Early fetal gender test demands rapid ethical policymaking
Research news from the journal Prenatal DiagnosisThis alert highlights the research published this week in a special issue of Prenatal Diagnosis entitled, Fetal Sexing: Global Perspectives on Practices, Ethics and Policy. The special issue arose out of a workshop organized as part of the SAFE network of excellence.
Reviews highlighted in this newsalert:
- Early pregnancy maternal blood test for fetal gender demands rapid ethical policy-making. The sex of a 5-7 week embryo can be determined by a new test – about two months earlier than was possible with ultrasound. But should we use this new technology 'just because it is there?'
- Sex selection – liberally ok but not without problems. Sex selection fits with a liberal view of permission in reproduction, but using abortion as part of the process is less defensible and may degrade our value of human life.
- Will easier access to more effective sex selection affect gender balance? Probably not. Increasing ease of travel to countries with lax rules on sex selection makes it possible for wealthy couples to have a baby of the desired sex. But surveys that ask whether people would prefer to have a boy or a girl show that, at least in Western countries, the sex-ratio is unlikely to change considerably.
- Most people do not favour sex selection. Surveys conducted to date show that, overall, people have negative attitudes towards sex selection for non-medical reasons, particular if the method involves terminating a pregnancy.
Lyn Chitty, Senior Lecturer in Clinical Genetics and Fetal Medicine at the UCL Institute of Child Health, London, says, "this Special Topic issue presents a range of papers that discuss the scientific, social and political implications of fetal sex selection. It begins by describing the technological advances that have made early non-invasive fetal sex determination a practical, reliable and safe option for women at high risk of sex-linked disorders if the test is performed in accredited and experienced laboratories.
It then goes on to explore the views of clinicians, scientists and social scientists as well as the evidence from the developed and developing world on the potential impact of this technology if used for non-medical reasons.
It gives no answers and, to quote the editors of this issue – 'It remains to be seen whether the triumph of modern science to allow fetal sexing at increasingly early stages of gestation will be seen as a triumph, allowing those at risk for sex-linked disorders to learn of the health of their fetus at the earliest point possible, or a tyranny, making simpler the selective termination of female fetuses with its attendant social and political consequences.'"
Early pregnancy maternal blood test for fetal gender demands rapid ethical policy-making
The sex of a 5-7 week embryo can be determined by a new test – about two months earlier than was possible with ultrasound. "It is imperative that an authorized committee of experts in each country generates and official policy regarding use of this test," says Dr. Esther Guetta from the Danek Gertner Institute of Human Genetics, in Israel, writing in the latest edition of Prenatal Diagnosis.
To understand the test you need to know two things:
- Fragments of DNA from an embryo can be found circulating in its mother's blood.
- While males have an X and a Y chromosome, females only have two X chromosomes.
If you take a sample of a pregnant woman's blood plasma and find DNA that is only present in males, the woman is most probably carrying a male fetus.
Unlike other highly accurate invasive tests, this test poses no risk to the embryo. It can also be carried out early in pregnancy. Add these together and it is likely therefore to become popular with anyone who is prepared to use abortion as a way of choosing their child's sex.
"We need to think about this quickly because the technology is already with us," says Guetta. In the USA, for example, some mail order products already use this sort of technology.
"Should this new technology be applied 'just because it is there'?" asks Guetta.
Review Title: Guetta, E: Noninvasive detection of fetal sex: The laboratory diagnostician's view: Prenatal Diagnosis DOI: 10.1002/pd.1478
Sex selection – liberally ok, but not without problems
Sex selection fits with a liberal view of permission in reproduction, but using abortion as part of the process is much less defensible and is liable to degrade the value of human life. This is the conclusion of Thomas Baldwin who works in the Department of Philosophy at the University of York, England.
While there is reasonable acceptance of sex selection to help parents avoid passing on a genetic disease to their children, many surveys show that people do not welcome the possibility of sex selection merely to choose the sex of a child.
In order to understand the opposition to sex selection, Baldwin considers the arguments against sex selection in four key areas:
- religion – Baldwin believes that religious arguments by themselves should not be used to drive public policy in a liberal secular state, but suggests that the main religiously-derived arguments are taken into account in secular ethical debates.
- social consequences – some people argue that a serious objection to sex selection is that it will lead to a substantial imbalance of boys over girls within society. Baldwin, however, argues that if sex selection is primarily used for family balancing, the numbers of boys and girls in Western societies will not become unbalanced.
- child's autonomy – it is argued that deciding a child's sex violates his or her autonomy by imposing a particular destiny on the child. Baldwin rejects this view largely by pointing out that there are many ways during our upbringing in which parents influence who we become. Sex selection is therefore not introducing something radically new, although it does extend parental influence into a new dimension.
- children as a commodity – still others argue that sex selection turns the child into a commodity that has been designed to satisfy a need and thus that parents will not give their child the unconditioned love it needs. But the connections here are not inevitable, and it may equally be argued that enabling parents to have the kind of child they want increases the chances of them giving their child the love it needs.
Since these objections are not decisive, Baldwin concludes that the liberal argument for permitting sex selection is the reasonable position to take, though its use should be restricted for the moment to family balancing situations. When it comes to looking at methods of sex selection, Baldwin believes that there is nothing problematic in any method that does not destroy an embryo or fetus.
Once an embryo has been implanted and allowed to develop, however, termination of the pregnancy merely for the purpose of sex selection is in principle wrong. But he accepts that the combination of new non-invasive methods of testing with over the counter hormone abortion kits will make sex selection by early abortion something that is in practice impossible to stop.
