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Gender selection: should parents be able to choose the sex of their baby?
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2000/06: Gender selection: should parents be able to choose the sex of their baby?
Echo Issue Outline 2000 / 06: copyright © Echo Education Services
First published in The Echo news digest and newspaper sources index.
Issue outline by J M McInerney
What they said ...
' ... the technology is available, and, provided it doesn't use up community resources, it is a private decision for the families'
Professor Robert Jansen, the medical director of Sydney IVF, commenting on whether parents should be able to select the gender of their children
'How can we take a moral position against the abortion or infanticide of girl babies in China, if we permit such a procedure here'
Caroline Williamson, freelance writer and editor
Early in October, 1999, it was reported that at least two interstate couples had gone to a Sydney IVF clinic so that they could choose the sex of their child on social rather than medical grounds.
This has occurred because New South Wales law allows parents to use IVF technology to 'gender balance' their families whereas the practice is illegal in both South Australia and Victoria.
The situation has led to calls for a liberalisation of the laws in South Australia and Victoria to allow for gender selection based on parent preference. On the other hand there have been suggestions that sex selection of babies, other than for medical reasons, should be prohibited in New South Wales.
There has been significant media debate about the appropriateness of such procedures.
Background
Medically assisted sex selection for non-medical reasons is banned in the United Kingdom and Canada.
In Victoria, sex selection using artificial insemination or IVF is banned under section 50 of the Infertility Treatment Act 1995.
In South Australia such procedures are banned under section 13 of the Reproductive Technology Act 1988, which requires that artificial fertilisation be used only for the treatment of infertility.
Both the Victorian and South Australian acts allow exceptions to avoid the risk of a sex-linked genetic disease or defect.
Methods of sex selection
(This information is drawn from an article published in the Medical Journal of Australia on October 4, 1999. It is titled Sex selection: the case for and was written by Professor Julian Savulescu, director of the Ethics Unit at the Murdoch Institute and director of the Ethics Program at the Centre for the Study of Health and Society, University of Melbourne.)
There are three basic methods of attempting to ensure that a child will be born of a predetermined gender.
The first method is preconceptual, that is, occurs prior to conception. It involves attempts to select, screen or filter sperm so that only X or Y sperm are used for fertilisation.
(Y sperm produce male children and X sperm female children.) The most reliable form of this method, flow cytometric sepration of X and Y sperm, is no longer available. It was between 65% and 85% successful, and was more effective at producing girls.
The second method occurs at the time of conception (that is, it is periconceptual). This generally involves attempts to control how close to ovulation conception occurs. (Conception close to ovulation is more likely to produce a boy.) If it can be determined when ovulation has occurred then intercourse can be timed so as to maximise the couple's chances of producing a child of the desired gender. There is a variety of means of trying to determine when ovulation has taken place, including hormone level testing and checking the thickness of cervical mucus.
Other periconceptual techniques include varying intercourse positions and vaginal douching. The effectiveness of such methods is uncertain.
The method currently being disputed is used after the egg has been fertilised (that is, it is postconceptual).
The method involves preimplantation genetic diagnosis (PGD). This means that a number of eggs are fertilised outside the woman's body using IVF technology, their sex is determined and only zygotes (fertilsed eggs) of the correct gender are implanted in the woman's womb.
The other postconceptual method available involves testing the gender of a normally conceived foetus, in utero (within the womb), and then terminating the pregnancy if the child is of the wrong gender. There are a number of means of testing the gender of a foetus in the womb.
Such practices are not sanctioned in Australia other than when an abortion is indicated to prevent the transmission of a gender-linked disease or abnormality. However, abortion is generally available to a woman, effectively on demand, at least up to 11 weeks gestation. It is impossible to know to what extent women may be having abortions because of the gender of the foetus, however, it seems unlikely to be a common practice.
There are cultures where abortion and even infanticide are practised as a way of preventing families having to raise children of the 'wrong' gender. This practice has been quite common in China, for example, where couples have for many years been legally allowed to have only one child. Where abortion and infanticide are practised as means of gender selection, the preference is usually to allow male children to live.
