Ethical Issues Of Sex Selection

Sinauer AssociatesTopic Number Search Bioethics Help Home Link Contents for all chapters 1. Developmental Biology: The Anatomical Tradition 2. Life Cycles and the Evolution of Developmental Patterns 3. Principles of Experimental Embryology 4. The Genetic Core of Development 5. The Paradigm of Differential Gene Expression 6. Cell-Cell Communication in Development 7. Fertilization: Beginning a New Organism 8. Early Development in Selected Invertebrates 9. The Genetics of Axis Specification in Drosophila 10. Early Development and Axis Formation in Amphibians 11. The Early Development of Vertebrates: Fish, Birds and Mammals 12. The Emergence of the Ectoderm: Central Nervous System and Epidermis 13. Neural Crest Cells and Axonal Specificity 14. Paraxial and Intermediate Mesoderm 15. Lateral Plate Mesoderm and Endoderm 16. Development of the Tetrapod Limb 17. Sex Determination 18. Postembryonic Development: Metamorphosis, Regeneration, and Aging 19. The Saga of the Germ Line 20. An Overview of Plant Development 21. Medical Implications of Developmental Biology 22. Environmental Regulation of Animal Development 23. Developmental Mechanisms of Evolutionary Change

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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 desire--the 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