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Sex selection: the case for
There is a strong argument in favour of sex selection, based on respect for procreative autonomy -- the autonomy of couples to decide for themselves how to procreate, and what children to have. Objections based on possible harm to the child, the parents, or society, are not compelling, particularly in Australia.
Julian Savulescu
MJA 1999; 171: 373-375
Introduction -
Inconsistency -
Harm -
Procreative autonomy -
Playing God -
Conclusion -
Acknowledgements -
References -
Authors' details
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More articles on Obstetrics & gynaecology and women's health
| Introduction |
Various methods now exist for attempting to choose to have a baby of a
desired sex (see Box). With the recent advent of flow cytometric
separation of X and Y sperm and preimplantation genetic diagnosis
(PGD) (see Box), couples no longer have to employ abortion to select
sex. Sex selection may therefore become more acceptable to some
couples, and requests for clinics to provide it may become more
common. In Australia, requests for medically assisted sex selection
are not common; for example, one in-vitro fertilisation (IVF) clinic
in Australia receives about 15-20 requests for sex selection each
year (L Wilton, Consultant, Melbourne IVF, personal
communication).
Medically assisted sex selection for non-medical reasons is banned in the United Kingdom and Canada.7 In Australia, sex selection employing artificial insemination or IVF is banned explicitly in Victoria by section 50 of the Infertility Treatment Act 1995. In South Australia, section 13 of the Reproductive Technology Act 1988 requires that artificial fertilisation only be used for the treatment of infertility. Both Acts provide exceptions to avoid the risk of transmission of a genetic defect (assisted reproduction for medical reasons). In Australia, IVF clinics now offer PGD. One centre performs sex selection for non-medical reasons using IVF and PGD. This has been provided for fertile couples, but has been fully funded privately, costing couples around $10 000. So far, two boys and two girls have been born after sex selection for non-medical reasons (R Jansen, Medical Director, Sydney IVF, personal communication). In Victoria and South Australia, where it is illegal to perform PGD for sex selection, PGD to exclude aneuploidy may reveal the sex of embryos. Couples might in the future request "healthy" embryos of a desired sex -- "incidental sex selection". The legality of transferring embryos of a desired sex in this circumstance is not clear. Although many jurisdictions ban sex selection for non-medical reasons, there are a number of arguments in favour of allowing it. | ||
| Inconsistency | Paradoxically, it is legal to attempt periconceptual sex selection by "natural" means, even if these employ technology developed specifically for that purpose.7 Prenatal testing and termination of undesired-sex pregnancies is also accepted practice in some centres. It is inconsistent to provide couples with information from prenatal testing which allows them to select sex and not allow them to select sex by means which are more acceptable to them. | ||
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| Harm |
Harm to the child: The mutagenic risks of the sex selection procedure to children born must be evaluated.8 Many of the methods use well established procedures (such as IVF), though the long term consequences of some are not certain: these include PGD, intracytoplasmic sperm injection,9,10 and cryopreservation.11,12 Despite encouraging data from animal studies and existing human experience,13 there is a theoretical mutagenic risk associated with ultraviolet light and bisbenzimide used in sperm separation. Concerns about these risks should be addressed by scientific investigation and by ensuring that consent is properly informed, not by banning the procedure. Sex selection might also cause psychological harm if the procedure does not produce a child of the desired sex. However, parents inevitably have hopes and expectations for their children which are deflated every day. Most parents come to accept and love the child they have, even if that child has a serious disease or disability. Some parents want their children to be great musicians. Sometimes this desire becomes overbearing, as depicted in the film Shine. But the answer is not to ban music schools. The solution is to help parents to be more tolerant and accepting. Sex selection may be beneficial to the child born if parents will treat a child of that sex more favourably. However, it might be argued that the desire to select sex itself reflects a dysfunctional psychology. Furthermore, sex selection may allow people who are "unsuitable" to be parents to believe that they could cope with a child of a particular sex. It is dangerous to make such judgements about the "suitability" and the "functionality" of people as parents in the absence of any good evidence -- society is now rightly loath to enquire into people's fitness to parent. Moreover, preventing sex selection is no guarantee that such people, even if dysfunctional, will not have children. One objection in bioethics is that sex selection represents a violation of Kant's dictum never to use a person as a means, but always to treat him or her as an end. According to this argument, by selecting sex parents use their child to fulfil their own desires and fail to respect the child as a person. In one way this objection is fanciful. Parents have many desires related to their children: perhaps to have a companion, to have a friend to the first child, or to hold a marriage together. It is unlikely that any parent ever desires a child solely as an end in itself. Moreover, Kant's dictum is actually never to use a person solely as a means.14 Provided that parents love their child as an end in itself, there is no problem with the child's life also fulfilling some of the parents' desires for their own lives. Most importantly, without sex selection, without a unique sperm and egg uniting, that particular child would not have existed. Even if the child is disadvantaged psychologically, this is only wrong from the child's perspective if its life is so bad that it is not worth living. It is difficult to point to any life which can be judged from the outside to be not worth living (possible examples might include