Sarah Nelson, OTS Biomedical Ethics Term Paper Biomedical Ethics Mount Mary College Mary Anne Urlakis 12/8/97
Psalm 139:13-16 (NIV) For You created my inmost being; You knit me together in my mother's womb. I praise You because I am fearfully and wonderfully made; Your works are wonderful, I know that full well. My frame was not hidden from You when I was made in the secret place. When I was woven together in the depths of the earth, Your eyes saw my unformed body. All the days ordained for me were written in Your book before one of them came to be.-1-
Table of Contents
(Appendixes not included in HTML file)
Introduction Making the Case For Fetal Tissue Transplantation Making the Case Against Fetal Transplantation My Views on Fetal Tissue Transplantation Appendix A: "The Ethics of Fetal Tissue Transplants," by Alan Fine. Appendix B: "Rights, Symbolism, and Public Policy in Fetal Tissue Transplants," by John A. Robertson Appendix C: "Genug est Genug: A Fetus is Not a Kidney," by Katherine Nolan. Appendix D: "Spare Parts From the Unborn?: The Ethics of Fetal Tissue Transplantation," by Scott B. Rae. Appendix E: "The Ethical Options in Transplanting Fetal Tissue," by Mary B. Mahowald, Jerry Silver, and Robert A. Ratcheson. Appendix F: "Public Law 103-43; June 10,1993. National Institutes of Health Revitalization Act of 1993: Title I-General Provisions Regarding Title IV of Public Service Act: Research Freedom: Part II- Research on Transplantation of Fetal Tissue." Appendix G: "Can the Fetus be an Organ Farm?," by Mary Anne Warren; Re: Case Study 477. Appendix H: Collected Stories of Abortion Survivors: Sarah Smith, Heidi Huffman, and "Baby Doe." Endnotes
As medical science progresses, new processes and medicines are developed to combat previously untreatable diseases. A latecomer to the medical field is the process of fetal tissue transplantation, in which tissues from an aborted fetus (whether ectopic, spontaneous or elective) are cultured, genetically tested, and implanted into a living, usually adult, host (although the use of fetal tissue has been proposed to treat many disorders in other fetuses en utero-2-). These tissues then mature according to their nature and renew functions of the injured/dysfunctional organ. Highly experimental procedures, variably successful-3-, have been implemented for such diseases as Parkinson's Disease-4-, and Huntington's Disease-5-. Scientists searching for the cure for diseases including, but not limited to, Duchenne's Muscular Dystrophy-2- diabetes-6-(using fetal pancreas-7-), blood and immune deficiency disorders-8-(such as AIDS, sickle cell anemia, leukemia-9-, using fetal liver-7-) and those seeking to repair CNS-5,10- or organ (heart-11-, kidney-12-) damage look to fetal tissue transplantation. Even curing blindness-13- or infertility-14- may be possible with this "therapy." Do these marvelous uses with such huge potential benefits-15- to the global community outweigh the burdens of the ethical and moral issues concerning the source of the tissue (the unborn child)?
Most ethicists and scientists concur that the use of tissue from ectopic pregnancies and spontaneous abortion is ethically acceptable, but not practical-12,15,16,17-, being "unpredictable and... not yeild[ing] enough tissue for all the potential uses...[This tissue must be] fresh, disease free, and at the right age for it to grow and proliferate in its new site-18-." With ectopic pregnancies (those which implant in locations other than the uterus and must be surgically removed to save the mother's life), the tissue is often genetically abnormal-16,17- and "rarely...recognizable or viable in culture"-16-. Spontaneously aborted (SAb) or miscarried tissue is considered ethically neutral because "these fetuses were only unable, and not unwelcome, to join the human community-19-". However, SAb tissue is not considered practical because of the high incidence of genetic abnormality (up to 60%), length of delay between fetal death and fetal expulsion, and contamination from environmental bacteria-16-. Consequently, in order to meet the transplantation (not to mention the experimental) demand, tissue from electively aborted fetuses must be used. Another source suggests that the scientific integrity of studies concerning tissue from spontaneous abortions vs. elective abortions is suspect because of pro-life/pro-choice political debate. In Dr. Maria Micedja's experience, a larger proportion of spontaneously aborted fetal tissue may be usable than the studies show ("46%-68%... of viable stem cells could be harvested from...[miscarried fetuses] up to 24 hours after recovery-17-." This brings up the question: are there really practical alternative sources for fetal tissue transplantation? If not, should the moral stigma of the tissue prevent its use?
Scientists say fetal tissue is prime, or well suited for transplantation because of the fewer complications it presents: first, "human fetal tissue is unlikely to be rejected by a recipient or precipitate graft vs. host disease...[because] prior to the first twelve weeks of life, fetal tissue lacks... immunologic markers"; secondly, "its relative lack of differentiation;" thirdly, "its ability of tissues to develop into multiple cell types; and lastly, its "rapid growth rate.-20-" Under the UAGA (Uniform Anatomical Gift Act), the dead fetus (or abortus) may be "donated" as an "anatomical gift" by the mother to science, making available tissue for experimentation and transplantation. Critics argue that the mother should forfeit the right to donate the fetus, having been the one to choose its termination-8,15,21-. Women are encouraged to think of the fetus as a "product of conception," a mere cluster of their own cells worth nothing. To scientists, because of the aforementioned special qualities, it holds immense significance. An interesting ethical issue is raised because of the remarkable disparity of the value of the fetus. To quote Kathleen Nolan, "How can something be simultaneously "worthless" and "priceless"-15-?" Do we have a moral obligation to this fetus?