There is a large number of Internet sites supplying information on the gender selection of children.
Within Australia, the debate surrounding sex selection of the unborn has been contributed to by a number of bioethicists and those directly involved in the relevant research and its implementation.
The current debate in Australia was in part brought about by an article published in The Medical Journal of Australia on October 4, 1999.
The article is titled Sex selection: the case for and was written by Professor Julian Savulescu, director of the Ethics Unit at the Murdoch Institute and director of the Ethics Program at the Centre for the Study of Health and Society, University of Melbourne.
Professor Savulescu gives an overview of the various means of gender selection available in Australia and then gives a number of fairly detailed arguments as to why gender selection, especially that involving IVF and preimplantation genetic diagnosis, should be legal in all Australian states and territories.
The article can be found at http://www.mja.com.au/public/issues/171_7_041099/savulescu/savulescu.html
A consideration of the issue from a United States' perspective can be found in a series of articles dealing with a sperm sorting sex selection technique developed at the Genetics and IVF Institute in Fairfax, Virginia.
A useful place to start is with a Science News Online article published on November 28, 1998.
The article is titled Is sex selection the first step to designer children? and was written by Kathleen Fackelmann.
The article begins by looking in detail at the sperm sorting sex selection technique recently tested at the Genetics and IVF Institute in Fairfax, Virginia.
It then discusses in some detail why parents might want to select the gender of their children and the broader question of whether attempts should be made to alter the genetic characteristics of the unborn.
The article can be found at http://www.sciencenews.org/sn_arc98/11_28_98/Bob2.htm
(Science News is a scientific news magazine which is published weekly. It began in 1922 and is now available on the Internet as well as in hard copy. It is produced in the United States.)
The ethics of the technique being tested by the Genetics and IVF Institute in Fairfax, Virginia are further discussed in an article titled Merits of new technology debated in sex selection. The article was written by Darrell Turner and Art Toalston. The article is a report on discussion promoted by the Ethics and Religious Liberty Commission of the Southern Baptist Convention.
Those cited within the article appear to believe that this technology should only be available to prevent the transmission of sex-linked diseases and suggest that the procedure may led to other attempts to manipulate the genetic characteristics of the unborn. It points to a number of potential dangers of such genetic manipulation.
The article can be found at http://www.erlc.com/Biomed/Articles/merits_of_new_technology_debated.htm
A further report on the same Virginian sperm sorting technique can be found at http://www.bergenrecord.com/healthw/gender199809104.htm
The article is titled, Parents may be able to choose baby's sex, scientists say and it was written by Dale Hopper. It was published on September 10, 1998 in the North Jersey, Record Online.
The report includes some of the justification the technique's developers have given for its use as well as some criticism of its potential misuse from a number of other researchers.
A similar overview of debate on this sperm sorting technology and gender selection has been published in the Nando Times News. The article is titled The ethics of selecting a baby's sex and was written by Sara Terry.
It was published on September 18, 1998 and can be found at http://www.nandotimes.com/newsroom/ntn/health/091898/health3_29203_body.html
The situation regarding sex selection in Canada can be appreciated from a number of Internet sources.
The April 1995 Canadian Bioethics Report included the position of the Society of Obstetricians and Gynaecologists of Canada (SOGC) on medical techniques of gender selection.
SOGC concludes such measures 'are controversal because they are being used to meet the societal needs rather than the medical needs of some segments of society.
Measures designed to support societal preferences for male children whether by selective implantation of embryos, selective abortion of healthy fetuses after amniocentesis or infanticide, all reinforce discriminatory attitudes towards women and female children.
Any similar attempt to favour birth of female children would be discriminatory against males.'
SOGC believes that medically assisted gender selection should be available only to prevent the transmission of sex-linked genetic diseases.
This position statement can be found at http://www.cma.ca/cbr/apr95/cbrapr95.htm#SOGC
A consideration of sex selection from the perspective of less developed nations can be gained from an article published in The Medical Post Online in 1999.
