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Day 4
Published in Bertha Alvarez Manninen, Dialogues on the Ethics of Abortion, 2022
Well, we have some guidance here. It seems like we should appeal to some sort of precedent, no? In cases where someone needs the body of another in order to survive, the choice is ultimately left in the hands of the person whose aid is needed. It was only Shimp who could decide how to use his own body, and his decision not to donate his bone marrow cost McFall, a person, his life. A savior sibling always has to continually decide whether she wants to continue serving her sick sibling, and the decision always rests with her. Similarly, the woman is the one who gets to decide whether she wants to use her body to sustain the fetus, even if the fetus is a person.10
The Dawn of GM Humans
Published in Tina Stevens, Stuart Newman, Biotech Juggernaut, 2019
Developmental intervention techniques can potentially result in anomalies and malfunctions that have yet to be identified in natural populations. The bodies and mentalities of people produced this way would potentially be very different from anyone resulting from sexual reproduction or from “standard” IVF (i.e., IVF not involving embryos that have been genetically engineered). Some parents, desperate for a cure for an existing sick child, have sought to produce a second child, a “savior sibling” from whom they can yield potentially lifesaving bone marrow or umbilical cord stem cells. The inefficient process involves the creation of dozens of embryos to be discarded in search of a good “match” of tissue type, before implantation and birth takes place and the eventual grafted tissue is accepted by the patient. Even then, there is no guarantee of success. Cloning the sick child may increase chances for success because then all embryos created would constitute a perfect match. The first child would not reject the tissue grafted from the second child. In 2002 a mouse study that combined the techniques of embryo gene alteration, ES cells, and cloning, succeeded in doing just that (Rideout et al., 2002), opening the door to eventually creating the so-called savior siblings mentioned above, or potentially down the line, when techniques to ensure the biological product was sufficiently outside the realm of moral concern (as in the Slack-Wolpert proposal), part- or non-reproducing humans for instrumental purposes proposed by the bioengineer Drew Endy (see Specter, 2009 and Chapter 6).
A response to Manninen
Published in Bertha Alvarez Manninen, Jack Mulder Jr., Civil Dialogue on Abortion, 2018
But what about savior siblings? Well, I don’t think Manninen or I have any new problems in store for one another on this one. I don’t think either of us wants to deny people’s ability freely to reproduce, even if their motives are less than ideal. Certainly a savior sibling who didn’t want to donate an organ could file for medical emancipation, but not all savior siblings will have reached an age at which they could assess whether or not to do so with the kind of clarity of mind that might be required to gain medical emancipation. The truth is, having two young children myself, I have enough difficulty figuring out when a parent needs to make it clear what’s to be done come hell or high water, and when it’s better to let children bump into the untoward consequences of their own bad decisions. But I don’t think I need to get to the bottom of that one for the sake of my dispute with Manninen because it’s not clear to me that either of us see savior siblings significantly differently from one another. If savior siblings can successfully apply for medical emancipation, then they can utilize whatever rights travel with that emancipation, even if they might otherwise have had certain things urged upon them by their parents. I’m a little more willing to countenance the idea that a just law could require a very unique donor to donate, say, bone marrow, to a very unique donee than Manninen is, but that doesn’t mean Manninen and I are going to disagree about anything new or germane to this dispute when it comes to savior siblings.
Rational Freedom and Six Mistakes of a Bioconservative
Published in The American Journal of Bioethics, 2019
However, the embryo is not the future person. Genes are not persons. To manipulate a gene or embryo is not to manipulate a person. One can still have a communicative relation with a future child if an embryo’s genes were modified, or a genetic disorder cured. One can treat a future child as an end while still having selecting it as stem-cell donor (savior sibling), or improving its genetic hand. At the heart of all these concerns is a reductionism that reduces persons (and their treatment) to genes or embryos. How we choose to treat persons is entirely separable from how we choose to treat the genes of an embryo.
Review of Robert Klitzman’s Designing Babies
Published in The American Journal of Bioethics, 2020
Providers must also navigate hard decisions. They work with patients to choose the course of treatment, yet sometimes patients make requests that providers feel uncertain about supporting. The ART industry begets inherent tensions relating to patient autonomy—the right of individuals to make their own medical choices—and paternalism, which can be thought of informally as a “doctors know best” approach. Providers may struggle with counseling patients about whether to proceed with an intervention if it has a low probability of success or when to use donor gametes. “Many providers feel that the patient alone, not the doctor, should decide—that the patient’s autonomy is paramount—that they themselves would not do what the patient is doing but should not stand in the way,” Klitzman writes (Klitzman 2020, 47). Yet a few pages later, he notes, “given that ongoing interventions may fail and have risks, other providers feel that the patient should not make the final choice” (Klitzman 2020, 52). He also considers providers’ roles in evaluating would-be parents for child-rearing capability (e.g., their age), holding that physicians should carefully consider these issues since their involvement “in creating a human being…arguably elevates their moral duties” (Klitzman 2020, 187). Also explored is whether physicians should have a role in deciding whether a couple can use PGT for sex selection or to create an “HLA matched” child as a savior sibling. Providers and agencies also act as gatekeepers for gamete donors. Although Klitzman supports some screening measures as well as the idea of limiting use of samples from a particular sperm donor in order to prevent genetically-related donor-conceived children from unknowingly having children together, he seems less comfortable when clinics evaluate egg donors based on a “gut feeling” (Klitzman 2020, 60).