The Moral Limits of Consent to Harm: The Case of Uterine Transplants

Wednesday 26 February 2020 (15:15-17:00)
Contact (Wouter Peeters)

  • Gulzaar Barn

This seminar is part of the 2019-20 Global Ethics Tea Seminar Series hosted by the Centre for the Study of Global Ethics.

The talk will start at 15:15, but please join us for tea and cake from 14:30.

Venue:  TLB-109 (please note the change of room)


The Moral Limits of Consent:

Living Uterine Donation and Harm

There have been significant recent advances in the development of the human uterine transplant (UTx) as a procedure to alleviate absolute uterine factor infertility (AUFI). It has also been suggested that UTx would allow trans women to gestate their own pregnancy. Here in the UK, only deceased uterine donation is permitted, although this may be set to change soon. The use of living uterine donors, however, would raise unique ethical concerns. Living donor transplant surgery necessitates inflicting harm upon both the donor and the recipient. This harm is typically seen as justifiable if all parties have provided valid consent to undergoing the procedure, and thus to undertaking this harm. The harm is also seen as justifiable if, according to a cost-benefit calculation, it does not exceed the overall benefit that is to be produced by the surgery.

Some commentators have likened uterine donation to the participation of healthy volunteers in clinical trials, whereby an acceptable harm is imposed upon individuals, for wider societal benefit. In this paper I suggest that UTx differs to accepted instances of living donation and clinical trials in three crucial ways. Firstly, UTx is an ephemeral and non-life-saving transplant. I argue that these differentiating factors have a strong impact on, and indeed may render otiose the kind of harm-benefit calculations used to justify existing transplants.

Secondly, although clinical trials impose what is seen a justifiable level of harm upon healthy volunteers, who typically do not reap the benefit of this research themselves, there is a crucial difference in kind between this “accepted harm” and the harm imposed upon living uterine donors. The harm consented to in uterine donation is tied up with the permanent loss of an organ and the attendant loss of that organ’s functioning – this is at the very least, different, and in some ways, beyond, the harm imposed upon research volunteers and other organ donors, who do not lose an organ that is seen as ‘expendable’, or an organ’s full functioning. As a result, we ought to consider whether such a harm may be consented to according to our ordinary model of consent. Perhaps the kind of harm necessitated by uterine donation; the permanent loss of functioning and the seeming expendability of a body part that cannot be replaced or regenerated, is not a harm that we should accept someone’s consent to.

One final way in which uterine donation differs from other accepted donations is the particular loss of functioning that is entailed: (female) sexual identity. The gaining of female sexual identity is often cited as a reason for allowing UTx, in order to give women the chance to gestate a foetus,[1] and alleviate the psychological distress surrounding uterine dysfunction. Yet, a corollary of this is that if cultural notions of femininity, womanhood, and the womb, are so engrained as to necessitate UTx, then there is reason to believe that UTx donors could plausibly experience a corresponding loss/harm once this functioning/organ has been permanently lost. Ostensible consent may do nothing to ‘magic’ away such engrained cultural notions. I conclude that these key discrepancies between UTx and clinical trials/existing organ donation necessitate a different approach to the regulation and delivery of UTx. 

[1] To be clear I am merely reporting this view of female sexual identity as being tethered to pregnancy and gestation, not endorsing it. 

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