Conscientious Nondisclosure and the Savior Sibling Debate: Does Moral Justification for Nondisclosure Matter?

Abstract

In cases in which a suitable donor cannot be found for a child in need of a stem cell transplant, parents of that sick child may have the option to use in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD) to bring another child into existence who could serve as a donor. In “It’s Time to Reframe the Savior Sibling Debate,” Strong, Jordens, Kerridge, Little, and Ankeny (2011) report the results of interviews with health professionals and parents about the practice of creating such “savior siblings.” The interviews revealed that the health professionals who participated in the study do not generally raise the option of using PGD to create a suitable donor with parents of a sick child. Further, the authors report that the clinicians interviewed identified a number of ethical concerns about the use of this technology as reasons for not disclosing this alternative. The authors critique the ethical reasons for nondisclosure offered by clinicians and argue that none can withstand scrutiny. They then conclude that failing to inform parents about the option of creating a savior sibling is morally problematic because the clinicians’ ethical reasons for withholding this information are not justifiable. In other words, clinicians’ conscientious objection to disclosure of this alternative is not defensible because the reasons offered by clinicians are not good reasons. Thus, they suggest, the focus of the debate over savior siblings should shift: The debate about the morality of the use of this technology should be reframed as a critique of clinicians who fail to disclose the alternative of creating a savior sibling when doing so could save the life of a sick child. This argument raises a thought-provoking question about conscientious objection: Does it matter whether the ethical reasons grounding the objection are justifiable? The structure of the paper makes it clear that Strong and colleagues believe that it does, even though an argument in support of this position is not laid out. However, a strong case can be made that the opposite is, in fact, true. That is, the extent to which a clinician’s ethical reasons for con-