Savior Siblings and the Ethics of Preimplantation Genetic Diagnosis
This paper examines the ethical and moral controversies surrounding preimplantation genetic diagnosis (PGD) when used to create "savior siblings" — children conceived and selected to provide HLA-compatible stem cells or tissue to a critically ill brother or sister. The paper traces PGD's origins, outlines the diseases that make such procedures medically necessary, and surveys competing ethical positions on embryo selection, the moral status of embryos, and the psychological welfare of the donor child. Real-world cases, including the Whitaker and Hashmi families in the United Kingdom, illustrate how policy, law, and ethics intersect. The paper also discusses the unique role nurses play in supporting and assessing families who pursue this process.
- Introduction: Overview of savior sibling concept and PGD
- Preimplantation Genetic Diagnosis: History, definition, and uses of PGD
- Ethical Controversies and the Debate: Arguments for and against savior sibling creation
- Moral Issues in Embryo Selection: Embryo moral status and objections to selection
- The Medical Need for Savior Siblings: Diseases requiring HLA donors and real UK cases
- Summary and Conclusion: Synthesis of debate and nursing responsibilities
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What makes this paper effective
- The paper draws on multiple peer-reviewed sources and real case studies — the Whitaker and Hashmi families — to ground abstract ethical arguments in concrete, human situations.
- It presents opposing viewpoints fairly, giving space to both supporters and critics of savior sibling creation, which strengthens its analytical credibility.
- The conclusion connects the ethical debate to the specific professional role of nurses, giving the paper a clear disciplinary focus and practical takeaway.
Key academic technique demonstrated
The paper uses a multi-perspective ethical analysis framework, systematically presenting deontological concerns (the child as an end versus a means), consequentialist arguments (saving 330,000 children annually), and virtue-based reasoning (the character of loving parents). This layered approach allows the author to show that no single ethical lens resolves the dilemma, reflecting mature academic reasoning about contested bioethical questions.
Structure breakdown
The paper opens with a definition and history of PGD, then moves through escalating levels of controversy — from general ethical debate, to specific moral objections about embryo status, to the medical necessity argument. Real-world UK policy cases provide applied examples. The conclusion synthesizes the tension and introduces the nurse's professional responsibility, bookending the clinical framing established at the outset.
Introduction
This paper addresses the ethical issues that arise when parents undergo a procedure to conceive a child who will perfectly match the blood type of an existing sick child, for the purpose of saving that sick child's life. This procedure is known as preimplantation genetic diagnosis (PGD). While it provides hope to desperate parents, it also carries significant ethical implications and concerns.
Preimplantation Genetic Diagnosis
Preimplantation genetic diagnosis is described as an "early form of pre-natal diagnosis and a procedure in which a biopsy is taken from an embryo previously fertilized outside of a woman's womb to determine different characteristics about that embryo prior to in vitro fertilization and implantation" (Fasbender, 2009, p. 17). This procedure was first used in 1989 for the purpose of avoiding "the implantation of an embryo that was affected by a mutation or chromosomal abnormality associated with serious illness" (Fasbender, 2009, p. 17).
Uses for PGD since that time include "family balancing" — that is, choosing the sex of a child — and, more controversially, the creation of a child "who is Human Leukocyte Antigen (HLA)-matched with a preexisting sibling in need of stem cell transplants" (Fasbender, 2009, p. 19). Using the procedure in this manner enables parents to select an embryo free from serious genetic disease while simultaneously selecting for a tissue match, so that the umbilical cord blood of the resulting baby can provide stem cells to treat a seriously ill sibling (Spriggs, 2005, p. 341). Future marrow and tissue donation may also be expected from the donor child, which further intensifies the ethical debate (Fasbender, 2009, pp. 19–20).
Ethical Controversies and the Debate
Ethical controversies surround the creation of the "savior child" because, as Fasbender (2009) explains, when PGD is used to test for genetic diseases, that testing is done in the best interest of the embryo or the person it will become. By contrast, when PGD is used solely for tissue typing, the controversy centers on the fact that the only direct benefit is to the already existing and sick child (p. 20). Devolder (2005) states that PGD "is not a cure, it is a selection procedure. An embryo is selected because of the genetic characteristics it already had" (cited in Fasbender, 2009, p. 20). The basis for creating a child to save another child's life rests on the fact that transplantation from an HLA-identical sibling "is associated with a much higher success rate than a transplant from alternative donors" (Fasbender, 2009, p. 20). The ethical debate focuses on the extent to which the donor child may become "a lifelong donor subject to repeated tests and procedures, as well as the risks associated with procedures and the extent of bodily invasion" (Fasbender, 2009, p. 20). To this concern, Devolder (2005) states:
"…the standard employed is what would be acceptable if the donor child already existed. Umbilical cord blood harvest is widely accepted since it entails no physical intrusion. Bone marrow donations from young children to siblings are also widely accepted. Harvesting vital organs from children is not acceptable in view of the risks involved for the donor child." (p. 584)
Some individuals view the use of PGD to create a savior child as "merely conceiving a child as an instrument to cure another child." However, it is noted that the reasons parents have children today are many and varied, including "benefits to the couple's marriage, continuity of the family name, economic and psychological benefits to the parents upon aging, and providing a playmate for an existing child" (Devolder, 2005, cited in Fasbender, 2009, p. 21). The work of Knoppers et al. (2006) states:
"…most parents have a broad range of reasons and expectations when they decide to have children, which also instrumentalizes them to a degree, leading some authors to conclude that, as long as the tissue donation would be ethical if performed on an existing child, bringing a child into the world to serve as a tissue donor is ethical if the child is also valued for him or herself." (cited in Fasbender, 2009, p. 21)
Those who support the use of PGD argue that the practice is acceptable if the parents intend to "rear and love the donor child" (Fasbender, 2009, p. 20). Indeed, Devolder (2005) holds that the fact that "these parents make so much effort to try to save their child suggests they are caring and loving parents and makes it very unlikely that they will treat the new baby as a 'bred to order child'" (p. 584). An ethical dilemma that has not yet been fully investigated concerns the psychological ramifications for the donor child upon learning that they were selected for the express purpose of saving another life. Additional psychological factors include "whether the child's welfare is subordinated to that of the sick sibling, whether initial tissue donation is successful or further donations are required, and whether the sick child is ultimately cured or dies" (Fasbender, 2009, p. 21).
Bibliography
Dobson, R. (2003). "Savior sibling" is born after embryo selection in the United States. BMJ, 326(7404), 1416. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1151027/
Devolder, K. (2005). Preimplantation HLA typing: Having children to save our loved ones. Journal of Medical Ethics, 31, 582–586.
Fasbender, W. (2009). The savior child: Having a child to save a sibling — is this right? The Journal of Undergraduate Nursing Writing, 3(1).
Hashiloni-Dolev, Y., & Shkedi, S. (2007). On new reproductive technologies and family ethics: Pre-implantation genetic diagnosis for sibling donor in Israel and Germany. Social Science & Medicine, 65, 2081–2092.
Knoppers, B. M., Bordet, S., & Isasi, R. M. (2006). Preimplantation genetic diagnosis: An overview of socio-ethical and legal considerations. Annual Review of Genomics and Human Genetics, 7, 201–221.
Spriggs, M. (2005). Is conceiving a child to benefit another against the interests of the new child? Journal of Medical Ethics, 31, 341–342.
Wolf, S. M., Kahn, J. P., & Wagner, J. E. (2003). Using preimplantation genetic diagnosis to create a stem cell donor: Issues, guidelines, and limits. Journal of Law, Medicine & Ethics, 31, 327–339.
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