Taking Issue with Fetal Tissue, Are Women Being Conned?
The crisis over a woman's right to abortion and reproductive self-determination in the United States has produced a situation in which many women's health supporters have leaped to advocate problematic and potentially dangerous technologies for women. With this advocacy, they are abandoning the kind of critical thinking and independent judgment that has, for the last 20 years, characterized the women's health movement. Why is it that to be prochoice has come to mean that we must accept a problematic chemical abortion method called RU 486, as well as a host of experimental new reproductive technologies - in-vitro fertilization (I VF), embryo transfer, and now the new, much touted field of tissue research and transplantation?
Why is it, for example, that the consequences to women of fetal tissue research have all but been ignored in the fetal tissue debate now being waged by opponents and proponents of abortion? Medical research involving fetal tissue has been going on for decades, but only in the last five yean has it been used to treat people; there is a particular hope for its efficacy in treating devastating illnesses such as Parkinson's and Alzheimer's.
The altering of abortion techniques is one of the more immediate consequences for those women undergoing the procedure who consent to donate their fetuses for research and transplantation. In the suction or curette methods, for instance, fetuses are macerated before they are removed from the uterus; this causes the woman as little discomfort and danger as possible. However, it makes it difficult to identify specific sorts of tissue and to retrieve, intact, fetuses with the fully developed cells and tissues necessary for fetal tissue transplants. Doctors who need good tissue samples must therefore modify the suction method and extend the time it takes to perform an abortion, something which could put women at additional risk of complications. To obtain usable tissue in the first trimester of pregnancy, the Institute for the Advancement of Medicine, the largest U.S. supplier of fetal tissue, encourages doctors to employ ultrasound to find the fetus in the woman's uterus and then to vary the amount of suction so as to trap the whole fetus in the catheter. This method, however, is not very successful. Other doctors use a method by which a suction abortion takes 15-25 minutes instead of the usual five to seven minutes. For Australian doctors, the preferred method of obtaining intact fetal tissue is to dilate the woman's cervix to the point where the fetus can be extracted whole and alive. Disagreement in the medical community over whether older or younger fetuses are more useful for fetal tissue transplants raises the possibility that women will be induced to have abortions after the first trimester to thus insure that the fetuses will be intact.
Since salvaging intact fetal tissue requires that a fetus be delivered as whole as possible, yet it is generally better for the woman if a fetus is fragmented in the womb - the question must be asked: Who is the primary patient in abortions involving fetal tissue procurement - the aborting woman or the possible recipient of the tissue? Will doctors determine the timing and methods of abortions to conform to the need for a certain kind of intact and/or usable fetal material?
One primary effect of fetal tissue research and transplants has been to turn women into fetal tissue containers; mere maternal environments for the fetus. (In many of the new reproductive technologies - egg extraction and donation, for instance - women can all too easily be objectified as "natural resources" whose bodies are mined for medical and scientific "gold.") The role of women in fetal tissue research is, after all, to provide the raw material.
Ironically, a justification for fetal tissue transplants cited by medical researchers is that all this tissue is "going to waste." And with the increased assault on abortion in the United States, even some prochoice advocates have come to feel they must justify abortion by citing a general benefit from it. Unfortunately, women themselves are made to feel that their abortions should have a redeeming virtue. Fetal tissue donation can provide "redemption" for what is often a difficult and painful decision. But to have an abortion is a hard enough decision for women without their having to be burdened with worry over whether or not to donate fetal tissue.
Is it possible that one day abortions could become the handmaidens to fetal tissue procedures? A majority of respondents in a 1989 survey conducted by Glamour magazine argued that donating fetal tissue to medical research will give women the chance to be altruistic by putting the tissue to good use instead of wasting it.
More and more, it is women who are expected to be altruistic with what issues from their bodies. Donor systems, especially in the reproductive realms, mainly depend on women. In surrogacy arrangements women contribute gestating capacities; women undergoing hysterectomies are being asked to donate their eggs for IVF research. Comparatively, where men donate sperm, the procedure is quite different: It is simple, short lived and procured from a pleasurable act. Eggs, however, are procured from an uncomfortable and unpleasurable medical procedure - laparoscopy. Prior to laparoscopy, a woman must submit herself to risky hormonal injections for five to seven days to increase the production of eggs, have her blood drawn three times, undergo ultrasound, and 30 minutes of anesthesia. Women undergoing tubal ligations, too, are being asked in increasing numbers to donate their eggs for IVF research. In 1988, U.S. News and World Report estimated that about 125 medical centers in the U.S. offer to purchase eggs and advertise quite widely for donors. Whether or not women donating eggs are compensated, the egg donation is pitched by the clinics as aiding the infertile. the pervasiveness in our society of appealing to women's personal and social obligation to nurture and give is clearly being exploited in these medical contexts. It is with the advent of fetal tissue transplants however - still a questionable field - that we see just how readily the pervasive notion of women as givers and donors comes to the fore. There has been a lot of miracle talk about the promise of fetal transplants, but it is, so far, only a promise.
