It is indeed terrible to watch: A doctor arrives for lunch, breezily chats about L.A. traffic, casually gives out medical advice (drink water if you have a headache and are having alcohol), and then sits down for a lunch chat: salad, red wine, and abortion.
The video, distributed in two versions—an edited tape of about 9 minutes, and three-hour tape of the entire conversation—is then posted on the Internet, and becomes the focal point for an intense debate about abortion. The debate spills over, in conservative circles, to death threats, Nazi parallels, and now a congressional investigation of the event. Planned Parenthood—the employer and the largest provider of clinical abortions in the county—issues a statement calling the practices described legal. Then, after more criticism, including the outrage of bioethicists, two days later the organization agrees that the doctor’s tone is not reflective of compassion.
But after the first video is released, a second video is released a week later, and it is even more explicitly disturbing: another doctor, another meal, and more talk about money, secretly filmed (one wonders how many Planned Parenthood executives were swept up in this scheme). In this video, a woman identified as Dr. Mary Gatter, a medical director for Planned Parenthood, starts by giving a price of $75, then $50, to cover the costs of preparing fetal tissue. She jokes that she “wants a Lamborghini” in a particularly cringe-worthy moment. Perhaps the very worst ethical problem is when she discusses changing the abortion procedure—despite noting there are consent forms to make no such change—to retain a more intact specimen. “We’re not in it for the money,” she says, adding, “We don’t want to be in the position of being accused of selling tissue.”
What can be made of this entire story, of the videos, with their grisly description of how tiny liver, heart, and muscle tissue are taken from aborted fetuses and shipped to tissue companies?
First a caveat: The films are political, made by a group committed to anti-abortion politics, furtively filmed. The organization is clear that it considers abortion murder, and morally impermissible. They made the films (and possibly more films to come) to ramp up the debate that the Right has largely lost, since there is consensus that abortion should be legal but rare. Few Americans want to jail women or doctors, nor force women into state-sponsored, unwanted pregnancies. This is largely because of these facts: According to the Guttmacher Institute, “At least half of American women will experience an unintended pregnancy by age 45; at 2008 abortion rates, one in 10 women will have an abortion by age 20, one in four by age 30 and three in 10 by age 45.” And Guttmacher notes that 51 percent of women who have had abortions used a contraceptive method in the month they got pregnant. Abortion is a private, deeply personal decision, made most commonly early in pregnancy (89 percent) and yet it has been used as a descriptor of an entire political position, a sign that stands in for ideas about the family, faith, freedom, sex, race, and especially, women’s bodies and women’s power. The religious objections derived from Catholic moral philosophy have been used in arguments made by Protestants who would scorn the pope, and by many political conservatives to screen judges as a surrogate for other issues. The films focus on two (very obtuse) doctors to make a critique of Planned Parenthood’s entire existence, and one of their long-standing goals is to close the clinics that provide safe abortions.
And yet, despite the political agenda, and despite the “gotcha” method, these videos must be watched, I would argue, their essential point debated: Is the collection and exchange of the tissues and organs of aborted fetuses an ethical gesture? Here are some issues that should be raised in such a debate.
Take the first video: It is terribly disturbing, not just because the word “crush” appears in the same sentence as the body parts of a fetus, but because the physician, Dr. Deborah Nucatola, Planned Parenthood’s senior director of medical services, seems to be engaged in a transaction, an exchange of goods at a business lunch, utterly confusing persons and things. She explains to the two actors posing as employees of a fetal tissue procurement company about how she would position her forceps in order to keep the fetus’s body intact. “You’re just kind of cognizant of where you put your graspers,” she says. She continues: “We’ve been very good at getting heart, lung, liver, because we know that, so I’m not gonna crush that part.”
The actual event—an abortion—is occluded, changed into a site of production, where the goal is to extract tissue to meet the needs of a company, rather than being focused on the core purpose of the clinic, which is to provide a safe medical procedure. Turning the fetus around in the womb, with the sole goal of protecting organs, seems to compromise this purpose. This calculated deliberacy is unjustified, for it may well extend the time of the medical procedure, and it creates risks that could well be avoided. Even dilation of the cervix more than is needed would be unethical. The doctor’s focus on the “tissue” that “they”—the company—wants makes the women and their situation invisible.
