Health – Gender-Science homework help

Health – Gender-Science homework help

Gender Genetics and Sex Selection and Discrimination

Sex selection involves a number of medical techniques to choose an offsprings’ sex that is

surrounded by a wide range of legal, social, and ethical implications. One significant ethical

concern is that women engaging in sex selection for non-medical reasons reinforce sexist

stereotypes and discriminatory actions that devalue females. Cultural and social bias in our

societies sometimes forces couples to engage in sex selection because of gender preferences

reasons in favor of a particular offspring often male. A woman who gives birth to only females

may be discriminated against by members of her society; therefore, will engage in sex selection in

favor of males.

Sex selection distorts the natural sex ratio that could lead to gender imbalance. Sex-

selective abortion results to distortion of the natural sex ratio often in favor of males. It is quite

disheartening that our societies have made the male children to be considered more valuable than

the female child that could lead to an abortion. Additionally, use of genetic technologies for sex

selection such as preconception sex selection methods and prenatal sex selection procedures have

ethical concerns. The techniques reinforce gender discrimination by encouraging parents to pay

attention to gender. For instance, a couple may decide to have their first child as a male due to

societal pressures.

On the other hand, sex selection for medical reasons such as preventing the birth of affected

children or at risk children for a genetic disorder related to a particular gender is justifiable. This

implies that women have access to safe abortions instead of turning to unsafe abortions that are

risky to them and the unborn. Undergoing unsafe abortions violates the rights of girls and women

to life, health and development.

Sex selection may be encouraged to avoid neglect for surviving unwanted children. A son

preference could lead to neglect of the girl child that involves inadequate clothing, biased feeding

practices and lower- quality of health care. When families successfully achieve a desired sex ratio

of children, for instance, two boys and one girl, they are likely to treat the girl in a better way such

as giving them better treatment. Additionally, sex selection provides family balancing that gives

them they joy of raising both girls and boys. Parents are likely to manage small families that have

both genders.

Children are a gift from God and should all be treated with respect and value regardless of

their gender. I consider children to be a blessing whether it is a boy or girl for we all have a purpose

to fulfill in this world. Sex selection and gender genetics should be discouraged unless it is for

medical reasons aimed at preventing disorders in a child. In case of multiple miscarriages or

advanced maternal age, parents can be encouraged to undergo sex selection. Attempting to control

an offspring sex to achieve a desired one is like controlling God’s work. People should stop

devaluing the girl child in preference to the boy child and treat all children equally and consider

them a blessing. Again, the process is quite costly and parents can save that money and spend it

on their children. Health practitioners should encourage women to have healthy pregnancies but

not focus on a specific gender. It is quite unfair that we can select the gender we want but not other

characteristics like height or hair color. Let us appreciate our children since sex selection is a form

of gender discrimination.

Reference

Kockler, N. J., & Shannon, T. A. (2009). An Introduction to Bioethics. Paulist Press.

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Preconception Gender Selection

Preconception Gender Selection1 John A. Robertson,

School of Law, University of Texas at Austin

Safe and effective methods of preconception gender selection through èow cytometric separation of X- and Y-bearing sperm could greatly increase the use of gender selection by couples contem- plating reproduction. Such a development raises ethical, legal, and social issues about the impact of such practices on offspring, on sex ratio imbalances, and on sexism and the status of women. This paper analyzes the competing interests in preconception gender selection, and concludes that its use to increase gender variety in a family, and possibly for selecting the gender of érstborn, might in many instances be ethically acceptable.

Advances in genetics and reproductive technology present prospective parents with an increasing number of choices about the genetic makeup of their children. Those choices now involve the use of carrier and prenatal screening techniques to avoid the birth of children with serious genetic dis- ease, but techniques to choose nonmedical charac- teristics will eventually be available. One nonmedical characteristic that may soon be within reach is the selection of offspring gender by pre- conception�gender�selection�(PGS).

Gender selection through prenatal diagnosis and abortion has existed since the 1970s. More re- cently, preimplantation sexing of embryos for transfer has been developed (Tarin and Handyside 1993; The Ethics Committee of the American So- ciety of Reproductive Medicine 1999). Yet prena- tal or preimplantation methods of gender selection are unattractive because they require abortion or a costly, intrusive cycle of in vitro fertilization (IVF) and embryo discard. Attempts to separate X- and Y-bearing sperm for preconception gender selec- tion by sperm swim-up or swim-through tech- niques have not shown consistent X- and Y-sperm cell separation or success in producing offspring of the�desired�gender.

