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While being treated for COVID-19, President Trump took experimental COVID-19 treatments that have come under scrutiny because its development included testing using cells from the tissue that might have come from an aborted fetus. Several potential vaccines for the coronavirus—including two promising vaccines produced by Pfizer and Moderna—have also used the same cell line for testing.

Here is what you should know about fetal tissue cells and the ethical concern about using them to develop therapeutics and vaccines.

What are fetal tissue cells, and how are they used?

A human fetus (Latin for “offspring”) is the stage of human development from the embryo stage (the end of the eighth week after conception, when the major structures have formed) until birth. When the fetus dies, either naturally or by an elective abortion, the tissue (including intact organs) can be legally donated for research purposes.

Fetal tissue can be used in biomedical research for transplantation material and other purposes, though they are more often connected to the creation of “immortalized” cell lines. Immortalized cell lines are established by culturing fetal cells in such a way that they continue growing and multiplying in laboratory dishes indefinitely. Such cells can then be used for such activities as testing a drug’s ability to damage genetic material or to test the effects of specific viral infection.

While immortalized cell lines began with fetal cells, they no longer contain fetal body parts, and no fetal tissue remains. No cells remain from the original fetal tissue, so they are not themselves “fetal cell.”

Fetal tissue—obtained both ethically and unethically—has been used to develop life-saving vaccines and therapeutic treatments for diseases such as cancer. For example, the 1954 Nobel Prize for Medicine was awarded for a polio vaccine developed from fetal kidney cells. Fetal cells were also used in the production of a widely used vaccine for measles. In both cases, the tissue was obtained from spontaneous abortions and ectopic pregnancies. Cells from aborted fetuses, however, have been used in a number of more recent vaccines for chickenpox, hepatitis, measles, mumps, poliomyelitis, rabies, rubella, and smallpox. Fetal tissue from aborted fetuses has also been used in cosmetics and anti-aging creams.

As Nicholas Evans, a bioethicist at the University of Massachusetts Lowell, says, “Chances are if you have had a medical intervention in this country or pretty much any other country, you have benefited from the use of these cell lines in some way.”

Were fetal cells used in the treatment President Trump took for COVID?

President Trump was given an experimental antibody cocktail known as REGN-COV2, which is manufactured by Regeneron Pharmaceuticals. Regeneron has clarified that the company tested the effectiveness of REGN-COV2 by creating a “pseudovirus” mimicking the actual one. One element of the pretend virus is a cell line known as HEK293T.

HEK293T is a widely used immortalized cell line that was made from fetal tissue acquired in the Netherlands in the 1970s. The records pertaining to the origins of HEK293T were lost, so it is not known where the fetal tissue originated. However there are strong reasons to believe the tissue came from a miscarriage, and no compelling reason to believe it came from an elective abortion.

The cell lines were created by Alex van der Eb and Frank Graham, medical researchers working at the University of Leiden in the Netherlands. The pair needed cells for their cancer research.

At the time HEK293T was developed (circa 1973), abortion was still illegal in the Netherlands. While some illegal abortions did occur, they were not being conducted at that time in hospitals. Obtaining fetal tissue from an abortionist would not only have been illegal, but would have been exceedingly difficult and would have possibly tainted the research. For HEK293T cells to have been taken from an aborted fetus we have to believe that two highly respected researchers were willing to put their careers at risk to forge paperwork (to avoid revealing their illegal activity to their university), risk going to jail for trafficking in illegal aborted tissue to acquire possibly contaminated cells from a disreputable source when, at the time, it was much easier to obtain tissue from miscarriage at a hospital.

There was also no financial motive to use tissue from an elective abortion The commercial potential for these cells was not even recognized until the early 1990s. For twenty years, the researchers had simply given the cell lines away to other academics.

In the absence of stronger evidence, we must avoid slandering the reputations of these researchers by implying that they were engaged in activity that was not only unethical but illegal.

Were cells derived from fetal cells used in the creation of COVID-19 vaccines?

In addition to the use on REGN-COV2, at least five of the candidate COVID-19 vaccines being developed in America use cells from HEK293T cells or PER.C6, a cell line from developed from retinal cells from an 18-week-old fetus aborted in 1985.

