Procreative Liberty and Sex Selection

1
Procreative Liberty and Sex Selection

• Professor Julian Savulescu

2
Reliable Methods of Genetic Selection

• prenatal testing (chorionic villous sampling,
  amniocentesis, ultrasound) at 11 weeks followed
  by termination of pregnancy
• in vitro fertilisation (IVF) and preimplantation
  genetic diagnosis (PGD) no need for termination

3
PGD and Sex Selection

• PGD does not require abortion
• reduces a major barrier to selection (abortion)
• requires IVF and intracytoplasmic sperm
  injection.
• embryo biopsy removing one or two cells is
  performed on day 3 at the 8 cell stage.
• PGD can be used to detect
• chromosomal abnormalities
• single gene disorders
• gender
• in the future, any genetic state

4
PGD and Non-medical Genetic Selection

• Genetic selection for non-medical reasons is
  illegal in Vic, SA and WA in Australia and UK
• Sydney IVF performs sex selection on fertile
  couples
• costs around 10,000

5
The Question

• Should selection of a disabled child or the sex
  of offspring by preimplantation genetic diagnosis
  be illegal?

6
Procreative Liberty

• procreative autonomy reproductive liberty
• Liberty to choose
• When to have children
• How many children to have
• What kind of children to have
• Designer children

7
Justification for Procreative Liberty

• Privacy of reproduction
• Families are different and bear costs
• Experiments in living let the experiments run
• Role of parent self interest vs maximizing
  opportunities for child. Nature as rational
  autonomous agents to make decisions about
  children
• Respect the choices of people including the
  disabled

8
How do we decide?

• Nature or God
• Experts philosophers, bioethicists,
  psychologists, scientists
• Authorities government, doctors
• Decide for ourselves liberty and autonomy

9
How do we decide?

• Principle of liberal state (Mill)
• Neutrality to conceptions of the good life
• Personal Autonomy
• Sole ground for interference is harm to others
• Advice, persuasion, information, dialogue
  permissible
• Negative liberty coercion and infringement of
  liberty impermissible

10
Limits

• Limits of positive liberty
• What should be provided?
• Safety
• Harm to others
• Distributive justice

11
Children

• Young children, embryos and fetuses
• Incompetent
• Non-delayable interventions

12
Who decides?

• Nature or God
• Experts philosophers, bioethicists,
  psychologists, scientists
• Authorities government, doctors
• Parents procreative liberty and autonomy

13
Limits to Parental Liberty

• Safety
• Harm to others
• Distributive justice
• Plausible conception of well-being and a better
  life for the child

14
Ethics of Sex Selection

• Ethics Committee of the American Society of
  Reproductive Medicine
• Sex Selection and Preimplantation Genetic
  Diagnosis
• while the Committee does not favour its legal
  prohibition
• sex selection solely for non-medical reasons is
  morally inappropriate and should be discouraged

15
Inconsistency

• legal to attempt periconceptual sex selection by
  natural means, even if these employ technology
• Disabled couples can choose to procreate and
  deliberately have a disabled card

16
Harm to the Child?

• Harm of being born disabled
• Not harmed
• Would not otherwise exist

17
Harm to the Child?

• Physical harm
• PGD
• also, ASRM objection to sperm sorting
• scientific investigation and properly informed
  consent,
• not by criminalising it

18
Harm to the Child?

• Psychological harm
• psychological harm if the procedure does not
  produce the child of the desired sex
• unlikely with IVFPGD
• parents inevitably have hopes and expectations
• most parents come to accept and love the child
  they have

19
Harm to the Child?

• reflects dysfunctional parental psychology.
• dangerous to be making such judgements about the
  suitability of people as parents
• preventing sex selection is no guarantee that
  such people will not have children

20
Harm to the Child?

• violation of Kants dictum never to use a person
  as a means, but always to treat him or her as an
  end
• Unconditional love

21
Harm to Child?

• parents have many desires related to their
  children
• to have a companion,
• to hold a marriage together,
• to be a friend to the first child
• Kants dictum is actually never use a person
  solely as a means
• Provided that parents love their child as an end
  in itself, OK to have other desires

22
The Issue in Genetics

• Identity altering interventions
• That particular child would not have existed
  without a unique sperm and egg uniting
• that would not have occurred without sex
  selection
• Even if the child is disadvantaged
  psychologically, this is only wrong from the
  childs perspective if its life is so bad that it
  is not worth living.

23
Person Affecting vs Impersonal Harm

• Procreative beneficence impersonal harm
• But are there impersonal harms?
• Indirect personal harm

24
Harm to Parents?

• IVF has risks
• ASRM unreasonable for individuals who do not
  otherwise need IVF to undertake its burdens and
  expense solely to select the gender of their
  offspring
• but clearly within acceptable range
• paternalistic not to leave the weighing of risks
  and benefits to the woman

25
Harm to Other Siblings?

• Choosing to have a child of a certain sex does
  not imply that the other sex is undesired in
  other children.
• Their treatment will be determined by the
  pre-existing belief structure of parents.

