by Craig Klugman, Ph.D.

Before you being reading, I have a disclaimer: Growing up, my mother worked for Planned Parenthood. As a nurse, she practiced in their clinics offering well women services, counseling, and contraception. After many years, she went on to direct their clinic’s in vitro fertilization program. I also heard the word “Planned Parenthood” stated with a quick northeastern accent. Said that way, as a child, I thought the place was called “Plant Parenthood” and wondered what plants had to do with women’s health.

Ironically, despite the numerous bomb threats while she worked there, her clinic did not perform abortions. I always viewed my mom as doing important community health work for women who could not get services elsewhere because of finances, lack of education, or living in fearful relationships.

By now you have seen parts of the Center for Medical Progress’s videos regarding secretly recorded conversations with two leaders from Planned Parenthood. In their original release (8:51 minutes), the videos were edited to appear to show that Planned Parenthood was selling fetal organs—an illegal and unethical enterprise. As the full video (2:42:22 hours) was released, it became clear that Planned Parenthood was donating organs and only requested to receive reimbursement to cover their costs for preparing and donating the fetal tissue—a legal and (debatably) ethical enterprise.

The Center for Medical Progress pretended to be a biologics company and secretly recorded these conversations. It is a bit of a mysterious organization. They list a postal box as their address. They claim a 30-month investigation, but did not exist on the Internet until a few weeks ago. Its major players are anti-abortion activists and are related to the Life Legal Defense Fund (some of their web information appears to be on LLDF’s website) which is a strongly anti-abortion group.

The facts are that tissue donation is legal. The facts are that Planned Parenthood does not profit from the donation of this tissue, but merely tries to recover the costs for preparation and shipment of this tissue.

Still, this highly political issue has evoked many ethical debates in regards to Planned Parenthood, abortion, women’s health, and fetal tissue research. For example:

• The ethics (and legality) of secretly recording a conversation.
• The politics of attempts to defund Planned Parenthood
• The use of fetal tissue in research
• The politics of abortion
• The politics of women’s health
• Questions of medical professionalism and the attitudes displayed by the recorded Planned Parenthood representations
• Questions of professionalism in whether the method used for conducting the abortion was for the benefit of the women or preserving organs

This is a highly charged debate in part because of the special controversial place that abortions and the status of the fetus and embryo have in American culture. For those on the pro-choice side, the embryo is a potential human and at the early stages of development are tissue, or a cluster of cells, dependent on a woman to exist. Personhood comes at some point during or after the pregnancy. If one believes that abortion is acceptable and that an embryo is not a fully vested human being, then there are few concerns with the procedure, donation, or research. For them, this case is about a political organization using unscrupulous methods to show a women’s health organization in a negative light.

If, however, one believes that life begins at or near conception and that an embryo or fetus has the same rights to life that a fully formed human being does, then abortion is murder and the use of these tissues is akin to doing experiments on people facing execution. Using the tissue or data is seen as wrong and provides an immoral justification for the deaths. For them, this is using all means necessary as part of a greater effort to save lives by convincing people that this is all very wrong and to pressure politicians to make abortion illegal.

While many of the political and ethical issues have been debated extensively in the press, two claims against Planned Parenthood’s fetal tissue donation have received less attention:

• Neither an embryo nor tissue can give consent for research and informed consent is required for research participation;
• Medical procedures were altered to preserve the organs, rather than focusing on the needs of the woman.

The first point is that donating fetal tissue is wrong because embryos and fetuses are incapable of giving consent. The presumption here is that abortion is (a) wrong and (b) that an embryo has the full rights of a born human being. But a born child of 5 cannot give consent to a medical procedure or to donate organs. So in fact, to accept that an embryo or fetus would have to give consent means that the embryo or fetus has more rights than a born human under the age of 18. We would have to accept that one has adult rights in utero, then loses rights after birth, and they are reclaimed on turning 18. From birth until 18, the parents give consent, which is the situation here—the women (and sometimes their male partners) give permission for the tissue to be donated to research.

The second point to the consent argument is that as a society, there is already a standard of using organs for transplant and research without a person’s permission. Upon death, corneas can be taken from corpses without anyone’s permission or even informing the family. If a person is dead by neurological criteria and was not a registered organ donor, by law, the hospital through the regional transplant agency must ask the family if they wish to donate. If the family agrees, then the organs are taken even though the deceased may have never expressed an opinion. Thus we have strong precedence for not getting consent from people who donate organs.

The second argument about altering the procedures is also worth a further look. Commentators say that we should be shocked and appalled that a medical procedure would be altered simply to preserve organs. The presumptions here are that (a) abortion is an immoral act and (b) that altering procedures puts a woman’s health at risk. The alterations are a matter of how to approach the procedure, but no claims or evidence are provided that these alterations threaten the women’s health or that they pose an extra or unnecessary risk.

The fact remains that we do regularly perform procedures with the intent of preserving organs. For instance, if a patient is declared dead by neurological criteria, he or she may be maintained on a ventilator and other functional support not to preserve life, but to keep the organs healthy until transplant recipients are identified. The reason is that organs start degrading after death and for many of them, the sooner they are removed from a dead body, the higher the chance of success in the transplant.

In controlled donation after cardiac death, a dying patient’s death is carefully coordinated. The person is often give heparin to prevent clotting and maintain the flow of blood in the organs. In some cases, large catheters are inserted into the blood vessels to quicken the introduction of preservatives after death is declared. None of this benefits the patient—it makes the procurement of the organs easier and faster. Also consider that death may be declared as quickly as 2 to 5 minutes after the onset of asystole. Remember that the brain can normally go about 4 minutes without oxygen before being permanently damaged. And some patients have been resuscitated with no cardiac activity for 2 to 5 minutes.

How is altering a safe procedure to preserve organs in an abortion any less respectful than donation after cardiac death? Indeed, this treats an embryo or fetus the same as a born human being. One difference is that the organs from after cardiac death are intended for transplant where as those from the abortion are intended for research. Both ends have the intent of saving lives and improving the quality of life. With organ donation there are specific people to be saved. In research, there is all of humanity and future generations to be saved.

The debate on these issues is a strawman. No one’s mind is going to be changed because of the videos. In an age of uncivil discourse, we do not listen to the other side(s) but rather only hear what supports are existing beliefs. The intent for these videos was not to provide a space for ethical debate, but rather to create a political “gotcha” moment that would embarrass the country’s largest provider of women’s health and pressure legislatures to restrict women’s access to abortion.