Disclaimer: The views expressed are that of the individual author. All rights are reserved to the original authors of the materials consulted, which are identified in the footnotes below.
By Danielle Mitchell
Introduction
Tissue typing is a form of pre-implantation genetic diagnosis (PGD). In the context of saviour siblings, it is the process by which the cells of an embryo are tested for tissue compatibility with an existing child, to determine the future child’s suitability to act as a donor for the existing child. A treatment licence for tissue typing may be authorised under the Human Fertilisation and Embryology Act 2008 (HFEA) where the sibling ‘suffers from a serious medical condition which could be treated by umbilical cord blood stem cells, bone marrow or other tissue of any resulting child’.[1]
According to Glover, there must be ‘a very powerful reason to resist the means by which a child’s life can be saved’.[2] As such, it will be argued that the oppositions to tissue typing are inadequate to prohibit the practice. Rather, the HFEA reaches an appropriate balance by permitting tissue typing in the circumstance set out, but not going so far as to permit the creation of embryos with the intention of the resulting child donating a non-regenerative organ.
Commodification
A key objection to saviour siblings is the idea that it treats the child as a commodity. The procedure is ‘undertaken simply for the benefit of another’ and consequently the resulting child is being created to serve another.[3] This criticism is founded in the dictum of Kant; ‘never use people as a means but always treat them as an end’.[4]
However, there are several problems with relying on this interpretation of Kant. Firstly, it is not clear that Kant’s statement applies to embryos, since Kant refers to personhood as requiring rationality, which embryos do not possess.[5] Moreover, Boyle and Savulescu contend that the statement has been misinterpreted; it does not prohibit treating a person as a means if you simultaneously treat them as an end.[6] Therefore, provided that the parents treat the child as a person in its own right once it has been born, the commodification objection fails. As Ram notes, ‘it is reasonable to believe that parents willing to go to such extraordinary lengths to save their existing sick child are likely to be the sort of parents who would care deeply for each of their children in their own right’.[7] Consequently, it is unlikely that a saviour sibling would ever be treated solely as a means, and disposed of after donation.
The Welfare of the Child
In determining the ethical acceptability of any reproductive technology, it is necessary to consider the welfare of the child being created. There are two main strands to this argument, concerning physical harm and psychological harm.
In terms of physical harm, it is argued that because the risks of PGD remain unclear, and because testing does not benefit the embryo itself, tissue typing may be ethically impermissible.[8] However, the same risks are involved in PGD testing for disability; if such risks are accepted to screen out disability, then those risks should also be justified to save a life. Additionally, Sheldon and Wilkinson point out that PGD testing for disability does not benefit the embryo, since it is used to select an embryo that does not have a disability in the first place; it is simply an information tool.[9] Since PGD testing for disability is permissible, tissue typing cannot be argued to be impermissible on the grounds of physical risk and a lack of benefit to the embryo.
Alternatively, it is claimed that the potential psychological harm to the child from knowing that they were a saviour sibling is sufficient to prohibit the practice. The concern here is that if the child knows they were conceived not because of their parent’s desire to have another child, but to save their sibling, it might induce feelings of not being wanted. In addition to being a merely speculative problem, the virtue ethics response to this concern highlights the loving motives of parents who opt for tissue typing; ‘the fact that the parents are willing to conceive another child to protect the first suggests that they are highly committed to the well-being of their children, and that they will value the second child for its own sake as well’.[10]
Therefore, the potential risks to the embryo and future child are not sufficient to warrant a ban on tissue typing. Moreover, even if the risks were proven, it could be argued that tissue typing should be permissible nonetheless. As per a utilitarian view, the potential benefits for the sick child are so significant that they justify the minimal risks to the future child.
Slippery Slope
The premise for this opposition is that permitting tissue typing would eventually lead to permitting ‘designer babies’. The ethics of ‘designer babies’ will not be discussed here, but for argument’s sake, it will be assumed that such practices are ethically impermissible. The criticism, as voiced in the Quintavalle litigation, is that ‘the new technique is a dangerous first step towards allowing parents to use embryo testing to choose other characteristics of the baby, such as eye colour and sex’.[11]
In response to this, it is argued that not only is there a lack of empirical evidence to support the claim, but also that any potential slide down the slope can be prevented through pre-emptive legislation. The HFEA only permits PGD in specific circumstances, all of which focus on health outcomes, rather than aesthetics. As Ram notes, ‘disease testing PGD is designed to secure healthy children. Tissue typing PGD is aimed at that same end’.[12] Since the aims of tissue typing differ to the aims of ‘designer babies’, there is no clear link in how one might lead to the other. Therefore, as long as the legislation is not reformed to include PGD for reasons other than health, ‘designer babies’ will remain illegal.
Conclusion
Whilst there are some genuine concerns about the impact of tissue typing on the saviour sibling, it has been contended that these risks are insufficient to render the practice morally impermissible. This article has attempted to demonstrate the inadequacies of several key objections to tissue typing, concluding that none offer a powerful enough reason to prohibit a means to save the life of an existing child. The HFEA provides a suitable compromise which limits the risks to the future child whilst still providing a way to save the existing child.
Sources
[1] Human Fertilisation and Embryology Act 2008, sch 2, para 1ZA, s(d)
[2] Jonathan Glover in Sally Sheldon and Stephen Wilkinson, ‘Should Selecting Saviour Siblings be Banned?’ (2004) 30 J Med Ethics 533, 533.
[3] Natalie Ram, ‘Britain’s New Preimplantation Tissue Typing Policy: An Ethical Defence’ (2006) 32 J Med Ethics 278, 279.
[4] Immanuel Kant in Sheldon and Wilkinson (n2) 534.
[5] (n3) 279
[6] Robert Boyle and Julian Savulescu, ‘Ethics of Using Preimplantation Genetic Diagnosis to Select a Stem Cell Donor for an Existing Person’ (2001) 323 BMJ 1240, 1241.
[7] (n3) 279.
[8] (n3) 278.
[9] (n2) 535
[10] John Robertson et al, ‘Conception to Obtain Hematopoietic Stem Cells’ (2002) 32 The Hastings Center Report 34, 35.
[11] R (Quintavalle) v Human Fertilisation and Embryology Authority [2003] EWCA Civ 667.
[12] (n3) 281
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