"Since there are no straightforward victims, it is a mistake to try and enforce its prevention," says Baldwin. "We will just have to learn to live with the resulting degradation of the value of human life."
Review Title: Baldwin, T: Understanding the opposition: Prenatal Diagnosis, DOI: 10.1002/pd.1473
Will easier access to more effective sex selection affect gender balance? Probably not ..
Increasing ease of travel to countries with lax rules on sex selection makes it possible for wealthy couples to have a baby of the desired sex. But surveys that ask whether people would prefer to have a boy or a girl show that, at least in Western countries, the sex-ratio is unlikely to change considerably.
The desire to choose the sex of our offspring is not new – it has been part of human culture for millennia. However until recently there has been no successful method of achieving this goal.
Now that methods, like sperm selection and non-invasive methods of testing an embryo's sex, are becoming available, the issue is moving from one of mild interest, to one that needs serious consideration.
"It will be very difficult for governments to stop people who want to use these new techniques," says Frank van Balen who works at the Faculty of Social and Behavioural Science at the University of Amsterdam, The Netherlands. The question then is whether this use will alter the gender balance within the population.
Many initial comments suggest that these tools will create a population with more boys than girls, but van Balen thinks this is not necessarily the case.
While 'son preference' tends to be stronger that 'daughter preference', recent surveys show increased 'daughter preference' particularly among women. Given that abortion laws give the woman the decision-making power over a termination, the argument that sex selection should be barred because it would discriminate against women may not be so strong.
'Light' sex selection methods, especially those known not to be effective, enjoy a high degree of social acceptance. But it will also be interesting to see how attitudes change as people get used to the presence of technologies that 'work'.
Review Title: Van Balen, F: Attitudes towards sex selection in the Western world: Prenatal Diagnosis, DOI: 10.1002/pd.1471
Most people do not favour sex selection
Surveys conducted to date show that, overall, people have negative attitudes towards sex selection for non-medical reasons, particular if the method involves terminating a pregnancy. This was the main conclusion of a review that drew together data from 21 separate studies. The research was carried out by Dr Sue Hall and colleagues working in the Department of Psychology at Guy's College London.
"Some of the studies show that while people may be in favour of the general principle of reproductive choice, they feel that they would not use sex selection themselves," says Hall.
The surveys cover a range of time from 1971 to 2005. Sixteen were carried out in the USA, 4 in Germany and 1 in the UK. Attitudes were particularly negative in Germany.
"People's attitudes become more negative when the methods used to select the gender of a child are explained – eg the cost and effort involved, the unreliability of sperm sorting or the need for termination of pregnancy following prenatal diagnosis," says Hall. "People are particularly reluctant to endorse prenatal diagnosis and abortion for sex selection."
Earlier this month MP Caroline Flint declared that choosing the sex of a baby for social reasons would be banned and the Department of Health has been conducting a review of the 1990 Human Fertilisation and Embryology Act – the legislation governing human fertilisation.
"Such debates need to consider the way that policy, guidelines and legal frameworks drawn up to work with Western attitudes and cultures will impact regions of the world that have more positive attitudes toward sex selection such as India and China," says Hall.
Review Title: Hall, S: Attitudes towards sex selection for non-medical reasons: a review, DOI: 10.1002/pd.1472
To receive a full copy of the articles or to arrange an interview with an author, contact Polly Young (+44 (0)1243 770633 or by email [email protected]).
Notes to Editors
- Special Issue: Prenatal Diagnosis: Fetal sexing: global perspectives on practices, ethics and policy.
- Prenatal Diagnosis: The aim of the journal is to communicate the results of original research in a variety of clinical and scientific specialities concerned with in utero diagnosis of fetal abnormality in humans (and in animal models) resulting from genetic and environmental factors. Prenatal Diagnosis can be accessed online at: www.interscience.wiley.com/journal/pd
- John Wiley & Sons Ltd., with its headquarters in Chichester, England, is the largest subsidiary of John Wiley & Sons, Inc. Founded in 1807, John Wiley & Sons, Inc., provides must-have content and services to customers worldwide. Its core businesses include scientific, technical, and medical journals, encyclopaedias, books, and online products and services; professional and consumer books and subscription services; and educational materials for undergraduate and graduate students and lifelong learners. Wiley has publishing, marketing, and distribution centres in the United States, Canada, Europe, Asia, and Australia. The company is listed on the New York Stock Exchange under the symbols JWa and JWb. Wiley's Internet site can be accessed at http://www.wiley.com/
- The Special Non-Invasive Advances in Fetal and Neonatal Evaluation Network (SAFE) is a Network of Excellence established under the European Commission Sixth Framework Programme which aims to implement routine non-invasive prenatal diagnosis and cost effective neonatal screening through the creation of long-term partnerships.
The SAFE network will develop a series of measures to enable the rapid introduction of Non-Invasive Prenatal Diagnosis (NIPD) and Neonatal Screening (NS) throughout the EU and beyond. At present NIPD , based on a pioneering observation that circulatory cell free fetal DNA is present in maternal plasma and serum, has already begun to impact clinical practice. It started on 1 March 2004, will run for 5 years and has 53 partners from 19 countries currently participating. One of the reasons for the setting up the network is that relevant knowledge is dispersed across many disciplines, including molecular biology, medical genetics, bioinformatics, social justice, and ethical studies. SAFE brings together leading experts from the key disciplines in a programme designed to achieve intellectual and practical integration with a view to enhance the efficacy of NIPD and NS for genetic disorders within and beyond the European Community. For more information please visit: www.safenoe.org
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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