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

A personal view

K. Sermon

Centre for Medical Genetics, Brussels Free University, Laarbeeklaan 101, B-1090 Belgium e-mail: karen.sermon{at}az.vub.ac.be

A personal view:

Dear Sir,

I would like to comment on the paper by Seif personally, rather than in the capacity of Chair of the ESHRE PGD Consortium, because opinions on this matter show a complete and continuous spectrum. Also, my comments are not in favour or against social sexing but rather I would like to give nuance to the reaction of Seif against the letter of his French colleagues.

Seif has a problem with the way Ray et al. (2002Go) use the word ‘eugenics’. Indeed the word eugenics is perhaps used in the wrong sense. Although Seif’s definition is exact, eugenics has in the last 50 years been brought more in relation to the forced sterilization of some populations (e.g. psychiatric patients) and Nazi ideology than to its true definition. Seif seems to be deliberately misunderstanding Ray et al., but he is correct that we can only conduct fruitful discussions if we use correct wordings.

Seif’s comment that many medical acts are performed for non-medical purposes is a crooked comparison. PGD for social sexing (PGDSS) should here be compared with prenatal diagnosis followed by abortion for social sexing. Both sexing practices can be done for true medical indications, as well as termination of pregnancy (TOP).

Does the fact that other medical practitioners apart from the ones performing PGDSS perform medical acts purely for the money make it alright? This is rather part of the discussion whether good medical treatment is a fundamental right and should be accessible to everyone or whether it is an economical goods that can be sold to the highest bidder.

There was a consensus within the ESHRE PGD Consortium, and also within the ESHRE Special Interest Group (SIG) on Law and Ethics, that these data should be published. They are not only, as Seif has pointed out, real scientific data, but as they were performed in countries where PGDSS is not illegal, there were no legal objections to their publication. In fact, it was this decision that triggered the reaction of Ray et al.

As a woman, I have serious doubts whenever a man tells me that sex discrimination does not exist in Western countries. A cynic might remark that the absence of sex discrimination explains why in a Western country like Belgium the average salaries of women are still 20% lower than those of men.

The choice to exclude PGDSS from the field of practice is not arbitrary, as other ethical and moral points such as the fundamental human right not to be discriminated against on the ground of sex, play an important role in decision making. Allowing PGDSS in countries such as China or India to avoid worse is hypocritical, as only the few happy rich in either of these countries will be able to make use of these services.

I fully agree that social attitudes towards sex should be changed in developing countries, but allowing PGDSS is going against it by giving the message that it is alright to prefer boys.

Finally, the decision not to publish the names of the centres was taken because the data collection is done on an anonymous basis. We would no more divulge the names of the centres performing PGDSS than to divulge the names of the centres which have experienced misdiagnosis in PGD. The centres themselves have full responsibility in this.

In conclusion, Seif has made a tendentious and superficial comment on our French colleagues’ letter, and they have perhaps somewhat overreacted. I personally still await the informed and weighted opinion of our friends—ethicists from the ESHRE SIG on Laws and Ethics.

References

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]





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