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Saviour Siblings is a term used to describe children whose conception is for the sole purpose of being an organ, tissue or stem cell donor for their sick sibling. Saviour Siblings is a long discussed bioethical issue, with the debate surrounding whether or not it is moral to conceive a child to only be a donor.
Is the conception of Saviour Siblings breaching the ethical concepts of Nonmaleficence and Beneficence from a physiological perspective?
Saviour Siblings are concieved to be donors. This conception occurs artificially using the parents' sperm and egg. Conception occuring in an artificial, laboratory setting allows for the screening of the embryo prior to insemination.
This includes ensuring the embryo is free of genetic diseases or vulnerable to the same illness as their sibling.
Additionally, Screening allows for scientists to determine if the embryo is a Human Leukocyte Antigen (HLA) match to their sibling.
General standards or guidelines of human morals that all personnel in a medical or scientific setting must abide by at all times when conducting research or procedures.
Include Beneficience and Nonmalificience
HLA are proteins that can be found in a majority of cells in the human body, which are utilised by the Immune System to determine what cells in the body are meant and are not meant to be there.
Two individuals are considered a HLA match if they share the same HLA type. HLA matching therefore is commonly utilised to match individuals, patients and donors, for transplants such as bone marrow and blood.
In making a Saviour Sibling that is a HLA match with their sick sibling, parents and medical staff are able to have a genetically identical individual who can be used as a donor and provide required identical biological materials to aid their sick sibling.
Nonmaleficence is the obligation of a physician not to harm the patient. This simply stated principle supports several moral rules − do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life
According to National Library of Medicine
The principle of beneficence is the obligation of physician to act for the benefit of the patient and supports a number of moral rules to protect and defend the right of others whilst preventing harm and remove conditions that will cause harm to others
According to National Library of Medicine
ADVANTAGE OF SAVIOUR SIBLINGS THROUGH HLA SCREENING
DISADVANTAGE OF SAVIOUR SIBLINGS THROUGH HLA SCREENING
Detailed answer of the experiment research question
PARTIES INVOLVED AND THEIR VIEWPOINTS
An advantage of Saviour Siblings through HLA screenings is that it enables medical care for fatal illnesses to occur that otherwise may not be able to if there are no other applicable donors available.
In screening, essential matching biological materials that can be used as treatment, such as matching stem cells or bone marrow, are able to be found and accessed by medical professionals when the donor is born.
This can aid in treating various highly fatal illnesses and in turn limit many preventable deaths of children from occurring.
Saviour Siblings concepted following HLA screenings can be at risk of an array of potential physiological and psychological implications in the future.
Physiologically, this includes having to potentially undergo invasive medical procedures in order to acquire their required biological materials to treat their siblings.
Bone Marrow harvesting, which is a common procedure for Saviour Siblings, is described by the National Institute of Health to be a ‘’very painful procedure (for young children) requiring anaesthesia; this presents yet more risk for the (young children)’’. This therefore could cause the Saviour Sibling physiological pain or harm.
Additionally, psychological risk factors include the children finding out they were conceived solely to be a donor, or the emotional impacts they experience if their donations are not successful.
Studies have found that Saviour Siblings were depressed, angry and experienced guilt following unsuccessful HSC transplantation or if the ‘’the death of the sick sibling was directly associated with failure of engraftment’ from the Saviour Sibling. Saviour Siblings also reported that many failed to receive any form of emotional support following their siblings death.
This puts the Saviour Sibling at risk of psychologcial distress or harm, through increased likelihood of developing mental health struggles or mental disorders, such as depression, later in life.
PARENTS
CHILDREN
MEDICAL PROFESSIONALS
GOVERNMENT
The conception of Saviour Siblings could potentially breach Nonmaleficence from a physiological perspective. Procedures that the Saviour Sibling may have to undergo, such as bone marrow removal or going under general anaesthetic, can present heightened risks of physical harm occurring to the Saviour Sibling. This could be as a result of the procedures themself, or errors and side effects in the recovery process following the procedure. If this does occur, then Nonmaleficence has been breached as harm has occurred to the child. However, if the procedures undergone are not harmful and cause minimal pain and harm to the child, then Nonmaleficence may not be breached.
Beneficence may also be breached in the conception of Saviour Siblings, if the harm caused to the Saviour Sibling is greater or outweighs the benefit for the ill sibling. For example, in a very rare case if the Saviour Sibling dies as a result of complications during or after a procedure to donate their biological materials. This would breach Beneficence as any benefit to the ill sibling, such as receiving the required treatment, is outweighed by the harm caused to the Saviour Sibling as they have died. However, in the majority of cases Beneficence is not breached. The benefit to the ill sibling following receiving a donation is usually much greater than any potential harm caused to the Saviour Sibling.
In conclusion, whether the conception of Saviour Siblings breaches the ethical concepts of Nonmaleficence and Beneficence from a physiological perspective varies, and is dependent on each specific case. However, in most cases Beneficence is unlikely to be breached as the benefit for the sick sibling is greater than any harm caused to the Saviour Sibling, whilst Nonmaleficence is slightly more likely to be breached due to the wide variety of potentially painful procedures the Saviour Sibling may endure.
- What is leading their decisions on the ethics of the situation is heavily connected to what will best benefit their child
- Must consider whether they feel comfortable at the idea of creating a child with the role of being a donor
- Must consider the potential implications for both children in the future
- Likely to decide to go ahead if it ensures their sick child a higher chance of survival
-If they are old enought to be included in the decision of being a donor, they may have to decide their view on whether they want to be a donor or not
- Due to being unborn they do not have any opinion in their conception for being a donor
-Most cases, when they are donating the biological resources they are too young to consent to being a donor themselves, which is when their parents decide for them
-In the future when they find out that they are a saviour sibling they may be hurt or proud, depending on their view on the matter.