The use of éow cytometry to separate X- and Y- bearing sperm may turn out to be a much more re- liable method of enriching sperm populations for insemination. Laser beams passed across a éowing array of specially dyed sperm can separate most of the 2.8% heavier X- from Y-bearing sperm, thus producing an X-enriched sperm sample for insemi- nation.2 Flow cytometry has been used successfully in over 400 sex selections in rabbit, swine, ovine, and bovine species, including successive genera- tions in swine and rabbit (Fugger et al. 1998). A human pregnancy was reported in 1995 (Levinson, Keyvanfar,�and�Wu�1995).

The United States Department of Agriculture (USDA), which holds a patent on the éow cy- tometry separation process, has licensed the Genet- ics and IVF Institute in Fairfax, Virginia, to study the safety and efécacy of the technique for medical and “family balancing” reasons in an institutional review board–approved clinical trial.3 In 1998 re- searchers at the Institute reported a 92.9% success rate for selection of females in 27 patients, with most fertilizations occurring after intrauterine in- semination (Fugger et al. 1998). A lower success rate�(72%)�was�reported�for�male�selection.4

At this early stage of development much more research is needed to establish the high degree of safety and efécacy of éow cytometry methods of PGS that would justify widespread use. With only one published study of outcomes to date, it is too soon to say whether the 92% success rate in deter- mining female gender will hold for other patients, much less that male selection will reach that level of efécacy. Animal safety data have shown no ad- verse effect of the dye or laser used in the technique on offspring, but that is no substitute for more ex- tensive human studies (Vidal et al. 1999). In addi- tion, if éow cytometry instruments are to be used for sperm separation purposes, they may be class- iéed as medical devices that require U.S. Food and Drug Administration (FDA) approval. Finally, the holder of the process patent—the USDA—will have to agree to license the process for human uses.

If further research establishes that éow cy- tometry is a safe and effective technique for both male and female PGS, and regulatory and licensing barriers are overcome, then a couple wishing to choose the gender of their child would need only provide a sperm sample and undergo one or more cycles of intrauterine insemination with separated sperm.5 A clinic or physician that offers assisted re- productive technologies (ART) and invests in the

Target Article

Keywords

gender discrimination

preconception

procreative liberty

sex selection

Open Peer Commentary

Norman Daniels, p. 10

Rebecca Dresser, p. 11

Carson Strong, p. 12

Scot D. Yoder, p. 14

Mary B. Mahowald, p. 15

Julian Savulescu, p. 16

Owen D. Jones, p. 19

David B. Resnik, p. 21

Judith Daar, p. 23

Sandra Anderson Garcia, p. 24

Diane Paul, p. 26

Carl H. Coleman, p. 27

Mark V. Sauer, p. 28

Nancy King Reame, p. 29

Rosamond Rhodes, p. 31

Gregory Stock, p. 33

William Ruddick, p. 34

Dorothy C. Wertz, p. 36

Jenny Dai, p. 37

John Oberdiek, p. 38

éow cytometry equipment could run the separa- tion and prepare the X- or Y-enriched sperm for in- semination, or it could have the sperm processed by a clinic or érm that has made that investment. Flow cytometry separation would not be as cheap and easy as determining gender by taking a pill be- fore intercourse, but it would be within reach of most couples who have gender preferences in off- spring.6

Demand for Preconception Gender Selection

Unkown at present is the number of people who have offspring gender preferences robust enough to incur the costs and inconvenience of PGS. Al- though polls have often shown a preference for érstborn males, they have not shown that a large number of couples would be willing to forego coital conception in order to select the gender of their children. If PGS proves to be safe and effec- tive, however, it may be sought by two groups of persons�with�gender�preferences.

One group would seek PGS in order to have a child of a gender different from that of a previous child or children. A preference for gender variety in offspring would be strongest in families that have already had several children of one gender. They may want an additional child only if they can be sure that it will be of the gender opposite to their existing children.7 Couples who wish to have only two children might use PGS for the second child to ensure that they have one child of each gender. If social preferences for two-child families remain strong, some families may use PGS to choose�the�gender�of�the�second�child.

