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SEX SELECTION

Explanation of Terms and Procedures
Methods of Sex Selection
Reasons advanced for Sex Selection
Ecclesiastical Rationale for opposition to Sex Selection
Sex Pre-selection for sex-linked Disease specifically 
Sex Selection, Prenatal Diagnosis and Abortion
Non-ecclesiastical Arguments against Sex Selection
Non-ecclesiastical documents on Sex Selection

Explanation of Terms and Procedures  

Sex selection "refers to means whereby the sex of an offspring can be chosen." (l) This includes the use of  reproductive technologies which attempt to achieve the conception of a child of a particular sex (sex preselection) and the abortion of a child of an unwanted sex.

   Policy 

Sex selection is not permissible.

   Sources of Policy

A negative judgment on sex preselection is rendered in the Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae) from the Vatican  Congregation for the Doctrine of the Faith (1987): 

Certain attempts to influence chromosomic or genetic inheritance are not therapeutic but are aimed at producing human beings selected according to sex or other predetermined qualities. These manipulations are contrary to the personal dignity of the  human being and his or her integrity and identity. Therefore  in no way can they be justified on the grounds of possible beneficial consequences for future humanity. Every person must be respected for himself: in this consists the dignity and right of every human being from his or her beginning. (2) 

Sex selection through abortion falls under the general prohibition against abortion clearly articulated in the Ethical and Religious Directives for Catholic Health Care Services from the National Conference of Catholic Bishops:   

      Abortion (that is, the directly intended termination of  pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before  viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. (No. 45)  (3) 

The Declaration on Abortion  of the Vatican Congregation for  the Doctrine of the Faith (1974) explicitly affirms the right  to life as independent of considerations of sex: 

The first right of the human person is his life. He has other goods and some are more precious, but this one is fundamental--the condition of all the others. Hence, it must  be protected above all others. It does not belong to society,  nor does it belong to public authority in any form to recognize  this right for some and not for others: all discrimination is evil, whether it be founded on race, sex, color or religion. (4)

   

   1. Gale Largey, "Reproductive Technologies: Sex Selection," Encyclopedia of Bioethics (1978).

 2. Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation  (Washington, DC: United States Catholic Conference, 1987): I.6, pp. 19-20.

3. National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services (1994) (Washington, DC: United States Catholic Conference, 1995).

 4. Congregation for the Doctrine of the Faith, Declaration on Abortion III.ll  in Catholic Mind (April 1975): 54-64 at 58.           

 

COMMENTARY 

SEX SELECTION

  Methods of Sex Selection 

Over the centuries folklore has contained various prescriptions for having a child of a particular sex. For  example, "The Hebrew Talmud suggested that placing the marriage  bed in a north-south direction favored the conception of boys."  (l) In Germany a father was advised to take an ax to bed with  him if he wanted to conceive a boy. (2) Yet other prescriptions  for influencing the sex of the child conceived included having  intercourse in dry weather or when there is a north wind; having  the man wear boots to bed or hanging his pants on the right  bedpost; or having the woman lie on her right side during  intercourse or wear male clothing to bed on her wedding night. (3) 

On a more scientific level, methods which have been examined for conceiving a child of a particular sex (i.e., "sex  preselection") include the timing of intercourse during the  woman's menstrual cycle (4), the time of artificial insemination  (5), the provision of acidic (or alkaline) environments for  sperm (6), the degree of penetration (7), a woman's diet (8), and low or high sperm count within the female tract. (9) Another  method of trying to conceive a child of a particular sex is  to inject the woman with antibodies against androgenic (i.e., male-determining, Y-bearing) sperm or gynogenic (i.e., female-determining, X-bearing) sperm. (10) There has also  been speculation "about the eventual development of a  sex-selection pill which might, for instance, alter the ratio  of androgenic and gynogenic sperm produced by the man, or  induce the woman's immune system to selectively attack and  destroy sperm of one or the other sort." (11) Development  of a diaphragm which would allow only one type of sperm to pass  through has also been suggested. (12) 

