Fetal Tissue Transplantation: An Ethical Analysis

Lehrman Dorothy Summary: Fetal Research and Fetal Tissue Research. Washington, D.C.: Association of American Medical Colleges, 1988, p. V & 10.

Center for Biomedical Ethics, The Use of Human Fetal Tissue: Scientific, Ethical, and Policy Concerns. Minneapolis: University of Minnesota, 1990, p. 21.

Weiss Rick “Forbidding Fruits of Fetal-Cell Researching — Ethical Issues Raised by Promising Therapy,” Science. 134(19), November 5, 1988, pp. 296–297.

Center for Bioethics, p. 83.

Center for Bioethics, p. 4; Lehrman, p. 10; and Weiss, p. 296.

Consultants to the Advisory Committee to the Director, National Institutes of Health, Report of the Human Fetal Tissue Transplantation Research Panel, Vol. *. (no publisher is given) 1988, pp. 1–18.

Sullivan Louis , Statement by Louis W. Sullivan, M.D., Secretary of Health and Human Services, November 2, 1989.

Center for Bioethics, pp. 7, 8, 211; and Harbaugh Robert E. M.D. “The Ethical Implications of Fetal Tissue Transplants,” National Right to Life News, June 7, 1990, (no page nubmers are given).

Harbaugh (no page number is given).

Center for Bioethics, p. 224.

Harbaugh. (no page number is given).

Harbaugh. (no page number is given).

Center for Bioethics, p. 216.

Harbaugh (no page number is given).

Harbaugh: and Center for Bioethics, p. 212 “Implicit in the arguments of some is the view that research involving aborted fetuses should be considered against the framework of research involving human subjects particularly, research involving living fetuses. On this view, research involving aborted fetuses should satisfy the Federal regulations for research involving living fetuses and be reviewed and approved by an institutional review board (IRB).”

A similar question can be asked of the government if it in any way promotes such research.

burtchaell James T. “University Policy on Experimental Use of Aborted Fetal Tissue,” IRB: A Review of Human Subjects Research. 10(4), July, August, 1988, p. 8.

IRB: A Review of Human Subjects Research. 10(4), July, August, 1988, pp. 9–10.

Harris Curt “Do We Need Fetal Tissue Research?” Focus on the Family Physician. 2 (5), Sept./Oct., 1990, p. 2.

Burtchaell “University Policy,” p. 9.

Bopp James , and Burtchaell James “Fetal Tissue Transplantation: The Fetus as Medical Commodity,” This World. 26, Summer, 1989, p. 64.

Shabecoff Philip “Head of E.P.A. Bars Nazi Data In Study on Gas,” New York Times. May 23, 1988, pp. A1 and A17.

U.S. House of Representatives, Committee on Energy and Commerce, Subcommittee on Health and the Environment, “Public Hearing: Subject — Fetal Tissue Transplantation Research,” April 2, 1989, statement by James Burtchaell, p. 3.

Report of Research Panel, Vol. 1, statement by David Bleich Rabbi J. p. 41.

Consultants to the Advisory Committee to the Director, National Institutes of Health, Report of the Human Fetal Tissue Transplantation Research Panel. Vol. II, December, 1988, Statement by Richard Doerflinger, representing the National Conference of Catholic Bishops, Bishops’ Committee for Pro-Life Activities, p. E43.

U.S. House subcommittee, statement by Keith A. Crutcher, Ph.D., Department of Neurosurgery, University of Cincinnati, College of Medicine p. 10.

Miller Richard “On Transplanting Human Fetal Tissue: Presumptive Duties and the Task of Casuistry,” The Journal of Medicine and Philosophy. 14(6), December, 1989, p. 629, “Formal cooperation refers to the active assistance, with an attitude of approval, in performing an immoral act. If the act is immoral, then formally cooperating is also immoral.” For Miller the researcher would only formally cooperate if he or she approved of and actively assisted in the immoral act (i.e., induced abortion). “Material cooperation refers to that in which without approving another's wrong doing one helps to perform his evil action by an act which is not of its nature morally wrong. It may or may not be immoral, depending on extenuating circumstances, placed in a calculus of proportionate reasoning.” By introducing extenuating circumstances and proportionate reasoning into this definition of material cooperation. Miller has opened up this type of cooperation to much debate since reasonable people can disagree on what value to give to circumstances and what constitutes a proportionate reason.

Report of Research Panel, Vol. I, statement by Bleich, p. 42. the question of proportionality is difficult to determine at this point in the research since the therapeutic benefits are not fully known.

Miller p. 630.

Freedman Benjamin “The Ethics of Using Human Fetal Tissue,” IRB: A Review of Human Subjects Research. 10(6), November/December, 1988, p. 4.

Miller p. 638.

IRB: A Review of Human Subjects Research. 10(6), November/December, 1988, p. 631.

Robertson J. A. “Fetal Tissue Transplant Research is Ethical,” IRB: A Review of Human Subjects Research. 10(6), November/December, 1988, p. 7.

Report of the Research Panel, Vol. I, statement by Aron A. Moscona, pp. 27–28.

