As a teenager, the movie “My Sister’s Keeper” initiated my interest in saviour siblings. It portrays a young girl who tries to gain medical emancipation from her parents when urged to donate a kidney to save her leukaemia-stricken sister. After further research, I discovered that the movie addresses the ethics of saviour siblings. Consequently, it prompted questions, like whether it is right to do whatever is necessary to save a child’s life at the expense of infringing upon the rights of another?; and ultimately, is creating a saviour sibling ethical in the first place?

For those unaware, a saviour sibling is a child conceived through IVF. An embryo undergoes pre-implantation genetic diagnosis such as HLA typing to create a genetically compatible individual who can provide stem cells, blood, or organs to a sibling requiring them to live. Although creating a saviour sibling appears to be a noble endeavour, when addressing the ethics; three arguments are considered.

1. Saviour siblings as commodities:

This perspective stems from the idea that saviour siblings are a continuous and potentially expendable resource, contradicting Immanuel Kant’s maxim, “Never simply use people as a means, but always at the same time as an end”, and subsequently opposes the view of ethics as “right”. However, some argue that Kant’s assertion, in this case, doesn’t distinguish between having a child as a saviour sibling and having a child for another objective, like completing a family or saving a marriage, as the child is still a tool for serving a purpose. Thus, from a Kantian perspective, what is wrong is to create saviour siblings for a specific reason and then just discard them afterwards.

2. Saviour Siblings could lead to designer babies.

No!! Designer babies are not Gucci babies! They refer to genetically engineering pre-implantation embryos to influence the traits children will have. The creation of saviour siblings could be seen as a step towards pre-determining a child’s purpose and characteristics, illustrating a desire for perfectionism in a child by a parent rather than wanting them for who they are, thereby limiting their development as individuals. Furthermore, like the genetically “perfect” society in the sci-fi movie Gattaca, this argument allowed me to consider the path to negative eugenics that creating saviour siblings could create, selecting favourable traits to the detriment of people who cannot compete, and with the development of gene-editing tools like CRISPR-Cas9, such societal perfection and extreme segregation could be a misguided future reality.

3. The welfare of the saviour sibling

This argument considers the physical and emotional well-being of the saviour sibling. Alnasir et al. 2020 argue that regarding saviour siblings, the principles of beneficence and nonmaleficence of medical ethics are violated; since their creation and donation process carries no medical benefits for them but does impose potential harm, as they risk not only a painful invasive transplantation procedure but also abandonment and long-term detriment to their self-worth; if their donation is unsuccessful since their identity and value originate from being a cure to their older sibling.

Final thoughts

The conception of saviour siblings is an ethically controversial practice to which there is no clear answer; fortunately, this delicate process is regulated by the Human Fertilisation and Embryology Authority, authorising the creation of saviour siblings as per approved set conditions. Overall, this topic expanded my learning and prompted the conclusion that though it appears impossible to grasp the full extent of saviour siblings, the answer is that there may be no good answer, but as humans and a society, we must make decisions and applicable regulations for a virtuous future for those born to save another.

After a long day of lectures, my housemates and I decided to watch a couple of episodes of Black Mirror on Netflix. This is an series based on the dangers of technological advancements in a dystopian near future. The scary aspect of Black Mirror is that the rationale and vision for these technological advancements portrayed in the series is highly compatible with our own. Even with good intentions such as curing disease and reducing crime, brings its own consequences.

We watched an episode whereby all your memories were recorded so that you could watch them back or could be used by police and authorities. In the show, it was originally designed to help with those suffering with Alzheimers, but now has evolved into something more sinister than intended. It brought up an ethical debate within our house on whether or not we would do it, as well as the topic of free will.

We discussed that very few have an issue with prostheses to help with motor functions such as hip and knee replacements, prosthetic legs, and even replacement organs such as a pacemaker. However, what about prostheses in the brain? I am a Neuroscience student and realised there were very few examples of neuroprosthesis so, naturally, I was intrigued. The brain is one of the only organs in the body where we cannot get a transplant, and this is only explored in science fiction.

What are the current technological possibilities?

Elon Musk is currently developing a technology called ‘Neuralink’ that will give people with quadriplegia the ability to control computers and mobile devices with their thoughts. Fascinating!

https://neuralink.com/ – Read more about their approach and applications

Here is a podcast discussing the current breakthroughs in commercialising Brain-Computer Interfaces using a minimally implantation method and a soft electrode device. They explain how they received lots of support in the early stages of research, showing it to be an area of interest for investors. Their approach is to build on existing research and translating that into clinical practice.

Next Steps…

If our liver stopped working, we could use stem cells, and get a transplant, and there is even research regarding a 3D-printed liver. What about the brain? For an Alzheimers or Multiple Sclerosis patient, would you consider using stem cells or an implant to replace parts of the hippocampus or myelin for neurons? Yes, most likely. What about someone with Schizophrenia, would you replace their frontal or temporal lobes? What about depression, autism, ADHD or OCD? By definition, they have an illness or a disorder.

Where would we draw the line?

Discussion point:

Imagine someone in the army or someone who has experienced trauma. Prosthesis is a way of improving someone’s quality of life, so how far can we go? Would we attempt to make people less emotional, smarter, remove traumatic memories, and stop people from experiencing fear? This would certainly improve their capabilities as a soldier, improving their quality of life and removing the risk of developing PTSD, experienced by many soldiers.

Is this improving their quality of life or eradicating a vital part of their identity?

How would society change if this was the norm?

