Fetal Tissue Harvesting:
An Ethical Free-Fall

By Paul Ranalli, M.D.

Spring is the season of renewal - - from the Christian belief in the resurrection of Christ to the more secular appreciation of the earth's rebirth from the winter months. Renewal is a driving force in medical research as well, particularly in the fields of tissue rejuvenation, regrowth, and transplantation.

Yet, if not properly grounded in sound moral reasoning and relevant medical data, renewal as a medical therapy can led us far astray.

Pro-lifers can be forgiven if they confuse two separate but related controversies. The first involves tissue or whole fetal body parts harvested from aborted babies. The second is the question of so-called "embryonic stem cells," taken either from aborted babies or lethally removed from embryos created at infertility clinics who were not implanted. The former is an ongoing debate that extends back to the late 1980s. The latter is new, at least in the sense that knowledge of it is has come to light only relatively recently.

As recent ghoulish news reports have revealed, medical researchers at universities in British Columbia, Nebraska, and Colorado (and likely other institutions) do not simply order " fetal tissue" from providers; they order leg bones, livers, spleens, whole eyes, and other organs. And despite admonishment from the Canadian Royal Commission on New Reproductive Technologies and a U.S. congressional prohibition against a money-making marketplace for fetal tissue, there are clear indications that just such a marketplace has developed; human fetal parts are being sold for a profit.

In both instances proponents have attributed unique, near- miraculous curative properties to tissue/body parts reaped from unborn babies.

PARKINSON'S DISEASE AND FETAL BRAIN TISSUE

The most direct clinical application of human fetal tissue has been the decade-long attempts to transplant fetal brain tissue from aborted babies into the brains of patients with Parkinson's disease. Herein lies a tale of desperate hope, moral anguish, initial scientific and public enthusiasm, and ultimate (though still strongly denied) failure.

Parkinson's disease is a progressive, degenerative brain disorder characterized chiefly by a loss of motor control, involuntary tremor, muscle rigidity, slowness of movement, and problems with balance and walking. While the exact cause of Parkinson's disease is unknown, we do know it is associated with a decline in the production of the brain chemical dopamine.

In the early-to-moderate stages, neurologists have a fair degree of success treating patients with a variety of medications that either boost dopamine synthesis or directly stimulate dopamine receptors in key deep brain structures.

After a number of years, however, the effectiveness of these drugs wears off, or is accompanied by troubling side effects. A search for novel therapies has led to a variety of experimental brain surgery procedures.

The theory behind reaping and transplanting fetal brain tissue is that dopamine-producing cells extracted from the brains of a number of aborted fetuses can be injected deep into critical brain regions of the recipient Parkinson's disease patient. The hope is they will take root and begin to produce the needed dopamine.

However, despite tremendous hype that continued to capture the public imagination, a series of limited, uncontrolled case reports provided little evidence of real success.

Finally, in 1999, the results of a well-designed study funded by the U.S. National Institutes of Health revealed that the use of fetal tissue had proven to be essentially worthless. Unfortunately, the public was misled by unjustifiably optimistic headlines such as "Parkinson's progress" and "Hints of Success in Fetal Transplants."

Even for those who do not recognize an individual human life as beginning at conception, from an ethical perspective, the fetal transplant issue draws attention to certain scientific facts about early fetal development that should be more than a little unsettling.

Most abortions take place in the latter part of the first trimester of pregnancy, from eight to 12 weeks. This is exactly the stage at which fetal brains are removed for potential transplant. Far from being an undifferentiated "blob" of tissue, the first- trimester fetus not only has a brain but has also developed a fantastic level of specialization.

Much as he or she may wish otherwise, the scientist who uses fetal tissue in either pure laboratory research or clinical experimentation cannot avoid the abortion controversy. Any attempt to do so risks being seen as a somewhat disingenuous form of denial. Hans Jonas, who rejects the concept of the moral immunity of discovery, has observed the widely held view among scientists that "freedom in inquiry is claimed, granted and cherished as unqualified on the premise that inquiry as such raises no moral problems."

Defenders of the use of fetal tissue often advance two lines of argument. One, that fetal tissue transplantation is merely an extension of organ donation, a long and honored form of medical altruism. Opponents of the use of fetal tissue, however, counter that organ donation arises from tragedies we try to prevent: fatal accidents or murder. Abortion, on the other hand, is an elective choice in our society and many affirm it as an absolute right.

A second point to be made in support of the use of fetal tissue is the "let's not let it go to waste" sentiment, in which even those who profess to be troubled by elective abortion see the benefit of salvage in making a contribution to science with material that would otherwise be discarded. This inevitably raises the specter of other ill-gotten medical data, such as the human experimentation under the Third Reich or the Japanese cold- exposure data extracted from murderous experiments on Asian prisoners of war.

However, there is a further deeply troubling aspect attached to the unwarranted aura of success that surrounds the practice of fetal tissue transplantation. A 1995 survey by the Joint Centre for Bioethics at the University of Toronto found that, among women who would consider having an abortion, 17% would be more likely to undergo an abortion if fetal tissue could be donated for medical use.

When one considers the current abortion rate of over 100,000 per year in Canada, and 1.4 million per year in the U.S., the extra number of abortions that may occur, based on a false premise of " being of help," becomes a real public health issue.

PROMISING ALTERNATIVES

While unknown to the general public, the truth is that the world of medical research may be passing by fetal tissue transplantation.

It is now over a decade since the experiments began and precious few advances have occurred. Meanwhile, new medications continue to be added to the treatment of Parkinson's disease.

In addition, there are now two brain surgery procedures, (pallidotomy and deep brain stimulation), which do not require fetal tissue, that have been proven effective at extending the functional longevity of patients with advanced Parkinson's disease. Recently, new hope and controversy has arisen with the potential use of implanted stem cells. These primitive, undifferentiated cells are capable of being coaxed into developing along one of several cell lines, including brain cells. The controversy has been over those who insist the best, if not exclusive, source for these versatile cells come from aborted human embryos.

Yet, as Richard Doerflinger's review article on page 8 makes clear, there are ethically acceptable alternatives. There has been a series of stunning reports that such stem cells can be found, albeit in small numbers, within the tissues of adult humans. Although much work needs to be done, some scientists now suspect that each person may harbor all the cells he or she will ever need to regrow or rejuvenate ailing body parts.

Which goes to show that, given time, science will often find a way to advance, without the need to compromise human dignity in the interim.

Dr. Paul Ranalli is a neurologist on the Faculty of Medicine at the University of Toronto.