Ethical dilemmas present themselves every day, especially within the healthcare field. Over the years, there has been the development of different viewpoints on how to navigate through these dilemmas. In this paper, the ethical issue commonly referred to as savior sibling will be discussed. A savior sibling is an individual who is conceived through in vitro fertilization for the sole purpose of being a donor to a sick child. During the process of conceiving a savior sibling, fertilized eggs are tested for genetic compatibility using Preimplantation Genetic Diagnosis (PGD) with a human leukocyte antigen (HLA) and only eggs that are compatible with the existing child that is sick are selected. This process has also led to many questions including if it is ethical to dispose of all of the other embryos that were not compatible with the existing child. Since the first savior sibling was born in the United States in 2000, there have been varying viewpoints and stances regarding this ethical dilemma. The ethical problem will be dissected by looking at it through the utilitarian viewpoint as well as the deontological viewpoint.
The question of whether or not it is ethically correct to conceive a child for the purposes of the child being a donor for a child that is sick is one that still debated today. The utilitarian ethical approach supports that decisions should be made in regard to what is best for most people. This approach is fixed in the assumption that the right decision is made if it leads to a balance of good consequences or to the least amount of bad consequences. (Jacob and Cherry, 2017). From the utilitarian stance, the conception of a child that will be either an organ, bone marrow or cell transplant donor to a child that is sick is right because it will result in the sick child being treated or cured. In a case similar to the Nash family, the health authorities in the U.K. approved of the authorization of the creation of a savior sibling to cure the illness of a child. The U.K. health authorities deemed the conception of the child therapeutic because the family would be selecting an embryo that would be free from the genetic disease of the existing child (Zuniga-Fajuri, 2018).
The utilitarian ethics theory focuses on making decisions that are based on the greatest amount of benefit for the greatest number of individuals. It is ultimately guided by the benefits outweighing the risks (Mandal, Ponnambath, & Parija, 2016). In the case of PGD and savior siblings, studies have shown that families motivating factors in choosing to go through the process were to avoid suffering of the existing child, the desire to improve the health and quality of their child as well as the desire to raise a child that is healthy (Garzon, Rubin, Lobel, Stelling, & Pastore, 2017). These motivating factors align with the utilitarian point of view because they are rooted in the result being good for the parents and the existing child. In line with the utilitarian ethical theory, the benefit of going through with PGD and conceiving a child that will be able to help the existing child outweighs the risks and is done for the overall wellbeing and good of the family. In regard to the potential disposal of unselected embryos during the PGD process, the utilitarian viewpoint would view that as ethical because unselected embryos present with the risk of being born with genetic diseases and studies have shown that families who consider PGD would feel guilty and see no benefit in passing on genetic health problems to future generations (Pastore et al., 2017).
According to Jacob and Cherry (2017), the deontological view point is rooted in the belief that ethics are to be based on the principle of consistently acting one way and doing what is right. This is a contrast to the utilitarian viewpoint because it is centered on harm being unacceptable (Mendal et al., 2016). The originator of the deontology theory, Immanuel Kant, believed that human beings should not be treated as a means to an end but as an end in themselves (BBC, 2014). The deontological stance views the process of PGD and conceiving a savior sibling as unethical because it violates human rights by disregarding the dignity of the savior sibling for the sake of the overall good and social well-being (Zuniga-Fajuri, 2018). According to Zuniga-Fajuri (2018), studies have shown that infant donors have an increase in anxiety and stress. The article goes to state that there are a number of physiological problems that infant donors deal with that arise from the medicines given for anesthesia during the transplant procedure and the adverse effects of the transplant itself. In cases of bone marrow transplant, problems such as fatigue, pain, bleeding, headaches, nausea, and difficulty walking, and sleeping were all reported. From the deontological viewpoint, the decision to have a savior sibling would be wrong because it violates the sibling and does harm to them as an individual.
In regard to the potential disposal of unselected embryos during the PGD process, the deontological viewpoint would view that as unethical because there is the belief that at the time of conception there comes into existence a new life a living cell from the father fertilizes a living cell from the mother Each such new life is the life not of a potential human being but of a human being with potential (Dickens, 2016, p. 115).
The utilitarian theory and the deontological theory provide opposing views on the ethics of savior siblings and PGD conception. While the utilitarian theory would deem the conception of a savior sibling as right because the result would benefit the sick sibling and allow for treatment of the illness, the deontological theory deems it as wrong because harm would be done to the savior sibling as they would be seen as a means to an end.
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