"A lot of people want intact hearts these days," she says. "Always as many intact livers as possible. Some people want lower extremities too, which, that's simple. That's easy. I don't know what they're doing with it."
The woman in the video is Deborah Nucatola, Planned Parenthood's medical director. She thinks she's talking to a biologics firm that provides fetal tissue to researchers. She isn't. She's talking to actors from the anti-abortion group Center for Medical Progress, which over the past three years has secretly taped meetings with her and at least three other Planned Parenthood officials.
This summer, the Center for Medical Progress has released five 10-minute segments that purport to show that Planned Parenthood profits from procuring fetal tissue for researchers. They are full of moments like the one leading the first video, conversations about fetal tissues and organs that feel grisly against the backdrop of wine and a light lunch.
But behind those excerpts are just over 12 hours of video. Planned Parenthood has charged that the Center for Medical Progress's clips are "heavily edited," created by "activists who have been widely discredited." They argue that when you watch the full video, it shows no wrongdoing. (Update: Planned Parenthood later released a report arguing that the full videos were edited, too)
I've covered the Planned Parenthood scandal for months now, and it's only become bigger. The videos kicked off a firestorm in Congress, which will hold today a hearing on the footage. The Planned Parenthood fight, once again, threatens to shut down the government.
In all that, there seems to be one question at the core of the debate: Are the edited videos fair? So this summer, I watched the 12 hours of footage that had had been released by August 13th. Here's what I learned.
The videos are edited to make Planned Parenthood look bad. But that doesn't mean Planned Parenthood didn't do anything wrong.
The videos are sting videos that are designed to smear Planned Parenthood. The longer, less edited footage shows the fake buyers actively attempting to make the discussions look worse for the hapless Planned Parenthood staffers. They are the ones, for instance, who suggest that Nucatola order wine with her meal ("I really, after this week was looking forward to a glass of wine, maybe a bottle, to share of course," one of them says).
The Center for Medical Progress argues that these videos show the organization was selling fetal tissue for profit — which is, to be clear, a crime. But abortion clinics are allowed to receive compensation for any time spent procuring fetal tissue — for example, the extra time a staff member has to spend getting consent to donate or the work a lab technician does identifying specific types of tissue. Planned Parenthood says this is all the videos show, and for the most part they're right.
It's routinely the fake buyers, not Planned Parenthood, who move the discussion toward money. When Planned Parenthood officials are asked about their motivation, they talk about fetal tissue donation as a real, positive good that could lead to medical advancements. They talk about patients who request these types of services, who like the idea of something productive coming out of their decision to terminate a pregnancy.
"I've had patients ask me before, 'Can I donate this?' I wish!" one Planned Parenthood nurse says.
These moments don't show up in the edited videos. But they are, arguably, the key to understanding the broader debate around these issues. Planned Parenthood is an organization that believes it can do good in the world by procuring fetal tissue for medical researchers. Their critics find fetal tissue research self-evidently repugnant. To a large degree, what you think of the videos comes down to what you think of the fraught topic of fetal tissue research.
But there are also moments that should give supporters of the women's health provider pause — moments when officials with the group seem to haggle over fetal tissue compensation and appear to make women's health a secondary priority.
These are moments that do not appear any less troublesome when watched in the full video. They are not simply a product of biased editing — and, if anything, the biased editing is making them too easy for Planned Parenthood's supporters to ignore.
Planned Parenthood officials go out of their way to say they're not making money
This is a consistent theme throughout the 12 hours of video footage: Planned Parenthood officials emphasize, repeatedly, that they do not see fetal tissue as a revenue stream, nor do they intend to make money off of fetal tissue procurement.
Rather, they talk about it as a service they can provide to researchers and patients — something that patients want to participate in and that they want to facilitate, provided it does not lose their clinic any money.
This is the type of footage that tends to get edited out of the Center for Medical Progress clips — and it's much more prevalent than the troublesome moments I'll discuss later.
This was especially true for a three-hour lunch with Nucatola. She makes this point repeatedly during the lunch. Here are a few examples:
"This is not a new revenue stream the affiliates are looking at. This is a way to offer the patient the service that they want. Do good for the medical community."
"Our goal, like I said, is to give patients the option without impacting our bottom line. The messaging is this should not be seen as a new revenue stream, because that's not what it is."
"Affiliates are not looking to make money by doing this. They're looking to serve their patients and just make it not impact their bottom line."
In the tapes I watched, Planned Parenthood officials never started the conversation about price; it was always something the buyers brought up.
So why take a meeting with a (fake) fetal tissue procurement company in the first place? Mostly, Planned Parenthood's staffers seemed to think they were doing something good — but they wanted to make sure they wouldn't lose money if they began to devote more staff time and work to processing fetal tissue donations.
Savita Ginde, medical director at Planned Parenthood of the Rocky Mountains, talks repeatedly about offering a service to patients seeking to terminate pregnancies.
