Sex Selection:  Some Ethical Sex Selection:  Some Ethical & Policy Considerations & Policy Considerations

Eike-Henner W. KlugeEike-Henner W. Kluge

University of VictoriaUniversity of Victoria

Plan: to do four thingsPlan: to do four things

Look at ethics of sex selection itselfLook at ethics of sex selection itselfLook at some factsLook at some factsLook at what goes into policy Look at what goes into policy

considerationsconsiderationsSuggest some conclusionsSuggest some conclusions

Ethics of Sex Selection:Ethics of Sex Selection:the standard versionthe standard version

Sex selection is ethically acceptable for Sex selection is ethically acceptable for medical reasonsmedical reasons

BeneficenceBeneficencenon-Malfeasancenon-Malfeasance

Sex selection is ethically unacceptable for Sex selection is ethically unacceptable for all other reasonsall other reasons

Sexist values are unethical because they violateSexist values are unethical because they violate Human dignityHuman dignity Equality of personsEquality of persons

Directed at condition, not sex; therefore species of medical care

Objections to medically based sex Objections to medically based sex selectionselection

Interference in human reproductionInterference in human reproductionDonum vitaeDonum vitae

Instrumentalistic view of human lifeInstrumentalistic view of human lifeHuman beings viewed as manipulable objectsHuman beings viewed as manipulable objects

Mistaken view of parenthoodMistaken view of parenthoodOnly conditional acceptance of children Only conditional acceptance of children

Negative valuation of differently-abled Negative valuation of differently-abled personspersons

Deaf culture and the case of cochlear implantsDeaf culture and the case of cochlear implants

Ethics of Sex SelectionEthics of Sex Selection

The non-standard versionThe non-standard version

Some Basic AssumptionsSome Basic Assumptions

Political correctness is not ethicsPolitical correctness is not ethicsConsensus is not ethicsConsensus is not ethics

““A consensus means that everyone agrees to say A consensus means that everyone agrees to say collectively what no one believes individually.”collectively what no one believes individually.”

attributed to Abba Ebanattributed to Abba Eban

Inconsistent ethics is unethical in its Inconsistent ethics is unethical in its implications.implications.

Ethics that ignores facts is politics in Ethics that ignores facts is politics in another guise.another guise.

Some ethically relevant factsSome ethically relevant facts

Preferences are logically different from Preferences are logically different from valuesvalues

Social policy that ignores material facts isSocial policy that ignores material facts isunworkableunworkableunethical unethical

Values Values vs.vs. Preferences Preferences

Values accord worth to what one valuesValues accord worth to what one values Sexist values accord greater worth to the members of a Sexist values accord greater worth to the members of a

particular sexparticular sex Therefore Therefore

they are discriminatorythey are discriminatory they violate equality and dignity of personsthey violate equality and dignity of persons

Preferences do not accord greater worth to what Preferences do not accord greater worth to what one prefersone prefers

Preferential social associations are not unethicalPreferential social associations are not unethical friendshipsfriendships clubs, etc.clubs, etc.

Therefore they do not violate equality and dignity of the personTherefore they do not violate equality and dignity of the person

Conclusions # 1Conclusions # 1

Sex selection based on preference is not Sex selection based on preference is not subject to the same ethical critique as sex subject to the same ethical critique as sex selection based on sexist valuesselection based on sexist values

Christine Overall 1987, 1993Christine Overall 1987, 1993 Murphy, 1990Murphy, 1990 Society of Obstetricians and Gynaecologist of Canada, Society of Obstetricians and Gynaecologist of Canada,

1991 1991 CMA, 1991CMA, 1991

Therefore value-based reasons against Therefore value-based reasons against sex selection do not apply to preference-sex selection do not apply to preference-based sex selectionbased sex selection

Data on sex preferenceData on sex preference

Canadians do not want more children of one sex Canadians do not want more children of one sex than of anotherthan of another

Proceed With Care: Final Report of the Royal Commission Proceed With Care: Final Report of the Royal Commission on New Reproductive Technologieson New Reproductive Technologies (1993) (1993)

Most Western Countries do not want more Most Western Countries do not want more children of one sex rather than anotherchildren of one sex rather than another

JainJain, Missmer, Gupta and Hornstein. Preimplanttion sex selection demand and preferences in an infertility population Fertility and SterilityFertility and Sterility, , 2005;83:649-58 ;83:649-58

Dahl, Beutel, Brosig and Hinsch. Preconception sex selection Dahl, Beutel, Brosig and Hinsch. Preconception sex selection for non-medical reasons: a representative survey from for non-medical reasons: a representative survey from Germany. Germany. Human Reproduction , Human Reproduction , 2003;18(10): 2231-2234 2003;18(10): 2231-2234

General position: “We want matched pairs.” General position: “We want matched pairs.”

Conclusion # 2Conclusion # 2

Data do not show that in Western society, Data do not show that in Western society, sex selection would be based on sexist sex selection would be based on sexist values values

Therefore, to be ethically defensible, Therefore, to be ethically defensible, prohibition of non-medical sex-selection in prohibition of non-medical sex-selection in Western countries must have some other Western countries must have some other justification justification

Ethics and Public Policy:Ethics and Public Policy:Some basic considerationsSome basic considerations

Not everything that is ethical should be Not everything that is ethical should be mandated by law.mandated by law.

