Operating Theater

Summary: For decades, medical researchers have dreamed of finding or creating tissue that would grow rapidly within humans to repair damage caused by injury or such diseases as Parkinson's. Early experiments on animals have shown that tissue from fetuses might be an ideal transplant material. However, reports of these early successes quickly conjured the specter -- especially among right-to-life groups -- of a runaway market in aborted fetuses, and the shade remains today.The abortion takes roughly seven minutes, ticked off with the tinkle of stainless-steel instruments and punctuated by the sound of suction.To the tune of that timbre, the aborted embryo and placenta snake through a tube leading to a hole in the wall. On the other side, a nurse collects the remains of a seven-week-old embryo weighing only 2 ounces, in a small plastic saucer.This one isn't going to the incinerator. Instead, a technician races the tissue to a sterile table, chisels out a few grams of neural cells and puts them on ice. Other scientists perform rapid-fire tests: No genetic defects. No AIDS. No bacterial contamination.Six hours later the tissue is rushed to an operating theater, where doctors drill dime-size holes into the skull of a patient with Parkinson's disease. A surgeon draws the fetal cells into a wee needle and, guided by an MRI scan mapping the gray matter ravaged by the incurable disease, injects them into the brain of a patient who lies wide awake on the operating table.What just happened? One life was ended and another one saved? Or did an unborn child die while someone underwent an experimental operation not even certain to be beneficial?Can anyone even say? There are many ways to describe the use of aborted fetal tissue, just as there are infinite individual values through which the practice is refracted. It's the Rashomon of science."That's one of the things that makes life interesting," says Robert Walker, a USF medical ethicist. "Not everything's neat and tidy."***Although Parkinson's disease can trap fertile minds in useless, stiff-locked bodies, the symptoms are unalarming at first. In fact, the early signs of Parkinson's, in their cunning subtlety, are often ignored by patients and misdiagnosed by doctors.Fred Karl, former state senator and Tampa General Hospital president, told himself that the slight limp in his left leg was nothing serious, that the weakness in his left arm was just his imagination. But eventually these dismissals failed to cut it as comfort."Strange things began happening to my body," he says, remembering how his left foot would swell without cause and how, when he walked, his left arm hung impotent at his side.Karl, now 73, sought the advice of his doctors, and, after a series of "exotic tests," was diagnosed in 1989 with the early stages of Parkinson's disease. Since, Karl has been lucky. He has symptoms of the disease, but they are relatively minor, and eight years after being diagnosed with Parkinson's, Karl remains able to work practicing law.But in many cases the disease progresses fleetly, affecting speech and causing uncontrollable tremors in the arms and legs. Victims of advanced Parkinson's are helpless as their gait slows to a flat-footed shuffle and their faces freeze into unblinking, unsmiling masks.In this stage of the disease, fetal tissue transplant, an experimental and controversial procedure, may be the last hope.Only a smattering of research facilities, including Yale University, Good Samaritan Hospital in Los Angeles, and clinics in England, France and Sweden, perform fetal tissue transplantation. Some of the most important breakthroughs in the therapy, however, have happened right here in Tampa, at the University of South Florida.In 1995, a team of university researchers found the first definitive evidence that brain tissue transplants can reverse the debilitating effects of Parkinson's. Two years earlier, in 1993, USF neurosurgeon Dr. Tom Freeman implanted fetal cells into the brain of a 59-year-old man suffering Parkinson's "palsy." After the surgery, which took place at Tampa General Hospital, the man's symptoms improved. Eighteen months later, the patient died of a blood clot in the lungs during unrelated surgery.Although an unfortunate end to what had been a remarkable recovery, the man's death allowed researchers the opportunity to observe the effects of the transplant in the brain. What the autopsy revealed was landmark: The implanted tissue had not only taken root, but had also stimulated new nerve connections in the brain, showing that tissue grafts were a viable treatment for Parkinson's.The cause of the Parkinson's, which afflicts an estimated 1.5 million Americans, remains unknown, and there is no cure. Scientists do know that Parkinson's debilitates its victims by destroying a section of the brain roughly the size and shape of a quarter, called the substantia nigra.The substantia nigra supplies the neurotransmitter dopamine to a larger area in the center of the brain, the striatum, which controls movement. As dopamine supplies from the substantia nigra to the striatum dry up, movements slow, become erratic, and finally grind to a halt.Parkinson's patients, like non-sufferers, have healthy amounts of dopamine elsewhere in their bodies. The trouble is replacing it in the brain. Dopamine can't pass through the