Currently the most promising methods of sex preselection  are those involving the separation of androgenic and gynogenic spermatozoa followed by artificial insemination of a woman or  in vitro fertilization with sperm of predominantly one type. (13)  Such methods increase  the probability of conceiving a child of a particular sex. (14)

 Sex selection after conception is also being practiced. Postfertilization procedures involve determining the sex of the child conceived through some form of prenatal diagnosis, such as amniocentesis or ultrasound, and then aborting a child of an unwanted sex. (15)  Yet other methods which may be used for determining sex include removing chorionic placental tissue via the cervix and identifying Y-specific DNA, measuring the level of testosterone (a hormone  produced more in male than in female fetuses) in maternal blood  or saliva, determining fetal hormone levels in amniotic fluid, and assessing fetal blood cells in maternal blood. (16)

 In vitro fertilization (IVF) with preimplantation diagnosis also offers an opportunity  for sex selection: the developing cells can be tested for sex, and only those embryos implanted which are of the desired sex. (17) It is likewise speculated that the experimental procedures of parthenogenesis and the fusion of ova could be  used as sex selection technologies. (18)  (See the entries on In Vitro Fertilization, Preimplantation Diagnosis, and Proposed Reproductive Technologies).

 Reasons Advanced for Sex Selection 

Some reasons given for sex selection are matters of parental  self-fulfillment, e.g., the pleasures associated with one or  the other sex, replacing oneself biologically, carrying on  the family name. (19) In some cultures, such as India, sons  (rather than daughters) are important economically and in  providing support for aging parents. (20) In some cultures  sons are also important for religious reasons. For example,  males carry on the line of ancestors in China, and in Judaism  it is a son who says the Kaddish for a dead father. (21) 

"Quality of life" arguments have also been advanced for  sex selection, namely, that "sex choice would enhance quality  of life more for a child of the 'wanted' sex than a child of  the 'unwanted' sex," that it "would provide better quality  of life for the family that has the 'balance' it desires,"  and that it would provide "a better quality of life for the  mother, because she will undergo fewer births to have the desired  number of children of each sex." (22) Further, sex selection  is viewed by some simply as a more sophisticated form of family  planning. (23) 

An alleged societal benefit of sex selection is that it  will help to limit the population. (24) In the United States,  some parents "keep trying" until they have a child of a specific  sex. (25) It is speculated that, "in other cultures, assurance of having male children--highly valued for economic, religious  and cultural reasons--could have a considerable impact on  population size." (26) 

The aforementioned reasons for sex selection are non-medical  in nature. However, some genetic diseases are sex-linked,  and couples might be motivated to select the sex of their child  in order to ensure the health of the child. (27) 

Ecclesiastical Rationale for Opposition to Sex Preselection 

The Vatican Instruction's rejection of sex preselection  (i.e., attempts to achieve the conception of a child of a  particular sex) is based on the dignity, integrity, and identity  of the human person: 

These manipulations are contrary to the personal dignity of the  human being and his or her integrity and identity. ...Every person  must be respected for himself: in this consists the dignity and  right of every human being from his or her beginning. (28) 

The importance of respecting each individual for himself or herself is a consideration which has appeared in other  discussions of choosing the sex of children. In this vein,  Catholic ethicists Benedict Ashley and Kevin O'Rourke have  made the following comments about sex preselection: 

...Christian teaching shows that it is highly significant to  children that they be accepted by their parents as a divine gift  to be loved for what they uniquely are and not merely because  they conform to the parents' hopes or expectations. At present,  society is becoming more aware of the immense injustice and harm  done to women by cultural patterns and structures that constantly  say to a girl, "You should have been a boy." Sex selection by  the parents either will reinforce this male preference pattern  or, if parents can be reeducated to equal preference, will still  say to the individual child, "You are loved because you conform  to your parents' preferences." This seems an injustice to the  child and further reinforces the cultural message that children  exist primarily to fulfill the needs of the parents rather than  for their own sake. This implication is already built into many  cultural structures, and people have an ethical responsibility  to fight against it. (29) 

