Edward and Susan: My Sister's Keeper ethical dilemma
The film My Sister's Keeper is an emotionally wrought dramatization of what is a very real medical conundrum for some parents today, given advances in medical technology. The drama revolves around the question of the creation of a 'savior sibling,' genetically designed from birth to help her existing sibling survive (My Sister's Keeper: Science Background Talk, n.d., SCU). In the parallel case of Edward and Susan, a couple with a daughter with Acute Childhood Lymphoid Leukemia, many of the objections that people have raised to IV will not likely be persuasive to them: they have already used the technology to have their first child. Additionally, the sibling would be a wanted child, given the couple had always wanted a bigger family, but had held off because of fears of passing on a genetic disorder. The main ethical question for the parents is if it is right, morally speaking, to bring a child into the world which would likely feel tremendous pressure to sacrifice her body for the sake of her sibling and who might have the psychological trauma of feeling unwanted, once the purpose of her genesis becomes clear.
In-vitro fertilization is the fertilization of eggs outside of the mother's womb. "In order to maximize the number of eggs for in vitro fertilization, the patient takes medication that can be utilized alone or in combination to induce several follicles to develop" (In-vitro fertilization, 2013, Arizona Center for Reproductive Endocrinology and Infertility). The eggs are then harvested, inseminated with the partner's semen, and "the eggs are placed in a petri dish in a special culture medium which consists of several essential chemicals. We retrieve as many eggs as possible and immediately transfer them to the incubator where conditions simulate body conditions as closely as possible" (In-vitro fertilization, 2013, Arizona Center for Reproductive Endocrinology and Infertility).
A number of factors may cause a couple to select IV, including low egg or sperm count or, as in the case of Susan and Edward, to screen for genetic defects. According to one laboratory which performs the procedure: "we recommend that all the eggs be inseminated so that there will be a chance of obtaining several embryos. If there is male factor infertility, this is the point at which we would perform ICSI to assure fertilization" (In-vitro fertilization, 2013, Arizona Center for Reproductive Endocrinology and Infertility). The need to plant as many eggs as possible means that selective abortion may be required to ensure that not too many babies grow within the mother's womb, which (despite a few much-publicized successful multiple births) can be highly risky to the health of both mother and child. Also, when certain diseases such as hemophilia are male-specific, selective screening for gender can also be deployed.
The moral objections raised to IVF are thus very similar to those raised to abortion: that it is wrong to take the life of an embryo because it is analogous to a person. Using IVF almost invariably requires selective reduction of embryos for it to be safe and effective, particularly if used to have a sex-specific child. For some people, according to their religious beliefs, this is tantamount to murder, because the life of one embryo should not be regarded as superior as to the life of another. They may regard it as 'God's will' when and if the couple can reproduce, and do not believe it should be placed in the hands of medical science. A slightly less fundamentalistic viewpoint still might find it objectionable to so cavalierly dispose of even potential human life. However, supporters of the procedure note that it is often the last hope of a couple who desires to have their own biological child; the difficulty of adoption in many instances, and most notably the use of the embryos in valuable applications, such as stem cell research; which could potentially provide cures to diseases much like the one from which Susan and Edward's daughter Michelle is suffering. (Of course, opponents to IVF and abortion also oppose stem cell research as unnecessary, and advocate the use of other applications instead).
Creating a 'savior sibling' for Michelle would not only require another IVF procedure, but would demand careful selection of the resulting embryos so they are a good match to allow for hematopoietic stem cell transplantation and also are not likely to have Michelle's particular condition. Thus selective termination of some embryos would be inevitable. The use of PGD would be essential. "Preimplantation genetic diagnosis (PGD) is a reproductive technology used with an IVF cycle. PGD can be used for diagnosis of a genetic disease in early embryos prior to implantation and pregnancy" (What is PDG, 2013, Genetics and IVF institute). Its advocates note that selective screening for potentially deadly disorders like Huntington's Disease, Duchenne Muscular Dystrophy, cystic fibrosis, and other genetic disorders can prevent potentially traumatic abortions well into the pregnancy, after the woman has undergone amniocentesis.
However, opponents to PDG once again raise the objection that it is 'playing God' and consider it wrong to terminate an embryo simply because it has a genetic disorder. The most extreme opponents to PDG view it as tantamount to killing people who have conditions deemed by society to be disorders. However, even persons who do not feel an embryo is analogous to a baby may be uncomfortable with the idea of genetically 'engineering' a child by carefully selecting an embryo with the most desirable characteristics. What is the moral difference, they ask, between selecting a child because it is female because one of the parents has a genetic disorder vs. parents selecting a male embryo simply so they can have a son vs. A daughter?
However, given that the couple has already used IVF and PDG, the most serious ethical question which arises is the ethics of specifically using these technologies to create a child that would not otherwise exist to serve the needs of their current child. This scenario does not only exist in fiction: in one much-publicized event a couple had a child with "Fanconi anemia, a blood disorder that almost always results in leukemia by the age of 10 [without a bone marrow transplant]…It took several rounds of in-vitro fertilization…to get an embryo that cleared both hurdles" (Marcotty 2010). The baby boy, named Adam, saved his sister's life and the parents said that they felt justified. "After all, they simply used a few teaspoons of Adam's umbilical cord blood that would otherwise 'have hit the trash can'" (Marcotty 2010).
Issues of 'savior siblings' become murkier in instances where the sibling must undergo multiple procedures. In the case of My Sister's Keeper, the savior sibling was forced to undergo repeated medical treatments, many of which were not risk-free. Being asked to donate a kidney, for example, is a major operation, and there is always the risk that the donor's one kidney may fail. Even when the medical demands are less extreme than in My Sister's Keeper, the parents, however lovingly, are effectively making a decision for their younger child that could have lasting physical consequences. The second child is under tremendous pressure to submit and there will always be the lingering question of who the parents love 'more' -- the sick child or the child who is being 'used' as the savior.
Parents of savior siblings would counter that such anxieties are not abnormal even in conventional families, where a much younger sibling might wonder if he or she was really 'wanted.' Even medical ethicists have countered that the idea of having a child for 'instrumental' purposes is not necessarily so different from other supposedly 'intentional' reasons such as to have a boy or to please one's own parents, etcetera (Sheldon & Wilkinson 2004). Even the fear of…