Wednesday, March 14, 2007

Top Ten Reasons Against Sex Selection (and few more they missed)

Jennifer Lahl of the Center for Bioethics and Culture summarizes an article from Reproductive BioMedicine Online by Dr. Edgar Dahl. In response to a recommendation that the British Parliament ought to outlaw sex selection except for the most serious medical reasons (a recommendation mirrored by an opinion issued by the Committee on Ethics of the American College of Obstetricians and Gynecologists), Dahl lists what he perceives as the top ten reasons against sex selection and then proceeds to refute them:

  1. Sex selection is 'playing God' and since western democracies are built on the separation of church and state, if sex selection is against ones religious belief they can refrain from it.
  1. Sex selection is 'playing mother earth' and therefore it is 'unnatural' however on the basis that something is natural or unnatural doesn't make it moral or immoral. Dahl gives the example of heart transplants being 'unnatural' but not immoral.
  1. Sex selection is using medical procedures for non medical purposes but we've crossed that boundary ages ago with plastic surgery being used for cosmetic purposes.
  1. Sex selection wrongly allocates limited medical resources but since western societies are run on private economies based on free and open markets, resource allocation is not an issue.
  1. Sex selection distorts the natural sex ratio leading to imbalances as seen in India and China. Dahl maintains that since western societies do not have marked preference for one sex over another we will not be at risk for imbalances in sex ratios.
  1. Sex selection distorts the natural birth order leading to a society of first-born 'son and heir'.
  1. And Sex selection creates a society of 'little sisters' since girls will be desired after the first born son. Dahl combines his argument against reasons 6 and 7 maintaining that "it is highly unlikely that hundreds of thousands of couples would employ sex selection technology for their first child to be a boy" and second born children do not feel second best so there will be no harm to our sons and daughters by ordering their birth.
  1. Sex selection is sexist but Dahl states that parents do not view one sex as more valuable than another but use sex selection out of a desire to have children from each sex.
  1. Sex selection negatively impacts the welfare of the child by imposing gender specific behavior on that child. Dahl insists, couples who use sex selection want a girl, not Angelina Jolie or they want a boy, not Brad Pitt.
  1. Sex selection leads down the slippery slope of designer babies. But since this is not an argument against sex selection per se, but of the consequences of sex selection, Dahl feels optimistic we can manage these desires and "draw a legal line permitting some forms of selection and prohibiting others."
I have yet to hear an ethicist who is a woman come forth in support of sex selection; part of it, I think, it is that it wasn't that long ago that the women were considered mere property... it wasn't all that long ago that the expression "rule of thumb" referred to the circumference of the stick that a husband could beat his wife with... it was only 1920 that women could finally vote...
Dahl misses two major points: first, he is forgetting the history of women, not just in western society, but all over the world and secondly, he dismisses attitudes in India and China as insignificant or not having an impact on the rest of world. In this day and age, in this global economy, in this shrinking world, we can neither afford to ignore history nor stick our heads in the sand and pretend that one part of the world is somehow isolated or insulated from other other parts of world. The United Nations recognizes that sex selection, in most parts of the world, reinforces the devaluation of women.

Because the patient is entitled to all personal medical information, including the sex of the fetus, it might impossible for health care professionals to avoid unwitting participation in sex selection, but it would send a strong and clear message if laws were passed that prohibited sex selection except for the purpose of preventing serious sex-linked genetic diseases.

[Editor's note: One of the readers asks what message we send our disabled friends by permitting sex selection for serious genetic defects -- my intent is not to devalue the disabled, but to prevent unnecessary suffering. I acknowledge, though, that is an area fraught with difficulties -- see the editorial by Dr. Colin Gavaganh (Embryo testing: Why drawing lines risks devaluing the disabled). I also think philosopher Rosamond Scott has some interesting things to say about this in her article Prenatal Testing, Reproductive Autonomy, and Disability Interests: ... "the language of 'suffering' may be of particular concern to people with disabilities, at least in that it may make presumptions about, rather than listen to, their views. This again highlights the importance of careful reflection about whose interests may be truly or most at stake in prenatal screening, PGD, and associated selection decisions. The pressing issue in relation both to parents’ interests in making reproductive decisions as well as to the interests of those with impairments is how best to enhance the deliberative processes attending these reproductive decisions."]

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