Fetal Tissue Transplants and Abortion
FETAL TISSUE TRANSPLANTS AND ABORTION
The use of fetal tissue transplants raises serious questions of moral co-operation
by Antonio G. Spagnolo
Institute of Bioethics Catholic University of the Sacred Heart, Rome
In the past few years the human fetus, in spite of itself, has become the focus of scientific or pseudo-scientific news reports. Apart from the horrors which have recently come to our attention concerning the illegal trade in fetuses obtained from induced abortions and destined for use in cosmetic products, and which have demonstrated the extent of human perversity, the possibility of using human fetal tissue in the treatment of several currently incurable diseases has been examined by researchers.
Thus, after a decade of experimentation on rodents and more recently on monkeys, experiments have been carried out on human beings in Sweden and Mexico. These have involved grafts of fetal nerve cells in patients with Parkinson's disease in the hope that this operation might restore the irreparably damaged function of some parts of the brain. However, even today, there is no unequivocal data on the true effectiveness of such operations-which are still at the experimental stage - although certain studies indicate an improvement in these patients.
But there is a hypothesis that other diseases could also be improved by fetal tissue grafts: neurological disorders such as Huntington's chorea, Alzheimer's dementia, diabetes mellitus, several forms of anemia, leukemia, and serious immunodeficiencies.
Finally, not long ago, it was suggested -and some experiments made-that the oocytes be removed from aborted fetuses for use in fertilization, thus adding to the unacceptability of heterologous fertilization the macabre prospect of a genetic mother who was never born.
Relationship of fetal tissue and induced abortion
Nonetheless, there is no doubt that we are dealing with an area still entirely at the experimental stage, which in some cases gives us a glimpse-as when a treatment for grave human pathologies is proposed-of the possible developments which are encouraging but which raise serious questions for the moral conscience of researchers themselves as well as of health authorities and citizens in general.
Reflection at the moral and social levels has focused on a few precise details, for the most part related to moral evaluation and social policies concerning induced abortion, since this is the chief source of fetal tissue. It was soon realized, both by those opposed to induced abortion per se as well as by those who were indifferent or who justified it under certain conditions, that it could lead to many degrading practices as well as to the inevitable temptation of commercialization. First and foremost, the increase in the number of abortions: the woman could perceive the possible benefit for humanity associated with fetal tissue transplants as a sort of "moral compensation" for her decision to have an abortion. Then comes the development of a manipulative and exploitative mentality regarding the unborn. Further, a lowering of the moral sense of the medical profession and of society, since abortion could be considered useful and almost justifiable. Finally, the very decision to become pregnant could have as its only aim to enable a sick relative to benefit from a fetal tissue transplant.
However, even at the procedural level, the connection with abortion gives rise to concern. Since fetal tissue must reach a certain level of development in order to be utilized, the abortion itself would need to be planned, with regard to both the stage of fetal development and the type of abortion technique to be employed. The need for fetal tissue to be in an excellent state of preservation and fully viable would imply that at the time of removal the fetus would have to be in a viable state. This would lead to a strong suspicion that the removal of the fetus was its "cause of death".
Since 1987, with the Instruction of the Congregation for the Doctrine of the Faith , Catholic morality has pointed out that "the corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings" (, 1, 4). And on this topic, the same document gives precise ethical criteria for the removal of fetal tissue: the verification of death before removal, the consent of the parents or of the mother, the absence of any complicity in deliberate abortion, care to avoid the risk of scandal, prohibition of all commercial use.
The connection between induced abortion and the removal of fetal tissue for transplantation or biomedical research is thus the crux of the issue, and why strict separation between the two actions is stated as one of the fundamental ethical requirements, not only by but also by a series of national agencies such as the National Institutes of Health (USA), or the French and international ones, such as the Council of Europe (Recommendation 1046/86) or the World Medical Association (Hong Kong Declaration, November 1989).
