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The Foetus as Transplant Donor: Scientific, Social, and Ethical Perspectives.

The Foetus as Transplant Donor: Scientific, Social, and Ethical Perspectives

A central proposition of The Foetus as Transplant Donor is that any discussion of the ethical implications of scientific activities requires an accurate appreciation of the technical facts of that activity. As a result, over half the book's chapters are technical in nature. Although these chapters are perfectly comprehensible to the lay reader, and Peter McCullagh's argument about the importance of technical information is irrefutable, in practice it can lead to a bit of tedium. For instance, twenty-five pages about the outcome of fetal tissue transplantation in animals will tell most readers rather more about this subject than they want or need to know. The problem may be that McCullagh's thorough knowledge in these areas compels him to explain details that many lay readers would never have questioned.

In part, the perceived need for a comprehensive account stems from an assumption that much of what is "known" about the utility of fetal tissue for transplantation is myth. McCullagh shows, convincingly, that scientists are as subject to secondhand misreporting as are the rest of us--even in their own fields. In the process, he reviews much of what has been said about fetal tissue and its immunological characteristics and shows that, more often than not, these statements are based on little or no real data. When the original research is tracked down he finds that the work done was badly flawed or only partially reported. It has led the author to assume that his readers share this folklore. Yet as few lay readers do share it and none are likely to be very committed to it, McCullagh's refutation is disproportionate. For the nonspecialist reader this section, like the technical chapters, engages in overkill.

The author justifies his technical chapters not as refuting scientific error but as setting the stage for an informed discussion of ethical and policy issues. He starts by arguing that abortion and fetal tissue transplantation are distinct issues. In particular he shows that one can be supportive of abortion but still object to fetal tissue transplantation. Unfortunately, as one progresses through the book, it becomes clear that the two issues cannot be separated in all circumstances. If one rejects abortion because of the belief that fetuses are human beings with human rights little remains to be said about using fetal tissue for transplantation: the practice is simply wrong. McCullagh does appear to believe that fetuses are humans but he is not very explicit about this belief and this greatly weakens the entire last section of his book.

McCullagh's arguments in his concluding ethical analysis of the implications of fetal tissue transplantation are often quite bewildering. At times he is at pains to refute positions that nobody has yet advocated. Who, for instance, justifies procuring fetal tissue based on some idea of consent from the fetus? Who believes that the debate in organ donation consent between "opting-in" and "opting-out" (presumed consent) has any application to fetuses?

Yet a more basic shortcoming is that most of his arguments seem circular, even tautological. In fact, my first response was to dismiss them as simply ill thought out. Only by the end of the book did the actual problem become clearer: All of McCullagh's ethical positions on fetal tissue use are predicated on his views regarding the immorality of abortion. With this as a postulate, much of what is said becomes more comprehensible. Had McCullagh made his assumptions more explicit his arguments would have been far stronger.

Viewed in this light The Foetus as Transplant Donor is quite different from the book McCullagh presents it as being. Very few of its arguments are directly relevant to the issues of fetal tissue procurement alone. For those who do not share McCullagh's views on abortion his arguments about fetal tissue transplantation are almost wholly irrelevant. The author does have more to say to those who do share his views on abortion. He makes a number of points in support of the proposition that it is impossible to consistently oppose abortion and support fetal tissue procurement. The most telling of these is essentially technical and regards the circumstances of fetal tissue procurement. McCullagh indicates that usable fetal tissue for transplant cannot be obtained by spontaneous or early abortions. Only induced abortions in the later stages of pregnancy yield transplantable tissue. Abortion is therefore a precondition of fetal tissue transplantation.

As a summation of the history of the therapeutic use of fetal tissue this is a good source book. While it may be a bit too detailed for the average reader it does provide comprehensive data on the real status of this medical technology. In the process, it also demonstrates that intelligent discussions of bioethics require a sound grounding in technical facts. However, as a contribution to the debate on the ethics of fetal tissue transplantation it is of limited use. The connection between abortion and fetal tissue use is not clearly considered and this obscures much of the book's ethical arguments. Had the author been more explicit regarding his assumptions he might have helped those who reject abortion and have a less clear position on fetal tissue transplantation.

Peter McCullagh. New York: John Wiley & Sons. vi + 215 pp. $45.00, cloth.
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Author:Prottas, Jeffrey
Publication:The Hastings Center Report
Article Type:Book Review
Date:Feb 1, 1988
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