The article is titled 'We must protect women', says ob/gyn world leader and was written by Susan Mulley.
The article refers to calls from a number of international health experts to halt practices such as the aborting of female foetuses and the killing of female children.
It suggests that this is a relatively common practice in many Asian countries and includes the claim that 'there are an estimated 60 million to 100 million missing females in the world, attributed to selective abortion of the female foetus as well as female infanticide'.
The article can be found BY CLICKING HERE
Arguments against the medically assisted sex selection of babies
There are three main arguments offered against making it legal for parents to seek medical assistance to select the gender of their children.
The first argument holds that to select a baby on the basis of gender is discriminatory. In particular, it is claimed that such a choice discriminates against the gender that is not selected.
This point has been made by Mr Nicholas Tonti-Filippini, a consultant ethicist for the Catholic Church.
Mr Tonti-Filippini has claimed that it is discriminatory of parents to favour one sex and further claims that 'to go to the absurd lengths of having IVF for such a minor social issue is appalling'.
According to this line of argument, if we make it legally allowable to refrain from implanting, and to discard, embryos on the basis of gender, then we are acting unfairly against children of the discarded gender.
It has been suggested that using PGD and IVF technology to ensure that a couple only has a child of the gender of their choice is a similar action to that taken in countries where foetuses are aborted or babies killed because of their gender.
This point has been made by Chris Sitka, in a letter published in The Age on October 8, 1999.
Chris Sitka has argued that Australians need to adopt a perspective that goes beyond the wishes of individual parents and adopt a 'broader vision'.
Chris Sitka's letter makes claims about femicide in China and suggests that in countries where there is a marked gender imbalance women are particularly vulnerable to 'rape, servitude, compulsion [and] violence.'
A similar point has been made by Caroline Williamson, a freelance writer and editor.
Ms Williamson has asked, 'If we applaud the South Korean Government for legislating against sex selection, how can we allow it in our own society? How can we take a moral position against the abortion or infanticide of girl babies in China, if we permit such a procedure here.'
(The pronounced sex imbalance in South Korea, where many parents have had female foetuses aborted, is the reason why it is now illegal for South Korean parents to have the sex of their child diagnosed before birth unless there is the possibility of a sex-linked inherited disorder.)
The second major argument offered against making it legally allowable for parents to seek medical assistance to ensure the gender of a child is that such procedures devalue both children and parenthood.
According to this line of argument, children are of worth in themselves, irrespective of their gender.
Critics of gender selection have argued that parents who seek such procedures see their potential children as products or commodities, rather than as unique human beings with intrinsic dignity and value.
This point has been made by Dr John Fleming, the director of the Southern Cross Bioethics Institute in Adelaide.
Dr Fleming has claimed, 'It reduces embryos to products of a factory. It is a quality control mechanism.'
A similar point has been made by freelance writer and editor Caroline Williamson.
Ms Williamson has claimed, 'Having a child and raising it is a long education for most of us. We learn to discard our fantasies of parenthood ... We get to know our real children and love them for what they are ... We learn to stand back and let them be.'
It has been claimed that supposedly excessive attempts to shape the nature of one's unborn offspring can lead to unreasonable expectations being placed on children. It has also been suggested that it can lead to them feeling inadequate or unwanted.
According to this line of argument, if parents have selected their children solely on the basis of their gender, they would not be likely to treat well offspring who did not conform to the conventional gender stereotype of either a male or a female.
It has been suggested that an unfeminine girl or an unmasculine boy may not be accepted by such parents.
In addition it has been claimed that allowing the gender selection of babies will encourage a further 'commodification' of children.
According to this line of argument, once parents are able to select the gender of their children, it will not be long before they also wish to select other qualities, such as height, eye colour, and, should it be possible, such behavioural attributes as intelligence and sexual orientation.
This point has been made in an Age editorial of October 6, 1999.
