MR Images of Postmortem Fetuses

Re: Kinoshita et al. Volumetric Analysis of the Germinal Matrix and Lateral Ventricles Performed Using MR Images of Postmortem Fetuses. AJNR Am J Neuroradiol 22:382-388, February 2001

Our initial response to the cover of February's issue of AJNR, displaying gross images of aborted fetal brains, was one of disbelief. We would like to express our deep concerns related to the ethical questions raised by such a study and its publication without appropriate editorial comment.

Research conducted on aborted fetuses, some of whom were as old as 28 weeks (6½ months) at tile time, should have given someone serious pause during the editorial process. "Rat there was no significant thought given to the ethical implications of such a study and its publication is apparent by the obvious lack of detail in the procedure section of the article, where a cursory single sentence states the method of acquiring the fetal specimens used iu this study. The use of human subjects in clinical research and the ethical necessity of informed consent is a hot button issue in medicine today. Was consent obtained from the parents of these children? Surely, these researchers would have to be on hand at the time of the "termination" to preserve the corpora in the best possible condition for imaging. Did the fact that their brains were to be preserved during the abortion have any impact on the type of procedure used to end their lives'? If so, did the type of procedure that was chosen pose any additional risk to the mother? Were any of the procedures delayed at all to allow for further maturation of the fetal brain? Were the parents provided any compensation, monetary or otherwise, for the postmortem use of these children? None of these issues seem to have been addressed by the authors or the editors of AJNR.

These questions raise serious ethical issues that require answers. Why do we physicians, including the AJNR Editorial Board, choose not to recognize the ethical concerns raised by this kind of medical research? The silence of our editors, in this case, is reminiscent of the attitude expressed by Julius Halloverden, German neuropathologist, when interrogated by American authorities in 1945 regarding his research on brains taken from victims of legalized euthanasia, “I accepted these brains of course. Where they came from and how they came to me, was really none of my business” (1). (It is noteworthy that data from many German “medical experiments,” even though potentially medically relevant, were deemed morally and ethically abhorrent and therefore were never published or disseminated to the international medical community [2]).

We understand that in our society, a moral consensus on the personhood of fetal life or its rights and its place in our human community currently does not exist. The view that fetuses should be accorded the same rights guaranteed by natural law to all humans complicates the issue of performing research on the “terminated” fetus and publishing data from such an endeavor. All of us have been involved in the prenatal and postnatal care of babies similar in age to the study population presented by Kinoshita et al. It strikes us as inconsistent that, on one hand, we should attempt to preserve the lives of sick children and, on the other, look to profit intellectually from the killing of healthy children. It would behoove the editors of AJNR to be sensitive to the diversity of views of its ever-increasing readership. It is our sincere hope that the editorial board will address our concerns and adopt some basic ethical standards for publication to prevent this kind of oversight in the future.