How work reconfigures an ‘unwanted’ pregnancy into ‘the right tool for the job’ in stem cell research

Authors


Address for correspondence: Naomi Pfeffer, Applied Social Sciences, London Metropolitan University, 62-66 Highbury Grove, London N5 2AD
e-mail: n.pfeffer@londonmet.ac.uk

Abstract

Tissue derived from the aborted fetus is considered ‘the right tool for the job’ in some stem cell laboratories. Relatively little is known of the arrangements in Britain for sourcing aborted fetuses for research purposes. This paper uses data from interviews with stem cell scientists, policy makers, tissue bankers, sponsors of stem cell research, clinicians and nurses, and ‘pro-choice’ and ‘pro-life’ activists to reconstruct the work involved in reconfiguring an ‘unwanted’ pregnancy into a source of fetal stem cells. A close scrutiny of the work allows the politics of collections to emerge. Aborted fetuses undergo a process of decorporealisation that enables scientists to claim them for their professional and economic advantage. The work, however, has consequences for women rhetorically through being reconfigured into a repository of usable fetal tissue, and, in some sites, materially, through alteration in method of abortion.

Introduction

The eminent embryologist Anne McLaren (1927–2007) called stem cells found and manipulated in the laboratory ‘cultural artefacts’ (McLaren 2006). In other words, they are not ‘natural’ body parts identical to stem cells found in the human body. Or, as Marx might have put it, work is congealed in and hidden within them. Tissue derived from the aborted fetus is considered ‘the right tool for the job’ in some stem cell laboratories (see Clarke and Fujimara 1992). This paper offers a reconstruction of the work congealed in fetal stem cells. It focuses on the work involved in reconfiguring an ‘unwanted’1 pregnancy into a source of fetal stem cells. Interview data are used to reconstruct and analyse how in Britain2 stem cell scientists establish a ‘collecting site’ in an abortion clinic (Parry 2004), how women are recruited as ‘donors’, how ‘donors’ of aborted fetuses are treated in the clinic, how aborted fetuses arrive in the stem cell laboratory, and finally, how they are transformed into the right tool for the job.

Methods

Seven British laboratories where fetal tissue is used in stem cell derivation, and a national resource that curates fetal tissue for investigators and which is based at two further institutions, were identified through a review of publications in scientific and medical journals and web-based materials, and participant observation at a range of meetings. With the approval of an NHS multi-centre research ethics committee, 29 interviews with 34 people were conducted. Interviewees included: stem cell scientists (7), policy makers (5), tissue bankers (3), sponsors of research from both the public and voluntary sectors (4), clinicians and nurses (6), ‘pro-choice’ and ‘pro-life’ activists (4). These categories were in some instances overlapping, so for example some clinicians were active stem cell scientists, and some sponsors of research had scientific backgrounds. Seven people declined to be interviewed including members of the policy community and a stem cell scientist known for their strong views on using embryonic stem cells. Two British companies which use fetal tissue in stem cell research also refused to be interviewed.

The interviews took place in interviewees’ workplaces, lasted between one and two hours and, with permission, were taped and transcribed. The topic guide included: where and how aborted fetuses were obtained; the scientific rationale for and therapeutic targets of fetal stem cell research; views on the regulation and governance of both the collection of aborted fetuses and their use in stem cell research and therapies.

The transcripts were read and re-read, and emergent significant themes noted. Verbatim quotes are included here to provide examples of how actors describe their actions. To preserve anonymity we have included neither names nor titles in the text.

The analysis of work draws on The Social Organization of Medical Work, Anselm Strauss’ influential multi-sited ethnography of hospital work undertaken in the 1970s (Strauss et al. 1985). Strauss and colleagues conceived of the hospital as a workshop where what they called projects are prosecuted. However, in the analysis discussed here the abortion clinic is both a workshop and a ‘collecting site’ (Parry 2004); that is, it is analogous to sites established in distant colonial times for the collection of valuable materials. Reconfiguring an ‘unwanted’ pregnancy into the ‘right tool for the job’ in a stem cell laboratory is what Strauss called a project (Strauss 1985). Projects have a horizon which is reached through what Strauss called an arc of work, which has distinct phases or segments during which clusters of work or tasks are carried out. Although he was keenly interested in who carried out the work, Strauss deliberately rejected analyses of the division of labour which he called ‘the allocative issues of the division of labour’ (Strauss 1985: 3) and which are largely political critiques of occupational hierarchies, prestige and power. As is now well known, his theories are grounded in observations of what happens in practice, that is, on work itself, how it is organised, who does it and how, how workers relate to their work, and how language ‘manages’ all of these (Strauss 1985). Work is divided up according to various criteria among actors (persons, classes of persons, departments or other organisational units), and uses a range of resources (space, skills, ratios of labour force, machines, consumables such as drugs, supplies, and so on). The study contributed a major insight to medical sociology, such as that many tasks of hospital work are performed by patients, their relatives and friends, a finding which challenged traditional understandings of the division of labour in medicine.

