include increase in influence of the rarer gender, reduced population growth and interbreeding of different populations (Sureau, 1999). In a practical sense, sex selection employing preimplantation genetic diagnosis may be preferable to the alternatives. It would be morally preferable to many people to termination of ‘wrong sex’ pregnancies or female infanticide (Sureau, 1999) and is preferable to increasing population burdens in an attempt to have a child of the desired sex (Simpson and Carson, 1999).
The Committee also does not base its reservation about sex selection on vague ‘slippery slope’ arguments. The Committee is well aware that it is perfectly possible to draw a legal line between the selection for sex and the selection for other characteristics, such as eye colour, height or intelligence. Thus, if there is consensus that selection for sex is morally acceptable but selection for, let us say, intelligence is not, professional or legislative controls can be employed to allow the former but not the latter. Arguments claiming that sex selection is the initial step down a road that will inevitably lead to the creation of ‘designer babies’ or a ‘new eugenics’ are simply invalid.
However, if it is not the fear of a distorted sex ratio or a slide towards eugenics, then, what are the social risks the Committee is referring to? The Committee rests its case against sex selection for non‐medical reasons upon four claims. Firstly, sex selection is to be opposed because it identifies ‘gender as a reason to value one person over another’. Secondly, it may ‘contribute to a society’s gender stereotyping and gender discrimination’. Thirdly, because it is ‘unreasonable for individuals who do not otherwise need IVF to undertake its burdens and expense solely to select the gender of their offspring’. And fourthly, because it represents a ‘misallocation of limited medical resources’.
Consider the first objection. The claim that couples requesting sex selection ‘identify gender as a reason to value one person over another’ is simply unsound. Couples seeking the service of Gender Clinics are typically in their mid‐thirties, have two or three children of the same sex and wish to have at least one child of the opposite sex. Their choice for a child of a particular sex depends entirely upon the sex of the children they already have. If they already have two or three boys they tend to choose a girl, if they already have two or three girls they tend to choose a boy (Fugger et al., 1998). Since their choice is simply based on the gender of already existing children, and not on the absurd assumption that one sex is ‘superior’ to another, the claim that these couples are making a sexist choice is an unjustified accusation.
The existing data of Gender Clinics also undermine the second objection of the Committee that sex selection for non‐medical reasons may ‘reinforce gender bias in a society’. Since couples seeking sex selection are almost exclusively motivated by the desire to balance their family and choose girls with the same frequency as boys, it is hard to see how their choices are supposed to contribute to a society’s gender discrimination (Khatamee et al., 1989; Liu and Rose, 1995). If these were real concerns, sex selection could be limited to balancing family sex, and only after the first child.
The third objection that it is ‘unreasonable’ for a woman to undergo a burdensome IVF treatment solely to select the sex of her child smacks suspiciously of medical paternalism. The Committee seems to be aware of this as it tones down its statement in the following sentence, saying that ‘individuals may be free to accept such burdens’. Yet, it insists, ‘to encourage preimplantation genetic diagnosis for sex selection when it is not medically indicated presents ethical problems.’ What ethical problems does it present? Unfortunately, we are not told. More importantly, the issue is not whether preimplantation genetic diagnosis for sex selection is to be ‘encouraged’, but whether the mere fact that an IVF treatment cycle imposes a burden on a woman is a sufficient reason to ‘discourage’ her. If a woman is aware of the physical and psychological costs to herself but thinks having a child of a certain sex is worth the trouble, it is an autonomous decision that needs to be respected. After all it is her life and her body. The Committee seems blind to the importance of gender to parents, and that parents are best left to themselves to make decisions about the constitution of their family (Savulescu, 1999).
The Committee did not focus on the physical risks of preimplantation diagnosis to children born and these clearly need to be evaluated in any sex selection procedure (Benagiano and Bianchi, 1999; Simpson and Carson, 1999). Experience so far is encouraging, with several hundred children being born after PGD without apparent detriment. Systematic review is continuing (ESHRE PGD Consortium Steering Committee, 1999).
The fourth and last objection of the Committee is that preimplantation genetic diagnosis for sex selection constitutes ‘inappropriate use and allocation of medical resources’. To our knowledge, no‐one has so far seriously advocated that the state, i.e. the tax‐payer, should subsidize sex selection for non‐medical reasons. Again, the Committee seems to be aware of this when it continues: ‘If an individual is able and willing to pay for desired services, there is no direct, easy way to show how any particular set of choices takes away from the right of others to basic care.’ Nonetheless, it claims: ‘Yet even here, individual and group decisions do have an impact on the overall deployment of resources for medical care and on the availability of reproductive services.’ The Committee is relentless in its claim that allowing sex selection is a misallocation of resources, repeating itself at least four times on this issue. Since this objection seems to be the most compelling, it would have been helpful to show how a privately paid service for sex selection can possibly deprive the community of its scarce medical resources. If people are permitted to spend their own money on cosmetic surgery without being accused of violating ‘the right of others to basic care’, it is hard to see why couples willing to spend their own money on sex selection should be treated differently. Moreover, given the burdens, the expense and the low success rate of IVF, it is highly unlikely that preimplantation genetic diagnosis for sex selection will ever become so widespread as to have an ‘impact on the overall deployment of resources for medical care and on the availability of reproductive services’.
Thus, when the Committee concludes that preimplantation genetic diagnosis for sex selection poses a ‘risk of unwarranted gender bias, social harm, the diversion of medical resources from genuine medical need and should therefore be discouraged’, it seems that the boldness of its statement is in conspicuous contrast to the weakness of its arguments.
References
1 Benagiano, G. and Bianchi, P. (1999). Sex preselection: an aid to couples or a threat to humanity? Hum. Reprod., 14: 868–70.
2 ESHRE PGD Consortium Steering Committee (1999). ESHRE Preimplantation Genetic Diagnosis (PGD) Consortium: preliminary assessment of data from January 1997 to September 1998. Hum. Reprod., 14: 3138–48.
3 Ethics Committee of the American Society of Reproductive Medicine (1999). Sex selection and preimplantation genetic diagnosis. Fertil. Steril., 72: 595–8.
4 Fugger, E. F., Black, S. H., Keyvanfar, K. et al. (1998). Births of normal daughters after Microsort sperm separation and intrauterine insemination, in‐vitro fertilization, or intracytoplasmic sperm injection. Hum. Reprod., 13: 2367–70.
5 Khatamee, M. A., Leinberger‐Sica, A., Matos, P. et al. (1989). Sex preselection in New York City: who chooses which sex and why. Int. J. Fertil., 34: 353–4.
6 Liu, P. and Rose, A. (1995). Social aspects of >800 couples coming forward for gender selection of their children. Hum. Reprod., 10: 968–971.
7 Savulescu, J. (1999). Sex selection – the case for. Med. J. Australia, 171: 373–5.
8 Simpson, J. L. and Carson, S.A. (1999). The reproductive option of sex selection. Hum. Reprod., 14: 870–2.
9 Statham, H., Green, J., Snowdon, C. and France‐Dawson, M. (1993). Choice of baby’s sex. Lancet, 341: 564–5.
10 Sureau, G. (1999). Gender selection: a crime against humanity or the exercise of a fundamental right? Hum. Reprod., 14: 867–8.
11 Why We Should Not Permit Embryos to Be Selected as Tissue Donors