26
Harm to Women?

• ASRM gender as a reason to value one person
  over another
• gynocide
• Tabitha Powledge we should not choose the sexes
  of our children because to do so is one of the
  most stupendously sexist acts in which it is
  possible to engage. It is the original sexist
  sin.

27
Harm to Women?

• Does sex selection devalue girls?
• Preference does not imply betterness
• Boys and girls are different, and this difference
  matters to different families in different ways.
• Does selecting a disabled child devalue the
  abled?

28
Sex selection in Asia

• Sex selection is more likely to harm women in
  Asia
• The male to female ratio 1.2 in China and India
  (1.6 in Rajasthan)
• Disturbed sex ratios may not be a bad thing
• Compare with social construction of disability
  treating the symptom not disease

29
The State and the Kind of Children

• Social ideals, eg equality ,may be promoted by
  people having certain kinds of children
• Example disability and respect
• Primacy of reproduction over social ideals
• Burden of care argument
• Parents bear the burden of care so should have
  the choice

30
India Is Different

• Hinduism
• a man who has failed to sire a son cannot achieve
  salvation.
• only a male descendant can perform the last
  funeral rites to ensure the redemption of the
  de-parted soul.
• Indian custom
• a dowry for daughters marriage.
• 25,000 up to 500,000 Rupees. (average income of
  three years)
• boys mean prosperity, but girls mean poverty,
  Indian couples have thus a strong incentive for
  sex-selective abortions.
• Invest 500 Rupees now, save 50,000 Rupees
  later.

31
The Western Perspective Balancing Family Sex

• 90 of couples came forward for sex selection
  for the purposes of balancing sex within the
  family.
• Parents were in their mid thirties
• two or three children of same sex
• ASRMs claim is false sex selection will
  contribute to a societys gender stereotyping
  and gender discrimination
• No change in sex ratio or adverse effects on women

32
Playing God/Against Nature

• Using chloroform to relieve the pain of
  childbirth was considered contrary to the will of
  God as it avoided the primeval curse on woman.
• Similarly, the use of vaccination was opposed
  with sermons preaching that diseases are sent by
  Providence for the punishment of sin and it is
  wrong of man to escape from such divine
  retribution.

33
Playing God/Against Nature

• Thomas Hobbes life is nasty brutish and short
• People have been playing God ever since they
  first decided to control which children they
  would have by abortion or by contraceptive use or
  abstinence.

34
Slippery Slope to Eugenics

• allowing selection of non-disease characteristics
  is the first slide down the slippery slope to
  selecting for IQ, personality, etc - designer
  babies
• allowing sex selection does not imply we must
  allow other selections
• eugenics is here plastic surgery, cleft lip

35
Distributive Justice

• ASRM
• misallocation of limited medical resources
• No argument if it is fully funded by individual
• One problem with private funding inegalitarian
• only the rich get the children they want.
• Genetic selection can be used to correct the
  effects of unfair natural genetic lotteries

36
Rational Limitation of Reproductive Liberty

• Against natural lottery
• Use sex selection in order to promote or in so
  far as it does not disrupt the gender balance
• Use sex selection to promote social ideals or
• Use sex selection to promote the desired sex
  ratio

37
Limits to Reproductive Liberty

• Harm to child
• Life Not Worth Living
• Duty to select the best child
• Harm to society
• Public interest
• Distinguish between existing beneficial
  technology and new technology
• We can allow some choices which produce disabled
  people in an affluent society we can afford
  liberty

38
Procreative Beneficence and Liberty

• Can conflict
• Desire to select disabled child
• Desire not to use information to select the best
  child
• Procreative Liberty trumps Beneficence as public
  policy/legal principle
• The child is not harmed by violating procreative
  beneficence

39
Selection vs Enhancement

• Selection is different to enhancement
• Selection chooses between possibly existing
  individuals
• No direct person affecting harm from failing to
  select the best

40
Enhancement

• Does directly affect existing and future people
  (not merely possible people)
• Strong reasons not to harm and to benefit
• Liberty trumps beneficence in cases of competent
  adults (can refuse the best for themselves)
• Beneficence trumps liberty with respect to
  children and dependents
• Choosing a deaf child is different to deafing a
  child or failing to make a deaf child hear

41
Summary Reproduction

• Selection
• LibertygtBeneficence
• Enhancement (Competents)
• LibertygtBeneficence
• Enhancement (Incompetents)
• BeneficencegtLiberty
• Justice and the Public Interest .