Compartmentalizing A Culture War: A Stem Cell Biologist’s Relationship With Abortion Policy
Reprinted from an article written by SPG’s Yuki Hebner for Knowing Neurons
The use of fetal tissue for scientific research has long been at the intersection of political polarization and medical breakthroughs. In 2019, the Trump administration passed restrictions on human fetal tissue research, mobilizing scientists to testify to the power and scope of such work. Upon Biden’s inauguration, scientists again pleaded with the Federal administration to repeal the restrictions, a request that was recently granted and follows the pattern of oscillating regulations that accompanies changes in partisan control.
However, scientists’ responses are missing an important aspect: policy limiting fetal tissue research is inextricable from restrictions on reproductive healthcare. The dilemma surrounding fetal tissue research is rooted in the abortion debate because experimental fetal tissue is obtained, and can only be obtained, from elective abortions rather than miscarriages. This is because miscarriages can arise from a developmental mishap or underlying genetic mutation, which introduce confounding variables in the tissue. Additionally, surgical care provided for miscarriages often disrupts the tissue’s structural integrity.
The repeal on fetal tissue restrictions comes at an interesting time for the University of California system, where I am conducting my doctorate studies. Californians recently voted to renew funding for the California Institute of Regenerative Medicine (CIRM), a stem cell research center that was established in 2004 in response to Federal restrictions on fetal tissue research. The renewal passed with just 51% of votes, compared to 59% in 2004. Diminished voter support is attributed to issues of transparency and accountability at CIRM: scientists had projected misleading expectations about the timeline to cure rare diseases, and conflicts of interest have been prevalent in CIRM’s grant-allocation procedures as many members of the governing board are affiliated with recipient institutions, like the UCs.
The UC system is arriving at another moment that will be consequential for its relationship to the public: the decision of whether to continue business partnerships with faith-based hospital systems. The UC system operates California’s largest training program for health professionals and boasts principles of equity and inclusion, yet these partnerships prohibit assisted reproductive technology for same-sex couples, gender-affirming care for transgender patients, and reproductive freedom for women.
The debate surrounding UC’s partnership with Catholic hospitals is multifaceted and encompass issues like resource shortages within hospitals and universities, the economic burden and racially-charged history of controlling reproductive freedom, and the disproportionate presence of Catholic hospitals in socioeconomically disadvantaged and geographically isolated communities. Focusing on just any one of these angles is reductive and unlikely to promote a resolution. Here, my sole argument is that the lack of input on this partnership from UC stem cell biologists illustrates how we have effectively divorced abortion policy from policy on fetal tissue research.
It is worth contemplating whether picking and choosing aspects of this culture war to take a stand on sends a muddied message to the public about our principles, since building public trust is a cornerstone of scientific progress. Habitual complacency from scientists towards these efforts can culminate into crises (an obvious example is how widespread skepticism of scientists has been in the COVID-19 pandemic) that damage public health or jeopardize research-permissive policies, as demonstrated by waning Californian support for CIRM. The fight over family planning and bodily autonomy is likely to retain its prevalence in our society — unfortunately for women and sexual & gender minorities — and will continue to bleed into concomitant policies — unfortunately for stem cell biologists. What responsibility, if any, do stem cell biologists have to more comprehensively examine our role in this fight?
Pulling back the curtain: How fetal tissue research contributes to neuroscience
Scientists advocate so fiercely for access to fetal tissue research because its applications are expansive. It has facilitated vaccine development against diseases that were consequently eradicated, like polio, or that are beginning to be subdued, like COVID-19. A fetal tissue processing center at UCLA, my research institution, provides samples to a range of laboratories studying degenerative diseases like muscular dystrophy, psychiatric illnesses like schizophrenia, and developmental disorders like autism. The latter two are focuses of my research at UCLA on brain development, a field that has been revolutionized by access to fetal tissue.
The developing human brain is composed almost entirely of something called the neocortex. The neocortex is the region of the brain that gives rise to the cerebral cortex, our information processing center. Neocortical development is fascinating: through a phenomenon called “epigenetics”, neural stem cells that are genetically identical (containing the exact same DNA) give rise to hundreds of unique neurons. In ways we are still trying to understand, each neural subtype coordinates functions like sensory perception, emotion regulation, or critical thinking. Cortical development therefore determines much of our intellectual, social, and psychological function, and is a key feature of human evolution.