A good supply of early to mid-gestational fetuses is necessary, and presently the volume of aborted fetuses would meet that demand. However, with the advent and approval of RU-486 in the United States, an oral abortifacent drug which is most effective in terminating 1st trimester pregnancies (up to 49 days)-22-, this supply may dwindle. Another supply/demand enigma may occur if FTT becomes therapeutically "effective in treating a wide variety of degenerative diseases, [with] the amount of tissue fall[ing] short of the demand.-17-" A supply/demand shortfall has of ethicists worrying that the pre-viable life of the unborn child would become trivialized as a commodity-5-. Will women become pregnant, planning to abort for non-altruistic reasons (e.g. a family member's need for a transplant, profit)? Another question arises when a woman is faced with the hardest decision of her life: whether to abort. Will women be more likely to abort because of the moral redemption or legitimization-18- offered by fetal tissue transplantation; sacrificing one being for another for the good of society-15-? The amount of transplantable tissue needed for a Parkinson's surgery (derived from fetuses 6 to 11 weeks of gestational age) varies according to the surgeon and the procedure (anywhere from 1-8 fetuses per surgery-23-). "Each year in the United States, 1.3 million pregnancies are voluntarily terminated... [and] in 1981, 78% of induced abortions were performed... at stages appropriate for neural transplantation.-20-" According to Jarmulowicz, the 7th-19th week old fetal liver is "an important source of blood stem cells...[which] could be used to relieve a wide range of blood, metabolic and immunological disease...[and] the prospect of fetal-fetal transplantation for the treatment of hereditary blood disorders."-12- In order to procure transplantable tissue of the right age, "gestation may need to be prolonged, and the method of abortion may need to be altered...to increase the chances of therapeutic success for the recipient. If midgestation is the optimal time for... transplantation (a possibility what has not been established), a woman who might otherwise undergo abortion during the first trimester might be asked to continue her pregnancy until the second semester"-21-. With situations like those described above a possibility, it is important to consider this question: Can the issue of fetal tissue transplantation be ethically separate from the issue of elective abortion?
Benefits of FTT outweigh the ethical/moral burden of source of tissue. Great strides in medical research involving fetal tissue bring potential cures and treatments for debilitating conditions ever closer. One day, a person who has severed his spinal cord may walk again due to CNS nerve regeneration-10-. After a heart attack, an injection of fetal cells could re-grow cardiac cells-11-. An elderly person may regain their sight-13-. A diabetic could forgo insulin, having new cells to make it naturally-6-. An infertile woman will bear children-14-. A child's brain damage, otherwise resulting in cerebral palsy, could be repaired-2-. An HIV positive man's immune system may be renewed-24-. Those with neurological disorders (Parkinson's-25-, Huntington's-5- and Alzheimer's-9-) may lead normal lives once again. For some patients, this day has come. Transplantation of fetal thymus has long been recognized as a therapeutic treatment for DiGeorge's syndrome-20-. Clinical trials are planned to be underway as early as November 1997 to test the efficacy of neural fetal tissue transplantation in the treatment of Parkinson's disease-26-, a disorder from which up to an estimated million Americans suffer-27-. Experimental transplants are progressing for treatment of Huntington's chorea-5-, showing promising first results.
Conclusive results of the Parkinson's fetal nigral transplants are variable. The case study provided by Kordower indicates that (during an observation period 1-3 months after surgery) "the patient's motor function improved, and he could again perform all activities of daily living independently and engage in an active exercise programs. Motor fluctuations, dyskinesias and on-period dystonia virtually disappeared.-3-" Each patient reacts differently, with varying degrees of specific symptom improvement. It is uncertain if these grafts temporarily halt the degeneration or if the benefits are permanent. More "carefully designed clinical research" is needed-25-, to more carefully design a transplant/medication program to best benefit each patient.
The first results from the same type of transplant performed on patients with Huntington's disease returned with the patient showing improvement over the six months post-operative follow-up. Jacques and his associates reported that after 2 weeks the patient was able to perform daily living tasks such as dressing and self-medication. After 8 weeks, he was driving a car (a complex neurological and physical task), and handling money in simple transactions. His functional mobility and fine-motor coordination are also greatly improved. The patient's cognitive functions had improved as well-memory skills, reading and comprehension. The scientists hope to see the same improvements in other HD patients, and hope that these improvements remain stable over time.-5-
These disorders together affect a large portion of the population of the United States. In the case of treating infertility, John Gilliott states: "the transfer of ovarian tissue...from a cadaver and fetus to a woman is no different and....raises no new problems.-28- He argues that no one can take away the right of a woman to have children, despite the process used. Robertson points out that "the abortion and the subsequent transplant use are clearly separated, [and].... Concerns [are]...insufficient to justify a public policy hat bans or refuses to fund research or therapy with fetal tissue from induced abortion.-8-" The potential good for millions of people brought about by these medical advances outweighs any negative ethical questions brought about by the source of the tissue. Senator Edward Kennedy is in favor of FTT, calling the ethical questions proposed to Congress "unsubstantiated fears and concerns.-29-"
If there are no practical alternatives sources, the moral stigma of the tissue should not preclude its use. Those who advocate transplantation believe tissue from elective abortions to be the safest to the recipient and the most practical for procurement purposes (as discussed in the introduction). At the moment, no other treatments involving cultured cell transplants or enzymes are near readiness for human testing-23-. It doesn't make ethical sense to abandon FTT while searching for alternative treatments. In the long run, if FTT turns out to be more effective than the other suggested treatments, it would be unethical to suggest substandard treatment because of the ethical burdens the primary treatment offers. According to Gilliott, there is no moral stigma to FTT than that placed upon it by the anti-abortion advocates, blaming any possible maladjustment of persons affected by FTT on them. He compares the plight of those under this "placed social stigma" to the past attitudes to children born out of wedlock-28-. If the religious and conservative critics had not placed an undeserved value on the fetus and, consquently, moral shame on the death of the fetus, such a stigma would not exist.
