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Sex Selection: Ethical Issues
A paper to be used as background for discussion
K. Cloonan, C. Crumley, and S. Kiymaz
Edited by S. F. Gilbert and E. Zackin
Discussions of cloning and stem cell research involve whether we should set limits on technologies that do not yet exist. However, the debate on whether sex selection is an ethical practice involves technology that is already perfected. It is possible, through prenatal genetic screening, to determine which four-to-eight-cell human embryos are male and female and to implant into the uterus only those of the desired sex.
This technology was developed for the implantation of female embryos into the uteri of women carrying X-linked lethal or debilitating diseases. For instance, a woman who is a carrier for X-linked hemophilia or Tay-Sachs disease may want to have a child and not undergo the tentative pregnancy associated with amniocentesis or chorionic villi sampling. Therefore, she could have fertilization with her partner done in vitro, and have only the XX embryos implanted. Since these diseases are recessive, the girls should not have the disease (although they will have a 50% chance of being carriers themselves).
However, if a couple have a son and want a daughter, should they not be allowed to have sex selection to get one? If a couple has daughters and the husband wants a son to "carry on his name," should they be allowed to use this technology? Once the technology has been developed, though, there are no laws (in the United States) making it illegal to have sex selection for any reason. In some countries, sex selection is not legal: see http://www.bionetonline.org/English/Content/db_leg2.htm#sex.
The professional organizations concerned with sex selection in vitro have been ambivalent about this issue. There are two groups that occupy the primary places of the preconception sex selection debate, one is the American Society for Reproductive Medicine (ASRM) in the United States and the other is the Human Fertilisation and Embryology Authority (HFEA) in Britain. Britain's HFEA, unlike the ASRM, is a government body and can determine whether or not clinics are legally able to perform sex selection technologies. The ASRM is an organization composed of doctors, nurses, and scientists who have a hand in making their views on reproductive medicine known at the state and federal levels (1) The HFEA banned sex selection for social reasons in 1993 after the majority of respondents to a consultation exercise felt that sex selection should not be available for "family balancing." (2) Their decision did, however, allow its use for medical reasons to persist. This remains the opinion and current regulation in Britain as dictated by the HFEA (3) However, the ASRM was not unanimous in their decision, and in 2001 the ASRM concluded that "it is proper and ethical to help couples to choose the sex of their babies." (4). The ASRM had previously said that sex selection "was justified when parents were aiming to avoid the incidence of certain sex linked genetic traits."(5).
There is still debate within each group. For instance, despite the ban on sex selection in the United Kingdom, Dr. David McCarthy, a philosopher at the University of Bristol, supports the technology. McCarthy argues that sex selection should be legal because, although most people do oppose many ideas (i.e., abortion), it is still legal though with certain restrictions (6). Moreover, he contends that if a difference in sex ratio exists, it will result in an increase in the value of women in the eyes of men (7). He further believes that enhancement of the offspring is a positive thing for the future, and like the American attourney and philosopher John Robertson, he holds that selecting the sex of a child "would not interfere with the basic liberties of others." (8). McCarthy claims that making sex selection illegal will interfere with reproductive rights.
The arguments of the ASRM Ethics Committee in favor of preconception gender selection focus on the maximization of parental happiness. It is an issue of desireothe desire to have a certain order and a certain distribution of offspring. Some couples may not have children if they cannot make such choices as those that sex selection technology allows them.
Suggested ethical issues surrounding sex preselection according to the ASRM include "the potential for inherent gender discrimination, inappropriate control over nonessential characteristics of children, unnecessary medical burdens and costs for parents, and inappropriate and potentially unfair use of limited medical resources" (9). There is a possibility that the children that are products of this technology will feel added pressures or higher expectations placed on them. It may cause marital conflicts over the order of children or the gender distribution. In addition, the selection technology may exacerbate the already present gender biases within societies (10) Parents may seek gender balance as a social trend or as a fashionable idea rather than specifically considering their situation. They may lose sight of the pleasure of children by having expectations of them even before they are conceived. A greater emphasis may be placed on a child's genetic characteristics, as opposed to his or her inherent worth (11).
As noted previously, there are many possible negative outcomes to sex preselection technology. Gender discrimination may be exacerbated (12). A less obvious ethical issue is the possibility that offspring will "be expected to act in certain gender-specific ways when the technique succeeds and who may disappoint parents when it fails." (13).
One of the most discussed topics of sex selection is the possibility of an unbalanced sex ratio (14). The projected effects of a ratio change vary as much as degree to which the ratio will change. Some authors, such as Mary Anne Warren and the majority of feminist authors, believe that an uneven sex ratio will result in more humiliation and mistreatment of women (15). On the other hand, some people believe that a reduction in the female population will cause greater competition among men for female partners. In contrast to the feminist writers, some researchers believe that a decrease in the female population will make them more valuable and result in them being treated better by males (16).
