Speculation as an argument: artificial placenta technology, clinical translation, and the ethical debate about the ethical debate.

Abstract

Researchers developing artificial amnion and placenta technology (AAPT) regard this endeavor as one to enhance outcomes in neonatal intensive care units (NICU), by reducing mortality and morbidity for extremely premature neonates. While other applications can be imagined and have been the topic of ethical debate, there is discontent about bioethical considerations of potential AAPT applications beyond NICU praxis. Dismissed as 'speculative', the latter allegedly cloud 'real' ethical work necessary for clinical translation. This trope requires ethical attention, since it goes to the heart of bioethical praxis as an effort of studying emerging technologies like AAPT, and as a critical enterprise tethering ethical contemplation to empirics and uncovering value-ladenness of empirical 'facts'. We explore different functions of speculation in ethics, after which we examine the main criticisms against the purported speculative implementation of AAPT. We then address how defining a practice as speculative reveals more about research priorities and biases, than about some quality of the practice. Labeling scenarios as 'speculative' seems to function as an argument in and of itself, rather than that an argument is provided for labeling certain scenarios as speculative, and why this matters. More: the 'speculation argument' can be extended to the translational aims of AAPT, its potential risks, and the assumed 'benefits' in terms of mortality and morbidity. Projections about 'morbidity' and 'quality of life' that do not start from insights and experiences of members of the disability community are precisely the type of speculation that should be questioned from a critical ethics perspective.