Is it Ethical to Have a Child to Save a Child?

Abstract

Source: Sheldon S, Wilkinson S. Should selecting saviour siblings be banned? J Med Ethics. 2004;30:533–537.Human leucocyte antigen (HLA) typing can be combined with preimplantation genetic diagnosis (PGD) to identify a human embryo for implantation that is HLA-matched to a sibling, and therefore capable of donating life-saving tissue to that sibling. The creation of “savior siblings” raises several ethical concerns. Arguments against the procedure fall into 3 categories. First, savior siblings may be treated as commodities or, in Kantian terms, as a means rather than an end in themselves. Second, a slippery slope argument suggests that allowing this technology may lead to the creation of “designer babies” with traits chosen for superficial reasons. Third, a child welfare concern about the possible physical or psychological harm to the savior sibling exists. The authors address these 3 arguments and offer the following 3 counter-arguments. First, Kant’s dictum prohibits treating others “solely as a means to an end,” and while savior siblings do serve an end, they are not used solely as a means to that end, but are recognized as important beyond their ability to donate tissue. Second, the slippery slope concern can be met by limiting the use of selection to non-trivial purposes. Finally, there is no reason to assume that savior siblings will, on average, have worse lives than other children undergoing PGD. The authors conclude that this therapy should not be banned, at least in cases in which only umbilical cord tissue is needed.Dr. Silber has disclosed no financial relationships relevant to this commentary.Unless one is opposed to preimplantation genetic diagnosis, the scenario discussed by these authors is not only ethically permissible, but it even raises the issue of whether physicians have a duty to educate parents who have a child with cancer about the existence of this possibility. A “savior child,” as the name denotes, will always have a special place in the family mythology. A child that comes into the world with such awesome gifts is not likely to be looked upon as a commodity by the family. Parents that demonstrate such loyalty to one of their children that they prepare to pursue a cure through this new technology are also likely to be parents who will prove just as loyal to their newborn. When one life can be saved by bringing into the world another life that will be loved, what is there not to like?Despite the support by these authors and the commentator, the ultimate benefits versus risks of savior sibling therapy remain to be seen. Siblings of children with chronic illness and disabilities who were brought into the world expressly to save an ill sibling may suffer psychologically in families attuned to the demands of the physically ill child. Future evidence-based studies of this practice are needed before we can conclude that the answer is in.