Five sting videos from an anti-abortion group, released throughout July, show Planned Parenthood executives and other workers discussing how the organization provides fetal organs and tissues to researchers.
The videos led to a new, Congressional investigation of Planned Parenthood — a Senate vote to defund Planned Parenthood, which ultimately failed on Monday.
The videos also open a debate that split bioethicists decades ago: Is it ethical to use the remains of aborted fetuses for medical research?
The Center for Medical Progress, which opposes abortion, had actors pose as buyers for a company that procures fetal tissue for researchers. They secretly recorded lunches Planned Parenthood executives, as well as trips to clinics in Colorado and Texas.
In the videos, officials discussed the types of body parts in demand and how doctors will slightly alter abortion procedures to deliver the type of organs customers might want. They also show footage of fetal remains in Planned Parenthood labs.
The videos themselves raise two issues. The first is whether Planned Parenthood's actions are legal; selling fetal remains for profit is against the law. But Planned Parenthood says it only charges enough to cover its own costs for preserving and transporting the fetal tissues, and that's allowed under federal law.
The larger issue raised by the video is harder to resolve, and it's about the medical ethics of using fetal tissue in research.
Fetal tissue has historically played an important role in scientific research because of fetal cells' ability to rapidly divide and adapt to new environments. In the 1980s and '90s, researchers had looked at fetal tissue transplants as a possible treatment for Parkinson's disease and diabetes.
"The study of fetal tissue has already led to major discoveries in human health," Samuel M. Cohen, a microbiologist at the University of Nebraska, testified before Congress in 2009.
Elective abortion has historically been a common source of fetal tissue — and that has raised a host of moral questions that divide the profession even today. Arthur Caplan, a bioethicist at New York University, previously described fetal tissue research as "the ticking time bomb of medical ethics."
What's in the Planned Parenthood videos?
The Center for Medical Progress has released five videos at this point, and tend to release new footage every Tuesday now.
In the first video, Planned Parenthood's Deborah Nucatola appears to be sharing a meal with Center for Medical Progress actors. They pepper her with questions about how Planned Parenthood works with the buyers of fetal tissue.
"This is not something with any revenue stream that affiliates are looking at; this is a way to offer patients the services they want and do good for the medical community and still maintain access," Nucatola tells the actors.
One of them follows up with a question:
Okay, so, um ,when you are or the affiliate is determining what that, what that monetary ... so that it doesn't raise crazy questions ... this is, this is what it's about ... what price range would you...
Nucatola answered, "It's probably anywhere from $30 to $100 [per fetal specimen], depending on the facility and what is involved."
She also discusses the adjustments that doctors will make to the procedure if they know a buyer is interested in purchasing the fetal remains.
"There are little changes they [abortion providers] can make in their technique to increase your success," she tells the actors.
"Even though they have a set way that they do it, they're open to changes?" one actor responds.
"If they're reasonable people, sure," Nucatola responds.
In the second video, Planned Parenthood's Mary Gatter discusses the type of compensation the nonprofit would possibly receive for fetal tissue. Gatter starts by making it clear that patients do not receive any compensation for tissue donation. Then there's a section near the beginning where the Center for Medical Progress actors push her to discuss specific amounts that Planned Parenthood would want for the donation:
Actor: What would you expect for intact tissue? What sort of compensation?
Gatter: Why don't you start off by telling me what you're used to paying?
Actor: I don't think so. I'd like to know what would make you happy. What would work for you.
Gatter: You know that in negotiations the person who throws out a figure first is at a loss, right?
Actor: No, I don't look at it this way. I know, you want to play that game, I get it –
Gatter: I don't want to play games. I just don't want to lowball —
Actor: You know what? If you lowball, I'll act pleasantly surprised and you'll know it's a lowball. What I want to know is, what would work for you?
Gatter: $75 a specimen.
Actor: Oh. That's way too low. And really, that's way too low. I want to keep you happy.
Gatter: I was going to say $50. I've been places that did $50, too. But see, we don't, we're not in it for the money. We don't want to be in the position of being accused of selling tissue and stuff like that. On the other hand there are costs associated with the use of our space.
Gatter, like Nucatola, also discusses the possibility of changing the abortion procedure to better ensure that fetal tissue comes out intact — and acknowledges some of the ethical boundaries around that.
"A little bit of a problem, which may not be a big problem, if our usual technique is suction at 10 to 12 weeks and we switch to ... using something with less suction, to increase the odds that it will come out as an intact specimen, then we're kind of violating the protocol that says to the patient, 'We're not doing anything different in our care of you,'" Gatter says.
