Ethics and Sex selection

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Dark567
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Ethics and Sex selection

Postby Dark567 » Tue Aug 02, 2011 8:03 pm UTC

This is kinda of an offshoot of the "Religious medical students not wanting to do their jobs" thread, but thought it deserved its own thread.

So I came across another article in today about medical ethics, and was wondering what the fora's opinion on it is and whether or not doctors should be forced to provide these procedures or not. The article talks about sex selection, that is using certain medical techniques(only implanting certain embryos, only using certain X or Y chromosome sperm, or selective abortion) to dictate the sex of fetus before birth. There are number a problems this can cause, things like gender imbalances, allowing the continuation of sexist practices etc.

http://www.slate.com/id/2300663/pagenum/2

Spoiler:
"The first thing she said to me was, 'I know it's a girl, and I need your help to get it out of me.' "


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Dr. Carpenter's brow furrowed as she told me about the first time she met Priya. Carpenter was an OB-GYN resident at the time. Priya was a recent immigrant from India who worked as a manager in a retail store and had come to the central California clinic on her lunch break. Punctuating her story with glances at her watch, she told Carpenter how, one week earlier, she had used another lunch break to go to a private ultrasound clinic, where she learned that she was pregnant with a girl. With her arms tightly crossed along her abdomen, she explained that her husband and his parents expected a boy, and that Carpenter's help could change her life.
"I have a daughter," Priya said. "I don't need another one."
***
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Mara Hvistendahl's new book Unnatural Selection has sparked animated conversations about the frightening global consequences of sex selection, or the use of medical technology to ensure the birth of either a male or female child. Rising numbers of "missing women" around the world are leading to increased cases of sex trafficking and rape, with excesses of restless, unmarried men expected to worsen societal violence.
But sex selection isn't something that only happens in foreign countries like India or China. It happens in the United States, too, as I learned in my six years of interviewing patients and physicians on the topic. And while these procedures, which can involve fertilizing a woman with only X- or Y-bearing sperm, implanting her with embryos of the desired sex, or aborting fetuses of the unwanted sex, are all legal in this country, there's no consensus among doctors about whether—or when—it's ethical to offer them.
Unlike their Chinese and Indian counterparts, who cannot legally offer sex selection, American doctors are left to decide on a case-by-case basis whether to perform these procedures, without any consistent ethical guidelines. The reasons American women undergo them are complex, from situations that don't seem particularly troubling (the upper-middle-class woman who wants a daughter to "balance out" her three boys) to those that are deeply concerning (the immigrant woman who wants a son to avoid emotional abuse by her in-laws).
Sex selection is openly advertised everywhere from mainstream parenting magazines to Indian community newspapers, and patients are requesting it more often, according to the physicians I interviewed. A 2007 study found that 42 percent of American fertility clinics surveyed had helped patients conceive a boy or a girl by implanting them with the appropriate embryos. Yet despite sex selection's growing profile in the United States, many physicians remain deeply ambivalent about the emotional and ethical dimensions of what they're being asked to do.
Dr. Bradley met Laura and David, a professional Chinese immigrant couple, when they came to his Washington state clinic seeking an abortion. Laura was distraught, unable to speak clearly through her tears. David explained that his recent unemployment meant they couldn't have another child. In the examination room, Bradley gently asked Laura why she was there, and she hesitantly admitted that she wanted this baby, which she had recently learned was female. Her in-laws, however, did not; they had been pressuring David to divorce her because she didn't have a son. Bradley got a social worker involved and Laura was referred to a nearby shelter, eventually deciding to file for divorce herself. Bradley now screens every couple who comes into his clinic—immigrant or otherwise—for family pressure and domestic violence. It's simply the responsible thing to do, he says.
Other doctors disagree. Reproductive choice and patient autonomy are pillars of American medical practice, after all. Asking a woman for her reasons for wanting a boy or a girl, one doctor told me, is simply not a physician's responsibility or business; educating her on the latest technology is. Doctors have to trust that patients know their lives, families, and needs best, he said. In some cases, a physician may know—and loathe—the reasons behind a patient's choice, yet still believe that providing sex selection may help her. If a woman faces threats of divorce, abandonment, or abuse, or if her child would ultimately be mistreated or neglected, then aborting an unwanted female or implanting male embryos may help keep that woman—and any future children—safe.
And it's not just immigrant women whose requests are ethically challenging. Dr. Daniels, based in Northern California, felt uncomfortable when a middle-aged, white patient of his wanted a daughter "for the pink and the malls," as he told me. "She seemed to think of this kid as a mail-order product." But what if this girl ended up being a tomboy, he wondered—or gay? How would this woman treat her child then? Other doctors at his practice insisted that he "keep his own beliefs out of it." Daniels ended up referring this case to one of those colleagues and has since stopped offering sex selection services completely. Parents pursuing it may presume a child will turn out a certain way based solely on its gender, with poorly understood consequences for the child, mother, and family if the child doesn't. A shortage of women, Daniels believes, is not the only harm sex selection may cause. It's just what has gotten the most attention.
Ultimately, physicians are on their own when making these ethically and emotionally charged decisions. The professional medical societies they might otherwise turn to offer conflicting advice: The American College of Obstetrics and Gynecology recommends that providers not meet requests for sex selection, given the risk of reinforcing sexist beliefs and practices, while the American Society of Reproductive Medicine states that it would be premature to prohibit such technologies without studies suggesting their potential harm in the United States.
The few papers that have been written on the topic have looked at very small numbers of patients and focus on the role ethnicity plays in the process. They conclude that since white American patients opt for daughters, sex selection in this country won't contribute to the worldwide shortage of women. But a large-scale demographic shift isn't the only outcome that should rouse our concern. After all, more than 30 countries, including Canada and the United Kingdom, have already banned sex selection on the grounds that it reinforces gender inequality and sets a precedent for legitimizing eventual selection of traits ranging from eye color to intelligence.
In cases involving sex selection, there are often no clear "right" or "wrong" answers. And to be sure, doctors have to make decisions about challenging cases all the time in the absence of concrete guidelines. But many doctors I spoke with had at times wondered whether they'd made the right decisions, and felt that further guidance—especially around how to screen for red flags in patients' home lives without appearing invasive or judgmental—would have been helpful.
Dr. Carpenter could have used this kind of support. She ultimately performed two more abortions for Priya, who adamantly refused to have another daughter. Eventually, Priya did have a son, and Carpenter was thrilled, hoping that she would finally find peace and acceptance in her family. She was shocked when Priya returned two years later, saying she was pregnant with another girl that she needed to terminate. Priya had provided her in-laws with a son, only to discover that they still didn't want any more daughters.
"Not every situation I've seen is as complicated as Priya's," Carpenter said, "but maybe that's because I haven't asked the right questions, or I've assumed the best when I shouldn't have. [You] need to base your decisions on information, not just on your assumptions. I think it's about time we had serious conversations about how to do that."
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Re: Ethics and Sex selection

