I. Background
III. Ethical considerations from those who support fetal tissue transplantation
IV. Reasons for supporting a ban on government funding of fetal tissue research
V. Conclusion
In 1967 James Conniff, a reporter for the New York Times Magazine, wrote that the womb was the new frontier of science (Maynard-Moody, 1995). His article, and a smattering of other voices uncomfortable with fetal research, were a foreshadow of the great political and social controversy over the use of fetuses in scientific research. Prior to the Supreme Court's ruling in Roe vs. Wade in 1973, fetal research went on relatively peacefully without any protests from the public. After abortion was made legal by the Court's decision, the country was split between pro- and antiabortionists. While not their primary target, fetal research became another issue used by the antiabortionists to further their political interests. "Fetal research became a small skirmish in the larger battle over abortion" (Maynard-Moody, 1995). Representatives in government were sometimes elected based solely on their abortion position. The immense political pressure brought on by the antiabortionists caused otherwise pro-research politicians to vote for bans on fetal research. A ban on federally-funded fetal research was put in place by the Reagan Administration and continued through Bush's years in office. A day after Clinton was inaugurated, he lifted this ban.
The political and social controversy surrounding the use of fetuses has not died down or been resolved, however. No one doubts the value that fetal cells might have in the treatment or cure of many diseases, but the arguments on both sides of this issue deal with ethical considerations. The basic factor that informs both sides is how they define the rights of the fetus. On one side is the view that if the fetus is nonviable or is going to be aborted anyway, it is just tissue that should not go to waste. The other side of this issue are those that consider it immoral to use tissue from abortions. One proponent of this view is John Cardinal Krol who said, "If there is a more unspeakable crime than abortion itself, it is using the victims of abortion as living human guinea pigs" (Maynard-Moody, 1995).
Steven Maynard-Moody, in his book The Dilemma of the Fetus, discusses the underlying tension that makes this and other medical advances such as gene therapy or human cloning so controversial in our society. He says that the underlying tension is "the friction between our addiction to progress and our fear that science erodes human values" (Maynard-Moody, 1995). He gives the example of the tragedy of the medieval Dr. Faust who sold his soul to the devil in order to gain forbidden knowledge and power. The cost of his dream was to relinquish that which made him uniquely human (Maynard-Moody, 1995). Another analogy can be taken from the Christian tradition, specifically the story of the Fall. Eve was tempted to eat the fruit of the forbidden tree because the serpent told her it would give her the knowledge that only God had. The price of this action was eternal life. Dr. J. Russell Elkinton said, "What man can do is becoming more obvious. What man ought to do is yet a dark enigma" (Maynard-Moody, 1995).
The fight over whether fetal tissue should be used in medical research brings with it many issues relating science and medical progress with ethical and moral concerns. A basic tenet of science is that research, though not its applications, is neutral and must be protected. It is ironic that scientists detest controversy over research from the public sphere and yet encourage it within scientific circles. Scientific inquiry has mostly been sheltered from social controversy and the freedom to follow one's own interests in research is seen by scientists as a basic democratic right, just as free speech or freedom of religion are. However, most people would agree with Robert Proctor's statement, "Science is the product of society and must remain accountable to that society" (Maynard-Moody, 1995). Conflict over science is essential, even if the various issues are not resolved. It is better to have controversy and make us aware than to avoid the basic questions and issues this conflict creates. Unfortunately, the public did not become aware or involved in the ethical issues surrounding fetal research until the abortion debate made it politically and socially divisive.
Research using fetuses or fetal tissue before the abortion controversy was fairly common. The findings were published and discussed without any public controversy or alarm. The earliest use of fetal tissue was for a diabetic patient. Researchers in Italy in 1928 transplanted fetal pancreatic tissue into the patient and in 1939 the same procedure was repeated in the United States. None of the diabetics showed improvement. Salk introduced his polio vaccine in the 1950s after using fetal kidney cells as part of the tissue to develop it. The first successful transplantation of human fetal cells into another human occurred in 1968 when fetal liver cells were grafted into patients with DiGeorge Syndrome. This is a genetic disorder that causes abnormal gland organs and strikes 1/10,000 newborns. Transplantation of fetal cells became the accepted treatment for this disorder.