Here are 2 episodes of Black Mirror that show the applications of neural implants that go beyond treating neurodegenerative disease…

My final thoughts:

I believe that neuroprosthesis should be encouraged as it could change millions of lives for the better. Only with strict regulations can these advancements benefit society and help those suffering with physical and mental health problems. I don’t belive that society will be benefitted from technology enhancing memory, intelligence or physical capabilities in those who don’t require serious help or assistance.

My interests lie within sustainability and how we can be better for our environment, which led me to think about the sustainability of prosthetic limbs currently, and what research is being carried out to improve them. Prosthetic limbs use a great deal of plastic, which is made up of hydrocarbons mined from the ground. These pollute our environment and are a massive contributer to the enhanced greenhouse effect, and therefore global warming. While they do not cause as much of an issue as single use plastics do, due to their long term use, they still impact the planet once they are no longer needed. They will end up in landfil where they will slowly be broken down into microplastics that pollute terrestrial and aquatic environments. These can lead to disruptions in food chains, and sometimes even the increase in death of organisms.

Biologically Derived Plastic

Researchers have been looking into the use of polyhydroxyalkanoate, which is a bioplastic, meaning it does not origniate from petroleum, and is biodegradable. These have similar properties to plastic and are already used in many industries, therefore are a good candidate as an alterantive material. These properties include being durable and versitile, which are important when applied to prosthetics. This material is not only better due to its reduce carbon footprint and lower energy consumption, but it is also a cheaper alternative, which will make prosthetics more accessible to those needing them.

Recycled Plastics

Recycling plastic bottles is another avenue of research that is currently being explored by researchers. These researchers are hoping to produce polyester yarn from bottles that can then be moulded into artificial limbs. This is a great way of moving towards a circular economy, by taking plastic waste and upcycling it into something new, with a much longer term use. However, there are issues with this method, which include the plastic being degraded into microplastics and polluting the environment. Although, if these plastics had not been recycled, they would have degraded anyway.

Agricultural Waste

Researchers in Malaysia and the UK are attempting to use natural fibres generated within agricutlure, as a composite material in prosthetic limbs. By using waste material, this method also promotes a zero waste and circular economy, and in a low cost way. The researchers want to further this zero waste goal by using left over materials and energy and use it in other stages of production. This method won’t fully remove plastic though, and will just reinforce the plastic. Despite this, the method still reduces plastic while removing waste where possible. This is a method that could hopefully be furthered in the future and help to fully remove plastic.

Whilst making prosthetics more sustainable is important for our planet, it should not come at a cost to the wearer. Function and comfort are some of the most important aspects, but hopefully the researchered being carried out can lead to a solution that also benefits the planet. Removing waste from the environment while reducing plastic production are great ways of achieving this goal.

My first well-formed academic interest took shape in the form of bright-eyed awe at the beauty, diversity, and complexity of every life-form that I set sights on. How wonderful the pattern of that tree’s branches! I would wonder at the factors driving the formation of that pattern.

This might all seem to be getting away from the topic of tissue-engineering, but morphogenesis (how the shape of organisms arises during development) is of great relevance in research and the clinic! There are two main views of how development occurs, with the classical ‘mosaic’ view, in which cells obey a deterministic programme, their fates determined genetically, and the ‘regulative’ view, in which cell-cell interactions and multidirectional information transfer affect the developmental trajectories of the cell, with evidence pointing that both have their place in different developmental stages, as the cells take in physical, electrical, and chemical cues to “decide” how to arrange themselves. The way that organs and tissues form is at the core of many regenerative medicine issues, from birth defects, to genetic diseases, to cancer. Contrary to the intuitive assumption that organisms with higher regenerative capacity would also have higher propensity for cancer due to their higher cell proliferation, they actually have lower cancer incidences, implying the competent morphogenetic pathways used for regeneration may also prevent cells from falling into the disorder which can lead to tumorigenesis.

Indeed, this ability of cells to self-organise into tissues and organs has been exploited in the form of organoids, mini 3D structures which can be derived from Embryonic Stem Cells (ESCs) and induced Pluripotent Stem Cells (iPSCs), which can have very similar functions to in vivo organs, having incredible potential for drug testing, disease models, and even the possibility of becoming an alternative for organ transplants, overcoming barriers such as long waiting times and tissue rejection in patients; an organ grown from the patient’s own iPSCs, maybe edited genetically into a healthy form if applicable. This might even be an alternative to xenotransplants, bypassing several of the ethical issues associated with using animals for organ harvesting. Of course, organoids come with their own suite of ethical concerns, from source of the stem cells to the moral and legal status of organoids, especially in the cases of multi-organ and brain organoids, but the benefits of organoid research are worth the extra necessary steps to ensure such research follows our moral values.

And if that sounds fantastical, imagine my surprise when I found this property of cells could lead to the possibility of replacement limbs, not in the form of prostheses or even grown on scaffolds, but grown by the patient themselves! Over the course of a 2022 study, Murugan et al were able to trigger the regrowth of frog legs with the use of a bioreactor which served to protect the site of injury and deliver a drug-cocktail which, among other things, prevented growth of scar tissue by inhibiting collagen and encouraged nerve, muscle growth, and vascularisation, activating the body’s own regenerative abilities and molecular pathways used during embryonic development. Over the next 18 months, the frogs subjected to the 24-hour treatment grew back almost fully functional legs which they could stand and swim with. Of course, this technology is a long way away from clinical application, with mice being currently used to test whether this approach would even work in mammals. This, and other techniques discussed here, are yet in their infancy, with much of the basic groundwork yet to be done. Still, the future landscape of regenerative medicine holds many incredible possibilities that I am excited to witness.