Postby alexh123456789 » Tue Aug 02, 2011 10:00 pm UTC

I feel that doctors and patients should have the choice to do whatever procedures they'd like to. In this case, the selection works to prevent cases where people feel resentment to a child for being the wrong sex, which can't hurt.

Plus, banning this isn't really going to stop sexism- this is more of a symptom, and one that doesn't harm anybody. The other problems, like gender imbalance, seem relatively unlikely to occur in say, the US, because relatively few people use this procedure, and the numbers likely cancel each other out anyway.

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Re: Ethics and Sex selection

Postby Aaeriele » Tue Aug 02, 2011 10:03 pm UTC

If you want to stop sexism, it's probably better to actually work on stopping sexism rather than just preventing one possible sexist choice. If there were no reason to favor children of one sex over the other, there wouldn't be much problem with gender imbalances from giving people a choice.
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Re: Ethics and Sex selection

Postby CorruptUser » Tue Aug 02, 2011 10:21 pm UTC

So how do we battle sexism? Not sure that this is the type of war involving brave mutli-gendered armies gallantly defending the ramparts against the misogynist/misanthropic hordes (who are unable to win because of their refusal to co-operate with the other gender).

Ideally it could be done through education, but the stuff I had throughout public school and 3 CSR required courses in college just left a bitter taste in my mouth. I'd rather have spent that time learning something useful; the jerkasses usually tended to be the ones that skipped class anyway.

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Re: Ethics and Sex selection

Postby Aaeriele » Tue Aug 02, 2011 10:26 pm UTC

Simple version? Don't tolerate the jackasses. When people do sexist stuff, call them out on it. There's no miracle solution that will solve the problem tomorrow, but that's the way to solve it in the long run.
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Re: Ethics and Sex selection

Postby Ulc » Tue Aug 02, 2011 10:38 pm UTC

Aaeriele wrote:Simple version? Don't tolerate the jackasses.