Findings

The empirical research reported here, at times felt less like social science and more like investigative journalism. There is no published information on how aborted fetuses reach the stem cell or any other laboratory because the work of reconfiguring an ‘unwanted’ pregnancy into a source of stem cells proceeds in a contentious and highly sensitised environment, and much of it is hidden. A ‘pro-life’ activist interviewed in this research, who predictably was strongly opposed to using tissue from aborted fetuses in stem cell research, admitted knowing little about the arrangements for its collection, which they described as ‘very hush-hush’ (AC2130706). Yet this interviewee could speak eloquently about the arrangements through which stem cell laboratories gain access to pre-implantation embryos created in vitro. The interviewee was well informed about pre-implantation embryos because over the past two decades British ‘pro-life’ activists have focused their energies on opposing the use and inevitable destruction of pre-implantation embryos in research. The scientists who agreed to be interviewed were mostly willing to discuss their arrangements for collecting aborted fetuses in abortion clinics. They did not however want their activities advertised, and some expressed concerns about being the target of anti-abortion activists. Indeed, one investigator even drew an analogy between their tactics and those of extremists who oppose the use of animals in research. Companies using fetal stem cells, until very recently, were also reticent about their practices.

Investigators are encouraged to respect the Polkinghorne guidelines which were drawn up in 1989 in response to a controversy provoked by experimental transplants of neural tissue derived from aborted fetuses as a treatment for Parkinson's disease (Department of Health 1989). The guidelines recommend review of research using aborted fetuses by a research ethics committee. They are however advisory, lack sanctions and rely on professional self-regulation rather than independent oversight. Formal records are not kept so it is not possible to say how many aborted fetuses are collected for research, which laboratories use them, and for what purposes. However, one interviewee, a stem cell scientist, guessed that around one thousand aborted fetuses are collected by stem cell laboratories each year. Aborted fetuses are used in other fields of medical research such as virology and embryology, and some findings reported in this paper may also apply to them.

The trajectory of the work described here falls into two distinct phases. In the first, the woman is reconfigured into a ‘donor’, and her ‘unwanted’ pregnancy is transformed into a source of human biological material for stem cell research. In the second, the aborted fetus is reconfigured into the right tool for the job in a stem cell laboratory.

Reconfiguring women into ‘donors’ and ‘unwanted’ pregnancies into a source of human biological material

Termination of pregnancy in order to provide tissue for use in research or experimental treatments is illegal in Britain but the collection of aborted fetuses for research is allowed. Stem cell scientists seek mostly ‘healthy’ fetuses aborted under Ground C of the Abortion Act 1967 as modified by the Human Fertilisation and Embryology Act 1990. Ground C is the so-called ‘social clause’ under which the vast majority of abortions – 97 per cent in 2006 – are allowed (Department of Health 2007). The Act provides that a registered medical practitioner may lawfully terminate a pregnancy that has not exceeded its 24th week of gestation, in an NHS hospital or on premises approved for this purpose, if two registered medical practitioners are of the opinion that continuance of the pregnancy would involve risk to the life of the pregnant woman, or injury to her physical or mental health, or to the physical or mental health of any existing children. The risk must be greater than if the pregnancy were terminated.

Stem cell scientists have to undertake what Strauss called articulation work, that is, the invisible, unacknowledged and often arduous work of arranging a source of aborted fetuses and managing people and relationships. Clinic and laboratory are separate work organisations: the abortion clinic is situated either within an NHS hospital or the independent health-care sector, and the stem cell laboratory is in a university or a commercial company. Each organisation has its own workforce, practices, techniques, technologies, ethos and ‘bottom line’. Arguably, both British state and taxpayer are also involved. The number of abortions paid for by the NHS increases every year: in 2006, it funded just over 17 out of every 20 procedures. Furthermore, interviewees enjoy grants from research councils and the Department of Business, Enterprise and Regulatory Affairs.

