• Reproductive Medicine
• Family
• Regulation
• Genetic Screening/Testing
• In Vitro Fertilization and Embryo Transfer

A key objective of Saviour Siblings was to begin a conversation about how we should approach the welfare of the child in the context of selective reproduction. I am very grateful to the journal and my critics for the opportunity to continue this conversation. By viewing the welfare of the child to be born through a relational lens, I challenge the prevailing orthodoxy surrounding questions of harm, benefit and moral obligation. I will address the questions raised by Stephen Wilkinson and Colin Gavaghan on these issues shortly.

I would first like to deal with the primary question raised by Emily Jackson about whether my relational model differs in practice from the ‘significant harm’ approach in the UK. The overarching purpose of my book is to propose a normative framework for regulating decision-making in the ethically complex and emotionally fraught area of selective reproduction. While I agree with Jackson that protecting the child's ‘basic interests’ within my relational model provides a similar threshold level of protection to the UK ‘significant harm’ test,ⁱ this is not the focus of my book.

My relational model is designed to accommodate the ‘conflict, confluence and confusion of interests’ within families seeking selective reproductionⁱⁱ more effectively than one centred on the interests of the child to be born (even one that recognises the child's interests are influenced by family outcomes). The aim of my devolved and collaborative decision-making model is to actively support patients to make the best decisions for their own families and according to their own values in an ethically complex area. I introduce the notion of collective family interests less as a test to determine whether selecting a saviour sibling is acceptable than to provide a clear ethical foundation on which to base the decision-making process.

For decisions such as saviour …