Journal ofmedical ethics, 1991, 17, 70-76

Fetal tissue transplantation: can it be morallyinsulated from abortion?Carson Strong University of Tennessee, Memphis, USA

Author's abstractEthical controversy over transplantation ofhuman fetaltissue has arisen because the source oftissue is inducedabortions. Opposition to such transplants has been basedon various arguments, including the following: rightfulinformed consent cannot be obtainedfor use offetal tissuefrom induced abortions, andfetal tissue transplantationmight result in an increase in the number ofabortions.These arguments were not accepted by the NationalInstitutes ofHealth (NIH) Human Fetal TissueTransplantation Research Panel. The majority opinion ofthe panel stated that abortion andfetal tissue use areentirely separate issues, and that tissue use is ethicallyacceptable because it can be morally insulatedfrom theissue ofabortion. In support of this view, panel membersand others have replied to the arguments putforward byopponents offetal tissue use. However, replies to the twoarguments mentioned above have been unsatisfactory, andthe shortcomings ofthose replies are identified herein.Examination of the arguments pro and con suggests thatfetal tissue use cannot be completely insulatedfrom theissue ofabortion. Thus, in seeking an ethical justificationfor fetal tissue transplantation we must consider reasonsother than those putforward by the NIH panel. In thispaper it is argued that whateverwrong is involved in usingfetal tissue from induced abortions must be balancedagainst the benefits for patients, and it is on this basis thatfetal tissue transplantation can be ethically justified.

In recent years, transplantation of fetal tissue hasemerged as a possible approach to the treatment of avariety of human diseases. One area of research thatseems promising involves the treatment of Parkinson'sdisease. Animal models of Parkinson's disease can beproduced by injecting neurotoxins into the substantianigra of the midbrain, selectively destroyingdopamine-producing cells (1). Monkeys and rats withsuch lesions have been treated by transplanting fetalsubstantia nigra into the brain, with remarkable results.The transplanted tissue survives (2), its neurons growinto host tissue (3-5), and in some cases there has been

Key wordsFetal tissue transplantation; medical ethics; fetus;transplantation; fetal research.

significant reversal of symptoms of the drug-induceddisease (6,7).

In 1988, researchers in Mexico reported clinicaltransplantation of human fetal tissue into the brains ofpatients with Parkinson's disease (8). Fetal substantianigra was transplanted into the caudate nucleus of afifty-year-old man with a nine-year history of disease.He was suffering from severe symptoms withpredominance of rigidity and tremor. At three monthsfollow-up there was considerable improvement in hiscondition (9). Rigidity was imperceptible, and akinesiawas absent. He was self-sufficient in most personalactivities and could use lower doses of medications.More recently, Swedish researchers reported

success in transplanting fetal substantia nigra into theleft putamen of a forty-nine-year-old man who had hadParkinson's disease since 1977 (10). He had had severerigidity, hypokinetic movements, and a moderatetremor in the right arm, with less marked symptoms inthe left arm and legs. Following surgery, there wereclinically significant improvements in the patient'scondition, including improved mobility. By threemonths after surgery, the rigidity had almostcompletely disappeared. Moreover, positron emissiontomography scanning five months after surgeryshowed that the grafted tissue survived, and thussupported the view that the clinical improvementswere due to dopamine production resulting from thegraft.To date, at least eight cases of human fetal tissue

transplantation for patients with Parkinson's diseasehave been reported worldwide (11-14). However, theresults overall have been mixed, with no improvementfor some patients.Another area of research involves treatment of

diabetes mellitus. Transplantation of fetal pancreatictissue has reversed drug-induced diabetes in mice andrats (15). Initial clinical studies have shown that humanfetal pancreatic tissue survives in the human host (15).Fetal tissue also has been transplanted in the treatmentof DiGeorge's syndrome, aplastic anaemia, leukaemia,and severe combined immunodeficiency. Otherconditions that animal research suggests might betreatable by fetal tissue transplantation includeAlzheimer's disease, Huntington's disease, spinal cordinjury, and neuroendocrine deficiencies (16).