She continues, "Now to me, that's kind of a specious little argument."
The third video focuses on a former Planned Parenthood employee who worked in fetal tissue procurement, and charges that the clinic profits off of providing the specimens to researchers. It shows footage of fetal tissue filmed within a Planned Parenthood clinic.
The fourth video is an interview with Savita Ginde, Planned Parenthood of the Rocky Mountains' vice president and medical director. It shows footage of workers at a Colorado clinic sorting through fetal body parts on a dish.
The fifth video is an interview with Melissa Farrell, who directs research at the Texas-based Planned Parenthood Gulf Coast. She talks about the possibility of slightly altering the abortion procedure in order to get researchers better specimens.
"We've had studies in which the company, or in the case of the investigator, has a specific need for a certain portion of the products of conception, and we bake that into our contract and our protocol, that we follow this, so we deviate from our standard in order to do that," Farrell tells the anti-abortion activists posing as buyers.
Farrell also says that some of the doctors who perform abortions at Planned Parenthood also use some fetal tissue specimens for research:
Farrell: Some of our doctors in the past have projects, and they're collecting specimens, so they do it in a way that they get the best specimens, so I know it can happen.
Buyer: The doctors were also doing research?
Farrell: Mmhm [nods in video]
The deeper question: Is it ethical to use aborted fetuses for research?
Supporters of fetal tissue research and transplant point to the many medical advances that these types of cells have supported.
In the mid-20th century, researchers used fetal tissue to discover multiple vaccines still in use today. The 1954 Nobel Prize for Medicine was awarded to scientists who developed the polio vaccine using cultures from fetal kidney cells. One version of the rubella vaccine also came from research done on tissue taken from an aborted fetus.
In the 1980s and '90s, research shifted toward fetal tissue transplant as a possible treatment for diseases ranging from diabetes to Parkinson's. Research using fetal tissue has waned in recent years, New York University's Caplan says, as researchers began to see embryonic stem cells as a more promising way to treat disease.
Still, some scientists have continued to defend Planned Parenthood's practice, citing the possibility of medical advance.
"Obtaining cells from legally obtained abortions for potentially lifesaving purposes is ethically permissible and indeed ethically necessary," Cohen, the microbiologist from Nebraska, argued in his 2009 testimony.
This is the argument Planned Parenthood makes, too.
"At several of our health centers, we help patients who want to donate tissue for scientific research, and we do this just like every other high-quality health care provider does," spokesperson Eric Ferrero said in a statement.
Critics have four main objections to the use of aborted fetuses in research
In a 1991 article, a team of four bioethicists including Caplan summarize the objections to fetal tissue research succinctly:
- The transplantation of tissue from an electively aborted fetus is morally inseparable from the morality of elective abortion.
- Fetal tissue transplant will cause more abortions.
- Fetal tissue transplant will change how doctors do abortions.
- Fetal tissue transplant will cause women to abort in order to donate.
The argument in the video tracks points two and three on this list: that Planned Parenthood performs more abortions, and performs them differently, because of researchers' needs.
While Caplan does not oppose abortion, he disagreed with Planned Parenthood's stance on donating fetal tissue to research for similar reasons.
"It shifts the focus away from the women and their needs," he says. "It makes Planned Parenthood or any abortion clinic look like it's trying to generate some other source of income, and it puts the clinic in a position that generates a lot of unease."
Ethics policies around fetal tissue research attempt to address these issues. The American Medical Association's policy paper on the issue, for example, says that patients should have made a final decision on whether to terminate a pregnancy before the physician "initiates a discussion of the transplantation use of the fetal tissue." The same guidelines also prohibit patients from designating their fetal tissue be used for a particular purpose or by a specific researcher.
Even if these issues are addressed and rules are followed, that is unlikely to settle a core ethical disagreement: that research using tissues from aborted fetuses is wrong because abortion is wrong. This gets to the first objection from the bioethicists' earlier list: that "the transplantation of tissue from an electively aborted fetus is morally inseparable from the morality of elective abortion."
For abortion opponents who take this view (and not all abortion opponents do), there's no way to make the use of fetal tissue in research acceptable: It will never be okay for the remains of aborted fetuses to be used for any purpose, research or otherwise.
"For critics of abortion, the idea of making something good from something they see as inherently evil is not something they have room for," Caplan says.