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Title: Kinderen voor kinderen
Subtitle: Ethische overwegingen rond pre-implantatie genetische diagnose voor stamceldonatie
Author(s): VEULEMANS, Sophie , HANSEN, Bart
Journal: Bijdragen
Volume: 68    Issue: 1   Date: 2007   
Pages: 67-86
DOI: 10.2143/BIJ.68.1.2019444

Abstract :
Preimplantation genetic diagnosis (PGD) is a technique which was originally developed as an alternative to prenatal diagnosis for couples at high risk of transmitting a genetic defect. It allows scientists to check specific genetic defects of the embryo obtained through in vitro fertilization (IVF) so that only embryos not affected by the tested disease or balanced for the tested chromosomes can be replaced. Recently, case reports reveal that clinicians applying PGD are increasingly confronted with requests by parents with an affected child whishing for PGD not only to test IVF-created embryos for genetic disease but also to test for a nondisease trial related to immune compatibility with a child in the family in need of a hematopoietic stem cell transplant. Only embryos HLA matched with an existing sibling in need of a compatible donor of haematopoietic stem cells would be transferred. In this article, our main objective is not to answer the question of the ethical permissibility of this technique. We rather want to clarify some anthropological options underpinning this technique, which have to be taken into account for an ethical evaluation. By virtue of its very being, the human person is multidimensional: open to itself, to another and to society. This multidimensional character of the human person is a real challenge in the field of human genetics and medically assisted reproduction: a couple never decides solely for itself, but its decision has an enormous impact on their offspring; the physician is a necessary third person in the decision making process; a parental decision is influenced by and ma y change the public support of PGD.
First we have to evaluate the request of the couple to use PGD in order to create a donor sibling. The main ethical argument against this kind of request is the instrumentalization of the future child. The child becomes an instrument to cure another child. One of the fundamental rules underlying Western moral thinking is the Kantian imperative. The second formulation of the categorical imperative goes as follows: ‘Act in such a way that you always treat humanity, whether in your own person or the person of any other, never simply as a means, but always at the same time as an end’. From this perspective we advance the ethical requirement to surpass the apparent discrepancy between the need of the parents to produce a healthy child and the desire of parents to have a child.
Second, the physician should take into account the fact that a technological innovation may have such a compelling character that human reproductive freedom will be restricted rather than enlarged. Thus the physician should be guarded from engaging in so-called medical futile acts.
Third, the experience of the donor child will be discussed. It could be argued that a heavy burden is placed on the donor child. The transplantation may fail and this may give the child a fundamental sense of unworthiness and deficiency and a feeling of not being able to live up to the expectations. The psychological impact of stem cell donation among siblings should indeed not be underestimated.
Finally, on societal level, the need for instant success has contributed to ever more invasive reproductive technologies. We question however that reproductive success does not necessarily depends on the invasiveness of the techniques. Parents should be given time to put meaning on their lack of reproductive omnipotence.

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