Fetal Tissue Research Raises Disturbing Questions

By Paul Ranalli

(Dr. Paul Ranalli is a pro-life neurologist in the Faculty of Medicine at the University of Toronto.)

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, can renewal as a medical therapy be a bad thing?

On the subject of the biomedical use of human fetal tissue, this is an important question to ponder. For alongside the promise of fetal-tissueresearch there are uncomfortable realities. As recent ghoulish news reports have revealed, medical researchers at universities in British Columbia, Nebraska, 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 a civilized society there are things that should not be for sale,” Andrew Kimbrell, author of The Human Body Shop, said recently. “But right now we are in an ethical free fall.”

The most direct clinical application of human fetal tissue has been the decade-long experience in transplanting fetal brain tissue 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. The exact cause of Parkinson’s disease is unknown, but we do know it is associated with a decline in the production of the brain chemical dopamine. In the early to moderate stages of the disease, 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 fetal transplantation is that dopamine-producing cells extracted from the brains of several aborted  fetuses can be injected deep into critical brain regions of the recipient Parkinson’s disease patient, hopefully to take root and begin to produce the needed dopamine. However, a series of limited, uncontrolled case reports provided little evidence of real success, despite tremendous hype that continued to capture the public imagination.

Finally, a well-designed study funded by the U.S. National Institutes of Health revealed that the use of fetal tissue was essentially worthless. This was an immense disappointment to workers in the field but the public was shielded from the full force of this result, with headlines such as“Parkinson’s progress” and “Hints of success in fetal transplants.”

From an ethical perspective, even for those who do not recognize an individual human life as beginning at conception, 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.

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 medical altruism. Opponents of the use of fetal tissue, however, would 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 acontribution to science with material that would otherwise be discarded.  It is probably not unfair to characterize this position as Pontius Pilate-like in its hand washing of any concern about the troubling source of this tissue. And what of the limits of this justification of the use of potentially expedient data, however obtained? Although Professor Michael Marrus has, recently in this space, wisely cautioned us against the overly promiscuous invocation of Nazism in bioethical debates, one simply cannot address the subject of ill-gotten medical data without referring to the searing examples of human experimentation under the Third Reich or the Japanese cold-exposure data extracted from murderous experiments on Asian prisoners of war.

Since the 1988 Supreme Court of Canada Morgentaler decision struck down the old hospital abortion committee law, there has been a legal vacuum on the subject of fetal rights. Moreover, the current unrestrained practice of abortion supersedes a number of recommendations contained in the 1989 report from the Law Reform Commission of Canada, Crimes Against the Fetus. Another Law Reform Commission report, on human biomedical experimentation, goes to the heart of the matter: “At what moment in the development of the product of conception are we dealing with a human being or a human person?”

There is a troublesome aspect 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 percent 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, becomes a real public health issue.

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. On the other hand, new medications continue to be added to the armamentarium in treating Parkinson’s disease and there are now two brain surgery procedures, which do not require fetal tissue, that have been proven effective at extending the functional longevity of patients with advanced Parkinson’s disease. University of Toronto neurosurgeon Andres Lozano, in collaboration with neurologist Anthony Lang, is recognized as a pioneer in the surgical techniques of pallidotomy and deep brain stimulation.

Recently, new hope and controversy has arisen with the potential use of implanted stem cells. These primitive “pluripotent” cells, normally present in the human embryo, are capable of being coaxed into developing along one of several cell lines, including brain cells. The controversy has been over the need to use aborted human embryos to retrieve these versatile cells. Yet even this ethical dilemma may be averted, following the stunning recent 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 re-grow 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.