Text of Vicki Evans' thesis on abortion industryMay 8th, 2010
ATHENAEUM PONTIFICIUM REGINA APOSTOLORUM
Faculty of Bioethics
"Commercial Markets Created by Abortion: Profiting from the Fetal Distribution Chain"
Professor: Father Joseph Tham
Student: Victoria Evans
Matriculation n.: 00006495
BE2001 Dissertation for the Licentiate
Rome, 18 November 2009 2
1. Foundations of Abortion……………………………………………………………..7
1.1. Individual Impact…………………………………………………………….7
1.2. Socio-Economic Impact……………………………………………………...9
2. The Abortion Industry……………………………………………………………….12
2.1. Industry Composition………………………………………………………..12
2.2. Case Study…………………………………………………………………...13
2.2.1. Planned Parenthood Business Operations…………………………...15
2.2.2. Clinical Trials…………………………………………………..........18
2.3. Political Landscape…………………………………………………………..20
2.3.1. Federal Framework…………………………………………………..20
2.3.2. Planned Parenthood Structure………………………………………..21
2.3.3. Grassroots Lobbying…………………………………………………22
2.3.4. Direct Lobbying……………………………………………………...24
3. The Fetal Parts Industry……………………………………………………………..27
3.1. Legal History………………………………………………………………...28
3.2. Investigative Report…………………………………………………………32
3.3. Fetus Farming………………………………………………………………..37
4. The Pharmaceutical Industry………………………………………………………..40
4.1. Industry Dynamics…………………………………………………………..40
4.3. Human Technology Manufacturing Platforms……………………………....47
5. The Cosmetics Industry……………………………………………………………...51
5.1 Cosmeceutical Development………………………………………………...51 3
5.2. Market Demographics………………………………………………………53
6. Ethical Assessment………………………………………………………………….56
6.1. The Human Person………………………………………………………….56
6.2. The Past and the Future……………………………………………………..57
6.3. Cooperation in Evil………………………………………………………….59
INTRODUCTION The abortion divide is commonly viewed as an ideological conflict. Does a woman‟s right to make reproductive choices eclipse the right to life of a developing fetus? Too often the rhetoric begins and ends at this level of discourse.
An ideology may be defined as “a system of collectively held normative and reputedly factual ideas and beliefs and attitudes, advocating and/or justifying a particular pattern of political and/or economic relationships, arrangements and conduct.”1 It is a wide-ranging shared belief system that can serve to motivate and justify and to provide the foundation for programs of political and social action. “Leaders of sociopolitical movements realize that there will inevitably be times when a movement‟s ideology will conflict with the experiences and moralities of their followers. At those moments, followers must reject their own consciences and blindly fall back on the accepted dogma.”2
This quotation characterizes the ideological divide surrounding abortion. It is today‟s most polarizing issue. There is a particular cultural vision that provides motivation and justification for access to legal abortion by focusing on a woman‟s autonomy, privacy, equality and right to self-determination. Understanding this vision is fundamental to understanding the deep reluctance of the pro-choice community to abandon the status quo as it relates to abortion. By the same token, those who reject abortion do so based on an anthropology that embraces as central the individual human person, his dignity, intrinsic worth and right to life, regardless of stage of development or state of life. This vision of the person is irreconcilably at odds with the acceptance of abortion.
1 M. B. HAMILTON, “The Elements of the Concept of Ideology”, Political Studies 35 (1987) 18-38. 2M. CRUTCHER, Lime 5: Exploited by Choice, Life Dynamics, Incorporated, Denton 1996, 205.
Today the abortion industry claims a unique place as an established structure of American society. It benefits from legal and governmental protections. Juridical cases upholding abortion rights indicate its relatively secure position in federal and state courts. Explanations as to why it has come to occupy this position vary. Perhaps it is the will of the majority, the sheer political strength of an ideological movement, or a postmodern vision of what constitutes a “right” for the human person and a “good” for the society. Putting aside the ideological question for the moment, it appears that abortion-related businesses, silently springing up and maturing over the past forty years, could now be influencing the abortion debate. The reality of these businesses is not often part of the general public‟s knowledge or concern.
Is there a commercial case for preserving the abortion industry in its present form that transcends ideology? Are special interests driving the industry? How much power, if any, do financial considerations wield when weighed against societal norms, rules and laws that govern abortion? Does the public‟s ignorance of these factors contribute to maintaining the abortion culture as it exists today? If people understood these factors, might their ideas about abortion change? As commercial ventures, how much profit do the abortion industry and those industries dependent upon it generate---and to what interests? What extent does money, “the root of all evil,” play in understanding the complex calculus of abortion?
As a practical matter, this paper cannot settle the question of whether abortion is predominantly an ideology or a commercial enterprise. To some degree, it is both. It will instead focus on industrial sectors whose origin and growth are a result of legalized abortion. The culture of abortion is multifaceted. Its influence has permeated countless segments of society. It has created new commercial markets and molded existing ones. While it fulfills the definition of an ideology, particularly in those who inhabit its two extreme positions, economic revelations that underlie the abortion industry may affect the thinking of those less resolved individuals inhabiting the more moderate center.
Little is widely known about the business aspects of the abortion industry that relate to its function of supplying electively aborted fetuses to industries that exploit them for economic gain. An unintended consequence of the essentially unencumbered right to abortion has been the creation of a vast and lucrative market in fetal tissue, fetal organs and fetal parts.
This paper will attempt to follow the money trail in an effort to expose those special interests that contribute to abortion‟s control over the American culture and the American economy. It will examine some industries connected with and profiteering from the abortion industry, some directly and some more remotely.