blood-brain barrier, a membrane that guards the interior of the capillaries in the brain. A drug commonly known as L-dopa can pass through the barrier, and once it reaches the substantia nigra, cells there convert it into dopamine.Thanks to treatment with L-dopa, many Parkinson's sufferers, like Karl, are able to lead relatively normal lives for several years. But L-dopa inevitably fails as Parkinson's destroys substantia nigra cells, eventually leaving too few to convert the drug to the mobility-giving dopamine. As the disease progresses and L-dopa loses its effectiveness, sufferers experience "on-off" episodes -- "freezing" when the drugs wear off, alternating with spurts of convulsive, jerky movements when dopamine shocks the system into overdrive.In a fetal tissue transplant, cells culled from aborted fetuses are implanted into the striatum. Doctors hope the grafted cells will grow and integrate into the damaged brain, pumping out enough dopamine to replenish depleted supplies and giving back patients some of their lost mobility.Much of the groundbreaking Parkinson's research has been applied to Huntington's, a disease that mirrors Parkinson's. Both involve a breakdown in the neurotransmitters, the basic chemicals through which nerves send information through the brain. In Parkinson's, the breakdown occurs at the sending end of the nerve, causing a type of paralysis. In Huntington's, the breakdown is at the receiving end, resulting in jerky movement.In July, USF's Freeman transplanted fetal tissue into a 54-year-old man suffering with Huntington's and plans to perform five more operations over the next year.While Freeman first developed the technique for obtaining striatal tissue from a human fetus, Dr. Paul Sanberg, chairman of the USF neuroscience program, was the first researcher to show that a transplant of striatal brain tissue could improve symptoms of Huntington's disease in rats. Sanberg is also developing "cell line" technology that involves replicating healthy brain cells in a laboratory, and perhaps someday replacing the need to use fetal tissue in transplants.***For decades, medical researchers have dreamed of finding or creating tissue that would grow rapidly within humans to repair damage caused by injury or disease. The possibilities are astounding: What if decaying brain tissue from Alzheimer's or Parkinson's disease could be regrown? What if severed spinal cords could be rejoined? What if millions of diabetics could produce insulin again? And what if genetic blood disorders, such as sickle-cell anemia and Tay-Sachs disease, could be reversed?By the mid-1970s, experiments on animals had shown that tissue from fetuses might be an ideal transplant material. The ability of fetal tissue to adapt and survive suggested that even large damaged areas of cells could be rejuvenated. Furthermore, fetal tissue (naive tissue, as researchers call it) is unlikely to be rejected by the recipient.Every cell in the body has a special set of protein markers that identifies it as being part of a particular body. If a cell with different marker molecules enters the body, the immune system recognizes it as foreign and, as it would with an insidious virus, attempts to destroy it. This is what happens, for example, when an organ transplant is "rejected."But fetal cells, as they grow, gradually change from a stage of no specialization to a stage where they have specific form and function. Before they develop a unique "signature," they can be implanted in the body and not be recognized as an "enemy." After being injected, fetal cells continue to grow and gain specialization suited to the new "host."Fetal tissue experiments first proved successful in growing new brain tissue for Parkinson's patients in the late 1980s. Around the same time, experiments with diabetics showed that the tissue could even recreate the functions of organs. Fetal cells that produce insulin, for example, can be inserted into the abdomen of a diabetic, where they will mimic the effect of the pancreas in controlling blood-sugar levels.Reports of these early successes quickly conjured the specter -- especially among right-to-life groups -- of a runaway market in aborted fetuses, and the shade remains today.Opponents of fetal tissue research fear that women will get pregnant to provide aborted fetuses to save loved ones' lives, and that women will be encouraged to "sell" their abortions when the eventual demand -- several fetuses are required to produce enough tissue for one Parkinson's transplant, for example -- for fetuses outstrips the supply.Behind these objections lies the suspicion that aborters will ease their consciences with the lore they might be doing some good."For a woman who might not be so sure about getting an abortion, justifying the procedure to herself with, 'This abortion is for a good cause,' just might put her over the edge," says Douglas R. Scott, president of Washington, D.C.