Sex selection by preimplantation genetic diagnosis: should it be carried out for social reasons?

Rony Seif

7 rue du Sergent Godefroy, 93100 Montreuil, France e-mail: ronyseif{at}aol.com

Dear Sir,

The last data published by the ESHRE PGD Consortium on Preimplantation Genetic Diagnosis (PGD) include gender screening on preimplantation embryos for social reasons (ESHRE PGD Consortium Steering Committee, 2002Go). Performing PGD for social reasons and publishing related data did not meet with everyone’s approval (ESHRE PGD Consortium Steering Committee, 2002Go; Ray et al., 2002Go). I will not go through all the arguments against sex selection—as this has already been done (Savulescu and Dahl, 2000Go)—but only some of them.

Thus, we can read "the eugenic potential of PGD... is now becoming reality" (Ray et al., 2002Go). Eugenics is by definition the science of improving the hereditary characteristics of the human race. Sex selection by PGD for social reasons cannot be related to this definition. On the other hand, detection of genetic diseases and chromosomal anomalies by PGD or prenatal diagnosis (PND) can be termed similar to an improvement of the human race since it leads to elimination of sick embryos or fetuses, keeping only those which are healthy. So why don’t we talk about eugenics when using PGD and PND for medical reasons? The use in this debate of the word ‘eugenics’ to qualify the Social Preimplantation Diagnosis (SPD) is inappropriate. As for the real eugenic drifts of PGD, it is possible to draw a legal line between what is ethically acceptable and what is not (Savulescu and Dahl, 2000Go).

"We want to insist on the fact that there is no medical indication for such a practice". But it is generally known that in the same hospitals where PGD is practised for medical reasons, abortion is being carried out in all legality. However, abortion, like SPD, is an act practised by a doctor, which is not in response to any medical condition, in >95% of cases. The same applies for contraception (pill and coil). Abortion, contraception and SPD can be considered as social indications, so this reasoning appears rather incoherent.

"The preimplantation diagnosis for social sexing is a purely money-driven enterprise exploiting preferences derived from social pressures". Such a remark makes you think about plastic surgery, as well as curative traditional medicine where exploitation does also exist. In France, some consultations and operations are invoiced well above the basic prices of the Social Security allowance. Do these activities constitute a financial windfall for the doctors who practise them? Do these doctors exploit the wish of patients for a medical outcome of better quality? SPD may be a money-driven enterprise, but it is not the only medical activity exploiting human desires (to have a pecuniary benefit). Moreover, it will affect only a very low number of couples.

In addition, there would be ‘genuine scientific and medical works’ that deserve to be published in scientific or medical journals and not others. Both PGD practised for a medical reason like an X-linked disease, and PGD practised for a social reason such as family balancing, follow exactly the same procedure. So why would the first one ‘belong to the field of medicine and science’ and not the second one? Is it only the required goal that gives a ‘scientific and medical’ legitimacy to a work?

It is not valid because any objective, precise and methodical work is ‘scientific’. In medicine, it is admitted that a person who is in a difficult situation which leads to a physical, psychological or social suffering deserves to be helped: not programmed pregnancy, to have many children... It is because medicine must relieve physical, psychological and social sufferings that various societies have accepted contraception and abortion. To exclude SPD from this field of practice is an arbitrary choice that threatens the social integrity of all couples who wish to balance their families between boys and girls. This can take on dramatic proportions, particularly in India and China, and some couples may resort to abortion, infanticide or abandonment of the undesired sex, especially girls. Sex selection by PGD is preferable when compared with these alternatives (Savulescu and Dahl, 2000Go).

The sex discrimination does not exist in Western countries since preferences go as well for girls as for boys (Savulescu and Dahl, 2000Go; Sureau, 1999Go). For the countries in the process of development, it will be necessary to undertake social and educational reforms in order to put an end to the popular preference for the male sex. The prohibition of the SPD from this perspective is not useful.

"We want to distance ourselves from such a practice". Then it is sufficient to publish the names of those who practise SPD as proposed by two PGD centres (ESHRE PGD Consortium Steering Committee, 2002Go) rather than to censure the publications as indicated by French centres (Ray et al., 2002Go).

All these arguments lead us to a fundamental question, whether to allow or prohibit the use of PGD for family balancing? Norbert Gleicher, Chairman of the Institutional Review Board of the Center for Human Reproduction in New York (CHR), tried to obtain a clear response on this subject from the American Society for Reproductive Medicine (ASRM). In a letter, the Chairman of the ASRM’s Ethics Committee 2001, John A.Robertson announced: "In light of the Ethics Committee’s 2001 analysis of sex selection for gender variety in a family, a programme might ethically offer PGD for that purpose when there is good reason to think that the couple is fully informed of the risks of the procedure, and are counselled about having unrealistic expectations about the behaviour of children of the preferred gender." Following a media uproar, the ASRM distanced itself from that statement. In a letter of February 7, 2002 to the CHR, the ASRM’s Ethics Committee concluded that "initiating IVF and PGD solely to create gender variety in a family should at this time be discouraged." This side of the Atlantic, the European Society of Human Reproduction and Embryology has not yet issued a statement concerning SPD, but it will do so in the near future (ESHRE PGD Consortium Steering Committee, 2002).

If there is difficulty in approaching this issue of sex selection for social purposes serenely, opinions seem less confused on preconception gender selection for nonmedical reasons. Some, in a personal capacity, like Claude Sureau (Sureau, 1999Go), member of the French Academy of Medicine and others on a collective capacity, like the ASRM (Ethics Committee of the American Society for Reproductive Medicine, 2001Go), think that it is an ethically acceptable procedure, which remains a personal ethical choice. It should be the same for using PGD to select gender for social reasons. These arguments—as those emitted against the PGD for medical reasons—distort the facts and bias the debates. That is precisely what can ‘revive the fears’ of the general public towards biotechnology.

References

ESHRE PGD Consortium Steering Committee (2002) ESHRE Preimplantation Genetic Diagnosis Consortium: data collection III (May 2001). Hum. Reprod., 17, 233–246.[Abstract/Free Full Text]

Ethics Committee of the American Society for Reproductive Medicine (2001) Preconception gender selection for nonmedical reasons. Fertil. Steril., 75, 861–864.[CrossRef][ISI][Medline]

Ray, P.F., Munnich, A., Nisand, I., Frydman, R., Vekemans, M. and Viville, S. and French GET-DPI (2002) The place of ‘social sexing’ in medicine and science. Hum. Reprod., 17, 248–249.[Free Full Text]

Savulescu, J. and Dahl, E. (2000) Sex selection and preimplantation diagnosis: a response to the Ethics Committee of the American Society of Reproductive Medicine. Hum. Reprod., 15, 1879–1880.[Abstract/Free Full Text]

Sureau, C. (1999) Gender selection: a crime against humanity or the exercise of a fundamental right? Hum. Reprod., 14, 867–868.[Free Full Text]





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