Chapter 1 will look at general foundational aspects of abortion. Chapter 2 delves into the social, commercial, political and juridical systems that make the abortion industry itself profitable. Chapter 3 examines the fetal parts industry, an industry that could not have developed without a legal and protected abortion structure. Chapter 4 follows fetal-tissue technology into the pharmaceutical industry. Chapter 5 reveals how fetal-tissue supply and demand shape the cosmetics industry. Finally, Chapter 6 analyzes the ethical implications of the practices taking place and why it is necessary to shine a light on these practices. The scope will generally be limited to the United States, except in cases involving worldwide markets. 7
Chapter 1 FOUNDATIONS OF ABORTION
Who profits from abortion? Abortion does not affect just one person. It impacts individuals, families, businesses and society at large. Thus, many people and entities can potentially be involved not only in abortion‟s choice and execution, but also in its aftermath---the disposition of the fetus. 1.1. Individual Impact The terminated fetus would seem to profit least from abortion. There may be cases where he is spared a life of hunger and pain, suffering and sorrow; however, this is a decidedly nihilistic view of mankind. Not only does it discount the possibility of the experience of pain by the fetus during abortion, but it also avoids the larger question of the purpose and value of human life and existence in general. As a philosophical tenet, most would agree that it is better to be than not to be.
Whether the mother benefits from abortion has been the subject of considerable debate. The pro-choice community points to the relief experienced by the woman who escapes an undesirable situation, her crisis pregnancy. She is restored the ability to control her body and her future. The pro-life community cites a not insubstantial body of evidence that documents a woman‟s feelings of guilt and pain, as well as the physical and emotional distress that can accompany abortion.3 Pro-choice advocates point out that the father, if he knows, may also experience relief on emotional and economic levels---often more so than the mother. But men too have been shown to suffer as a result of abortion and regret the loss of fatherhood. Some have voiced frustration at a legal system which gives the woman sole control over determining the fate of their child.4
3 V. THORNE, “Manifestations of Abortion‟s Aftermath in Women”, in http://www.noparh.org [6-2-2009]. D. M. FERGUSSON - L. J. HARWOOD - J. M. BODIN, “Reactions to Abortion and Subsequent Mental Health”, The British Journal of Psychiatry 195 (2009), 420-426. 4 G. CONDON - D. HAZARD, Fatherhood Aborted, CareNet U.S.A. 2001, 31. 8
Compared with the volumes written about the post-abortive woman and the terminated fetus, remarkably little has been written about the third necessary participant in abortion---the abortionist. Doctors who have the training and vocational calling to perform the procedure are crucial to the abortion industry‟s ability to provide abortion access to women. Besides impacting the doctor, a facility‟s medical and administrative staff is affected by its proximity to abortion. The staff closely participates in that it counsels the women, prepares them for the operation, assists during surgery and recovery, and disposes of fetal remains.
In Necessity and Sorrow, pro-choice author Magda Denes chronicles her research evidencing the conflicts experienced by abortionists. One abortionist confessed, “As a physician, I‟m trained to conserve life… I guess I feel guilty because according to the Hippocratic Oath5 you‟re not supposed to do abortions.”6 But others are dedicated to the field. The Executive Director of the American College of Obstetricians and Gynecologists says, “By and large, [abortion doctors] are zealots who are strongly committed and who believe, in most instances correctly, that if they don‟t provide the service, no one will.”7
5The Hippocratic Oath, as originally formulated in the latter half of the fourth century BC, contained the following prohibition: “I will not give a woman as pessary to cause an abortion.” 6M. DENES, In Necessity and Sorrow, Basic Books, Incorporated, New York, 1976. 7W. H. PEARSE, M.D., American College of Obstetricians and Gynecologists, New York Times (8-1-1990). 8 M. CRUTCHER, Lime 5: Exploited…, 189.
While many doctors enter the field on ideological grounds or based on a belief that this area of medicine is underserved, abortion is also a lucrative business. Doctors can earn significantly more money performing abortions than they can by practicing other kinds of medicine. Although the chargeable fees and reimbursements available for a routine first-trimester abortion are generally low, the per-procedure fees are more than offset by the high volume of abortions that can be performed in a single day.8 This is particularly true since many women below the poverty level, who might not otherwise be able to pay for an abortion, are subsidized through state Medicaid programs. 9
1.2. Socio-Economic Impact
An early argument advanced in favor of legal abortion was that it would contribute to the common good by solving prevailing social problems: child abuse, violence against women, single-parent households, poverty, etc. “Every child, a wanted child,” was a popular slogan. However, these social ills would seem to remain notwithstanding the elimination of millions of presumably unwanted children. As to child abuse, studies indicate a reverse trend. A prior history of abortion has been shown to produce more child abuse, not less, in subsequent pregnancies.9
9 P. NEY - T. FUNG - A. R. WICHETT, “Relationship Between Induced Abortion and Child Abuse and Neglect: Four Studies”, Pre- and Perinatal Psychology Journal 8/1 (1993), 43-63. 10Margaret Sanger founded the American Birth Control League in 1916, which eventually became Planned Parenthood. According to the Birth Control Federation of America‟s “Margaret Sanger Papers Project”, she supervised the “Negro Project” which assembled clinical data to influence the adoption of clinics and contraceptive techniques primarily in the black communities of the South. 11UNITED PRESS INTERNATIONAL, INC., ”Abortion Demographics Show Big Changes”, The Washington Post (23-9-2008).
12 C. H. CHILDRESS, JR., “The Dawning of a King‟s Dream” (2003), in http://www.blackgenocide.org/king.html [6-15-2009].
Some claim that one ideology underlying abortion is eugenic in nature.10 Demographic data points to a disproportionate concentration of abortion facilities located in economically-disadvantaged black and ethnic neighborhoods. According to a 2008 study performed by the Alan Guttmacher Institute and reported in The Washington Post, “While the overall number of abortions has been falling in recent years, black and Hispanic women are making up a larger percentage of those receiving them. A large racial disparity was evident. Non-white women have the procedure at three to five times the rate of white women, the study found.”11 Currently, 36% of abortions performed in the U.S. are performed on African-American women, although black women of child-bearing age account for less than 13% of the population.12
Has the common good benefited from legal abortion? More women have taken the opportunity to complete their education, enter the workforce and leave the welfare roles. From an environmental standpoint, the collective “carbon footprint” may have been reduced and there may have been lower consumption of natural resources, both nationally and globally. But after nearly fifty million legal U.S. abortions between 1973 and 2009, the data is inconclusive or dubious at best. Born in 1973, Caleb King, pastor at the Assembly of God‟s New Life Christian Center in Novato, California, lamented, “There is a growing sense in my generation that there are a lot of us missing, a lot of people with great potential.” The logical question flowing from this is whether society has benefited from the largely unregulated, uncontrolled and uncontrollable abortion industry. This question has gone largely unasked and almost completely unanswered. The answer may be a function of economics.
