The tissue issue: take it slow on fetal transplants.

What has always been true about politics is so true it's a truism: when the votes are counted, there are winners and losers. Ambivalence is little valued when the vote is taken and at the end of the day there is room only for unabashed celebration or morose lamentation. But as the issue of fetal tissue transplantation research is brought to closure, at least temporarily, it is not clear who has won and who has lost.

A few weeks ago I went to a party in Northwest Washington held to celebrate the lifting of the ban on fetal tissue research. All the players were there: Congressman Henry Waxman (D-Calif.), who led the congressional charge to remove restrictions on using federal funds; the Reverend Guy Walden, a profile minister whose own family had benefited from experimental fetal tissue transplantation therapy; Joan Samuelson, a Parkinson's patient, who had toiled endlessly to see that research using fetal tissue be continued; and many others. I understood them, but I still felt out of place at this celebration and stayed only a short while.

On January 22, the day that President Bill Clinton issued the executive order lifting the ban on fetal tissue research, National Right to Life condemned his decision saying it would lead to "harvesting these babies for spare parts." This was also a sentiment with which I could not fully agree.

As a legislative assistant from 1989 to 1992 for John C. Danforth (R-Mo.), a committed prolife Senator and Episcopal priest, I had numerous conversations with him about this issue. At first, I felt strongly that he should support lifting the ban on fetal tissue research. But by the time it came to a vote in 1992, I was feeling a degree of uncertainty and discomfort that I had not felt before. Now that the ban has been lifted only one thing is clear about my own viewpoint: I am ambivalent.

I had originally been swayed by the view that abortion was a separate issue from fetal tissue transplant. No matter what one's view on abortion, fetal tissue transplantation research could be supported. The argument took a variety of forms: Abortion is legal, and probably always will be, so we may as well bring some good out of it. (As Senator Strom Thurmond [R-S.C.] recently said in congressional debate, "This is not about taking lives, but saving lives.") Also: Accepting a donated organ from a suicide or murder victim doesn't make suicide or murder acceptable. There were also powerful emotional appeals by people suffering a variety of ailments describing the amazing potential therapies that would come from the use of fetal tissues. Since such claims had as yet no solid scientific support, all the more reason, proponents argued, to put scientists to work on the research.

Finally, proponents relied heavily on the recommendations of the Fetal Tissue Transplantation Research Panel. They never neglected to emphasize that it was a Reagan-appointed advisory panel with some prolife members. The panel had approved the research in December 1988 with certain safeguards: the tissues could not be sold for profit; informed consent for the tissue research could only be sought after a woman had made the abortion decision; a woman could not designate a recipient for the tissue. That the panel approved the research with only a few dissenting voices was seen by proponents as a knockdown, clincher argument. (No doubt, if the same panel had reached a different conclusion, research supporters would have charged that the panel was a political body with only an advisory role.)

Earlier, I had been convinced by these arguments. But in 1992, as the matter came up in the Senate, I began to have some hesitation. The ease with which research proponents denied any connection between abortion and this type of research began to bother me. Proponents dismissed the opposition by charging "political interference with science." They lamented that the issue had become "mired in abortion politics." They treated disagreement from members of Congress as an annoyance, necessary to placate profile supporters, rather than respecting a genuine moral hesitation about the implications of medicine becoming dependent on abortions for lifesaving therapies.

These slogans simply did not ring true for me; those lobbying to lift the ban never adequately addressed the symbolic sanction of abortion that this research implied. Perhaps this research could be isolated from abortion and the abortion decision, but could it ever be morally separated? Could we accept a therapy that, if proven effective, would require thousands of abortions a year to sustain an adequate level of fetal tissue? Did we want to become dependent on abortion as a means of curing people? Wouldn't it be preferable, in experimenting with fetal transplantation therapy, to rely on the tissue from spontaneous abortions and those occasioned by ectopic pregnancies?

Despite a detailed briefing by an NIH scientist about the limited usefulness of tissue from spontaneous abortions and ectopic pregnancies, in which he argued that only a small percentage would yield usable tissue, I began to wonder why we shouldn't just do research with this small percent. I was not convinced by the scientific or policy argument that using tissue from sources other than elective abortions was not feasible. But a proposal to study the feasibility of using fetal tissues from non-elective abortions was soundly rejected by Congress and was seen by many research proponents as simply another maneuver to stall research. Ultimately President George Bush authorized such a fetal tissue bank through executive order, but it is likely to lapse under the Clinton administration.

Despite the limited parameters of the debate on fetal tissue research, at some point, even in the midst of uncertainty and ambivalence, public policy must be shaped; a decision must be made as to whether to proceed or to continue to ban such research. President Clinton has made the decision and Congress has approved it. I regret that neither seriously entertained a third option: to proceed with caution and with open eyes. This approach, though, would have required concessions from the proresearch contingent acknowledging that we should be hesitant about the possibility of creating a high demand for aborted fetuses. Proceeding with caution would mean allowing fetal research to move ahead using tissue from elective abortions as well as ectopic and spontaneous abortions, but on a limited basis while continuing to study seriously the feasibility of using only tissue from non-elective abortions. Proceeding with open eyes would mean allowing fetal research while remaining conscious of, and uncomfortable with, its inherent connection to abortion.

Liz Leibold McCloskey, formerly on the staff of Senator John C. Danforth, is now a research assistant on the National Advisory Board for Ethics in Reproduction.