Hoffer and van Horne indicate that the ethical situation seems in favor using aborted tissue: the medical field has shown marvelous strides in benefits to patients, and new laws assure "the privacy and safety of both the women from whom fetal tissue is obtained and the recipients," as well as providing guidelines to prevent motives from secondary gain-25-. Providing these standards will assure that none of the ethical scenarios possible will actually occur. John Robertson declares that a ban on using electively aborted tissue would be "burning down the house to roast the pig,-8-" meaning that placing such a ban would cause a terrible blow to the progress of medical science. It is ethically unacceptable to prevent progress when such treatments could end the suffering of thousands of people yearly. According to Fine, clinical trials are ethically warranted for those in the end stages of disease, with symptoms no longer controllable by medication-7-. These people have no other options to end their suffering.
We have no or limited moral obligation to the fetus. Several models have been offered to define the moral rights and status of the fetus:
The option of fetal tissue donation will have little or no effect on the choice of a woman to terminate her pregnancy. Strict guidelines have been set to prevent fetal tissue transplantation from having an effect on a woman's right to control her reproductive freedom and her body. These guidelines also prevent her from selling the tissue for secondary gain. This prevents commercialization of the fetus. After the woman has chosen to terminate her pregnancy, then and only then is she asked to sign the tissue donation form. Throughout the donation process, both she and the tissue recipient(s) remain anonymous so that no pressure can be placed on either party, and privacy and safety maintained. The woman's autonomy is fully protected by the consent forms-she is to be fully informed as to the medical and other risks associated with donating tissue as connected to her own medical care. The guidelines also prevent the changing of the time or type of abortion recommended solely due to tissue obtainment-31-.
Ethicists supporting fetal tissue transplantation agree: the argument that the benefit an anatomical gift of the fetal tissue could encourage more women to abort, seeking legitimization, is highly speculative-8-. Since there is a great enough tissue supplied from elective abortion, we need not consider that scenario. The pro-choice advocates maintain that a woman chooses to abort to relieve herself of the burdens of pregnancy. Women have this choice, they are never forced into an abortion--the woman always has free choice. Planned Parenthood rejects the idea that women feel guilt for choosing abortion. PP reports a largely positive emotional response to abortion-32-. Thus, the assuagement of guilt does not play the role the anti-abortion side assigns it.
Aborting for Tissue Procurement Purposes.
The scenario of aborting for procurement purposes causes a few additional ethical questions. However, if one follows Warren's model, it is not ethically inappropriate to conceive and abort for procurement purposes, as the recipient has the greater right to live. If we follow Robertson's model, as long as the abortion takes place before sentience and cognition, and no harm is caused to the fetus, one may abort as needed. Mahowald, on the other hand, worries that science's demands will push us down the slippery slope, allowing not only aborting for procurement, but procurement from nonviable but living abortuses, or from others who are not dying but chronically ill. She also worries that not just a bit of tissue here or there, but whole organs or even brains could become routinely utilized. Once having slid down the slope, Mahowald foresees for-profit situations. Her solution is to place "wedges" in the system to prevent to prevent a tumble-21-. While these may seem purely arbitrary at times, they are necessary to prevent total ethical collapse of the wall of separation constructed by the legal guidelines for transplant research.The issue of FTT and elective abortion are separate issues. (Re: Appendix F and previous discussion). All legal lengths are being taken to separate the processes and issues of fetal tissue transplantation and elective abortion. These guidelines are our "wedges" in the slippery slope-21- , as proscribed by Mahowald. Use of fetal parts is not complicity in the abortion itself. A model suggested is that of an accident victim: The doctors had no influence over the driver of the car, or the driver of the other car which hit him and killed him. All they can do is hope to help others and create a gift of life out of tragedy-8-. But neither they, nor the medical student who learns from dissecting the body, are guilty of causing the death in any way.
The ethical/moral burden of the abortion outweighs any benefits FTT might have. In the Ten Commandments (Deuteronomy 5:6), God gave a specific directive to the Israelites: "You shall not commit murder." In Romans 3:8, Paul condemns those who say " Let us do evil that good may result.-1-" No matter how much results from an evil act will greatly benefit another person, that doesn't make the evil act any less evil. Such is the case with elective abortion. The moral burden of evil that comes from the taking of an innocent life (the unborn child) surely outweighs any benefit that the transplantation of tissue from the dead child to the suffering adult. The sanctity of life should be preserved, not surrendered to another.
In the preface to her book, Suzanne M. Rini speaks more strongly of the unborn child as a member of a "race of slaves" because "where there is human sacrifice, human slavery is also found." These children, she says, are slaves to the women to whom they are an inconvience, and "booty" to be passed on to medical science, once aborted. She finds horror in the fact that the suffering of a fellow human no longer causes shock, but indifference. She quotes Hillaire Belloc (author, The Great Heresies): "That same force which ignores human dignity also ignores human suffering-33-." Looking at the past, we note the times when the suffering and slavery of races have occurred (the slavery of the African-Americans prior to the Civil war; the forced labor and slaughter of the Jews by the Nazis), and we, as a society, condemn the culprits for the injustices they have committed. What we don't realize is that at the time these atrocities transpired, the culture of the area at the most encouraged, and at the least, tolerated these atrocious events. As long as we can continue to see the unborn child as an object, unworthy of status as a person, these injustices and the suffering caused by them will continue.
No one denies the urgency of finding treatment for the suffering. But at what cost does this potential therapy come? Several patients with Parkinson's Disease have already made public statements about their wishes concerning their disease and the use of fetal transplantation to relieve their suffering. They believe, unquestionably, "no matter how promising the use of fetal tissue is in alleviating the suffering of others, no sufferer should expect another to die that he or she might live". In the same source, Eileen Fleming, in a quotation from ALL About Issues, says: "I have made up my mind that I will refuse any prescription or treatment that involves using fetal tissue. My life is no more valuable than that of the baby who would be giving its life-not for my life, but for my comfort-18-." For pro-life advocates, this is a central issue in the controversy over fetal tissue transplantation: [that]...babies must die in order to improve the quality of life for adults-34-."