In the 1960s, fetal research became an exciting field that showed great promise for medical advances in many areas. Part of the incentive for this growing interest actually came after a great disaster in medicine. Thalidomide was a drug being used by many women in Europe, some of them pregnant. This drug had been tested on animals and showed no negative effects. It was not widely used in the United States but some women received it by pills brought over from Europe or trials handed out by some doctors. Babies began to be born with "seal-like" limbs and the connection was finally made between Thalidomide and the deformations. The Thalidomide disaster showed that animal studies alone were not enough to prove that a particular drug was safe for the fetus. So fetal research became more common as it became necessary to test the effect of drugs on the fetus. During the 1960s there were also more planned abortions taking place in hospitals and thus greater availability of fetal tissue.
The importance of fetal research soon moved beyond just testing drugs. Doctors became able to test for Rh disease, they developed new neonatal treatments for respiratory distress, and amniocentesis and genetic screening became nearly routine. In the early 1970s researchers tested new systems for fetal life support, essentially an artificial placenta, and used as their subjects living but nonviable fetuses. By the scientists' definitions, "living" meant there was some sign of life such as a heartbeat and "nonviable" meant that the fetus was too undeveloped to live outside of the womb (Maynard-Moody, 1995). All of these activities were done with essentially no guidelines set up by a funding or governing body such as the National Institutes of Health (NIH).
A controversy in Britain produced the Peel Commission and the NIH followed suit with its own panel to set up some ethical guidelines regarding fetal research. Unlike the Peel Commission, however, the NIH panel were mostly university researchers who began with a pro-research view. Their premise was that fetal research was too important to limit so they did not give any new restrictions. They did address the questions of viability and the research of fetuses at different developmental stages; and they stressed the need to be more careful in obtaining the mother's consent to use her fetus for research. The panel published its report in September of 1971 (Maynard-Moody, 1995).
Public awareness of medical research took a crucial turn when the Associated Press reported in July of 1972 that the Public Health Service had been studying the progression of syphilis among poor African-American men in Alabama for forty years. The editors of the Atlanta Constitution wrote a good summary of the public view that was developing towards medical research: "Sometimes, with the best of intentions, scientistsin working for the benefit of us allconcentrate so totally on plans and programs, experiments, statistics- on abstractions- that people become objects, symbols on paper, figures in a mathematical formula, or impersonal 'subjects' in a scientific study" (Maynard-Moody, 1995). This incident pushed the NIH to reconsider all guidelines for human experimentation.
Still, there was no controversy or public involvement in the fetal research issue until after the controversial issue of abortion separated the nation. In 1973, after the Roe vs. Wade decision, the Washington Post reported the NIH panel's guidelines. This prompted the first demonstration outside NIH and secured the association between abortion and fetal research. Here was another intrusion of political and social agendas into the freedom of scientific inquiry. "Researchers who thought of themselves as contributing to the noble cause of helping unborn babies were branded by their critics as amoral, if not 'mad scientists'" (Maynard-Moody, 1995).
Although there are several different fields in fetal research, the following discussion will focus more closely on research into transplantation of fetal tissue. Both sides of this debate generally agree that transplanting fetal tissue is ethically endorsable. However, the connection between the abortion issue and fetal research becomes evident here because the source of fetal tissue is where the two sides diverge. The pro side wants to be able to use the great amount of tissue from the millions of elective abortions performed every year. They emphasize the potential medical benefits of such research. The con side opposes using fetal tissue from elective abortions and they focus on larger issues of human experimentation and its moral and ethical concerns.
The controversy over tissue transplantation soon found its way to the policy-makers of this nation. The Reagan Administration put two panels together, one of them again from the NIH in 1988. This panel was chaired by a pro-life man but less than one quarter had a "solid pro-life position" (Right to Life.., 1997). In the end they voted 17-4 in favor of government funding for fetal tissue research using tissue from elective abortions provided certain safeguards were in place. The hope of the panel in setting up these safeguards was to separate the decision to have an abortion (the means) from the transplantation of the fetus (scientific use). They proposed that a counselor could not discuss donation of a woman's fetus until she had already decided to abort and she could not designate a particular recipient. They also banned the sale of tissue. Costs were only to cover the expenses in procuring and preparing the tissue for transplantation. The researchers and recipients had to certify that they knew the tissue may have come from several sources, including elective abortions. The researchers were also unable to obtain the fetal tissue themselves. Basically, the same respect must be given to fetal tissue as is given to cadavers (Committee on Labor,1991).
Despite the recommendations and safeguards set forth by the NIH panel, the Reagan Administration decided to put a ban on this research, and it was continued during the Bush Administration. The ban was fairly narrowly defined: it included only research that was funded by the government and only tissue procured from elective abortions. In fact, Bush set up fetal tissue banks to collect tissue from ectopic pregnancies and spontaneous abortions (Woodward, 1993). Privately funded research with tissue from these sources continued.
