Explainer: Is it ethical to accept medical treatments derived from abortions?

President Donald J. Trump speaks outside the White House on Oct. 8, 2020. In a video from which this photo was taken, Mr. Trump described his treatment for Covid-19 with an experimental antibody drug and antiviral treatment. (CNS photo/@realDonaldTrump via Reuters)

In the aftermath of Donald J. Trump’s four-day treatment at Walter Reed Medical Center last week after he began experiencing serious symptoms from Covid-19, he touted the medications he received—two monoclonal antibodies manufactured by Regeneron and the antiviral drug Remdesivir—as remarkably effective remedies. “I call that a cure,” Mr. Trump said in a video posted to Twitter. (It’s not.) His enthusiasm for these remedies was so great that he suggested he would use his executive powers to order hundreds of thousands of doses for widespread use—and possibly for free. Under the White House’s “Operation Warp Speed,” the pharmaceutical companies making both treatments are already receiving federal funding in the frenetic quest for a Covid-19 vaccine.

The only problem? Both remedies were developed using cells procured from an aborted fetus in 1972 in order to test their efficacy. Beyond testing done to develop the therapeutic treatments, five Covid-19 vaccines in development, including two selected for Operation Warp Speed, use cell lines derived from aborted fetuses in order to produce the vaccines themselves.

In 2019, the Department of Health and Human Services eliminated federal funding for scientific research that makes use of fetal tissue procured from abortions, stating that “[p]romoting the dignity of human life from conception to natural death is one of the very top priorities of President Trump’s administration,” but did not include projects using fetal tissue from previously existing cell lines. In the case of Covid-19 treatments, in addition to the cell line from 1972 (known as “HEK-293T”), a number of other drug companies are using cells from a second fetus aborted in 1985 (known as “Per.C6”).

Can a person who truly believes in the sanctity of life from conception to natural death make use of any treatment derived from cells whose origin was an aborted fetus?

In other words, while one might fairly accuse Mr. Trump of hypocrisy for banning the use of new fetal cell lines on moral grounds while trumpeting medication derived from old fetal cell lines as “miracles coming down from God,” he is technically not violating the terms of his 2019 decree.

However, a stickier question arises in the realm of moral theology: Can a person who truly believes in the sanctity of life from conception to natural death make use of any treatment derived from cells whose origin was an aborted fetus?

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The Catechism of the Catholic Church makes the church’s position on abortion clear: “Direct abortion, that is to say, abortion willed either as an end or a means, is gravely contrary to the moral law,” and “[s]ince it must be treated from conception as a person, the embryo must be defended in its integrity, cared for, and healed, as far as possible, like any other human being.” Indeed, according to church teaching, whoever directly participates in procuring an abortion is automatically excommunicated. But back to our question: Can a Catholic make use of medical treatments derived from a procured abortion?

The answer is a familiar one: It’s complicated.

It entails the use of terms not usually heard around the water cooler (and, Lord knows, not heard in a presidential debate): Formal cooperation with evil; material cooperation, both remote and proximate; active and passive material cooperation with evil. But the short answer is the most helpful one: If you can avoid using medical treatments derived from fetal cells, you should. If there isn’t another practical option without grave health risks, the Catholic Church considers it morally acceptable for you to take advantage of medical treatment derived from fetal cells.

If there isn’t another practical option without grave health risks, the Catholic Church considers it morally acceptable for you to take advantage of medical treatment derived from fetal cells.

“The notion of ‘cooperation with evil’ addresses situations when an agent must decide whether to perform an act that cooperates with, by contributing to, the morally objectionable action of another agent,” Tobias Winright, an associate professor of theological and health care ethics at Saint Louis University, told America over email. “In this present case under consideration, however, the problem that is faced by agents—Catholics who are considering using the drug that President Trump used—is whether to make use of the fruits of another agent's morally objectionable action (e.g., an elective abortion).”

