How the Church views experiments on human embryos
A recent Straits Times article reported on how scientists here are growing fertilised human embryos to treat ailments. Fr James Yeo, a lecturer in Fundamental Moral Theology at the seminary, gives the Church's view on this and other related issues.
FETAL tissue transplant has generated great interest and excitement in the medical community. Some even compared what fetal tissue transplant is for medicine with what superconductivity is for physics.
I want to begin by examining why fetal cells or fetal parts are used and the sources for these fetal cells. The issue of abortion and the complicity for those involved in fetal parts transplant will also be examined. In fact, the issue of abortion permeates the whole of the fetal tissue transplant issue as we shall see.
And now there is the possibility of producing fetal cells or embryonic cells in-vitro or producing embryos or fetuses genetically so that fetal or embryonic cells can be obtained from these.
I want also to examine the question of consent for the use of the embryonic cells and who really has the authority over the embryonic cells and tissues. In each of these subissues, I will present the position of the Catholic Church. I will end with some guidelines for fetal or embryonic cell or tissue transplant.
Uses, sources of fetal/ embryonic cells
The concept of using fetal cells or fetal tissue for transplantation and research is gaining worldwide momentum. Attempts at fetal transplant and other medical use of fetal or embryonic cells and tissues go back to 1928 when an attempt was made unsuccessfully to transplant fetal pancreas cells into a patient with diabetes.
The first successful use of fetal tissues was the utilization of fetal kidneys in the development of the polio vaccine in the 1950s. (Vawter, Dorothy et. al., The Use Of Human Fetal Tissue - A Report of Phase I of an Interdisciplinary Research Project Conducted by the Centre for Biomedical Ethics, Minneapolis, University of Minnesota, 1990, p. 194.)
In 1988, a team of doctors in Denver, USA announced they had performed the nation’s first neural transplant tissue. The doctors implanted tissue from the brains of fetuses into the brain of a 50-year-old patient who was suffering from Parkinson’s disease. In the months after the operation, doctors reported some improvement in the patient’s memory and coordination.
Fetal tissue transplants are also being tried as a therapy for diabetes, Huntington’s disease, leukemia, metabolic disorders, Alzheimer’s disease etc. But even the ardent advocates of fetal tissue transplant admit that its use as a cure for various ailments and diseases is far from proven. Many would classify fetal tissue transplant as experimental. Many early reports about the success of such operations have been exaggerated and inaccurate.
Several recent reports indicate that for now, fetal tissue transplants have been largely unsuccessful. (See the medical article by Sarah Glazer, The Fight Over Fetal Tissue, Washington Post, June 30th, 1992, p.ll and also the article by Keith A. Crutcher, Fetal Tissue Research, Linacre Quarterly, May 1993.)
Despite the controversy over their effectiveness, fetal tissues transplant operations are expected to continue and to increase. What does this mean? How do we view this use of fetal tissue transplantation ethically?
I WANT to discuss now why fetal tissues are used and where and how they are obtained. There are basic properties in fetal cells or embryonic cells that make them clinically useful for transplantation purposes.
1. They have the ability to grow and to proliferate, i.e. they exhibit tremendous developmental potential.
2. They have the ability to undergo cell and tissue differentiation, i.e. they have intrinsic plasticity.
3. They have the ability to produce growth, i.e. the factors which promote new cell growth, the survival of the fetal cells themselves and the regeneration of damaged tissues.
4. They reduce antibody reaction by the recipient.
5. They are resistant to injury and lack of oxygen. (From Medical Applications Of Fetal TissuE Transplantation American Medical Association Journal of the American Medical Association, 263, 4, 1990 p. 566)
Another reason why fetal tissues are used is the abundance of supply as contrasted to the scarcity of human organs. Over 1.6 million fetuses are aborted a year in the United States alone and over 30 million are aborted in the world each year.
