The Sale of Fetal Tissue

TUESDAYS WITH ROSEMARY AND MYRA

Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post.

The Sale of Fetal Tissue

M:  Rosemary, you know all the hub-bub about the video of the executive from Planned Parenthood being caught on tape talking about the sale of fetal tissue to two people posing as employees of a company looking to procure fetal tissue for research purposes. It’s been all over the Internet…

R:  I do know about it. It’s gone viral!

M:  It certainly has, and it has provided fodder for those hoping to be nominated by one of the parties for the 2016 presidential election. The video has been proven to be an example of “hit and run” journalism, but that doesn’t negate the ethical question that underpins it, i.e., “Is it acceptable to sell fetal tissue?” And that’s what I want to talk about.

R:  And I want to ask is there any difference in fetal tissue and other human tissue, all of which gets “sold.”

M:  THAT’S THE QUESTION!

R:  Of course, there is something special about fetal tissue, but does that mean that it can’t be used for research. It’s not the same kind of tissue that comes off your elbow…

M:  Why not? What makes it different?

R:  It is because of the potentiality involved in what it can or could become, but let’s don’t have an argument about that right now. Even though it will certainly come up in our argument later, I’m still going to say that fetal tissue can be used for research purposes.

M:  Okay, but your first claim reminds me of one that Don Marquis, a philosopher at Kansas University, made in an argument against abortion years ago in an article he wrote for the Center. He said the difference between tissue from your elbow and a fetus is that the elbow has a past, i.e., we know something about the arm it hinged, but has no future, whereas a fetus has a future but no past that could reveal anything about its history or values. Is that your argument?

R:  No! It’s not just about tissue’s history; I am trying to skirt intrinsic worth. So, don’t you push me into talking about that, Myra Christopher. I hate objective whatevers!

M:  Whatevers? Sorry, Rosemary, but I want to push you just a little. Most all of us will say that human life is sacred/special, and what I want to talk about may align with your “potentiality” comment, but it may not; I don’t know. But I want to talk to you about the difference between human tissue and a human “being.”

R: I would find it morally reprehensible to use fetal tissue for insignificant research purposes.

M: You‘re still avoiding my issue, but OK….  Insignificant research like what?

R:  I’m trying to get circumstances involved here so that they cast a moral evaluation on their use in one instance and their not being used in another. For example, I would not object to fetal stem cells being used to find cures for cystic fibrosis or sickle cell disease, but I would find it morally reprehensible to use fetal tissue to find a better face cream and make old women look younger.

M:  I agree. I think it is repulsive. It reminds me of the former chair of the President’s Bioethics Commission Leon Kass’s determination based on what he called the “yuck factor”, i.e., if it is just plain old gross, it may be just plain old wrong.

R:  I’ve thought this for a long time, and there is something to be said that should lead us to reflect on why we feel the “yuck”, and maybe in some instances it should cause something to be tagged “unethical”, but in other instances it may simply be a societal “no-no”.

M: I think the point you are getting to is important – not just in this discussion, but in many arguments claimed to be “ethical arguments”. There are important distinctions that should be made between ethics, social norms, etiquette, and the aesthetic.

Last night, I was thinking about us possibly blogging about this topic today, and I remembered being at a women’s rights rally once and a person claiming to be absolutely opposed to abortion was walking around trying to force people to look at an aborted fetus she had in a box. It struck me as the epitomy of irony that a person crusading for the sanctity of life would objectify a fetus for political purposes. 

R:  Poor soul! She was very confused. 

M:  Rosemary, when I was thinking about this last night, I thought about the many, many times I have heard you ask (when teaching ethics committee members), “Is it wrong to torture little children?”

R:  “Needlessly, needlessly torturing little children!” Is what I asked? The point behind that was that, most often, general rules need to have adverbs to make them valid and true.

M:  I agree and add that speaking in “absolute” terms almost always forces you into a corner. But I want to go back to the distinction I need to make between human “tissue” and human “beings” Because it is critical to my position.

For me, “being” implies “personhood” and by that I mean an independent individual whether 1 day old or 100 years old. I would argue that it applies only to fetuses that are sustainable independent of the mother.

R:  You’re not placing the same meaning on potentiality that I am. So, you and I will have a different argument because we differ in the meaning of the potentiality involved in the fetus. That is so simple to me. You want to say that the point of differentiation is when it (the fetus) can live on its own. I say that is not the point; we have to respect it until it gets there; so I am going to call for more heavy arguments for the use of fetal tissue than you would before it is sustainable.

