Reproductive Technologies: II. Sex Selection

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II. SEX SELECTION

Sex selection or sex selection techniques usually refer to methods that can be used to help ensure that children are of a specific sex.

Traditional and Scientific Techniques

INFANTICIDE. The simplest, most effective and most morally problematic form of sex selection is infanticide. Before the development of modern techniques the only way to determine the sex of offspring was to kill infants of the undesired sex after birth. This method has been practiced in many areas and at many times in human history.

While some people argue that infanticide can be morally acceptable (Tooley), such support is usually in cases where the individual would have a life that was not worth living. It is implausible to suppose that sex alone could ever be a condition that makes a life not worth living. Therefore even if we accept that there can be justified instances of infanticide we are not committed to permitting infanticide for the purposes of selecting sex.

PRENATAL DIAGNOSIS AND ABORTION. The first genetic testing technologies emerged in the 1950s. They provided the possibility of determining the sex of the fetus in utero (Bubeck).

The development of ultrasound during the 1970s further opened up the possibilities for determining the sex of offspring. It enabled parents to determine the sex of their child in utero and then abort the fetus if it was not of the desired sex. This practice is prevalent in India, China and other countries where a high value is placed upon the first child being male.

PREIMPLANTATION GENETIC DIAGNOSIS AND EMBRYO SELECTION. Preimplantation Genetic Diagnosis (PGD) was developed primarily so that embryos could be tested for genetic abnormalities before implantation. While the intention was to provide a technique for avoiding genetic diseases, it can also be used for determining the sex of the embryo. While PGD does not involve aborting a fetus growing in utero, it can involve discarding unwanted embryos. Some legislative bodies draw a distinction between techniques that are requested for medical as opposed to nonmedical reasons (see The Ethics Committee of the American Society of Reproductive Medicine). The implication is that a technique may be acceptable for a medical reason (PGD for avoiding genetic disease) but unacceptable for nonmedical reasons (PGD for determining the sex of the child). PGD is, next to infanticide, the most effective method of sex selection with an effectiveness of nearly 100 percent.

SPERM SORTING. Rather than determining the sex of a child after it has become an embryo or fetus, sperm sorting techniques attempt to ensure that sperm is sorted by whether they are X chromosome bearing (female) or Y chromosome bearing (male). If this is done successfully then the sperm can be used in artificial insemination or in vitro fertilization (IVF) to help ensure that any resulting child will be of the desired sex.

Sperm swim up or swim through techniques have been in development for some time but have not proved to be effective. More recently greater success rates have been achieved using flow cytometry. Recent figures on the effectiveness of this technique rate have evaluated it as 88 percent effective for determining X chromosome bearing sperm and 73 percent effective for determining Y chromosome bearing sperm. (Microsort.com)

Successful sperm sorting techniques have a number of advantages over other sex selection methods. They are less expensive in that, instead of invasive and potentially harmful techniques such as ultrasound and abortion or PGD and IVF, they involve relatively noninvasive Assisted Insemination. For those who believe that there is something morally significant about aborting a fetus or discarding unwanted embryos, sperm sorting is morally less problematic than PGD or selective abortion.

While these techniques are not likely to become very cheap in the foreseeable future they are already at a cost that could be born by most parents wanting to access this service. For those needing selection services in order to prevent a genetic disease that is carried by the X or Y chromosome, the techniques provide an attractive alternative to other forms of treatment.

Motives for Determining the Sex of the Child

There are a number of reasons why people might want to determine the sex of their child. These reasons range widely in the ethical difficulties that they present.

SOCIAL VERSUS MEDICAL REASONS. At the least problematic end of the spectrum is the intention to determine the sex of offspring so as to avoid the transmission of sex-linked disease. Sperm sorting for this reason is, arguably, morally unproblematic. PGD might also be justifiably used for this reason. Even ultrasound followed by abortion has a morally strong case to support it. However the greatest demand for these technologies comes from those who want to determine the sex of a child for so-called social reasons.