Commerce, defined as “the exchange or buying and selling of goods, commodities or property,”13 capitalizes on opportunity. It looks for utility in things that would otherwise be wasted and searches for innovative business ideas. Maximization of profits is the ultimate goal. Markets are created by exploiting supply and demand.14 The choices the public exercises regarding the sort of markets it allows to be created are important. These choices create the kind of world in which we live. They define the ethics of a society. When abortion became legal in the United States, no one anticipated that it would give rise to a tremendous market in fetal parts, tissues and cells. Campaigns advocating for a woman‟s right to choose never looked beyond the stated motivation---a desire for legal access to abortion---to the collective forces representing the creation of emerging markets.
13 Merriam-Webster's Dictionary of Law, Merriam-Webster, Inc. 1996. 14Supply and demand is an economic model based on price, utility and quantity in a market. It concludes that in a competitive market, price will function to equalize the quantity demanded by consumers and the quantity supplied by producers, resulting in an economic equilibrium of price and quantity. 15 Roe v. Wade, 410 U.S. 113, 160-165 (1973).
Abortion became legal throughout the United States in 1973 with the Roe v. Wade Supreme Court decision. Until that time it was controlled by state law. Each of the fifty states regulated the practice to varying degrees. In Roe v Wade, the Justices ruled that abortion could not be restricted at all in the first trimester of pregnancy. Second-trimester abortion could be regulated only for reasons of the mother‟s health. During the third trimester, after viability, abortion could be prohibited except when necessary to preserve the mother‟s life or health.15 Thus, the definition of “health” became all-important in determining the parameters of legal 11
abortion. A companion case, Doe v. Bolton (which the Court directed be read in conjunction with Roe v. Wade), defined maternal health so broadly as to effectively remove all significant legal barriers to abortion throughout pregnancy. Health was defined to include “all factors---physical, emotional, psychological, familial, and the woman‟s age---relevant to the well-being of the patient.”16 As a practical matter, if the existence of any of these health reasons could be demonstrated, abortion was legal during all nine months of pregnancy in all fifty states.
16 Doe v. Bolton, 410 U.S. 179, 192 (1973).
17 Following the 8th Circuit Court's Stenberg v. Carhart, 530 U. S. 914 (1992), decision that Nebraska's "partial birth abortion" statute violated the Federal Constitution, as interpreted in Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U. S. 833 (2000), and Roe v. Wade, 410 U. S. 113 (1973), Congress passed the Partial-Birth Abortion Ban Act of 2003 to proscribe the dilation and extraction (D&X) method of ending fetal life used in the later stages of pregnancy. 18Matthew 6:21.
Other notable Supreme Court cases on abortion rights followed. Planned Parenthood v. Casey decided in 1992 upheld and more deeply entrenched in law the basic right to abortion, while expanding the ability of states to enact all but the most extreme restrictions on its access. Stenberg v. Carhart decided in 2000 overturned a Nebraska state ban on “partial-birth abortion” due to the lack of an exception for maternal health.17 This unbroken line of cases has provided a continuous safe harbor for the abortion industry since Roe, allowing the growth of various satellite businesses that utilize the readily available fetal parts supplied by abortion.
“Where your treasure is, there also will your heart be.”18 Does the heart of the abortion industry in the United States really lie in the financial realm? 12
Chapter 2 THE ABORTION INDUSTRY 2.1. Industry Composition
The most direct financial gains from the abortion industry are realized by those physically providing abortions. Who are these providers and how many exist? In 2005, the most recent year for which complete statistics are available, there were 1,787 abortion providers in the United States. Just under half of these, or 887 clinics, offered RU486 chemical abortions.19 Approximately 20% of abortion providers were members of the National Abortion Federation (NAF), according to information from its annual report. 20 Forty-five percent of abortion providers did business in independent free-standing clinics. Hospitals housed 34% of the providers and doctors‟ offices the remaining 21%. The greatest percent of abortions performed, 93%, were done in dedicated abortion clinics and other clinics; that is, those clinics where the majority of services provided are non-abortion services. Hospitals had a 5% share of the abortion market, with doctors‟ office registering only 2%.21
19RU486 is a chemical abortion drug regime consisting of mifepristone or methotrexate and misoprostol. It was approved by the U.S. Food and Drug Administration September 2000 for abortions up to 49 days. Manufactured in China, it is distributed in the U.S. by Danco Laboratories, LLC. Mifepristone blocks progesterone, causing the uterine lining to thin and detach; methotrexate stops cell division, so is toxic to trophoblast tissue; misoprostol causes uterine contractions that expel the embryo and placental tissue. F. H. STEWART - E. S. WELLS - S. K. FLINN - T. A. WEITZ, “Early Medical Abortion: Issues for Practice”, University of California at San Francisco, Center for Reproductive Health Research and Policy, San Francisco 2001, 20.
20The National Abortion Federation is a professional organization of abortion providers in the U.S. and Canada. Members include health care professionals at clinics, doctors‟ offices and hospitals (375 U.S. and 25 Canadian members), according to its website at http://www.prochoice.org. Some Planned Parenthood affiliates are included among member provider clinics. 21 R. K. JONES - M. R. S. ZOLNA - S. K. HENSHAW - L. B. FINER, “Abortion in the United States: Incidence and Access to Services: 2005”, Perspectives on Sexual and Reproductive Health 40/1 (2008), 6-13.
