Artificial placentas, pregnancy loss and loss-sensitive care

Abstract

In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity survives the premature ending of the pregnancy. In outlining the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process—and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used.

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

“…(37,61,63,64) Included publications focused on which parents should be involved in the clinical trial and how to counsel them. (25,26,44,50,63) They identified a set of eligibility criteria for potential participants. First, AP should only be proposed to pregnant persons for whom the caesarean is already indicated and for whom it would be better not to be pregnant.…”

“…They should receive all necessary information regarding the experimental treatment, including the uncertainty of outcomes, and the fact that the pregnant person will be a parent and a research subject. (25,26,50,61,63) Further, counsellors must pay attention to avoid therapeutic misconception, i.e., the mistaken belief that the experimental treatment will be curative. (26,63) To be appropriate, counselling also needs to be nondirective (26,44) to avoid undermining pregnant people's safety for the sake of the fetus.…”

“…They advised counsellors to use a language that conveys the important message that AP is substituting current neonatal care not the pregnant person's role. (50) They also advised to provide psychological support for pregnant persons after the preterm delivery. ( 50) Finally, parents should have enough time to decide, and properly understand all the information and possible implications of their choice.…”