ETHICS AND FETAL RESEARCH:

...the congressional statute required a moratorium on government-supported re-search on living fetuses in the interim...

...Research on fetal tissue presents few problems beyond those associated with autopsies on corpses and similar cases...

...Serious congenital abnormalities often re-sulted when women were infected with the rubella virus during pregnancy...

...The sessions I attended were not quite Plato's Academy, but they were a far cry from congressional committee hearings or even a number of scholarly conferences in this area I have observed...

...Even without knowing the final outcome of the Com-mission's deliberations on fetal research, it is a pretty safe prediction to say that they will not satisfy anybody...

...To those unwilling to be impressed with the authority of tradi-tional medical ethics, it may appear that Ramsey is begging a number of basic questions...

...Research meant to save or benefit the particular fetuses on whom the experimental pro-cedures are performed is naturally subject to common-sense calculations of potential risks and benefits, but no one challenges the ethics of allowing a fetus, any more than an adult patient, to undergo such risks if they are necessary for survival or well-being...

...From what I have observed, however, the Commis-sion has gone about its very difficult task in an extra-ordinarily thorough and diligent manner...

...At least one other distinction should be kept in mind...

...A fetus which is delivered live, either through abortion or spontaneous miscarrige, may either be viable, i.e., possessing a chance of survival and there-fore, in effect, a premature infant, or it may be non-viable, i.e., without a chance of survival given present medical knowledge and technology...

...The Commis-sion may not agree with the substance of Paul Ramsey's conclusions in The Ethics of Fetal Research, but it is my impression that it has gone a long way in fulfilling Ramsey's hope that the level of the debate be raised.vel of the debate be raised...

...Almost all involved chemical or physical in-trusion on the fetus or fetal environment while the fetus was in utero...

...The second distinctive fact about the fetus is that it cannot speak for itself, nor is it clear who else can...

...But once abortion or impending abortion had removed the factor of potentiality to become a person from the calcula-tion, then Wasserstrom saw many of the objections to research on living fetuses disappear...

...Consider the opposing argument...

...Other members of the Commission could not accept this position, though no one seemed to take the diametri-cally opposed stance that once abortion is decreed then anything goes, or the utilitarian position that the end does justify the means as long as aggregate benefits to society outweigh the harms...

...Most of the media will ignore them or carry minor reports...

...On the one hand, the book is an extension of the lines of argument which Ramsey has set forth during many years and which have made his writings, in books like The Patient as Per-son and Fabricated Man, reference points for everyone seriously concerned with medical ethics...

...The human fetus is...

...Not many will recognize the Com-mission's work for what it is: a significant attempt to guide our civilization into the age when human beings rather than non-human materials will increasingly be-come the direct object of scientific exploration, an age where medicine and biology promise us immensely at-tractive benefits-but only with some adjustment of our traditional notions of humanhood, its limits, its obliga-tions, its dignity...

...Should it be treated as a per-son, with all the protection and rights this implies...

...It even contains a lengthy rebuttal of an article by Willard Gaylin and Marc Lappe in the May Atlantic: in other words, Ramsey got his rebuttal into print-in book form-before the original article hit the magazine stands This is testimony both to the skill of the Yale "Fastback" editors and to Ramsey's own dedication...

...Or does the fetus only fit into some distinctive normal category of its own...

...Second, "at a time when persuasive appeals, heightened emotional utterances, non sequiturs, and opinions plainly danger-ous to the moral becoming of mankind have served as surrogates for 'good reasons,' " Ramsey wishes to in-still rigor and sober reflection into the public debate...

...risks which could be called "minimal" for a fetus with a life expectancy of a few weeks are not necessarily "mini-mal" for a fetus which will develop into a child or adult and carry the burden of abnormality...

...Some members apparently felt it would be unethical not to carry out research like that on the rubella vaccine first on fetuses scheduled for abortion rather than risk the future well-being of fetuses that will be brought to term...

...Some agreed with McCormick-Walters that both fetuses scheduled for abortion and those which will be carried to term should be treated similarly, but then qualified this by arguing that impend-ing abortion is relevant to defining similar treatment...

...National Institutes of Health-which attempt to apply that tradi-tion to fetal research...

...Second, what is at stake is non-therapeutic research on living fetuses...

...This position, articulated in submitted testi-mony by the moral theologian Richard McCormick, S.J., and LeRoy Walters of the Kennedy Institute Center for Bioethics, would permit certain types of non-therapeutic research, carrying minimal risk, on living fetuses...

...They will probably not satisfy Paul Ramsey...