The largest existing network of affiliated abortion clinics is Planned Parenthood Federation of America (PPFA). It first performed abortions on July 2, 1970, the day after abortion became legal in New York state. By 1984, its clinics performed 5.5% of all U.S. 13
abortions, by 1997, 12%, and by 2004, just under 20%.22 By 2008, that percentage was approaching 25%. Thus, its market share has increased steadily. The great majority of non-PPFA abortions are performed at independent clinics specializing in abortions, followed by more broad-based independent clinics. In Table 1, PPFA‟s percentage of the abortion market is translated into number of abortions performed and estimated clinic income (in millions of dollars) generated by the abortions. The table covers the most recent five calendar years available. Table 1 _____ 2003 2004 2005 2006 2007__ Number abortions 245,092 255,015 264,943 289,750 305,310 Income (in millions) $ 88.2 $ 94.4 $ 100.7 $ 113.0 $ 122.1 Number of abortions was derived from published annual reports of PPFA and includes all of its affiliates. Estimated income was computed by multiplying the number of abortions performed by the estimated cost of a first-term abortion.
22 LIFE DECISIONS INTERNATIONAL, “Planned Parenthood Budget Up”, The Caleb Report 7/8 (2007), 5. 23 R. K. JONES - M. R. S. ZOLNA - S. K. HENSHAW - L. B. FINER, “Abortion in the…”, 14-16.
The typical average cost of a first-trimester abortion is from $300 to $500. A second-trimester abortion can range from $1,000 to over $1,500. More complicated third-trimester abortions can cost up to several thousand dollars. Nearly 90% of abortions are performed during the twelve weeks of the first trimester.23 To the extent that some abortions included in Table 1 were performed in the second or third terms at correspondingly higher costs, income shown in the table is conservative. 2.2. Case Study
Planned Parenthood Federation of America, founded in 1916, and its overseas affiliate, International Planned Parenthood Federation, founded in 1952, represent the largest and most efficiently-organized providers of abortion in the U.S. and worldwide. These non-profit organizations enjoy considerable economic and political power. Thus PPFA is central to any study of how a special interest is able to profit from the abortion industry and become a significant force in American society.
PPFA presents a comprehensive case study on how business evolves to capitalize on changes in the law and the prevailing culture. Another factor that makes it a good candidate for study is the availability of extensive public information for analysis. Each year, PPFA publishes an annual report24 that offers complete financial information. Much of that information is attested to by independent certified public accountants. The financial activity of its U.S. operations is corroborated by tax-exempt income tax returns required to be filed annually with the Internal Revenue Service, a branch of the U.S. Department of the Treasury.25 These tax returns are filed by the corporate officers under penalty of perjury and are open to public inspection by law.
24An annual report is a comprehensive report on a company‟s activities during its fiscal year and is intended to give shareholders and other interested parties information about the company‟s activities and financial performance. Most jurisdictions require public companies to prepare and disclose annual reports. 25 Form 990, Return of Organization Exempt from Income Tax, is required to be filed annually by nonprofit organizations exempt from income tax under Section 501[c] of the Internal Revenue Code. 26 Guttmacher Institute Annual Reports, 2007 and 2008. 27Department of Health and Human Services, Center for Disease Control and Prevention, Abortion Surveillance--United States 2000, 52/12 (2003), 1-32.
Before examining statistical information, it is important to be aware of some key facts about abortion-related statistics. The Alan Guttmacher Institute, an affiliate of PPFA, is perhaps the only source of available, and arguably reliable, statistical data on abortion.26 Guttmacher compiles more abortion-related data than any other U.S. source, including the federal government agency‟s Center for Disease Control and Prevention (CDC). To compile its abortion statistics, the CDC relies on submissions from state departments of health. State reporting requirements vary widely. The completeness of reporting compliance by providers to their respective state departments of health also varies. Some states---California, for example---do not collect or report abortion data at all.27 Since California, the most populous state, is estimated to perform 20% of U.S. abortions, the CDC inevitably has significant gaps in its statistical data. 15
According to its annual report, Guttmacher receives substantial government funding to carry out this data-collection function. In 2007 and 2008, the Institute received government grants and contracts of $1.9 million and $1.2 million, respectively.28 To accumulate statistical data, Guttmacher surveys nationally-representative samples of women who obtain abortions in the U.S. It conducts a periodic census of all known abortion providers and gathers information directly from them. Guttmacher is an affiliate of PPFA so access to confidential internal information regarding the activities of PPFA is virtually certain. The disadvantage of this arrangement is the lack of independence between Guttmacher as researcher and PPFA as the organization it putatively reports on. To illustrate, PPFA‟s 2007 tax return shows a $350,000 grant to the Guttmacher Institute. Economically self-serving reasons to shade or manipulate data thus undeniably exist, but no other comprehensive statistical sources are reasonably available.
2.2.1. Planned Parenthood Business Operations
28 The percentage of support Guttmacher Institute received from government grants and contracts was 15% in 2007 and 10% in 2008. The most significant source of support received is from private foundation grants, which represented 70% of gross receipts in 2007 and 81% in 2008. More than half of these grants are restricted by donors for designated purposes or studies. 29 Planned Parenthood Federation of America Annual Report for fiscal year ended June 30, 2008. National organization figures include the operations of Planned Parenthood Action Fund, Inc., which engages in lobbying activities through its Political Action Committee and its segregated fund, Planned Parenthood Votes. The operations of 115 affiliates are also included. Affiliates are independent corporations that operate local Planned Parenthood clinics. Each U.S. affiliate is a member of Planned Parenthood Federation of America.
