High-tech sex selection
We may have heard the other shoe drop for clinics that specialize in reproductive medicine. The chair of the ethics committee of the American Society for Reproductive Medicine -- one of the professional organizations for that medical specialty -- wrote a letter endorsing gender selection testing of embryos created by in vitro fertilization. While the statement included the recommendation that the use of gender selection be limited to "family gender balancing" for couples who already have one or more children, it has drawn reaction from both the public and members of the profession. What are the implications of offering this gender-selection technique? How far can we -- and should we -- go in testing our future offspring?
Do means matter?
The society has considered sex selection before, most recently this year when it suggested that it is permissible to use sperm-sorting techniques that greatly increase the chance that a chosen sex will be born, again with the caveat that it ought to be used only for family balancing. Sorting sperm is one thing -- it's quite another to create and test embryos before they are implanted in a woman's womb and discard those of the "wrong" gender, at least for many professionals and members of the public. A looming moral question for reproductive medicine is what to do with the many thousands of embryos created for couples, but no longer needed by them. These embryos mostly remain frozen in labs until patients decide whether to donate them to another couple, donate them for research, discard them, or leave them in limbo. The ethical issues involve how long to keep them and what should be done with them eventually. In the case of using in vitro fertilization for sex selection, couples test embryos and discard those of the unwanted gender -- a process that seems to discount or even ignore the seriousness of the ethical issues it raises.
Limits to parental control
Testing embryos created by in vitro fertilization isn't new, and is being used to avoid genetic diseases. But can we really control what kind of children we'll have? We can certainly try. The range of characteristics that can be tested is limited only by the results of advancing genetic research. While today parents may be able to test embryos for gender and the risk of a few diseases, it is only a matter of time before we'll see a menu of genetic tests available, for everything from diseases to physical traits such as eye and hair color, or behavioral characteristics such as personality, intelligence and athletic or musical ability. The longer the list becomes the more it begins to look like the menu of options on a new car -- moving toward the ultimate commodification of the process of having children.
The fact that testing embryos for their gender has sparked such disagreement within reproductive medicine is a lesson itself. It is a part of medicine that has traditionally offered whatever technology has made possible, driven more by market forces than moral qualms. So when the profession itself has serious doubts about a practice, it is time to articulate limits. While choosing to have a child of one gender or another for family balancing may not lead to terrible consequences, we need policies that establish how far parents can go. It may be gender that we choose today, but it could easily be one of a thousand other characteristics tomorrow.
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