The questions are arranged in three sections: Organ Transplantation/Donation, Genetics Testing/IVF, and “Designer Babies.” They are designed to raise key ethical issues, provide important information on the science, and help you get in touch with your own moral compass. With a nod to the realities of many women’s lives, we have written them in such a way that you can participate in the discussion even if you haven’t read the books.
We suggest you read through the questions and select 5-10 for discussion purposes. The last question is the ACTION CONNECTION QUESTION which ties all the issues raised into a relevant policy consideration. After your discussion, we encourage all readers to check out the Policy Questions section of the website for more detailed information on the science, ethical frameworks to consider these issues, and policy options.
Download a printer-friendly copy of the Discussion Questions for Never Let Me Go (.pdf format requires Adobe Reader—download a free copy)
Bioethics Book Club Discussion Questions
Bioethical Issue: Organ Transplantation/Donation
• There is a significant shortage of donor organs available for transplant in the United States. According to the United Network for Organ Sharing, more than 90,000 people are currently on the waiting list for an organ. Last year, nearly 6,000 people died while waiting for an organ to become available. Kathy H.’s story takes place in a society that has addressed this problem through the creation of clones to serve as a source of genetically matched organs for those who need them.
If such a program were technically feasible, do you think this would be a good solution to the shortage of donor organs for transplant?
• In admitting to the students that she had smoked before—an activity Kathy H. compares to “attacking someone with an axe”—Miss Lucy says, “You’ve been told about it. You’re students. You’re…special. So keeping yourselves well, keeping yourselves very healthy inside, that’s much more important for each of you than it is for me.” (p. 68–69).
What do you think about this idea?
Do people who have agreed to donate organs have an obligation to act as stewards of those valuable resources?
• According to UNOS, almost half of the people currently waiting for donor organs are from minority populations. African Americans represent 13 percent of the U.S. population, but 35 percent of patients awaiting kidney transplant. Hispanic/Latinos also represent 12 percent of the U.S. population, but 17 percent of patients awaiting kidney transplant.
What are some of the ethical questions this might raise?
Do you think the high rate of diabetes in minority populations is relevant to this issue?
• In 1984, China enforced the “Rules Concerning the Utilization of Corpses or Organs for the Corpses of Executed Prisoners.” The rule provided “that corpses or organs of executed prisoners could be harvested if no one claimed the body, if the executed prisoner volunteered to have his corpse so used, or if the family consented.”
How would you compare this policy to the Hailsham program?
Do you think the Chinese policy is ethical?
• Out of concerns about fairness and exploitation, the sale of organs is a felony crime in the United States. However, a large international black market for organs exists.
What do you think of claims that allowing organ sales would exploit poor people?
If a family member needed an organ transplant and you had the means to buy an organ, would you do so?
• In a November 2005 article in the New York Times, Sally Satel—who needed a kidney transplant—described the process of her search for a live donor, thus bypassing the UNOS system. She asks, challenging the laws prohibiting payment for organs, “Is it really more ethical for people to go on dialysis or die while waiting for an organ?”
How would you answer this question?
Bioethical Issue: Genetic Testing/IVF
• In the novel, individuals are able to create a perfect match for their future organ needs. Because they are genetically matched with their donor, there is no risk of transplant rejection and no need for the complex drug regimens involved in preventing rejection. There is also no need to wait for a matched donor to die.
Would these benefits outweigh the risks and harms of cloning for transplantation purposes?
• The central moral dilemma in the novel concerns the moral status of clones—the Hailsham “students.” At the end of the book, Miss Emily explains the reason the guardians took away the children’s best art. “We took away your art because we thought it would reveal your souls. Or to put it more finely, we did it to prove you had souls at all.” (p. 260)
Do you believe human clones would have souls?
Do you think human clones, should they ever be created, ought to be treated the same as the rest of us?
What is your opinion of what Miss Emily and Madame did at Hailsham?
What about Miss Lucy?
Which character in the book do you feel most sympathetic toward, and why?
Given that the cloning program was ongoing, and that some clones lived in much worse conditions than at Hailsham, do you agree with Miss Emily that the Hailsham children were “lucky pawns”? (p. 266)
Bioethical Issue: Designer Babies
• When Kathy and Tommy finally meet up again with Miss Emily and Madame at the end of the book, Miss Emily tells them about “the Morningdale business.” She says, “What he wanted was to offer people the possibility of having children with enhanced characteristics. Superior intelligence, superior athleticism, that sort of thing…Well, he was discovered, they put an end to his work and that seemed to be that. Except, of course, it wasn’t, not for us….[It] did create a certain atmosphere, you see. It reminded people, reminded them of a fear they’d always had. It’s one thing to create students, such as yourselves, for the donation programme. But a generation of created children who’d take their place in society? Children demonstrably superior to the rest of us? Oh no. That frightened people. They recoiled from that.” (pp. 263–264)
This frightening vision, of human creations turning on their creators, is often depicted in stories and movies—think of Frankenstein, or Hal the computer in 2001: A Space Odyssey, or the “domestic assistants” in the more recent film I, Robot.
What do you think drives our interest in such portrayals?
Do you think these kinds of unintended consequences would result from a program like the one at Hailsham?
• In light of the organ shortage in the U.S., UNOS and other transplant advocacy groups are considering whether the current policy requiring affirmative consent from donors should be changed to one of presumed consent—that is, unless a person specifically opts out of donating organs when they die, s/he would be presumed to have consented to organ donation.
Should such a policy be adopted in the United States?
Although genetic engineering remains on the distant horizon, technological advances are bringing it from the imaginable to the possible. Policy makers are evaluating the potential options. Based on today’s discussion, what factors would you want policy makers to keep in mind as they decide the future of genetic engineering?