A second group of PGS users would be those persons who have strong preferences for the gender of the érst child. The most likely candidates here are persons with strong religious or cultural beliefs about the role or importance of children with a particular gender. Some Asian cultures have belief systems that strongly prefer that the érstborn child be a male. In some cases the preference reéects reli- gious beliefs or traditions that require a érstborn son to perform funeral rituals to assure his parents’ entrance into heaven (for a discussion of son prefer- ences in India and China, see Macklin 1999, 148– 151). In others it simply reéects a deeply embed- ded social preference for males over females. The érst-child preference will be all the stronger if a one-child-per-family policy is in effect, as occurred for a while in China (Greenlagh and Li 1995, 627). While the demand for PGS for érstborn children is likely to be strongest in those countries, there has

been a sizable migration of those groups to the United States, Canada, and Europe.8 Until they are more fully assimilated, immigrant groups in West- ern countries may retain the same gender prefer- ences that they would have held in their home- lands.

Other persons with strong gender preferences for érstborn children would be those who prize the different rearing or relational experiences they think they would have with children of a particular gender. They may place special value on having their érstborn be male or female because of per- sonal experiences or beliefs. Numerous scenarios are likely here, from the father who very much wants a son because of a desire to provide his child with what he lacked growing up, to the woman who wants a girl because of the special closeness that she thinks she will have with a daughter (Belkin�1999).

The Ethical Dilemma of Preconception Gender Selection

The prospect of preconception gender selection ap- pears to pose the conéict—long present in other bioethical issues—between individual desires and the larger common good. Acceding to individual desires about the makeup of children seems to be required by individual autonomy. Yet doing so leads to the risk that children will be treated as ve- hicles of parental satisfaction rather than as ends in themselves, and could accelerate the trend toward negative and even positive selection of offspring characteristics. The dilemma of reconciling procre- ative liberty with the welfare of offspring and fami- lies will only intensify as genetic technology is fur- ther integrated with assisted reproduction and couples seek greater control over the genes of off- spring.

Arguments for Preconception Gender Selection

The strongest argument for preconception gender selection is that it serves the needs of couples who have strong preferences about the gender of their offspring and would not reproduce unless they could realize those preferences. Because of the im- portance of reproduction in an individual’s life, the freedom to make reproductive decisions has long been recognized as a fundamental moral and legal right that should not be denied to a person unless exercise of that right would cause signiécant harm to others (Robertson 1994, 22–42). A corollary of this right, which is now reéected in carrier and prenatal screening practices to prevent the birth of

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children with genetic disease, is that prospective parents have the right to obtain preconception or prenatal information about the genetic characteris- tics of offspring, so that they may decide in a par- ticular case whether or not to reproduce (Robertson 1996,�424–435).9

Although offspring gender is not a genetic dis- ease, a couple’s willingness to reproduce might well depend on the gender of expected offspring. Some couples with one or more children of a par- ticular gender might refuse to reproduce if they cannot use PGS to provide gender variety in their offspring or to have additional children of the same gender (E. F. Fugger, personal communication to author). In other cases they might have such strong rearing preferences for their érstborn child that they might choose not to reproduce at all if they cannot choose that child’s gender. Few persons con- templating reproduction may fall into either group; but for persons who strongly hold those preferences, the ability to choose gender may de- termine�whether�they�reproduce.

In cases where the gender of offspring is essen- tial to a couple’s decision to reproduce, the freedom to choose offspring gender would arguably be part of their procreative liberty (Robertson 1996, 434). Since respect for a right is not dependent on the number of persons asserting the right, they should be free to use a technique essential to their repro- ductive decision unless the technique would cause the serious harm to others that overcomes the strong presumption that exists against government interference in reproductive choice. Until there is a substantial basis for thinking that a particular use of PGS would cause such harms, couples should be free to use the technique in constituting their fam- ilies. The right they claim is a right against gov- ernment restriction or prohibition of PGS. It is not a claim that society or insurers are obligated to fund PGS or that particular physicians must pro- vide�it.

Arguments Against Preconception Gender Selection

There are several arguments against preconception gender selection. Although such methods do not harm embryos and fetuses or intrude on a woman’s body as prenatal gender selection does, they do raise other important issues. One concern is the poten- tial of such techniques to increase or reinforce sex- ism, either by allowing more males to be produced as érst or later children, or by paying greater atten- tion to gender itself. A second concern is the wel- fare of children born as a result of PGS whose par-

ents may expect them to act in certain gender spe- ciéc ways when the technique succeeds, but who may be disappointed if the technique fails. A third concern is societal. Widely practiced, PGS could lead to sex-ratio imbalances, as have occurred in some parts of India and China due to female infan- ticide, gender-driven abortions, and a one-child- per-family policy (Sen 1990). Finally, the spread of PGS would be another incremental step in the growing technologization of reproduction and ge- netic control of offspring. While each step alone may appear to be justiéed, together they could constitute a threat to the values of care and concern that have traditionally informed norms of parent- ing�and�the�rearing�of�children.

