by John Wyatt
Read: Sex Selection (Part 1)
Those who argue for sex selection for medical reasons point to the seriously debilitating nature of some sex-linked disorders. In this case, the issue is about maximising the chance of having a healthy baby.
Opponents say that while using sex selection to avoid X-linked diseases appears to benefit the offspring because they don’t suffer effects of the disease, it does not help the individual avoid the harmful effects of disease. Instead it avoids the person’s existence. Such sex selection effectively says that it is better that this type of person, or a person with this genetic disorder, never exists.
Many disabled people argue that the main problems of living with a disability come from discrimination and the attitudes of other people, rather than the medical problem itself. This may not apply if there is very profound disability. But even in these cases, many Christians would not wish to argue that the life of a disabled person was not worth living.
Opponents of sex selection ask, ‘where does it stop once you start selecting the “kind of babies” we have?’ Sex selection for medical reasons introduces the notion that deciding to have healthy babies is morally acceptable. While sex selection can only be used for a small set of X-linked disabilities, PGD can be used for any other genetically influenced disease or characteristic.
Society would soon be faced with requests from parents to select the colour of their children’s hair, or genes that influenced their child’s potential intelligence.
The evidence is that we are not good at stopping part-way down a ‘slope’. For example, abortion was legalised in the UK on the basis that it would be used only in extreme circumstances, but changes in social and medical attitudes have led effectively to abortion on demand.
If society does move down the slippery slope, prospective parents could end up being expected, or perhaps even required, to have certain tests done to ensure that the child they have meets the health criteria. At this point it will also become a duty of any health providers to supply their patients with the relevant tests.
Parents who refuse interventions and have a child with a disability may find themselves judged harshly, and blamed for the birth. This could result in a lack of social support with the family being left to face the emotional, social and financial cost of care alone.
Valuing All People
Christians need to emphasise that while they wish to prevent or alleviate disability, they are also commited to love and care for people with disabilities. Not all means of preventing disability are ethical; and certainly not if these means involve destroying or selecting against disabled individuals. They will do everything to remove disability, but at the same time will do all they can to help people with disability live fulfilled lives.
This also includes recognising that able-bodied people have a lot to learn from friends who have physical or mental abnormalities; and that part of being human involves learning to serve and help others less fortunate than ourselves.
Most commentators believe that India has a particular problem regarding sex selection.
- In 1984 UNICEF claimed that of the 8.000 babies aborted in Jaipur, 7,999 were girls.2
- In 1993 a survey covering 300 small poor rural communities in one area of Tamil Nadu, India found that 196 girl babies had died under suspicious circumstances.3
- In 1994 the Indian Parliement outlawed sex selection, but there was no conviction in the next five years due to the social acceptability of the practice.4
- A 1999 report claims that ultrasound is now the preferred method of determining a baby’s sex, allowing parents to decide a baby’s fate as early as 14 weeks into pregnancy.5
- A paper published in 2002 from a private IVF clinic in India descibed using PGD to sex embryos for family balancing purposes.6
- A paper published in 2003 estimated that between 2 and 5 million female fetuses are aborted each year in India, with 130 boys being born for every 100 girls.7
There is a long-standing tradition of female infanticide and abandonment that pre-dates the 1949 formation of the People’s Republic.
- During the 1950s, 60s and 70s the practice subsided, but returned when in 1979 the government introduced a ‘one child’ policy. A recent publication suggests that there are now 117 boys born for every 100 girls.8
- There are currently an estimated 111 million Chinese men who are unable to find a wife as a direct result of the one-child policy. This has fueled a growing black market in women.9
Safety and Reliability
If you argue that sex selection is always wrong, then issues of safety and reliability are irrelevant in the debate. Even if the techniques were totally safe and provide the right sex baby 100 percent of the time, they should not be used. For those who consider that there may be cases when sex selection could be used, safety and reliability are important considerations.
There are growing anxieties about the safety of many assisted fertility techniques. Using them as a mechanism for sex selecting therefore exposes any offspring to the risk of long-term side effects.10
No method is likely ever to be 100% reliable, so there will always be children of the wrong sex conceived. Parents will either choose to abort the baby, or there is the chance of the child growing up living under the burden of being ‘wrong’.
Restore or Select
Medicine is traditionally built on restorative actions. Christians believe that health is good and see disease and disability as an effect of the Fall. It is therefore not part of God’s original intention for humanity. Medicine seeks to ‘restore the masterpiece’ within the physical limits of our fallen humanity; to help people to live their lives as fully as possible.
Reproductive medicine enters a new domain since it enables choice about the people that are brought into existence, choices made primarily on the basis of their health. This is not restorative, but selective.
Christians would also want to emphasise that this life is not all that there is. Life does not end at death but there is life after death where, if we have faith in Christ, we will live forever with new bodies, like that of Christ after his death and resurrection, that are free from all disease and disability. For this reason alone the life of a disabled person is always worth living because the best by far is yet to come.
An Issue of Control
Perhaps the critical issue is control. And the question is whether there are limits to the control we should exert on our future children. In Christian thought, all human beings are equal under God and we receive the children that God gives us. They are gifts given to us to love and care for, not commodities that we choose and own. There is a danger that in extending the scope of the choices parents make, we will alter the nature of parenthood, and change the structure of our society.
Medical technology gives us many new choices, but not all these choices are good for us or for society. Nearly all Christians are opposed to sex selection for social reason, whereas some would allow it to avoid having a child with severe disability.
All the sama, there are many reasons why we should have grave reservations about selecting the sex of our children even on medical grounds, both becauseof the way it discriminates against certain kinds of people, and because of the way it may change our society and ourselves.
We cannot know with certainty what life has in store for us, or our children, but Christians believe that God holds the future and works for our good in all things.11 This does not mean that we are necessarily protected from suffering, but rather that God will helps us to cope with the burdens that life brings. Christians believe that living with burdens can enable a person’s character to grow as God gives them strength, both directly and through the help of others to face it. Bearing one another’s burdens is at the heart of Christian morality.12
- Zeng Y et al. Causes and implications of the recent increase in the reported sex ratio at birth in China. Pop Dev Rev, 1993;19(2):297
- Case Study:Female Infanticide (www.gendercide.org/case_infanticide)
- Mudur G. Indian medical authorities act on antenatal sex selection. BMJ 1999;319:401
- Ramachandran R. In India, sex selection. BMJ 1999;319:401
- Ramachandran R. In India, sex selection gets easier.(www.unesco.org/courier/1999_09/uk/dossier/txt06.htm)
- Malpani A et al. Preimplantation sex selection for family balancing in India. Human Reproduction 2002;17:11-12
- Allahbadia GN. The fifty million missing women. J Assist Reprod and Genet (in press – 2003)
- Plafker T. Sex Selection in China sees 117 boys born for every 100 girls. BMJ 2002;324:1233
- The Vancouver Sun 11 Jan 1999/The Times 7 Dec 2002
- Fraser LR. ART: Boon or bane? 2002. Nature Cell Biology & Nature Medicine. s10-s13. www.nature.com/fertility
- Romans 8:28
- Galatians 6:2
Christian Medical Fellowship (CMF) Files No. 21, 2003