Ethical vacuum in fetal tissue research

January 20, 1991|By SARA ENGRAM | SARA ENGRAM,Sara Engram is deputy editor of the editorial pages of The Evening Sun.

YOU MAY HAVE MISSED the announcement, but President Bush has declared tomorrow "National Sanctity of Human Life Day."

The proclamation comes in the same week as the 18th anniversary of the Supreme Court's Roe vs. Wade decision legalizing abortion. That 1973 ruling initiated a stand-off that has proven to be just as resistant to dialogue as Saddam Hussein's determination to hold onto Kuwait.

Almost two decades later, there seems to be no chance of civil discussion, let alone compromise, between those who see a fertilized egg as a potential life that is still part of a woman's body and those who see the same microscopic speck as a tiny person with rights of its own.

The nation is paying a price for this impasse. A prime example is the government's approach to the issues surrounding reproductive research -- or, rather, its determination to avoid offending abortion opponents by washing its hands of the matter altogether.

As long ago as 1979, the Department of Health and Human Services let its Ethics Advisory Board lapse. That action brought an end federal financing of research on fertility -- new forms of birth control as well as ways to help infertile couples conceive. All such projects had to be approved by the board.

Then, in 1988, the department ended federal funding for fetal tissue research. Department officials, including Secretary Louis W. Sullivan, have attributed that decision to their fear that further progress in using fetal tissue to treat diabetes or Parkinson's disease or other conditions could actually increase the number of elective abortions.

There is no evidence to support that fear -- despite the assertions of a few women who say they would conceive if their fetus could provide tissue to treat a relative.

Arthur Caplan, director of the University of Minnesota's Center for Biomedical Ethics, maintains that of all the issues raised by fetal tissue research, the fear that it will encourage abortions is probably the easiest to deal with. The demand for fetal tissue is not so great that every clinic that performs abortions would need to request donations. Those that do could make the request randomly, so that women would not know beforehand whether they would even be asked.

Such practical suggestions have gotten lost in the shouting, as anti-abortion activists succeeded in getting the government entirely out of the business of fetal tissue research.

Their victory not only leaves a funding vacuum for researchers; it also takes away an important force for oversight and regulation -- a moral compass, if you will. While everybody focuses on abortion, other questions that pose more troubling questions are conveniently ignored.

Earlier this month, two medical societies, the American College of Obstetricians and Gynecologists and the American Fertility Society, announced the formation of their own panel to provide ethical guidelines for research involving fetal tissue and reproductive technology. The two groups say their board will not be dominated by doctors and scientists, but will draw on a broad base of opinion.

Certainly the panel is a step in the right direction. Even so, a group set up by scientists and doctors simply doesn't have the public accountability that a government-appointed group would have. Neither will it have the power to enforce its guidelines by controlling funding.

But at the moment, it's our best hope of coming to terms with some pressing questions:

* It's illegal to sell fetal tissue, but who is to make sure that procurement or handling fees are not excessive?

* Who will make sure that those involved in procuring fetal tissue are not also involved in counseling women about abortions or actually performing them?

* At what point will women be asked to donate -- when they are deciding whether to have an abortion, after the decision has been made but before the abortion occurs, or after the abortion? As Dr. Caplan points out, the timing of the request is in itself an ethical consideration.

* Who will ensure that abortions are not timed or the techniques modified for research purposes?

* Who will protect recipients of fetal tissue transplants by making sure the tissue is tested for infectious diseases?

A lot of thinking through has yet to be done. Which raises an even more puzzling question: Our leaders are willing to spend American lives to stand up to Saddam Hussein's aggression. Why can't they show equal resolve in coming to terms with the political pressures that are preventing sound ethical thinking about reproductive research?

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