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At present, guarded optimism over fetal tissuetransplantation seems reasonable. Althoughfavourable results were reported in the two casesdiscussed above, in a similar type of surgery involvinggrafts of the patient's own adrenal medulla tissue intothe brain clinically significant neurological side-effectshave been reported (17-19). Further research andconfirmation is needed before the benefits and risks offetal tissue transplantation can be adequately assessed.The ethics of fetal tissue transplantation was

recently debated by the National Institutes of Health(NIH) Human Fetal Tissue Transplantation ResearchPanel. The panel was established in 1988 after theAssistant Secretary for Health issued a moratorium onfunding of research using fetal tissue (20,2 1). Thecharge to the panel was to examine the ethical issuesand advise NIH on whether such research should besupported by government funds.

Ethical controversy has arisen because the source offetal tissue is induced abortions. Tissue fromspontaneous abortions is generally consideredunsatisfactory because of the high rate of fetalpathology, such as chromosomal abnormalities andviral infections, as well as anoxia due to the delaybetween death of the fetus and expulsion from theuterus (22-24). Opposition to use of fetal tissue isbased on the view that abortion is wrong and that tissueuse is tied to the morality of abortion. Leadingspokesmen for this view have been Burtchaell andBopp, NIH panel members who gave dissentingarguments to the recommendations of the panelmajority. One of Burtchaell's arguments is thatrightful informed consent cannot be given for donationof fetal tissue from induced abortions (25). He claimsthat informed consent for use of tissue is importantbecause of our views concerning respectful treatmentof human cadavers. He points out that when weremove body parts to further our own purposes respectfor the deceased requires consent, either by the donorprior to death or by one who has moral authority toserve as guardian of the deceased person's remains.Thus, to use Burtchaell's example, to utilise thecadaver of a derelict without consent in order to studyanatomy is to fail to accord the full respect that isnormally given to human cadavers. If one assumes, asBurtchaell and other abortion opponents do, thatfetuses have the moral status of persons, then theproblem in using fetal tissue is that the individual whowould ordinarily serve as guardian of the remains, themother of the fetus, has made a decision resulting inthe fetus's destruction. Burtchaell asserts that inmaking such a decision the mother forfeits her moralauthority to donate the fetal remains. He argues thatwe would make a similar judgement if, for example, aman were to kill his wife. He would be morallydisqualified from acting as executor of her estate, andit would be inappropriate to vest in him the right todonate her organs for transplantation. For similarreasons, the doctor who performs the abortion couldnot appropriately serve as guardian of the fetal

remains. A policy of allowing the father of the fetus toauthorise donation would also be unaccepable, becausein many cases the father either is unavailable or concurswith the abortion. Moreover, agents ofthe government(such as coroners) could not legitimately give consentbecause in permitting abortions the governmentforfeits any moral claim it might have to serve asguardian of fetal remains. Thus, according toBurtchaell there is no one in a moral position to provideauthorisation of the use of fetal tissue for research ortransplantation.Another argument by Burtchaell and Bopp is that

fetal tissue transplantation will increase the number ofabortions, for several reasons (16). First, abortionsmight be regarded more favourably by the generalpublic if there are significant benefits fromtransplantation. If so, a further entrenchment of theinstitution of abortion could occur. Second, for somewomen considering abortion who are particularlyambivalent about the decision, the prospect ofbenefiting others through fetal tissue transplantationmight tip the balance in favour ofhaving the abortion.These arguments were not accepted by the majority

of the 21-member NIH panel. In its report, the panelconcluded that it is acceptable public policy to supporttransplant research using fetal tissue. Part of thepanel's defence of that conclusion was the claim thateven if abortion is immoral, the fetal tissue obtainedcan ethically be used for research and transplantation(16). This claim was based on the view that abortionand fetal tissue use are entirely separable issues andthat tissue use therefore can be ethically isolated fromany immorality associated with the source of the tissue(16,26,27). To help ensure that tissue use would bemorally insulated from abortions, the panel includedthe following among its recommended guidelines (16):

(a) The decision to terminate a pregnancy and theprocedures of abortion should be kept independentfrom the retrieval and use of fetal tissue.(b) Payments and other forms of remuneration andcompensation associated with the procurement of fetaltissue should be prohibited, except payment forreasonable expenses occasioned by the actual retrieval,storage, preparation, and transportation ofthe tissues.(c) The decision and consent to abort must precedediscussion of the possible use of the fetal tissue and anyrequest for such consent as might be required for thatuse.(d) The pregnant woman should be prohibited fromdesignating the transplant-recipient of the fetal tissue.(e) Anonymity between donor and recipient should bemaintained, so that the donor does not know who willreceive the tissue, and the identity of the donor isconcealed from the recipient and transplant team.(f) The timing and method of abortion should not beinfluenced by the potential uses of fetal tissue fortransplantation or medical research.

