When we first set out to do a special report on fetal tissue research (FTR) in 2016, then CBHD Executive Director Paige Comstock Cunningham testified before a Select Investigative Panel of the House Energy and Commerce Committee on the subject of “Bioethics and Fetal Tissue.” The creation of the Select Panel was prompted by undercover videos from the Center for Medical Progress showing Planned Parenthood representatives negotiating with citizen journalists posing as brokers for fetal tissue. The videos exposed a troubling pattern of fetal tissue procurement laden with conflicts of interest that appeared to violate a 1993 federal law and regulations prohibiting commerce in fetal tissue. The Select Panel issued a lengthy report in December 2016 and referred potential violations of law to the Department of Justice for further investigation.
In 2019, the Trump Administration evaluated the standing regulations on the use of human fetal tissue (HFT) from elective abortions in government-funded research. The Department of Health and Human Services (HHS) subsequently placed restrictions on federal funding of FTR and directed the National Institutes of Health (NIH) to invest in alternatives to such research. The HHS Secretary established an Ethics Board to evaluate NIH research proposals involving fetal tissue and determine whether funds should be withheld or distributed. David Prentice, one of the fifteen members of the Congressional Ethics Advisory Board, writes in his article “Regulation of Human Fetal Tissue Research in the United States” that the Board met on July 31, 2020 and voted to withhold funds from thirteen of the fourteen proposals under consideration.
In April 2021, the Biden Administration reversed the decision that all research grants must be evaluated by an Ethics Board but, according to NIH Notice Number NOT-OD-21-11, left all other requirements unchanged. For example, grant proposals for research using HFT from elective abortions must justify the use of such tissue and “indicate why the research goals cannot be accomplished using an alternative to HFT (including, but not limited to, induced pluripotent cells not developed from HFT, organoids not developed from HFT, neonatal human tissue, human tissue obtained from adults, HFT not derived from elective abortion, animal models, and in vitro models that are not developed from HFT, and computational models).” Researchers must also explain how they determined that alternatives to HFT cannot be used.
The ethics of fetal research, and specifically fetal tissue research, received prominent reflection in the 1980s, culminating in the 1988 Report of the Human Fetal Tissue Transplantation Research Panel. Yet while the research questions have continued to evolve, much of the ethical reflection regarding FTR has not materially changed since the release of the 1988 report. Updates regarding the state of the science of FTR, its accomplishments, alternatives, and emerging ethical considerations have received little attention in the relevant secular and Christian bioethics literature. With the reemergence of FTR as a contentious topic of national discourse, the general absence of continued scholarship regarding the ethics of FTR became more pressing.
Against this broader context, CBHD commissioned the present report to address the perceived gap in the literature regarding the current direction and ethics of FTR. The 2019 emergence of COVID-19 caused by the SARS-CoV-2 virus and the ensuing global pandemic gave further urgency to these issues as various vaccine candidates proposed the use of fetal tissue in the research, development, and/or testing phases. As such, this report seeks to accomplish several ends. The first is to provide an overview and introduction to FTR with respect to the state of the science, the law, and ethical considerations. Secondly, it provides ethical and theological reflections from a wide spectrum of the Christian ecclesial traditions (Catholic, Orthodox, and Evangelical Protestant). These contributions move beyond the scope of previous bioethics work (at a national level or beyond) that sought to explore the ethical considerations of FTR exclusively from within a purportedly “neutral” frame of public morality in order to propose a basis for ethical analysis grounded in distinct but complementary theological perspectives.
Major ethical issues in the use of HFT for research purposes include: (1) whether there is an inextricable link between FTR and the wide availability of elective abortion, and (2) whether a woman intending to have an abortion can give consent to an abortion and separately give consent to donating the aborted fetus, without one decision affecting the other. As Edward Grant points out in his overview article on the history of regulations on federal funding for FTR, without widespread elective surgical abortion, sufficient HFT for new research would not be available. Additionally, consent for donating the aborted fetus must be given prior to the abortion procedure so the fetal tissue can be preserved immediately. And, as the Center for Medical Progress videos appeared to demonstrate, specific research needs can influence how the abortion procedure itself is carried out.
