You are not currently logged in. Log in

Response to the HFEA's Sex Selection: Choice and responsibility in human reproduction

22 January 2003

Introduction

Without prejudice to concerns as to whether sex selection is within the HFEA's remit, the HFEA is to be commended on setting out so clearly the key ethical arguments for and against the practice of sex selection in such an even handed way. This mode of presentation should assist people to come to their own conclusions as to the ethical acceptability of the practices which are directed towards sex selection.

Having said that, the document seems to use the following propositions as its point of departure in the section on Ethics/Social Issues:

We have seen that some uses of sex selection are currently viewed as ethically acceptable. The question therefore is where to draw the line between acceptable and unacceptable uses of sex selection.¹

The most straightforward area in which sex selection might be seen as acceptable is where it is used to enable prospective parents to avoid having a child with a serious sex-linked disorder.²

It is submitted that this represents a serious confusion between sex selection on the one hand, and the eugenic desire to eliminate children with an unwanted health deficit on the other.

The confusion in terms

The HFEA helpfully defines what is meant by the term 'sex selection'.

One of these issues is sex selection, which for the purposes of this consultation means any practice, technique or intervention intended to increase the likelihood of the conception, gestation and birth of a child of one sex rather than the other.³

In setting out its definition in these terms the HFEA follows the traditional expression of the nature of a human act. That is the act is described in terms of its intention and the intended primary end of the act (ie, increase the likelihood of the conception, gestation and birth of a child of one sex rather than the other).

However, the HFEA then assumes that prenatal genetic diagnosis (PGD) of embryos to determine which embryo may have a sex linked abnormality is an example of sex selection.

But it is not.

Sex identification is not the same as sex selection. Sex identification is the preliminary step necessary to do either of two things: eliminate embryos with a specific sex-linked inherited condition be it a male with a male-linked condition or a female with a female-linked condition (health selection), or eliminate an embryo simply because it is either male or female (sex selection).

The purpose of PGD is to favour the gestation and birth of a child which does not have the inherited genetic abnormality. It is not about a favoured sex since it is not the achieving of a child of a particular sex that is the object of the act. The child could as well be male as female. What matters in these circumstances is that the child which is unwanted because of the serious risk of a serious inherited disability is not allowed to come to term as a baby.

It is quite misleading and, indeed, tendentious to argue on the basis that sex selection has in principle already been accepted that what remains is to determine where the line is drawn.

Medically indicated 'sex selection' is not sex selection

The fact that fetal abnormality was accepted as a lawful ground for induced abortion in the Abortion Act 1967 prepared the ground for legal approval of discarding embryos believed to be defective in IVF programmes, and then for the subsequent acceptance of PGD for improved detection of genetic abnormalities.

Where sex-linked genetic abnormalities are concerned, PGD is used to determine the sex of embryos as the basis for discarding all the embryos of the sex which might have the abnormality irrespective of whether or not that particular embryo is in reality a carrier.

The goal here is to eliminate children being born with serious abnormalities, although "serious" has in recent times been interpreted to include a case where the unborn child was believed to have a cleft palate.⁴ In this latter case involving a eugenic abortion it would seem that "serious" was, perhaps, taken to mean "less than perfect".

The medical case for "sex selection" referred to in the HFEA consultation paper is in fact not a case for sex selection but a case for sex identifying techniques being used to disfavour the birth of a child with a disability while favouring the birth of the child without a disability.

Medically justified 'sex selection' is not ethically justified

The Universal Declaration of Human Rights states that "recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world."⁵ Moreover, "everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind ..."⁶

The Society for the Protection of Unborn Children has consistently argued that the embryonic human being is a member of the human family and is entitled to have his or her human rights protected in law.⁷ Moreover, the Society has long objected to the killing of the unborn even when the unborn child is sick or disabled on the grounds that it represents a violation of the fundamental human rights of a member of the human community.