"Some of them would actually be fairly satisfied to know that they're having their termination but those products are getting used — like you were saying, that something good could come out of it," she says in the third Planned Parenthood tape. "I think a lot of the patients would really be pleased with that opportunity."
"There are patients who do come in and say, 'Can I do something with this medical research?'" J. R. Johnstone, who works at the same Planned Parenthood as clinical director, says later on.
But in some of the videos, Planned Parenthood reps get very close to the line
The Center for Medical Progress spent a lot of time with Planned Parenthood officials, at least 12 hours released on video so far. And during most of it, there really isn't a suggestion that Planned Parenthood intends to make money.
At the same time, there are specific moments that suggest Planned Parenthood is operating in an ethically gray area — one that really should raise questions for the organization and its supporters.
Nucatola, the national medical director, is the one who says repeatedly that fetal tissue procurement is "not a revenue stream" for Planned Parenthood. Still, she proactively suggests an alternative: that the fetal tissue buyers might consider some type of in-kind donation to the clinics in order to build partnerships. About an hour into lunch, Nucatola suggests that clinics currently struggle with how to dispose of the tissue from abortions that won't be used for research — and suggests that the fetal tissue company could offer disposal services as an "in kind" service. This is the exchange, on page 22 of this transcript:
Buyer: Yea, what if we could take it all. That is the better way to negotiate about this.
Nucatola: Yea, that's gonna win your business. "We'll take all of your tissue at the end of the day."
Buyer: Right. So we're bartering more about services, than money.
Nucatola: Yes, and again, affiliates don't - affiliates are not looking to make money by doing this. They're looking to serve their patients and just make it not impact their bottom line. If anything, you can make it even better to their bottom line by giving them services in kind instead of money. I think a lot of them will take you up on that. That would definitely get people. Say, "I'll give it to you for the same price, AND I'll do that."
Nucatola knows that under federal law, Planned Parenthood can't earn money off the procurement of fetal tissue. But what she suggests is, in a way, similar: that a fetal tissue procurement company could take care of all tissue disposal and save a clinic money.
Most of the moments that jumped out at me as problematic were in the second video, an hour-long lunch with Mary Gatter, president of Planned Parenthood's Medical Directors Council. Gatter is also the medical director for a clinic in Pasadena, and in the video is shown meeting with the fetal tissue buyers to discuss the possibility of a partnership there.
There's an exchange in which Gatter and one of the buyers discuss how much Planned Parenthood would receive for each fetal tissue specimen procured. The discussion, both in the longer and shorter versions of this video, sounds like a negotiation:
Gatter: Okay. $75 a specimen.
Buyer: Oh. That's way too low.
Buyer: And that's, really, that's way too low. I don't, I want to keep you happy.
Gatter: I was going to say $50, because I know places that did $50, too. But see we don't, we're not in it for the money, and we don't want to be in a 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, and that kind of stuff, so what were you thinking about?
Buyer: Exactly. Way higher than that.
Buyer: So I'd like to start at around $100.
Gatter does make a point of saying her clinic is "not in it for the money." She's clearly being baited by the "buyer" into a negotiation. Still, this haggling over price shouldn't happen if the clinic simply intends to receive reimbursement for costs associated with procuring tissue.
By contrast, Melissa Farrell, who directs research at Planned Parenthood Gulf Coast in Texas, gets incredibly specific in identifying the exact costs of fetal tissue procurement. One of the added costs of fetal tissue procurement is that a lab technician has to identify and isolate the particular type of tissue that a researcher wants. Typically an abortion clinic wouldn't do that — so Farrell suggests figuring out reimbursement for that particular step.
"I need to know everything that's involved, have it in writing so that I can sit down with the parties involved actually doing the work, so I can say, 'Okay, guys, let's work this out now.' We even will go as far as to have timed trials where we go up there with a stopwatch and time how much, so we can at least know what our cost is."
This gets to something key in the videos. Planned Parenthood may be one organization, but it's not one person. Some of the organization's staffers come off better than others. There's someone like Farrell, who wants to get into the exact nitty-gritty of how much fetal tissue procurement will cost and use that to set a reimbursement fee. That approach hews closely to the intent of federal law.
But the way Gatter, from California, talks about fetal tissue procurement is quite different. She engages in what I think can fairly be called a negotiation, discussing price points ranging from $50 to $100 without any discussion of the actual costs involved in procurement. This is a discussion that should, at the very least, raise questions for Planned Parenthood supporters about how the organization handles these types of situations.
The moment that I found most disturbing
Whether Planned Parenthood makes money selling fetal tissue is the focal point of the Center for Medical Progress's campaign against the group. So this tends to be the focus of the videos, too.
But there's another issue the videos touch on, and it's arguably more damaging than the discussions around tissue donation: the ethics of changing the abortion procedure to procure better tissue.