The panel's view that the issues can be kept separate by

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72 Fetal tissue transplantation: can it be morally insulatedfrom abortion?

following appropriate guidelines is initially tempting,for several reasons. First, it avoids the need to take adefinite position on the abortion issue. Thus, the ethicsof fetal tissue transplantation becomes morestraightforward than it would be if it were inseparablefrom the complex issue of abortion. Second, it seeks abroad consensus based on the idea that, regardless ofone's views on abortion, one should consider fetaltissue transplantation to be ethically acceptableprovided that it is regulated in an appropriate manner.In support of this approach, replies to the arguments ofBurtchaell and Bopp were put forward in the panelreport itself (16), by a panel member in otherpublications (28,29), and by another commentator(30).However, those replies have failed to refute the

above-mentioned arguments of Burtchaell and Boppand their basic position that the ethical issues ofabortion and fetal tissue use are unavoidablyintertwined. In order to see this, let us examine thosereplies. Freedman (30) has argued that the analogywith derelicts is not apt, because using the cadavers ofderelicts to study anatomy is less respectful than theburial they would otherwise receive. By contrast, fetaltissue is usually disposed of as organic waste. InFreedman's view, such disposal is substantially lessrespectful toward fetal remains than its use as a sourceof transplanted material. A better analogy, Freedmansuggests, is a hypothetical case in which a patienturgently requires some blood factor. The onlyavailable sample is found in the pathology lab, but thelabel identifying the person from whom the bloodfactor was extracted is missing. Thus, it is not possibleto contact that person in order to obtain consent for useof the blood factor. Moreover, if the sample is not givento the patient it will be discarded. Freedman claimsthat this is a case in which we would be ethicallyjustified in using the sample, illustrating that consent isnot necessary. However, Freedman's arguments arenot persuasive. Not all of a fetus's remains willnecessarily be retrieved for use in research andtransplantation. Much ofthe tissue will, in many cases,be disposed of, in the usual ways. It is not at all clearthat using some of a fetus's remains for research anddisposing of the rest is more respectful than disposingof it all. The case involving blood factor is not a goodanalogy because it does not involve removal of bodyparts from cadaveric remains. It misses the point thatBurtchaell's argument is based on views about how weshould treat dead human bodies. The example could bemodified to involve removing and using cadavericbody parts, but then it would be much less clear thatthe parts should be utilised. After all, many wouldoppose the removal of organs from a brain-deadindividual for transplantation without proper consent.Such attitudes are in fact reflected in the UniformAnatomical Gift Act, which has been enacted into lawin every State in the United States and in the District ofColumbia (31). This law authorises removal of organsfrom cadavers, but only if consent is given by the

patient prior to death or by next-of-kin.Robertson (28) has responded to Burtchaell and

Bopp by arguing that respectful treatment of humancadavers does not require consent. Rather, therespectfulness of treatment depends only on what isactually done with the cadaver. In defending this view,he claims that autopsies for scientific or lawenforcement purposes are not undignified, eventhough next-of-kin might object. He also states thatlaws in twelve states permit corneas to be removed fortransplant without consent of next-of-kin, with no lossof human dignity. However, replies can be made tothese arguments. To begin, it is not clear that autopsiesfor scientific purposes in face of objections from next-of-kin are fully respectful. American law holds that,aside from coroner's cases, the consent ofnext-of-kin isrequired prior to autopsy, regardless of whether thepurpose is scientific (32). Doctors who perform privateautopsies without consent are at risk of liability (32).The purpose of such laws, in part at least, presumablyis to promote treatment of cadavers that is consistentwith the wishes of the deceased and the views of thedecedent's family concerning respectful treatment ofthe body. Admittedly, some States authorise autopsiesdespite family objections in certain cases involvingsuspected infectious diseases (33). However, theexistence of such laws does not demonstrate thatautopsies for scientific purposes over the objections ofthe family are respectful. Rather, such laws might bedefended on the grounds that the disrespect that wouldbe involved can sometimes be outweighed by othermoral considerations, such as a compelling interest inpublic health. Similar considerations apply toautopsies for law enforcement purposes and to removalof corneas. In law enforcement cases, autopsies areauthorised because there is a public interest at stake,often involving suspected foul play (33,34). Here theoverriding considerations are protection of the publicand promotion of criminal justice (34). The laws inquestion permitting cornea removal seem to involve abalancing of the diminution of respect associated withremoval of corneas without consent of next-of-kinagainst the therapeutic benefits to be obtained. Itmight be argued that the diminution of respect in suchcases is relatively small, for several reasons. First, thelaws apply only to situations in which the coroner ormedical examiner is authorised to assume temporarycustodianship of the body for the purpose ofperforming autopsy (35). Second, the 1987 revision ofthe Uniform Anatomical Gift Act includes arequirement that in such cases reasonable efforts bemade to locate the next of kin and that tissues,including corneas, be removed without consent only ifsuch efforts are unsuccessful. To date, six States haveincorporated such a requirement into their lawsconcerning the custody of cadavers by coroners orsimilar officials (36). Third, the laws in question do notpermit removal if the decedent or family members areknown to have objected (36). Fourth, because thecorneas would be removed during this period of

