March 1990 XI/7
AN EMOTION LADEN ISSUE:
CONCEIVING ONE CHILD TO SAVE ANOTHERAbe and Mary Ayala, a California couple in their mid-forties, did not plan to have another child. But they changed their minds when their 17-year-old daughter Anissa was diagnosed as having leukemia, a cancer of the blood cells which can sometimes be cured by transplanting bone marrow cells from a compatible donor. Because the medical team could not find a suitable donor among relatives or friends, the Ayalas decided to have another child, taking a one in four chance that the new born child would be a compatible bone marrow donor for Anissa. The one in four gamble seems to be paying off. Prenatal testing indicates that the female fetus will be a compatible bone marrow donor.
When the Ayala story became public, medical ethicists were consulted and they criticized the venture because the newly conceived child was being treated as a "means," not as an "end." In response to the observations of the ethicists, several media persons affirmed the right of the Ayalas to do whatever they desired as long as love is their motive. At the same time, some columnists berated the ethicists for offering opinions from an ivory tower. Can we evaluate the actions of the Ayalas from an ethical perspective? Does ethics have anything to offer in regard to such a personal and emotion laden decision?
Principles
Though there is no method of ethical evaluation which eliminates emotional reactions, there are distinctions and considerations which may help to minimize them. First of all, it is necessary to distinguish the remote intention or purpose of the act in question from the proximate intention or purpose. If only the remote intention of an action is emphasized to the exclusion of the proximate intention, then one can justify just about anything. If I rob poor widows to pay for my college education and consider only the remote intention, then robbing widows might be put forth as a good action because it enabled me to obtain a college education. Discussions concerning the morality of abortion often breakdown because of failure to make this distinction. In the case of the Ayalas, their desire to prolong the life of Anissa is a good intention. But the means they utilize to prolong her life must be evaluated in their own right. Is it ethically acceptable to conceive a child mainly with the intention of providing therapy for another child? This is the ethical issue under consideration.
When assessing an action with emotional overtones it is helpful to step back and say: "What if everybody performed the action with the same purpose in mind?" Emmanuel Kant recommended that a similar question be asked when forming ethical norms. What if every child were conceived as a means to prolong the life of other living persons? What would this do to our society and to the self-esteem of children as they progress to maturity?
Another approach which helps to evaluate an emotion laden action is to consider the action from a perspective that all would consider acceptable. Then consider the action in question from a perspective that all would consider perverse. Finally, compare the action in question to both good and perverse actions to determine whether it more closely resembles the good action or the perverse action. For example, it seems that if a child is conceived as a sign and result of the mutual love of the parents, and is nurtured and educated with the intention of helping the child attain human fulfillment, then most would agree that this is a good action. On the other hand, all would agree that conceiving children in order to sell them into slavery would be wrong; wrong because it debases and disvalues the worth and dignity of the human persons who will be slaves. Even if the parents plead poverty and state that their children will have a more comfortable life in slavery than if they had stayed with their poor parents, the act of generating human beings with the intention of selling them into slavery is simply unacceptable. A child should never be considered the property of the parents. Clearly, generating a child as a potential bone marrow donor is not exactly the same as conceiving a child in order to sell him into slavery. But does the intention of the Ayalas resemble more closely the good or the perverse intention mentioned above?
Discussion
Mrs. Ayala responded to remarks of ethicists by saying: "We are going to love our baby. Out baby is going to have more love than she probably can put up with." While there is no desire to question the overall dispositions of the Ayalas', the aforementioned statement illustrates the difficulty of using accurately the word "love" in the English language. In English, we convey three different human actions through the one word "love." In Greek, three words are used to convey these three types of love: philia, eros, and agape. The significance of this examination of words and concepts is that the deepest form of human love, agape, is the type of love we predicate between parents and children. Agape is incompatible with self-serving intentions. Can we say we have the deepest form of love for another if we are going to use that other person to achieve goals which we have determined without consulting the person in question? Thus, the need for more accurate distinctions and soul searching evaluation when we use the word "love" to justify human actions.
Stepping back from the immediate question once more, let us consider the activity and outlook of the physicians who advised the Ayalas. While they remained behind the scenes insofar as the news stories were concerned, we surmise that they were deeply involved in the decisions to create a "suitable" bone marrow donor. Once again, we face the question: Is the goal of medicine to prolong life as long as possible, no matter what means are used? Or is the goal of medicine to help people pursue a better life, the worth and dignity of all persons being respected in the process? If one opts for prolonging life as the ultimate purpose of medical care, then the patient (and/or family) is often subjected to therapy with no view to the values and priorities of the person. Most cases of over-treatment as death approaches are examples of the "prolonging life at all costs" outlook. In the immediate future, as the ability to prolong life increases, for example through mechanical devices such as the artificial heart, or through xenografts, the question of human benefit must be put in the forefront of medical and ethical decisions. What risks and burdens are to be endured to prolong one's own life or the life of another?
Conclusion
Finally, do ethicists have any role in commenting upon personal and emotion laden decisions which have ethical ramifications? Seemingly. they have as much right to comment as do newspaper columnists; but saying this doesn't answer the question. Clearly, the observations of ethicists are offered more effectively before than after the fact. If offered after the fact, the observations must be thorough and circumspect or they will be lost in the emotional reaction to which they give rise.
Kevin O'Rourke, OP
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