What makes an unborn child's life worth less than that of an adult's? An adult may be seen as having more of a "moral right" to health and happiness because they are established, contributing members of society. An aborted fetus, who was only a potential member of society, now will only be discarded. Why not use the remains for some good? Mahowald and her colleagues suggest that as a member of the human society, the fetus might want to help others in the same community-15-. According to Nolan, these FTT advocates 'cite Richard McCormick: " With respect to the participation of children in low-risk experimentation, membership in a community may justify the procedure."' Nolan responds by exposing the conceptual bind that these advocates have caught themselves in: "...in transplantation, the recipient community will largely be older children and adults, so that the justification...resides in the claim society... has on a fetus.... A cruel irony thus emerges: fetuses that have been excluded from membership in the human community by a socially sanctioned maternal decision to abort now have obligations to that same community because of membership in it.-15-"
If there are no practical alternative sources, the moral stigma of aborted tissue should prevent its use. Michejda has suggested that "miscarriages can provide enough cells for transplantation if we would collect them effectively and store them in banking-9-." As quoted previously in her letter to JAMA, she believes that the conclusive study referred to was biased by the pro-life/pro-choice debate and refers to another study (MN) as more accurate. In the Minnesota study, 27% of the SAb samples showed Grade 1 viable tissue (appropriate for transplant purposes), contradicting the AMA report of only six of 544 useful specimens-17-. However, funding would be difficult to obtain, considering the stringent testing and collection purposes necessary to assure the safety of SAb tissue. Clinical trials would also be difficult to approve. Other studies have not duplicated Michedja's results or the MN study's, and the general consensus of the scientific community is of that stated in the introduction.
Since there seem to be no practical alternatives to elective abortion as the source of transplantable tissue, should the tissue be used at all? Pro-life advocates say no, because of the moral taint of the tissue and the devaluation of the fetus (described above) it came from. Rae states, "Since abortion done for family planning purposes cannot in any sense be considered good, the use of fetal tissue obtained from abortion is morally tainted-19-." Some of the effects of this moral stigma have been discussed, especially those concerning a fertility treatment in which fetal ovary is transplanted to a women whose own ovaries are not functional. The Human Fertilisation [sic] and Embryology Authority (HFEA) has discussed such dilemmas. "[Their] biggest worry is the effect on a child of finding out that he was born from an egg taken from a fetus...[Members] argue that such a child would be psychologically disturbed-35-." Many children have a difficult time (psychologically) when they discover their adoptive status. How would a child feel if he/she found out his/her biological mother was an aborted fetus, who never actually lived? What about a child who received a fetal organ when young and had no say in the decision? They might react negatively when they grow old enough to understand the issues behind the decisions made for them.
In ethical terms, the stigma comes from using the fetus as a means to an end. A woman choosing to abort for socio-economic or social reasons (they cannot afford to support the child, or not wanting the social stigma of letting their sexual activity be known) is using the fetus by ending its life to improve their own. With FTT, the child is used twice, especially if the mother conceives, then aborts for the purpose of providing tissue for transplantation. According to Robertson, "such deliberate creation... denotes a willingness to use fetuses as a means or object to serve other ends." In Alan Fine's opinion, "if we hold it wrong to treat persons only as a means, we may prohibit commerce in body parts. If, by extension, we consider it wrong to treat human fetuses only as a means, we condemn conception with intent to abort, whatever the ultimate purpose-7-." Most pro-life advocates agree with Nolan: "Being used once is enough" -15-, and "reject the use of electively aborted fetal tissue for any purpose-18-."
In response to the pro-choice/transplantation statement that banning tissue procurement is "burning the house to roast the pig-8-", Rae counters with a statement about the ban's necessity to prevent abuses of the procurement system and to halt the "slide down the slippery slope" at the top. He worries that "as interest groups... become more dependent on the tissue, they will... press their "rights" to the tissue...complicating the ability of society to stop the descent...before it reaches a place that only the most extreme proponents advocate.-19-" One is naïve who thinks such demands will not place huge pressures on women to provide the tissue to spur on medical progress.
We have a moral obligation to the unborn child.The members of the human community have a responsibility to the unborn. Right to Life of Michigan declares the moral status of the unborn child: "An embryo is a distinct human life and is worthy of the same respect and dignity granted to all humans...[R]esearch creates an immeasurable loss of dignity and respect for all humanity because it involves... subsequent destruction of a unique individual." The pro-life advocates have already declared the fetus to have the same moral status as an infant, child or adult-36-.
FTT violates the moral status of the unborn child through its procurement of fetal tissue from an elective abortion. "The Uniform Anatomical Gift Act (UAGA)... treats fetal remains like other cadaveric remains, and allows next of kin to donate the tissue. After the abortion, the "mother-not-to-be-15-" is the legal next-of-kin, and under law, may consent to the use of the fetus. Those who oppose the mother's right to "donate" the fetus do so for several reasons: 1) the deliberate intention of the death of the fetus-21- and 2) the status given to a fetus as a "gift" to another.
In the consideration of the first point, The accident or homicide model used by pro-transplantation advocates does not parallel the actual situation. This child was not killed accidentally, nor killed by a stranger, This child's death was the intent of the abortion operation, ultimately the mother's choice. Her role is especially disturbing, that of an agency in her child's death-15-. According to Nolan, "It would in general seem desirable to disqualify anyone having agency in another's death is ultimately to objectify that other, to use the other for purposes not of his or her own". In other words, a person who made the decision to have the second person killed should not be allowed to dispose of the body for any purposes the deceased would not have wanted. However, to do away with consent of any kind and resort to a "routine salvage" of fetal tissue would objectify the fetus even more.
