Fetal Research

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Fetal research encompasses a broad array of research activities and potential clinical applications. It is ethically controversial because, although it may yield beneficial results, it involves the human organism at a stage of development where its moral status is contested and informed consent is not possible.

One key distinction centers on the stage of development of the human organism when the research is conducted, from pre-implantation to late fetal stages. The general sources of fetal material include tissue from dead fetuses; pre-viable or nonviable fetuses in utero prior to an elective abortion; nonviable living fetuses ex utero; or embryos, either in vitro or pre-implantation. Another distinction is that between investigational research that cannot benefit the subject fetus and therapeutic research that might benefit the fetus subject or is likely to benefit future fetuses. Clinical applications including transplantation using fetal material such as tissues, cells, or organs represent another form of fetal research. Moreover, among the many non-clinical uses of human embryos are the development of contraceptives and abortifacients and the study of abnormal cell growth and chromosomal abnormalities.

One of the most controversial types of fetal research involves embryonic stem cells. Stem cells are primitive cells that have the capacity to divide for indefinite periods in culture and give rise to specialized cells. Most attention is focused on pluripotent cells, those capable of giving rise to most tissues of an organism but not all types necessary for fetal development. The source of these cells can be adult humans, modified stem cells from other species, or most promising (and controversial), cells from aborted fetuses or human embryos (either "spare" embryos from in vitro fertilization or embryos created specifically for research purposes). Some of the potential benefits of stem cell research being discussed are growing new organs, reversing paralysis and other neural/spinal damage, reversing the effects of neuro-degenerating diseases such as Alzheimer's, repairing heart damage, and treating diabetes, cancer, and other diseases.

Potential benefits of other types of fetal research include both knowledge and therapeutic applications. Among the many non-clinical uses of fetal and embryo research are: (1) investigation of abnormal cell growth including various cancers; (2) studying the development of chromasomal abnormalities and other birth defects; (3) understanding implantation problems and miscarriages; and (4) increased knowledge of cancer and aids.

Fetal research first appeared on the national policy agenda in the early 1970s after widely publicized exposés on several gruesome experiments conducted on still-living fetuses. In response, the U.S. Congress passed the 1974 National Research Act (Public Law 93–345) establishing the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, whose first charge was to investigate the scientific, legal, and ethical aspects of fetal research. In 1976, regulations for the federal funding of such research were promulgated (45 CFR 46.201–211). Under the regulations, certain types of fetal research are fundable, with constraints based on parental consent and the principle of minimizing risk to the pregnant woman and the fetus.

In 1985, Congress passed a law (42 U.S.C. 289) forbidding federal conduct or funding of research on viable ex utero fetuses with an exception for therapeutic research or research that poses no added risk of suffering, injury, or death to the fetus and leads to important knowledge unobtainable by other means. Federal regulations on fetal research, then, appear to be quite clear in allowing funding within boundaries. However, in two key areas—embryo research and fetal tissue transplantation research—there in effect was a moratorium on federal funding between 1980 and 1995, which, according to the Institute of Medicine, severely hampered knowledge in medically assisted reproduction because the reliance on private funding shifted emphasis from essential basic research to rapid and often risky clinical applications. In addition, many states have laws regulating or even prohibiting certain types of fetal research, often either part of or attached to abortion statutes (for details see NCSL 2003).

At the center of the controversy over fetal research is disagreement over the moral and legal status of the fetus. Questions also center on who may consent for the use of fetal materials, under what circumstances the abortion procedure can be modified to meet the needs of the research, and what type of compensation, if any, for fetal tissues should be allowed. As a result of these issues, fetal research has been elevated to the public agenda and has become a highly volatile moral and political issue (Vawter, Kearney, and Gervais 1990).