What I'm saying is that justification for use of fetal tissue ought to be weightier the closer the fetus comes to live birth before being aborted. I'm trying to show that potentiality develops and thus the arguments must take that development into account.

M:  I think that’s true. However, I think at a certain point in the development of the fetus our lines cross, and we find ourselves at the same place. However, I want to say that I agree wholeheartedly that fetal tissue, no matter the gestational age of the fetus from which it comes, should always be treated with respect. 

I am reminded of a situation years ago, probably 20 years ago, when a faith-based hospital reached out to the Center for help in deciding what to do with fetal tissue that was not suitable for research. Fertility specialists in their institution were burning such tissue in trash cans in their clinic. That is one extreme. Another was a time when the Center was contacted by a hospital because a group was demanding that the hospital “bury” fetuses with a proper ceremony – no matter its gestational stage.

R:  Why do you call burning tissue in a trash can an extreme?

M:  Good question, because I wouldn’t find it objectionable to burn it in the hospital’s incinerator.  I think the “aesthetics” of the situation were objectionable to me. The whole idea that it was “trash” bothered me and others in the hospital. 

R:  I see it’s not the “burning”; it’s the “trash” that bothers you. So much of these arguments depend on the way we use language and define specific terms.

M: Back to the Planned Parenthood fiasco; I think we agree and disagree about components of this situation. Although we get there along different paths, we agree that when used for significant research that could potentially help people living with disease and injury AND when conducted in done in a way that is respectful of the “donation”, the use of fetal tissue in research can be justified.

However, there are other important factors as well, including “tone”, context, and intent when in discussion about ethically sensitive issues.

About Rosemary and Myra

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!

We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.


I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.

Rapping about Dying

ZDoggMD is something of a celebrity among physicians and medical students. He is the “Weird Al” Yankovic of the medical world – parody songwriter extraordinaire, satirist of medical culture and, at his best, a seriously funny human being. Whether lampooning hospital readmissions or mocking anti-vaxxers, his music videos bring humor to physicians’ challenges as well as their follies.

But listen closely and you will find that, beneath the humor, there often lies a serious message in ZDoggMD’s lyrics. The parodies aim to entertain healthcare workers, of course. But they also seek to educate. “Let’s just prevent readmissions/manage those chronic conditions/need time preparing the handoffs/move along to other clinicians,” he raps in “Readmission,” a parody of the R&B hit “Ignition (remix).” In the music video, ZDoggMD utters these lines in a hospital ward, wearing a lavish fur coat and sunglasses in the fashion of a rap musician. The routine is absurd – and funny – but the goal is more than mere entertainment. ZDoggMD’s light touch of humor warms us up for a serious conversation on a topic that is no laughing matter.

Ain’t the Way to Die

For his latest video, “Ain’t the Way to Die” (a parody of Eminem’s “Love the Way You Lie”), ZDoggMD forgoes humor altogether – a first, according to his blog. Stripping away humor, the song takes a more direct approach to talking seriously about a topic that many of us prefer to avoid – death and dying. As ZDoggMD writes, “…we too often fail to have those difficult but crucial discussions about dying, and this failure leads to untold human suffering and billions in squandered resources. We are failing as caregivers, we are failing as family members, and we are failing as individuals – failing to simply have a conversation that ensures that we direct our own destiny. Plainly put, we need to talk about dying.”

Talking about dying is hard. It’s uncomfortable. As a medical student, I’ve become acutely aware of the discomfort. I feel it too, even as an observer. For all of us, the challenge is to communicate effectively about death and dying in spite of the discomfort, and in that regard ZDoggMD’s sentiment too often rings true: We are failing as caregivers, family members, and individuals to have these crucial conversation about the end of life.

Conversation Starter

Thankfully, there are people working to make these conversations a little easier. Caring Conversations, a resource developed by the Center for Practical Bioethics, for years has guided patients and their families through the process of advanced care planning. In its own way, ZDoggMD’s “Ain’t the Way to Die” can also facilitate these conversations, by melodically breaking the ice on death and dying: “Just gonna stand there and watch me burn/end of life and all my wishes go unheard/they just prolong me and don’t ask why/it’s not right because this ain’t the way to die, ain’t the way to die.” 

The musical stylings may be off-putting to some, but for those who enjoy rap music – and those who can tolerate it – the lyrics of “Ain’t the Way to Die” succeed in broaching a wide range of end-of-life issues, from family discord to resuscitation. And this brings us to what is perhaps the greatest virtue of “Ain’t the Way to Die” – that the breadth of issues addressed in the short video makes the parody a conversation-starter for healthcare workers and patients alike.  