The first operations using fetal tissue took place in Mexico City in 1987, and then in Stockholm, Sweden and Birmingham, England. The first U.S. fetal tissue transplant was performed at the University of Colorado in 1988. Initially, the Mexican team reported that the condition of one of the Parkinson's patients receiving a fetal tissue brain graft was markedly improved, yet three of the eight Mexican transplant patients had died within two years of the operation. In 1988, the Swedish team reported that their implantations had not had any clinical significance. In the same year, the American Academy of Neurology issued a statement urging great caution in expanding the use of fetal tissue transplants in the treatment of Parkinson's disease. Two weeks before their position was publicized, the American Association of Neurological Surgeons had issued warnings to their membership about performing fetal tissue surgery. Both groups took the position that what little we know about the actual results of fetal tissue surgeries, especially with Parkinson's patients, is more a cause for caution than a case for cure.
A UNESCO report also found that despite great initial enthusiasm, the promise of fetal tissue transplants has not been fulfilled. In the wake of largely discouraging results researchers continue to perform experimental transplants of fetal tissue into the brains of Parkinson's patients. People with no other hope of cure are lining up for fetal tissue grafts.
Although newspaper headlines in November, 1992, reported success using fetal tissue to repair the brains of a small group of Parkinson's patients, the text told a different story. The Boston Globe, for example, reported that the techniques, "Did not alleviate all symptoms or achieve consistent results." Three patients gained "modest improvement," and one patient died four months after the implant surgery. The results of eight other patients, "could not be discussed." Success, it seems, was limited to two people who, after injecting themselves with synthetic heroin, had become literally frozen in place. The study reported they regained the ability to walk, dress and feed themselves. Researchers also admitted that to improve the survival rate of transplanted tissue, multiple abortions would have to be scheduled within hours of the fetal implant operation, as only 10 percent of the implanted fetal cells survive. Clearly this raises a question about the even larger amounts of fetal tissue needed, and where it will come from.
The only restraint on fetal tissue research and surgery has been the Bush administration's ban on federally-funded fetal tissue transplants into humans The administration's ban was based on its position that "permitting the human fetal research at issue will increase the incidence of abortion across the country." It was this decision that linked the fetal tissue debate with the controversy over abortion. Ever since then, liberals and feminists have been supporting fetal tissue research and transplantations in what appears to be a line of defense against the erosion of abortion rights.
Several Congressional hearings have been held, and legislation has been proposed to overturn the ban on federally-funded fetal tissue research and transplantation. In 1991, the House of Representatives Subcommittee on Health and Environment held public hearings on a bill to overturn the ban, and I appeared before this subcommittee as the only witness to testify against this bill. All of the witnesses in favor of lifting the ban testified on the presumption that the research was progressive, proven to be therapeutic, and lifesaving. No one questioned its claims or seemed aware of the skepticism in the scientific community. None of those in favor of lifting the ban, including all the Congressmen on the subcommittee, addressed the consequences for women of fetal tissue procurement. All those supporting the research appeared to acquiesce in the widely expressed sentiment that abortions were a waste if fetal tissue was not put to medical use. These supporters were willing to give the legal go-ahead to a system of routinely harvesting fetal tissue before its success has been proven. Some have argued that fetal tissue donation and procurement should be legally regulated to insure the aborting woman's informed consent. In 1988, the Institute for the Advancement of Medicine did insist that its clinic and hospital suppliers obtain a woman's consent before giving fetal tissue. But about half the suppliers refused, and they no longer provide the Institute with tissue. In England, where hospitals must get a woman's consent before distributing her fetal tissue for research, only 50 percent of women undergoing abortion give it. But even if all the women undergoing elective abortions consented, there would still not be enough fetal tissue to meet the demand.
Regulations that would ban the sale of fetal tissue have also been proposed. They would: Insure that fetal dissection cannot take place while fetuses are still alive; dissociate doctors performing abortions from those using fetal tissue; prevent women from designating beneficiaries of fetal tissue; and confine research and treatment with fetal tissue to quality controlled medical centers. Aside from the fact that none of these regulations addresses the changes in abortion methods and the consequences for women, a system of regulation that would allow fetuses to be used for medical research and treatment will begin a process that is likely to end with the widespread use of fetal remains for a host of purposes - experimental, therapeutic and commercial. And, as we have seen with attempts to regulate surrogacy, those who have the most to gain - surrogate brokers and lawyers - are those who are at the forefront of influencing and crafting the direction of the legislation. The incentive for legal regulation of fetal tissue is coming from the medical researchers and fetal tissue processors, not from the women directly involved. True, the proposed regulation of fetal tissue would close some of the loopholes now present in the unregulated world of fetal tissue procurement but, if enacted, would give the procurers and researchers a stable marketing and experimental environment. Finally, regulation doesn't address the political reality that has cast women in the role of human incubators.
Fetal tissue legislation is discussed as if there are only two sides to the issue: Those who are prochoice are in favor of fetal tissue research, those who are antiabortion are opposed. Public debate over the use of fetal tissue has already been stereotyped as a controversy between the forces of medical progress and the retrogressive right wing. Within this camp of only two recognized positions, there has been no room for others. It is a tragedy and a travesty of feminist drinking and politics that feminist critics of fetal tissue procurement and research are accused of being in league with the right wing, and genuine feminist dissent is suppressed.
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