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 also 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: this will nearly always be the case for couples in their position. The case against this use of PGD does not depend on fine analysis of each couple’s motivations and emotional states, or on how much they succeed in loving their new child despite the reasons for his/her conception, but on the consequences of breaking the ethical rule.
While most people would agree with the ethical principle, many 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 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. 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 no 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 leads to 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 fetuses for use in IVF, or at the end, with the constant shifting of definitions of death to facilitate ‘harvesting’ 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, as shocking, the co‐option of reproduction for reasons other than procreation, push 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 fetuses and ‘harvest’ tissues at that stage?
Leaving aside these next steps, many people could benefit medically from matched tissue donation – there is nothing unique about Charlie Whitaker’s disease. How will we feel when the tissue recipient is not another child, but an adult, maybe a parent or a more remote family member?
In the reproductive context, objectification has a particular ethical meaning, often summed up in the term ‘designer babies’. The increasing technologisation of reproduction, and the use of technology to choose our children’s characteristics, tend to make reproduction just another process for producing consumer goods. Although the outputs of this process are undeniably human beings, by choosing their characteristics we turn them into things, just human‐designed objects. Conversely, by taking this new power of selection/design over a key part of what constitutes those individuals, we elevate 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. In one sense this is 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 to be a source of spare parts for another.
As the discussions about how Jamie is likely to feel and 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? What if the transplant fails? There is a considerable chance that the cord blood transplant will fail: the next step is bone marrow extraction, which is painful and has risks. It is not hard to see that, having conceived Jamie 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 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. First, two wrongs do not make a right. Secondly, 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 we can always draw a line, are the same people who, when the time for linedrawing arrives, tell us it would be inconsistent to do so. 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.
In summary, when we look at these cases in their proper context, it is clear that the rule not to use people as mere means to an end (instrumentalising them) is not just a remote theoretical principle. Objectification and instrumentalisation are an inherent feature of reproductive biomedicine, not something that just crops up in occasional cases. Thus we can be quite certain that, if we abandon the principle now, we will see more and worse to follow.
What Kind of Ethics Do We Need?
It is apparent that cases like these pose a challenge not only to our mechanisms for discussion and decision, but to the kind of ethics that underlie the mainstream of debates.
First, it should be clear that the kind of ethics purveyed by the HFEA [Human Fertilisation and Embryology Authority] is not merely grossly inadequate but positively misleading. It is not only that the HFEA is dominated by a philosophy that allows no critique of science itself, or of the direction of medicine. Nor is it that the ethics employed are abstract and have to conform to the discourse rules of bioethics, which forbid historical analysis of social processes, such as the trend of objectification and the forces driving it. The problem is worse: the HFEA cannot even articulate the basic ethical issues at the centre of public concern.
Surveying