...Established under the National Research Act of July 1974 and mandated to survey the whole field of scientific experimentation with humans, the Commission's first assigned task was to make recom-mendations to the Secretary of HEW, concerning the regulations of fetal research...

...Insofar as the National Commis-sion's recommendations are restrictive of research, it will be accused of conservativism and an anti-scientific out-look...

...In addition, of course, many moralists point out that in themselves genuine gains are not sufficient justification for questionable actions...

...Would the vaccine have the same dire results as the infection itself...

...By early April, one group on the Commission appeared to have settled upon a position slightly less restrictive than Ramsey's...

...What Ramsey is dedicated to can be put, with the usual risk of oversimplification, into two statements...

...Pur-poses range from studying normal fetal behavior and development to developing means of detecting fetal dis-ease or abnormality...

...In testimony sub-mitted to the National Commission, Richard Wasser-strom, a lawyer and philosopher, agreed with Ramsey's view that the living fetus was clearly more than tissue or experimental animal...

...By the time this article reaches its readers, therefore, the Commission's findings may be public...

...We may submit children or unconscious patients to risky experiments when these are necessary for their own survival or well-being, but we do not take the preroga-tive of "volunteering" such non-consenting individuals to run risks altruistically which can only be of medical benefit to some future group...

...But wide-spread legal abortion has greatly expanded its scope...

...The National Commission sponsored a major review of research done on living fetuses during the past decade...

...It consists of one segment of the medical research community, which may be directly affected, another larger group of scientists concerned about public attitudes toward research, of dedicated opponents of abortion, of a smaller number of abortion defenders, and finally that growing, but still limited, group of people concerned with bio-medical ethics gen-erally...

...In the 1960's a vaccine was developed for rubella...

...Contro-versy arises when fetal research is carried out with no intention of benefiting this fetus but rather to gain scientific or medical knowledge which may only be of benefit to some other individuals in the future...

...ETHICS AND FETAL RESEARCH PETER STEINFELS For new moral problems, a paucity of analysis Last December, eleven members of a National Com-mission for the Protection of Human Subjects of Bio-medical and Behavioral Research were sworn in by Health, Education and Welfare Secretary, Caspar W. Weinberger...

...Ramsey realizes he cannot recapitulate the first principles of oral philosophy in a few pages, so he prefers to make his starting points the tradition of medical ethics and the several docu-ments-the Peel Report in Great Britain and the 1973 and 1974 guidelines proposed by the U.S...

...First, in philosophy, in American law, and in popular opinion, the status of the fetus is unsettled...

...This position, in other words, does not consider the impending death of a fetus to be a morally rele-vant fact which might justify greater latitude for non-therapeutic research...

...This category, he said, had more in common with persons than with tissue or animals, but what it had in com-mon was the potentiality of becoming a person...

...At least some people argue that research which would not be justifiable in the case of the viable fetus (or premature infant) should be permitted in the case of the non-viable, living fetus, which is about to die anyway...

...The vaccine was found safe and effective for adults and children, but its safety when ad-ministered to pregnant women (logical candidates for the vaccine) was unknown...

...Of course, recommendations from a Commission like this one usually receive prominent coverage in only a few newspapers...

...This, however, raises the problems of (a) establishing criteria for distinguish-ing viability and non-viability in the midst of changing medical abilities to sustain fetal life, and (b) agreeing on safety margins which would prevent occasional er-rors...

...To those unfamiliar with medical ethics, this procedure may seem confusing...

...If the previous studies had shown the further use of the vaccine to be of minimal risk {as the rhesus monkey tests appeared to do), then trials on pregnant women should not have discriminated be-tween fetuses scheduled for abortion and those to be carried to term...

...The McCormick-Walters position would not have al-lowed such research...

...He argued that it constituted a moral category of its own...

...All these categories, however, are unquestionably human persons, and that is precisely what many people ques-tion in the case of the fetus...

...The answers will be found, either explicitly or implicitly, in the final report...

...First, he believes, that since neither the fetus itself nor the parent of the fetus can consent to non-therapeutic fetal research, conducting such research on the living fetus simply because it is going to be aborted anyway offends the basic canons of medical ethics and substi-tutes a kind of "net-benefits" utilitarianism for medi-cine's traditional protection of the individual...

...The Commissioners had done their homework, were willing to talk across professional and ideological lines, posed questions which revealed a tutored under-standing of the issues...

...I can only say that if the Commission recommendations end up in one camp or other, it will not be because the Commisssioners landed there unwittingly or thoughtlessly...

...The Commission was given a deadline, May 1, 1975...