Stem cell scientists have no influence on how abortion clinics are run and a change in the service offered, reorganisation of theatre lists, new staff, and so on, can result in their supply drying up, as this scientist explained:

It was just a very fragile structure and then as I say, we, what happened was, a particular junior doctor changed; the one guy left, another lady [doctor who performed the abortions] took over and she just wasn't really interested in having it work. I don't know if she had some objection to what was going on, or it was just something she wasn't bothered about, or it was just added to her workload and she wasn't . . . but that was enough to bring it all crashing down and we simply never got another embryo [i.e. a fetus of fewer than eight weeks gestation], even though everything was bona fide and agreed and so on and so forth, and so it just came to a halt really (SS5040406).

The work of turning an ‘unwanted’ pregnancy into the right tool for the job in the stem cell laboratory inevitably requires negotiations with the pregnant woman (Hogle 1995), who, as Strauss would no doubt observe, is also working towards termination of the pregnancy. Completing an abortion involves at least two visits to a health-care facility. Some women first consult their General Practitioner (GP) who will refer them to an abortion clinic (or, if they refuse on grounds of conscience, should refer them to a sympathetic colleague); other women self-refer to the abortion clinic. Women return to the clinic several days after their initial consultation in order to undergo the procedure.

During the initial consultation women are interrogated for both legal and medical purposes. It is common to hear abortion discussed in terms of rights – of the ‘mother’ (woman), the fetus and, sometimes, the ‘father’. But British abortion law recognises none of these: Parliament gave the medical profession the right to decide on whether a woman's circumstances fall within the law (Sheldon 1997). However although British law on abortion may be seen as highly restrictive compared to other countries, official policy ensures it is liberal in its operation. The number of pregnancies legally terminated in England and Wales has increased from just over 54,000 in 1968, the first full year of the Act's operation, to around 194,000 in 2006. As a result, most abortion clinics are extremely busy.

The request to donate the aborted fetus to research is usually, but not always, made during the first clinic visit. It is choreographed around what is known as ‘the separation principle’ which was laid down in the Polkinghorne guidelines. The separation principle is organised around a division of labour – a person different from the clinician who seeks the woman's consent for the termination must seek her agreement to donate the fetus to research – and phasing of tasks; consent to the termination must be sought before that for donation (Department of Health 1989).

In most cases a research nurse invites women to allow the aborted fetus to be used in research, although one clinical investigator uses junior staff in their team. Strauss insisted on treating the distinction between tasks and actors who carry them out with the utmost analytic seriousness, because they represent different issues (Strauss 1985: 5). Although both research nurses and junior staff enact the separation principle, they are on different rungs of what Strauss called an ‘accountability ladder’ (1985: 7). The work of research nurses is dedicated and formal whereas that of the latter is informal, just one of their many duties. Junior staff are responsible to their team whereas research nurses are independent of both clinic and laboratory. Independence is ensured structurally by research teams handing over the funds for their salary to a third party who acts as their official employer. Nonetheless, in their day-to-day work some research nurses identify with the clinic staff whereas others maintain a formal distance, or as one interviewee put it: ‘I'm not on their tea list, I don't get tea with them’ (CL6200606).

Much of the work undertaken by research nurses is found in collections of aborted fetuses for other kinds of research. They are not directly involved in the care of women and are dependent on the co-operation and goodwill of clinic staff to identify ‘suitable’ potential candidates and exclude ‘unsuitable’ ones. The system of triage is informal and improvised, although most clinics exclude women under the age of 16, women who speak little or no English, and women who are visibly upset (although that doesn't mean the other women are not troubled).

Clinic staff direct ‘suitable’ potential candidates to the research nurse after their interrogation has been completed, and the consent form for the termination of pregnancy has been signed. The research nurse in a separate private room invites the woman to consider donating the fetus. The Polkinghorne guidelines, which are out of step with current law and guidance on good practice in consent, insist that consent must be broad, and only vague information may be provided about the research (Pfeffer and Kent 2007). Nonetheless there is a wide variation in the amount of and detail in the written information offered to women, with some research teams being more forthcoming than others. This suggests a lack of consensus among investigators and research ethics committees who review and approve the research on what broad consent entails (Pfeffer and Kent 2006). Some women agree to donate the aborted fetus without asking any questions about what the research involves. But others want to know more about the consequences, in particular what will happen to the aborted fetus in the stem cell laboratory, as this research nurse explained:

They do ask, I have been asked, ‘will the baby once it's born, is it dead’? You know. And I've also been asked, ‘so you want to take its brain out and use it’, you know, quite explicit terminology like that, which, I think, you know, if I said to them at the beginning of the discussion, ‘we want to take your fetus’ brain out and use it for research’, that's a really quite hard thing to ask but if they ask me in that terminology, I will say, yes, because there's no point in pussy footing around the you know. At the end of the day, that's what we are going to do (CL6200606).