Winright noted other ethical considerations. “Do the researchers (and the benefactors of their research, the patients) share the intent of those who were originally involved in the presumably elective abortion from nearly five decades ago? A clue here might be provided by asking whether they would be fine with (and thus intend) more such abortions taking place to facilitate further similar research,” he commented. “Without such an intent, though, this appropriation of evil appears morally permissible.”

In April, a number of U.S. bishops (including Archbishop Joseph F. Naumann, the chairman of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities) asked the U.S. Food and Drug Administration not to use cell lines from aborted fetuses in the search for a Covid-19 vaccine. The U.S.C.C.B. has also urged drug manufacturers to make alternative vaccines available so that “Catholics and others will not face this moral dilemma,” but concedes that in cases where no alternative is currently available, ”Catholics may licitly accept vaccination for themselves and their children using a vaccine based on tissue from abortion.”

In other words, the goods of vaccination (the protection of children and the health of the larger population) enter the moral calculus of using such a vaccine. The concern from the church is not only that the vaccines are “tainted” by the involvement of the cells from abortions (the use of which is material cooperation with evil), but that continuing to make use of such cells could potentially encourage efforts to derive new cell lines from abortions, which might involve formal cooperation with evil (because it could endorse an intention to abort).

In April, a number of U.S. bishops asked the U.S. Food and Drug Administration not to use cell lines from aborted fetuses in the search for a Covid-19 vaccine.

“Other questions should be considered, too,” Winright added. “Virtue ethicists, for example, observe that our actions affect our character. Does accepting this use of fetal tissue from an elective abortion make the researcher and the beneficiary less likely to see elective abortion as morally problematic and perhaps even more positively than they otherwise would? Would it function as a precedent encouraging more funding and research involving elective abortions?”

The question of giving support—either rhetorically or by funding—to the development of a vaccine through the use of such cell lines is thornier, since the material cooperation with the evil of abortion in that effort is nearer (more “proximate”) than a physician or patient making use of a vaccine to preserve health. When it has considered the question of making use of a vaccine, rather than researching and developing one, the church has treated it as a form of distant remote material cooperation with the evil of abortion.

Christopher Kaczor, a professor of philosophy at Loyola Marymount University and author of Disputes in Bioethics, told America over email that “Catholic teaching is clear that formal cooperation with evil, including the evil of abortion, is always wrong. The use of tainted vaccines or treatments is material cooperation with evil, which can be justified for a serious reason.” Kaczor pointed out that the Vatican released a document in 2005 noting that “the duty to avoid passive material cooperation [i.e., material cooperation without specific opposition to the prior evil act] is not obligatory” if there are proportional reasons to use a vaccine—the classic example being the vaccination for rubella (German measles), where the only option is a vaccine derived from fetal cells. “This same reasoning would apply to the use of vaccines and treatments for Covid-19,” Kaczor wrote.

"The case of using vaccines produced using cells from aborted fetuses runs like this: Vaccinating oneself against a deadly disease is usually part of good stewardship of one’s health," Lisa Fullam, a professor of moral theology at the Jesuit School of Theology of Santa Clara University in Berkeley, Calif., told America over email. "The moral remoteness of the question of receiving a vaccine grown on cells derived from an abortion decades ago compared to the moral urgency of stopping spread of the Covid-19 pandemic with a safe and effective vaccine makes it permissible at least, and perhaps even obligatory," Fullam commented. "Even more will die if we refuse a vaccine for reasons other than safety or efficacy. While some might refuse a vaccine or other treatment on 'pro-life' grounds, in fact many more will die if we refuse a vaccine that will be produced despite those who object to its provenance—and that is not being pro-life."

Truth be told, if you press any moral theologian hard enough, he or she will admit that it is essentially impossible to exist in society without some degree of remote material cooperation with evil. Driving your car, filling up your garbage can, buying vegetables at the store—they’re all textbook cases of remote material cooperation with the evils of environmental destruction, exploitation of workers and many other unethical practices. Life is messy. But as Pope Francis might say, the secret is not to flee from the vexing moral questions of life, but to approach them in a spirit of discernment.

Editor's note: This article was updated on Tuesday, Oct. 13, with additional quotes.

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