Analysis of some suggested guidelines
As the reader will recall, it was precisely the uncertainty about the possibility of separating the two actions that was one of the reasons for the moratorium declared by the USA in 1988 about using federal funds to finance research on tissue from deliberately aborted fetuses. Five years later, in 1993, the Clinton Administration halted the moratorium and passed legislation to authorize federal funding for research centers that work with fetal tissue resulting from induced abortion. This legislation includes some strict guidelines and concretely defines -and thus prohibits, inflicting a penalty for violation-all those circumstances which could indicate a linkage between induced abortion and the removal of fetal tissue. Other agencies subsequently drafted some concrete recommendations on this subject.
Briefly, the recommendations of all the most recent guidelines, with their stated objective of isolating the two actions and avoiding all the degeneracy feared, can be summarized as follows:
a) the decision to abort must not be influenced by the removal; therefore the woman's consent to the removal must be sought only after she has definitely decided to abort; b) the death of the fetus must not be caused by the removal of the tissue: this must take place only after the death of the fetus has been clinically verified; it is not permissible to keep aborted fetuses artificially alive for the sole purpose of removing tissue; c) the time and method of abortion must not be influenced by the removal; d) the woman's consent to the removal must not depend on carrying out a therapeutic operation on a specific recipient indicated by the woman; thus the recipient must remain anonymous; e) any form of profit or compensation connected with tissue removal must be avoided; fl all therapeutic or research protocols must be approved by a local Ethics Committee.
Despite these recommendations, there are many reasons to doubt the concrete feasibility of carrying them out in scientific practice, and frequently procedures are reported which are far removed from these recommendations. Moreover, it seems clearly impossible to eliminate several connections, such as the need to submit the woman who is to abort to various diagnostic procedures for the sole purpose of subsequent tissue removal (for example, in order to avoid transmitting infectious diseases through fetal tissue, such as AIDS, viral hepatitis and others) or the very procedure of obtaining the woman's informed consent.
Some Catholic moralists who have dealt with this problem do not exclude the possibility that under certain conditions a complete separation between the abortion and the tissue removal can be achieved, although they are aware that if these transplants were to become frequent, the above-mentioned conditions would be less and less respected.
One of the analogies which is often drawn to maintain that there is no complicity is that of using the body of a murder victim for organ transplants. No moral problem, it is said, ever arises with regard to the possible complicity between those carrying out the transplant and the homicide, while for tissue removal from aborted fetuses theological, philosophical, social and political questions have been raised. However, if this analogy is examined more closely, its untenability is clearly apparent. In the case of a homicide, in fact, there is no prior agreement between those removing the organs and the murderer; indeed, unless the contrary is proved, this does not occur. However, in the case of the removal of fetal tissue after deliberate abortion, the team removing the tissue itself is led by technical necessity to come to an agreement with whoever kills the fetus (the gynecologist and the woman), who is the one truly responsible for the death of the fetus itself.
The inevitable problem of complicity
It should be pointed out, however, that even those who are opposed to abortion but consider the use of tissue from deliberately aborted fetuses permissible - questionably weighing the evil of abortion against the benefit to patients -clearly admit that , despite the fact that it can be hypothesized. In other words - although it would provide further justification of their position-they frankly exclude the possibility that the two moral acts could be completely isolated.
Furthermore, there are some who, over and above any moral concern about procured abortion in itself, have specifically examined this issue and, in view of the recommendations supplied by various agencies to avoid linking the two actions, hold that not only are these impracticable but that, were they actually to be applied, they would also be ethically unacceptable. In this regard, three reasons are adopted, linked with the informed consent which must be requested from the woman (which is the true and unavoidable point of connection between the two actions): 1) the very dynamics of the process of acquiring informed consent from the woman makes impracticable the recommendation to seek this consent only at a certain moment and not earlier; 2) the information publicized by the mass media on fetal tissue transplants, familiar to women who seek abortion, is such as to vitiate the care taken by health-care workers not to influence the woman's decision when asking for her consent to remove fetal tissue after the abortion; 3) finally, the much vaunted principle of the woman's autonomy requires her to be totally informed on all the decisions to be taken concerning the use of the tissue of "her" fetus, thereby establishing a strong bond between her and the research physician who requests her consent.