Report of Research Panel, Vol. I, Statement by John A. Robertson, pp. 32–33.

Robertson pp. 6–7.

Mahowald Mary B. , Silver Jerry , and Ratcheson Robert “The Ethical Options In Transplanting Fetal Tissue,” Hastings Center Report. 17 (1), February, 1987, p. 14.

Report of Research Panel, Vol. I. statement by Robertson, p. 31.

Robertson pp. 6–7, Robertson uses the following analogy to make his point. “Suppose X murdered Y. a woman who was three months pregnant at the time. Surely if her husband, Z. could consent to donation of Y's organs for transplant, he should be free to consent to donation of the dead fetus's organs as well.”

Bopp , and Burtchaell p. 68.

Report of Research Panel, Vol. I, statement by Moscona, p. 30.

O'Rourke Kevin “Research with Fetal Tissue,” Parameters. (special double issue) 12 (4) & 13 (1), 1987-1988, p. 18; and Report of Research Panel, Vol. I, statement by Robertson, p. 29.

Statement by Sullivan, November 2, 1989.

Center for Bioethics, p. 259. Bopp and Burtchaell, p. 53. Bopp and Burtchaell argue that the respectability given to abortion by the use of fetal tissue by medical researchers will motivate pregnant women who are ambivalent about abortion to have an abortion. Hence, respectability will lead to an increase in the number of abortions.

Bopp , and Burtchaell p. 58.

Post Stephen G. “Fetal Tissue Transplant: The Right to Question Progress,” America. 164(1), January 5-12, 1–991, p. 14-15. Bopp and Burtchaell, p. 55. Bopp and Burtchaell believe that fetal tissue transplantation from induced abortions possesses strong potential to increase abortions by providing both selfish (payment for the tissue) and selfless (help those who need the transplant) reasons for abortion.

Bopp and Burtchaell, p. 59. Bopp and Burtchaell state that for the tretment of Parkinson's disease only 10,280 fetal transplants could be expected from aborted fetal tissue compared with 300,000 to 500,000 patients who could potentially demand the benefits of such transplants. This overwhelming demand for tissue will lead to demand for more legal abortions. U.S. House Subcommittee, p. 2. In his testimony, Burtchaell argues that even if abortion clinics only charge a fee to cover the costs of retrieval and transplant, such a possibility of almost doubling the cash flow per abortion would inevitably stimulate the imagination of the abortion providers and perhaps also supply an indirect subsidy to make abortions more economical. Harris p. 2. Harris concurs with Burtchaell's argument. Weiss, p. 297. Weiss states that tissue procurement agencies currently (1988) pay abortion clinics $25.00-$50.00 per fetal-tissue sample. He too believes that these transactions could create some incentive for physicians to urge more women to abort.

America. 164(1), January 5-12, p. 52–53. Bopp and Burtchaell also believe that a symbiotic relationship will exist between the abortion industry and the researcher because research people will need to be present at the abortion clinic to insure that tissues are fresh and that sufficient tissue will be available.

Post, p. 15.

Fine Alan “The Ethics of Fetal Tissue Transplants,” Hastings Center Report, 18 (3), June/July, 1988, p. 6. Fine states that on the basis of animal experiments, dopaminergic neurons from a single fetal midbrain seem sufficient for effective transplantation. Based on this and on the current rate of legal abortions in the U.S.A., the tissue from 90,000 appropriately aged fetuses are available to meet the need of 60,000 new cases of Parkinson's disease which arise each year. The total cases of Parkinson's disease would be less than this since not all of the persons with the disease would be satisfactory candidates.

The Stanford University Medical Center Committee on Ethics, “The Ethical Use of Human Fetal Tissue in Medicine,” The New England Journal of Medicine. 320 (16), April 20, 1989, p. 1096.

Center for Bioethics, pp. 8–9.

O'Rourke, p. 19.

U. S. House Subcommittee, Crutcher, pp. 12–13. Fine, p. 6. Fine reports that of the 1.3 million abortions performed in 1981 78% were performed between 6 and 11 weeks. 94% of these abortions were done by suction and curettage. Since fetuses aborted in this manner are definitely dead, the concern about defining death is not entirely relevant. The type of tissue needed for fetal tissue transplantation generally comes from first or early second trimester fetuses.

Harbaugh, (no page number is given); Harbaugh states that any institutional review board would reject such a study as an act of madness or barbarism.

U. S. House Subcommittee, testimony by Burtchaell, p. 2; and testimony by Crutcher, p. 11. Crutcher makes the point that the need for informed consent on the part of subjects used for medical experimentation applies in circumstances where the proposed research is intended to benefit the experimental subject, and rarer cases in which the subject will not benefit but vital medical information will be obtained or another individual will benefit. Since the fetus neither benefits nor gives consent to such research, Crutcher wonders if research on such individuals can be justified under any circumstances.

Burtchaell “A Rebuttal,” p. 9.