Another source of fetal tissue is fetuses obtained through miscarriages and ectopic pregnancies. There is a great potential for fetal tissues from these sources but they are less preferred because they often have some abnormality or chromosomal defects which may be passed on to the receiving patient.
But the real extent and potential uses of tissues from this source have not yet been studied and researched into because of the availability of fetal cells from induced abortion and now IVF technologies.
Besides fetal tissues from miscarriages, there is also the possibility of cultured fetal tissues from fetal cells. When I say cultured fetal tissues, I do not mean fetal tissues obtained from fetuses that are obtained in-vitro or through any other genetical or technological methods of reproduction.
While the use of cultured fetal tissues has been allowed by the Church, the use of fetal parts or cells from IVF technologies or genetic engineering is condemned.
Here I want to say that US Cardinal Bernard Law has even suggested that the Pope John Centre in the US study the medical and moral feasibility of a Catholic fetal tissue bank. This bank would coordinate the retrieval, processing, storage and distribution of human tissues for experiments or for transplantation, but solely from fetuses of miscarriages and ectopic pregnancies.
It is important at this point to distinguish in connection to the source of fetal cells whether these cells are obtained in-utero or ex-utero.
Fetuses obtained in-utero are fetuses that are usually alive. Fetuses obtained ex-utero may be dead or alive. If alive, they may be viable (having reached a stage of development at which further development can occur independently of the mother) or non-viable.
I state here immediately that the Church allows only the use of fetal cells that are ex-utero and certifiably dead. Fetuses that are alive even though non-viable should never be used.
Here I quote the Church document Donum Vitae (Instruction On Respect For Human Life In Its Origin And On The Dignity Of Procreation) which says: “No objective however noble in itself, such as a foreseeable advantage to science, to other human beings or to society, can in any way justify the use or the experimentation on living human embryos or fetuses whether viable or not either inside or outside the mother’s womb.”
The Church’s teaching on this point is very important because there have been cases in which living fetuses and embryos were harvested for their tissues.
There are verified reports of modifications to abortion techniques so that the fetus can be removed from the uterus alive and intact in order to make it easier to obtain certain types of fetal tissues, (see Vawter et. al. The Use Of Human Fetal Tissues, 102).
To compound the problem, there is great difficulty in defining the death of a fetus and an embryo. A variety of medical groups and commissions have tried to define fetal death but these guidelines are not clear. Brain death is extremely difficult to ascertain in fetuses. The Encyclopedia Of Bioethics has a very good section on the brain death criteria for infants and fetuses.
The process of determining brain death in fetuses is complicated and most doctors simply ignore the criteria (s.v. Brain Death) Most doctors involved in fetal tissues procurement do not make any serious attempt to ascertain whether aborted fetuses are still alive or dead. Even the standard confirmation of death by two doctors monitoring the heartbeat or other vital signs is routinely not conducted.
Most researchers do not bother whether fetal tissues are acquired from living or dead fetuses. (See Andrew Kimbrell The Human Body Shop. London: Harper-Collins Publishers, 1993, 58ff)
Some have even recommended that aborted fetuses be classified as dead, regardless of continuing heartbeat or lung activity. Others suggested that the fetuses be given a new name, for example “not yet living”.
Others argue that most abortions result in non-viable fetuses and even fetuses still alive after being aborted have no chance of survival. Again I have recourse here to Donum Vitae which says: “Human life must be absolutely respected and protected from the first moment of conception..... and that the uses of fetuses whether viable or not, either inside or outside the mother’s womb, is to be condemned.”
The abortion connection
Ethicists are already alarmed at the growing number of cases in which individuals are seeking to arrange their own source of fetal organs by conceiving with the intent to abort. There can be a number of scenarios:
1. A woman wants to be artificially inseminated by her father, an Alzheimer’s victim, so that geneti- cally-matched fetal cells can be obtained to treat him.
2. A woman with severe diabetes wants to conceive and then abort in order to use the pancreas cell of the fetus for transplant to help her condition.