There is an obvious conflict of interest here. For while it seemed clear that the ethical problem was not really the money, nor was there “selling,” nor were the patient, doctor, and clinic making a profit from the tissue exchange, unlike much hostile social media suggested, the focus of the clinic procedure had slid into procurement. The doctor seemed only to be asking for money from the company for shipping—it was the least of the moral problems. The issue is subtler: the doctor was eager to please the company, and astonishingly enough, was willing to change her practice and her training duties to give the company what they asked for when her only concern should have been her patient. And her rationale seemed vague. The doctor seems to have no idea where the tissue goes, or why it is needed. She seems to have no idea of the nature, goal, and meaning of the actual science, which is a pity, since research on fetal tissue has been conducted for years, serving, for example, as a basis for early work on gamete-derived stem cells.
The decision to end a pregnancy is private, and it can be difficult and emotional—the woman is herself quite vulnerable. It is true that the chance to donate to science may offer a small chance to do something good and meaningful at this time. Extra care must be taken when getting true informed consent for anything, especially if the plan is to take the fetus and dismember it as a source of tissue. One would have to actually check the consent forms, of course, to be sure this entire project was realistically described as frankly as it is told to us on the videos—I doubt if the doctors say the same thing to patients that they say to these fake companies—and this is a problem.
An abortion is not like other medical procedures—it has a moral gravity that is not present in other surgeries, or other tissue donations. When Planned Parenthood made this an issue of equality of opportunity to participate in research, they did not really address this considerable difference. Donation of fetal tissue can be an important part of basic research science, and it has been, which is precisely why the careful structure of consent, the rules of procurement, and the medical guidelines are so carefully maintained.
Research on the earliest stages of human development is very important, but it must be carefully carried out. The work must be funded privately because of the Hyde amendment, which prohibits the use of federal funds for fetal tissue research, and there must be full and well informed consent prior to the abortion. The abortion itself or any medical procedure associated with it must be carried out with the entire attention of the doctor on the women. No change in the procedure merely to get “better” tissue is acceptable. And, finally, every single staff member must be aware of the moral gravity of the situation and must be at all times serious, professional, and compassionate.
The doctors in these videos seem extraordinarily cavalier, morally unaware of their role and their specific duties as physicians to protect the women under their care. Having this discussion over a meal takes this further from the realm of professional clinical medicine and into the realm of business. Of course, this is nothing new for anyone who works in a hospital, where dismissive language is too often used to create an odd verbal shield between the terrible starkness of illness, death, and loss, and the day-to-day practice of medicine, but it is inexcusable.
Within many religious traditions, the act of abortion itself is morally impermissible. The specter of cutting up fetuses and using hearts and lungs and legs from aborted fetuses disturbs even supporters who are pro-choice. Even religious traditions, such as Judaism, Islam, Hinduism, Buddhism, and many forms of liberal Christianity, all of which allow abortions under certain circumstances and have a developmental view of moral status of the fetus, have ethical norms that would limit such a practice, and surely they would abhor the way it was discussed. This violates both prohibitions on abortion and prohibitions on how the bodies of the dead are respected. These physicians seem, in the videos, to be unaware of these basic moral problems. One of the basic requirements of moral citizenship should be an awareness of your neighbor’s deepest convictions.
Moral status issues have long been at the center of the most intense American debates. Think of the treatment of Native Americans; of the “three-fifths” status issue of personhood for slaves; of the long debate about women; on the ongoing debates about immigrants. Abortion is only one in a long line of intense and furious conflict about who counts as fully human—and that is why the first video went viral. The videos do indeed raise at least two important points, ones not addressed in most of the debate. First, they highlight the distinction between what is legally permissible and consistent with the widest view of an American as an autonomous citizen, and the creation of a person as a moral agent, whose words, work, and actions can be called to a different sort of standard. Second, they remind us, especially those of us with traditions that allow abortion and who work to be sure it is legally available (such as this author) of the tragic reality of the act, and of the stakes at play in research with human fetal tissue. The videos remind us of the need for attention, mercy, and care at every moment of this act, and of why our language, even in private, must remind us of the gravitas and responsibility of medicine.
Laurie Zoloth is a professor of religious studies and a professor of bioethics and medical humanities at Northwestern University.
*This post has been updated with more information about the second video.