Bopp , and Burtchaell p. 49. They state that there is nothing inherently unethical in research or experimentation upon the remains of humans who are victims of homicide, provided that consent is given, as is normally required, by the surviving guardian or next-of-kin and that experiment does not enact indignity upon the deceased. They maintain, however, that such consent is not possible in the case of the use of fetal tissue for transplantation obtained from induced abortions.

Burtchaell “A Rebuttal,” p. 9; and Bopp and Burtchaell, p. 49.

Robertson p. 5–6. Robertson reasons that since research with human remains is dignified, then fetal tissue research dignifies the fetal remains. He states that next-of-kin have interests in controlling the disposition of human remains even in the case of abortion. Robertson contends that even if they have forfeited or waived their decisional authority the use of fetal remains for research and therapy may still occur with dignity.

“A Rebuttal,” p. 6.

Freeman p. 3. Freeman makes an analogy to demonstrate that the absence of a positive warrant should be no bar to the use of tissue. “Your patient urgently requires some blood factor. The required sample is found in the pathology lab, but its label has fallen off. Ordinarily, you might have contacted the patient from whom the factor has been extracted for his consent to this use of the sample; and routinely, he or she would have granted the consent. Again, were there a labeled sample which could serve equally well and to the use of which consent can be obtained, you might prefer to use that one. But there is no other sample available. If you are to treat, you will have to use the anonymous sample, with no positive authorization. The blood factor, in the alternative, will simply be discarded, and the treatment foreclosed,” Freedman concludes, “It is to my mind obvious that you are justified in employing the sample without any positive authorization - that you are, in fact, morally obligated to use it in that fashion, as one instantiation of your general obligation to treat patients … Like fetal transplantation, tha case of the blood factor represents the only possible recourse … the alternative to use is ignominious disposal.”

Burtchaell “A Rebuttal,” pp. 9–10.

Harris p. 2.

Burtchaell “University Policy,” p. 8.

Burtchaell “University Policy,” p. 8

Burtchaell “University Policy,” p. 8

Burtchaell “University Policy,” p. 8

Congregation for the Doctrine of Faith, Instruction on Respect for Human Life in Its Origin and the Dignity of Procreation: Replies to Certain Questions of the Day. (Authorized Vatican Translation), San Francisco: Ignatius Press, 1987. The Instruction was approved on February 22, 1987. The Instruction “does not intend to repeat all the Church's leaching on the dignity of human life as it originates and on procreation, but to offer, in the light of the previous teaching of the Magisterium, some specific replies to the main questions being asked in this regard.”

Instruction on Respect for Human Life in Its Origin and the Dignity of Procreation: Replies to Certain Questions of the Day., pp. 12–13, The Instruction quotes from a previous Congregation document, “Declaration on Procured Abortion: “ “From the time that the ovum is fertilized, a new life is begun which is neither that of the father nor of the mother: it is rather the life of a new human being with its own growth. It would never be made human if it were not human already. To this perpetual evidence … modern genetic science bring valuable confirmation. It has demonstrated that, from the first instant, the program is fixed as to what this living will be: a man …” The Instruction admits that the scientific evidence does and cannot prove the existence of a soul at the moment of conception but the evidence does “provide a valuable indication for discerning by the use of reason a personal presence at the moment of the first appearance of a human life.”

Instruction on Respect for Human Life in Its Origin and the Dignity of Procreation: Replies to Certain Questions of the Day., p. 13.

Instruction on Respect for Human Life in Its Origin and the Dignity of Procreation: Replies to Certain Questions of the Day., p. 15. The Instruction also states, “Medical research must refrain from operations on live embryos, unless there is a moral certainty of not causing harm to the life or integrity of the unborn child and the mother, on the condition that the parents have given their free and informed consent to the procedure.”

Some like Paul Ramsey have argued that nontherapeutic experimentation on children who cannot give consent for themselves violates a “canon of loyalty” which society owes to incompetent children. (cf. Paul Ramsey, The Patient as Person, New Haven: Yale University Press, 1970, pp. 12–13.) What Ramsey says here about children can be applied to the fetus especially as it is understood in the third ethical model.

The Patient as Person, New Haven: Yale University Press, 1970, p. 16. The Instruction states “If the embryos are living, whether viable or not, they must be respected just like any other human person; experimentation on embryos which is not directly therapeutic is illicit. No objective, even though noble in itself, such as a foreseeable advantage to science, to other human beings or to society, can in anyway justify experimentation on living human embryos or fetuses, whether viable or not, either inside or outside the mother's womb. The informed consent ordinarily required for clinical experimentation on adults cannot be granted by the parents, who may not freely dispose of the physical integrity or life of the unborn child.”

The second ethical model views the fetus as a cadaver and presupposes that the consent to use the fetal tissue is given only after the fetus is dead. However, since delaying consent post mortem may result in less “fresh or sterile” tissue, it may not be the preferred method of obtaining fetal tissue. Consent before the fetus is dead may be preferable.

Instruction, pp. 16–17.

Boyle Joseph “Moral Outrage and Medical Benefits,” Ethics & Medics. 16 (4), April, 1991, p. 4.