-based Life Decisions International, a "pro-family" lobbying organization.In 1988, a request from the National Institute of Health to do a fetal transplant procedure hit a snag when officials of the Reagan administration halted funding for fetal tissue research until a panel of 21 physicians, ethicists, theologians and lawyers could debate its ramifications. By a majority of 18-3, which included the panel's chairman, Arlin Adams, a retired federal judge opposed to abortion, the committee concluded that while the source of the tissue from induced abortions was of "moral relevance," it was overshadowed by "the possibility of relieving suffering and saving life." To prevent abuses, the panel recommended that donors not be allowed to designate the recipient of fetal tissue or be paid for it. Despite the recommendation, the ban on funding continued until November 1989, when President Bush extended it indefinitely.In the wake, clinical studies were limited to a handful of patients, with many medical investigators quitting their fetal transplant work altogether, unwilling to risk their careers for research that often subjected them to hate mail and harassment from right-to-life groups. Others quietly went private, doing the work with limited funding and treating only a handful of patients or confining their work to animal studies.Fetal cell research stepped-up again when the ban was lifted by executive order during the first days of the Clinton administration -- a move that made possible research such as that being done by University of South Florida scientists.The USF team is headed by Freeman and Sanberg and includes Dr. Robert Hauser, director of the Movement Disorders Center at Tampa General Hospital.Sanberg says the significance of USF's fetal tissue research is that it's a departure point for other types of "important cell line study," which researchers hope will lead to cell transplantation successes involving fetal alternatives such as cultured specimens and animal cells."(Fetal tissue transplantation) is not going to be a major treatment, considering all the ethical implications," he says. "Rather, fetal tissue is proof of principle. Scientists feel that we can implant new cells in the brain, and at this point fetal tissue is simply a proof of that principle, not the end-all, be-all of this approach."Late last month, in fact, the USF investigators published new, related findings that could represent a significant advance. The researchers found that Sertoli cells, cells collected from the testes that supply nutrients and defenses to sperm, hold promise for enhancing the success of cross-species and other kinds of transplantation, which don't carry the same controversy as tissue harvested from aborted human fetuses.Again, only fetal tissue transplantation works because, unlike other types of cells, fetal cells are not yet "marked." Animal cells, which are in ready supply and not so contentious, could replace the use of human tissue in transplantation if scientists could overcome the barrier of rejection. USF's recent findings -- that Sertoli cells release non-toxic agents that appear to provide effective localized immune suppression in the brain, protecting foreign cells from the body's immuno-reactive attack -- might well be a way.Sertoli cells, as they are nutrient providing, may also prompt growth and grafting in fetal cells that are implanted, reducing the amount of tissue required.Sanberg says the Sertoli research "departed very closely" from the university's fetal tissue research.Federal funding for fetal work again came into question in September, when the U.S. senate voted 60-38 against a plan that would have restricted federal funding for medical research using tissue from fetuses harvested from elective abortions.With this decision, government money for fetal tissue research is secure, at least for now. The ethical debate, however, rages on, an unbidden but familiar chiller pitted against the fever of new discovery.Proponents argue that no matter what one's view on abortion, fetal tissue transplantation should be supported. The argument takes a variety of forms. Among them: Abortion is legal and probably always will be, so there may as well be some good brought out of it."My feeling is that once the abortion has been done, it is wholly ethical to, rather than take the tissue and throw it away, use the tissue to help someone with a fatal disease," says Freeman.Further reasoning says that accepting a donated organ from a suicide or murder victim doesn't make suicide or murder acceptable. Not to mention the powerful emotional appeal that people suffering a variety of ailments might benefit from therapies begot of fetal tissue research.On this side of the spectrum, fetal tissue opposition is dismissed as political interference with science."The issue has become mired in abortion politics," says Freeman.This doesn't ring true to opponents of fetal tissue use, who feel scientists and legislatures have never adequately addressed the symbolic sanction of abortion they believe this type of research implies.Perhaps the science can be isolated from abortion and the abortion decision, but can it ever be morally separated? Can we accept a therapy that, if proven effective, would require thousands of abortions a year to sustain an adequate level of fetal tissue? Do we want to become dependent on abortion as a means of curing people?Theresa Colette, who teaches a course entitled "Legal Limits on Medical Decision Making" at the South Texas College of Law, says no."This issue is a highly-focused version of the larger debate about the use of human subjects in research, period. It requires people to decide whether they are fundamentally pragmatists or if they have some conception of the human person that can