Evaluation of Ethical and Social Issues

Concerns about sex-ratio imbalances, welfare of offspring, and technologizing reproduction may be less central to debates over PGS than whether such practices would be sexist or contribute to sexism. If the number of persons choosing PGS is small, or the technique is used solely for offspring gender variety, sex-ratio imbalances should not be a prob- lem. If use patterns did produce drastic changes in sex ratios, self-correcting or regulatory mecha- nisms might come into play. For example, an over- abundance of males would mean fewer females to marry, which would make being male less desir- able, and provide incentives to increase the number of female births. Alternatively, laws or policies that required providers of PGS to select for males and females in equal numbers would prevent such im- balances.10 A serious threat of a sex-ratio imbalance would surely constitute the compelling harm nec- essary�to�justify�limits�on�reproductive�choice.

It may also be difécult to show that children born after PGS were harmed by use of the tech- nique. Parents who use PGS may indeed have spe- ciéc gender role expectations of their children, but so will parents who have a child of a preferred gen- der through coitus. Children born with the desired gender after PGS will presumably be wanted and loved by the parents who sought this technique. Parents who choose PGS should be informed of the risk that the technique will not succeed, and coun- seled about what steps they will take if a child of the undesired gender is born.11 If they commit themselves in advance to the well-being of the child, whatever its gender, the risk to children should be slight. However, it is possible that some couples will abort if the fetus is of the undesired

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gender. PGS might thus inadvertently increase the number�of�gender-selection�abortions.

Finally, technological assistance in reproduc- tion is now so prevalent and entrenched that a ban on PGS would probably have little effect on the use of genetic and reproductive technologies in other situations. With some form of prenatal screening of fetuses occurring in over 80% of United States pregnancies, genetic selection by negative exclu- sion is already well-installed in contemporary re- productive practice. Although there are valid con- cerns about whether positive forms of selection, including nonmedical genetic alteration of off- spring genes, should also occur, drawing the line at all uses of PGS will not stop the larger social and technological forces that lead parents to use ge- netic knowledge to have healthy, wanted offspring. If a particular technique can be justiéed on its own terms, it should not be barred because of specula- tion of a slippery slope toward genetic engineering of offspring traits (for an analysis of the slippery- slope problem with genetic selection, see Robert- son�1994,�162–165).

Is Gender Selection Inherently Sexist?

A central ethical concern with PGS is the effect of such practices on women, who in most societies have been subject to disadvantage and discrimina- tion because of their gender. Some ethicists have argued that any attention to gender, male or fe- male, is per se sexist, and should be discouraged, regardless of whether one can show actual harmful consequences for women (see Grubb and Walsh 1994; and Wertz and Fletcher 1989). Others have argued that there are real differences between male and female children that affect parental rearing ex- periences and thus legitimate nonsexist reasons for some couples to prefer to rear a girl rather than a boy or vice versa, either as a single child or after they�have�had�a�child�of�the�opposite�gender.

To assess whether PGS is sexist we must érst be clear about what we mean by sexism. The Compact OED (1991, 1727) deénes sexism as “the assump- tion that one sex is superior to the other and the re- sultant discrimination practised against members of the supposed inferior sex, especially by men against women.” By this deénition, sexism is wrong because it denies the essential moral, legal, and political equality between men and women. Under this deénition, if a practice is not motivated by judgments or evaluations that one gender is su- perior to the other, or does not lead to discrimina- tion�against�one�gender,�it�is�not�sexist.

