Sex Selection Oxford

Procreative Liberty and Sex Selection: 

Procreative Liberty and Sex Selection Professor Julian Savulescu

Reliable Methods of Genetic Selection: 

Reliable Methods of Genetic Selection prenatal testing (chorionic villous sampling, amniocentesis, ultrasound) at 11+ weeks followed by termination of pregnancy in vitro fertilisation (IVF) and preimplantation genetic diagnosis (PGD) – no need for termination

PGD and Sex Selection: 

PGD and Sex Selection PGD does not require abortion reduces a major barrier to selection (abortion) requires IVF and intracytoplasmic sperm injection. embryo biopsy removing one or two cells is performed on day 3 at the 8 cell stage. PGD can be used to detect chromosomal abnormalities single gene disorders gender in the future, any genetic state

PGD and Non-medical Genetic Selection: 

PGD and Non-medical Genetic Selection Genetic selection for non-medical reasons is illegal in Vic, SA and WA in Australia and UK Sydney IVF performs sex selection on fertile couples costs around $10,000

The Question: 

The Question Should selection of a disabled child or the sex of offspring by preimplantation genetic diagnosis be illegal?

Procreative Liberty: 

Procreative Liberty =procreative autonomy = reproductive liberty Liberty to choose When to have children How many children to have What kind of children to have Designer children

Justification for Procreative Liberty: 

Justification for Procreative Liberty Privacy of reproduction Families are different and bear costs Experiments in living – let the experiments run Role of parent – self interest vs maximizing opportunities for child. Nature as rational autonomous agents to make decisions about children Respect the choices of people including the disabled

How do we decide?: 

How do we decide? Nature or God 'Experts' – philosophers, bioethicists, psychologists, scientists 'Authorities' – government, doctors Decide for ourselves – liberty and autonomy

How do we decide?: 

How do we decide? Principle of liberal state (Mill) Neutrality to conceptions of the good life Personal Autonomy Sole ground for interference is harm to others Advice, persuasion, information, dialogue permissible Negative liberty: coercion and infringement of liberty impermissible

Limits: 

Limits Limits of positive liberty What should be provided? Safety Harm to others Distributive justice

Children: 

Children Young children, embryos and fetuses Incompetent Non-delayable interventions

Who decides?: 

Who decides? Nature or God 'Experts' – philosophers, bioethicists, psychologists, scientists 'Authorities' – government, doctors Parents – procreative liberty and autonomy

Limits to Parental Liberty: 

Limits to Parental Liberty Safety Harm to others Distributive justice Plausible conception of well-being and a better life for the child

Ethics of Sex Selection: 

Ethics of Sex Selection Ethics Committee of the American Society of Reproductive Medicine 'Sex Selection and Preimplantation Genetic Diagnosis' while the Committee 'does not favour its legal prohibition' sex selection solely for non-medical reasons is morally inappropriate and 'should be discouraged'

Inconsistency: 

Inconsistency legal to attempt periconceptual sex selection by 'natural' means, even if these employ technology Disabled couples can choose to procreate and deliberately have a disabled card

Harm to the Child?: 

Harm to the Child? Harm of being born disabled Not harmed Would not otherwise exist

Harm to the Child?: 

Harm to the Child? Physical harm PGD also, ASRM objection to sperm sorting scientific investigation and properly informed consent, not by criminalising it

Harm to the Child?: 

Harm to the Child? Psychological harm psychological harm if the procedure does not produce the child of the desired sex unlikely with IVF+PGD parents inevitably have hopes and expectations most parents come to accept and love the child they have

Harm to the Child?: 

Harm to the Child? reflects dysfunctional parental psychology. dangerous to be making such judgements about the 'suitability' of people as parents preventing sex selection is no guarantee that such people will not have children

Harm to the Child?: 

Harm to the Child? violation of Kant’s dictum: never to use a person as a means, but always to treat him or her as an end 'Unconditional love'

Harm to Child?: 

Harm to Child? parents have many desires related to their children to have a companion, to hold a marriage together, to be a friend to the first child Kant’s dictum is actually never use a person solely as a means Provided that parents love their child as an end in itself, OK to have other desires

The Issue in Genetics: 

The Issue in Genetics Identity altering interventions That particular child would not have existed without a unique sperm and egg uniting that would not have occurred without sex selection Even if the child is disadvantaged psychologically, this is only wrong from the child’s perspective if its life is so bad that it is not worth living.

Person Affecting vs Impersonal Harm: 

Person Affecting vs Impersonal Harm Procreative beneficence – impersonal harm But are there impersonal harms? Indirect personal harm

Harm to Parents?: 

Harm to Parents? IVF has risks ASRM: unreasonable for individuals who do not otherwise need IVF to undertake its burdens and expense solely to select the gender of their offspring but clearly within acceptable range paternalistic not to leave the weighing of risks and benefits to the woman

Harm to Other Siblings?: 

Harm to Other Siblings? Choosing to have a child of a certain sex does not imply that the other sex is undesired in other children. Their treatment will be determined by the pre-existing belief structure of parents.

