In 1975 Paul Ramsey published a little book titled The Ethics of Fetal Research. In it he was at pains to distinguish experimental use of the dead fetus or of cadaver fetal tissue from research on the still living fetus (whether newly aborted or still in the womb but intended for abortion). Already in the book’s introduction he made clear that, in his view, “the ordinary canons of medical ethics” could not justify “research using abortuses that are not yet dead.” And then he noted that, in saying this, he had “not said a word” about the use of the dead fetus, fetal tissue, or fetal organs for transplantation: “Questions arising in these connections fall under the heading of our use of dead bodies, or at most our treatment of the newly dead.”
Unfortunately, he continued, “both the foes and the proponents of abortion frequently confuse research using fetal tissue or the dead abortus with research using the human fetus in situ or the previable living abortus—the one to escalate its moral outrageousness, the other to praise its great and indispensible [sic] benefits.” Alas, proponents of both views “poison the wells of public-policy formulation in the matter of fetal research.”
There was a period in the mid-1970s when this issue was widely discussed. The reason is obvious. The Roe v. Wade decision in 1973 meant that many new subjects—newly aborted fetuses, or fetuses still in the womb but intended for abortion—had become available for possible experimental use. No one doubted that important medical benefits might be gained from such study—techniques for aiding infants born very prematurely, information about normal fetal development and inborn errors of metabolism, possible techniques of genetic therapy for fetuses still in the womb, prevention of hyaline membrane disease. These and other possible benefits of such research were noted and could hardly be ignored.
In 1974 the first national bioethics commission, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, was formed. Among its first tasks was a study of the ethics of fetal research. Ramsey himself, believing that “God so loved the world that he did not send a committee,” did not hope for much from commissions aimed chiefly at reaching consensus. Still, he recognized their necessity and inevitability. Over time, as ethical guidelines governing fetal research were established, the issue faded from attention. In our own day, however, the use of fetal tissue in development of COVID-19 vaccines has again made it a matter for lively debate. Even today there is much to be learned from the position Ramsey staked out in that first round of debate. It is essential to keep in mind that he was at pains to distinguish what he opposed—research on the still living fetus—from research that used cadaver fetal tissue, which he did not oppose, even if that tissue had been obtained after abortion.
He was careful not to try to win the argument simply by a choice of terminology. He spoke of the living human subject in the womb and of the fetal human being. “I do not say ‘person,’” he wrote. “There is a need for a more neutral expression, a word less laden with controversy.” At the same time, “always to say ‘fetus’ in discussing the ethics of fetal research is as question-begging and laden with moral controversy as to insist on always saying ‘person.’” But in a formulation such as “fetal human being,” “the stage of development is properly placed in an adjectival, not substantive, position.”
That the still living fetus used for research has just been aborted or is intended for abortion should not, in Ramsey’s mind, make that fetus available as a research subject, for it is still a living human subject. He noted that those opposed to abortion
are apt to analyse their troubled consciences in terms of complicity in a system of which they disapprove, even as sensitive souls in recent years have struggled to separate the good they would do . . . from involvement in corporate investments in South Africa.
But his case against using still living fetal human beings as research subjects did not depend on the connection to abortion. Instead, he suggested that we ask ourselves whether we would be willing to do research on living human beings who were unconscious, or in the process of dying, or condemned to be executed. Agreeing with Hans Jonas that “utter helplessness demands utter protection,” Ramsey argued that such (still living) human beings could not properly be used as research subjects:
No one’s views on the morality of abortion alters or can remove the offensiveness of such research practiced on the dying. The prohibition would hold even if all abortions were morally justified.
Hence, his argument against research on fetuses who were still living though soon to die because they had been aborted did not depend on the concern “sensitive souls” might have about complicity in a great evil. Rather, it rested chiefly on the fact that the “ordinary canons of medical ethics” could not justify nontherapeutic research on still living human subjects who would be used without their consent simply as means to the good of others. Likewise, decisions about using cadaver fetal tissue were not determined by the possibility of complicity with abortion. That question would, he thought, “fall under the heading of our use of dead bodies.”
Notwithstanding his belief that decisions about fetal research of either sort did not turn on the problem of complicity with abortion, Ramsey did not hesitate to make clear his belief that abortion was a great moral wrong. He emphasized that, here as always, “there are more right-making and wrong-making ingredients in ethical analysis and judgment than beneficial consequences.” Some argued, of course, that since these still living fetuses were soon to die anyway as a result of abortion, we might at least gain some good from using them in research. Reflecting upon that, Ramsey wondered whether “a load of guilt” might not be what was propelling much of the argument: “The wastage of unborn lives needs redemption; something ‘must’ be saved from it.” A “religious commentary” might suggest, Ramsey wrote, that we “are searching for some therapy for our collective souls.”
I myself think that revisiting Ramsey’s analysis could be helpful as we reflect upon the use of cadaver fetal tissue in the development and testing of COVID-19 vaccines. His concern (and the primary issue at the time) was the use of still living fetal human beings, not the use of cadaver fetal tissue obtained after abortion. Now the focus has shifted. And now a certain strand of pro-life sentiment seems determined to oppose the use of currently available COVID-19 vaccines on the grounds that tissue used in development of these vaccines has been derived (albeit, mostly decades ago) from elective abortions. Of course, the abortions were not done in order to provide tissue for research. The women’s reasons for aborting were not related to the benefits we may get from use of a fetal cell line, and we can hardly be said to be perpetuating the moral wrongness of that deed. Yet, we find ourselves mired in arguments about whether such research involves “cooperation” with the evil of abortion—and if so, what kind of cooperation, what degree of cooperation, and so forth. As other moralists have noted, we have to consider whether this sort of cooperation with evil—if that is even the right word for it—is worse than buying products made in China where genocide of the Uyghurs continues, buying Dole bananas (since the company used a chemical that it knew would sterilize workers), or using railroads first built with slave labor. We will need to consider whether it could be right to transplant an organ from a homicide victim. Indeed, we may have to wonder how we can really live in society at all without profiting from and cooperating with a wide range of evils. Whatever we may say about the purity of our hearts, once we take this approach to moral reasoning, the attempt to have clean hands will be a never-ending and largely futile one.
I find it hard to believe that this sort of argument is going to help our society sort out the important moral questions involved in research and development of vaccines. Moreover, I fear that this kind of opposition to COVID-19 vaccines is likely to harm the pro-life cause, limiting its scope to an increasingly small core of true believers. Hence, I have found myself returning to Ramsey’s analysis from almost half a century ago. There is a difference between experimental use of still living human beings (whether in or out of the womb) and experimental use of dead human beings. Different moral considerations should govern our reflection on these different kinds of research.
We can recognize that difference, and allow our thinking to be guided by it, while simultaneously wondering whether, in a society so determined to make abortion readily available, we may not also be “searching for some therapy for our collective souls.”
Gilbert Meilaender is Senior Research Professor at Valparaiso University.