The second point, according to Rae, is that "the fetus is at least a potential person, not to be treated merely as a piece of tissue that is exclusively the property of the woman-19-. Many ethicists who do not advocate transplantation have a problem with the language of the UAGA. The term "gift", according to Nolan, should not apply to the fetus. "[One] "gives" something valued to someone who will welcome it... To most women having abortions, fetal tissue has no value-15-." One does not give away something one would otherwise throw in the trash. The fact that these previously worthless tissues are now worth more because of their marvelous potential helping benefits seems to downplay the value of the life the fetus could have led, had it been allowed to grow up and join the human community.
More women will abort, hoping for redemption or legitimization of their actions. The circumstances and emotions of most women change greatly in the periods of time directly before the procedure. Many women feel forced into the procedure as their only choice-some by others (parents, boyfriend/spouse), some by their circumstances. Dr. David Rheardon reports that many also feel self-betrayal as they submit to an "evil neccessity" which counters their own moral beliefs-37-. Many (1/3 to 40%) are dubious, changing their minds several times before deciding to abort-19-. The idea that their abortion might save another's life could push even more women to terminate their pregnancies, assuaging their own grief-21- and guilt. Even if no aborting woman would specifically name this as a influencing force, media highlighting the great successes of transplants may consciously or unconsciously help to tear down her own moral barriers, thus making it more self-acceptable-15-.
FTT may also help socially redeem the abortion procedure. As phrased by Nolan, "enhancing abortion's image could thus be expected to undermine efforts to make it as little needed and little used a procedure as necessary." Imagine watching a news magazine such as "48 Hours," and a story about a miracle cures possible through FTT comes on. The magazine tells a story about one family, and the positive changes the mother went through as a result of FTT to treat her end-stage Parkinson's. The portrayal of an individual sways public opinion much more than the presentation of a few statistics.
Ethical issues: abortion for FTT purposes. In the introduction, RU-486 was mentioned as a possible method of reducing the number of first trimester surgical abortions. According to Davis, Goldie and Stamper,
"It is naive to assume that successful use of fetal tissue would be confined to one procedure only. New applications would generate an increased demand and one could foresee a time when the available tissue produced in the United States could not fill such a demand.-38-"As transplant and research demand increases and the supply goes decreases, pressure may be put on women to become pregnant for procurement purposes. If tissue demand cannot be met through altruistic donation after elective abortion, the "wedges" may slip and medical science may lead us to the bottom of the slippery slope, reimbursing women for their time and inconvenience. If the guidelines provided by Public Law 103-4339 continue to be enforced while the supply dwindles, real danger of a market in fetal tissue looms-29-. In the transplantation treatment for blindness in the elderly, caused by macular degeneration, tissues from a second-semester abortion (relatively rare) were utilized-13-. According to this source, 3 million people in the U.S. suffer from various stages of degenerative blindness. A transplant procedure for treating diabetes mellitus, originated in Sweden, requires pancreatic glands from babies of 12-34 cm crown-heel lengths (34 cm=~28 wks. gestation). These fetuses are already well into the second and even third trimesters of pregnancy-25-, when abortions are less likely to occur.
Should these treatments and other like them become commonly used, more tissue from these older fetuses will be needed. Mahowald and her associates have already set the scenario: gestation may need to be prolonged, or the method of abortion altered... to increase the chances of therapeutic success for the recipient-21-. If abortions are performed later in gestation, greater pain and suffering will be caused to the fetus because the nervous system is more fully developed. More risks are also involved for the woman, especially if the type of abortion must be changed to procure certain types of viable tissue (such as hysterotomy or prostaglandin)-21-.
Postulation: a woman's husband or other close relative is in the end stages of Parkinson's disease. The woman cannot bear to watch her loved one waste away, but she has heard of FTT. She volunteers to become pregnant and to abort the pregnancy to supply the necessary tissue. The good this woman wants to accomplish does not cover up the willful destructiveness of her choice. Nolan invokes Andrew May's image of the devourer: "a mother turning and eating her own child-15-." This betrayal and use of her own child is horrifying.
The issues of FTT and elective abortion cannot be separated. Arthur Caplan, speaking before the NIH panel, referred to FTT as "the ticking time bomb of bioethics-19-." Although at this time the medical technology available has not caught up with the questioning ethical minds of our country, widespread usage of FTT advances. Dragging behind medical science is the abortion issue, impossible to unfetter. Although many ethicists and scientists insist that the two procedures can be and are entirely separate, the pro-life advocates insist any use of the tissue is complicity, that "participation in any aspect of FTT implies a degree of responsibility for the elective abortions through which the tissue became available-20-."
The tissue utilized for FTT must be fresh, of the appropriate age, and viable, as well as having been previously screened for HIV or genetic abnormalities (both mother and fetus). "References which discuss the collection of fetal tissue discuss the modification of an abortion procedure so as to maximise [sic] tissue preservation," says Jarmulowicz, pointing out that it is "difficult to argue that there is not co-ordination [sic] between the two groups of doctors-12-." The doctor performing the transplant procedure needs to indicate the amount and age of tissue he needs, this tissue is then procured by purchase from the abortion facility. It is inane to insist that the issues are separate "because fetal tissue comes directly from abortions-- the only possible source of supply of suitable tissue-25-." It is also naïve to think that one could control a neurosurgeon working independently.
My grandfather suffered from Parkinson's disease, as well as a number of tiny strokes causing symptoms similar to Alzheimer's disease. When my family went to visit him, it was hard to remember the strong, caring, independent man he had once been. I remember the pain he was in; one visit, when I was about 14, he was suffering terribly. He asked me to take a sledgehammer and kill him. In normal capacity, he would never have considered such a thing. It caused great stress and emotional pain on my father's side of the family, and some of the family fractures that occurred prior to his death have never healed. I would have loved to see my grandfather receive treatment, to have him become again what he was once. My grandfather went to great lengths to protect and care for his children and grandchildren, and I am sure, as a Christian, he would never consider such a procedure, even to improve his quality of life or prevent his own death.