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custodianship, their removal would normally create nointerference with burial plans or other arrangementsthe family might make for disposition of the body.Moreover, cosmetic restoration can be provided ifneeded, so that the appearance that the body wouldhave during a funeral is not altered. Thus, it might beargued that removal of corneas without consent ofdonor or family in such cases is justifiable because thediminution of respect that is involved is minor and thepotential benefits to those in need of corneas issignificant.These replies to Freedman and Robertson suggest

the following conclusion: if human fetal cadaversdeserve the same respect as adult cadavers, thenconsent for use of fetal remains by one morallyauthorised to give it is required, and this requirementmay be lifted only if there are overriding ethicalconsiderations.Robertson has also responded to the argument that

fetal tissue transplantation will increase the number ofabortions (28,29). With regard to furtherentrenchment of abortion, Robertson points out thatlaws permitting abortions are based on the widedisagreement that exists over the status ofearly fetuses.Concerns about fetal interests and the right to self-determination of women are more central to thecontroversy than possible benefits of transplantation.Robertson claims that if a majority believed thatfetuses should be respected as persons despite theburdens placed on pregnant women, then the possiblebenefits of fetal tissue transplants would not prevent achange in the legality of abortion (29). Concerningindividual abortion decisions, Robertson points outthat the feared impact is speculative. Even if therapiesprove successful, the prospect of benefiting othersmight tip the balance in only a small number of cases.Moreover, a small increase in abortions would notmake use of fetal tissue unacceptable. As he points out,highway engineering, drug licensing, and gun saleswill lead to some loss of life as a result of the activity.The risk of losing some lives is not sufficient to stopthose projects when the number of deaths is notsubstantial, the activity serves worthy goals, andreasonable steps to minimise the loss have been taken(16). Similarly, forbidding fetal tissue transplants isnot justifiable just because there would be someincrease in the number of abortions.However, Robertson's replies fail to support the

view that fetal tissue use can be morally isolated fromabortions. His response to the entrenchment argumentis itself speculative, as almost any prediction aboutthese matters is bound to be. He assumes that even iffetal tissue transplantation were highly successful intreating a variety of conditions, it would not influencepublic opinion about abortions. It would seem morereasonable to acknowledge the uncertainty about howattitudes would be affected. Moreover, a reasonablejudgement that there might be a further entrenchmentof the institution of abortion is all that is needed toestablish that the issues of tissue use and abortion are

not completely insulated from each other. If furtherentrenchment is bad and has a chance of occurring,then the potential harm it represents must be balancedagainst the potential benefits ofthe transplantation. Tosay that the issues are isolated, on the other hand,implies that no balancing is needed.

Robertson's reply to the argument concerningindividual abortion decisions seems implicitly toacknowledge that the issues are not morally isolated.He suggests that the deaths associated with an activitylike highway engineering are an evil that sometimes isoutweighed, in part, by the worthy goals of theactivity. Thus, his analogy implies that a small increasein the number of abortions is an evil that would beoutweighed, in part, by the benefits of fetal tissuetransplantation. But to carry out this balancing is toacknowledge that there is an ethical conflict betweenthe benefits of tissue use and respect for fetal life, notan isolation of the two.