Fetal tissue transplantation for patients with Parkinson's disease became a popular therapy to research. Parkinson's affects 500,000 Americans and results in a loss of motor control. This loss is the result of the destruction of an area of the midbrain which in turn causes a loss of production of the neurotransmitter dopamine, necessary for impulses from the brain to the muscles (Mullet, 1996). Drugs have been developed to treat Parkinson's, such as L-Dopa, a precursor to dopamine. Unfortunately it can cause psychosis and its usefulness wears off over time. Transplantation of fetal brain cells into the area of the brain destroyed in Parkinson's patients was done at the University of Colorado. The initial success rate or improvement in the patient was 10% (Wadman, 1996). This is considered to be great, by some scientists at least, for initial research efforts.
Another common disease that could be treated by transplantation of fetal pancreatic cells is Diabetes. Many more rare diseases that affect the nervous system such as Huntingtons, Alzheimer's, Hurler's Syndrome, Leukemia, epilepsy, spinal cord injuries, and ALD could possibly be treated with transplantation of fetal cells. Besides transplanting cells into adults, research has been done regarding transplanting fetal tissue to a live fetus in utero. This was successful for Reverend Walden and his wife whose fetus received a bone marrow transplant for a rare genetic disorder. Walden and his wife are staunch antiabortionists but they felt that the source of tissue, an ectopic pregnancy, made it ethically right. In fact, they argued that research into fetal transplantation could prevent the 12% of elective abortions that occurred in 1990 due to medical problems (Committee on Labor, 1991).
Developments in other fields of medical research such as embryology also occurred despite the ban. Ironically, new discoveries in development and fetal diagnosis created more conflict between the woman's right to her body and the fetus' right for treatment because the fetus began to be treated as a patient separate from its mother. Assumptions about when the fetus becomes human and what rights it can claim were challenged.
Despite some new challenges, there could be great strides in understanding why some fetuses do not develop properly or why they are susceptible to teratogens, substances that cause developmental defects in the fetus. Studies done today could help produce alternative transplantable tissues such as genetically engineered cells and fetal pig tissue. They could find out which cells worked well and then clone these for multiple transplantations (Committee on Labor, 1991). Thus, fetal tissue might only be a temporary solution.
Why is fetal tissue so ideal? There are several reasons why young fetal cells are good for transplantation. They grow quickly and divide rapidly and are therefore more easily incorporated into the patient's existing cells. Fetal cells lack membrane receptors so the recipient should not have to take immunosuppressor drugs because their immune system will not attack them as foreign. Young fetal cells are said to be "plastic" or totipotent. This means that they are undifferentiated and can become any number of cell types depending on where they are placed in the body (Woodward, 1993). Fetal tissue can be transplanted both as an organ and a cellular suspension and the actual transplantation techniques are fairly straightforward. There is also the possibility for long-term storage through freezing or cyropreservation (Committee on Labor, 1991).
Scientists who opposed the ban lamented that while ectopic pregnancies would produce normal tissue, their other source, spontaneous abortions, the fetal tissue was often genetically abnormal and/or susceptible to infection. There was also not enough quantity of fetal tissue necessary to carry out needed research. The private research was going too slowly, they argued, and only those who were very wealthy could afford the experimental treatments. They also argued that private research was not under the NIH and so was not subject to any guidelines (Committee on Labor, 1991).
As the small triumphs in the field of fetal transplantation continued despite the ban, there seemed to be endless possibilities for this new frontier of science. "As fetal research moved from promise toward treatment, from the lab to the doctor's office, controversy lost its grip. The good ends of medical advance may not justify questionable means, but, once achieved, good ends do allow us to forget the means" (Maynard-Moody, 1995). An attempt was made with the Research Freedom Act of 1991 introduced to Congress to overturn the government's ban but it failed. By the middle of 1992, the election year for Clinton, "moral politics was losing its grip on fetal research" (Maynard-Moody, 1995). In his second day of office, Clinton overturned the five-year ban on federally funded fetal tissue research. He said, "We must free science and medicine from the grasp of politics and give all Americans access to the very latest and best medical treatments" (Anderson, 1993).