My aunt suffers from adult-onset diabetes. She has been in the hospital repeatedly for heart trouble (she has a pacemaker) and when she becomes injured, the diabetes slows healing and prolongs the pain. Her lifestyle has altered considerably, and she has trouble getting around the house. As a former teacher, she loves children, especially her own grandchildren. She takes such joy from them. As a Christian, she believes in the sanctity of life so strongly that I know if anyone suggested such treatment she would refuse it. She would never agree to have the life of an infant, even one not born, sacrificed for her.
So although I know what suffering those with all those diseases go through, I can have faith in my firm belief that fetal tissue transplantation is 100% wrong because of the death of the baby that must precede the transplantation process and the use made of said child. A baby is a miracle, a gift from God that should not be disposed of. The baby, as are all of us, "fearfully and wonderfully made," with all our days laid out before us. No one has the right to kill the child. If something happens and the baby doesn't survive, and in its death the mother will die as well, surgical intervention must be taken, of course, but the situational reasons many abort for nowadays sicken me. It is throwing a blessing back in God's face.
It is unwarranted to think that this child would not want to be born (see Appendix H, Stories of Abortion Survivors), and would want their limbs torn asunder or body burned in excruciating pain, then have their various body parts distributed to others deemed more worthy than they! No one seems to want to discuss the quality of life or even quality of death for the fetus. Those who advocate abortion ignore or dismiss the fact that a fetus can experience pain until it is delivered. Developmentally, this is untrue. According to Dr. Vincent J. Collins, a recognized authority on pain, "fetal pain responses begin at the latest, by 13 and 1/2 weeks gestation and probably as early as eight weeks, based upon the development of the preborn baby's nervous system-40-." The same source finds that "biologists have known since 1968 that the unborn's sensory pain transmitters are complete by 14 weeks. The cerebral cortex is 30-40% complete by this time, which... allow[s] the pain transmitters and receptors to function quite effeciently." Looking at the age tissue required for neurological transplants (8-12 wks.) and those later term abortions for the eye cell and pancreas transplant (2nd-early 3rd trimester) means these children are suffering as they die. Society calls it a crime to torture and kill an animal. Why is the fetus treated more poorly than they? Because the fetus isn't worth anything to some people, and it's their voices we hear the loudest.
It is also unwarranted to think that a fetus would prefer to "live on" as a part of the renewed life of a patient. Would you? If knowing that another person's life would be improved, would you sacrifice your perfectly healthy life or allow others to kill you to save theirs? I know of only one precedent for such a sacrifice-- and only a Lord such ours could love so much to have made it.
I also find it ironic that as wanted premature infants are living at younger and younger ages, their unwanted counterparts are objectified, killed and used in high demand procedures and experiments. Sir William Lilley, commonly known as the "Father of Modern Fetology", commented:
"Around the world, we find a systematic campaign clamoring for the destruction of the embryo and fetus as a cure-all for every social and personal problem. I, for one, find it a bitter irony that just when the embryo and fetus arrive on the medical scene, there should be such a sustained pressure to make him or her a social nonentity.-41-"Medical technology goes to great lengths to help prospective parents conceive, even going to the point of manipulating natural processes to have them take place in a petri dish. These wanted beings are seen as "babies" and "children" as soon as they fertilize. The unwanted fetus is a non-entity, destroyable up until a few days before birth through the horrible process of partial birth abortion and until a few years ago, cremated or thrown into the garbage can. The tissues reclaimed from the fetal cadaver are then "up for grabs," only valuable for the therapeutic value in transplantation.
I know that women who become pregnant and are unsure of their ability are under a lot pressure to relieve themselves of their responsibilities. Many want to believe, to assuage their own guilt, that the child they are carrying isn't a child at all. I don't believe these women are cold, heartless creatures as they are portrayed in much of the hard core pro-life media, they are just scared, confused and under a lot of pressure. Being a single mom, choosing to be responsible for the life growing inside, can be overwhelming to look forward to. Many young girls do not want their parents to know what they have done; other girls are pressured by the father of the child to 'get rid of it'; other girls' parents want to protect the family's "good name." Fearing abandonment by their loved ones, they choose abortion. Finding out (before or after choosing to abort) that the fetus that will be expelled can help others live better lives will help to soothe immediate guilt of the procedure. I fear it will make the long-term guilt and depression that many women suffer worse.
Considering the ethical issues discussed previously (in addition to the evil of the abortion itself), especially those concerning the coercive attitudes that the prospective mother faces and the additional risks tissue procurement may ask her to undertake, I cannot support the claim that the issue and process of FTT is separate from that of elective abortion. In the descriptions I've read about how neural tissue is "recovered" from the fetus, it appears to me that if the fetus wasn't viable (able to survive) after an abortion, its life has most definitely terminated during the tissue procurement process. That is, both procedures are fatal to the donor of the organ tissue. Again, I am 100% against fetal tissue transplantation utilizing tissue from elective abortions. Without the electively aborted tissue, there would be no practical means for transplant into sufferers and this I greatly regret. But the line must be drawn here.
