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Selective reproduction is an area where the law often lags behind the science. There is increasing pressure on governments to reconsider the ethical issues raised by selective reproductive technologies and regulate accordingly. Genetic screening technologies involving preimplantation genetic diagnosis raise important ethical questions about the welfare of the child to be born. Should parents be allowed to select a child with particular traits or characteristics? How does selection impact on the identity of the child who is born? Are children who are selected for a particular purpose harmed or treated as commodities? How far should the state interfere with reproductive choice?
To date, concerns about the welfare of the child in selective reproduction have focused on the individual interests of the child to be born. Saviour Siblings1 re-evaluates the welfare of the child through the controversial topic of saviour sibling selection using applied ethics. Drawing on relational feminist and communitarian ethics, I argue that the welfare of the child to be born is inextricably linked with the welfare of his/her family. I propose a new relational model for selective reproduction based on a broad conception of the welfare of the child that includes both individual and collective family interests. I then compare regulation in the UK and Australia to map out how law and policy might support a relational decision-making model for saviour sibling selection.
Chapter 2 of the book describes how three main ethical concerns—commodification, harm and ‘designer babies’—have shaped the debate over selective reproduction. The first two concerns relate specifically to the welfare of the child to be born, whereas the third is a broad societal concern about our future humanity. I explore the non-identity problem and reject the argument, commonly used to justify selective reproduction, that it is better to be born than not. I then introduce saviour sibling selection as the primary case study for evaluating the welfare of the child principle in selective reproduction. I discuss current regulatory approaches to saviour sibling selection in the UK and Australia before introducing an alternative ‘relational approach’ to the welfare of the child that highlights both individual and collective family interests. This relational approach is explored in detail in the second half of the book.
Given the strong focus in assisted reproductive treatment (ART) on the welfare of the child to be born, Chapter 3 examines the role and relevance of the welfare of the child principle in ART regulation. I scrutinise the uncertain origins of the welfare principle in ART legislation in the UK and Australia before analysing the two key ethical concerns that have dominated the debate over saviour siblings—commodification and harm. I contend that these concerns reflect an individualistic approach to the welfare of the child to be born and conclude that the welfare of the child should be conceptualised more broadly to include both the child's individual interests and the collective interests the child shares with his/her family.
Chapter 4 presents the core argument of the book. I propose a relational approach to the welfare of the child to be born based on the notion of human flourishing, which situates the interests of the child within the context of his/her family. Given that a child living in an intimate family is both an individual and the member of an intimate collective, I argue that the child's interests should be considered in connection with rather than in opposition to the interests of other family members. I examine familial duty as a justification for compromising some individual interests of family members for the welfare of the family as a whole, but conclude there should be limits on what parents can ask of a child in order to protect the child from exploitation, abuse or neglect.
Applying the relational approach to the welfare of the child developed in Chapter 4, Chapter 5 proposes a relational model for selective reproduction, which accommodates individual and collective interests. I emphasise the importance of developing an effective process to assist parents in making decisions about selective reproduction in collaboration with their healthcare providers. In order to protect the child to be born from exploitation, abuse or neglect, I contend that the state should provide a threshold level of protection for the child to be born. Drawing on the ethical concerns about commodification and harm discussed in earlier chapters, I propose safeguards to ensure that the child to be born is treated with respect and protected from harm.
Chapter 6 addresses issues associated with the implementation of a relational model for selective reproduction by outlining a framework for regulating saviour sibling selection. I draw on elements of UK and Australian regulation to map out a permissive regulatory framework. I conclude that decisions about saviour siblings should be made on a case-by-case basis by parents in collaboration with their healthcare team in accordance with legislation and policy guidelines and subject to ethical oversight by a regional clinical ethical committee. I then explain how a relational framework for saviour sibling selection is less restrictive and more responsive to the individual circumstances of each case than current regulatory frameworks in the UK and Australia.
Finally, Chapter 7 highlights the benefits and burdens of a relational model for selective reproduction and identifies areas where further research is needed. The relational framework for saviour sibling selection proposed in this book is intended as a starting point to trigger debate about how ethically complex decisions about selective reproduction could be made. By situating the child within the context of his/her family, I conclude that a relational model offers a more realistic and transparent lens through which to view the thorny issues posed by selective reproduction in the future.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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