Almost right away, four different groups sent research proposals to the NIH to study transplant therapy for Parkinson's. Of course, the political controversy over this issue has not stopped. Just last year there were two bills in the U.S. House of Representatives. One wanted to raise funding from $28 to $100 million to set up Parkinson's research centers and the other wanted the same thing but with the provision that tissue from elective abortions would not be used (Wadman, 1996). The House chose the first bill. This year a Republican Senator from Indiana, Dan Coats, offered a similar amendment to a measure that would allocate even more money for the search for a cure. The Senate voted 38-60 and rejected the amendment (Santana, 1997).
Scientists and others who are pleased with the ability to carry on with fetal tissue research do not sidestep the important ethical questions brought up by those who oppose this research. They trust that the NIH guidelines are adequate and will not encourage women to have abortions. They separate the act of the abortion from the use of the fetal tissue. It is often likened to organ donation: "The transplant of that tissue of a dead fetus is no different than the transplant of an organ from a human being who has suffered a death. A gift of life as a result of a loss of life." (Committee on Labor, 1991).
Those who want the ban reinstated focus on ethical considerations related to fetal tissue research's connection to abortion. James T. Burtchaell of Notre Dame and James Bopp, Jr., a lawyer, wrote, "a symbiotic relationship between the abortion industry and fetal tissue transplantation therapy cannot be avoided" (Committee on Labor, 1991). They fear that the NIH guidelines are not strong enough to prevent women from making the decision to abort in order to donate her fetus to help someone else. It is hard to believe that a woman would make the agonizing decision to have an abortion for altruistic reasons, but as a Professor Robinson said, "To do something that will save other human lives is not to do something cavalier" (Ryskind, 1997). If a woman is on the edge between having an abortion or not, she may choose the abortion with the rationale that her sacrifice may help another person.
The guidelines did not delineate how they should make sure the standards were being met by punishment or method of policing. The guidelines also do not say how testing the tissue for AIDS should be done or whether this information can be confidential. Opponents also fear that if cures and therapies do become very successful, there will be such a demand for tissue that the guidelines will be loosened, pushed aside, or a black market in fetal remains will develop.
Another concern is that there is false hope that the research will have spectacular results. Dr. Landau of the Washington Medical School is an expert on Parkinson's and said, "There is simply no evidence to prove that either clinical or experimental parkinsonism in primates is specifically cured by transplantation of tissue into the brain" (Committee on Labor, 1991). The pro side's retort to the charge that fetal tissue has not proven to be a cure is that medical progress would stop if we only did research on things we knew in advance would work. Also, transplants may offer only temporary relief since we often do not know the underlying mechanisms that caused the disease in the first place, so the new tissue may be attacked as before.
Antiabortionists and others charge that even the mother's health is compromised because of the special methods needed to obtain appropriate tissue. For instance, fetal research with Parkinson's requires live brain tissue when the fetus is between 9-11 weeks gestation. In order to prevent mangled tissue or a mixture of different cell types, the fetus' brain must be suctioned out while it is still living inside the womb. This method also requires the woman to undergo general rather than local anesthesia and the abortion lasts 15-20 minutes instead of the usual 5-7 minutes (Committee on Labor, 1991).
Those who oppose fetal tissue transplantation offer alternative therapies that could become more available than transplantation therapies. These would also have the added benefit of not being ethically controversial. Parkinson's and its drug therapy with L-dopa was discussed earlier. One problem with this drug may be that it does not effectively cross the "blood-brain barrier", a vascular system that protects the brain from substances in the blood. Solutions to this problem have been developed by using chemical carries that are linked to dopamine and carry it across this barrier and then gradually release it. Another area where transplantation may be avoided is in the treatment of Diabetes. Researchers are working on a pH-sensitive polymer that contains insulin and surrounded by glucose oxidase. As the blood glucose levels rise, it penetrates the outer glucose oxidase layer and converts this to gluconic acid. This in turn lowers the blood pH and triggers the release of insulin from the polymer in direct proportion to the concentration of blood glucose. Genetic engineering could possibly prevent nerve cell degeneration by splicing the nerve growth factor gene into a fiberblast cell (Committee on Labor, 1991).
The alternative therapies just discussed are still in the research phase, just as fetal tissue transplantation is for the most part. Scientists must decide which research route to take would be the most beneficial to the most people, and the most reasonable. Politicians and the public must become aware of what the research community does and make scientists accountable to the ethical and moral concerns that might otherwise be sacrificed unintentionally or for the sake of medical progress. So far, the medical researchers have taken advantage of federal funding for fetal research and have forged ahead into new transplantation therapies. The fetal research field has once again become an exciting place with new discoveries but the controversy over whether fetal research using tissue from elective abortions should proceed will always be present as long as people disagree on the rights of the unborn fetus.
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