Bioethics And Medical Humanities
Sex selection of embryos for the purpose of family balancing is not ethically permissible. First, I would first like to share my personal background on the issue. Thanks to assisted reproduction, I am here on this earth today. However, had my parents selected to have a son as opposed to a daughter, I might never have walked the earth. Fortunately, my parents did not use sex selection of their embryos as they only wanted to have a normal, happy and healthy child. The sex of their future child did not concern them as they felt just blessed to finally become parents. Here I am, 22 years later today, their daughter, writing this paper. Let’s dive in and explore this topic.
There are two main categories of reasons proponents argue that sex selection of embryos is ethically permissible. These are medically indicated and elective (nonmedical) reasons. In the former category, sex selection is used to prevent so-called sex-linked diseases, that male children inherit from their mothers, such as hemophilia A and B, Duchenne muscular dystrophy, Lesch-Nyhan syndrome and others. In some instances, conditions are more severely expressed in one gender (e. g. , fragile X syndrome in males) than the other. However, elective sex selection is not done for medical reasons, but to accord with a desire for “family balancing” or a strong preference for a child of a particular sex. A situation in which parents who have lost a child desire another child of the same sex could be considered another nonmedical indication for sex selection (Aghajanova & Valdes, 2012).
Proponents of elective sex selection argue about one’s right to reproductive choice including sex selection in regards to constitutional rights. Family balance is viewed as another valid reason for sex selection. For the most part, Judaism and Islam allow sex preselection, while it is forbidden by the Catholic Church even for medical use. The major argument for pre-implantation sex selection is that it may be thought of as a lesser evil than prenatal diagnosis (ultrasound or amniocentesis) and abortion only for unwanted sex. The latter options carry more significant risks for the mother’s health and needless to say stronger ethical concerns (Aghajanova & Valdes, 2012).
However, opponents of elective sex selection feel that sex selection is playing divine, a form of genetic engineering and could perpetuate gender discrimination. (McGowan & Sharp, 2012). Furthermore, sex discrimination can result in an imbalance in the sex ratio within a given society. This already exists in China and India, where male children are particularly favored but is less likely to happen in the Western world where “family balancing” is the usual reason for nonmedical sex selection (Aghajanova & Valdes, 2012).
Another argument against sex selection for nonmedical reasons is exposure to unnecessary medical risks. The risks associated with sperm sorting which is required in sex selection of embryo remain unclear due to the lack of relevant research. Yet, some studies have found that Hoechst dye can have a mutagenic effect on sperm. Patients also need to be aware of the small possibility of having a child of the unwanted sex despite the procedure or of having produced embryos only of the “unwanted” sex. It is better to agree prior to the procedure if the couple will still choose to transfer healthy embryos even if they are of the “wrong” sex, or if they will donate those embryos if there are none of the desired sex (Aghajanova & Valdes, 2012).
Such procedures also carry a large financial burden in countries where patients are typically responsible for treatment costs. Another issue in countries in which patients pay treatments costs is the fairness of access to medical resources (Aghajanova & Valdes, 2012).
As is clearly outlined in the latest statement of the ethics committee of the American Society for Reproductive Medicine (ASRM), PGD for sex selection to prevent the transmission of serious sex-linked genetic disease is acceptable and recommended. Interestingly, there is no argument against medically indicated sex selection. The ASRM’s position is that all families have a genuine right to healthy offspring, and they may implement all available technologies to avoid a known genetic disorder. Further, in such cases, no preference of one sex to another is expressed based on its supposed value. While, the ASRM committee advocates that use of PGD for nonmedical sex selection should not be encouraged but does not favor its legal prohibition. The nonmedical reasons are of continuing debate (Aghajanova & Valdes, 2012).
To wrap things up, selection for sex-linked disease prevention is well established and not considered controversial. However, sex selection for nonmedical reasons is not encouraged, but neither is it prohibited in the U. S. Based on available research data, it is believed that sperm sorting should not be used until more safety data are available.
In sum, sex selection of embryos for the purpose of family balancing is not ethically permissible for the aforementioned reasons discussed in this paper.
References
- Aghajanova, L. , & Valdes, C. T. (2012, February). Sex selection for nonhealth-related reasons. Retrieved February 18, 2019, from AMA Journal of Ethics website: https://journalofethics. ama-assn. org/article/sex-selection-nonhealth-related-reasons/2012-02
- McGowan, M. L. , & Sharp, R. R. (2012, December 1). Justice in the context of family balancing. Retrieved February 13, 2019, from NCBI website: https://www. ncbi. nlm. nih. gov/pmc/articles/PMC3872136/
