Fetal-cell transplants can help victims of debilitating disease. But is the price too high?
Wednesday and Thursday mornings, medical technician Lisa Norris drives from her job at the University of Colorado Health Sciences Center in Denver to a local abortion clinic and dissects the remains of aborted fetuses. She is looking for the pancreas, the gland that produces insulin. After “harvesting” pancreases from a number of fetuses, she takes them back to her lab at the university, which has become the national hub for fetal-tissue research. There, she minces the tissue and further prepares it for surgery.
In surgery, doctors tuck this insulin-producing tissue beneath the surface of the kidney in a patient suffering from diabetes. If the graft works, the cells will begin producing natural insulin, furnishing the patient with an improved ability to process and regulate sugars in her body, thereby improving her overall health. Surgeons have performed similar operations for Parkinson’s disease sufferers, and researchers are currently investigating whether such implants might also help schizophrenics, Alzheimer’s patients, and victims of spinal-cord injuries.
Norris, who describes herself as “prolife” and a “strong Christian,” says the issues of abortion and fetal-cell implants are separate and ethically unrelated to each other. “We’re trying to derive some benefit out of this situation. That’s how I justify it,” she says. Most ethicists agree with her. But are abortion and fetal-cell implants really separate issues? Should human suffering be a society’s controlling concern in deciding whether to use new medical technologies? Are these new technologies dependent on immoral and unbiblical actions and attitudes?
Diabetes
Fetal-cell implant surgery is theoretically similar to replacing a car’s worn-out parts with new ones. Surgeons take cells from various organs of aborted fetuses and transplant them into adults suffering from various diseases. (Fetal tissue is preferred because it has a much higher chance of being accepted by the immune system of the receiving patient.) Surgeries differ depending on which “part” in the body has “worn out.” A brief look at diabetes and Parkinson’s disease will bear this out.
Diabetes strikes more than 11 million people nationally. The problem with those who suffer from diabetes is that their pancreases are unable to produce enough of the chemical insulin. The body needs insulin to process sugars and carbohydrates. Complications from diabetes can result in blindness, organ damage, loss of limbs, coma, and death. Ten percent of those who suffer from the condition have Type I diabetes, meaning that they are dependent on insulin treatments, usually self-injected with hypodermic needles. (Type II diabetes can normally be controlled by diet and exercise.) There is currently no cure for diabetes.
Greg Fujita, 36, was diagnosed with Type I diabetes when he was two years old. By age 32 he was learning to adjust to glaucoma and had undergone seven eye operations, including the removal of cataracts from both eyes and surgery on the blood vessels in his eyes, which had started to bleed. Apart from the specter of possible blindness, limb loss, or death, Fujita says it is the routine problems associated with diabetes that are frustrating: not being able to eat ice cream with friends on summer nights, or go on backpacking trips to remote areas, plus the uncontrollable mood swings that often accompany fluctuating blood-sugar levels.
In 1982 his kidneys began to fail. In early 1986 he went in for a kidney transplant and a new experimental procedure: the grafting of a small amount of fetal pancreatic tissue under his kidney. The results of the procedure performed at the University of Colorado were significant. After six months, the fetal tissue began to produce insulin, reducing Fujita’s need for daily treatments by 60 percent. And he also resumed what had been an active life, full of skiing, racquetball, and running. “I don’t really agree with people who are for abortion,” he says, “but the operation has enabled me to live a more normal life.” To date, 24 kidney-transplant patients at the university have undergone the procedure.
Parkinson’S Disease
Parkinson’s disease, which affects about 500,000 Americans, destroys cells in the brain that manufacture dopamine, the chemical that allows smooth walking and lucid speaking. Thus, shaking of the hands, head, and feet, and general body rigidity characterize the disease. In November 1988, in the first operation of its kind in the United States, surgeons at the University of Colorado drilled a quarter-sized hole into the skull of 52-year-old Parkinson’s victim Don Nelson and implanted fetal brain cells deep into his brain. (Yale University surgeons performed a similar operation one month later. To date, there have been nine implants performed in the United States for Parkinson’s.)