Back to Main1 The Holy Bible, New International Version. 2 Newton, Judith. "Beyond the Ban: Fetal Tissue Research." http://bilogy.uoregon.edu/Biology_WWW/Biospheres/spring93/newton.html 10/22/97 15:26:44. 3 Kordower, Ph.D, Jeffrey H. et.al. "Neuropathological Evidence of Graft Survival and Striatal Reinnervation After the Transplantation of Fetal Mesencephalic Tissue in a Patient With Parkinson's Disease." The New England Journal of Medicine 332.17 (27 April 1995) 1118-23. 4 Fahn, M.D., Stanley. "Fetal Tissue Transplants in Parkinson's Disease." The New England Journal of Medicine 327.22 (26 November 1992): 1589-92. 5 Jacques, M.D., Deane B., Oleg V. Kopyov, M.D., Ph.D.; Kaaren S. Easle, Ph.D. "First Results of Fetal Striatal Transplantation in Huntington's Disease (April, 1996)." http://dem0nmac.mgh.harvard.edu/neurowebforum/Huntington'sDisease/ExperimentalFetalTransplantsf.html 10/22/97 15:51:54. 2 Newton, Judith, p1. 6 Beattie, Gillian M., Timo Otonkoski, Ana D. Lopez and Alberto Hayek. "Functional ?-Cell Mass After Transplantation of Human Fetal Pancreatic Cells: Differentiation or Proliferation?" Diabetes 46.2 (February 1997). http://www.diabetes.org/Diabetes/97/Feb/pg244.html 11/08/97 13:46:45. 7 Fine, Alan. "The Ethics of Fetal Tissue Transplants." Hastings Center Report 18.3 (June/July 1988): 5(3). (Appendix A) 8 Robertson, John A. " Rights, Symbolism and Public Policy in Fetal Tissue Transplants." Hastings Center Report 18.6 (December 1988): 5(7). (Appendix B). 9 Rothacker, Jennifer. "Fetal marrow transplants promising against disease." The Detroit News 4 May 1997. http://detnews.com/1997/nation/9705/04/05040057.html 10/22/97 15:55:32. 7 Fine, Appendix A, p 10 Horner, Philip J., Paul J. Reier, and Bradford T. Stokes. Abstract. "Quantitative analysis of vascularization and cytochrome oxidase following fetal transplantation in the contused rat spinal cord." The Journal of Comparative Neurology 364.4 (22 January 1996): 690. http://journals.wiley.com/0021-9967/abs/v364n4p690.html 11/08/97 13:44:50. 11 Leor, M.D., Jonathan; Patterson, Ph.D., Michael; et al. American Heart Association. "Transplantation of Fetal Myocardial Tissue Into the Infarcted Myocardium of Rat". http://www.at-home.com/get_doc/1085630/9842 11/08/97 13:25:34. 12 Jarmulowicz, Michael. Christian Medical Fellowship. "Fetal Tissues in Transplantation." http://www.cmf.org.uk/pubs/nucleus/nucju196/fetal.html 11/21/97 16:09:38. 13 "Transplantation of fetal eye cells may restore sight: University team first in U.S. to perform procedure." The University of Chicago Chronicle Online 6 February 1997. http://globe/uchicago.edu/Chronicle/Feb._6,_1997_Issue/Eye.html 11/08/97 13:33:24. 14 Uttamchandani, Shonali A. "Fetal Ovarian Transplantation a Possibility in Tomorrow's World." http://www.sourceindia2.com/bio_med/novdec96/ovarian.html 11/18/97 21:22:55. 15 Nolan, Kathleen. "Genug est Genug: A Fetus is Not a Kidney." Hastings Center Report 18.6 (December 1988): 13(6). (Appendix C). 12. Jarmulowicz, p2. 16 Garry, M.D., Ph.D., Daniel J., Arthur L. Caplan, Ph.D., Dorothy E. Vawter, Ph.D., Warren Kearney, M.D. "Sounding Board: Are there really alternatives to the use of fetal tissue from elective abortions in transplantation research?" New England Journal of Medicine 327.22 (26 November 1992): 1592 (3). 17 Michejda, Maria and Thomas J. Gill III. "Suitability of fetal tissue for transplantation." JAMA, The Journal of the American Medical Association 274.1 (5 July 1995); 24(1). 18 Baptists For Life Inc. "Position Paper: What about Fetal Tissue Transplants?" http://www.bfl.org/fetal.html 11/08/97 15:30:55. 16. Garry, et al., p1593. 17. Michejda and Gill, p2. 16. Garry, et al., p1593. 19 Rae, Scott B. "Spare Parts From the Unborn?: The Ethics of Fetal Tissue Transplantation." The Christian Research Journal (Fall 1991), p28. http://www.iclnet.org/pub/resources/text/cri/cri-jrnl/crj0145a.txt 11/18/97 21:47:31. (Appendix D). 16. Garry, et al., p1594. 17. Michedja and Gill, p2. 20 Nora, Lois Margaret, and Mary B.Mahowald. "Neural Fetal Tissue Transplants: Old and New Issues." Zygon 31.4 (December 1996):617. 8. Robertson, Appendix B, p . 15. Nolan, Appendix C, p . 21 Mahowald, Mary B., Jerry Silver and Robert A. Ratcheson. "The Ethical Options in Transplanting Fetal Tissue." Hastings Center Report (February 1987). (Appendix E). 15. Nolan, Appendix C, p . 22 Planned Parenthood Federation of America, Inc. "Planned Parenthood Fact Sheet: Mifepristone (Formerly known as RU-486)." http://www.igc.apc.org/ppfa/mifepris.html 12/03/97 19:57:42. 17. Michedja and Gill, p1. 5. Jacques, et al., p . 18. BFL, p2. 15. Nolan, Appendix C, p . 