Thus, the view that use of fetal tissue can be fullyinsulated from the issue of abortion is unfounded. It isnot true that, regardless of one's views on abortion andthe moral status of fetal remains, one can consistentlyconsider use of fetal tissue to be morally acceptable.One might ask how a prestigious national panel of

experts could have adopted such an untenable view.Perhaps the majority opinion was clouded by the issueof whether those who perform research with fetal tissueare accomplices to the abortions that produce thetissue. A third argument of Burtchaell and Bopp hadbeen that there is such complicity and that researcherstherefore inevitably have dirty hands (16). The panelmajority was quick to respond to this argument,pointing out that researchers would play no causal rolein the abortions, that they were merely using tissue thatwould otherwise be discarded (16). This response isbolstered by an analogy with a brain-dead, adult,murder-victim whose organs are removed fortransplantation. We certainly would not say that thesurgeon who removes the organs is an accomplice tothe murder. Similarly, the researcher who makes use ofwhatever fetal tissue is available has no complicity withthe abortion (37). The majority's response to theargument in question appeared satisfactory. Withregard to the issue of complicity, fetal tissue use ismorally isolated from abortion, provided that thepanel's guidelines are followed. The complicityargument was inflammatory, however, with Burtchaelland Bopp going as far as comparing fetal tissueresearch with Nazi atrocities. At least some membersregarded these comparisons as outrageous, asevidenced by comments in the report (16). Perhapsinfluenced by its own vehement rejection of thecomplicity argument, the majority went too far inclaiming that the issues of abortion and fetal tissue useare completely isolated.The fact that the issues are not totally isolated does

not imply, of course, that use of fetal tissue in researchand transplantation is wrong. It means, however, thatin seeking an ethical justification for such activities we

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74 Fetal tissue transplantation: can it be morally insulatedfrom abortion?

must turn to reasons other than those put forward bythe NIH panel. If such tissue use is ethical, then it isimportant to state explicitly why it is so. One mustargue either that there is nothing morally problematicabout abortion, or that whatever wrong is involved inusing tissue from induced abortions is morallyoutweighed by other considerations.

It is not plausible to maintain that there is nothingmorally problematic about abortion. At the very least,one can argue that the potential of the fetus to becomea person gives abortion some moral significance.However, it can be argued that whatever wrong mightbe involved in use of fetal tissue obtained from inducedabortions is outweighed by the potential benefits topatients. This moral balancing involves two basicfactors: the degree of wrongness in using the tissue;and the degree and likelihood of potential benefits topatients resulting from tissue use. The less thewrongness and the greater and more likely the benefits,the stronger is the argument that fetal tissuetransplantation is ethically justifiable.

Several considerations suggegt that the degree ofwrongness is relatively low. First, it can be argued thatfetuses in early gestation are not persons. One suchargument is based on the implausibility ofholding thatthey are the type of individuals that can have rights. Ithas been persuasively argued that a prerequisite ofhaving rights is that one be a type ofindividual that canhave moral interests (38). Moreover, it is notreasonable to think that individuals lacking desires,cognitive awareness, and perceptions have interests(38). With regard to substantia nigra transplants, tissuewould be obtained from fetuses at approximately 8-11weeks gestational age (13,16). Although the stage ofgestation at which fetal perception begins is not clear,current research suggests that it is considerably laterthan the 8-11 week period. The brain structures thatgive rise to such experiences are not sufficientlydeveloped until later (39). For example,thalamocortical connections necessary for painperception do not seem to be established until sometime between 20 and 24 weeks of gestation (40). Forthese reasons, the claim that fetuses at 8-11 weeksgestational age have rights is questionable. And if theydo not have rights, then they cannot be persons,because part ofwhat it means to say that one is a personis that one has a right to life.

It might be objected that interests the fetus will havein the future can create rights that the fetus possessesnow (38). On this basis one might claim, for example,that the fetus has a right not to be subjected to high-risk, non-therapeutic research because at some futuretime the fetus will have an interest in being free ofharms that might occur through such research. Even ifwe were to accept this objection, however, it would notfollow that the fetus now has a right to life. If the fetusnow is killed, there will be no future individual havinginterests. Because an individual with interests neverexists, it is difficult to claim that a right to life - or anyright, for that matter - is violated by killing the fetus.

Second, a lack of personhood status of the fetuses inquestion has implications for the argument concerninginformed consent. Ifthese fetuses are not persons, thenit is doubtful that respectful treatment of the fetalremains involves exactly the same requirements asrespectful treatment of adult cadavers. Specifically,although consent for use ofadult cadavers is necessary,it is not clear that it is needed for respectful use of fetaltissue early in gestation. Consent for use of fetal tissueseems to be required, rather, in order to protect theinterests ofthe woman having the abortion (29). Third,a lack of personhood status has implications for theargument that the number of abortions will increase. Iffetuses early in gestation lack rights and interests, thenan increase in abortions does not have the same degreeof moral significance that it would have if fetuses hadrights and interests that needed protection. Theseconsiderations do not imply that there is nothing at allmorally problematic about use of tissue from inducedabortions. Ifhuman fetuses in early gestation have somedegree ofmoral standing, then an increase in abortionswould seem to be morally undesirable to some degree.However, the above considerations suggest that thewrongness of using early-gestation fetal tissue is notnearly as great as that claimed by Burtchaell and Bopp.