I used to think that this was the only solution, that making laws about it would only make people find other ways to express their sexism. Law should follow after public opinion had changed, not the other way around, if we wanted it to work.

To anyone that agree with Ulc from 2 years ago, can I point you to the Norwegian law about business councils and gender ratio? It was basically the government stepping in and saying "we know the public disagree with us, but now we dictate that all business councils of companies stock registered must adhere to certain gender ratios" - when it was made the law, the public disagreed strongly.

Now? The public agree with it, the people in the councils from before the law was passed say that it has made their companies stronger, and relatively few have take creative solutions to get around it.

The research following that law has made it really hard for me to hold my previous position. It appears that as a matter of fact, it is viable to enforce gender equality to a degree the public doesn't support - and the opinion of the public will follow!

Edit for clarity: What I'm saying, is that no, we shouldn't accept sexist jackassery from idiots. But it appears that passing laws, not just heaping scorn on them, against being jackasses actually seem effective.
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Re: Ethics and Sex selection

Postby Feddlefew » Tue Aug 02, 2011 10:44 pm UTC

I have a different problem with this.

I see this as the start of "Children as Consumer Products" doom and gloom. I'm not certain how to explain this without using a slippery slope argument, but what starts with the relatively easy process of gender selection in invitro pregnancies will eventually lead to there being... Other options. Eye color, hair color, maybe even height and intelligence. What if it ends up like the health food crazes, with the discovery of genes that are linked to musical talent leading to a rush of people wanting children with them? People already have enough problems with thinking of their children as separate entities than themselves.

I also worry about how the consumer selection of genetic traits might effect the integrity of our gene pool*, but I don't think we have to worry about that just yet.

*Diversity is better.
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Re: Ethics and Sex selection

Postby Newt » Tue Aug 02, 2011 11:28 pm UTC

Ulc wrote:Now? The public agree with it, the people in the councils from before the law was passed say that it has made their companies stronger, and relatively few have take creative solutions to get around it.


I don't have the article(or the cited research on hand), but according to an article in the Economist a couple weeks ago, more recent research indicates the opposite.

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Re: Ethics and Sex selection

Postby M.C. » Wed Aug 03, 2011 1:50 am UTC

Sex selection is.... Questionable at best, but i think my main objection is not that diversity is what makes us, as a society stronger. Having people of different genders, sexual identities and physic attributes is what makes us interesting as a species. If we were to allow customisation of children, we end up allowing peoples standards of what the ideal is - which is wrong.

Add to that, the type of people who are going to have a need for a particular sex child (That is, not a preference, but an absolute no exceptions) aren't the type of people I want passing their values on to children.

Furthermore, I would guess that there would be an expectation of a certain gender of a child if their sex had been selected for them. Gender dysphoria or same sex attraction would suddenly become another level of performed disappointment for the parents, who just wanted a "normal" boy or girl.
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Re: Ethics and Sex selection

Postby Cathy » Wed Aug 03, 2011 3:39 am UTC

alexh123456789 wrote:I feel that doctors and patients should have the choice to do whatever procedures they'd like to. In this case, the selection works to prevent cases where people feel resentment to a child for being the wrong sex, which can't hurt.


Or it could just fuel resentment when the child is not what they expected, like the quote from the article here:

OP's Article wrote:Dr. Daniels, based in Northern California, felt uncomfortable when a middle-aged, white patient of his wanted a daughter "for the pink and the malls," as he told me. "She seemed to think of this kid as a mail-order product." But what if this girl ended up being a tomboy, he wondered—or gay? How would this woman treat her child then?


Honestly, I don't have quite so much of a problem with in-vitro sex selection, but sex-selecting abortion does set my nerves on edge. Ultimately, I think it is the patient's choice, but it is not something I would like to encourage.
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Re: Ethics and Sex selection

Postby masher » Wed Aug 03, 2011 4:05 am UTC

The only time that I would support sex selection via in vitro fertilisation or abortion would be if there was a genetic disease that would cause undue suffering/death to the child.

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Re: Ethics and Sex selection

Postby Greyarcher » Wed Aug 03, 2011 4:50 am UTC

Can't say I have a problem with this sort of thing offhand. I imagine various regulations could be enacted if and when it is necessary to deal with problematic consequences.
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Re: Ethics and Sex selection

Postby mmmcannibalism » Wed Aug 03, 2011 5:22 am UTC

I'd say I have more of a problem with most people who would use sex selection then the procedure itself. I can imagine some strange situations* where I don't see the sex selection as negative in anyway though**.