be violated by certain attempts to achieve an otherwise good end."There are absolutes that can't be considered to be violated," Colette continues. "One being the belief that what's capable of becoming human should not be used for scientific research, because that is to begin to crumble the very high wall we began to build at Nuremberg."Transplantation of tissue from aborted fetuses is also an emotional controversy.A pro-life couple, Terri and Guy Walden of Houston, Texas, allowed the treatment on their unborn son after he was diagnosed in-utero with Hurler's syndrome, a fatal genetic disorder, in 1990.Many parents-to-be opt for abortion when faced with pre-natal test results that show serious abnormality or illness, but the Walden's, who are southern Baptists, don't condone abortion -- not in any circumstance."Abortion violates God's law; it's wrongful death," Guy says.A Hurler's specialist in Minnesota put the couple in touch with two medical researchers, physiologist Email Zanjani and obstetrician Nathan Slotnick, who had developed a technique that might allow healthy cells from an aborted fetus to be transplanted into a living fetus before it was born. Zanjani and Slotnick hoped fetal liver cells -- injected into the Waldens' unborn child -- would find their way to bone marrow, where they might grow and eventually produce a critical, life-saving enzyme.The Walden's were overjoyed, but with opportunity came crisis: How could they live with the fact that the tissue being used to save their child's life would come from an aborted fetus?With only three weeks to decide what to do -- the procedure had to be done before Terri's 18th week of pregnancy -- the Waldens turned to friends, pastors and lawyers for advice. They met with little support."Everyone saw it in terms of the abortion issue, and everyone we know is against abortion," Terri remembers.Struggling to wade their way through visceral truths, the Waldens began to regard fetal tissue as they would the donated kidneys, hearts and bone marrow used to save thousands of lives each year."Abortion and fetal tissue transplants are two separate issues," Guy says. "We're very much opposed to abortion, but right now it's legal, and to let the tissue from these babies rot in the trash means letting children die who might be saved. We aren't talking about ideology here, we're talking about hope."Albert Brooks suffers Huntington's disease, a condition both debilitating and fatal. He is also a member of the Roman Catholic Church, a strident foe of fetal tissue research. Daring the dogmas of Catholicism, Brooks benefited from abortion in 1995, when he received a fetal tissue transplant at Good Samaritan Hospital in Los Angeles."I don't see my decision as supporting abortion," he says.Some ethicists agree."Putting fetal tissue to good medical use, even where abortion is considered wrong, brings out good in evil," says Robert Stamper, a bioethicist at the Woodrow Wilson Biology Institute at Princeton University in New Jersey.Others strongly reject such arguments, contending that research and surgery using fetal tissue will inevitably uphold and may well even advance abortion.Dr. Richard McCormick, professor of moral theology at the University of Notre Dame, is among those opposed. He strongly objects to fetal tissue transplants because he believes the American public is already "desensitized" to abortion."To allow fetal tissue to be used for good would only advance that desensitization," he says.Members of Brooks' former parish in Kansas City helped to raise the $50,000 he needed for the surgery, but his family is distressed about how outsiders have since regarded his decision.Brooks' son Todd worries that his 59-year-old father has been characterized as "a hypocrite rather than as a man watching his life drain away and reaching for a procedure that could help him."Brook's position could be viewed as morally opportunistic. Even Freeman, the USF surgeon, says that circumstance is dogma's great mitigator."When people get the disease, they become very clear about the issue," he says.Two years after the operation, Brooks, who now lives in Centerview, Missouri, stands firm."I certainly do not believe the abortion issue is relevant to this particular operation. I look at this on the same basis as a heart transplant or liver transplant. It's making tissue available from other donors."Walker, director of USF's Division of Medical Ethics and Humanities, has a different perspective. "However you feel about fetal tissue research -- whether you believe it to be right or wrong -- you have to realize it is different, simply because the abortion issue is involved and, as in all debates involving abortion, emotions on both sides run high."Ethics, like poetry and history, tries to bring critical reflection, organization and deepened meaning to human experience. The alternative is to judge complex questions with slogans, rhetoric and opinions couched in "ethically loaded" ordinary language."People on both sides of this issue tend to load their arguments with ammunition rather than intelligence," says Brooks. "That's fine for philosophers, but it's awfully difficult on the people who have to make life-and-death decisions about their bodies and about their faiths."