Lesch-Nyhan or Sanfilippo syndrome). Harm to other family members: It is hard to see how sex selection harms parents if they have a child of the desired sex; they may even benefit. If a parent will not be able to accept a child of a certain sex (say, a woman was sexually abused as a child and wants to have a girl), then it may be better for both parent and child if the parent selects sex. Another example might be parents who have one autistic boy. Autism is more common in boys but is not sex linked.15 Such parents might be happier with a girl. Could other siblings of the undesired sex be mistreated? Firstly, choosing to have a child of a certain sex does not imply that the other sex is undesired in other children. Secondly, treatment of children of the other sex will be largely determined by the pre-existing belief structure of parents. Social harm: Does sex selection represent a slide to eugenics and the creation of "designer babies"? We already allow parents to select the kind of children they have. Parents have enormous power (often unconscious) in shaping the kind of people their children become. Parents have the right to choose the environment according to what they believe is best for their child. Moreover, they are already allowed to choose what they believe will be the best children. Parents are allowed to use prenatal testing for disability -- even repairable disability such as cleft palate -- because they are allowed to decide whether they can accept that child. If parents can decide whether they can accept a child with cleft palate, they should be allowed decide whether they can accept a child of a given sex. Are women harmed by sex selection? Some critics claim that allowing sex selection implies that, in general, one sex is superior to the other16 -- to do so is sexist.17 According to Tonti-Filippini, it "devalues girls".2 However, it does not, any more than choosing to play Australian Rules football rather than soccer implies the former is "better" in some general sense. Boys and girls are different, and this difference matters to different families in different ways. Sex selection is more likely to harm women in Asia. There, sex selection is already common. The male-to-female ratio has risen to close to 1.2 in China18 and some urban parts of India.19 This situation has worsened since the advent of prenatal sex determination.8 It was estimated in 1990 that, globally, there are 100 million women "missing" (died prematurely) as a result of various forms of discrimination.20 It has been claimed that sex selection would "foster the already existing bias against the female child".8 Yet, even in Asia, it is not clear that sex selection should be banned.21 Disturbed sex ratios may not be a bad thing.22 Advantages which have been postulated include increase in influence of the rarer sex, reduced population growth and interbreeding of different populations.23 Most importantly, a false belief in the inferiority of women is not a product of sex selection -- sex selection is the product of that belief. Education and improving social and employment arrangements for women are more important in correcting these false beliefs than preventing sex selection. Consider an analogous argument: some disability advocates argue disability is a social construct; the lives of such people are made worse by the discriminatory attitudes of others.24 They argue prenatal testing serves to reinforce these attitudes and question whether it should be available for conditions like spina bifida.25,26 The community accepts that parents should be allowed to employ prenatal testing and selective termination to have a child without a disability, even if having a child with a disability would improve the plight of the disabled. By analogy, parents should be able to choose the sex of their child, even if not being able to choose the sex of their child would improve the plight of women. | ||
Procreative autonomy | |||
|
"Procreative autonomy" is the liberty to decide when and how to have
children according to what parents judge is best.14 Parents know
best their own circumstances, and ultimately it is parents who must
live with and make sacrifices for their children. Procreative
autonomy should not be sacrificed to correct social inequality. It is
totalitarian for the State to dictate which children parents should
have and rear.
In the US, 90% of couples wanting sex selection wished to balance sex within the family. Parents were in their mid thirties, had two or three children and only wanted one more.1 In both the US and UK, just over half of couples choose a girl.27,28 Sex selection for family balancing would prevent, rather than contribute to, a disturbed sex ratio and harm to women. There is no risk of psychological harm to anyone with this kind of sex selection. | |||
| Playing God | Is selecting sex playing God? People have been playing God ever since they first decided to control which children they would have by abortion or by contraceptive use or abstinence. The fundamental question is: to what degree should parents be allowed to decide which children they will bear? | ||
| Conclusion | I have considered objections that sex selection might harm the child, other members of the family or society. Although, in a few cases, these objections may be valid, none is necessarily compelling in a country like Australia, where there will not be a systematic bias in favour of one sex across the whole community. The harm that might arise from sex selection is not of a degree sufficient to warrant State infringement of liberty. In my view, legislation in Victoria and South Australia should be changed to permit sex selection for balancing family sex. | ||
Acknowledgements | |||
| The following people are thanked for critical comments on earlier drafts: Robert Jansen, Leeanda Wilton, Lach De Crespigny, John Rogers, Agnes Bankier, Mike Parker, Bob Williamson. | |||
| References |
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| Authors' details |
Royal Children's Hospital, Melbourne, VIC.
Julian Savulescu, MB BS, PhD, Director, Ethics Unit, Murdoch Institute, and Director, Ethics Program, Centre for the Study of Health and Society, University of Melbourne.
Reprints will not be available from the author. ©MJA 1999
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 1999 Medical Journal of Australia. We appreciate your comments. | ||
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