...a novel subject of investigation in medical ethics, and the discussion has in fact hardly begun," writes Paul Ramsey in his new book, The Ethics of Fetal Research (Yale U. "Fastback," $7.95, $2.95 paper, 1975...

...Wasserstrom also rejected the notion of treating the fetus as a full person...

...to resolve it, Ramsey does have a tendency to enter in medias res...

...Insofar as they are permissive, it will be accused of yielding to "the research imperative...

...For the uninitiated- and I assume that it was in considerable measure in-tended for the uninitiated-it presents several difficulties...

...Despite his book's concise history of the fetal research and the efforts in England and the U.S...

...In which case, we must define that category in relation to the others, searching out the similarities and differences which would justify similarities and differences in the protections and rights we affirm for the living fetus...

...To many other citizens, if they read of the Com-mission's work at all, it will probably strike them as another obscure operation by those innumerable govern-ment agencies which issue reports on rainfall, fix rates on utilities, regulate insurance policies, and set standards for wood screws...

...The problem is com-pounded in the case of the fetus about to be aborted...

...The Ramsey Book The degree to which fetal research poses new moral problems is evidenced by the paucity of extended moral analysis of the question...

...However, tests on women about to undergo abortions showed that the vaccine did cross the placenta and infect the human fetus...

...At least until the National Con mission publishes the views it solicited from about a dozen philosophers, religious ethicists (in-cluding Ramsey), and other specialists in ethical aspects of medicine, Ramsey's book will remain the only readily available general treatment...

...The medical gains resulting from fetal research are undeniable, although it is not clear to what extent these gains were due to the most controversial types of research and to what extent the same knowledge could have been obtained through alternative approaches...

...To understand the controversy over fetal research a few distinctions are in order: First, what is at stake is research on living human fetuses...

...They certainly will not satisfy the more adamant oppo-nents of abortion...

...Fetal research is, of course, not new...

...Some drastic experiments on living, delivered fetuses were aimed at developing techniques for saving future premature infants...

...Tests on rhesus monkeys showed it would not...

...Should it be treated as human tissue which suggests virtually no limits on experimentation...

...I do not know how Ramsey could have solved this problem within the space and time available to him...

...Gen erally non-therapeutic research can only be justified when the human subject volunteers for it, which na-turally the fetus is in no position to do...

...A historical example might clarify the significance of this argument...

...Where the mother or both parents together would normally be the obvious spokesperson for a fetus as for a child, the prospect of abortion indicates that the interests of parent and fetus are at least radically di-vergent if not in total conflict...

...On the other hand, they will probably not satisfy a segment of the medical research community who bristle at the very idea of any public regulation in this area...

...No experimental procedures, however, should be done to fetuses aborted or scheduled to be aborted which would not also be done on fetuses which will be carried to term...

...Should it be treated as something akin to a laboratory animal de-serving attention at most to questions of pain and a minimal animal dignity...

...In searching for ways of thinking about our moral obligations to the living fetus, especially the fetus spontaneously aborted or scheduled for induced abor-tion, Ramsey usefully compares it to the unconscious patient, the dying patient, and the condemned prisoner...

...The moral uncertainty about research on living fetuses arises from two simple facts...

...How specific should national guidelines be, how much should be left to local discretion, how should ethical review commit-tees be constituted, what mechanisms should be set in place for periodically updating the entire discussion...

...Among the basic questions passed over swiftly by this method is that referred to earlier, the status of the fetus...

...The National Commission's findings involve other complicated issues, that of consent, for instance, or of defining viability with more or less precision and with wider or narrower margins for safety...

...Some research has been done in the course of abortion, and a very small percentage has been performed upon living, delivered fetuses...

...And why not...

...For anyone deeply concerned with this debate, Ramsey's book is essential reading...

...At the moment of my writing, it is precisely this ques-tion which promises to give the National Commission its most difficult moments...

...Let the accusations be what they will...

...Appearing in early 1975, the book nonetheless contains references to material published as recently as last November...

...Is the impending demise of a living fetus a morally relevant fact which should enter into ethical judgments about permissible research...

...Studies have been made to measure the effects on the fetus of drugs administered to a woman prior to abortion...

...On the other hand, The Ethics of Fetal Research is an extraordinarily up-to-date feat of writing and publishing...

...In part this is intentional...

...it remains a problem nonetheless...

...It was central in the development of the Salk-polio vaccine...

...Since the special status of the fetus rested in this potentiality, to destroy this potentiality by abortion was, according to Wasserstrom, "a morally worrisome act...

...The number of Americans intensely interested in the Commission's work is not large...