SOCIAL REASONS. Social reasons are reasons for wanting sex selection that do not aim at avoiding disease. John Robertson (2001) thinks that there are two different types of social reason, which, together, constitute the most significant demand for sex selection services. First, there are those who want a child of a particular sex because they already have a number of children of one sex or because they are only having two children and have a preference for one of each sex. A second group is those who have a strong preference for their first child being of a particular sex. The first scenario is often referred to as a family balancing reason and is often viewed as less morally problematic than valuing male children more highly.

Ethical Issues Raised by These Technologies

It is vital that the ethical issues raised by sex selection techniques are carefully considered because they are, essentially, techniques that select for particular genes.

Because couples or individuals, typically, request these techniques, the historical worries about eugenics have tended not to be raised in this context. However in contexts where there is a widely held view about the relative worth of a specific sex whether sex selection is a form of eugenics is much less clear. It is because of considerations such as these that Mary Anne Warren coined the term Gendercide for the systematic way in which female embryos, fetuses and children are killed and neglected in some parts of the world.

PROCREATIVE AUTONOMY. The main argument for open access to sex selection services is the interest that individuals have in exercising their reproductive autonomy. One key advocate of extending reproductive autonomy to sex selection is Robertson (1994) who borrows from English philosopher and economist John Stuart Mill's (1806–1873) harm principle. Mill theorized that the only reason a society has for restricting the liberty of individuals is if the exercise of that liberty would result in physical harm to others. A key freedom in western democracies is the liberty to make choices about procreation. The level of harm that is required for us to interfere with procreative autonomy is ordinarily very high. Even if there were some harms to others that result from the use of sex selection technologies, they would not be as serious as the harm that would be required to constrain this important liberty. Therefore we should not restrict access to sex selection services.

A second important defense of autonomy comes from German philosopher Immanuel Kant (1724–1804). He argued that persons must always be treated as ends in themselves and never as a means only. There are a number of reasons upon which Kant based his opinion but very significant among them is the status of human beings as project pursuers. It is the ability of persons to pursue projects that bestows value upon these projects. The wish to have children is an important component of the life projects of many people. Not only do people wish to have children they can also desire that those children be of a specific sex. Thus blocking access to sex selection services is a severe limitation upon the interests of individuals who want a child of a specific sex.

Restricting access to sex selection technologies may frustrate more than just the desire to have a child of specific sex. Robertson (2001) argues that in cases where the sex of a child will be the deciding factor in whether that child is born, selection techniques are necessary for parents to exercise their reproductive autonomy.

RESPECTING CHILDREN AS PERSONS. While Kantian considerations about how we should treat persons can count in favor of sex selection technologies, the same considerations can also be used to argue against them. When parents wish to use sex selection services they do so because they have a preference about what kind of child they want to have. If they use a sex selection technology and have a child the child's sex has been determined to satisfy an end of the parents and the child has been used as an instrument to bring about this end.

There are a number of responses to this argument. A child is either male or female and all sex selection does is to remove the randomness from the natural process. Children are born a specific sex and removing the randomness from this process does not violate them. A possible counter to this argument is to insist that children have the right to an open future (Feinberg). An open future means that a child has the right to its own liberties or conceptions of the good that are not intentionally limited by decisions and preferences of others. In the context of sex selection this would derive to the right to have one's sex determined by a random process. In other words, while most of us know that our sex resulted from no human action, persons whose sex has been selected will know that they are a specific gender because of a parental preference.

A second response is to think carefully about what the Kantian theory demands. Kant requires us to treat persons as ends in themselves and never as a means only. In actuality, it would be impossible to never use other persons as a means because it implies that employing the assistance of another to achieve any end negates the personhood of that other. Kantian theory directs us to only use persons for our own ends when this does not violate their status as persons. So while it may be that parents who use sex selection techniques are using their children as a means it is not obvious that this in consistent with respecting their children as persons. Furthermore it is not clear that "wanting to have a child of a specific sex" for your own reasons is any different from wanting to have a child for your own reasons.

SEX-RATIO IMBALANCES. A major objection to the widespread introduction of sex selection is that it might result in a significant imbalance of male to female sex ratios. A preference about the value of having male children or a male first child could result in many more male babies being born.