The unique nature of human brain development can be a double-edged sword. While the complexities of neurodevelopmental mechanisms lend humans specialized cognitive functions, mistakes in these processes can give rise to various psychiatric and developmental disorders. Our understanding of and ability to treat such disorders has been progressed by studying cortical development, but hindered by the scarcity of relevant experimental models. Popular developmental models like mice and induced pluripotent stem cells (iPSCs) are valuable yet insufficient to address questions most salient to the understanding of disorders that arise during neurodevelopment. (Note: The cortex comprises only around a third of the developing mouse brain, and mice lack various neuronal subtypes and cortical regions that are crucial in humans. Meanwhile, the “epigenetic reprogramming” required to produce iPSCs likely obscures the exact biological processes that drive neurodevelopment.) For these biologically intriguing yet technically challenging reasons, stem cells from a primary source — fetal tissue — are essential for neuroscientists to investigate psychiatric and developmental disorders.
An unholy union: Fetal tissue research and reproductive healthcare
Access to fetal tissue is critical to advancing our understanding of biomedical fields beyond neurodevelopment, and restrictions have evoked a foreseeable surge of advocacy from scientists across disciplines and institutions. Researchers have been outspoken on the consequences of such restrictions on both the scientific community and those afflicted by conditions being investigated in fetal tissue models. Notably absent is the recognition that fetal tissue restrictions reflect momentum on efforts to target abortion — a fact that those enforcing restrictions are not loath to to make clear. In fact, the Department of Health and Human Services highlighted such efforts as the motivation when announcing recent fetal tissue restrictions: “Promoting the dignity of human life from conception to natural death is one of the very top priorities of President Trump’s administration”.
Policies restricting fetal tissue research are indivisible from constraints on reproductive healthcare. Still, it is understandable that even research institutions that support and pioneer stem cell research, like UCLA, are hesitant to engage in the contentious politics of the abortion debate. There is, however, a striking hypocrisy demonstrated by the willingness of UCLA scientists to advocate for access to fetal tissue acquired from abortions while recusing ourselves from calls for UCLA to divest from hospitals that restrict reproductive healthcare.
UCLA is trying to have its cake and eat it too
Namely, UCLA is currently partnered with the Catholic hospital system Dignity Health. This means that UCLA medical students and physicians sent to work in these hospitals cannot exercise clinical judgement if it contradicts the teachings and beliefs of the Catholic Church. Hospital policies enforcing these beliefs state, for example, that “a sexually assaulted woman [should] be advised of the ethical restrictions that prevent Catholic hospitals from using abortifacient procedures” and “in case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion”.
UCLA’s partnership with Catholic hospitals is a reflection of a larger trend: one in six hospital beds across both California and the country operate under health care provisions determined by the US Conference of Catholic Bishops. Through their rapidly expanding network of partnerships, Catholic hospitals have covertly restricted healthcare that even the most hostile state laws have conceded are medically necessary. For example, extrauterine pregnancies (when a fertilized egg implants outside of the uterus; also known as “ectopic” pregnancies) are no longer viable and are a common cause of miscarriages. The only appropriate medical procedure is abortion, and providing this care in a timely and competent way is critical for a patient’s survival. Even in such cases, physicians at Catholic hospitals are forbidden from providing this care.
Cherry-picking the beneficiaries of comprehensive health care
Reproductive health care is the explicit target for supporters of restrictions on fetal tissue research. It is striking that the scientists that rely on and vocalize support for abortion-permissive policies, like funding for fetal tissue research, appear to regard the women whose healthcare is being impacted as mere collateral damage in this political contest. I appreciate that the dogma of scientific research is to push the boundaries of the unknown, and that this is an endeavor that demands the intense commitment for which scientists are renowned. However, approaching our research with a focus so myopic that we lose sight of how our work relates to society is a loss. Can UCLA scientists advocate for their right to access fetal tissue obtained from abortions and remain equivocal on UCLA policies that prevent people from receiving that very same procedural care?
