“You’re now looking at me with eyes colder and more petrifying than the first time you learnt this truth.
I do not mind.
As long as you can be saved, it doesn’t matter.
To me, you, Yoon-jae, always come before everything.”
With these words from their mother, amnesic elite doctor, Yoon-jae, came to the shocking realization that the teenage orphan, Kyung-joon, lying in coma at his hospital was a savior sibling born through surrogacy to be his tissue donor but ruthlessly abandoned after serving his use. Except that it was no amnesia, and he was not Yoon-jae. Unbeknownst to their parents and most people around them, the brothers had, in typical drama fashion, swapped souls in a car accident. Kyung-joon, the unloved child, was receiving the truth in one of the most brutal manners possible.
It can be retorted though that, as much as the idea of “spare parts” children provides much fodder for dramatic angst, injustice is not invariably done to savior siblings. After all, parents can still love a child wholeheartedly even if they have brought him into existence to rescue an existing child. Perhaps one can claim that, as per Kantian ethics (a duty-based ethical theory attributed to philosopher Immanuel Kant), the treatment of persons as means is always wrong regardless of the consequences. That, however, would be a misreading of Immanuel Kant: Kant actually stated that one should treat humanity “always at the same time as an end and never simply as a means” In other words, Kant did not object to the utilization of people for some purpose if their needs and rights remain taken care of. In fact, life often involves making use of people, whether in an act as weighty as extracting blood from donors to replenish a blood bank or one as banal as ordering a cup of cappuccino from a barista. Regarding everyone only as ends in themselves is probably too much of a tall order.
Even if we were to make an exception for the sacred act of bearing children, scholars have pointed out that parents frequently have motives for reproduction, other than bestowing the gift of life on someone who otherwise does not stand a chance of coming into existence. These include purposes as varied as pleasing prospective grandparents, continuing their lineage, reinforcing marital ties and, last but not least, creating a playmate for an existing child—a reason far more frivolous than saving his life. In Chinese culture, the tradition of bringing up children to take care of oneself (a certainly non-altruistic motive!) has been immortalized in the age-old aphorism “store grains to guard against famine, rear sons to guard against the debilitating effects of old age”.
These arguments are, nonetheless, not fully defensible. To start with, the Kantian reference works only if we have full confidence that the welfare of savior siblings will never be compromised. In the case of transplantation of cells derived from umbilical cord blood, the newborn experiences no more harm than he would have if he were born for his own sake. If, however, he were to be harvested for his organs, potential trauma and surgical complications might be in store for him. As the child grows up, psychological uncertainties also come into the picture: while it is certainly plausible that he will take pride in prolonging his sibling’s life, there is still the possibility that he will come to resent or feel inferior about being born as a tool for his parents and a ‘spare parts depository’ for his sibling. Even if none of these threats come to fruition, human experience itself carries monumental implications for the new being conceived—life, as theologian writings noted, is a “vale of tears”. This is likely more so in the event a child is born into a family ridden with difficulties. While a person already in existence should naturally be welcomed and nurtured with care and affection, the decision to bring someone new into existence is never to be taken lightly, even if the latter will not be subject to additional medical or emotional risks.
Furthermore, although we unavoidably treat many people as means in the course of our lives, this at least usually takes place with their consent in one way or another. In civilized countries, regulations are in place to ensure that blood donors sign agreement forms before a needle even prick their skins. Baristas, also, are not slaves forced into the trade but, in fact, enter the profession of their own free will. Admittedly, imperfections may exist in the systems. A donor may feel compelled to agree to an extraction procedure for a research study to maintain a cordial relationship with his research supervisor or physician. Inaccurate or incomplete information may have been presented in consent forms, calling into question the validity of the consent obtained. Workers in a flagging economy or dire personal circumstances may find themselves with no alternative but to take up a particular vocation, whether it is selling cappuccinos or selling blood. Nevertheless, symbolic consent, at least, is available to persons in these scenarios—while such consent makes no practical difference to their lives, it represents societal efforts at respecting their autonomy. Unborn children, unfortunately, do not even have the option of symbolic consent.
Finally, it is worth pondering whether traditions ought to be accepted without questioning or adaptation. Even though traditions often represent the crystallization of time-tested practices and human wisdom accumulated over the centuries, they are developed, after all, with the limited knowledge of forebears of a culture and in circumstances that may have changed since. Indeed, awareness regarding human rights, including those of vulnerable persons like minors, has grown considerably in the past decades. Increasingly vanishing, on the other hand, is the notion of children as personal assets, which, in turn, influences the acceptability of manipulating children for interests other than their own.
That is not to say that the creation of savior siblings can never be justified. On the contrary, depending on the specifics of the case, the potential to save an existing child’s life may well outweigh the uncertain harm faced by the new sibling. At the same time, however, outweighing should not be confused with negation in such contexts: relief at restoring the sick child’s health will not ameliorate any pain or injustice inflicted on his savior sibling. Instead of understating the moral injury done to savior siblings, bioethicists endorsing the reproduction choice should perhaps acknowledge that an evil is being performed, albeit probably a lesser evil than failing to prevent the original children’s avoidable deaths.
Such intellectual honesty would allow room for societal and familial contrition to savior siblings and restore some amount of human dignity they lose through society’s difficult decision to condone their production. Openness akin to that of a child, it can be said, is another healing gift, and one certainly owed to these guardians of life and hope.