In terms of number of existing abortion facilities, gross revenues generated, and profitability, PPFA leads the abortion industry by a substantial margin. For fiscal year ended June 30, 2008, PPFA boasted 115 affiliates with 844 health centers in all fifty states. Its gross revenues (defined as gross receipts before the deduction of expenses) for that fiscal year amounted to $1.038 billion. Net profits (excess of income over expenses) were $85 million.29
The gross revenue of Planned Parenthood Federation of America derives from three main sources: (1) health care income from clinic operations; (2) contributions and bequests; and (3) government grants and contracts. The less substantial “other income” category includes dividends, interest, gains or losses on sales of assets, rental income, sales of merchandise 16
inventory, membership dues, and income from special events. It also includes income from its affiliate, the Guttmacher Institute. Although exact percentages vary from year to year, for practical purposes it may be said that each of these three main revenue sources provides roughly one-third of PPFA‟s annual gross revenue. Table 2 provides detail on these revenue sources for its five most recent fiscal years (beginning July 1 and ending June 30). Table 2 (in millions) Fiscal year 03-04 04-05 05-06 06-07 07-08 Clinic income $306.2 $346.8 $345.1 $356.9 $374.7 Government $265.2 $272.7 $305.3 $336.7 $349.6 Contributions $191.0 $215.8 $212.2 $258.7 $244.9 Other income $ 47.6 $ 46.7 $ 40.2 $ 65.6 $ 68.8 Totals $810.0 $882.0 $902.8 $1,017.9 $1,038.0
Category one, clinic income, contributes the greatest revenue to Planned Parenthood‟s bottom line. A comparison of income from abortions, as shown in Table 1, with total clinic income, as shown in Table 2, (after adjustment for calendar vs. fiscal year differences) indicates that abortions generate approximately one-third of clinic income. A former PPFA director confirmed to WorldNetDaily news service that abortion represents the most lucrative part of clinic operations.30 The other two-thirds of clinic income is generated through compensation for services involving contraception, sterilization, pregnancy testing, HIV and sexually-transmitted disease testing, cancer screening and a growing RU486 chemical abortion business.
30S. ERTELT, “Planned Parenthood Director who Quit was Pressured to Meet Abortion Quotas”, LifeNews.com 11/5 (2009) in http://www.lifenews.com/state4548.html [7-11-2009].
Approximately 5,000 chemical abortions using RU486 were performed in the U.S. when this drug regime received government approval and went on the market in late 2000. That number rose to 55,000 in 2001, its first full year of use. In 2004, 140,000 women aborted using RU486, and in 2007, an estimated 158,000. RU486 is purported to be used in about 14% of all 17
abortions and 21% of abortions taking place in the first nine weeks gestation. The cost of a RU486 abortion is comparable to that of a first-trimester surgical abortion when follow-up visits are included.31 Government grants and contracts account for the second category of revenue noted in Table 2. Increasingly larger amounts are being obtained from various government programs each year. Almost $350 million was received in fiscal year 2007-2008. The money derives from several sources, but ultimately comes from taxpayer-funded subsidies. A portion of the governmental funding is from states and localities, particularly abortion-liberal states, like California and New York. The greater part, however, comes from two federal government programs---Title X and Medicare Waivers. Title X of the Public Health Services Act represents a bipartisan measure passed by Congress in 1970 as a way to prevent population explosion in the U.S. It accomplished its objective by distributing free contraceptives to low-income families. Although Title X officially expired in 1985, Congress continues to appropriate money for the program through regulations issued by the Department of Health and Human Services. Planned Parenthood affiliates are major beneficiaries of this program.
31 L. B. FINER - J. WEI, “Effect of Mifepristone on Abortion Access in the United States”, Obstetrics & Gynecology 9/12 (2009). 32Medicaid was founded in 1965 as Title XIX of the Social Security Act. It is a U.S. health program for eligible low-income individuals and families that is jointly funded by the states and federal government and managed by the states. 33C. ALLEN, “Planned Parenthood‟s Unseemly Empire: The Billion-Dollar Non-Profit”, The Weekly Standard 13/6 (2007), 10.
The other federal program channeling at least $61 million per year to Planned Parenthood is known as Medicare Waivers. The program began in 1993, when the Department of Health and Human Services decided to waive---for purposes of receiving free contraceptives---its usual income limits for qualifying for Medicaid32 benefits. Medicaid, unlike Title X, is an open-ended entitlement program so it is not dependent on Congressional appropriations for funding.33 18
The third main component of PPFA revenue is contributions, gifts, grants and bequests. It is generated through donations from individuals, corporations and large private family foundations, like the John D. Rockefeller and Bill and Melinda Gates Family Foundations. Since PPFA qualifies as a tax-exempt charity, tax laws are favorable to donors, allowing them a tax deduction against their income for amounts contributed.34 For private foundations, making grants to public tax-exempt charities is statutorily encouraged and not restricted within certain boundaries.35 2.2.2. Clinical Trials
34 INTERNAL REVENUE CODE (IRC) Section 170[c] allows a charitable contribution deduction to a corporation or trust organized in the U.S. and operated exclusively for religious, charitable, scientific, literary or educational purposes…or for the prevention of cruelty to children or animals. The organization must not be disqualified from exemption by IRC Section 501[c]3 for attempting to influence legislation. 35 Charitable organizations are classified as either public charities or private foundations, depending upon their sources of support. Generally, public charities have broad public support, while private foundations are typically supported by one individual or family.
36J. SEDLAK, “A Review of Planned Parenthood Clinical Trials”, Special Report (2009) in http://www.ss.all.org/pdfs/2009/stop_2009ppclinicaltrials.pdf, 1 [10-20-2009]. 37Cf. Ibid., 2.