Concerns that an aborted fetus donated for research might somehow be mistreated in the stem cell laboratory peppered the focus groups with women, held as part of this study (Pfeffer 2008). The research nurse quoted immediately above responds to this suggestion by providing more information as she deems appropriate. Put another way, her own values, or private ethics, allow her to improvise around the public ethics of the Polkinghorne guidelines (Wainwright et al. 2006). Private ethics allow another research nurse to withhold further information on laboratory procedures. She knows dissection is involved but the image it conjures up in her mind reminds her of the propaganda against animal testing that activists display on her local high street and justifies her belief that giving women detailed information about research is tantamount to cruelty (CL3120606). Research nurses can exercise discretion in how they enact the Polkinghorne guidelines because their structural position places them between two separate organisations where they lack a clear line of accountability.

Exercising discretion where a clear line of accountability is absent is a type of work performed by members of research ethics committees (Ashcroft and Pfeffer 2001). The Polkinghorne guidelines, which recommend research using aborted fetuses is reviewed by a research ethics committee, also insist that the method of abortion meets the clinical needs of the woman, not those of the investigator. The Royal College of Obstetricians and Gynaecologists has drawn up evidence-based guidelines which specify which method of abortion is appropriate at each gestational age (Royal College of Obstetricians and Gynaecologists 2004). And in most clinics ultrasound is used to confirm and date the pregnancy in order to ensure the appropriate method of abortion is selected. However, surgical abortion, the most common method (seven out of every 10 in 2006) is, as a tissue banker explained, ‘not a delicate procedure’ (TB3120506). It involves a vacuum aspirator, an electro-mechanical machine powered by a motor, drawing out the contents of the uterus. Powerful suction ‘macerates’ the tissue and makes it difficult to identify the various different body parts in the laboratory. In other words, the method makes it difficult to transform the aborted fetus into human biological material which can be fashioned into the ‘right tool for the job’. Some research ethics committees have accommodated the needs of investigators and have allowed the method of abortion to be altered to suit their needs. One team has arranged for the contents of the uterus to be drawn out manually using a syringe where suction is gentler. Several teams are experimenting with fetuses from so-called medical abortion which involves the administration of two drugs and where there is a reasonable chance of the expelled fetus remaining intact, although the value of tissue extracted this way in the stem cell laboratory is still doubtful as cells may have ‘died’ in utero and may not be viable in the laboratory. While most of the research teams interviewed collect fetal tissue following its expulsion from the woman's body, one team collects it at the time of the termination by inserting a cannula into the woman's uterus and into the fetal heart. This clinical scientist graphically explained the unique qualities of the human biological material this method produces:

So, there are two types of fetal tissue collection. Ours is very unusual which involves instrumentation prior to the termination – now maybe they’re asleep because they can't change their mind – instrumentation prior to the termination to allow us to collect stem cells, and then the clinical termination takes place. Whereas many people you talk to, just run round and fiddle through a bucket and pull out bits of brain or eyes or pancreas or something and play with it in the laboratory. . . . In our research we collect blood and things from the fetus before it dies, or as it dies. Collection may hasten its death. But I think we approach that by saying, it's all part of the termination procedure which has started at the end of which the fetus ends up dead (CL2030506).

Alteration of the Polkinghorne guidelines to suit investigators is officially allowed, as this senior policy maker confirmed:

It would be incredibly difficult, I think, for researchers if it said, ‘and you will proceed in this fashion’. In terms of practicalities it does say, ‘you will proceed in this fashion’ in terms of consent provisions and things like that, but once you actually get beyond that and you've got the material, it's for the researcher to decide on the protocols and for the research ethics committee to then look at those protocols and to see whether they think that . . . (PM4220606).

Pragmatism arguably is essential where work proceeds in a highly sensitised environment, but it also both confirms and contributes towards its contentious and hidden nature.