There is an ongoing debate over whether the use of fetal tissue from elective abortion encourages or legitimizes abortion. On the one hand, opponents argue that research using aborted fetuses gives abortion greater legitimacy and contend that use of embryos and fetuses for research exploits them and reduces them to biological commodities (Brown 2003). Moreover, because the fetus is unable to consent, there is concern over what type of consent and by whom is sufficient, and how to balance research needs with interests of the pregnant woman. On the other hand, supporters argue that research using human fetal and embryonic materials is critical for progress in many areas of medicine (Fletcher 1993).

As already suggested, perhaps the most controversial area of fetal research involves the use of fetal cells for transplantation to adult patients to treat a wide range of disorders (Stein and Glasier 1995). Such tissue can come from spontaneous abortions, induced abortions on unintended pregnancies, induced abortions on fetuses conceived specifically this purpose, or from embryos produced in vitro. A dependence on spontaneously aborted fetuses for research is impractical because of the limited number available and the inability to control the timing. The major supply of fetal tissue, therefore, is likely to come from induced abortions, but this raises vehement objections on moral grounds by groups opposed to abortion (Brown 2003).

In light of the extent to which stem cell research might revolutionize health care, there is a huge commercial stake in fetal/embryo research. Already, marketing and advertising has started in the area of umbilical cord stem cell preservation and this is certain to be followed by broader efforts to market the fruits of this research. Moreover, once the benefits start to materialize, demand for cell lines will intensify, thus putting pressures on potential suppliers. Both of the two options, production of designated research embryos or increasing the supply of spare embryos, bring risks to women and raise questions concerning the consent process and proprietary rights over what promise to be very lucrative human materials.

There is also concern that increased pressures for these scarce resources could lead to exploitation of poor women paid to conceive solely to provide fetal material or an international market for multi-national drug companies.

Moreover, the continually expanding field of potential uses of fetal tissues, complicated by the difficulty of ensuring cooperation from abortion clinics and obstetricians in making fetal tissue available, has raised concerns for maintaining an adequate supply of fetal tissue. The availability of RU-486 and other abortifacients might actually diminish the supply of usable fetal tissue at a time when demand is increasing.

Clearly some important areas of fetal research have been explicitly constrained on moral rather than scientific grounds. The presence of abortion politics continues to exert strong influence on research funded by the government across a wide range of substantive areas. In the process, some argue that long-term scientific goals are being compromised by immediate, pragmatic political objectives. The spirited debate over stem cell research in the 2004 election and the decision of California voters to invest $3 billion demonstrates that these issues will not dissipate. Given the sensitivity of human embryo and fetal research and its interdependence with abortion, this should not be surprising. Fetal research raises moral red flags for many persons and thus will remain a political as well as moral issue.

Abortion;; Embryonic Stem Cells;; Genethics;; Genetic Counseling;; Human Subjects Research;; In Vitro Fertilization and Genetic Screening;; Playing God;; Research Ethics.

Fletcher, John C. (1993). "Human Fetal and Embryo Research: Lysenkoism in Reverse—How and Why?" In Emerging Issues in Biomedical Policy, Vol. 2, ed. Robert H. Blank and Andrea L. Bonnicksen. New York: Columbia University Press.

Stein, Donald G., and Marylou M. Glasier. (1995). "Some Practical and Theoretical Issues Concerning Fetal Brain Tissue Grafts as Therapy for Brain Dysfunction." Behavioral and Brain Sciences 18: 36–45.

Vawter, Dorothy E.; Warren Kearny; Karen G. Gervais, et al. (1990). The Use of Human Fetal Tissue: Scientific, Ethical, and Policy Concerns. Minneapolis: Center for Biomedical Ethics.

Brown, Judie. (2003). "Recycling Babies: The Practice of Fetal Tissue Research." American Life League, Inc. Available from http://www.all.org/issues/eg99y.htm.

National Conference of State Legislatures (NCSL). (2003). "State Embryonic and Fetal Research Laws." Available from http://www.ncsl.org/programs/health/gen etics/embfet.htm.

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