As Europe’s leading fertility specialists gather at a conference in London this weekend, a major new publication from leading medical ethicists finds no justification to support the UK’s legal ban on sex selection before pregnancy for ‘social’ reasons.
Overall, the ethicists found that new techniques to choose the sex of future children would be ethical to offer in the UK, based solely on parents’ preference to have a child of a particular sex. The in vitro techniques are used at the embryonic stage or earlier, and at present are only legally permitted for use in the UK to avoid the birth of babies with medical problems such as sex-linked inherited disorders. [1]
Other findings include that
· No population-level sex ratio imbalance would occur if sex selection using fertility treatments were permitted for non-medical reasons, within a strong regulatory framework. [2]
No ethical distinction was found between providing ‘family balancing’ (sex selection to ensure that a new sibling is of the opposite sex to existing children), or sex selection for an only child, the firstborn, or for every child in a family, including selecting all the children to be of the same sex.
Sexism was not found to be inherent in the wish to choose the sex of a baby. Some requests reflect a high value placed on each gender being represented within a family. Other requests may stem from sexism or gender stereotyping, but these attitudes in themselves do not pose such risks to children that sex selection should be prohibited.
The authors concluded that, in the UK, it would not be right for ‘social’ sex selection treatments to be funded by the taxpayer. Proper regulation would be also required to minimise any harmful effects of treatments carried out for non-medical reasons.
British couples with the resources to do so are reported to be travelling overseas for costly sex-selection treatments involving IVF and embryo testing, or novel sperm ‘sorting’ techniques, although no official record is kept of their numbers. [3]
These cross-border treatments may pose obstacles to the follow up of the resulting children’s health. In some circumstances, they might involve fewer clinical or legal safeguards than would be in place if patients were able to access equivalent treatments in the UK. [4]
Professor Stephen Wilkinson, Professor of Bioethics at Lancaster University, and lead author of ‘Eugenics and the Ethics of Selective Reproduction’, said:
‘We examined the ethics of gender preference and sex selection techniques in the British context and found no reason to expect harm to future children or wider society if these techniques were made available for ‘social’ reasons within our regulated fertility treatment sector.
‘People who would prefer their new baby to be of a particular sex often have their own very personal reasons for this, to do with their family’s particular circumstances or history. We didn’t find any ethical arguments sufficient to justify a blanket ban on these people seeking sex selection.
‘As IVF and other techniques can now fulfil these often strongly-felt preferences, it’s important to ask why wishing for a girl or a boy baby might be so wrong that parents must be stopped from attempting to achieve it in the UK.’
ENDS
NOTES to EDITORS
The research paper ‘Eugenics and the Ethics of Selective Reproduction’ is embargoed until 00.01 on Wednesday 3 July 2013.
For further information, or to request an interview with the lead author, Professor Stephen Wilkinson, please contact Chris Stone in the Keele University Press office on 01782 733375 or via c.w.stone@keele.ac.uk. An ISDN line is available.
A case study is available for interview. She is a mother of five boys who wishes she could have used sex selection in the UK to have a daughter. Please make requests via the Keele University Press office.
· The ‘Eugenics and the Ethics of Selective Reproduction’ will be available to download from the Keele University website from 00.01 on Wednesday 3 July 2013 at http://www.keele.ac.uk/risocsci/currentactivities/theethicsofselectivereproduction/
[1] The techniques considered in the research are IVF with embryo biopsy, sperm sorting used with or without intrauterine insemination (see http://www.hfea.gov.uk/pgd-sex-selection.html for more detail on these techniques).
The Human Fertilisation and Embryology Act 1990 (as amended) governs fertility treatment and embryo research carried out in the UK. Schedule 2 1ZA (1) (c), allows embryonic sex selection to take place only if there is a “particular risk that any resulting child will have or develop (i) a gender-related serious physical or mental disability, (ii) a gender-related serious illness, or (iii) any other gender-related serious medical condition”. (http://www.legislation.gov.uk/ukpga/2008/22/schedule/2/crossheading/embryo-testing-and-sex-selection)
Issues around termination of pregnancy on the grounds of fetal sex were not included within the remit of this project and have not been examined by the authors. ‘Social’ sex selection is not a ground for legal abortion in the UK under the 1967 Abortion Act.
[2] In some areas of countries such as India and China, significant imbalances in population level sex ratios have resulted, despite ‘social’ sex selection being unlawful. Some of the UK’s ethnic subgroups also share a cultural preference for sons. If ‘social’ sex selection via fertility treatments was made available in the UK and taken up ubiquitously within these relatively small communities for non-medical reasons, it is possible that a sex ratio imbalance might develop. But the ethicists found this potential prospect insufficient to justify the restriction of the reproductive liberty of the population of the UK as a whole.
[3] Media reports indicate that some UK couples with the resources to do so are travelling abroad to access sex-selection treatment on non-medical grounds. (http://www.telegraph.co.uk/health/healthnews/9504503/British-couples-flying-to-US-for-banned-baby-sex-selection.html, http://www.guardian.co.uk/lifeandstyle/2010/apr/03/sex-selection-babies, http://news.bbc.co.uk/1/hi/uk/7696696.stm)
Participants in online forums may also discuss ways of accessing treatment outside the UK. (http://www.in-gender.com/cs/forums/default.aspx?GroupID=29, http://genderdreaming.com/forum/gender-disappointment/)
[4] A 2013 European Society for Human Reproduction and Embryology (ESHRE) Taskforce report on non-medical sex selection outlined problems with the legal position of banning non-medical sex selection in European jurisdictions. Problems were noted in the light of increasing genetic screening of embryos possibly becoming a routine part of all IVF treatments in future.
At present, they note, where couples are already undergoing IVF and embryo testing for medical reasons, and also have a preference for the sex of the future child, laws may be unclear as to whether clinicians can permit the parents to decide on the basis of sex, which of any healthy embryos should be used to begin a pregnancy. This may create uncertainty for patients and clinicians and may restrict choice unnecessarily, so the Taskforce recommended legal clarification.
Also, as fetal sex determination via a maternal blood test in very early pregnancy has become privately accessible online, critics argue that banning ‘social’ sex selection methods prior to pregnancy might inadvertently be pushing some women towards an early abortion.
‘ESHRE Task Force on ethics and Law 20: sex selection for non-medical reasons’,
W. Dondorp et al, Human Reproduction, Vol.28, No.6 pp. 1448–1454, 2013.
(http://www.ncbi.nlm.nih.gov/pubmed/23578946).
The 2013 ESHRE conference runs from 7-10 July in London. http://www.eshre.eu/ESHRE/English/Annual-meeting/London-2013/page.aspx/1541
Professor Stephen Wilkinson is lead author of ‘Eugenics and the Ethics of Selective Reproduction’ and Professor of Bioethics at the Lancaster University. He researches reproductive ethics and the regulation of reproductive technologies, most recently the ethics of selective reproduction (practices that involve choosing between different possible future people). His latest book is ‘Choosing Tomorrow's Children’(Oxford University Press, 2010). The research and writing of ‘Eugenics and the Ethics of Selective Reproduction’ was funded by The Wellcome Trust during Professor Wilkinson’s time at Keele University’s Centre for Professional Ethics. The views contained in the report are those of the authors and do not necessarily reflect the position of either Keele University or the Wellcome Trust.
Eve Garrard, second author, is an Honorary Research Fellow at the University of Manchester’s Department of Philosophy. She contributed to the report while working for Keele University’s Centre for Professional Ethics.