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Michelle Taylor-Sands is sceptical of the sorts of reasons that have typically been advanced in support of creating saviour siblings.1 In particular, she is critical of the claim that being created or serving as a tissue donor confers benefit to the child. Any such benefits, she contends, are ‘speculative and ultimately unconvincing’ (p. 60). With regard, for example, to the claim that the saviour sibling will sustain ‘psychosocial benefits’, she argues that this is contingent upon the success of the treatment; ‘where donation is unsuccessful, the psychosocial benefits to the donor child are outweighed by the psychosocial harms’ (p. 60).
The precarious nature of such claims, Taylor-Sands maintains, provides a reason to be sceptical of an individualistic approach to the child's interests, and to seek instead to justify the creation of saviour siblings, and their role as donors, on several other grounds. These include:
that the saviour sibling shares ‘collective interests’ with its intimate family; and
that the future child himself/herself owes duties to family members, simply by virtue of having been born into that family.
The first claim does more than reassert the familiar acknowledgement,2 ,3 that the child may come to sustain indirect personal benefit through the flourishing of other family members. Rather, Taylor-Sands seeks to attribute an identity, an ‘inherent’ value and perhaps interests, to the family itself (p. 71).
One problem with this approach may be that the sorts of risky and speculative aspects of the decision, which Taylor-Sands seems to be trying to avoid, are surely present with regard to ‘the collective interests of the family’ too. The pressures created by this process could impact negatively upon the family unit as well as its constituent members, especially if initial attempts at treatment with umbilical cells are unsuccessful, and decisions have to be made regarding more intrusive methods. It is not impossible that such stresses could lead to the weakening, or even the disintegration, of that family unit.
This is not to say that such an outcome is likely nor that such a possibility should prevent the use of this practice. But the suggestion that the element of risk and speculation could be avoided by focusing on the family rather than its individual members seems unlikely.
Duties for children
Perhaps the most controversial part of Taylor-Sands’ approach, though, seeks to locate the rationale for the creation and use of saviour siblings in the supposed obligations that the new child itself owes to its family members. This is so even though the child did not voluntarily assume such obligations or indeed choose to become a member of that family (p. 84).
Taylor-Sands seeks to locate the basis for such obligations in relational approaches to bioethics, though I wonder if it might not owe more to the sort of neo-Kantian ‘principled autonomy’ championed by Onora O'Neill,4 or even the ‘special obligations’ advocated by Anne Maclean.5 Neither approach, however, has—to my knowledge—previously been used to justify the imposition of obligations upon pre-autonomous infants (or perhaps even potential future people).
Taylor-Sands’ justifications for this additional and controversial step do not strike me as entirely persuasive. She asserts, for instance, that ‘[w]e owe a higher level of duty to family members than to strangers because we generally favour intimates over strangers’ (p. 89). Leaving aside that the ‘we’ in question is unlikely to apply to embryos, or perhaps even infants, that sort of preference—which is itself worthy of some degree of scrutiny when employed as a basis for decision-making6—seems like an unlikely basis for a moral duty. I do, as a matter of fact, favour some people over others, and rightly or wrongly, I would almost certainly prioritise their welfare over that of strangers. But the notion that this gives rise to a universal duty to prioritise family members seems to require some additional steps, which are not spelt out.
Acceptance or insistence?
One of the valuable contributions of feminist and relational ethics has been to problematise the notion of autonomous agents as rational self-maximisers. The recognition that emotions, relationships and perceived obligations often play a part in decision-making is important. But such recognition that something often happens is quite different from the insistence that it ought to happen. This is the sort of leap that can lead from the acknowledgement that some people imbue dead bodies with great value, to the insistence that all must do so; or from the recognition that many women find abortion traumatic, to the problematic conclusion that there is something amiss with those who do not. It is possible to recognise, accept and make provision for a particular view or feeling, without making it a universalisable moral imperative.
The fact that most of us feel a strong sense of obligation towards our family members, then, cannot in itself form the basis of a moral duty incumbent on those who do not, or cannot, have similar feelings. Something more would seem to be required.
In any event, it is not entirely clear that such an obligation—even were its existence to be accepted—would make the basis of decision-making in the context of saviour siblings any more straightforward. As Taylor-Sands notes, such obligations would have to be carefully balanced against the child's individual interests, lest it become a mere instrument or commodity. And that brings us back to the undeniably speculative and uncertain business of identifying and quantifying those interests.
I think Taylor-Sands may be onto something with her claim that it is more honest to admit that many medical decisions are made not for the benefit of the patient, but because they confer enormous benefit on others at little cost to the patients themselves. This may be preferable to adopting the sort of torturous and tangled reasoning employed in some court decisions concerning incompetent individuals.7 The notion that this can obviate the need for tough balancing acts and speculative predictions is considerably less likely.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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