Truth-telling Truth-telling Charity Charity

Not everything that is unethical should be Not everything that is unethical should be prohibited. prohibited.

Lying Lying

““There is ... a need for judicial There is ... a need for judicial restraint in the development of ... restraint in the development of ... law as it pertains to sensitive and law as it pertains to sensitive and

far-reaching issues of public far-reaching issues of public policy.” policy.”

(Supreme Court of Canada: (Supreme Court of Canada: Dobson v. Dobson v. DobsonDobson, 1999), 1999)

Ethics and public policyEthics and public policy

The purpose of public policy is toThe purpose of public policy is to prohibit unethical actsprohibit unethical acts encourage ethical behaviour encourage ethical behaviour encourage ethical valuesencourage ethical values

Public policy must bePublic policy must be enforceableenforceable consistent consistent

Cooper v. Hobart Cooper v. Hobart [2001] [2001] 3 S.C.R. 5373 S.C.R. 537

Rights may be curtailed only to the least degree Rights may be curtailed only to the least degree necessary to achieve legitimate endnecessary to achieve legitimate end

R. v. Oakes R. v. Oakes [1986] 1 S.C.R. 103[1986] 1 S.C.R. 103

Conclusion # 3Conclusion # 3

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

Important questionImportant question

Is it possible to operationalize the Is it possible to operationalize the difference between value-based and difference between value-based and

preference-base sex selection? preference-base sex selection?

Some more ethically relevant facts Some more ethically relevant facts that have been ignored in the sex that have been ignored in the sex

selection debateselection debate

Remember: ethics that ignores facts is not ethics but politics.

Sex Distribution at BirthSex Distribution at BirthSurprise,Surprise, Surprise! Surprise!

Male to female birth ration was 51.4% in Male to female birth ration was 51.4% in favour of males favour of males

Male to female birth ratio currently is 60% Male to female birth ratio currently is 60% in favour of females in favour of females Davis, Gottlieb and Stampnitzky. 1998; Møller, Davis, Gottlieb and Stampnitzky. 1998; Møller,

1998; Mocarelli, Gerthoux, Ferrari, Petterson, Kieszak, Brambilla, Vincoli, Signorini, Tramacere, 1998; Mocarelli, Gerthoux, Ferrari, Petterson, Kieszak, Brambilla, Vincoli, Signorini, Tramacere, Carreri, Sampson, Turner and Needham, 2000; Martuzzi, Di Tanno and Bertollini, 2001; Ryan, 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.Amirova and Carrier, 2002; del Rio, Marshall, Tsai, Shao and Guo, 2002.

Reasons Reasons

Long-lasting environmental pollutantsLong-lasting environmental pollutantsDioxinsDioxinsPolychlorinated biphenylsPolychlorinated biphenyls

They are found globallyThey are found globally In some locations, their effects are In some locations, their effects are

extremeextreme In some Canadian locations, they have resulted in a In some Canadian locations, they have resulted in a

male/female birth ratio of .35 to 1male/female birth ratio of .35 to 1

Mackenzie, Lockridge and Keith, 2005.Mackenzie, Lockridge and Keith, 2005.

Further FactsFurther Facts

Survival of human species requires sex-Survival of human species requires sex-balancebalance

Assumptions Assumptions Equality of personsEquality of persons Rejection of polygynyRejection of polygyny

Conclusion # 4Conclusion # 4

Sex selection is pragmatically necessary Sex selection is pragmatically necessary for species survival if polygyny, etc. are for species survival if polygyny, etc. are not to be institutionalized.not to be institutionalized.

Modest ProposalModest Proposal

Allow sex selection for sex-balanceAllow sex selection for sex-balance Institute sex selection lotteryInstitute sex selection lottery

Only for every second childOnly for every second childAdjust chances relative to existing sex distribution Adjust chances relative to existing sex distribution

of fertile members of societyof fertile members of society

Won’t this contradict the desideratum Won’t this contradict the desideratum of population reduction that underlies of population reduction that underlies

the claim that responsible the claim that responsible reproductive behaviour limits children reproductive behaviour limits children

to 1 per family?to 1 per family?

Some other ignored factsSome other ignored facts

Responsible reproductive policy cannot be Responsible reproductive policy cannot be national but must be globalnational but must be global

Sustainability of species requires more Sustainability of species requires more than one childthan one child

general estimate is 2.05 and 2.1 per couplegeneral estimate is 2.05 and 2.1 per couple Espinshade, Guzman and Westoff, 2003Espinshade, Guzman and Westoff, 2003 Australian Academy of Science, 2006.Australian Academy of Science, 2006.

Conclusion # 5Conclusion # 5

Carte blancheCarte blanche prohibition of sex selection prohibition of sex selection is not ethically mandatedis not ethically mandated

Sex selection can be allowed with Sex selection can be allowed with appropriately crafted public policyappropriately crafted public policy

Current public policy may be politically Current public policy may be politically correct, but correct, but

is not based on factsis not based on factsis not based on ethicsis not based on ethics

Thank you !Thank you !

The full version of the preceding analysis is The full version of the preceding analysis is forthcoming in forthcoming in Health Care AnalysisHealth Care Analysis