Reconfiguring the aborted fetus into the right tool for the job in stem cell research

The purpose of ‘social’ abortion is to deny the fetus the capacity to realise its potential human biography (Kopytoff 1986). Agreement to donate, however, triggers off a series of tasks which seek to impose a new identity on it – that of a human biological research tool – and to initiate a new biography – that of a fetal stem cell. Put another way, these tasks seek to eradicate knowledge of its origins that might be read from a fetus in the clinic and to replace it with knowledge that is legible in the laboratory.

The fetus is estranged from its origins in a series of successive moves, a process which Parry (2004) calls ‘decorporealization’ (2004: 196). Agreement to donate the aborted fetus to stem cell research diverts it from treatment as ‘clinical waste’ and disposal in an incinerator alongside other ‘residual tissue’ or, as happens in some NHS hospitals, being sent for ‘respectful disposal’ in a crematorium.3 However, its reconfiguration into a human biological research tool begins in the abortion clinic before the pregnancy is terminated. This research nurse describes how she transforms gestational age from a milestone on a personal social calendar into a scientific fact, a developmental marker:

When they go and see the doctor, they have a scan, they have a picture taken and that's got the week's gestation they are and the size of the fetus. And I then, while they’re having a read through this, I just have a quick look through the notes. I don't need to know anything about anything else, I just have a look, find the picture, have a quick look, look at the size, the crown to rump length, and look at how many weeks pregnant they are. And that then goes on my information which . . . there it is. And this is my form. I’ll have day at the clinic; gestation by date; gestation by scan. So they might say, ‘oh I'm 12 weeks pregnant’, but by scan they’re only 10 weeks, five days, and then the CRL – crown to rump length – and that is the only information I need out of the notes. So when they come into me, one of the girls, whoever is bringing them in, will give me, hand me their notes (CL6200606).

Traces of a fetus’ origins can be found in the consent form which ‘travels’ with the fetus. A tissue banker explains a process which ensures that they are removed:

We weren't going to be able to go back to the notes of the patient to find out if there was a consent form in there if we were ever challenged because we don't know who the patients are. So we developed a sign-off sheet. It's just a standard sheet that's to be signed by the clinician in the theatre that's providing us with material, and they put down the date and the number of samples and they sign, and they’re signing to say ‘I have seen the consent form on this number of samples’. And so for every sample we collect, we have a sign-off sheet, signed by the clinical person doing the termination or the nurse in charge. It's very simple but it took us quite a bit of discussion (TB1210206).

Traces of a fetus’ origins are mostly rendered irretrievable. However, one team maintains a link between fetus and woman. The key is guarded by a research nurse who never attends meetings where research findings are discussed in order to prevent the risk of the aborted fetus in the laboratory being contaminated with its origins, and women from knowing how a fetus was used.

Stem cell research requires very ‘fresh’ material. ‘Freshness’ is a measure of two related biological processes: tissue decomposition, a process which starts immediately the fetus is detached from its blood supply, and cell viability which also starts ‘dropping off’ immediately. The work of maximising ‘freshness’ entails ‘stabilising nature’ and engages with the spatial and organisational separation of clinic and laboratory (Parry 2004: 27). It involves storing the aborted fetus, sometimes immersed in ‘hibernation’ fluid (fluid which arrests decomposition), in a refrigerator until it is collected, and making sure it is collected and taken to the laboratory as quickly as possible by, for example, not holding on to it in the theatre or clinic until that day's list of patients is completed. The work is not standardised. Phasing of tasks and the division of labour between clinical and laboratory staff vary according to local agreement. This scientist explains how tasks have been divided between clinic and laboratory staff.

A: Well what we do is, it's in the afternoons, it comes over within sort of half an hour of being expelled. But what you said about ‘has it died already before it's expelled’, it's certainly died but that tissue remains viable for quite a long time after that. So when it's expelled, it's collected and put into cold media, which the nurse . . .

Q: In the clinic?

A: In the clinic. It goes into the fridge.

Q: Who does all that then, the nurse or somebody else?

A: The clinical nurse does that. It's anonymised, put into the fridge, and then they ring us. And then my staff come down and just pick it up and take it back, which is only 10 minutes away, so we can do that at any time. So we hope to be getting tissue within about between half an hour and an hour of it being expelled (SS7290906).

The research nurse in another team collects the aborted fetus packed in a little water-tight pot from outside the operating theatre, places it in a second opaque pot, attaches a label, and carries it to the stem cell laboratory (CL3120606). Laboratory staff of another team recovers the fetal tissue from the vacuum aspirator and places it into sterile containers containing ‘hibernation fluid’, which are ‘double bagged’–‘products of conception are very messy’, as one clinical scientist explained (CL5200606).

