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Rodolfo Melchy Prez. ELS. Research Paper: Bioethical principles in medical science. 1.

INTRODUCTION For this research paper, arguments about made-to-order sibling will be given. Made-toorder sibling situations will be related with ethical principles and how these principles are affected by these situations. These kind of situations can be understood easily by watching the movie My Sisters Keeper which is a drama film from U.S.A. producing. It was filmed in 2009 and directed by Nick Cassavetes. Synopsis. The synopsis given in the Internet Movie Database is the following:
Conceived by means of in vitro fertilization, Anna Fitzgerald (Abigail Breslin) was brought into the world to be a genetic match for her older sister, Kate (Sofia Vassilieva), who suffers from acute promyelocytic leukemia. Because of her sister's dependency on her, Anna is unable to live the life she wants; in and out of the hospital constantly, she cannot take part in extracurricular activities such as cheerleading or soccer. When Kate turns 13 she goes into renal failure. Knowing that she will have to donate one of her kidneys to her sister, Anna sues her parents for medical emancipation and the rights to her own body. Attorney Campbell Alexander (Alec Baldwin) agrees to work for Anna pro bono. The film is interlaced with flashbacks that detail the strong relationship between Kate and Anna, as well as how Kate's illness has affected her siblings' lives. Before the result of the case is known, it is revealed that Kate had asked Anna to file for medical emancipation. Believing that she would not survive the surgery, Kate wants to die. Anna wins the case, and due to her sister's wishes does not donate her kidney. Kate later dies at the hospital. The family moves on with their lives, being changed by Kate's death, but every year on Kate's birthday they go to Montana, which was her favorite place in the world.

2. DEVELOPMENT. The problems related with ethical perspective in made-to-order sibling cases, are presented in mainly two events. Firstly, when the made-to-order sibling is conceived and secondly, during his or her life in all medical treatments he or she has to take part in. Made-to-order sibling conceiving. Generally, made-to-order siblings are born because they are needed as a genetically compatible donor for her or his sibling and neither their parents nor other siblings already born are useful for the required treatments. The problem here involves firstly the parents, who take this decision. A made-to-order son can be cared by their parents and also may be beloved by them, but she or he was born for a specific purpose which is to help as a genetically compatible donor to her or his sibling. This person will be subject to several medical treatments in order to help her or his siblings but these treatments may produce side effects as infections, fevers, allergies and health problems which will reduce her or his life quality. Therefore, since the moment this person is conceived, he or she is subject to a lower life quality than he or she could have being conceived not as a made-to-order son.

What the problem is. On this situation, the will of the made-to-order sibling gets affected since this person is forced to take part in medical procedures in order to help his or her sibling. There are, also, analyses about the ethical principles, which are affected or in a contradictory situation under made-to-order sibling cases. Justification from ethical perspective. Autonomy is defined as the capability of self-govern, which involves skills of understanding, reasoning and decision making. Autonomy can be seen as two different kinds of obligation. A) Autonomy as a positive obligation. It holds that autonomy has a limit, as it is not affecting other people. In a society, taken actions of one person can affect another; therefore, there must be limits for autonomy. B) Autonomy as a negative obligation. This involves information revealing as well as decision making promoting. In order to get an autonomous decision, the knowledge of all the posible options is needed. This possible options are produced by others. This is the reason that when we are involved in other persons decision making we should show all possible information about the decision in question. In this way, getting more information, a better election is promoted. In made-to-order sibling cases, autonomy is not respected as a positive obligation, since forcing the made-to-order sibling to take part of medical procedures does not promote decision making by herself or himself. Besides, not all information about these procedures is revealed to the made-to-order sibling. This information would influence in the decision this person could make. In the other hand, parents are not respecting autonomy as a negative nor positive obligation, since their actions are afectiong the autonomy of the made-to-order sibling. The following analysis can be implemented in relation with the ethical principles. Below, each principle is described and the way how they are affected is mentioned. Beneficence/ No maleficence: This principle is in contradictory situation, since parents are looking for helping to their sick son but damaging to their other son. Also, autonomy of both sick son and made-to-order son are affected. Principio utilitarista: En la situacin de Kate y Anna. La salud de Anna se pone en riesgo para mejorar la de Kate. En este aspecto, parece una relacin de uno por uno. Sin embargo, el bienestar de Kate brinda felicidad a toda la familia, por lo que mejorando su felicidad se logra el mayor bien para la mayora. Justice: Not the same conditions are given to the siblings. Health of one of them is being damaging while betterment of the health of the other sibling is searched. The perspective of the family doctor in these cases is looking for the beneficence of sick sibling. This is in accordance to a doctors mission, which is curing sick people or

helping in sick people treatments. When parents of one sick son are looking for a genetically compatible donor, doctors suggestion about a made-to-order sibling as the solution to this problem affects the autonomy of this person (the made-to-order sibling), who is still unborn, and establish since that moment that this person is going to take part of medical treatments for his or her sick sibling. The Code of Ethics for the American Association of Physicists in Medicine (AAPM) holds in subsection C about human participants in researching:
Research involving human participants should adhere to the Belmont Principles of Respect for Persons, Beneficence and Justice. Respect for persons recognizes the autonomy of individuals and the right of each research volunteer to be treated with respect, to be fully informed about the research and its potential benefits and risks, and to be granted the ability to decide for him- or herself whether to participate in the research. Beneficence assures that some potential benefit will accrue from the research, to the participants themselves, to others with similar conditions who may benefit in the future, or to society at large. Justice means that potential participants in a study are not excluded without a valid reason for exclusion. Most institutions subscribe to the General Rule which says that all research involving human participants is subject to the same degree of oversight and follows the guidance of the Belmont Principles.

Besides, the Belmont Principles, a report created by the United States Department of Health and Human Services, refer to protection of human rights in the researching field. These principles hold repect for people, benficence and justice. Although, these principles are related with medical researching, made-to-order sibling cases can be taken as a medical research given the fact they are involved in several medical treatments and betterment in health is being looked for as a consequence of these treatments. The family doctor does not respectc the made-to-order sibling autonomy, therefore, he or she does not follow the lineament of this report. 3. CONCLUSIONS. Made-to-order cases may involves betterments in health for the sick sibling and even his or her cure, perhaps imposible events if the made-to-order sibling was never born. It also involves ethical arguments that break ethical principles. Feelings between parents, the made-to-order son and the sick son are comparing. Autonomy respect avoids the generation of these kind of situations where feelings are involved. Relationships between parents and sons get affeted, as well as relationships between siblings. The life quality level of the made-to-order son is affected as illness of the other son is getting worse and more medical treatments are required. Therefore, where is the lmit in these treatments? How worse should the made-to-order son get in order to save her or his sibling? 4. REFERENCES. The American Asociation of Physicist in Medicine (2009). Human Participants in Code of Ethics for the American Association of Physicists in Medicine: Report of Task Group109 (p. 6). Madison, U.S.A. Medical Physics. Beauchamp, Tom & Childress, James (2009). Respect for autonomy. In Principles of Biomedical Ethics (pp. 100-105). New York, U.S.A. Oxford University Press.

My Sister's Keeper (2009) - Synopsis.Visited on 14th August 2011. National Institutes of Health. The Belmont Report Ethical Principles and Guidelines for the protection of human subjects of research. Visited on 14th August 2011. Santa Clara University. Savior Siblings: A Case Study Based on My Sister's Keeper. Kari Kjos. Visited on 14th August 2011.