***There are practical questions about fetal tissue research and transplantation too.Currently, 1 to 1.5 million abortions are performed in the United States annually. Not all yield tissue that can be used in transplant therapy. Obviously, this means that there is a finite number of aborted fetuses of appropriate age -- 6 to 9 weeks roughly -- before surface proteins make immune response a consideration and before cells have developed a level of structural specificity that would eliminate them for transplant use.Although various estimates form the basis of clinical transplantation protocols, such estimates are often determined by the amount of tissue that is available. One American scientist who uses fetal brain tissue implants for patients with Parkinson's disease indicates that his work requires approximately 200 fetuses a year.Transplants of fetal pancreas tissue in diabetes research have used tissue from 6 to 18 fetuses per procedure. If only 10 patients with diabetes per year throughout the United States were to receive transplants of fetal tissue, this research could require as many as 180 fetuses.When the requirements of other fetal tissue transplant researchers are taken into account, many thousands of sources of fetal tissue could be needed per year.Given the potential for growth in demand for fetal tissues and the fixed amount of such tissue generated by legal means in this country, the possibility for a black market looms. Trade in fetal tissue could impact Third World nations resulting in trafficking by persons whose motives are purely profit.This can be likened to the slippery slope metaphor, but it can be contended that appropriate restrictions on fetal tissue transplantation constitute "wedges" that will facilitate "crossing" the slippery slope. Federal law requires that women sign a statement to the effect that the decision to donate fetal tissue was made independent of the decision to undergo abortion and prohibits any compensation. Discoveries such as the Sertoli Cell findings at USF might also mitigate quantity concerns, by providing other, non-human sources of tissue to transplant.The issue of quality specimens is a further adjunct to an increase in the demand for fetal tissue. How are recipients to be assured of getting viable tissue that will suit the therapy? Who will receive transplant therapy when both a Huntington's patient and a Parkinson's patient need the only available cells? What criteria will be used to decide? Presently, ability to pay has much to do with it. Although the implant surgery is usually research-funded and comes without cost to the patient, certain related therapies and treatments are not. For example, candidates for USF's upcoming Huntington's surgical trials must be able to afford $3,000 to $10,000 in associated costs. Insurance won't foot the bill, as the procedure is experimental. And if and when fetal tissue transplantation moves out of the trial phase, it's unclear how it will be treated by health insurers.New discoveries in biological science and the technological application of these discoveries lead to many dilemmas, ethical and otherwise. There are questions for legislatures. There are questions for scientists. There are questions for ethicists and theologians. The answers offered by each of these establishments, however, are ultimately a reflection of individual values in our society melding together into a consensus of what is acceptable."In the end, the debate over the issue of medical use of aborted fetal tissue is one we've hashed out countless times before in history," says Stamper. "Human beings making human decisions with very human implications. All we can really do is strive to raise our collective consciousness to a level where we can aptly reflect on and consider the social and practical implications of this, or any, developing field."Sidebar OneThe Transplant ProcedureHere's a (simplified) step-by-step of how fetal tissue implant operations happen:1. Fetal tissue, ranging in gestation from 6 to 9 weeks (an 8-week-old embryo is considered a fetus -- at this time, major body parts are present), is collected at the time of abortion, tested for disease, genetic defect and contamination, and then stored on ice.2. On the day of surgery, doctors bolt a band to the transplant patient's skull with four pins embedded in the outer layer of bone. A device that looks like a delicate bubble dome is attached to the band, preparing the patient for a magnetic resonance imaging (MRI) scan.As a gurney inches the patient through a powerful doughnut-shaped electromagnet, a scanner detects radio signals emitted by hydrogen atoms in the brain. These signals are reassembled into three-dimensional images by the MRI scanner's computer and projected onto a bank of monitors.3. From these images, doctors map the angle and route by way of which a needle will insert the fetal tissue implants into target sites in the brain, while avoiding injury to arteries and vital brain structures. The dome-like device provides a grid of reference points for plotting these routes.4. The patient is prepped for surgery and wheeled into the operating room, where the "bubble dome" is replaced with a stereotaxic frame, an awkward-looking device that resembles a large compass or sundial. The frame is a precision measuring tool -- its outer rim contains an array of small holes that can be adjusted to within a fraction of a millimeter to guide the needles delivering