The relationships between and among family members are personal and diverse among individuals across the globe. Naturally, parents always desire and want the best for their children. In many cases, a parent may opt for unconventional methods to ensure the safety and health of a child. For instance, in a case where a child is sick especially from severe chronic illness such as cancer, taking care of the child requires a lot of resources and sacrifices on the part of the parents from time to finances to emotional sacrifice. When two siblings are medically compatible, a parent may resort to using one sibling to keep another alive. Using one sibling to keep another alive while ethically dubious enables protection of life and a general benefit to the donor and family especially in instances where the donor’s choices are adequately informed, and they are prepared sufficiently for the sacrifice.
In the ethical debate of using one sibling to save another, it is essential to acknowledge the choice of the donor. It is crucial for the option to be voluntary, as such it is necessary for physicians to recognize age and familial pressure if any. In cases involving minors, parents make decisions on behalf of their children since in a legal sense minors cannot consent to medical procedures. The relationship between siblings is especially unique since they are peers as much as they are sisters, brothers or sister, and brother. In many cases, siblings understand each other at a level that even the parents cannot comprehend (Trifiolis, 2014) . It is natural that the close relationship between and among many siblings will influence many siblings to opt to assist the ill brother or sister at any capacity. The choice to voluntarily participate in an intrusive medical process from which the donor gains no benefit reflects the closeness of sibling associations.
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Additionally, many of the medical procedures involving siblings saving other sibling are done in efforts of preserving life and generally benefiting the health of the ill child. The decision makers are burdened with ethical qualms since their ultimate decision has life or death consequences for the sick sibling. One may argue that the mere consent of a child does not provide a solution since it is difficult to know when it is ethical to accept such a level of responsibility from a minor. According to the American Academy of Pediatrics Committee on Bioethics (AAPCOB) using one child to keep another alive is considered ethical when some conditions are met (Bendorf & Kerridge, 2011) . One of the requirements is the lack of an adult alternative. Majority of parents, medic al providers, and the community values the lives of children as such cannot be asked to sacrifice when there is an adult alternative. Moreover, many events of siblings saving a sibling involves their close genetics. AAPCOB asserts it is necessary for the sacrifice of the child to confer a reasonable benefit to the recipient (Bendorf & Kerridge, 2011) . The chances of survival in many cases where physicians opt to use a minor sibling are relatively high. As such being involved in the procedure often means saving a life. Moreover, the process is beneficial to the whole family since taking care of the ill child often affect household finances, time and emotional well-being.
Moreover, the donor child also benefits from the process. The question of ethical permissibility arises on account of the emotional, psychological and physical effects of the sacrifice on the part of the donor. Many physical consequences are considered in the decision making since many healthcare providers are conscious of their oaths to preserve human life. While emotional and psychological effects are not easy to weigh, the benefit of saving a bother's or sister's life when it meant death justifies the danger (Garcia et al., 2013) . Siblings are in close social fabric, a family, as such family dynamics such as the possibility of losing a loved one plays a significant role. The sibling sacrificing on behalf of another will feel a sense of purpose and happiness in saving the life of the brother or sister. Moreover, in the event, the donor sibling decides against helping, and the patient dies, it is deductible guilt, and psychological trauma will affect them for the rest of their lives.
However, in recent years, the concept of parents using one sibling to save another has gone beyond the mere aspect of checking for compatibility to efforts of creating a perfect donor. The idea of “savior sibling” involves creating a perfect donor through pre-implementation genetic diagnosis (PGD) and in vitro insemination (IVI) (Trifiolis, 2014) . The creation of a savior is risky since there are technical difficulties in using both PGD and IVI. Moreover, there are concerns for the welfare of the child since the “savior” can suffer emotional and psychological trauma because he or she feels unwanted. For instance, in the movie "My sister's keeper," Anna was "engineered" to save Kate, her sister. Throughout her life, Anna provided cord blood, white blood cells, and bone marrow to sustain her sister's life. In her endeavors to save her sister, she suffered infections, bruises, and distress of feeling like a means to an end. At 11 she sued her parents for medical emancipation since she did not have the desire to donate a kidney to Kate. The movie is unethical since unlike the concept of testing for compatibility amongst siblings, Anna was created to save her sister and her parents continued to ask her to do so despite the physical and psychological effects.
Conclusion
The use of one sibling to save another sibling is ethical when the child personally consents to the procedure, and her or his decision is well-informed. Moreover, it is essential for the donor child to be sufficiently prepared for the process. The concept of using one child to save another facilitates the protection of human life and closeness between the siblings and the family as a whole. However, the extremes of "engineering" a perfect donor merely to save another sibling's life are unethical and morally indefensible.
References
Bendorf, A., & Kerridge, I. H. (2011). The ethics of bone marrow transplantation in children. Journal of Pediatrics and Child Health, 47 (9), 614-619.
Garcia, M. C., Chapman, J. R., Shaw, P., Gottlieb, D. J., Ralph, A., Craig, J., & Tong, A. (2013). Motivations, experiences, and perspectives of bone marrow and peripheral blood stem cell donors: Thematic Synthesis of qualitative studies. Biology of Blood and Marrow Transplantation, 19 (7), 1046-1058.
Trifiolis, K. L. (2014). Savior siblings: The ethical debate. Law School Student's Scholarship Paper 432 , 1-24.