3. There may be a growth of surrogate mothers being recruited to conceive and abort for their fetal cells. To add to this frightening scenario is the possibility of doctors growing embryos in the laboratory from IVF technology or other genetic engineering methods to obtain these needed cells.
To these unethical methods can be added other unethical practices which are condemned by the Church. For example, extra eggs may be removed from women without their knowledge when they come for artificial reproduction so that these eggs may be fertilised later and cells obtained from them.
Women may deliberately ask to be artificially inseminated with the intention to abort so that fetal cells can be obtained. Embryos may be frozen for later use or experimentation. Some women may be recruited to sell their eggs to be fertilized in-vitro for immediate use or frozen for later use.
Fetuses may even be grown from the remaining embryos that are unclaimed or donated by couples after successful artificial births.
Doctors may also resort to cloning technology like the nucleus transfer of cells or the splitting of cells during the totipotent stage. There are really no long term studies of the effects of harm done to the embryos or fetuses where cells are harvested from them.
I do not want to go into the long debate on the status of the embryo. But suffice to state here that there are basically three major views about the status of the embryo. The embryo can be viewed as:
1. Mere tissues and cells.
2. A being with potential for human life.
3. A human life.
The third view is the position of the Catholic Church and this teaching has been constantly taught by the Church and reiterated in Donum Vitae:
“The human being must be respected as a person from the very instant of his existence... Life once conceived must be protected with the utmost care. Abortion and infanticide are abominable crimes. Human life must be absolutely respected and protected from the moment of conception.”
This same position was already stated in the earlier document, Declaration On Procured Abortion, which says: “From the time the ovum is fertilized, a new life is begun which is neither that of the father nor of the mother, it is rather the life of a new human being with his growth. It would never be made human if it were not human already.”
Consent and authority
With the organ tissue donation, there must be proper consent either from the person whose organ is being donated or from the one who may legitimately speak on behalf of the donor.
But in the case of induced abortion, can a woman ethically consent to the use of the aborted fetus when the death of the fetus is willed by her?
In such a case, how can a woman who has chosen to kill her unborn child still claim to speak on behalf of that child? She therefore does not fulfil the minimum qualification for giving consent in this case.
The Church has this to say about the giving of such consent in Donum Vitae: “No objective however noble in itself, such as a foreseeable advantage to science, to other human beings or to society, can in any way justify experimentation (and uses) of living human embryos or fetuses whether viable or not, either inside or outside the mother’s womb. The informed consent ordinarily required for clinical experimentation on adults cannot be granted by the parents, who may not freely dispose of the physical integrity of the life of the unborn child.”
The Church is referring here to the consent over the use of embryos or fetuses that are alive, whether viable or not. No consent can be given in this case even by the parents.
But since the Church is totally against induced abortion, the same principle holds good that the parents have no right to give consent to dispose of the physical integrity of the unborn child who has been deliberately aborted.
1. The Catholic Church is against abortion. Abortion is a crime against life and against humanity and therefore fetal tissue from an induced abortion should never be used.
2. Fetuses or embryos obtained by any artificial means of reproduction, by assisted means like artificial insemination or surrogacy, by IVF technology or any genetic engineering processes must be condemned. The very technologies themselves are already declared as illicit in Donum Vitae.
3. The tissues br cells from ectopic pregnancies or miscarriages which meet the specified medical requirements may be used but only after the fetus or embryo has been certifiably dead.
4. Appropriate consent is needed from the mother or proxy for the use of fetal parts or cells from the fetuses of miscarriages and ectopic pregnancies.
5. The participating hospitals should have the proper equipment and trained personnel to carry out the required procedures.
6. Proper instruction is needed regarding the nature of fetal tissue transplant or embryonic cell culturing to avoid the complicity of immoral and unacceptable practices.
7. All commercial trafficking of embryos or fetuses must be considered illicit and should be prohibited.
The CatholicNews, 25th June 2000, page 8