This is something Planned Parenthood officials talk about more openly than cost, and it's a difficult ethical issue to think through, even for supporters of abortion rights. Is it okay to change a medical procedure in service of something other than the patient's health? What about changes that don't alter the odds of success? What about those that make the procedure last a few seconds, maybe a minute, longer?
These are tough ethical issues, and they present serious dilemmas for providers who both believe in the promise of fetal tissue research and the integrity of the services they offer patients.
This is what made Gatter's comments on the issue, to me, the most disturbing part of the video. She dismisses these types of concerns about altering the procedure as a "specious little argument." Here's the full comment:
"Let me explain to you 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 an IPAS or something with less suction, and 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." Now to me, that's kind of a specious little argument and I wouldn't object to asking Ian, who's our surgeon who does the cases, to use an IPAS [a specific abortion technique] at that gestational age in order to increase the odds that he's going to get an intact specimen, but I do need to throw it out there as a concern."
Later in that discussion, Gatter describes these concerns as "technical issues":
"Well, there are people who would argue that by using the IPAS instead of the machine, you're slightly increasing the length of the procedure, you're increasing the pain of the procedure, is it local anesthesia or conscious sedation, so they're technical arguments having to do with one technique versus another."
Bioethicists don't treat the possibility of altering patient care as a specious issue. And I doubt patients think the length of their procedure is a specious issue.
Decisions to change a standard of care are important, and they matter to the women Planned Parenthood sees. And, to the organization's credit, others talk about this issue with more gravity and seriousness. This is what Farrell, from the Texas Planned Parenthood affiliate, says about the issue:
"We can't delay an abortion in order to get a later gestation," she says. "Of course, that's unethical or anything that's going to put her at risk in terms of 'no alteration was made in terms of the timing of the termination or the method used.' So if we're going to be doing a surgical procedure, the surgical procedure is going to be the same."
Farrell also displays an openness to changing the abortion procedure, but discusses it in a more nuanced way than Gatter — like weighing in on the idea of extending the procedure to procure more intact fetal tissue:
It will depend, obviously the change in the procedure will have to be where it's not gonna put the patient at more risk, prolong the procedure and put her at more risk.
Out of the 12 hours of video that I watched, I found Gatter's remarks in this space the most concerning and surprising. It was Gatter, more than anything else I saw, who brushed off of serious and important ethical issues that come along with using fetal tissue in research and who seemed to dismiss questions that would be of importance to patients.
The real issue in these videos isn't Planned Parenthood. It's abortion.
The disagreement at the heart of the Planned Parenthood videos isn't really about the organization and its internal policies. It's about the morality of fetal tissue research — and of abortion.
What these videos try to do is split the people who are actually comfortable with abortion from those who support it uncomfortably, and who might be repelled by the idea that aborted fetuses are being used for medical research. The Planned Parenthood staffers in these clips are genuinely comfortable with the morality of fetal tissue research — they speak easily, and even a bit dismissively, of issues that many Americans, including some who support Planned Parenthood, find ethically troubling.
But the real divide here isn't about fetal tissue research. It's about abortion.
Opposing fetal tissue procurement can be a position consistent with supporting abortion rights; it's possible to support a woman's right to terminate a pregnancy while also objecting to how tissue donation could alter or change the procedure.
But imagine, for a second, that Planned Parenthood came out tomorrow morning and said that the Center for Medical Progress had caused them to reconsider their position, and henceforth, they would no longer participate in fetal tissue research. Does anyone think Republicans would stop trying to defund Planned Parenthood? Or that the Center for Medical Progress would believe it had won?
Of course not. Planned Parenthood workers are comfortable with fetal tissue research because they are comfortable with abortion — they don't believe a first-trimester fetus to be a living, feeling human being, and so they see the donation of fetal tissue for medical research to be an obvious, unalloyed good. Their critics oppose abortion — they believe abortion to be murder and fetal tissue research to be a form of desecration. Where you fall on the Planned Parenthood videos really reflects where you fall on the fundamental questions of abortion.
Update: The timestamp on this piece has (understandably) created some confusion. This article was originally published on 8/13 (as you can see in the URL) and, at that time, I had watched all the Planned Parenthood sting videos released by the Center for Medical Progress.
In late August, Planned Parenthood released a report arguing that those videos were edited, and on September 9th, Congress held a hearing based on the Planned Parenthood videos. On 9/9, I updated this piece to mention the hearing and the controversy over whether the tapes I had watched were really unedited.
At Vox, when we update a piece with new information, we note that by changing the date in the "updated on" field, as I did here. But between 8/13, when I published the piece, and 9/9, when I added the Planned Parenthood update, CMP had released additional hours of footage. So the headline, which was correct when the piece was first published, should have been changed when it was updated. That was an oversight on my part, and it's been corrected now.