Moreover, it can be argued that the potential forbenefit from fetal tissue transplantation is morallysignificant. Those who might benefit - sufferers ofParkinson's disease, diabetes, and other disablingdisorders - are indeed persons, a fact that is absolutelywithout controversy. Thus, if there is benefit to thoseindividuals, it will undoubtedly have moralsignificance because it is a benefit to persons.Moreover, there is a reasonable chance that there willbe at least some benefit from going forward with thisarea of clinical research. Even if it turns out that fetaltissue transplantation does not provide effectivetreatments, knowledge will be gained about the humanbody, disease, and therapeutic interventions. Suchknowledge often has a way of eventually contributing,in greater or less degree, to the development of usefulapplications. In addition, if therapies prove effective,the degree of the benefits might be great.

In summary, transplantation and research involvinghuman fetal tissue appear ethically justifiable becausethe degree of wrongness that might be involved seemsrelatively low, no rights would be violated (assumingthe woman having the abortion gives informed consentto use of the fetal tissue, and other pertinent guidelinesand laws are followed), at least some benefit isreasonably expected, and great benefits are possible.

Nevertheless, research involving fetal tissue shouldproceed with caution. The potential benefits to thetissue recipient are still speculative, but risks exist.Protection of these research subjects should be ofuppermost concern. Published recommendationsinclude the following: more animal studies are needed(41,42); clinical research should be conducted at onlyhighly specialised centres (24,43); and researchprotocols should be carefully reviewed (44).

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Carson Strong 75

In order to defend a view concerning the ethics offetal tissue transplantation, it seems necessary to take aposition concerning the moral status of early-gestationfetuses, as is done in the above argument. Moreover,the above approach helps explain why it is appropriateto adopt guidelines that provide greater insulationbetween research and abortions. It is not desirable toincrease the number of abortions or to use tissue in amanner that some find offensive. Such features of fetaltissue use can be countenanced only if they areoutweighed by other moral considerations. Otherthings being equal, it is morally preferable to minimisethese effects. The greater the insulation produced byguidelines, the less pronounced will be any increase inthe number of abortions. Moreover, the healthinterests of the woman having an abortion areprotected by insulating procedures such as notallowing the timing or method of abortion to beinfluenced by the research uses of the tissue. Inaddition, there is a consensus that certain activitiesshould be flatly proscribed, such as abortions for thesole purpose of obtaining the tissue. This makes itappropriate to have additional insulating guidelines,such as a rule that the woman having the abortion maynot designate the recipient of the tissue. Appropriateinsulating guidelines have been recommended byseveral committees in addition to the NIH panel(45-48).

it might be objected that the above argument isutilitarian, that it approves the wronging of fetuses inorder to produce a net benefit overall. However, thisobjection fails to consider that an essential feature ofthe argument is that no rights would be violated,provided that relevant guidelines and laws arefollowed. The potential benefits of fetal tissuetransplantation are a compelling consideration onlybecause it is reasonable to think that the research canbe performed without violating rights. To appeal tobenefits in situations in which no rights are violateddoes not make one a utilitarian.

For those who strongly oppose abortion, thesearguments will be rejected. The arguments ofBurtchaell and Bopp help explain why many whoconsider abortion to be killing persons mightdisapprove of fetal tissue use. The United StatesAssistant Secretary for Health in the Department ofHealth and Human Services, Dr James Mason,recently announced that the ban on federal fundingwill be continued indefinitely (49). Thus, theAmerican administration continues to be stronglyinfluenced by anti-abortion views. We should expectfetal tissue transplantation to continue being ascontroversial as the abortion issue itself.

AcknowledgementI am grateful to John Robertson for critical commentson an earlier version of this paper. This does not implythat he endorses all the views that I express herein.

Carson Strong PhD is Associate Professor in theDepartment of Human Values and Ethics, College ofMedicine, University of Tennessee, Memphis, Tennessee,USA.

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