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 <in
vitro> 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 <Donum vitae>, 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" (<Donum vitae>, 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
<Donum vitae> but also by a series of national agencies such as the
National Institutes of Health (USA), or the French <Comite
Consultatif National d'Ethique,> 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 <the removal of
fetal tissue and procured abortion can never be totally separated in
concrete situations>, 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 <intrinsically> 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."
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