Book Review

The Dilemma of the Fetus: Fetal research, medical progress, and moral politics

N Engl J Med 1996; 334:610-611February 29, 1996

Article

The Dilemma of the Fetus: Fetal research, medical progress, and moral politics
By Steven Maynard-Moody. 235 pp. New York, St. Martin's Press, 1995. $23.95. ISBN: 0-312-11785-X

Fetal research is embroiled both in the controversy over abortion and in the controversy surrounding the independence and integrity of scientific research. Although the vast majority of Americans favor a woman's right to terminate a pregnancy, most would also like this divisive national debate to subside, with the right to choose legal abortion left intact for those (including themselves and their loved ones) who may need it. So it is with scientific research: most Americans trust scientists to conduct their research in ethical and respectful ways, but they recognize that misconduct does occur and is most often dealt with by the scientific community and its funding sources. However, it can be argued that science emanates from the larger society and must be accountable to it.

In The Dilemma of the Fetus, Steven Maynard-Moody presents a logical and detailed discussion of the issues raised by the debate on fetal research. He divides the subject into five topics: studies of fetal development, the diagnosis and repair of fetal abnormalities, studies of pharmacology and drug safety, research on the fetus outside the womb, and research on the transplantation of fetal tissue.

One event on which he bases many of his arguments is a notorious abortion case from Boston. In 1973, an article was published in the Journal (A. Philipson, et al. “Transplacental Passage of Erythromycin and Clindamycin.” 288:1219-21) describing research that attempted to determine the levels of drug that reached the fetus when antibiotics were given to a pregnant woman before an elective abortion at Boston City Hospital. The article caused an uproar in some corners of conservative Boston, resulting in hearings before the City Council during which testimony by religious leaders and antiabortion activists dealt mainly with the “horrors” of abortion. There was very little testimony about the value of the research. During a sometimes surreptitious investigation, the District Attorney's office “stumbled on” the remains of a fetus aborted in the second trimester. This discovery provided them with the opportunity to go after their real target — physicians who perform abortions. Six months later, two sets of indictments were handed down. The researchers were indicted for “grave robbing,” an offense still on the books from previous centuries, which prohibited the transporting of a body from one place to another for the purpose of dissection. Because of the death of a fetus during a legal abortion, another physician, myself, was indicted for manslaughter. Both indictments had a chilling effect on scientists conducting fetal research and physicians carrying out elective abortions. The charges of grave robbing were dropped years later. The manslaughter case — Commonwealth of Massachusetts v. Kenneth Edelin — went to trial and resulted in a guilty verdict that was overturned on appeal to the state's Supreme Judicial Court.

Maynard-Moody draws several lessons from this trial. Many who oppose fetal research use it as a foil for their real aim, to eliminate legally available elective abortion in this country. If an abortion yields tissue that may save lives, correct inherited diseases, increase our understanding of abnormal cell growth, further unravel the mysteries of the immune system, or answer other questions, then there is an added positive value to the procedure. Maynard-Moody accurately states that opponents of abortion and fetal research argue that a fetus is a “person” or “baby” and is thus protected under the laws that govern all of us. If such people can convert our image of a fetus to that of a baby, they believe their arguments will be convincing. In this connection Maynard-Moody refers to the moment in my trial when the jury, viewing photographs of the aborted fetus, affirmed their view that it was a baby.

The author spends considerable time tracing the steps of fetal development and the arguments over when life begins. He concedes that a developing fetus is biologically alive. It grows and changes rapidly, but these characteristics do not make it a living person. Sperm and egg cells are just as biologically alive before conception. And the argument that a fertilized embryo has a separate genetic identity is not completely watertight. Genetic identity is not enough to define personhood, since identical twins are considered two persons even though genetically they are duplicates, and the placenta is not granted the status of a person even though it shares the genetic code of the fetus it helped nourish. Defining human life or personhood as beginning at either birth or conception benefits from simplicity, because these are specific, easily recognized events. Both definitions ignore the complexity of fetal development. This is the core of the problem.

This author also discusses the future and the complexity of scientific research more broadly, and he rightly concludes that there will continue to be a need for public discourse. He believes that we cannot avoid the intrusion of politics into scientific research but that it should not be permitted to threaten intellectual freedom and scientific progress. Politics, on the contrary, is an essential element of a strong democracy.

This thoroughly researched treatise is generally accurate in reporting historical events. It is important reading for both sides of the debate over fetal research. As may be expected, since this is a book about the fetus, there is very little discussion of the other important persons in the abortion debate — women. Maynard-Moody believes that “abortion is always a tragedy.” There are many who would disagree. Many women choose abortion because of tragedies in their lives and in the circumstances surrounding their pregnancies. For these women, abortion itself is not a tragedy; instead, it liberates them from tragic circumstances. Women must never be left out of the abortion debate or the debate about fetal research, medical progress, and moral politics.

Kenneth C. Edelin, M.D.
Boston University School of Medicine, Boston, MA 02118