It should be said in this regard that there is much perplexity about the fact that a woman who has decided to abort should be given the right to consent to the removal of fetal tissue. The consent required from the woman is conceived only in the distorted and anti-scientific perspective that the fetus is a part of the mother which she can dispose of at will. If the human fetus is regarded as intrinsically autonomous with an autonomous personal dignity, she who has decided to put an end to its existence cannot be qualified to consent to the removal of tissue. Continuing the earlier analogy of organ transplants from a homicide victim, would anyone ever think of asking the person who ordered the killing or the murderer himself to consent to the tissue removal!?
Consequently the impossibility of completely separating fetal tissue removal and deliberate abortion inevitably involves the formal complicity of the person removing the tissue with the abortion itself. In other words, this act is immoral, since someone who has deliberately chosen to remove and utilize the tissue of intentionally aborted fetuses necessarily shares in some way the intention of the person having the abortion: he does nothing to save the fetus that he knows will be aborted but, - on the contrary, plans together with the patient the best time and way to remove the tissue. And this also applies even if the decision to abort is not primarily intended for the removal of tissue, even if the death of the fetus was certified and occurred before the tissue removal and was not caused by it, even if the time and method of the abortion were not influenced by the subsequent removal. In other words, not one of the proposed recommendations to eliminate this connection can in itself achieve it.
In addition, the medical researcher who finds himself operating in structures which rely on the routine use of fetal material procured from deliberate abortions should have the opportunity - which according to what has been said is also a moral duty-to raise conscientious objections.
Ethical criteria must be respected
It is nevertheless appropriate to recall in conclusion that all reflections on the removal of fetal tissue should not be limited to the case of deliberately aborted fetuses but should also include the prospect of using tissue from miscarried fetuses. Indeed, a valid alternative offered by tissue taken from spontaneously aborted fetuses would make recourse to deliberately aborted fetuses "less necessary", even by those who do not agree with induced abortion but, with regard to the potential benefits for patients, would accept their use. A recent survey of many European centers has shown that of the 66 per cent of professionals who consider the use of fetal tissue from miscarriages morally acceptable (therefore 34 per cent do not think it morally acceptable!), only 37 per cent consider induced abortion to be morally acceptable.
Regarding miscarriages, many researchers have been working for some time on techniques which would seem to offer the concrete possibility of the in vitro cultivation of tissue cells removed from miscarried fetuses, thus providing a sufficient supply for therapeutic and research needs. In this way the main concern of researchers, not to hinder scientific progress, is met.
Hence one can envision a licit use of fetal tissue when derived from spontaneous abortions. But even from this perspective, although there is no connection with a desire for abortion, certain ethical conditions must be respected. First of all, removal must occur only after the death of the fetus has been certified according to traditional clinical criteria, and not when the "absence of viability" is merely presumed (that is, at a gestational stage theoretically incompatible with survival outside the uterus), or when certain and imminent death is diagnosed.
It is fitting then (in this case, yes!) that the informed consent of the parents be obtained, especially the mother's, for the removal of tissue from the fetal cadaver and for the intended use of this material (whether therapeutic or experimental), just as consent is required for removing organs from the cadavers of relatives already born.
Again, the anticipated benefit to a sick person or for the development of related research resulting from the use of fetal tissue should be proportionally significant in terms of the gravity of the disorder it is meant to treat, in the absence of other equally effective treatment. This implies that the whole process of experimentation in the laboratory and on animals must have previously been completed with good results.
Finally, the obstetrical team responsible for a pregnant woman in danger of miscarriage or in the process of having a miscarriage should have no relationship, even scientific, with the team concerned with the tissue removal, in order to eliminate any doubt as to the efficacy of the efforts made to save the life of the fetus threatened by miscarriage. Indeed, various parties have emphasized the moral obligation of medical researchers to make a thorough examination of the causes of "spontaneous" abortion and to seek appropriate remedies. However, there seems to be no reason why doctors may not be legitimately obliged (perhaps by law, as is the case with the removal of organs from deceased adults or children) to inform the health authorities of the existence of a situation of spontaneous or indirect abortion, in order to carry out the measures necessary to safeguard the functional integrity of the tissue and to provide for its proper removal.
This article appeared in The February 8, 1995 issue of "L'Osservatore Romano."