Traditional treatments had failed Nelson, but following the surgery he reports that his “voice is much stronger, I can speak much plainer, my memory is improving and my mind is sharper and not confused. I can walk around the house or in my yard without cane or crutches.” The operating surgeon, Curt Freed, a University of Colorado medical school professor, says fetal cells provide the cell growth necessary for dopamine production.
Cadaver Or Victim?
Citing ethical concerns, the National Institutes of Health in the last days of the Reagan administration declared a halt to the use of federal funds in fetal research. This ban effectively stopped research, except in programs like the ones at the University of Colorado and Yale, where the research is privately funded. The ban, however, has not stopped the debate among ethicists, who can basically be divided into two camps: those who support research on the grounds that the fetus is a cadaver, and those who oppose most research on the grounds that the fetus is a victim.
Arguing the cadaver justification, John Robertson, law professor at the University of Texas, says the fetus is essentially an organ donor, and that abortion is an ethically separate issue. “The issue is whether or not the tissue will be used or simply disposed of,” he says. “What would be wrong with using it to help someone with a horrible disease?” Robertson would also allow a woman to get pregnant for the sole purpose of getting an abortion to provide tissue for her husband or child who needed it.
Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, would draw the line at “creating a tragedy [abortion] for some other good” but agrees that the fetus is essentially a cadaver. And, he adds, laws regulating use of cadavers have been in place for more than 20 years.
Arguing the victim rationale, Allen Verhey, professor of religion at Hope College and coeditor of On Moral Medicine, says a distinction must first be made between elective abortions and nonelective abortions that happen as a result of miscarriage or are performed to save the life of the mother. Verhey agrees with Robertson and Caplan that doctors may ethically use fetal tissue from nonelective abortions in research and surgeries. But he argues that trying to separate the issue of elective abortion from fetal-tissue use overlooks the context and associations in which fetuses come into the world. “It comes back to ‘shall we do evil that good may come?’ ” concludes Vernon C. Grounds, president of Evangelicals for Social Action.
The Scandal of Fetal-Tissue Research
“If you allowed yourselves to think of God, you wouldn’t allow yourselves to be degraded by pleasant vices. You’d have a reason for bearing things patiently, for doing things with courage. I’ve seen it with the Indians.”
“I’m sure you have,” said Mustapha Mond. “But then we aren’t Indians. There isn’t any need for a civilized man to bear anything that’s seriously unpleasant.”
Aldous Huxley, Brave New World
There are many unpleasant, even savage, diseases that wreak havoc in the lives of both loved ones and those who love. I know about this havoc firsthand: My mother has Alzheimer’s disease.
Alzheimer’s is a chronic, irreversible brain disorder, or dementia. Its chief characteristics are senile plaques of amyloid protein laid down between nerve cells, inhibiting message transmission. Microscopic fibers, resembling twisted, tangled threads of yarn, also cluster in brain cell nuclei, mixing up the mind, obliterating memory.
The biomedical community says human fetal-tissue research and transplantation (HFTRT) offers hope—if not for my mother, perhaps for me should my own memory start slipping down the slope toward that abyss.
But that held-out hope demands a terrible, unbearable cost. The price tag is innocent lives destroyed by even crueler acts of savagery than the ravages of a dementia: the savagery of elective, on-demand abortion.
The logic seeking to justify HFTRT using deliberately aborted fetuses is as twisted as the neurofibrillary tangles inside my mother’s mind: twisted, tangled, and flawed.
The principle argument in favor of a full-speed-ahead approach is that abortion and HFTRT are separate and distinct issues. You can hate the one yet embrace the other. Even if you grant that elective abortion is an essentially evil act, it is argued that salvaging and using the fetal remains for good purposes does not connote complicity with the abortion itself.
The analogy frequently used is that of transplantation with organs derived from victims of homicide. If it is ethical to transplant those organs made available through a violent, illegal act, why not use fetal tissue from an albeit violent, but still legal act?
No complicity? Nonsense!