Harm to Women?: 

Harm to Women? ASRM: 'gender as a reason to value one person over another' 'gynocide' Tabitha Powledge: 'we should not choose the sexes of our children because to do so is one of the most stupendously sexist acts in which it is possible to engage. It is the original sexist sin.'

Harm to Women?: 

Harm to Women? Does sex selection 'devalue girls'? Preference does not imply betterness Boys and girls are different, and this difference matters to different families in different ways. Does selecting a disabled child devalue the abled?

Sex selection in Asia: 

Sex selection in Asia Sex selection is more likely to harm women in Asia The male to female ratio 1.2 in China and India (1.6 in Rajasthan) Disturbed sex ratios may not be a bad thing Compare with social construction of disability: treating the symptom not disease

The State and the Kind of Children: 

The State and the Kind of Children Social ideals, eg equality ,may be promoted by people having certain kinds of children Example: disability and respect Primacy of reproduction over social ideals Burden of care argument Parents bear the burden of care so should have the choice

India Is Different: 

India Is Different Hinduism: a man who has failed to sire a son cannot achieve salvation. only a male descendant can perform the last funeral rites to ensure the redemption of the de-parted soul. Indian custom: a dowry for daughter’s marriage. 25,000 up to 500,000 Rupees. (average income of three years) boys mean prosperity, but girls mean poverty, Indian couples have thus a strong incentive for sex-selective abortions. 'Invest 500 Rupees now, save 50,000 Rupees later'.

The Western Perspective: Balancing Family Sex: 

The Western Perspective: Balancing Family Sex 90% of couples came forward for sex selection for the purposes of balancing sex within the family. Parents were in their mid thirties two or three children of same sex ASRM’s claim is false: sex selection will 'contribute to a society’s gender stereotyping and gender discrimination' No change in sex ratio or adverse effects on women

Playing God/Against Nature: 

Playing God/Against Nature Using chloroform to relieve the pain of childbirth was considered contrary to the will of God as it avoided the 'primeval curse on woman'. Similarly, the use of vaccination was opposed with sermons preaching that diseases are sent by Providence for the punishment of sin and it is wrong of man to escape from such divine retribution.

Playing God/Against Nature: 

Playing God/Against Nature Thomas Hobbes: life is nasty brutish and short People have been playing God ever since they first decided to control which children they would have by abortion or by contraceptive use or abstinence.

Slippery Slope to Eugenics: 

Slippery Slope to Eugenics allowing selection of non-disease characteristics is the first slide down the slippery slope to selecting for IQ, personality, etc - 'designer babies' allowing sex selection does not imply we must allow other selections eugenics is here: plastic surgery, cleft lip

Distributive Justice : 

Distributive Justice ASRM: 'misallocation of limited medical resources' No argument if it is fully funded by individual One problem with private funding: inegalitarian only the rich get the children they want. Genetic selection can be used to correct the effects of unfair natural genetic lotteries

Rational Limitation of Reproductive Liberty: 

Rational Limitation of Reproductive Liberty Against natural lottery: Use sex selection in order to promote or in so far as it does not disrupt the gender balance Use sex selection to promote social ideals or Use sex selection to promote the desired sex ratio

Limits to Reproductive Liberty: 

Limits to Reproductive Liberty Harm to child Life Not Worth Living Duty to select the best child Harm to society Public interest Distinguish between existing beneficial technology and new technology We can allow some choices which produce disabled people in an affluent society – we can afford liberty

Procreative Beneficence and Liberty: 

Procreative Beneficence and Liberty Can conflict Desire to select disabled child Desire not to use information to select the best child Procreative Liberty trumps Beneficence as public policy/legal principle The child is not harmed by violating procreative beneficence

Selection vs Enhancement: 

Selection vs Enhancement Selection is different to enhancement Selection chooses between possibly existing individuals No direct person affecting harm from failing to select the best

Enhancement: 

Enhancement Does directly affect existing and future people (not merely possible people) Strong reasons not to harm and to benefit Liberty trumps beneficence in cases of competent adults (can refuse the best for themselves) Beneficence trumps liberty with respect to children and dependents Choosing a deaf child is different to deafing a child or failing to make a deaf child hear

Summary: Reproduction: 

Summary: Reproduction Selection Libertyandgt;Beneficence Enhancement (Competents) Libertyandgt;Beneficence Enhancement (Incompetents) Beneficenceandgt;Liberty Justice and the Public Interest ….