the fetal tissue.The operation is nearly bloodless and, since brain tissue does not register sensation, almost painless as well. The patient is sedated with a local anesthetic but remains fully awake.General anesthesia is routinely used for open brain surgery, during which doctors can see what they're doing. But in this type of operation, called stereotaxic surgery, surgeons work blindly, directing instruments into the brain based on the computer calculations alone, and there's a chance (albeit remote) that the needles and catheters inserted into the brain could cause bleeding and precipitate a stroke.If the patient were asleep and the brain began to bleed, it could be too late before doctors noticed, so the patient is kept conscious and carefully monitored for signs of confusion or slurring speech.5. Doctors drill four holes, a shade smaller than the diameter of a pencil, into the patient's forehead and through the skull.6. The surgeon then carefully inserts the needle into the brain, while the fetal tissue, which has been transported to the operating room in a cooler, is bathed in sterile solutions and prepared.7. The tiny specks of aborted tissue are suctioned into a syringe designed to extrude the tissue in fine, noodle-like strands. These are loaded into a hollow stainless steel tube called a cannula.8. The surgeon takes the hollow needle, which is equipped with an inner stylet (making it a solid probe that will not cut a core), and gently taps the device through the holes in the skull and into the brain.9. With the needle in place, the surgeon removes the stylet and replaces it with one of the cannulas filled with fetal cells, and the infusion begins.10. Two hours later, with two small bandages covering the forehead incisions, the patient is wheeled out of the operating room into intensive care, and is usually sent home within a few days.Sidebar2A Black Market for Organs?By Jennifer JohnsonEver wonder why it's perfectly legal and moral to sell so-called soft tissues like blood and semen in the U.S., but illegal and amoral to sell fetal tissue, bone marrow, corneas or solid organs outright for transplant?Probably not, but the issue raises a few questions: Should transplantable hearts, fetuses, kidneys, bone marrow and other organs be treated by the law similarly to the way blood is treated? If a woman has the right to abort her fetus, should she also have the right to sell the valuable fetal tissue?The largest supplier of fetal tissue in the U.S., Exton, Pennsylvania-based International Institute for the Advancement of Medicine, contracts to take fetuses only from clinics where women have signed consent forms for donating the tissue and receive no compensation. And the National Institute of Health, which funds research in fetal transplants for Parkinson's disease patients, commands that no pregnant woman sell her fetus.NIH ethics guidelines assume that if financial incentives were allowed, poor women would likely become pregnant in order to make money through aborting the fetus and selling it to physicians or to patients with neurodegenerative diseases.The NIH also forbids the designation of particular fetal-tissue recipients such as a father or some other loved one, for fear of emotional pressure on the donor. Of course, even on the current basis of voluntary donation, many are disturbed by the very idea of encouraging the "harvesting" of fetuses as an act of beneficence, akin to donating blood.Will signs on buses some day read, "Be a giver of life! Donate your fetus today"?The utility of fetal tissue transplant still is debated in light of other possible medical therapies under development, but imagine what could happen if fetal tissue transplants were to work effectively as a cure or partial cure for the diseases of Alzheimer's and diabetes.Four million people in the United States have Alzheimer's disease, and the number will triple as the baby boomers become elderly. With several fetuses needed per transplant (as is the present case with the Parkinson's procedure), the demand could quickly reach into the tens of millions. A woman might be able to sell four fetuses a year, perhaps at several thousand dollars each.The radical libertarian might examine this new "marketplace" and proclaim, "Long live freedom!" In the meantime, the new trade finally solves the problems of poverty and of children having children -- a welfare conservative's dream! And caregivers for people with various dementing diseases might be liberated from a sea of diapers and nursing home payments.But critics of fetus commercialization quickly point to the injustice of it all: The poor become pregnant to earn money that ultimately comes from the wealthier classes. Surely a wealthy woman who is financially comfortable will not need to sell fetuses.While this is all rather futuristic, it should be remembered that in India a huge black market in non-vital body parts provides kidneys for the wealthy, and it's the poor who sell.Is this truly freedom, as libertarian ideology proclaims? Or is it a forced choice made in destitution and contrary to the seller's human nature? Is such a market the most demeaning form of human oppression? Would open season on fetuses reduce the unborn child to mere grist in the medical mill?Just a few conversation starters ...

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