All of us must find a way to communicate clearly in conversations about the end of life. “Ain’t the Way to Die” may help some of us find the words to do so. With that in mind, I encourage you to watch the video and share it with others.  No matter one’s background or profession, each of us will one day face the end of life. Starting a conversation about how you want to face it gives you the best shot at doing it on your own terms. 


Written By Joel Burnett. Joel Burnett is an MD candidate at the University of Kansas School of Medicine.

Strengthening Hospital Ethics Committees

The first hospital ethics committees in the nation were established in the 1970s, and the primary catalyst for their growth was the 1976 Karen Quinlan case. As the case was argued, the judge, who had read an article about ethics committees in the Baylor Law Review, remarked that cases like this belong before ethics committees rather than courts.

In 1992, the Joint Commission – then the Joint Commission for the Accreditation of Healthcare Organizations – mandated that hospitals establish a clinical ethics “mechanism.” For more than two decades, this guidance has allowed hospitals to craft widely varied responses. A facility may or may not have a standing ethics committee. The committee may or may not meet regularly. Its members may or may not have training in thinking through issues ethically.

The three primary functions of ethics committees, as identified by the American Hospital Association in 1986, are to:
• Educate themselves to “do ethics”
• Develop and review hospital policies
• Consult on complex cases arising in the hospital

Center for Practical Bioethics’ Efforts

In 1986, in response to numerous ethics committee members seeking opportunities to learn from each other, the Center for Practical Bioethics, which counseled both sides of the Cruzan case, convened the Kansas City Regional Hospital Ethics Committee Consortium, This is the oldest continuously operating Consortium of its kind in the nation.


In a project entitled “Organizational Ethics: Beyond Compliance,” Center staff traveled to cities across the country to present new standards for patients’ rights and organizational ethics, after collaborating with the Joint Commission in 1993 to promulgate them.

The Center has trained more than 200 hospital ethics committees across the country. Today, as a benefit of Center membership, Center staff members serve on the ethics committees of several hospitals in the Kansas City metro area. Many of these committees have made significant strides in strengthening their individual approaches to meeting the requirement for an “ethics mechanism, ” as illustrated by activities at Shawnee Mission Health, Liberty Hospital and North Kansas City Hospital.

Consultation Team Model

For many years, the ethics committee at Shawnee Mission Health (SMH) in Shawnee Mission, Kansas – one of the oldest ethics committees in the Kansas City area – met monthly at 7:30 am. On average, 20 of the committee’s approximately 30 members, including the hospital CEO and CFO, would attend. From time to time along with the committee members, clinicians and allied health practitioners would gather in response to a request for a formal “ethics consultation.” This “call” could result in a rather large group for an ethics consultation, and while the expertise was appreciated, the committee realized that family members and friends could find the process overwhelming. SMH envisioned a process that would be more intentionally responsive to its commitment to person-centered care and shared-decision making.

In Spring 2014, SMH asked Sandy Silva, vice president of education at the Center, and Mark Stoddart, the health system’s administrative director of spiritual wellness, to serve as committee co-chairs and encouraged them to explore alternative models for its operation. Silva proposed the consultation team model.

“Rather than call for ethics consults with the assumption that there’s a problem or something bad happened,” she said, “the idea is to cultivate and invite ethics questions. We want to create a mechanism for people to receive a nimble response to their questions, whether from a patient, family member or member of an SMH interdisciplinary care team.”

At the same time, the committee formed two three-person consultation teams with backups. Team leaders can be reached immediately depending which team is on call. If the leader can’t answer a question right away, he or she gathers appropriate records and contacts team members and others involved in the case. The model is designed so that the need to bring the full committee together to address a question will be rare.

“This model is appropriate and effective for the SMH culture,” said Silva. “No matter how small a question, providers, families and patients will know that if they have an ethics question they can get an immediate response. It’s about facilitating communication that is timely and responsive.”

At SMH, there is a dual-pronged emphasis on consultation effectiveness as well as education.  SMH provided consultation team members with a personal copy of Guidance for Healthcare Ethics Committees (Cambridge Medicine, 2012). The members of the consultation teams (including back-up members) meet quarterly to review assigned chapters to take a deeper dive into the material as well as discern its application for their hospital system.

Focus on Education

The focus on education is observable at SMH as well as at other hospitals in the region.