Consumables such as ‘hibernation’ fluids and packaging contribute to the process of decorporealisation, that is, they contribute to the transformation of the fetus into a cultural artefact. They also vary according to local context. One team receives the aborted fetus in what a scientist described as ‘a sort of sluice bucket’ (SS5040406). This scientist explains how packaging may be used as a disguise, one which allows the courier to escape the attention of anti-abortion activists who picket the clinic where aborted fetuses are collected:

A: From what [research nurse] used to just briefly tell me, sometimes there'd be people hanging around the clinics. But again they'd be very inconspicuous when they went to pick material up. They'd only take taxis, known taxi people. They don't discuss what gets picked up and goes back.

Q: What was it transported in?

A: They had a little black bag and there was a container within it and then the material was always in a plastic bag and that was put in another container. And that plastic container was put into that transported bag which was put in another leather bag. It looked like you were just carrying a bag around. It didn't look anything . . . simply because you don't want to draw attention (SS6050706).

The aborted fetus that arrives in the stem cell laboratory is ‘unequivocally dirty’, as one scientist put it (SS1160206). Interviewees identified three different sources of ‘dirt’. First, the environment, especially the air of the operating theatre or clinic where the aborted fetus is ‘produced’, is contaminated by unknown and potentially dangerous bacteria and other pathogens. A laminar flow hood is designed to provide a ‘clean’ environment in a laboratory but it is clearly not feasible to place women under one while the abortion is carried out. Secondly, the aborted fetus supports a ‘bio-burden’, that is, it is contaminated by unknown and potentially dangerous bacteria and other pathogens. All decomposing flesh and bodily fluids support a bio-burden but, and this is the third source of ‘dirt’, aborted fetuses are also symbolically contaminated because women who undergo an abortion are seen as morally reprehensible, as this tissue banker claimed:

One would imagine that a woman who was attending an antenatal clinic and a woman who had chosen to attend an abortion clinic might have different backgrounds and different behavioural risks and perhaps different epidemiology from other points of view. So I would also have concerns about the population that was being targeted and the risks in that specific population compared to other populations in general (TB3120506).

The aborted fetus itself could be examined in order to identify the weight and composition of its bio-burden. The tests are expensive, however, sometimes inconclusive, certainly not exhaustive – dangerous new pathogens such as bird ’flu regularly emerge – and, anyway, by the time test results arrive the aborted fetus will have long since lost its claim to ‘freshness’. Laboratories use some or all of three different methods of ‘cleansing’. The first is carried out in the clinic and involves excluding ‘risky’ women, as this clinical scientist described:

We screen for HIV, for syphilis, HTLB1, CMB, toxiplasma. So those are the ones we screen the maternal donor for. So once we get to that stage we also ask them to self-exclude if they think they’re at risk of HIV. And that's done using . . . I don't know if you've donated blood recently but when you donate blood you get a self-exclusion questionnaire that you do. So in other words, you know, have you been exposed to someone who has HIV? Have you slept with someone of the same sex? Have you had sex in Africa? You know, those sorts of questions (CL5200606).

The work of cleansing here takes the form of risk avoidance and its methodology has been borrowed from the NHS Blood Service. However, the work demands specialist and continually changing skills which, as this tissue banker explained, few research nurses have:

Somebody working in an abortion clinic, asking consent for an aborted fetus to be used in research wouldn't have access to that infrastructure. And even if they had the nous to look up such information, they wouldn't necessarily be always up to date, and they wouldn't have access to the advice that might inform their changing procedures as risks are perceived to change. And training is a very big issue (TB3120506).

The second cleansing method is derived from Good Manufacturing Practices (GMP), the established approach to ensuring quality of food and drugs that is recognised worldwide.4 GMP involves creating a paper trail which records in detail the route, chain of custody, and work through which the aborted fetus is transported from clinic to laboratory. A tissue banker succinctly explained its rationale:

If you think about a pharmaceutical in a pill, most of it is chalk and that comes out of a hole in the ground. Well you don't sterilise the whole area to dig the pit. What you do is it's about traceability so it's about knowing where your material comes from (TB3120506).

Of course, a paper trail cannot ‘cleanse’ the fetus of its bio-burden. It is a defensive strategy, a procedural approach to identifying risk and responsibility, should anything untoward emerge. It is a form of behavioural auditing (Parry 2004: 257) which belongs in what one scientist called a ‘blame culture’ (SS1160206).