23 "Something new in mind." The Economist 342.8009 (22 March 1997) 99(3). http://sbweb3.med.iacnet.com/infotrac 11/08/97 15:12:22. 20. Nora and Mahowald, p . 12. Jarmulowicz, p2. 21. Mahowald, et al., Appendix E, p . 10 Horner, et al., p1. 11 Leor, et al., p1. 13 UChicago, p1. 6 Beattie, et al., p1. 14 Uttamchandi, p2. 2 Newton, p1. 24AIDS Daily Summary. "Fetal Tissue Research Background: Tissue Transplantation in AIDS Treatment." http://www.aegis.com/aegis/ads/ads1992/AD922455.html 11/18/97 21:20:11 (1). 25 Hoffer, M.D., Ph.D., Barry J. and Craig Van Horne, M.D., Ph.D. "Survival of Dopaminergic Neurons in Fetal Tissue Grafts." The New England Journal of Medicine 332.17 (27 April 1995). http://www.nejm.org/public/1995/0332/0017/1163/1.html 11/08/97 13:42:30 (4). 5 Jacques, et al., p1. 9 Rothacker, p1. 20 Nora and Mahowald, p622. 26 "Innovative Transplant for Parkinson's Patients Safe, Ready for Controlled Trials." (2) http://pslgroup.com/dg/3a8be.htm 12/09/97 22:22:51. 27 Kassirer, M.D., Jerome, and Marcia Angell, M.D. "The Use of Fetal Tissue in Research of Parkinson's Disease." The New England Journal of Medicine 327.22 (26 November 1992): 1591 (2). 5 Jacques, et al., p1. 3 Kordower, et al., p1119. 25 Hoffer and van Horne, p2. 5 Jacques, et al., p3-4. 28 Gilliott, John. "No controls on infertility treatment." Living Marxism Archives, p3. http://www.informinc.co.uk/LM/LM66/LM66_HFEA.html 12/03/97 17:55:55 8 Robertson, Appendix B, p2. 29 Kennedy, Edward M. "Statement of Senator Edward M. Kennedy on Senator Coats Amendment concerning Fetal Tissue Research." http://www.senate.gov/member/ma/ke...eneral/statements/970903fetal.html 12/09/97 22:28:53 (2). 23 "Something new", p2-3. 28 Gilliott, p3. 25 Hoffer and van Horne, p2. 8 Robertson, Appendix B, p7. 7 Fine, Appendix A, p3. 30 Warren, Mary Anne. "Can the Fetus be an Organ Farm?" Hastings Center Report (October 1978): 22(2). Appendix G. 15 Nolan, Appendix C, p1. 8 Robertson, Appendix B, p3. 31 Appendix F: "Public Law 103-43.... National Institutes of Health Revitalization Act of 1993." 8 Robertson, Appendix B, p3. 32 Planned Parenthood. "The Emotional Effects of Induced Abortion." p1. http://www.plannedparenthood.org/Library/~abortion/EMOTIO~1.HTM 12/08/97 22:24:02. 21 Mahowald, et al., Appendix E, p8. 21 Mahowald, et al., Appendix E, p7. 8 Robertson, Appendix B, p3. 1 The Holy Bible, NIV version. 33 Rini, Suzanne M. Beyond Abortion: A Chronicle of Fetal Experimentation. Rockford, Illinois: Tan Books and Publishers, Inc., 1993, xii-iii. 18 BFL Inc. p2. 34 The American Life League. The Pro-Life Activist's Encyclopedia. "Fetal and Newborn Organ Harvesting: Respectable Grave-Robbing ." Chapter 74, p7. http://hebron.ee.gannon.edu/~frezza/plae/encyc074.html 10/22/97 15:36:07. 15 Nolan, Appendix C, p 15 Nolan, Appendix C, p 9 Rothacker, Jennifer. Quoting Maria Michejda. 17 Michejda and Gill p1. 19 Rae, Appendix D, p5. 28Gilliott, p3. 7 Fine, Appendix A, p4. 15 Nolan, Appendix C, p 18 BFL, Inc. p1. 8 Robertson, Appendix B, p 19 Rae, Appendix D, p10. 36 Right to Life of Michigan. "Embryo Research-Fetal Tissue Transplantation." p1. http://www.rtl.org/embapp.html 11/08/97 13:23:29. 15 Nolan, Appendix C. p 21 Mahowald, Silver and Ratcheson, Appendix E, p6. 15 Nolan, Appendix C, p3. 19 Rae, Appendix D, p5. 15 Nolan, Appendix C, p5. 37 Rheardon, David C. "Women at Risk of Post-Abortion Trauma." http://www.pro-life.org/afterabortion/women_a.html 12/08/97 22:30:10. p2. 19 Rae, Appendix D, p9. 21 Mahowald, Silver and Ratcheson, Appendix E, p5. 15 Nolan, Appendix C, p6. 38 Davis, Gene, Susan Goldie and Robert Stamper. "Socioeconomic implications of fetal transplantation an exercise in bioethics." p3. 1990. http://user.mc.net/dougp/ftrnews3.html 11.08/97 13:28:16. 39 Appendix F: "Public Law 103-43; June 10,1993. National Institutes of Health Revitalization Act of 1993: Title I-General Provisions Regarding Title IV of Public Service Act: Research Freedom: Part II- Research on Transplantation of Fetal Tissue." 29 Davis, et al. p3. 13 UChicago, p1. 25 American Life League, p.8. 21 Mahowald, et al. Appendix E,p7. 21 Mahowald, et al. Appendix E p7. 15 Nolan, Appendix C, p6. 19 Rae, Appendix D, p11, quoting Caplan from "The Report of the Human Fetal Tissue Transplantation Research Panel" 20 Nora and Mahowald, p620. 12 Jarmulowicz, p2. 25 American Life League, p5. 40 The American Life League. The Pro-Life Activist's Encyclopedia, "Fetal Pain: The Untouchable Subject." http://hebron.ee.gannon.edu/~frezza/plae/encyc075.html 11/21/97 14:55:42. 41 The American Life League. The Pro-Life Activist's Encylopedia. "The Preborn as Living Beings." http://hebron.ee.gannon.edu/~frezza/plae/encyc069.html 11/21/97 14:55:17.