In the Western world there is little reason to be concerned about sex ratio imbalances. Research in the United States and the United Kingdom on the preferences of those requesting sex selection services indicates that there was a slight preference for girls over boys (Lui and Rose). A majority of people wishing to access these services in the West do so for family balancing reasons.

However there are good reasons for worrying about sex ratio balance in parts of the world where male children are more highly valued.

IMPLICATIONS OF SEX SELECTION FOR COUNTRIES OR CULTURES WHERE SONS ARE VALUED MORE HIGHLY. In some parts of the world there is a significant imbalance in the sex ratios. By comparing the sex ratio of North America and Europe to that of Asia and North Africa there are more than 50 million fewer women in China than there should be. When the sub-Saharan ratio is used (where beliefs about the relative importance of women are more similar to Europe and America) there are 44 million in China, 37 million in India and over 100 million world-wide fewer women than there should be (Sen).

The differences in sex ratios are not due solely to sex selection; they are also a result of factors such as poor diet, limited access to healthcare and other environmental factors.

There is every reason to suppose that the introduction of new sex selection services will increase this imbalance. In 1993 ultrasound machines constituted 20 percent of the total Indian market in medical technology (Miller). Sperm sorting technologies could potentially become readily affordable and they are likely to result in an increase in the number of male babies born.

A society having a balanced sex ratio can be considered to be a public good. It is an indicator that there is equity between the sexes in terms of access to healthcare, education, nutrition and wealth. Barbara Miller has suggested that in India sex ratio imbalances correlate with high levels of intersocietal warfare, the frequency of violence, and violence towards women.

THE IMPLICATIONS FOR WOMEN OF A BAN ON SEX SELECTION. While there is a likelihood that better access to sex selection services in India and China will increase the selection of male offspring, it is important to bear in mind the implications of banning access to these technologies. Without access to pre-conception methods of sex selection women may be forced or coerced into aborting fetuses if they are female. There is also the likelihood that some female neonates will be neglected when that child might have been preconception selected as male. The arguments are counterbalanced to some extent by the fact that the increased use of these technologies might make it easier for these practices to continue and will do little to rectify the value system which makes them possible.

IS THE MOTIVATION SEXIST? OR ARE SOME REASONS MORALLY ACCEPTABLE? On one level it is hard to deny that sex selection is sexist because it is a practice that involves acting on a preference to have a child of a determinate sex. This implies that having a child of a particular sex is in some way better, according to the person with that preference. If a person did not believe that having a child of a specific sex would be better, they would have no reason for wanting a child of a specific sex.

The problem with this analysis is that it implies that any preference that has sex as a distinguishing feature is sexist. This is absurd because it implies that a heterosexual woman who has a preference for cohabitating with a man is sexist. Sexism is the making of morally relevant discriminations on the basis of morally irrelevant features. On this view if parents want to have a female child because they already have a male child and will only have two children, their preference is not sexist; the preference is not based upon believing that there is anything inherently more valuable about male children.

While there are some reasons for wanting to select the sex of a child that are sexist and therefore morally unacceptable, whether society should stop people from acting upon these reasons is another question.

Some justifications people give for their actions are so immoral that we might consider them illegitimate reasons—or reasons that are immoral to the extent that a liberal democracy does not need to respect their legitimacy. Profoundly sexist beliefs fall into the class of reasons that we might consider to be illegitimate.

However if a couple wishes to select the sex of their child for sexist reasons it is unclear whether allowing them access to sex selection services will make things any worse or perpetuate sexism. Failing to allow the couple access to these services may not do anything to change their beliefs about the relative worth of male and female children.

GROWING TECHNOLOGIZATION OF REPRODUCTION. Sex selection technologies are part of the growing trend towards the technologization of reproduction. Reproduction used to occur only naturally and within the context of a family unit. Care and concern in parenting has always been the province of traditional family units and technologization of reproduction might be a threat to this important human institution.

While the values that surround nurturing our children are of great value and ought not be placed at risk, it is unfair to single out sex selection technologies. If the growing technologization of reproduction is a serious problem then the response ought to be to place restrictions on all new reproductive technologies.