An interesting aspect of Planned Parenthood‟s revenue sources discussed above, and not readily discernible, is its involvement in clinical trials. Funded by a broad array of government agencies, universities, private foundations and pharmaceutical companies, twenty-eight PPFA affiliates have participated in thirty-three clinical trials over the past decade. Planned Parenthood not only augments its income through the trials, but also enhances its professional identity by strengthening its university, government and industry profile. Many of the trials carried out included young teens. A number focused on the African-American and Hispanic communities.36
Clinical trials conducted by the NIH and its pediatric branch, the National Institute of Child Health and Human Development, centered chiefly on birth control and emergency contraception; i.e.; contraceptive choice, long-term contraceptive use, hormonal contraceptives, condom use in high-risk women, and increasing emergency contraceptive use among fourteen to twenty-four year olds.37 19
Pharmaceutical company participation was common in contraceptive studies involving oral drugs, injections and device-related methods.38 Merck, along with Emory University, conducted a clinical trial with Planned Parenthood Georgia designed to increase the use of its Gardasil Human Papillomavirus (HPV) injections. Bayer, along with the American College of Obstetricians and Gynecologists and Virginia Commonwealth University, joined the Virginia League of Planned Parenthood to study using NuvaRing, a vaginally-inserted birth control ring, in adolescents. Pfizer, along with the University of North Carolina, collaborated with PPFA in a trial training women to either self-administer Depo-Provera, a contraceptive injection, or to have the injection administered at a pharmacy. HRA Pharma is currently conducting trials at fifteen Planned Parenthood clinics on the safety and efficacy of Ella, a new emergency contraceptive designed to prevent pregnancy if taken three to five days after unprotected sex. 39 These contraceptive trials gave way to a number of clinical trails involving medical abortion techniques. Trials are under way seeking possible variations in FDA-approved methods of administering mifepristone, misoprostol, methotrexate and other drugs that cause chemical abortions. Organizations funding these studies include Gynuity Health Projects (a research and technical assistance group promoting medical abortions worldwide), the Society for Family Planning and the David and Lucille Packard Foundation.
38These contraceptive methods can have an abortifacient rather than a preventative effect in that they prevent the fertilized ovum from implanting in the lining of the uterus, thus destroying the zygote. 39Cf. J. SEDLAK, “A Review of Planned…”, 2-4.
The amount of profit, if any, inuring to PPFA by virtue of its participation in clinical trials is unknown, as it is not separately stated for accounting purposes. However, the wealth of marketing information gleaned from these studies is likely to be of even greater value. In addition to being merely an abortion provider, PPFA is closely involved in researching and developing new contraceptives and more efficient abortion techniques. Thirty percent of its clinical trials included teens, age thirteen to eighteen. Attracting teenagers to contraceptive use is a component of the abortion industry‟s business plan, as is offering abortion as a remedy for failed birth control. According to a former Texas Planned Parenthood director, “The money was not in family planning or prevention, but in abortion.” When struggling under the weight of a 20
tough economy, its business model changed from one that pushed prevention to one that focused on abortion.40
2.3. Political Landscape 2.3.1. Federal Framework
40Cf. J. HOFT, “Planned Parenthood Leader Resigns after Watching Abortion Ultrasound”, in www.http://gatewaypundit.firstthings.com/2009/11/planned-parenthood-leader-resigns-after-watching-abortion-ultrasound/ [11-4-2009]. 41Applicable laws include, but are not limited to, the Internal Revenue Code, Lobbying Disclosure Act, Federal Campaign Finance Law, Federal Election Campaign Law. 42 INTERNAL REVENUE CODE Section 501[h]; Regulation Section 1.501[h]-1.
When analyzing the political environment, it must be stressed that money is inseparable from politics, for good or for ill. A complex network of laws has been enacted to regulate political expenditures and lobbying in the U.S.41 The laws attempt to guard against abuses, while preserving First Amendment Rights, particularly the right to free speech. Regulations were promulgated to establish who is eligible to lobby and what dollar limitations apply. Registration and reporting are required by entities making politically-motivated expenditures.
For reporting purposes, the U.S. Department of Treasury, through Internal Revenue Service Regulations, distinguishes between two categories of lobbying: direct and grassroots. Different regulations and contribution limits apply to each category. Direct lobbying is defined as “participation or intervention in any political campaign, on behalf of, or in opposition to, any candidate for public office.”42 In contrast, grassroots lobbying attempts to influence the general public on legislative or policy matters; it is issue-oriented rather than candidate-oriented. To understand the amount of influence PPFA has on the political system, it is essential to look at the financial magnitude of both its direct lobbying expenditures for candidates and its grassroots lobbying efforts related to issues.
Frequently, an organization established as a charity wishes to pursue multiple goals, including charitable outreach and education plus legislative and political advocacy. Structure becomes all-important to avoid running afoul of political expenditure and lobbying laws. This can result in monetary penalties and potential loss of tax-exempt status. The necessary structure can require a complex network of legally separate but affiliated entities under common control, but with differing stated purposes.
2.3.2. Planned Parenthood Structure
Planned Parenthood accomplished this objective by including in its overall structure four separate legal entities:43 (1) Planned Parenthood Federation of America is a tax-exempt Internal Revenue Code (IRC) Section 501[c]3 charitable organization prohibited from engaging in political activities or substantial lobbying activities; (2) Planned Parenthood Action Fund is a tax-exempt IRC Section 501[c]4 social welfare organization that may engage in political activities, as long as these activities do not become its primary purpose; (3) Planned Parenthood Votes is a tax-exempt IRC Section 527 political organization that raises money either for issue advocacy or to influence the nomination or election of candidates; and (4) Planned Parenthood Political Action Committee (PAC) is a political committee that raises and spends money for the express purpose of electing or defeating candidates.44
43 PUBLIC CITIZEN, “The New Stealth PAC‟s” (2008), in http://www.stealthpacs.org/profile.crm?print=print&org_id=2835 [7-24-2008].
44 OPEN SECRETS.ORG CENTER FOR RESPONSIVE POLITICS, “Types of Advocacy Groups” (2009), in http://www.opensecrets.org/527s/types.php [7-29-2009]. 45S. MARTINEZ, “Planning to Spend Big”, Roll Call (5-15-2008), Letters to the editor.
