Commentary: why it is wrong to select embryos to be tissue donors
The announcement of the birth of a son to the Whitaker family, who was selected as an embryo to be a tissue-matched donor for his sick brother, has sparked the usual massive media interest. It seems that the Whitaker family have great public sympathy, and support for their use of the technique. And, as usual, the main voices opposing the use of this technique have been those of the pro-lifers. In my view, the predominant view, which can be summarised as, 'what can be wrong with saving the life of a sick child?', demands a proper response, that is not grounded in the belief that embryos possess a right to life.
Children as things
The main objection to the use of pre-implantation genetic diagnosis (PGD) for this purpose is that it objectifies the child by turning it into a mere tool, and so contradicts the basic ethical principle that we should never use human beings merely as a means to an end (however good that end may be), because they should be treated as ends in themselves. That is the basic ethical objection to slavery, for example. In response to this, it is often said that the new child will be loved for himself, and will not be treated by his parents as a mere tool, and this is no doubt true. However, the Whitakers have made it very clear that their primary purpose for conceiving Jamie was to save their other son. The case against this use of PGD does not depend upon fine analysis of each couple's motivations and emotional states, but on the consequences of breaking the ethical rule. Couples in this position, will nearly always be conceiving the child primarily in order to save the sick child.
While most people would agree with the ethical principle, many people seem to feel that it is a case of abstract principles versus real individual suffering; and because, as is typical in our public discourse, the case is discussed without considering the key context, ie. the overall trends promoted by reproductive and biomedical technology, the reasons for concern about objectification seem remote and theoretical. However, I would argue that these cases, far from being special examples, in which we should allow exceptions to our principles, are in fact typical examples of the way that reproductive and biomedical technologies objectify human beings. And that is why it is so important that we resist the selection of embryos as tissue donors: because these cases significantly advance the objectifying trend, and the consequences of doing so are, in the not so long term, disastrous.
Selection of embryos as tissue donors falls squarely into the objectifying trend in two senses: the literal and the ethical. What makes many people very uncomfortable about biomedical technology in general is the way that the relentless march of reductionist science continually turns human beings, at various stages of development, into human organisms, useful sources of biological raw material for spare parts. As science discovers more and more about the workings of the human body, our bodies are seen as nothing more than machines, with no special moral meaning or dignity, and the pressure to extract various components in order to benefit others becomes ever greater. The problem is the way that this pressure continually leads to the rewriting of ethical rules. Whether it is at the beginning of the lifecycle, with the envisioned creation of cloned embryos purely as sources of stem cells and the proposed extraction of eggs from aborted foetuses for use in IVF, or at the end, with the constant shifting of definitions of death, in order to facilitate the extraction of organs for transplantation, the integrity of human organisms and the ethical rules protecting them seem everywhere under siege from the enthusiasm of biomedical technicians. Only able-bodied post-natal humans seem, for the moment to be safe. The creation of babies as sources of tissue, and, just as shocking, the co-option of reproduction for reasons other than procreation, push the instrumentalisation of human life one step further, and dispose of one more ethical principle. They also set the stage for further steps: how long before we will be told that saving a child this way is the best reason for cloning?; and if we can create embryos and children as sources of cells, if it proves necessary, (perhaps because it proves impossible to create the required organs from embryonic stem cells), why not allow the embryos to grow into foetuses and 'harvest' tissues at that stage?
Leaving aside these next steps, there are thousands of people who could benefit medically from matched tissue donation - there is nothing special about the particular disease that Charlie Whitaker is suffering from. Once this precedent is set, how will we prevent this eventually becoming a routine procedure, with thousands of babies being born as tissue donors for family members? As we contemplate such a scenario, expressions like 'baby farming' come to mind.
In the reproductive context, objectification has a particular ethical meaning, which is often summed up in the term 'designer babies'. The increasing technologisation of reproduction, and the use of technology to choose our children's characteristics tends to make reproduction just another process for the production of consumer goods. Although the outputs of this process are, undeniably, human beings, by choosing their characteristics, we turn them into things, just more human-designed objects. Conversely, by taking this new power of selection/design, over a key part of what constitutes those individuals, we evaluate ourselves above them. This is part of what people mean when they talk about playing God. The parent-child relationship becomes a designer-object relationship, rather than one between two fundamentally equal human subjects.
The selection of children as tissue donors is an example of the objectifying trend in techno-reproduction, albeit not a typical one. Here, the child is not selected for characteristics that will 'improve' it, but to benefit another child. This is in one sense more acceptable, since the aim of the procedure is undoubtedly good, and is not motivated by consumerist desires for 'enhancement'. But in another sense it is a more extreme example of objectification, because the primary reason for the child's being is not even to be a child as such, but as a source of spare parts for another.
As the discussions about how Jamie is likely to feel and to be treated have shown, there are immediate consequences of breaking the ethical rule: it is not a matter of 'real suffering versus abstract ethical principles'. Despite all the love that his parents will no doubt give him, how will Jamie feel, as he grows up, knowing that he was wanted first for his genes, and only secondly for himself? And what if the transplant fails? There is a considerable chance that the cord blood transplant will fail: the next step will be bone marrow extraction, which is both painful and not without risks. It is not hard to see that, having conceived Jamie in order to save his brother, his parents will feel impelled to submit him to this procedure, and the doctors who, might otherwise have counselled them against submitting a young child to this, will feel weakened.
In response to these points, it is often suggested that people often have children for bad reasons, and we do nothing about that, so why object to this? In my view this is intellectual laziness of the worst sort. Firstly, two wrongs do not make a right and it is precisely this kind of argumentation which always drives us down slippery slopes-'you've accepted X in the past, so there's no reason for not accepting Y, the next step? Often the very bioethicists who reject slippery slopes as non-existent, and insist that we can always draw a line, are the same people, who when the time for line-drawing arrives, tell us it would be inconsistent to do so. But more importantly, we must realise that the availability of technology to change chance and hope into certainty and expectation completely transforms the situation, and the nature of reproduction. While parents may have children for various more or less acceptable social reasons, this use of PGD wrenches procreation from its biological purpose and its social context in a way which objectifies the child in a qualitatively new way-now we have children as medical aids.
The need for clear ethical rules
What the Whitaker case, and the public reaction to it, shows is that we must resist pressure from parents who say they will do anything to help their sick children. Individual tragedy is not a good basis for public policy, because, as the old saying has it, the path to hell is paved with good intentions. We must not allow public pressure to erode important ethical principles, because the long term consequences of doing so are, it must be said, worse than the death of a child. The Whitaker case should provide us with an opportunity to reassess and ethics which insists that the release of immediate suffering overrides all other values.
David King June 20th 2003