Success, success! The word was not missing in any of the news that reported the birth, last month, at the Clínic de Barcelona hospital, of a boy named Jesus, whose mother had been able to have him thanks to a uterus transplant .
It was the first baby conceived in this way in Spain, although on a global scale it had precedents. The first in 2014, in Sweden, thanks to Dr. Mats Brännström and his team. In that case, as in the Clinic, the uterus came from a living donor; then cadaver uteri have been transplanted. In total, there are half a hundred girls and boys born through this process in the world.
Technically, there is no doubt, it is a feat, for which the Clinic must be congratulated. But it raises ethical dilemmas. In fact, in 2016, the ethics committee of the National Transplantation Organization analyzed the uterine ones and rejected them, for two reasons, explained its director, Beatriz Domínguez: the risks (for the living donor and the recipient ) and the use of public resources.
All of this is a symptom of where medicine is going. The dictionary defines it as "science that studies the diseases that affect humans, the ways to prevent them and the ways to cure them"; but this definition forgets the social determinants. In practice, the pathologies that medical science deals with are not so much those of "human beings" in general, as those of some in particular.
Diarrhea, dengue, malaria... kill millions of people, but we devote more resources to curing erectile dysfunction, which does not kill anyone; and male pathologies are studied much more, and are diagnosed, and therefore treated, more correctly than female ones (the carelessness of endometriosis would be an example), as Carme Valls Llobet explains in the book Mujeres invisibles para la medicina.
The logical consequence of this evolution is what we are seeing: a medicine increasingly dedicated to fulfilling wishes. Which wouldn't be a bad thing, if it wasn't that... Let's look at it more closely, with the example of the uterus transplant.
There is, first of all, as Beatriz Domínguez said, the use of public resources. In Spain, the public health system does not cover the correction of vision problems (glasses, contact lenses, myopia surgery) or dental treatments, and people with disabilities or serious illnesses bear high costs (prosthetics, certain therapies. ..) which are also not covered. Is it right that we spend astronomical amounts on surgeries for a woman to have her dream of becoming a mother?
Second, the dream is often fulfilled at someone's expense. I have been struck by the repeated idea that "the person who runs the risk is the same person who takes the benefit" in the arguments I have read in favor of uterus transplantation. They forget the living donor, a woman (in the case of the Clinic, sister of the recipient) who endures major surgery (eleven hours in the operating room) and the loss of an organ, with not inconsiderable effects, such as infertility and early menopause.
Is it fair – we have to ask ourselves – that we support the fulfillment of wishes, if it means physical and mental suffering for other people? The issue is also raised regarding surrogacy, and I think that injustice is more easily accepted when it affects women (the renting of wombs is legalized, but not the sale of kidneys). More questions: What consequences, specifically on poor women, can the spread of the "donation" (covering up the sale, as happens today with eggs) of wombs have?
More resources should be used to satisfy the longing of, for example, first-world men who dream of gestating and giving birth (Dr. Brännström explained that he receives many requests in this regard), than to cure pneumonia, that kills millions of third world creatures?
The obsession with technical success, guided by the megalomaniacal conviction that everything is possible, is not making us minimize, not only the cost to third parties, but even to one's own health (case of puberty blockers, hormones crusades, surgery and other sex-change treatments, for example)?
Medicine is one of the areas in which humanity has made the most progress since its existence. We hope that the ethics that must accompany it are up to the mark.