The vaccines by Pfizera and Moderna used HEK293T cells in the testing process. For anyone who has qualms about the connection to aborted tissue, these are the vaccines that would be preferable.

Is it immoral to use treatments and vaccines developed using aborted fetal cells?

A common way of addressing this question is to determine what type of cooperation is undertaken in the evil act of abortion. In cooperation in evil, the cooperator contributes in some way to the wrongful action of the principal agent, either by formal cooperation or material cooperation.

Formal cooperation happens when a person cooperates with the immoral action of another person, sharing in the latter’s evil intention, while material cooperation occurs when the person cooperates with the immoral action of another person, without sharing the evil intention. While formal cooperation is always evil, making a determination on material cooperation depends on other additional factors.

For example, if the abortion was conducted in order to harvest tissues that were to be used for the purpose of creating a cell line, then it would clearly be immoral. But even if an abortion occurred it was not carried out for that reason, and the tissue was acquired for the purpose of medical research only after the death of the child occurred for other reasons. This has significant consequences for determining whether such research is either licit or immoral.

To determine the morality of using the cells, it is helpful to compare it to another situation: the use of organs from a person who has been murdered. If a doctor were to offer to transplant a kidney or heart from the murder victim into a Christian, we would likely not have any objection. The primary concern would be whether the victim consented to organ donation prior to their death.

Most Christian ethicists agree that fetal tissue donation is not inherently unethical if the tissue was obtained from a spontaneous abortion (miscarriage) or an ectopic pregnancy (a pregnancy in which the fetus implants in the fallopian tube instead of the uterus) and was willingly donated by the parent. Such donations would be similar to a parent agreeing to donate the organs of an infant or a child who had died by natural causes.

The donation of fetal tissue may be morally tainted, though, when the tissue is derived from a fetus who has been killed in the womb. Allowing and condoning such donations of tissue derived from abortion to continue would make us indirectly morally complicit in the act of abortion and would convey a sense of approval for an ongoing regime that sanctions the killing of the unborn.

That raises the question of whether the use of cells from HEK293T would promote abortion in just such a way. While pro-life Christians may disagree on how to answer that question, there appears to be no reason to be overly concerned with the “slippery slope” of children being murdered in order to expand the number of fetal tissue cell lines. The reason is that it is completely unnecessary to create new cell lines from aborted children. As the Rev. Nicanor Pier Giorgio Austriaco, a Catholic biomedical researcher, explains:

. . . HEK293 is an established cell line. What this means is that these cells have been used and studied by biologists for nearly half a century. They are well characterized, and they have been validated for their safety. I point this out because it helps explain why it is unheard of for a vaccine manufacturer to seek out new human fetal cells from a recent abortion. Such novel fetal cells would be uncharacterized, unvalidated, and unapproved by regulatory agencies like the U.S. Food and Drug Administration (FDA) for human vaccine production. Why waste time, effort, and money to obtain, characterize, and validate new human fetal cells when the classic fetal cell lines obtained decades ago like HEK293 are readily and cheaply available?

Currently, the use in biomedical research of immortalized cell lines derived from fetal tissue is not increasing the number of abortions that are being carried out every year. If there was evidence of that happening, though, it would change the moral calculation.

The remaining question is whether accepting the use of HEK293T cells would potentially be cooperating with the killing of the child in the 1970s. For a number of reasons, many if not most Christian bioethicists would argue that it is not (assuming an abortion even occurred). The primary reason being that this situation is morally analogical to the case of the murder victim/organ donor. No one would say the Christian who received the organ was morally responsible in any way for the murder.

For this reason, Christians are not morally culpable if they use treatments and vaccines that were developed using such cells, even if the cells originated in aborted fetal tissue. As David Prentice, vice president and research director of the pro-life Charlotte Lozier Institute, says, “We would prefer they not use the controversial cell line even in the testing, because there are other alternatives. But that testing on the side doesn’t affect me in terms of the recipient of the drug.” Ethicist Christopher O. Tollefsen adds, “Because researchers may ethically use the HEK cell lines to develop vaccines, people can of course ethically use a vaccine should it be developed from the HEK cell lines.”

See also: The FAQs: What Christians Should Know About Vaccines

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