Saviour Siblings: A Relational Approach to the Welfare of the Child in Selective Reproduction by Michelle Taylor-Sands

Preimplantation genetic diagnosis (PGD) has opened up a new pathway to selecting the kinds of children we might have through allowing us an insight into the genetic make-up of embryos. While Michelle Taylor-Sands’ book acknowledges and responds to some of the now familiar controversies in the ‘designer babies’ debate such as selecting for traits like sex and disability, its primary concern is with the use of this technology to produce so-called ‘saviour siblings’—children deliberately selected to be born because genetic diagnosis shows them to be an exact tissue match for an existing sibling with a disease which could be treated with their umbilical cord blood, bone marrow or other tissue.

In countries such as the United Kingdom and Australia that have already legislated to allow the creation of saviour siblings under certain conditions, Taylor-Sands points out that the key consideration is the welfare of the child to be born. However, within the voluminous amounts of reasoning that have been produced in generating such legislation in both of these jurisdictions, she identifies a lack of any explicitly ethical reasoning regarding how the welfare of the child should be understood. Furthermore, in both the United Kingdom where the welfare of the child born through ART is understood essentially in terms of harm he or she might experience and in Australia where deliberation on selective reproduction centres on a consideration of the child’s ‘best interests’, Taylor-Sands detects a tension between the individual interests of the child and those of the family into which he or she is to be born. Conversely, her approach is to treat the individual child’s interests as being fundamentally bound up with those of the ‘intimate family’ of which he or she forms a part.

Before proceeding to set out her relational approach to the welfare of the child, Taylor-Sands gives consideration to concerns relating to the possible commodification of what she calls “the child to be born” (p. 1) and to the various ways in which that child might be considered to be harmed. In response to the concern that by selecting a child primarily on the basis of his or her ability to supply life-saving biological material to an existing child he or she is treated as a mere commodity, she acknowledges (following Beauchamp and Chil-dress) that the Kantian principle upon which such an objection has often been mounted (i.e. “to treat people ‘never simply as a means, but always at the same time as an end’”, p. 12) has been frequently misread as prohibiting all use of other persons as means to serve our own ends. Thus, if it can be shown that an individual is still likely to be treated as an end in him or herself while also being used to serve other ends, no such fundamental objection need arise. While Taylor-Sands does not adopt an overtly Kantian argument in relation to duties more generally, this is a desirable move for her to make in order to prepare the ground for the argument she goes on to develop.

In Chapter 2, Taylor-Sands considers potential harms to the child to be born as a result of the biopsy procedure on the embryo to test for a tissue match as well as the in vitro fertilisation (IVF) process more generally. She finds the available evidence suggests the risks are minimal, though she keeps an open view about the possibility of evidence to the contrary appearing over time. Having rightly acknowledged these fundamental concerns, she then deliberately side-steps the question of whether embryos that are destroyed in the IVF process have interests and as such are harmed by their destruction by emphasizing that she intends to focus only on harm to the child to be born. Nonetheless, she tips...