The full complement of the SMH ethics committee now gathers bi-monthly for mid-day meetings that include lunch sponsored by SMH. The agenda includes a review of any ethical questions and/or consultations that may have taken place over the ensuing 60 days. The emphasis, however, is on education regarding ethically linked trends and cases within the SMH sphere.  Silva and Stoddart envision this educational emphasis as the forum to offer continuing education credit that will be open to all SMH clinicians and staff.

Education is also a cornerstone of ethics committee invigoration efforts at North Kansas City Hospital and Liberty Hospital in Missouri. North Kansas City Hospital has invested in providing Guidance for Healthcare Ethics Committees to all members of their ethics committees and prioritized education as a key activity. The ethics committee chair at North Kansas City assigns chapters of the textbook to a specific member to present when the group convenes bi-monthly. While the “assignment” may be moderately ambiguous for the presenter, the presentation serves as the springboard for full committee analysis and discussion.

At Liberty Hospital, there is a resurgence of interest and dedication to the work of their ethics committee. Leaders in the hospital system from both the clinical and spiritual realms of healthcare have raised their hands to acknowledge the hospital’s decades-long commitment to quality care based on ethical principals and to support renewed emphasis on education as well as timely response to ethical questions from patients, families and staff. The immediate focus is on the revision of an online administered education module for hospital staff.

“It’s gratifying to see members of these hospitals’ ethics committees actively participating in the Kansas City Regional Hospital Ethics Committee Consortium,” said Silva. “Strengthening ethics committees is a significant part of the Center’s history and continues as a key component of our efforts to provide practical resources to those wrestling with complex ethical questions.”
Download free print, audio and video resources about ethics committees at practicalbioethics.org.


Trudi Galblum provides marketing and communications support for the Center for Practical Bioethics.

Tuesdays With Rosemary and Myra

Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher and Rosemary Flanigan have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). The words will come from Myra’s pen (actually her computer), but the writing will happen together.

Why We Are Blogging

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!

We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.

I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.

Blowing Smoke vs. Shocking with Electricity

Rosemary and I decided to focus our inaugural blog post on efforts to resuscitate the newly dead because on August 12, the Center will host David Casarett, MD, author of Shocked: Adventures in Reviving the Recently Dead, to deliver the 21st Rosemary Flanigan Lecture which will, as always, be held at the St. Joseph Medical Center. David is a physician/bioethicist at the University of Pennsylvania, and he will talk about his book, which is a history of resuscitation methods, including some that are REALLY weird, such as blowing cigar smoke into the rectum of someone who has died. GEEZ!! Can you imagine? However, we all know that tobacco, i.e., nicotine is a cardiac stimulant. (I still remember the first time I smoked and recall that it was great and took me ten years to stop in part because I loved the rush it gave me.) So, the theory was that “blowing smoke” could possibly revive a dead person, and as distasteful as it might seem, it was worth trying. (Or maybe they were just sickos….)

Is this really any stranger than resuscitating ALL those who die in our hospitals UNLESS the poor soul’s doctor has written a DNR (Do No Resuscitate) order? Is it stranger than policy based on our society’s belief that “anything is better than dying”, including the things we do to those who die in our hospitals today? Stranger than when someone calls a “Code Blue” over the hospital’s PA, people run down the hall with a crash cart? Then someone pounds on the deceased’s chest, inject stimulants directly into his or her heart, and/or shocks them with electricity? The two of us think that, in many instances, the current practice seems just as odd as blowing smoke up a dead person’s rear. We wonder if healthcare professionals have thought about adding a cigar to crash carts ...

August 12 Flanigan Lecture

Please join us on August 12 to hear Dr. Casarett talk about his research and all the weird things he discovered while writing Shocked (you won’t even believe it), and to also discuss this important healthcare policy issue with him. If you are not able to be in KC for the lecture, it will be videotaped and posted on the Center’s website shortly thereafter. Regardless whether you are there or not, we encourage you to tell us what you think about the universal application of CPR for those who die in hospitals by commenting on this blog post.


For more information about the Flanigan Lecture or other Center events, go to the Center’s website at www.practicalbioethics.org.


Myra Christopher is the Kathleen M. Foley Chair for Pain and Palliative Care at the Center for Practical Bioethics. Rosemary Flanigan, PhD, joined the Center’s board in 1986, was its chairwoman in 1991 and, for 17 years following her 1992 retirement from Rockhurst University, served on the Center’s staff.