The editorial argues, 'If a baby's sex comes to be regarded as an acceptable area of choice, it will be hard to argue against the range of other potential preferences: blonde hair, blue eyes, IQ or musicality, for example.'
The editorial concludes, 'We do not want to goose-step into a eugenic future.'
The warning against goose-stepping into a 'eugenic future' appears to be a reference to some of the experiments conducted by the Nazis during World War II.
The suggestion is that social engineers and genetic scientists may create dangerously narrow definitions of what it means to be an acceptable human being.
Critics of such definitions and practices fear a loss of tolerance for the full range of human difference and an impoverishment of our concept of what it means to be human.
Such genetic engineering, it has been suggested, could result in severe discrimination against anyone who did not fit the socially fashionable definition of perfection.
Thirdly, it has been argued that using IVF procedures as a means of selecting the sex of babies to suit the social priorities of parents trivialises an important procedure and makes it little more than a money-making device.
Ms Donna Howlett, Monash IVF's chief executive, has stated, 'My personal view is that we use the IVF technique for medical conditions ... and not for people wanting boys or girls.
Ms Howlett has also suggested that those couples going to Sydney to have the procedure performed so they can gender balance their families are being overcharged.
Ms Howlett has claimed that the technique should cost between $800 and $1000 to perform.
'Someone should not be charging more than $3000,' Ms Howlett has claimed.
A similar point has been made by Dr John Fleming, the director of the Southern Cross Bioethics Institute in Adelaide.
Dr Fleming has stated, 'It raises the question ... of whether doctors are in the business of making money or helping people with genuine health problems.'
Arguments in favour of the medically assisted sex selection of babies
There are three major argument offered in support of changing Australian law so that parents in any state can get medical assistance in selecting the sex of their children.
The first argument offered is that in the Australian context allowing parents to make such a choice would have few or no damaging consequences.
According to this line of argument, if an action does not harm society as a whole, it should be left to the free choice of those most involved - in this instance, the parents.
This point has been made by Associate Professor Julian Savulescu, director of the Murdoch Institute's ethics unit.
Professor Savulescu has claimed that any harm caused by gender selection is not serious enough to justify placing limits on the parents' choice.
According to this line of argument, because in Australia there is no general societal preference for either boys or girls, if parents were able to select the sex of their children this would not result in a gender imbalance within the Australian population.
This point has been made by Deborah Zion, who is completing a PhD at the Centre for Human Bioethics, Monash University.
Ms Zion has stated, 'In Australia ... it seems that sex selection is not being used to reinforce a social order in which sons are seen as more valuable than daughters ...'
Ms Zion has further argued that the IVF procedure is difficult, expensive and time-consuming and thus is unlikely to be taken up by a large number of Australian parents.
"It is therefore improbable that we are creating a sex imbalance through the use of this technology, ' Ms Zion argues.
Further, it has been claimed that the decision to gender select children does not appear to be based on gender discrimination. Rather, it has been suggested, parents are acting on a desire to balance their families.
According to this line of argument, in families where there are already a number or either boys or girls and no child of the opposite gender, wanting such a child is not an instance of discrimination against the other gender.
This point has also been made by Deborah Zion, who has claimed, '[Parents want] to balance families in which there are already several children of the same sex.'
It has further been argued that where the parents are able to pay for the procedure they are not straining state or national health budgets or otherwise overtaxing medical resources.
This point has been made by Professor Robert Jansen, the medical director of Sydney IVF.
Professor Jansen has noted that all the families making use of the procedure were 'fairly well off' and thus presumably able to meet the $10,000 cost of the procedure.
Professor Jansen has further claimed, ' ... the technology is available, and, provided it doesn't use up community resources, it is a private decision for the families.'
The second argument offered looks at the question of just how much say it is ethically appropriate to allow parents in what sort of children they will have.
Those who support parents being able to select the gender of their children note that there is already general community acceptance of parents being able to avoid giving birth to children with a known disorder.
This point has also been made by Deborah Zion, who has noted, 'Many accept that embryo testing - or indeed tests performed on a foetus - are legitimate if parents do not want to have a child with a disability.'