Professor Mary Mahowald, an American bio-

ethicist writing from an egalitarian feminist perspective, makes the same point with a conse- quentialist�twist:

Selection of either males or females is justiéable on medical grounds and morally defensible in other situa- tions [emphasis added] so long as the intention and the consequences of the practice are not sexist. Sexist intentions are those based on the notion that one sex is inferior to the other; sexist consequences are those that disadvantage or advantage one sex vis-à-vis the other.�(2000,�121)

In my view, the OED deénition, modiéed by Mahowald’s attention to consequences, is a persua- sive account of the concept of sexism. If that ac- count is correct, then not all attention to the bio- logic, social, cultural, or psychological differences between the sexes would necessarily be sexist or disadvantage females. That is, one could recognize that males and females have different experiences and identities because of their gender, and have a preference for rearing a child of one gender over an- other, without disadvantaging the dispreferred gender or denying it the equal rights, opportuni- ties,�or�value�as�a�person�that�constitutes�sexism.

If this conjecture is correct, it would follow that some uses of PGS would clearly be sexist, while others would clearly not be. It would be sex- ist to use PGS to produce males because of a paren- tal belief that males are superior to females. It would be nonsexist to use PGS to produce a girl because of a parental recognition that the experi- ence of having and rearing a girl will be different than having a boy. In the latter case, PGS would not rest on a notion of the greater superiority of one gender over another, nor, if it occurred in coun- tries that legally recognize the equal rights of women, would it likely contribute to sexism or further disadvantage women. As Christine Overall, a British feminist bioethicist, has put it, “sexual similarity or sexual complementarity are morally acceptable reasons for wanting a child of a certain sex”�(1987,�27;�quoted�in�Mahowald�2000,�117).

Psychological research seems to support this position. It has long been established that there are differences between boys and girls in a variety of domains, such as (but not limited to) aggression, activity, toy preference, psychopathology, and spa- tial ability (Maccoby and Jacklin 1974; Gilligan 1980; Kimura and Hampson 1994; Feingold 1994; Collaer and Hines 1995; and Halpern 1997). Whether these differences are primarily in- born or learned, they are facts that might rationally lead people to prefer rearing a child of one gender

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rather than another, particularly if one has already had one or more children of a particular gender. In- deed, Supreme Court Justice Ruth Bader Gins- burg, a noted activist for women’s rights before her appointment to the Supreme Court, in her opinion striking down a male-only admissions policy at the Virginia Military Institute (United States v. Vir- ginia, 116�S.�Ct.�2264�[1996]),�noted�that:

Physical differences between men and women . . . are enduring: “[T]he two sexes are not fungible; a community made up exclusively of one [sex] is dif- ferent from a community composed of both.” . . . “Inherent differences” between men and women, we have come to appreciate, remain cause for celebra- tion.

Some persons will strongly disagree with this account of sexism and argue that any attention to gender difference is inherently sexist because per- ceptions of gender difference are themselves rooted in sexist stereotypes. They would argue that any offspring gender preference is necessarily sexist be- cause it values gender difference and thus rein- forces sexism by accepting the gendered stereo- types that have systematically harmed women (Grubb and Walsh 1994; and Wertz and Fletcher 1989, 2112). According to them, a couple with three boys who use PGS to have a girl are likely to be acting on the basis of deeply engrained stereo- types that harm women. Similarly, a couple’s wish to have only a girl might contribute to unjusti- éed gender discrimination against both men and women, even if the couple especially valued females and would insist that their daughter re- ceive every beneét and opportunity accorded males.

Resolution of this controversy depends ulti- mately on one’s view of what constitutes sexism and what actions are likely to harm women. Al- though any recognition of gender difference must be treated cautiously, I submit that recognizing and preferring one type of childrearing experience over the other can occur without disadvantaging women generally or denying them equal rights and respect. On this view, sexism arises not from the recognition or acceptance of difference, but from unjustiéed reactions to it. Given the biological and psychological differences between male and female children, parents with a child of one gender might without being sexist prefer that their next child be of the opposite gender. Similarly, some parents might also prefer that their érstborn or only child be of a particular gender because they desire a spe- ciéc�rearing�and�companionship�experience.

If it is correct that using PGS for offspring di- versity is sexist, then those who deny that biologi- cal gender differences exist, or who assume that any recognition of them always reinforces sexism or disadvantages women, will not have carried the burden of showing that a couple’s use of PGS for offspring gender variety or other nonintentionally sexist uses is so harmful to women that it justiées restricting procreative choice. Until a clearer ethi- cal argument emerges, or there is stronger empiri- cal evidence that most choices to select the gender of offspring would be harmful, policies to prohibit or condemn as unethical all uses of nonmedically indicated�PGS�would�not�be�justiéed.