That there is a broad spectrum of technologization of reproductive services must be considered. At one end are the relatively low-tech practices of artificial insemination and at the other technologies such as PGD. Sex selection by sperm sorting is closer to the low-tech end of the spectrum and therefore does not have the same potential to technologize reproduction as do technologies like PGD.

INAPPROPRIATE USE OF MEDICAL TECHNOLOGY. Sex selection for social reasons is not a healthcare need. We can plausibly think of infertility as constituting a healthcare need because it is a deviation from a capacity that people of childbearing age usually have. But the capacity to determine sex is over and above normal human capacity. Sex selection is more like cosmetic surgery or other services that can be provided by physicians. Given that there are morally problematic reasons for wanting these services, reproductive specialists need to consider whether this is an appropriate use of their resources and expertise (see Dresser). The concern regarding the appropriate use of medical resources can be partially addressed if sex selection services are privately funded and do not result in any person not receiving treatment for a medical condition. However the issue of whether sex selection services are something that the medical profession ought to be using its knowledge and skill to provide is more difficult to resolve.

THE WELFARE OF THE SEX SELECTED CHILD. A major objection to sex selection technologies is that they may result in harm to children. There are a number of ways in which harm may result.

First, if a sex selection technique is used and fails, the child that results may be neglected or be psychologically harmed by the knowledge that he or she is not the sex that the parents wanted. This consideration can be also be used as an argument for sex selection technologies. If a child will be harmed if he or she is not of the desired sex, then it is better to ensure that the parents have a child of the sex that they want.

Second, if parents have strong views about the way in which children of a certain sex ought to be raised, a child of the undesired sex may be born into an overly restrictive environment.

Third, sex selection techniques can carry risks to the child that may result. At this point in time there is no evidence to suggest that there are harms to children born after sperm sorting interventions. PGD may carry some risks to resulting children. When PGD is used to predict disease the benefit may offset the risk of the technique, but when it is used in selecting sex, determining the value of the benefit in relation to the risk is more problematic.

Sex selection techniques present a broad range of ethical issues. Many objections can be turned into arguments for sex selection. However, some reasons for wanting sex selection are undoubtedly unethical. Moreover, the consequences of sex selection may justify regulation, if not prohibition.

john mcmillan

BIBLIOGRAPHY

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Dresser, Rebecca. 2001. "Cosmetic Reproductive Services and Professional Integrity." American Journal of Bioethics 1(1): 11–12.

Ethics Committee of the American Society of Reproductive Medicine. 1999. "Sex Selection and Preimplanatation Genetic Diagnosis." Fertility Sterility 72: 595–598.

Feinberg, Joel. 1980. "The Child's Right to an Open Future." In Whose Child? Children's Rights, Parental Authority and State Power, ed. W. Aiken and H. LaFollette. Totowa, NJ: Rowman and Littlefield.

Kant, Immanuel. 1997 (1785). Groundwork of the Metaphysics of Morals, tr. and ed. Mary Gregor. Cambridge, Eng.: Cambridge University Press.

Lui, P., and Rose, G. 1995. "Social Aspects of > 800 Couples Coming Forward for Gender Selection of their Children." Human Reproduction 10: 968–971.

Mill, John Stuart. 1991 (1859). On Liberty and Other Essays, ed. John Gray. Oxford: Oxford University Press.

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Robertson, John. 2001. "Preconception Gender Selection." American Journal of Bioethics 1(1): 2–9.

Savulescu, Julian. 2001. "In Defense of Selection for Nondisease Genes." American Journal of Bioethics 1(1): 16–19.

Sen, Amartya. 1995. "Gender Inequality and Theories of Justice" In Women, Culture and Development: A Study of Human Capabilities, ed. Martha Nussbaum and Jonathan Glover. New York: Oxford University Press.

Steinbock, Bonnie. 2002. "Sex Selection: Not Obviously Wrong." Hastings Center Report 32(1): 23–28.

Tooley, Michael. 1983. Abortion and Infanticide. Oxford: Clarendon Press.

Warren, Mary Anne. 1985. Gendercide. Totowa, NJ: Rowman and Littlefield Publishing.