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Response
Response to ‘A relational approach to Saviour Siblings?’ by Selgelid
  1. Michelle Taylor-Sands
  1. Correspondence to Dr Michelle Taylor-Sands, Melbourne Law School, The University of Melbourne, Parkville, Melbourne 3010, Australia; m.taylor-sands{at}unimelb.edu.au

Abstract

In his concise argument, ‘A relational approach to saviour siblings?’, Selgelid reiterates some of the arguments raised in the author meets critics discussion of my book, Saviour Siblings. In this response, I highlight an important misunderstanding in one of the arguments put forward by Selgelid, which forms the basis of a large portion of his analysis. Contrary to what Selgelid contends, I do not use the deafness case in my discussion of the non-identity problem to contend that the case of selecting for deafness is ethically different from the case of saviour siblings. As I state in my reply, I use the case of deafness not as a comparator for saviour siblings but rather to illustrate the different categories of risk that apply in selection cases. Given this confusion, I restate my objection to relying on the non-identity problem in evaluating risk of harm associated with the embryo biopsy process for preimplantation genetic diagnosis. Finally, I reiterate that the individual interests of saviour siblings remain important in the decision-making matrix and emphasise that Saviour Siblings offers a more contextualised approach to the welfare of the child in selective reproduction, which includes both individual and collective interests.

  • Embryos and Fetuses
  • Genetic Selection
  • In Vitro Fertilization and Embryo Transfer
  • Interests of Woman/Fetus/Father
  • Reproductive Medicine

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Response

In his concise argument,1 Selgelid reiterates some of the arguments raised in the author meets critics discussion of Saviour Siblings.2 It is not my intention to restate my reply to these arguments, which is set out in the same issue.3 This response highlights an important misunderstanding in one of the arguments put forward by Selgelid, which is central to his analysis.

In his discussion of the non-identity problem, Selgelid makes the same mistake as Wilkinson about my use of the deaf child example in my book.4 Indeed, Selgelid incorrectly states that, in my discussion of the non-identity problem, I argue ‘that the case of selecting for deafness is ethically different from the case of saviour siblings’.5 Put simply, I do not use the deafness case in this context to contend that the case of selecting for deafness is ethically different from the case of saviour siblings. As I state in my reply to Wilkinson, I use the case of deafness in this part of my book, not as a comparator for saviour siblings but rather to illustrate the different categories of risk that apply in selection cases. I could equally have used the case of saviour siblings to illustrate my point about the different risks that selection creates. For example, in relation to the first category of risk (associated with a child's identity), both the deaf child and the saviour sibling have to contend with the non-identity problem. They could also both argue that the second category of risk (associated with the preimplantation genetic diagnosis (PGD) process) could have been avoided had PGD not been used.

In relation to the second category of risk, Selgelid reiterates Wilkinson's claim that it is highly unlikely that the same child would have been born had the parents not used in vitro fertilisation (IVF) in conjunction with PGD. Unlikely as it may be, it remains possible that both the deaf child and the saviour sibling could have been created as a result of natural conception. To put it another way, neither IVF nor PGD are a condition precedent to either child's existence. As I explain in my reply, the ‘it's unlikely you would have been born using natural conception’ argument is conceptually quite different to the argument that ‘the only alternative to you being born with your current genetic blueprint is non-existence’. Strictly speaking, the non-identity problem only applies to the first category of risk associated with a child's identity and not to the second category of risk associated with the PGD process. The remainder of my discussion in this section of my book focuses on why the non-identity problem fails to address welfare of the child concerns in the context of selective reproduction more generally.

Although I focus on natural selection as an alternative option for a child selected using PGD, Selgelid alludes to another scenario whereby an embryo created using IVF may be implanted without biopsy. This scenario is less statistically challenging than my natural selection scenario because, as Selgelid points out, ‘there is at least a decent chance that the same embryo would have been implanted in the absence of testing’.5 Selgelid notes an objection (which he attributes to Wilkinson) that the embryos created using IVF would otherwise not have existed where the parents only used IVF in order to employ selective testing. In response to this objection, he suggests one could argue that is ethically problematic creating embryos upon which you intend to impose risk of harm associated with biopsy. Given that I have not in fact drawn an ethical distinction between selection for deafness and saviour siblings, I agree with Selgelid that any concern about harming individuals after they have been produced would apply equally to selection for deafness and saviour siblings.

It is also worth noting that the existence of an embryo created using IVF is not always a product of the decision to test it in selection cases. It is not unrealistic to envisage a case where parents or prospective parents (perhaps because of their age) must use IVF to conceive, irrespective of their plans to select a particular embryo. In this scenario, a decision to biopsy the embryos created could clearly be considered harmful. A saviour sibling (or a deaf child for that matter) selected using PGD in such a case could legitimately complain that s/he could have avoided any harm associated with the PGD biopsy process had the parents randomly implanted one or more of the embryos conceived through IVF. Although a saviour sibling (or deaf child) would have had less of a chance of being born as a result of random implantation, s/he still had a ‘decent chance’ of being born. This scenario further illustrates my point that the second category of risk (associated with the embryo screening process) can be avoided without running into the non-identity problem.

Finally, I do not disagree with the conclusion drawn by Selgelid that the individual interests of saviour siblings should be central to the decision-making matrix for selective reproduction. The purpose of my book is not to undermine the individual interests of the most vulnerable party—the child who is yet to be born. My goal is to ensure that parents, clinicians and policy-makers openly acknowledge that the welfare of a child extends beyond the child's individual interests to the collective interests the child shares with other family members. By contextualising the welfare of the child within his/her family, I aim to provide a richer and more realistic account of the welfare of the child in selective reproduction, with a view to enhancing the decision-making process.

References

Footnotes

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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