Sex Selection: Some Ethical & Policy Considerations

1. Sex Selection:  Some Ethical & Policy Considerations Eike-Henner W. Kluge University of Victoria

2. Plan: to do four things • Look at ethics of sex selection itself • Look at some facts • Look at what goes into policy considerations • Suggest some conclusions

3. Ethics of Sex Selection:the standard version • Sex selection is ethically acceptable for medical reasons • Beneficence • non-Malfeasance • Sex selection is ethically unacceptable for all other reasons • Sexist values are unethical because they violate • Human dignity • Equality of persons Directed at condition, not sex; therefore species of medical care

4. Objections to medically based sex selection • Interference in human reproduction • Donum vitae • Instrumentalistic view of human life • Human beings viewed as manipulable objects • Mistaken view of parenthood • Only conditional acceptance of children • Negative valuation of differently-abled persons • Deaf culture and the case of cochlear implants

5. Ethics of Sex Selection The non-standard version

6. Some Basic Assumptions • Political correctness is not ethics • Consensus is not ethics • “A consensus means that everyone agrees to say collectively what no one believes individually.” attributed to Abba Eban • Inconsistent ethics is unethical in its implications. • Ethics that ignores facts is politics in another guise.

7. Some ethically relevant facts • Preferences are logically different from values • Social policy that ignores material facts is • unworkable • unethical

8. Values vs. Preferences • Values accord worth to what one values • Sexist values accord greater worth to the members of a particular sex • Therefore • they are discriminatory • they violate equality and dignity of persons • Preferences do not accord greater worth to what one prefers • Preferential social associations are not unethical • friendships • clubs, etc. • Therefore they do not violate equality and dignity of the person

9. Conclusions # 1 • Sex selection based on preference is not subject to the same ethical critique as sex selection based on sexist values • Christine Overall 1987, 1993 • Murphy, 1990 • Society of Obstetricians and Gynaecologist of Canada, 1991 • CMA, 1991 • Therefore value-based reasons against sex selection do not apply to preference-based sex selection

10. Data on sex preference • Canadians do not want more children of one sex than of another • Proceed With Care: Final Report of the Royal Commission on New Reproductive Technologies (1993) • Most Western Countries do not want more children of one sex rather than another • Jain, Missmer, Gupta and Hornstein. Preimplanttion sex selection demand and preferences in an infertility population Fertility and Sterility, 2005;83:649-58 • Dahl, Beutel, Brosig and Hinsch. Preconception sex selection for non-medical reasons: a representative survey from Germany. Human Reproduction , 2003;18(10): 2231-2234 • General position: “We want matched pairs.”

11. Conclusion # 2 • Data do not show that in Western society, sex selection would be based on sexist values • Therefore, to be ethically defensible, prohibition of non-medical sex-selection in Western countries must have some other justification

12. Not everything that is ethical should be mandated by law. Truth-telling Charity Not everything that is unethical should be prohibited. Lying Ethics and Public Policy:Some basic considerations

13. “There is ... a need for judicial restraint in the development of ... law as it pertains to sensitive and far-reaching issues of public policy.” (Supreme Court of Canada: Dobson v. Dobson, 1999)

14. Ethics and public policy • The purpose of public policy is to • prohibit unethical acts • encourage ethical behaviour • encourage ethical values • Public policy must be • enforceable • consistent • Cooper v. Hobart [2001] 3 S.C.R. 537 • Rights may be curtailed only to the least degree necessary to achieve legitimate end • R. v. Oakes [1986] 1 S.C.R. 103

15. Conclusion # 3 • If preferences are ethically different from values, then an ethically defensible public policy should allow sex selection on the basis of preference but prohibit sex selection on the basis of values.

16. Important question Is it possible to operationalize the difference between value-based and preference-base sex selection?

17. Some more ethically relevant facts that have been ignored in the sex selection debate Remember: ethics that ignores facts is not ethics but politics.

18. Sex Distribution at BirthSurprise, Surprise! • Male to female birth ration was 51.4% in favour of males • Male to female birth ratio currently is 60% in favour of females Davis, Gottlieb and Stampnitzky. 1998; Møller, 1998; Mocarelli, Gerthoux, Ferrari, Petterson, Kieszak, Brambilla, Vincoli, Signorini, Tramacere, Carreri, Sampson, Turner and Needham, 2000; Martuzzi, Di Tanno and Bertollini, 2001; Ryan, Amirova and Carrier, 2002; del Rio, Marshall, Tsai, Shao and Guo, 2002.

19. Reasons • Long-lasting environmental pollutants • Dioxins • Polychlorinated biphenyls • They are found globally • In some locations, their effects are extreme • In some Canadian locations, they have resulted in a male/female birth ratio of .35 to 1 Mackenzie, Lockridge and Keith, 2005.

20. Further Facts • Survival of human species requires sex-balance • Assumptions • Equality of persons • Rejection of polygyny

21. Conclusion # 4 • Sex selection is pragmatically necessary for species survival if polygyny, etc. are not to be institutionalized.

22. Modest Proposal • Allow sex selection for sex-balance • Institute sex selection lottery • Only for every second child • Adjust chances relative to existing sex distribution of fertile members of society

23. Won’t this contradict the desideratum of population reduction that underlies the claim that responsible reproductive behaviour limits children to 1 per family?

24. Some other ignored facts • Responsible reproductive policy cannot be national but must be global • Sustainability of species requires more than one child • general estimate is 2.05 and 2.1 per couple • Espinshade, Guzman and Westoff, 2003 • Australian Academy of Science, 2006.

25. Conclusion # 5 • Carte blanche prohibition of sex selection is not ethically mandated • Sex selection can be allowed with appropriately crafted public policy • Current public policy may be politically correct, but • is not based on facts • is not based on ethics

26. Thank you ! The full version of the preceding analysis is forthcoming in Health Care Analysis