The sex selection question

In recent years, the media have become preoccupied by health – especially health scandals. Both the high death rate of children after cardiac surgery at the Bristol Royal Infirmary and the grisly career of mass-murderer Dr Harold Shipman have been given widespread coverage over the past two years.

But there is also a preoccupation with the ‘Frankenstein’ dimension of medicine – with much tabloid disgust and broadsheet agonising over cloning, ‘designer babies’, and, lately, ‘gender clinics’ that would allow prospective parents to select the sex of their children.

In early 2001, a Scottish couple, Alan and Louise Masterton, paid £6000 to a fertility clinic in Rome for in vitro fertilisation and gender diagnosis to ensure that their next child would be a girl (in fact, the attempt failed). They already had four boys but wanted another girl after their three-year-old daughter died in an accident in 1999. Recently, more and more couples have been asking for the procedure. The UK Human Fertilisation and Embryology Authority is now ‘looking into the matter’, and leading fertility expert Lord Winston has voiced his concerns about sex selection.

In the UK it is illegal to have IVF treatment for the purpose of choosing the sex of your baby – which is why the Mastertons went to Italy – and sex selection is widely considered immoral, conjuring up images of human clones and genetically engineered monsters. But is there any cogent moral objection to the practice? If it is morally acceptable to perform genetic tests on newly fertilised embryos to screen out those with serious genetic diseases, then why shouldn’t the process be taken further to include selection on other grounds – including sex?

Admittedly, the widespread sex selection that already goes on in many parts of the world – especially in India and China – does little to allay fears. In some third world countries, abortion and infanticide to weed out female offspring are commonplace, partly because of the overwhelming social stigma of being ‘unable’ to produce boys. The economist Amartya Sen has estimated that, as a result, there are about 100million fewer living women than we should expect there to be – and the resulting imbalance of the sex ratio could mean that before long, vast numbers of males will be unable to find women with whom to have children.

Against this disturbing background, the question of whether sex selection is morally objectionable in itself might sound ‘academic’, in the derogatory usage of the word – an idle theoretical preoccupation of no practical consequence. But in the interests of sound reasoning and sensible policy formation, ‘academic’ questions deserve better consideration than the half-baked coverage they often get in the media.

For a start, we should separate questions about the safety of sex-selection procedures from the ethics of sex selection per se. Equally, we should distinguish moral worries about the methods used for sex selection – such as infanticide, abortion or pre-implantation genetic diagnosis – from moral concerns about the desired end. Many of the familiar worries are really about the methods rather than the goal. If we object absolutely to abortion, we shall obviously object to sex selective abortion. If we adopt the ‘conservative pro-life’ stance towards fertilised human ova, we shall think it wrong to destroy a fertilised human ovum for any reason whatsoever – whether to do with serious genetic handicap, sex, or any other supposed ‘imperfection’.

However, people who are attracted to a middle way – those who want to condemn the discarding of embryos for sex selection, but not for other reasons – face some awkward questions.

One question is whether sex selection is intrinsically wrong, whatever the method used. Is it wrong to employ existing techniques of sperm filtration, separating androgenic from gynogenic spermatozoa, and fertilising eggs with the desired type? What about adopting sex positions recommended for the purpose, or going on (no doubt useless) diets? These techniques do not involve creating embryos and then getting rid of the ‘wrong’ ones, and so apparently side-step the objections of the ‘pro-life’ people. But the idea still makes many people deeply uneasy.

So some might object to the sexist attitudes underlying sex selection. If a couple are anxious that their child should not be a girl, doesn’t that suggest contempt for the female sex, of the sort most blatantly exemplified in cultures where girl babies are murdered or abandoned?

As a generalisation, this is surely false. Imagine a couple who try sex selection, not because they dislike one sex, but merely because they prefer the other. Or consider parents who have four girls already, and want a boy to ‘make up the balance’. Think of couples who have a strong preference, but never act on it. It must be common for parents to hope that their child will be of a particular sex, even if they would never dream of doing anything about it.

Does the ‘sexual justice’ issue arise because sex selection deprives members of the disfavoured sex of the chance to be born? This argument has its attractions. However, ingenious metaphysics aside, if these alleged victims of injustice do not yet exist, they surely cannot be wronged by not being brought into existence. Even the Roman Catholic Church’s arguments against contraception do not include saying that it takes away anybody’s right to life.

In the end, dogmatic reactions to sex selection are unconvincing, and often rooted in dubious unstated assumptions. But unfortunately, this doesn’t mean that sex selection can be given the moral green light without hesitation. We need to ask: what sort of people would want sex selection, and for what reasons? Do they show a manipulative attitude to nature, or an inability to be content with what they are given? Do they display unpleasant sexual attitudes?

No doubt some of them do, and we should be wary of their motivations. As with many other issues in the ‘new genetics’, the deep and difficult moral questions come down to character and attitude, rather than rigid principle. We should judge cases on an individual basis – and remember that tedious clichés about ‘playing God’ do little to advance understanding, but a lot to sow confusion.

Dr Piers Benn is a philosopher and lecturer in medical ethics at Imperial College London.

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