David Prentice, Tara Sander Lee, and Maria Feeney of the Charlotte Lozier Institute helpfully discern the landscape of ethical issues that arise in FTR, including current research using HFT. Lee and Feeney’s article on the science of FTR provides a thorough overview of scientific endeavors using fetal tissue, both past and present. By looking at the technical details, not only can we more carefully discuss ethical considerations, but we can also see opportunities for alternative research that is not ethically contentious. An example of how such alternative ethical research proposals might transform a field of research is human embryonic stem cell research (an ethically controversial area of research) and the subsequent development of induced pluripotent stem cells by turning on certain genes in “adult” stem cells. Similarly, there are alternatives that are less controversial to using HFT derived from aborted fetuses in research, including the option of using induced pluripotent stem cells. And where no alternative exists, this may be a place for new research opportunities.
The ethics of FTR has broader implications for other areas of scientific research, including research on leftover embryos from in vitro fertilization and organ or tissue donation from executed prisoners or people who have died from physician-assisted suicide. The Judeo-Christian Hippocratic perspective, in one sense, makes the discussion easy, and in another sense difficult. From this perspective, the destruction of nascent human life for utilitarian purposes is prohibited. Abortion is a clear boundary line for many Christians, and for this reason procuring tissue from a heinous act is unethical. Physician-assisted suicide or euthanasia is also a clear boundary for many Christians. The same guiding principles that mean it is wrong to kill nascent life also mean it is wrong to kill the elderly, the terminally ill, or the disabled. The act itself is unethical, whatever benefits may come of it.
In the case of research using HFT, a prevailing utilitarian or consequentialist ethos proposes that we can separate the donation of fetal tissue from the act of abortion, and even “redeem” that act by providing a larger benefit to society as a whole. In this sense, the controversy over such research is closely linked to that regarding experimentation on “excess” and cryopreserved human embryos resulting from in-vitro fertilization: the consequentialist viewpoint holds that the destruction of such embryos in the process of experimentation provides a benefit that would be lost if the embryos are preserved indefinitely. Proposals to facilitate organ donation from persons choosing to end their own lives through assisted suicide or euthanasia follow the same pattern of ethical reasoning. The proliferation of such proposals puts further pressure on Christians and other theologically informed persons to articulate an alternative ethical approach grounded in fundamental respect for the dignity of every individual human life.
Another challenging issue is whether it is wrong to benefit from past research that would be considered unethical if conducted today. Put another way, does benefitting from this research make one complicit with the original unethical act? There is some disagreement between various Christian traditions and among individuals as to whether products made from research with fetal tissue, particularly fetal tissue that was obtained in the distant past, are ethically permissible. This topic has come up most recently regarding the production of vaccines for COVID-19. Some vaccines, such as Johnson & Johnson’s adenovirus vaccine, are produced using an immortal cell line, PER.C6, that was originally obtained from a fetus that was aborted in the past. During the research and development phase, all vaccines are tested using the HEK293 cell line, originally made from a fetus that was aborted in the 1970s. Catholic, Orthodox, and Protestant views approach this topic from nuanced perspectives and are broadly represented in this report by Edward Grant, David Prentice, Matthew Vest, and Josh Wester. Although these articles do not represent the entirety of perspectives within the Christian tradition or even the differences within their respective traditions, they provide a helpful guide for some of the differences and similarities between how Catholics, Protestants, and Orthodox Christians approach the ethics of using products that employ the use of aborted fetal tissue (even if the abortion is from the distant past).
Ultimately, this issue is about how we should conduct science. Some of the most horrific affronts to human dignity in the twentieth century have occurred in pursuit of noble ends. The way we go about pursuing those ends is as important as the intended good that can come of them, because how we pursue those ends dictates what kind of society we become. Michelle Kirtley’s article places trafficking in fetal tissue within the broader context of trafficking in human beings, to which she points out that “trafficking in fetal tissue is not materially different from other forms of human trafficking.” Once we are in the business of buying and selling human body parts, how great a leap is it to commodify the human being, whether she is dead, dying, destined to die, or has a life that is deemed less valuable than other lives?
 “Update on Changes to the NIH Requirements Regarding Proposed Human Fetal Tissue Research,” Notice Number NOT-OD-21-11, NIH.gov, April 16, 2021, https://grants.nih.gov/grants/guide/notice-files/NOT-OD-21-111.html.
 “Changes to NIH Requirements Regarding Proposed Human Fetal Tissue Research,” Notice Number NOT-OD-19-128, NIH.gov, July 26, 2019, https://grants.nih.gov/grants/guide/notice-files/NOT-OD-19-128.html.
 Advisory Committee to the Director, National Institutes of Health, Human Fetal Tissue Transplantation Research (Bethesda, MA: NIH, December 14, 1988), U.S. Bioethics Commissions Archival Collection, https://repository.library.georgetown.edu/handle/10822/559348.