodies will remain the primary source of “donation” at least until male gestation is viable. So, the majority of “donors” would still be women or individuals who were assigned female at birth. Thus, the feminist worry about reinforcing sexist assumptions and values of women’s reproductive capacities remains.

Smajdor’s paper also ignores ethical issues relating to inequities in the use of reproductive technologies, including surrogacy. These are issues feminists are particularly concerned about, as these inequities reinforce existing systems of oppression on those who are already marginalized. Immaculada de Melo-Martín, for instance, notes that women who use reproductive technologies, including surrogacy, are most often white, affluent women. Surrogacy also tends to exploit poor women in the Global South.

Perhaps Smajdor could respond that whole body gestational donation does not entail these worries, as those “donating” would come from a variety of backgrounds. Like organ donation, “recipients” could be prioritized according to need, rather than by their ability to afford this form of donation.

But this response would fail to capture several key differences between regular organ donation and the proposed “whole body” donation. First, as the author notes, prolonging the life of a brain-dead individual for the purposes of gestation is likely to be a costly enterprise, given the requirements for ventilation and other life-sustaining procedures. Second, as the author also notes, whole body gestational donation is not a “life-saving” treatment, as is the case for other forms of organ donation. Further, in cases of commercial surrogacy, the “customers” must pay for surrogacy services to some degree. Given these considerations, it might be reasonable to assume that, if we agree with Smajdor that whole body gestational donation is permissible, the person seeking out a surrogate would shoulder the costs of the process for a non-life-saving treatment, similar to other fertility treatment procedures. Full body gestational donation would primarily be available to those who can afford it. Thus, feminist worries about inequities, especially ones about who benefits from whole body gestational donation, cannot be dismissed.

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Nicole Fice is an Assistant Professor of Philosophy at Trent University. @NicoleFice