Significant amounts of money are expended by Planned Parenthood for political purposes. It is extraordinarily difficult to determine which organization makes which expenditure. This lack of transparency is helpful in staying ahead of the political watch-dogs. Susanne Martinez, Planned Parenthood‟s Vice-President for Public Policy, wrote in a letter-to-the-editor that “Planned Parenthood‟s 501[c]4 group, its political action committee (PAC), and its 527 organization collectively spent more than $9 million during the 2000 elections.” She did not, however, offer a breakdown of spending by individual affiliate.45 22
2.3.3. Grassroots Lobbying
The blueprint for legislative advocacy issues opposed by PPFA can be found in the 1992 Supreme Court case Planned Parenthood v. Casey, which upheld the right to abortion while expanding the ability of states to regulate it. At issue in Casey were five provisions of the Pennsylvania Abortion Control Act of 1982. First, a woman seeking an abortion was required to give her informed consent prior to the procedure. Second, she was required to be provided with information about the fetus‟s development and abortion‟s health risks, along with counseling about abortion alternatives, at least 24 hours before performance of the abortion. Third, the law mandated the informed consent of one parent for a minor to obtain an abortion, allowing for a judicial bypass procedure when necessary. Fourth, a married woman seeking an abortion was required to sign a statement indicating that her husband had been notified of her abortion. Fifth, the law imposed certain reporting requirements on facilities providing abortion services. The Supreme Court only struck down the husband notification provision. All other provisions were deemed not to place an “undue burden” on a woman‟s access to abortion. “Undue burden” was defined as “a substantial obstacle in the path of a woman seeking the abortion of a nonviable fetus.” 46 PPFA, along with other abortion-rights advocacy groups, has a long history of opposing any restriction on abortion. The rationale is that any constraint on a woman‟s right or access to abortion systematically undermines the protections of Roe v. Wade. Proposed federal and state laws and initiatives that attempt to place any limitation on unfettered access to abortion have been vigorously fought. Both grassroots lobbying efforts and infusion of significant financial resources into legislative campaigns are employed to achieve this aim. Ballot initiatives containing restrictions proven to reduce the number of abortions are often defeated at the polls through PPFA‟s effective and costly campaigns. From the evidence, abortion reduction is not a goal of abortion providers. Abortion is a business and businesses are not in favor of legal restrictions leading to a loss of revenue.
46 Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992). 23
One of the key issues in Casey confronted both at the federal level and in virtually every state, is parental involvement in the abortion of a minor. More than half the states have laws that mandate parental consent or notification before an abortion can be performed on an unemancipated minor. However, these laws are often circumvented when minors are transported across state lines to states that do not require parental involvement. Congress has tried to prohibit this practice and protect parental rights. The U.S. House of Representatives passed legislation four times between 1998 and 2005 to make it a federal offense to transport a minor across state lines for an abortion, without fulfilling the parental involvement requirements in effect in the minor‟s home state. Similar legislation was passed in the U.S. Senate in 2006. It was procedurally blocked by the Senate Democratic leadership, consistent recipients of PPFA‟s campaign contributions and targets of its lobbying efforts. None of these bills passed into law.
At the forefront of the fight against the Senate‟s Child Custody Protection Act and its House of Representatives‟ counterpart, the Child Interstate Abortion Notification Act, was the abortion lobby. It was led by the National Abortion Federation, NARAL Pro-Choice America, Planned Parenthood Federation of America and The Alan Guttmacher Institute.47 One commentator expresses the dilemma that faces abortion providers this way:
47 AMERICAN CIVIL LIBERTIES UNION, “Coalition Sign on Letter Expressing Opposition to the Child Custody Protection Act” (2004), in http://www.aclu.org/reproductiverights/abortion/12586leg30040601.html [7-30-2009]. 48C.C. GARGARO, “Protecting the Rights of Parents and Young Women--in Defense of the Child Custody Protection Act”, The South Jersey Courier Post (7-12-1998).
“If abortion advocates support reducing teen pregnancies, as they often claim, then why are they so harsh on a law which has been proven to reduce teen pregnancies? Perhaps it is because, according to Planned Parenthood‟s own statistics, mandatory parental involvement provisions result in a 24% to 85% reduction in teen caseloads at family planning clinics. (Issues in Brief 4:3, March 1994, Alan Guttmacher Institute) This reduction in caseload creates a reduction in cash flow for Planned Parenthood. Is it any wonder they dislike parental consent and notification laws?”48
At the state government level, thirty-seven of fifty states had parental involvement laws on their books at June 15, 2006. These were passed either by state legislatures or voters. Planned Parenthood affiliates brought suit in fourteen of these states to enjoin or overturn the 24
statutes. Other abortion businesses sued in six other states to prevent the laws from going into effect.49 The challenges met with varying degrees of success in different states.
49NATIONAL RIGHT TO LIFE COMMITTEE, INC., “Parental Involvement Statutes-June 15, 2006” (2006), in http://www.nrlc.org/federal/CCPA/Index.html [7-30-2009]. 50In an effort to give Californians a voice in state government, the California Constitution grants voters a right to engage in an initiative process to amend their constitution, adopt a state statute, overturn legislation passed by the state legislature and recall politicians at the state and local level. The initiative process is generally believed to benefit grassroots movements.
51CALIFORNIA CATHOLIC DAILY, “Undue Burden on Reform-Minded Californians” (2009), in http://calcatholic.web141.discountasp.net/news/newsArticle.aspx?id=4c430d5a-5a7c-48d9-8ad5-c1622a66f1ef [10-15-2009].
52Cf. W.F. JASPER, “California’s Prop 4: Abortion and Parental Notification” (2008), in http://www.thenewamerican.com/index.php/culture/family/371?tmpl=component&print=1 [7-30-2009].
In California, three parental notification initiatives50 were placed before voters during the past three election cycles. PPFA was consistently the largest funder of efforts to defeat the initiatives. Campaign strategies included the effective use of campaign literature, well-timed television and print advertisements, editorials and news stories, as well as direct-calling campaigns. Although opinion polls consistently showed overwhelming public support for parental notification (from 70% to 80%), all three initiatives narrowly failed following massive television ad campaigns by Planned Parenthood in the weeks preceding election day.