The methods used to identify which embryos are sick or disabled are methods directed towards and therefore part of the means of destruction of those embryos. This includes techniques which identify the sex of the embryo in the case of sex linked inherited disability or sickness. Such killings of sick or disabled embryos are unethical since they represent not only an unjust discrimination against those embryonic human beings but also a violation of their fundamental human rights. This is a crime against humanity.

Recognising, as the consultation document does, that "public opinion does appear to favour this type of intervention", is not the equivalent of an ethical argument. At one time people accepted the slave trade and children working in factories, up chimneys, and down in the mines. Public acceptance of a practice, if indeed the public really does accept these practices, does not by itself render such practices ethically acceptable.

Where the killings of embryos and foetuses with a sex linked disorder are concerned, the ethical objection is an in-principle objection that it is always wrong to kill innocent human beings and none the less so when it is to eliminate children with serious disabilities. The consultation document raises concerns about "unacceptable consequences" which might flow if choices made by individuals were to be generalized.⁸ These consequences which might flow from such killings certainly are of ethical concern, as the consultation document clearly implies.⁹ Nevertheless, even if those consequences did not obtain, the intentional killing remains as the fundamental ethical objection.

We agree with the consultation document when it says:

Doing something for a medical reason is not the same as having a good medical reason to do it.¹⁰

The fact is that there never is a good medical reason for killing human beings. The first principle of medical ethics, primum non nocere, sometimes expressed as "first do no harm", forbids the medical killings of the innocent and the vulnerable.

Let it be clearly understood that SPUC objects to these procedures because they involve the killing of innocent human life, and not because they are examples of sex selection which they are not.

Formulating the ethical issues to be considered in sex selection

What Britain is being asked to consider is whether or not sex selection should, for the first time, be recognised as a legitimate practice, a legitimate choice for parents and, if so, against what criteria. It is not the case that there has been any in principle acceptance of sex selection. What the community is being asked to consider, for the first time, are three main questions:

Is sex selection in principle something which should be accepted legally and ethically?
If so, under what conditions or according to what criteria should it be made available?
What methods of sex selection should be accepted as legitimate methods to achieve sex selection?

Sex selection in principle

Sex selection, as the consultation document reminds us, "means any practice, technique or intervention intended to increase the likelihood of the conception, gestation and birth of a child of one sex rather than the other.¹¹

There are no identifiable medical reasons for such a procedure. The lack of a child of a particular sex cannot be held to be a pathological condition requiring medical or surgical intervention. That being the case, the ethical and social issues involved in sex selection are, essentially, those contained in the consultation document in paragraphs 70 to 99.

In addition to these ethical considerations ethical questions need to be asked about the nature and purpose of medicine. If the practice of medicine is directed to the restoration to good health and well-being of the sick and disabled, and to the maintenance of good health and well-being among those who are not sick or disabled, then it would seem to be improper for a medical practitioner to expose a woman or any child conceived and born of such procedure to unnecessary risk. Primum non nocere.

The World Health Organization provides a somewhat utopian definition of health in its Constitution, detached from the reality of human experience.¹² "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." It might be thought that such a definition could justify sex selection techniques with its appeal to "complete social well-being". Even so, if the techniques expose a person to unnecessary risk, then even the cause of "complete social well-being" may receive a setback if things should go badly. The risks here include the conception of a child of the 'wrong' sex with the concomitant demand for an abortion, or any of the risks associated with the conception and birth of children using assisted reproductive technologies followed by PGD, or simply the way the child turns out to be.

SPUC recognises that every child has the right to be accepted unconditionally, "that in having a child parents are bringing into existence a human being whom they should seek to nurture, not to design or control."¹³ Moreover, and without wishing to restate the arguments against sex selection so ably identified in the consultation document and with which SPUC would agree, SPUC has already noticed the human temptation to generalize and to expand what has been allowed by way of concession to hard cases, or emotionally suggestive scenarios, to a general right to determine the sex of one's own child.

