Many loving parents would not hesitate to sacrifice their own lives to save their child's. But should they create a new life to rescue an endangered son or daughter? A Los Angeles couple, Abe and Mary Ayala, has taken just such an unusual step. In April, Mary will give birth to a baby girl who was purposely conceived to serve as a bone-marrow donor for her ailing older sister. Anissa, 17, was found to have a virulent form of leukemia nearly two years ago, and her only hope is a transplant of compatible bone marrow that could allow her to produce healthy white blood cells. Tests indicate that the baby has compatible tissue. With marrow from her sister, Anissa has a 70% chance of & being cured. Says Abe of the unborn girl, who will be named Marissa: "This is our miracle baby."
As joyous as their news is so far, the Ayalas' actions raise some unsettling ethical questions. Chief among them: Is it right to conceive children expressly so that they can be donors? It is a dilemma that faces increasing numbers of parents today as researchers make possible more transplants of organs from living people. For the Ayalas, the drastic measure was a last resort. Neither Abe nor Mary has marrow that matches Anissa's. (Reason: her marrow has a mixture of genetic characteristics from both parents.) Nor does brother Airon, 19, have marrow that is compatible with his sister's. And a search for a suitable nonrelated donor has been fruitless to date, though the hunt continues.
In the fall of 1988, Mary turned to her husband with a proposal: "What if we have another child?" In the roll of the genetic dice, the odds were only 1 in 4 that such a child would have the right tissue type. And there were other daunting obstacles. Abe, 44, would have to undergo an operation to reverse a vasectomy done 16 years earlier, and Mary faced becoming pregnant at age 42.
The decision worries some ethicists, who see it as a step on the path to treating offspring as objects. What if tests show that a baby conceived to be a donor is not medically useful? Parents might be tempted to have an abortion and try again. Babies might be used before birth. For example, transplants of fetal tissue may one day help victims of Parkinson's disease or juvenile diabetes. Will babies be conceived, then aborted to provide fetal tissue? "Children aren't medicine for other people," declares George Annas, a professor at Boston University's medical school. "Children are themselves."
In truth, motives for having babies are never selfless. Children are called to life by adult desires: to experience parenthood, to have an heir, to ensure that a youngster is not an only child. "In a sense we all have children to use them," says bioethicist Michael Shapiro of the University of Southern California. And motives can be mixed. Mary Ayala has long wanted a third child. Abe points out that "if Anissa didn't survive, we'd have another child in the house to help us with our sense of loss." Human needs are so tangled that no one expects -- or wants -- to create rules setting forth acceptable reasons for having a child.