When questioning whether this technology should be implemented for the general public, long-term effects must be considered. If sex selection becomes very popular, sex imbalances could result in the institution of laws that would require providers to select both genders in equal numbers (17). This would result in a decrease in procreative liberty, which would defy the purpose of the procedure. If parents do end up having certain heightened expectations for their children as a result of this procedure, will the expectations be so extreme as to create a life for the child that is worse than if the child had been the unwanted gender? Furthermore, is the child likely to be harmed by such expectations, even if they are worse than those he or she would have had in the absence of gender selection? (18). These questions are unanswerable at present, but they certainly deserve consideration. According to the ASRM, "preconception gender selection is unlikely to drain substantial resources from the medical system" (19). That is, assuming that the most common use of the technology would be for parents who used it for the conception of children of a gender opposite to already existing children. It is unclear whether couples will choose a certain gender because of gender biases or whether their decisions will be based on the desire to raise a child of a certain gender because of their knowledge about child rearing and the psychological differences between male and female children (20).
The politics of these issues have been reported by Gina Kolata of the New York Times and by the Center for Genetics and Society (a group opposed to genetic engineering in general and to sex selection). Linked below are (1) the report by Gina Kolata concerning the ASRM's approving sex selection for non-medical reasons, (2) the statement signed by numerous people against this position, and (3) the revised ASRM document against the use of sex selection for non-medical reasons.
Fertility Ethics Authority Approves Sex Selection (The New York Times)
CAMPAIGN AGAINST ASRM STAND ON SEX SELECTION TECHNIQUES
Civil Society Organizations Oppose Sex Selection Technologies
ASRM Ethics Committee to Meet January 25-26
A wide range of U.S. and international civil society organizations and individuals have joined in opposition to a disturbing trend toward the marketing of new sex selection technologies and "designer" babies.
In an open letter to Dr. J. Benjamin Younger, Executive Director of the American Society for Reproductive Medicine (ASRM), signatories urge the ASRM to take immediate action to discourage the use of sex selection technologies for anything except the prevention of serious medical conditions.
The letter was written in response to the endorsement by Mr. John Robertson, acting chair of the ASRM Ethics Committee, of sex selection for "gender variety" using pre-implantation genetic diagnosis (PGD). The ASRM Ethics Committee is expected to consider the matter at its upcoming meeting January 25-26 (see "Fertility Ethics Authority Approves Sex Selection," Gina Kolata, New York Times, 9/28/01).
After Mr. Robertson's endorsement, the founder of a chain of U.S. fertility clinics stated he would begin offering PGD for sex selection.
The letter was jointly drafted by the Center for Genetics and Society; the Committee on Women, Population and the Environment (CWPE); Manavi, Inc., a New Jersey based organization for South Asian women; Andolan, an organization of South Asian low-wage workers in New York City; and the Boston Women's Health Book Collective. It expresses deep concerns about the inherent potential for gender discrimination posed by the practice of sex selection: "While motivations for desiring a child of a particular sex may vary, there are no non-sexist reasons for pre-selecting sex except in cases of preventing serious sex-linked diseases. This is true even in the United States, where economic and social pressures to raise male children are minimized in comparison to other societies."
The letter also expresses concern about advertisements for sex selection techniques that target South Asian Americans. In addition, it warns that the use of PGD for sex selection may normalize embryo selection based on other non-essential traits such as hair and eye color; thus legitimizing a new form of eugenics.
The letter has received support from 94 women's, reproductive rights, public health, disability rights, and South Asian organizations and individuals.
Fertility Society Opposes Choosing Embryos Just for Sex Selection (The New York Times)
More material on the political and ethical debates over sex selection can be found at :
President's Council on Bioethics
(For a history of sex selection, and the use of sex selection in differenct cultures, see Pink or Blue? The Historical, Scientific, Cultural, and Economic Aspects of Gender Pre-selection.)
Footnotes:
1. ASRM Website. (2002) ASRM: History and Purpose. http://www.asrm.org/history.html
2. Gottlieb, Scott. (October 2001) "US doctors say sex selection acceptable for non-medical reasons." British Medical Journal, Vol.323, Issue 7317, p. 828.
3. HFEA Website. (2002). PGD Press Release. http://www.hfea.gov.uk/pgd/pgdpress.htm
4. Ibid.
5. Ibid.
6. McCarthy, David. (Oct. 2001) "Why Sex Selection Should Be Legal." Journal of Medical Ethics. Vol. 27, Issue 5, p. 302.
7. Ibid.
8. Ibid.
9. ASRM Ethics Committee Report (1999). Op. Cit. ASRM
10. Ibid.
11. ASRM Ethics Committee Report (2001) Op. Cit. ASRM
12. Ibid.
13. Ibid.
14. Westoff, Charles F. and Ronald R. Rindfuss. (1974) "Sex Preselection in the United States." Science, New Series, Vol. 184, Issue 4137, pp. 633-636.
15. Warren, Mary Ann. (1985) Gendercide: The Implications of Sex Selection. New Jersey: Rowman & Allanhead Publishers.
16. Sen, Gita and Rachel C. Snow. (1994) Power and Decision: The Social Control of Reproduction, Massachusetts: Harward University Press.
17. ASRM Ethics Committee Report (2001). Op. Cit. ASRM
18. Ibid.
19. Ibid.
20. Maccoby, E. E., and C.N. Jacklin. The Psychology of Sex Differences. Palo Alto: Stanford University Press, 1974.
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