The consultation document has already fallen into that temptation by (wrongly) identifying "normality selection" with "sex selection" (thereby confusing means and ends), and then going on to say that all that needs to be determined is where (if indeed one can rationally choose any point) the line should be drawn.

And if that generalization should occur, who is to say what other characteristics should be excluded from the parents' "right to choose"? The fact is that there is no moral "right to choose" the sex of one's child or, indeed, any other characteristic.

The consultation document identifies the ethical justification of the pro-choice position in terms of a claim that "there is something potentially better about families where children are of both sexes", and so why should "the state seek to prevent" sex selection if it can be realised "in a way that does no harm to others?"¹⁴

However, there is no empirical evidence to support the contention that families of both sexes are better than those where all children are of the same sex, even if we could agree what criteria should be invoked as a specification of what "better" means. In any case, for those who think that having children of the same sex is something potentially better for the children, who could gainsay their right to choose to have (say) only girls? When we speak of sex selection we are, in reality, speaking of social control, an unworthy motive and aspiration for human parenting.

Under what conditions should sex selection be made available?

In the light of what has so far been argued, the State should not provide the legal possibility for couples to engage in sex selection.

What methods of sex selection should be accepted as legitimate?

There are no methods of sex selection which carry ethical legitimacy since sex selection is, in principle, ethically unacceptable.

Conclusion

SPUC has not wished to weary the HFEA by reiterating the arguments against sex selection which have been well proposed in the consultation document. What we have done, however, is to add some other ethical considerations.

We have carefully made a distinction between sex identification for health selection and sex identification for sex selection based upon the definition of sex selection proposed by the consultation document and with which we would agree. Sex selection is about identifying the sex of the embryo with the ultimate purpose of destroying embryos of the non-preferred sex. This is logically quite different from identifying the sex of embryos with the purpose of destroying embryos with a disability and not because of their sex per se. We believe we have clarified the real scope of sex selection and delineated it from the equally ethically abhorrent eugenic practice of eliminating lives considered not worthy to be lived.

Moreover, we have raised the ethical issue of the real purpose of the practice of medicine and have found that sex selection which is not a therapeutic measure but a method of social control is not a proper activity for medicine.

The Society for the Protection of Unborn Children (SPUC) www.spuc.org.uk
5-6 St. Matthew Street, Westminster, London SW1P 2JT
Tel: +44 (0)20 7222 5845
Email enquiry@spuc.org.uk

with thanks to:

Dr John I Fleming
Director
Southern Cross Bioethics Institute

Notes

HFEA, Sex Selection: Choice and Responsibility in Human Reproduction [2002], n 62
Ibid., n 64
Ibid., n 2
Sunday Times, 27 October
Universal Declaration of Human Rights, Preamble
Ibid., Article 2
See for example SPUC's submission to the Committee of Inquiry into Human Fertilisation and Embryology, 1984; SPUC's Submission to the Northern Ireland Human Rights Commission on abortion and the proposed bill of rights, 29 August 2000, and cf J Fleming and M Hains, "What Rights If Any Do the Unborn Have Under International Law?" (1997) 16 Australian Bar Review 181
HFEA, Sex Selection: Choice and Responsibility in Human Reproduction [2002], n 67
Cf Ibid., nn 67-69
Ibid., n 67
Ibid., n 2
The Constitution was adopted by the International Health Conference held in New York from 19 June to 22 July 1946, signed on 22 July 1946 by the representatives of 61 States (Off. Rec. Wld Hlth Org., 2, 100), and entered into force on 7 April 1948. Amendments adopted by the Twenty-sixth, Twenty-ninth and Thirty-ninth World Health Assemblies (resolutions WHA26.37, WHA29.38 and WHA39.6) came into force on 3 February 1977, 20 January 1984 and 11 July 1994 respectively and are incorporated in the present text.
HFEA, Sex Selection: Choice and Responsibility in Human Reproduction [2002], n 79
Ibid., n 98

Stumble It

Digg This

Add to del.icio.us