- Will consider the situation through a human rights and legal viewpoint.
- Will assess whether it is moral to utelise a child for biological donations
- Will assess whether donor children are at risk of harm/ if the outcome of the situation could lead to homicide
-Will consider through a concentual perspective, as children are too young to consent to be donors
- Will consider the situation through evaluating the Beneficience for the sick child
- Consider through a potentially more procedural, clinical viewpoint where the donor child is seen as an ''instrument'' or ''tool''
- Likely to suggest to parents to consider Saviour Siblings if it can allow effective medical treatment to occur that potentially may not be able to otherwise
- Must assess the timeline of the child's illness and the process of artificial conception to ensure they line up
Bibliography
Personal Opinion on Saviour Siblings
Reference listBeTheMatch.org (2018). Human Leukocyte Antigens (HLA) Matching | Be The Match. [online] Bethematch.org. Available at: https://bethematch.org/patients-and-families/before-transplant/find-a-donor/hla-matching/.English, V. (2002).
Ethics briefings. Journal of Medical Ethics, 28(6), pp.384–385. doi:https://doi.org/10.1136/jme.28.6.384.Halter, J., Kodera, Y., Ispizua, A.U., Greinix, H.T., Schmitz, N., Favre, G., Baldomero, H., Niederwieser, D., Apperley, J.F. and Gratwohl, A. (2009).
Severe events in donors after allogeneic hematopoietic stem cell donation. Haematologica, [online] 94(1), pp.94–101. doi:https://doi.org/10.3324/haematol.13668.Healthline. (2018).
What Are the Bone Marrow Donation Risks? Plus Recovery Timeline. [online] Available at: https://www.healthline.com/health/bone-marrow-donation-risks.Kolata, G. (1991).
More Babies Being Born to Be Donors of Tissue. The New York Times. [online] 4 Jun. Available at: https://www.nytimes.com/1991/06/04/health/more-babies-being-born-to-be-donors-of-tissue.html.Kuek, C.Y., Gurmukh Singh, S.K. a/p and Tay, P.S. (2021).
Conception of Saviour Siblings: Ethical Perceptions of Selected Stakeholders in Malaysia. Asian Bioethics Review. [online] doi:https://doi.org/10.1007/s41649-021-00166-2.Meek, J.B.J. (2000).
Parents create baby to save sister. The Guardian. [online] 4 Oct. Available at: https://www.theguardian.com/science/2000/oct/04/genetics.internationalnews.MiracleCord (2022).
What Is a Savior Sibling? Purpose, Laws, & Ethical Concerns. [online] MiracleCord. Available at: https://miraclecord.com/news/savior-siblings/ [Accessed 7 Nov. 2023].Olbrisch, M.E., Levenson, J.L. and Newman, J.D. (2010).
Children as living organ donors: current views and practice in the United States. Current Opinion in Organ Transplantation, 15(2), pp.241–244. doi:https://doi.org/10.1097/mot.0b013e328337352a.Sheldon, S. and Wilkinson, S. (2004).
Should selecting saviour siblings be banned? Journal of Medical Ethics, 30(6), pp.533–537. doi:https://doi.org/10.1136/jme.2003.004150.sites.lib.jmu.edu. (n.d.).
Savior Siblings and Cloning | Ethical, Legal, and Societal Implications of Biotechnology. [online] Available at: https://sites.lib.jmu.edu/elsi-biotech/reproductive-biotechnology/savior-siblings-and-cloning/.Varkey, B. (2021).
Principles of clinical ethics and their application to practice. Medical Principles and Practice, [online] 30(1), pp.17–28. doi:https://doi.org/10.1159/000509119.Wikipedia Contributors (2019). Savior sibling. [online] Wikipedia. Available at: https://en.wikipedia.org/wiki/Savior_sibling.Zúñiga-Fajuri, A. (2018).
Born to donate: proposals for ‘savior sibling’ regulation in Latin America. Colombia medica (Cali, Colombia), [online] 49(3), pp.228–235. doi:https://doi.org/10.25100/cm.v49i2.3619.
Thank you for reading! I hope you have developed a stronger understanding of the concept of Saviour Siblings and the Bioethical issues surrounding it.
In my opinion, the conception of Saviour Siblings solely to access required biological materials required for the treatment of the older sibling is unethical and potentially breaches ethical principles.
I believe that deciding to create another life is an extremely large decision and should not be taken lightly just to ensure effective treatment is available. As found in past studies, Saviour Siblings are at risk to both physiological and psychological harm following being a donor and later in life, as a result of both the procedures they endured- which was supported through research stating that bone marrow transplants are ''very painful procedures (for young children)'' and potential distress if they become aware of their purpose for being born or if their donation was unsuccessful- which was supported through research studies finding that Saviour Siblings were ''depressed, angry and experienced guilt following unsuccessful HSC transplantation''. I think that because of these risks, conception should only be pursued if there is absolutely no other available alternative treatments or donors available, as well as if the family are equipped and intend to give the child a meaningful and enjoyable life beyond being a donor.
However, I do understand that parents will go to great lengths to ensure their child’s survival and health, and believe that if there is a method that is highly effective and could aid in the prevention of child fatalities- such as the use of Saviour Siblings- then it should be an available option for parents to pursue. As mentioned earlier, if the family is commited to giving the Saviour Sibling an enjoyable and meaningful life beyond being a donor, then I believe that the decision to concieve a Saviour Sibling is permissible and not unethical.