*a family wanting one child of each gender

**tangent and possibly offensive opinion
Spoiler:
In fairness, I really don't understand why people use invitro at all. If you can't have children without medical aid, adoption makes about ten times as much sense to me. Granted, overpopulation makes me wonder why people want to have blood related children at all but whatever.
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Re: Ethics and Sex selection

Postby cjmcjmcjmcjm » Wed Aug 03, 2011 6:04 am UTC

I'm from a religious background, so I'm going to day that choosing a baby's gender isn't right, especially with selective aborting. I do wonder just how common this really is in the US. I also agree with mmmcannibalism's spoilered point and the fact that your perfect son might turn out gay or your daughter to balance your family may be a tomboy. There's nothing stopping that from happening (cue sex/gender dissertation).
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Re: Ethics and Sex selection

Postby Greyarcher » Wed Aug 03, 2011 6:28 am UTC

cjmcjmcjmcjm wrote:I also agree with mmmcannibalism's spoilered point and the fact that your perfect son might turn out gay or your daughter to balance your family may be a tomboy. There's nothing stopping that from happening (cue sex/gender dissertation).
Would either of those be problems? :wink:
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Re: Ethics and Sex selection

Postby cjmcjmcjmcjm » Wed Aug 03, 2011 6:30 am UTC

Greyarcher wrote:
cjmcjmcjmcjm wrote:I also agree with mmmcannibalism's spoilered point and the fact that your perfect son might turn out gay or your daughter to balance your family may be a tomboy. There's nothing stopping that from happening (cue sex/gender dissertation).
Would either of those be problems? :wink:

To someone who's selecting their child's sex, presumably yes. It doesn't bother me, if that's what you're asking.
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Re: Ethics and Sex selection

Postby Greyarcher » Wed Aug 03, 2011 6:44 am UTC

cjmcjmcjmcjm wrote:
Greyarcher wrote:
cjmcjmcjmcjm wrote:I also agree with mmmcannibalism's spoilered point and the fact that your perfect son might turn out gay or your daughter to balance your family may be a tomboy. There's nothing stopping that from happening (cue sex/gender dissertation).
Would either of those be problems? :wink:

To someone who's selecting their child's sex, presumably yes. It doesn't bother me, if that's what you're asking.
Haha, yes, I guess that's true nowadays. I can easily imagine people who simply want a son or daughter without caring about either of those, but I wouldn't be surprised if they were a tiny minority.
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Re: Ethics and Sex selection

Postby KestrelLowing » Fri Aug 05, 2011 7:57 pm UTC

mmmcannibalism wrote:**tangent and possibly offensive opinion
Spoiler:
In fairness, I really don't understand why people use invitro at all. If you can't have children without medical aid, adoption makes about ten times as much sense to me. Granted, overpopulation makes me wonder why people want to have blood related children at all but whatever.

Spoiler:
I feel horrible saying this, but if I'm going to have children, I want them to be related to me. Why? Because I believe that genetics really do play a huge role in personality and abilities - nurture can only go so far. As I'm not great with people to begin with, I would like the highest probability of being able to understand my child, although I know that probably won't happen. Also, if they share their dad's and my genes they'll be much more likely to turn out a natural geek, so I'd want that!

Also, I really think it's a biology thing too. I've got a bit of a dichotomy going on: I'd like to be pregnant at some point, but at the same time the thought terrifies me.

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Re: Ethics and Sex selection

Postby Izawwlgood » Fri Aug 05, 2011 8:02 pm UTC

I disagree; I'd like to think that I have more to offer a child than my exceeding good looks, propensity for allergies, and a predilection towards distractability. While I'm sure my biological imperative would rear it's ugly head and assert that babies from the fruit of my loins are to earn the lions share of my worldly possessions, I hope that my rational side will be able to usurp such foolishness.

Do I want kids of my own? Sure. Do I hope I'll be able to convince my primitive brain that 'children of my own' doesn't mean having one of my many swimmers break through one of her ova? You betcha.
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Re: Ethics and Sex selection

Postby CorruptUser » Fri Aug 05, 2011 9:53 pm UTC

In a nation of sons, the family with the daughter is king.

Yeah, the phrasing needs work

Anyway, as girls become rarer and more precious, the Indians and Chinese that have daughters may soon say "hey, why do I have to pay a dowry to get rid of my daughter when I have 30 families begging my daughter's hand in marriage? They should give one to me instead!". At least this is what I hope.


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