“Saviour sibling” is born after embryo selection in the United StatesBMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7404.1416-b (Published 26 June 2003) Cite this as: BMJ 2003;326:1416
The birth of what has been described as Britain's first saviour sibling has renewed pressure on UK authorities to allow selection of embryos on the basis that they may help save the life of an already born brother or sister.
The birth of Jamie Whitaker at the Royal Hallamshire Hospital has reignited the ethical debate over whether it is right to select an embryo that is compatible with an older, sick sibling and to use its cord blood as a reservoir of stem cells for the sick child.
Jamie's brother, Charlie, aged 4, has Diamond-Blackfan anaemia, and the only hope of successful treatment is a transplantation of stem cells from the cord blood of a perfect tissue match or a bone marrow transplantation from a matched donor.
The parents, Michelle and Jayson Whitaker, sought permission for the procedure in the United Kingdom but were denied it by the Human Fertilisation and Embryology Authority. They then went to the Chicago Reproductive Genetics Institute, where two embryos were selected to provide a match for Charlie.
The case has highlighted the ethical debate over preimplantation genetic diagnosis and the blurred line between what is allowed in the United Kingdom and what is not.
Raj and Shahana Hashmi were given permission by the authority to select an embryo that was a match with their son, Zain, who has thalassaemia (12 April, p 782). That ruling hinged on the fact that the condition could be inherited by other children they might have and that there was therefore a benefit to future children in ensuring that they would not develop thalassaemia.
In the case of the Whitakers the authority's ruling was that because the risk of another child developing Charlie's condition was so small there was no benefit to the future sibling.
Critics of the UK policy say that it has failed to keep up with the benefits that new technology can bring, while many supporters of controls say that the selection of who is born and who is not should be down to natural rather than medical selection.
LIFE, the UK pro-life charity, urges caution. “To create another child as a transplant source, however, could set a dangerous precedent for uses of this kind of technology. How will baby James feel, for example, when he discovers that he was brought into the world to supply ‘spare parts’ for his elder brother?” said spokesman Patrick Cusworth.
After the birth of Jamie the BMA reasserted its support for the selection of embryos in cases where siblings are seriously ill or dying.
“As doctors we believe that where technology exists that could help a dying or seriously ill child, without involving major risks for others, then it can only be right that it is used for this purpose. The welfare of the child born as a result of the treatment is of crucial importance, but in our view this is not incompatible with allowing the selection of embryos on the basis of tissue type. We would like to take this opportunity to wish the Whitaker family well,” said Dr Vivienne Nathanson, the BMA's head of science and ethics.
Although the case may present a quandary for ethicists, the choice is a simple one for the Whitakers and other families who seem likely to follow their route.
“There are hundreds of reasons for bringing a child into the world. Some want a child to give a sibling a brother or sister. We always wanted to have four children, so we just combined having more with helping Charlie,” said Mrs Whitaker.
A spokesman for the authority said that a meeting of the authority in September is scheduled to looks at its policies on preimplantation genetic diagnosis to ensure consistency.
The authority's chairwoman, Suzi Leather, said, “As the gap widens between the technology [that was] available when the Human Fertilisation and Embryology Act was passed in 1990 and the technology that is becoming available today, we may need to look at the act again.”