Historical Background
Despite gender selection going back to our earliest societies, the history of gender selection in human embryos is relatively short. Gender Identification was first made possible in the 1970’s with the advent of technologies such as chorionic villus sampling (CVS) combined with ultrasound. This early method of sperm sorting has an average cost today of $400-600
More recently in the 1990’s the ability to reliably sex embryos for in vitro fertilization (IVF) has been the basis of the media focus on gender selection in human embryos. In 1995 clinical trials to achieve FDA approval, of this second method of sperm sorting, were underway and by 2005 couples were able to pay $2,500 to enlist in the unapproved technology with 76% accuracy for boys and a 91% for girls.
The most recently developed method is Preimplantation Genetic Diagnosis (PGD), originally attempted on humans in the United Kingdom in the mid 1980’s. PGD was developed to determine X-linked genetic mutations. It was gradually adapted to sex selection given that this method provides a 99% accuracy despite its cost of around $18000-19000. The main issue identified by physicians is that early on there was no real ethical debate regarding these practices. In an article from December 30th 2015 on Preimplantation Genetic Diagnosis it is stated:
As of 2006, more than 15,000 PGD cycles have been reported. PGD is currently available for most known genetic mutations. Although the indications for PGD are well established, PGS is a relatively new, evolving technique and remains controversial.
Methods of Gender Selection
Ethical Controversies in Embryonic Selection
The medical ethics in the use of gender selection has been the topic of debate, and has lead to varying legislation, in several nations. 36 countries have laws regarding gender selection, of these countries 5 prohibit it outright and 31 prohibit it for non-medical reasons. At present the 5 countries prohibiting gender selection in all forms are Austria, New Zealand, South Korea, Switzerland and Vietnam.
This approach brings two principles, often pitted against each other, into conflict. The issue of one's autonomy, one's choice and the protection and beneficence of society as a whole in the enaction of new and untested practices. The autonomy of the individual should be considered more important than beneficence, which has lead to the highly information dense and decision based approach to medicine in many developed and developing nations. This ranges on a spectrum from prescription drug choice vs availability to genetic selection, a highly commercialized process however, in real world situations one's freedom to choose and beneficence are often marginalized by someone's profit. The issues of autonomy and beneficence in all regulatory bodies is often secondary to funding despite a whole host of laws on both sides enacted to prevent this very occurrence. This seems to suggest a flaw with the system, by in which we make these determinations as a whole.
Some of these laws, such as Canada’s Assisted Human Reproduction act of 2004 have been a main proponent in medical tourism. The United States has become home to a booming, “Family Balancing,” industry bringing in $18,000 per procedure with thousands of procedures annually. This has spawned a hotbed of discussion regarding the ethics of everyone from the individuals benefiting from the practice to the medical professionals forgoing more traditional insemination practices for the higher revenue. It is clear that this may be problematic however to managing this problem would require limiting the freedoms of choice for a lower return on investment; something the United States is not particularly known for.
The Moral Consequences of Social Ethics
The social ethics associated with gender selection revolve around gender based discrimination. A document from the UNFPA’s website, titled: “ Preventing gender-biased sex selection,” outlines the problem as follows:
The pressures to engage in sex selection in a gender discriminatory environment not only directly affect women’s reproductive decisions (with implications for their health and survival) they also put women in a position where they must perpetuate the lower status of girls through son preference.
An example is India’s governmental policies historically favoring male offspring and how this seems to have increased infanticide based on such discrimination. There have been a number of attempts by various governments to combat sex based discrimination at the gender determination level. The Indian government has taken it upon themselves to curtail this by legal prohibition of sex selection. At present they have not succeeded; numbers from the World Health Organization (WHO) show that in the age group under 6 years old nationally there is a ratio of 1000 males to 927 females.
Perhaps most identifiable is the current plight in China given a preference to a first born male child combined with the one child policy of the past generation. The impact to the country’s population’s gender distribution has been defined as the most extreme in the world. This is projected to have dramatic impacts on everything from economic growth to cultural dynamics.
Prior to the consequences of gender discrimination being better understood they were not morally justifiable. What is morally required is not dictated by these consequences, it is simply better understood in hindsight. A lesson we as humanity repeatedly fail with every injustice, genocide and war. What is morally required is dictated by one's morals, devoid of consequence.
Moral and Ethical Opposition in the form of Regulation
Some of the most notable opposition to PGD techniques is the American Society for Reproductive Medicine. In 1994, the American Society for Reproductive Medicine sided against prenatal sex selection in nonmedical instances siting gender discrimination as the main reason. In addition, there are concerns that the gradual trend towards gender selection may move doctors from attempting to help those trying to conceive at all, in favor of the more lucrative family balancing market. Further study and regulation has been proposed however as we’ve seen in various industries extraneous regulation may trend towards black market Practices and ultimately place more women in harm's way. If morals and ethical rules were to serve their purpose, by enacting more rules based on moral judgments and ethical practices these women would be safer. However As a result of the ethical framework by which we live our lives and the flexible morals which are required in pursuit of profit guidelines become assessed on a case by case basis due not to desire, but to necessity.
Conclusion
The nature of this issue is a complex one, varying by nation. Strong legal policy is necessary to manage a technology with such chaotic potential. There are health aspects to consider as well as the previously listed long term implications and at present it appears even medical experts and governments are in disagreement. These decisions we make now will have far reaching and shaping impacts on our future. Larger economic and health impacts alike will have to be determined. These are issues that need to be addressed head on as a unified front however past experience suggests this is unlikely.
References
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Dayal, M. B., & Lucidi, R. S. (2015, December 30). Preimplantation Genetic Diagnosis. Retrieved
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Divita, I. (2016, January 07). List of X-Linked Diseases & Sickle Cell Anemia. Retrieved September,
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