There is a general consensus among ethicists and researchers alike that a new “feel better” philosophy will result for both fetal donors and those who perform elective abortions if that fetus can be used to benefit humankind. Researchers and those receiving fetal tissue are not simply passive beneficiaries. They are, rather, actively providing opportunities to assuage both individual and collective guilt.
The same thing as an organ transplant? Absurd!
A fetus is not a heart or a liver, a kidney or a cornea. A fetus, electively aborted, is an innocent, developing human being that has been offered up as a living sacrifice to propitiate some lesser god of expediency, whose chief aim seems to be to rid us of anything (or anyone) that might make our lives unpleasant—even for as short a time as nine months.
The procurement and use of this human fetal tissue to enhance or elongate the life of another human being is not a simple salvage operation. It is, purely and simply, cannibalism.
The parent of a child gunned down by a homicidal maniac or whose life has otherwise been extinguished by illness or accident, does have the right to choose what to do with all or parts of their loved one’s body. The parent of a child electively aborted does not have that right. The issue of consent is no longer moot.
Having relegated the unborn to the status of nonhuman or prehuman, to give consent for the fetal remains following an elective abortion would imply the fetus was human after all. If this is the case, the parent is not simply a stranger who has abrogated rights as a result of the abortion, but is, in fact, the one responsible for the child’s death. Those who compare fetal-tissue transplantation to organ transplantation should take time to carry out their analogy to its logical conclusion.
“If you allow yourselves to think of God … you’d have a reason for bearing things patiently, for doing things with courage,” said John Savage in Huxley’s Brave New World. Patience and courage are two virtues sadly needed, in the research laboratories today that are bent on justifying the morality of fetal-tissue research and transplantations.
Patience is needed to wait: to wait for fetal tissue spontaneously or non-electively aborted that doesn’t bear the taint of sin. Patience is needed to pursue other, perhaps related, but ethically neutral avenues of inquiry.
Courage is needed, too. To seek to justify HFTRT by imbuing deliberately induced abortions with redeeming social value is the ultimate act of cowardice. The fact that justification is thought to be needed at all tells a tale. Morally righteous acts need no justification. So courage is needed to resist the vocal lobbyists representing sufferers of diseases like Alzheimer’s, Parkinson’s, juvenile diabetes, and AIDS, and to urge them to wait for treatments and cures that offer hope but also a peace of conscience for all concerned.
The supreme act of courage would be for researchers and ethicists alike just to say “no more” to certain avenues of inquiry. That slippery slope of ethical decision making needs fewer one-way streets and more roadblocks—not as obstacles to go around or over, but as places for rest, re-evaluation, and retreat. There is a desperate need for biomedical science to re-evaluate its understanding of suffering in light of the sovereignty of God. To do so may mean rewriting certain scripts and a giving up of certain powers. That, too, will be an act of courage, and for many people unaccustomed to restraint, a seriously unpleasant thought.
By Sharon Fish, R.N., M.S.N., author of Alzheimer’s: Caring for Your Loved One, Caring for Yourself (Lion).
At What Price?
Those who see the fetus as cadaver and those who see the fetus as victim agree on one issue: Since abortion is currently legal, fetal tissue will be abundant for the foreseeable future. Because of this widespread availability, fetal tissue will not be sold on the market nor will couples conceive for the purpose of providing tissue to someone else. As it turns out, surgeons do not want to use genetically related tissue because of concerns that it might be carrying the same disease as the patient. It is also illegal under current federal law to buy or sell fetal tissue. But the groups’ paths diverge on the central question of whether the goals, standards, and motives underlying this new technology are ethical and moral.
The goal of fetal-implant surgery is to relieve human suffering. “Society will not tolerate killing one life for another,” Caplan says in arguing against the thought of getting pregnant for the purpose of providing fetal tissue for someone else. But, as he told an advisory panel to the National Institutes of Health, “Those who would adhere to principle must be willing to answer the question: At what price?”