The third method of ‘cleansing’ is also derived from GMP and requires the production of evidence that no new contaminants have been introduced in the laboratory, as this scientist explained:

So, we have to show that, if we are, were, to start with clean material, and so it's all done on phantoms of sterile agar that all our processing, it comes out as pure and sterile and uncontaminated as it went in. If it goes in, we have to show that the purity of all our media, is absolutely sterile, at incredibly high standard, and all the air filtering allows minimal numbers of particles of certain size at incredible cost through. We are not required to show that at the end of the process itself, the material is that clean. It isn't, it's as filthy as it started [emphasis added] (SS1160206).

Whereas the second method of cleansing is largely bureaucratic, this method requires the production of evidence which can take several years, as the scientist went on to explain:

And we have been through a lot of validation in setting up a complete, several years of validation, before starting, before implanting anything in patients, showing that the establishing: the washing processes and establishing the standard operating protocols for washing and cleaning and sorting and dissecting cells, to eliminate ranges of contaminants, validating that the different types of contaminants would have been picked up either in the virology, so that we’re confident that, that . . . (SS1160206).

Complete reconfiguration of the aborted fetus into a human biological research tool requires removal of all visible traces of its origins and its incipient humanist biography. These traces are more evident in fetuses of eight weeks or more gestation, that is, when embryogenesis is complete, and in fetuses from medical abortions which are likely to remain intact after they have been expelled. This nurse explained what they look like:

Q: What does an eight-week fetus look like then?

A: Well it would just be about this width [gestured with fingers]

Q: Just about an inch?

A: It would have all of the hands and the feet. They do have a recognisable form. They don't obviously look like a baby but they are recognisable [emphasis added] (CL3120606).

Vacuum-aspirated fetal tissue arrives in the laboratory ‘all mushed up’. As the same nurse put it, ‘I don't want to be graphic about it but sometimes they would come apart a bit as they’re coming out’ (CL3120606). However, the ‘mush’ has to be made legible to ensure the tissue worked on in the laboratory is the ‘right one’. Making the ‘mush’ legible requires both work and skill because some body parts are more easily recognisable than others. The adrenal gland, for example, is relatively easy to spot as are kidneys which are pink. Whereas, as a clinical scientist explained, it is only possible to identify the region of the brain needed in about a third of cases of fetuses extracted using vacuum suction (CL5200606).

Recognisable body parts are reminders of origins and can provoke a conflict between emotional and instrumental values which this scientist experiences:

It is a really difficult question because it's sort of emotional as well as sort of logical. So from an emotional point, from just looking down the microscope or looking down a dissecting microscope, and you can see a baby at sort of 11 weeks, I mean, they've got hands and a head. So you do see that. But in terms that whether you should use it for research, I don't have any problems with it; so one's an emotional sort of viewpoint. . . . So when you see a pre-implantation blastocyst of 80 cells, they’re just cells to me . . . it's not anywhere near. Further down, where you see something that is clearly an organised developing fetus, then there is a sort of slight emotional tug on it (SS7290906).

In contrast, a bundle of ‘fetal cells’ which look like other cells is more easily objectified, as another scientist explained:

And so, we receive fetal material . . . when I put some hepatocytes, liver cells into culture, they are cells; they are no longer a fetus. They’re human cells but they are no longer human in terms of how we understand human life, they could as well be mouse or rat in terms of they are hepatocytes, they are cells, primary cells [emphasis added] (SS2200206).

Interviewees manage any personal unease about aborted fetuses’ human resemblance by performing ‘ethical boundary-work’, that is, the intellectual work through which ethical dilemmas are identified, negotiated, organised and neutralised (Wainwright et al. 2006). Ethical boundary-work can take different forms. Deference to informed consent, a common one, was employed by this scientist:

But in terms of using it for research, I don't have any problems’ cause in both cases they've been consented (SS7290906).

Another type of ethical boundary-work involves paying homage to the moral imperative of respecting the spirit of the gift of the aborted fetus, a scarce and precious resource, as this scientist explained:

Yeah, yeah, absolutely, and I think that's important because we’re incredibly privileged to get the material we get, we go to great lengths to do it properly and with all of the regulatory issues taken care of and therefore I think once we get the material, it's almost a social responsibility of us to make the best possible use of it (SS2200206).

Ironically, ethical boundary-work in relation to the aborted fetus allows some scientists to claim they are pursuing the ethically valuable ends of helping people through research, whilst concurrently arranging for the Polkinghorne guidelines to be subverted in the clinic.