The matter is further complicated by the need to respect a woman’s autonomy in determining whether a practice is sexist. If a woman is freely choosing to engage in gender selection, even gen- der-selection abortion, she is exercising procreative autonomy. One might argue in response that the woman choosing PGS or abortion for gender selec- tion is not freely choosing if her actions are inéuenced by strong cultural mores that prefer males over females. Others, however, would argue that the straighter path to equal rights is to respect female reproductive autonomy whenever it is exer- cised, even if particular exercises of autonomy are strongly inéuenced by the sexist norms of her com- munity�(Mahowald�2000,�188).

Public Policy and Preconception Gender Selection

Because of the newness of PGS and uncertainties about its effects, the best societal approach would, of course, be to proceed slowly, érst requiring ex- tensive studies of safety and efécacy, and then at érst only permitting PGS for increasing the gender variety of offspring in particular families.13 Only after the demographic and other effects of PGS for gender variety have been found acceptable should PGS�be�available�for�érstborn�children.

However, given the close connection between parental gender preferences for offspring and re- productive choice, public policies that bar all nonmedical uses of PGS or that restrict it to choos- ing gender variety in offspring alone could be found unconstitutional or illegal. If there are phys- ical, social, and cultural differences between girls and boys that affect the rearing or relational experi- ences of parents, individuals and couples would have the right to implement those preferences as part of their fundamental procreative liberty. The risk that exercising rights of procreative liberty would hurt offspring or women—or contribute to

sexism generally—is too speculative and uncertain to�justify�infringement�of�those�rights.

The claim of a right to choose offspring gender is clearest in the case of PGS for gender variety. If éow cytometry or other methods of PGS are found to be safe and effective, there would be no compel- ling reason to ban or restrict their nonmedical use by persons seeking gender variety in the children they rear. Couples with one child or several chil- dren of a particular gender might, without being sexist or disadvantaging a particular gender, prefer to have an additional child of the opposite gender. ART clinics should be free to proceed with PGS for offspring variety in cases where couples are aware of the risk of failure, and have undergone counsel- ing that indicates that they will accept and love children of the dispreferred gender if PGS fails. Clinics providing PGS should also ask couples to participate in research to track and assess the ef- fects�of�PGS�on�children�and�families.

The use of PGS to determine the gender of érstborn children is a more complicated question. The choice to have one’s érst or only child be fe- male has the least risk of being sexist, because it is privileging or giving érst place to females, who have traditionally been disfavored.14 The use of PGS to select érstborn males is more problematic because of the greater risk that this choice reéects sexist notions that males are more highly valued. It is also more likely to entrench male dominance. The danger of sexism is probably highest in those ethnic communities that place a high premium on male offspring, but it could exist independently of those�settings.

Yet restricting PGS to offspring gender variety and érstborn females may be difécult to justify. Given that individuals could prefer to have a boy rather than a girl because of the relational and rear- ing experiences he will provide, just as they might prefer a girl for those reasons, it might be difécult to show that all preferences for érstborn males are sexist. Nor could one easily distinguish érstborn male preferences when the couple demanding them is of a particular ethnic origin. Although the risk that érstborn male preferences would be sexist is greatest if the PGS occurred in a country in which those beliefs prevailed, the chance that PGS would contribute to societal sexism lessens greatly if the child is reared in a country that legally pro- tects�the�equal�status�of�women�and�men.

If prohibitions on some or all nonmedical uses of PGS could not be justiéed and might even be unconstitutional, regulation would have to take different forms. One form would be to deny public

or private insurance funding of PGS procedures, which would mean that only those willing to pay out-of-pocket would utilize them. Another form would be for the physicians who control access to PGS techniques to take steps to assure that it is used wisely. If they comply with laws banning dis- crimination, physician organizations or ART clin- ics could set guidelines concerning access to PGS. They might, for example, limit its use to offspring gender variety or érstborn female preferences only. As a condition of providing services, they might also require that any couple or individual seeking PGS receive counseling about the risks of failure and commit to rear a child even if its gender is other than that sought through PGS.15 Although such guidelines would not have the force of statu- tory law, they could affect the eligibility of ART clinics to list their ART success rates in national registries and could help deéne the standard of care in�malpractice�cases.