But human suffering cannot be the trump card in evaluating new medical technologies, says Kathleen Nolan, physician and ethicist at the Hastings Center, a secular research and educational institution in New York. “There is a tendency to go in that direction,” she says. “Some researchers have even wanted to take tissue from living fetuses, but that’s been tabled.”
The laudable goal of wanting to alleviate human suffering may ignore the fact that God, and not humanity, is sovereign over human suffering. “If we start with the premise that we’re going to totally alleviate human suffering, we’ll fail,” Verhey says. “Such an attitude takes the problem of solving evil out of God’s hands and puts it into human hands. The goal in suffering is not always to eliminate it but to share in it—to weep with those who weep, especially when we can solve the suffering technologically but can’t morally.”
Whose Consent?
The fetus-as-cadaver argument also sets the standards by which the use of fetuses is justified. With cadaver experimentation, researchers must gain consent before proceeding. Consent comes either from the person prior to death or from the deceased’s family after death.
In the case of fetal research, the fetus is a cadaver after the abortion, and the mother is the family member who grants consent. “I disapprove of car deaths and homicides,” Robertson says, “but not against the use of those cadavers in research. It’s the same thing with fetal cadavers. And even though it’s true that you’re deliberately killing the fetus, abortions are still legal.”
But the consent issue is trickier than that. Verhey disputes whether a mother’s consent following an elective abortion—as opposed to an abortion to save the life of the mother—is true consent. “One of the reasons we allow next-of-kin to give consent is that they’re presumed to have the person’s best interest at heart. But on the face of it, that is called into question by the fact that they’ve elected to have an abortion. The parents have, in effect, refused their parental identity over the child, and when that identity is called into question, then so is the justification behind the consent.”
Playing God
The motive behind fetal-cell implants is a desire to develop more effective methods of treating debilitating diseases. But the biblical doctrine of sin suggests another important, if unstated, motive behind such research. “I think these researchers are slipping into playing God,” says John White, retired psychiatrist and author. “All research arises out of a view of the universe, and secular doctors view matter as a thing in itself without reference to God. A scientist either takes the role of a magician or prophet. The prophet hears the word and obeys it. The power and authority of the prophet spring from his desire to be obedient to God.
“The magician, on the other hand, desires power in and of itself and wants God’s power to do miracles. He may not call it God’s power, but he lusts to play a God-like role. This magician’s mentality is almost universal in scientific research.”
Thus, starting points determine ending points. Those who view aborted fetuses as cadavers will usually support the goals, standards, and motives supporting most fetal research. Those who view aborted fetuses as victims will usually oppose the goals, standards, and motives cited in fetal research.
The Church’s Response
Much of the moral strength of the prolife position comes from the fact that convenience or the unwillingness to suffer consequences prompts most abortions. According to a 1989 Boston Globe poll, more than 90 percent of abortions are performed because of the emotional strain or inconvenience—economic or personal—to a mother carrying a baby to term (75 to 90 percent of voters polled would oppose abortion for such reasons). But the church can hardly fault diabetics, Parkinson’s victims, and others for taking hope from a new medical procedure. Nor can we discount their real affliction without, in the words of Isaiah, “hiding ourselves from our own flesh.”
The church needs to formulate cohesive arguments before going out into the world. “We need some kind of dialogue between theologians … and researchers,” says White. “It’s also important that we minister to the doctors in the church who are doing this kind of research, providing them with theological guidelines.”
Local churches can strive to influence the perspectives of their surrounding communities. “It is important that the church call the idolatry of technology idolatry,” Verhey says. “It’s also important that they shape the ethos of the community with respect to the unborn. And we can also shape the ethos by demonstrating other responses to suffering besides the technological response; i.e., we can endure and share suffering together.”
Attitudes toward abortion will continue to control most of the debate over the ethics of fetal-cell implants. For those Christians opposed to elective abortion, however, the issue becomes complicated because of the laudatory goals of those trying to help persons suffering from diabetes, Parkinson’s, and other diseases. The church cannot just say no to these people in regard to this procedure. It must also say yes to them in tangible ways.
