Nursing Ethics Related to Savior Siblings This work in writing addresses the ethical issues relating to parents undergo a procedure to conceive a child that will perfectly match blood with a child who is sick for the purpose of saving the sick child's life. This procedure is known as preimplantation genetic diagnosis (POGD) This procedure, while providing hope to parents who are desperate, carries with it ethical implications and concerns.

Preimplantation Genetic Diagnosis

Preimplantation genetic diagnosis is reported 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 used first in 1989 and was used for the purpose of avoiding "the implantation of an embryo that was affected by a mutation or chromosomal abnormality associated with serious illness." (Fasbender, 2009p. 17)

Uses for this procedure since that time include for "family balancing" or choosing the sex of a child and controversially was used for 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) The use of this procedure in this manner enables the parents to select an embryo free from serious genetic disease and simultaneously select 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, p.19-20)

II. Ethical Controversies

Ethical controversies surrounding the creation of the 'savior child' because "when PGD is sued to test for genetic diseases that testing is done in the best interest of the embryo or the person it will become, whereas when PGD is used solely for tissue typing the controversy is related to the only benefit being that for 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." (Fasbender, 2009, p.20) It is reported that the basis of the creation of a child for the purpose of saving the life of another child is 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 on this issue is focused on the extent to which the donor child may result in being 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, Devolder (2005) states as follows:

"…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)

III. The Debate

Some individuals view the use of PGD for the purpose of creating a 'Savior Child' to be "merely conceived a child as an instrument to cure another child" however, it is stated that in society today that the reasons that parents have children are many and greatly 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 as follows:

"…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." (Fasbender, 2009, p.21)

Those who support the use of PGD states that this practice is acceptable if the parents have the intention to "rear and love the donor child." (Fasbender, 2009,...

20) In fact, 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) Also stated as an ethical dilemma which has not yet been fully investigated is the psychological ramifications to the donor child knowing that they have been selected for the express purpose of saving a life. As well, there are psychological factors to consider including "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 he sick child is ultimately cured or dies." (Fasbender, 2009, p.21)
IV. Moral Issues

There are also moral issues related to the procedure of PGD since this procedures "involves the process of picking viable embryos and discarding unacceptable embryos" in that the matter of abortion is raised in terms of whether this is an acceptable or unacceptable procedure. The work of Knoppers et al. (2006) states two primary points-of-view in this debate as follows:

(1) The embryo is a new human life entitled to full moral status from the time of fertilization, because from that time it holds the potential to develop into a complete human being, or (2) The embryo has some moral status from fertilization, but to a lesser extent than a born human being, and gradually acquires "full" moral status during development. (Fasbender, 2009, p.23)

According to Wolf et al. (2003) "creating and discarding healthy embryos for lack of HLA-compatibility with the affected sibling is consistent with currently accepted embryo practices." (p.330)

The work of Hashiloni-Dolev and Shkedi (2007) states a belief that there are three primary moral objections relating to PGD:

(1) from those who believe that embryos are people and should be vested with human rights from the moment of conception because the selection and discarding of an embryo is opposed to completely;

(2) the act of the selection of an embryo because this process is held as unnatural and results in the production of a manufactured good; and (3) the future rights of the unborn child and how all children should "always be treated as an end in itself and never merely as a means. (p.2082, paraphrased)

Additionally stated in the work of Hashiloni-Dolev and Shkedi (2007) are the following two arguments:

(1) failure to implant a "pre-embryo is morally preferable to killing a more developed fetus"; and (2) "since pre-natal diagnosis in general is widely accepted, there is no reason to single out PGD and ban it." (p.2082)

V. The Need for PGD

There are several diseases that affect children where the only treatment that has the potential to save the life of the child requires a transplant of tissue from a human leukocyte antigen (HLA)-compatible donor." (Sparrow and Cram, 2010, p.1) Included in these diseases are "Fanconi anaemia, beta thalassaemia, sickle cell disease and some immunodeficiencies…" (Sparrow and Cram, 2010, p.1) It is reported that the requirement for savior embryos "…may lapse if it proves possible to derive suitable tissue for the appropriate transplants from embryos created using somatic cell nuclear transfer (SCNT) of DNA from a person who was HLA-compatible with the child requiring a transplant (Elsner, 2006, Vanikar et al., 2007) or from 'induced pluripotent stem (IPS) cells' created from such a person (Baker, 2007, Takahashi et al., 2007, Yu et al., 2007). " (Sparrow and Cram, 2010, p.1)

It is reported that these alternatives are many years away leaving only the creation of savior embryos for saving the lives of some children. It is reported that there are presently more than 330,000 children born annually affected with a condition needing a transplant from an HLA-compatible donor. Sparrow and Cram (2010) state that there is a "…compelling prima-facie case for the creation of savior embryos in at least some circumstances. This case is established by the moral weight of the urgent medical need of a living individual and the desperate desire of parents to save the life of their child." (Sparrow and Cram, 2010, p.1)

Sparrow and Cram (2010) note that the embryo from which stems cells are removed is comprised by a "ball of 80 -- 100 cells. It has no nerve cells, is incapable of experiencing any sensation, and has no desires; thus destroying it will not cause it any suffering or frustrate any preferences (Singer, 1999, Tooley, 1999). If implanted into a woman's womb, the embryo might develop into a child, but equally well it might not, as many embryos which succeed in implanting do not go to term. The moral significance of any potential the embryo does have is unclear." (2010, p.1)

It was pointed out…