Conclusion

The successful development of éow cytometry sep- aration of X- and Y-bearing sperm would make safe, effective, and relatively inexpensive means of nonmedical preconception gender selection avail- able for selecting female, if not also for male, off- spring. The nonmedical use of PGS raises impor- tant ethical, legal, and social issues, including the charge that any or most uses of PGS would be sex- ist and should therefore be banned or discouraged. Assessment of this charge, however, shows that the use of PGS to achieve offspring gender variety and (in some cases) even érstborn gender preference, may not be inherently sexist or disadvantaging of women. Although it would be desirable to have ex- tensive experience using PGS to increase the vari- ety of offspring gender before extending it to érstborn gender preferences, it may not be legally possible to restrict the technique in this way. How- ever, practitioners offering PGS should restrict their PGS practice to offspring gender variety until further debate and analysis of the issues has oc- curred. In any event, physicians offering PGS should screen and counsel prospective users to as- sure that persons using PGS are committed to the well-being of their children, whatever their gen- der.

A policy solution that gives practitioners and patients primary control without direct legal or so- cial oversight, although not ideal, may be the best way to deal with new reprogenetic techniques. Society should not prohibit or substantially burden reproductive decisions without stronger evidence

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of harm than PGS now appears to present. Ulti- mately, the use of PGS and other reprogenetic pro- cedures will depend on whether they satisfy ethical norms of care and concern for children while meet- ing�the�needs�of�prospective�parents. n

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Notes

1. “Preconception gender selection” (PGS) rather than “pre- conception sex selection” (PSS) is used throughout this arti- cle to convey the importance of the social and psychological meanings with which biologic sex is invested for prospec- tive parents and society generally. Because earlier versions of this article used “sex” rather than “gender,” commenta- tors may not have had the opportunity to revise their com- ments in response to the change. For the discussion at hand, either�“sex”�or�“gender,”�“PSS”�or�“PGS”�is�acceptable.

2. When combined with the X-chromosomes of oocytes, X- bearing sperm can produce only XX or female offspring. Similarly, Y-bearing sperm combined with the X chromo- some�of�oocytes�can�produce�only�XY�or�male�offspring.

3. See the study’s web page, http://www.microsort.net. This article uses the term “gender variety” rather than “family balancing” to avoid the misconception that a family is “un- balanced” if it has many or only children of one gender. (I am�grateful�to�George�Annas�for�this�suggestion).

4. See the study’s web page, http://www.microsort.net. Be- cause Y-bearing sperm are smaller and contain less DNA, there is more chance that the sorting machine will fail to distinguish X’s and Y’s, and thus provide samples that are insuféciently enriched with Y-sperm to give a high chance of�having�a�male�child.

5. Presumably éow cytometry separation of sperm could occur with donor as well as couple sperm. It could also be requested by couples undergoing IVF or intracytoplasmic sperm injection (ICSI) who request that the sperm provided be�enriched�or�chosen�to�effect�the�gender�of�choice.

Winter 2001, Volume 1, Number 1

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Preconception Gender Selection

6. The current cost of $1,500 per insemination cycle should decrease�as�further�progress�in�the�éeld�occurs.

7. Persons requesting PGS for gender balancing in the Fairfax study had an average of 3.4 children of the same gender, and sought boys and girls in roughly equal num- bers (Edward Fugger, personal communication to author, 23�February�2000).

8. See Chen (1999). The article describes immigration of a middle class family from the Indian state of Gujarat to Bridgewater, New Jersey, a suburb 40 miles from New York�City.

9. It should be emphasized that the right claimed here is a negative right against government interference, not an ob- ligation of a particular provider or public or private insurers to�provide�those�services.

10. See Glover (1994). Professor Glover has apparently changed his position from the more negative one he took in his earlier Ethics of New Reproductive Technologies: The Glover Report to the European Commission (1989, 141–144). See also Jones�(1992).

11. The risk arises because éow cytometry separation can only provide a greatly enriched sample of X- or Y-bearing sperm for insemination. It cannot guarantee that every sperm�in�the�sample�is�either�X�or�Y.

12. Wertz and Fletcher overlook how one could have gen- der preferences based on perceptions of experiential and rearing differences, rather than on differences in the worth or rights of women, when they assert that any form of gen- der selection violates the principle of equality between the genders “because it is premised upon a belief in sexual in- equality.”

13. FDA approval of the safety and efécacy of éow cytometry methods of PGS would also be required before widespread�use.

14. Persons taking a more purist approach to sexism would, of�course,�differ�with�this�assessment.

15. They might also require that consumers agree to partic- ipate in research so that policymakers will have reliable in- formation about the uses of PGS and the problems it pre- sents.

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