Discussion

This paper presents an analysis of the different kinds of work involved in reconfiguring an ‘unwanted’ pregnancy into the right tool for the job in stem cell laboratories. Interview data have been used as a proxy for participant observation in order to show how aborted fetuses are extracted from the chaos of the abortion clinic and placed in the laboratory, a privileged site for the production of scientific knowledge and commercial exploitation.

The work involved in reconfiguring an aborted fetus into the right tool for the job in the stem cell laboratory is not standardised. In Strauss’ terms, there is considerable variation in tasks, their phasing over time, their division amongst actors, and the resources used. As a result, different kinds of aborted fetuses are found and worked on in stem cell laboratories.

The work involved must be understood politically; it is a process of decorporealisation that enables individuals or groups of scientists to alienate aborted fetuses for their exclusive use and, subsequently, to strategically re-circulate them, albeit as a cultural artefact, for professional, economic and political advantage (Parry 2004). However, the aborted fetus is no simple organ or body part; complex processes are required in order to remove controversial traces of its controversial origins. Put another way, the aborted fetus resists ‘black boxing’.

Women are the source of highly prized and essential resources in the stem cell laboratory, specifically of pre-implantation embryos, cord blood, and also aborted fetuses (Waldby and Cooper 2006). However, whereas, thanks to Titmuss (1970), the ‘gift of blood’ to the NHS Blood Service is viewed as an act of direct civic responsibility between fellow citizens, several interviewees claimed the ‘gift’ of an aborted fetus allows a woman to derive a positive benefit to emerge out of a negative stigmatised, even guilt-ridden, experience. It is a sort of propitiatory sacrifice through which women may find redemption. Indeed, one scientist claimed that his team had ‘come to realise, we’re actually a significant part of the grieving process in this’ (SS2200206). Another interviewee offered a counter view: Parliament, in giving the medical profession the right to decide on whether or not a woman's circumstances fall within the provisions of the Act, has placed women in a situation where the request might easily amount to coercion. As one policy maker succinctly put it:

I suppose they’re not vulnerable women; they’re at a vulnerable time, I think. So there is always that element for some of them that this person who holds the power, usually the doctor about to agree to the procedure, could change their mind (PM21080506).

Work has consequences for women rhetorically through being reconfigured into a repository of usable fetal tissue, and, in some sites, materially, through alteration in method of abortion. Strauss insisted social scientists identify systems of accountability and their specific consequences in the substantive area (1985: 8). Agreement to donate effectively places the woman's body in two social worlds governed by competing, even contradictory, ethos. The duties of doctors providing abortion care include ‘make the care of your patient your first concern’ (Royal College of Obstetricians and Gynaecologists 2004: 16). In contrast, stem cell scientists seeking the right tool for the job in their laboratory are schooled in the instrumental rationality of science, albeit tempered by ethical boundary-work (Wainwright et al. 2006). The Polkinghorne guidelines are meant to protect women from the ethos of the laboratory, overwhelming that of the clinic. Yet some research ethics committees, with official knowledge and approval, have sanctioned alterations in method of abortion which facilitate the reconfiguration of the aborted fetus into the right tool for the job.

Acknowledgements

The research reported here was supported by the ESRC Stem Cell Programme (Grant number: RES-340-25-002). I would like to thank the interviewees, Julie Kent, University of West of England, co-applicant on the project who contributed to the research design and who carried out some of the interviews, and Clare Moynihan and two anonymous referees for their invaluable comments on the paper.

Notes

  • 1

    Throughout this paper we have used ‘unwanted’ in quotation marks in order to emphasise that women may have mixed feelings about the pregnancy and furthermore the term fails to capture the fluidity of women's feelings about the fetus.

  • 2

    The US federal government, under Republican presidents, has supported non-therapeutic research using tissue from miscarried fetuses and prohibited research using aborted fetal tissue on the grounds that the ends, however beneficial, can never justify the means – abortion.

  • 3

    ‘Respectful disposal’ of aborted fetuses, that is disposal in a crematorium rather than in an incinerator alongside other clinical waste, in the UK, has been promoted by nurses working in abortion clinics as a way of dignifying their work. In contrast, the ‘pro-life’ lobby has promoted the policy in the USA in order to gloss the fetus with personhood.

  • 4

    Laboratories increasingly apply GMP procedures to non-therapeutic research in case a cell line leads to a stem cell product (Pfeffer and Kent 2007).

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