According to state campaign reporting-requirement disclosures, Planned Parenthood operations from across the nation spent approximately $5.5 million to defeat California‟s 2005 parental notification initiative. They spent $6.5 million against the 2006 initiative. A record-breaking $10 million went towards defeating the 2008 measure.51 This influx of funds caused many to question whether state elections are being hijacked by out-of-state interest groups.52
2.3.4. Direct Lobbying
Which political candidates does PPFA support financially and ideologically? A comparison of the Democratic and Republican Party Platforms with respect to abortion answers the question. The Democratic Party Platform states, “Because we believe in the privacy and equality of women, we stand proudly for a woman‟s right to choose, consistent with Roe v. Wade. We believe it is a constitutional liberty.” The Republican Party Platform states, “We say the unborn child has a fundamental right to life. We support a human life amendment to the Constitution and we endorse legislation that the Fourteenth Amendment‟s protections apply to unborn children. We oppose abortion.” The logical inference, that the abortion industry overwhelmingly supports Democratic Party candidates, is supported by statistical data compiled by the Center for Responsive Politics. This organization tracks long-term political contribution trends by industry from information reported to the Federal Election Commission. During the 1990 through 2008 election cycles, the abortion industry made political contributions of $15.76 million. Of this amount, $12.61 million, or 80%, went to abortion-supportive Democrats running for office. The abortion industry was included in the top 80 industries contributing to the Democratic Party in each of these years, ranking 74th (on average) in total giving.
A review of the past several election cycles indicates that Planned Parenthood affiliates ranked in the top 50 abortion-industry political spenders.53 PPFA is a potential source of considerable campaign contributions. This accounts for much of the power it exercises in the political arena. It also sheds light on the reasons why candidates and potential candidates would seek to establish and maintain a favorable working relationship with PPFA. That is, unless severe ideological differences made it impossible. Congressional loyalty to this special interest group was demonstrated on July 29, 2009, when the Pence Amendment to defund Planned Parenthood was voted down in the U.S. House of Representatives primarily along party lines. The amendment to the Health and Human Services Appropriations Bill stated, “None of the funds made available under this Act shall be available to Planned Parenthood for any purpose under Title X of the Public Health Services Act.” The reasons for introduction of the amendment were articulated by Republican Representative Chris Smith of New Jersey. He spoke in favor of its passage:
53 OPEN SECRETS.ORG CENTER FOR RESPONSIVE POLITICS, “Abortion Policy/Pro-Choice: Long-Term Contribution Trends” (2008), in http://www.opensecrets.org/industries/indus.php?ind=Q15 [5-25-2008]. 26
“Planned Parenthood has caused a staggering loss of children‟s lives. The organization aggressively lobbies and litigates against every modest restriction proven to significantly reduce abortions and has even opposed bans on partial-birth abortions… Planned Parenthood lobbies and litigates against prohibitions on taxpayer funding of abortion even though Planned Parenthood‟s own research shows that funding bans reduce abortion by 20 to 35 percent.”54 As a practical matter, government funds awarded to PPFA for a specific restricted purpose----Title X spending, for example---results in available non-restricted funds being freed up for other elective purposes. This allows monies derived from any non-restricted source to support and enhance the abortion segment of its business, at the discretion of its directors. It is ironic that, in more than a few instances, the government has indirectly provided funds to PPFA to enable it to litigate federal cases restricting abortion; i.e.; cases requiring parental notification or banning partial-birth abortion. Thus, the government finds itself in the curious position of funding its own opposition in lawsuits of the type referred to above by Representative Smith.
54CATHOLIC NEWS AGENCY, “U.S. House Votes Down Pence Amendment Intended to Defund Planned Parenthood”, (2009), in http://www.catholicnewsagency.com/utilities/myprint/print.php [7-29-2009]. 55In his Senate nomination acceptance speech of June 15, 1858, Abraham Lincoln quoted Matthew 12:25, in reference to the division of the country between slave and free states.
“A house divided against itself cannot stand,” warned the great slave emancipator, Abraham Lincoln.55 The people and the government of the United States appear to be as divided on the question of abortion today as they once were on slavery. 27
Chapter 3 THE FETAL TISSUE INDUSTRY That a fetal tissue industry exists might surprise many people. Few questions are asked about what happens to the millions of fetuses that are by-products of abortion. In general, the public would rather not know the answers to these practical questions. Instead, assumptions are made or the aftermath of abortion is not consciously considered. The abortive mothers in particular are not the ones asking what becomes of the fetal remains. They understandably want to walk away from their experience quickly and quietly. Realistically, informed consent about the disposition of the fetus has little significance. Legal documents required to be signed before the abortion procedure takes place are frequently signed without understanding, under stress or even under duress. Consent may not always be free and informed. Simply defined, fetal tissue is tissue taken from a human fetus. It includes the fetus in its entirety or individual fetal parts: i.e.; blood, bone morrow, organs, brain, spinal cord, eyes, arms, legs, etc. More recent scientific advancements have expanded the scope and usage of fetal tissue to include the cells of the embryo---the fetus in its earliest stage. Fetal tissue can be obtained ethically from ectopic pregnancies or spontaneous abortion (miscarriage), but the most available and functional source is induced abortion. Its uses include research, experimentation and product development.
Although disposition of fetal remains can take several forms, this chapter will specifically treat the acquisition and utilization of fetal tissue for research and development. To the extent the bodies are otherwise disposed of, the law requires that they be treated as medical waste and be either buried or incinerated. However, the practice of accepting fetuses for incineration is not the industry norm. Stericycle, the largest medical waste disposal company in the country, refuses to dispose of fetal remains due to a clause in their drivers‟ labor contract that allows the drivers to refuse to accept fetal waste. Typically, cremation of the remains takes place or they are released into the sewage system.56
56Cf. M. GARCIA, “What do they do with them?”, San Francisco Faith (1-6-2001). 28
Several factors make fetal tissue a preferred source of transplant material, including its potential for growth, its ability to differentiate into other types of cells, and its ability to integrate into a transplant recipient with decreased possibility of rejection. These factors are the same ones cited today in identifying the unique advantages of human embryonic stem cells in research and potential medical treatments.
3.1. Legal History
American researchers have engaged in fetal tissue research since the 1930‟s. Fetal tissue transplants first became successful in 1968. These transplants were thought to hold particular promise for Parkinson‟s disease, diabetes, a<