Why the Government Should Lift the Moratorium
Moral and ethical concerns, raised appropriately when it was obvious nearly 20 years ago that abortions would be permitted, caused some individuals to envision the marketing of human fetuses for laboratory experiments. The United States government answered the public outcry not with strict guidelines by which legitimate fetal research could be conducted, but by ordering a temporary moratorium on all such research activity until a satisfactory policy could be decided.
The ban was imposed initially for five years. Now it is nearly 20 years later and still there is no federal policy. Periodically in the media we are reminded of the moratorium each time a medical breakthrough using the human fetus or its tissues is claimed—for example, in vitro fertilization of the human ovum to produce “test-tube babies.” Success with this technique has seen ethical concerns fade to legal bickerings over ownership of the unused eggs. But larger questions are also raised by this and other practices—for instance, in relation to abortion: When does life begin? or in relation to fetal surgery: When are the rights of a fetus considered apart from its mother, or, perhaps, parents? These issues are likely to remain unsettled for years to come.
Most recently, the proposed use of fetal tissue to treat several neurological conditions has rekindled the flame of the fire many thought doused by the moratorium. It seems that no decision on the matter of using fetal tissues for research is preferred to a less than perfect one, no matter how many unhealthy individuals might suffer or die, perhaps, unnecessarily.
Saving the premature
The consequences of indecision must be examined more closely. The original ban affected not only studies of the human fetus, but also untested treatments for newborn babies, especially those born prematurely—85 percent of whom would die. Specialized medical care existed then only in a few major university centers where a handful of investigators, mainly pediatricians and obstetricians, worked diligently to identify new clinical applications and, with the help of engineers, to design equipment that had the potential for improving survival of babies.
The majority of neonatal research at the time was conducted in the United States, and there was little possibility for continuing these research efforts in another country beyond the reach of the moratorium. In effect, the moratorium stopped virtually all research critical to the treatment of sick infants just as the threshold of promised breakthroughs was reached.
The basis for the early development of intensive-care nurseries was limited to techniques adapted primarily from the intensive-care management of sick adults. It would be many years until fetal and neonatal animal research revealed that many of the responses to treatment by the newborn infant are different—even opposite—from the adult. A treatment that benefited a sick adult might well cause the death of a premature infant whose responses for a time after birth are more like those of a fetus than a child or adult.
Even with these makeshift techniques, survival among high-risk infants gradually improved, but the cost of medical care to sustain irreversible injury, primarily to the lungs and brains of many survivors, and the emotional devastation to many families, were unacceptably high. Any victory claimed for the fetus during the moratorium must be tempered with an appreciation for the “Dark Ages” of neonatal research, attributable in large measure to the years of indecision and delay contributed by the moratorium and the uncounted deaths of babies who could have been saved.
A prolife issue
Fetal-tissue research raises many ethical issues, but our society has already dealt with most of those problems in principle. The transplanting of tissues retrieved from human cadavers to extend the life of another individual has gained widespread acceptance and provides an example for consideration. The ethical and moral concerns raised during the early years when human organ transplantation was considered experimental were not very different from the ones heard today regarding the use of fetal tissues, but these have been answered, at least in part, by the remarkable successes realized in recent years. For every four kidneys, hearts, or livers removed at the time of death from human donors, three of them will restore health in grateful recipients. Corneal transplants restore sight in an even higher percentage of blind persons, and skin covers the wounds of burn victims and facilitates recovery.
Where, then, is the difference in using tissues obtained from human fetuses to restore health or extend life, especially if the tissue is obtained from fetuses aborted spontaneously—which will occur unpredictably in many pregnancies—just as accidental deaths provide a source of donor organs? Advocacy for fetal-tissue research is not only compatible with a moral stance opposing abortion but also is, in fact, a prolife attitude. It is time to develop the long-promised federal policy so that promising research can proceed. The cost of indecision has been needless suffering and death. Why wait any longer?
By Billy S. Arant, Jr., M.D., professor of pediatrics and director of the Division of Pediatric Nephrology at the University of Texas Southwestern Medical Center at Dallas.