It has further been noted that there is no Australian jurisdiction where the law would not allow an abortion to parents who wished to avoid giving birth to a child with a disability.
Those who make these claims note that society has already allowed parents significant discretion in determining what type of child they will give birth to.
It has further been noted that even within conventional IVF undertaken to treat infertility it is standard practice for some embryos to be discarded, not necessarily because they are faulted in any way, but because the parents only want a certain number of children.
Deborah Zion has summed up these developments by claiming, 'The Australian population ... has accepted that most decisions about foetuses and embryos rest with parents, not governments.'
In this context, Professor Savulescu has suggested that it is inconsistent for the law in Victoria and South Australia to prevent IVF clinics in those states from assisting parents who wish to select the sex of their children.
Thirdly, it has been argued that allowing parents to seek medical assistance to select the sex of their children will not necessarily lead to other forms of genetically based selection of which the Australian community might not approve.
This is an attempt to argue against the 'slippery slope' argument which holds that once a relatively small step is taken in a certain direction it then becomes likely that other, more questionable, steps will be taken in that direction.
Deborah Zion has argued that the fear of genetic manipulation of human populations should not prevent us allowing parents to select the sex of their children. Ms Zion argues that carefully framed legislation can ensure that any developments that the Australian community does not wish to occur will be prevented.
Ms Zion argues, 'All new advances in biotechnology generate the fear that the most harmful scenario will necessarily come about. Tough and specific legislation, however, makes this unlikely.'
Further implications
If any number Victorian and South Australian parents continue to use NSW IVF facilities to select the sex of their children, while this procedure remains illegal for this purpose in their home states, it seems likley that pressure will grow for laws to be uniform across the various states and territories.
At this point it is not possible to say whether such uniform legislation would result in medically assisted sex selection becoming legal or illegal in all Australian jurisdictions.
What does seem clear is that the issue is unlikely ultimately to revolve around the issue of sex discrimination. The fundamental question at issue here appears to be that of how much medical interference we wish to allow in the creation and subsequent development of unborn life.
Given the medical profession and scientific community's growing capacity to detect and, in some instances, correct foetal abnormalities prior to birth there is going to be growing pressure both on and from parents for the elimination of supposedly undesirable traits.
The human genome project and the dramatic growth in knowledge of cloning and other procedures is also going to increase pressure on geneticists to experiment further with what are popularly referred to as 'designer babies', human beings whose various traits have been 'engineered'.
Currently our capabilities in this area are limited and there is no jurisdiction where such practices are allowed, however, the potential remains and the growth of knowledge and expertise has been very rapid.
It is to be hoped that community debate on these issues continues and that we arrive at a sound consensus on the underlying ethical considerations.
Too often technological and medical developments occur in advance of society having arrived at an agreed ethical position on them. The practical and ethical considerations raised by genetic engineering are of such significance that we cannot afford to be dragged along in the wake of bio-technological change.
Sources
The Age
4/9/99 page 20 (Good Weekend insert) comment by Lisa Belkin, 'Tom, Dick or Harriet?'
2/10/99 page 1 news item by Deborah Smith, '$10,000 can buy parents "designer babies"'
4/10/99 page 4 news item by Darrin Farrant and Victoria Button, 'Push to expand sex-choice laws'
5/10/99 page 3 news item by Darrin Farrant, 'Designer babies: couples cross border'
6/10/99 page 18 editorial, 'The dangers of designer babies'
8/10/99 page 16 letter from Chris Sitka, 'A terrible brave new world'
8/10/99 page 17 comment by Deborah Zion, 'Let parents decide'
11/10/99 page 15 comment by Caroline Williamson, 'Baby rage: one mother's revulsion'
The Herald Sun
8/10/99 page 20 comment by Jill Singer, 'The debate about babies made to order is spurious. The fact is, the market rules'
11/10/99 page 19 comment by Evelyn Tsitas, 'Why we like to choose'