The concern that sex selection fails to respect each individual  for himself or herself has also been expressed  by  the President's Commission  for  the  Study  of  Ethical  Problems in  Medicine and Biomedical and Behavioral Research, although in the context  of postfertilization selection. (30) The Commission points out that choosing the sex of children "seems incompatible with the attitude of virtually unconditional acceptance that developmental psychologists have found to be essential to  successful parenting." (31) Hence, "for the good of all  children, society's efforts should go into promoting the acceptance of each individual--with his or her particular strengths and weaknesses--rather than reinforcing the negative  attitudes that lead to rejection." (32) Indeed, the Commission  remarks that sex selection involves an attitude which, "taken  to an extreme,...treats a child as an artifact and the  reproductive process as a chance to design and produce human  beings according to parental standards of excellence...". (33) 

The Vatican Instruction  also states that procedures such  as sex preselection cannot be justified on grounds of "possible  beneficial consequences for future humanity." (34) It has  been claimed, for example, that sex selection procedures would  have the good consequence of alleviating population pressures,  especially in Third World countries. (35) Yet the very accuracy  of this prediction has been called into question. (36) Indeed,  it has been argued in the nonecclesiastical literature that  sex selection may have many harmful consequences (see below  "Nonecclesiastical Arguments Against Sex Selection").

 

Sex Preselection for Sex-Linked Diseases Specifically 

Some genetic diseases, such as hemophilia, Hunter's syndrome,  Cooley's anemia, and Duchenne's muscular dystrophy are  sex-linked, and couples might be motivated to preselect the  sex of their child in order to ensure the health of the child. (37) It might be suggested that distinctions should be made  ethically among various motives for and methods of sex selection,  with this case being a morally permissible use of sex  preselection. (38) 

In dealing with sex preselection, the Vatican Instruction speaks of "certain attempts to influence chromosomic or genetic  inheritance [which] are not therapeutic but are aimed at  producing human beings selected according to sex..." [italics added; 39]. It might be said that sex selection to prevent passing on a sex-linked disease belongs to a different category. Does the Vatican Instruction  leave open the use of sex  preselection in such cases? 

For one thing, the nature of the particular procedure used  for sex preselection would have to be evaluated. As a general  rule, only those reproductive methods and technologies are  permissible which facilitate the natural act of sexual intercourse or assist it to achieve the objective of conception but do not replace it (see the entry General Policy on Assisted Reproductive Technologies (ART) ). Two current  methods  of sex preselection involve a technological separation of  androgenic (i.e., male-determining, Y-bearing) and gynogenic  (i.e., female-determining, X-bearing) spermatozoa followed by artificial insemination with sperm of predominantly one type; one method is also used with in vitro fertilization. (40)  In vitro fertilization is not considered a morally permissible procedure according to the aforementioned principle (see the entry In Vitro Fertilization (IVF) ).  Further, even when the husband's sperm is used for artificial insemination, question could be raised about the method of sperm collection utilized. (41) 

 Suppose, however, that a technique for sex preselection  could be developed which operated within the context of a  substantially complete act of intercourse. Would sex  preselection in the case of sex-linked diseases then be morally  permissible? 

To answer this question, further clarification would have  to be sought from the magisterium. At the present time, the  most that can be said is that the Vatican Instruction  does  not explicitly make an exception for sex preselection in the  case of sex-linked diseases.

 

Sex Selection, Prenatal Diagnosis, and Abortion 

One method of sex selection currently being practiced  consists in determining the sex of the child conceived through some form of prenatal diagnosis and then aborting a child of  an unwanted sex. While it is recognized that abortion is morally impermissible, a further moral question is whether prenatal  diagnosis should ever be undertaken specifically to determine the sex of the child. 

In 1986 the Catholic Health Association of the United States  convened a Research Group on Ethical Issues in Early Human Development and Genetics. (42) This research group explicitly recommended that:            

Institutions and professionals should refuse to  participate in prenatal diagnosis performed solely  for the        purpose of sex selection. (43) 

The research group maintained that such use of prenatal diagnostic techniques "undermines the reason for which genetic testing  and counseling are done: namely, to prevent serious genetic  disease." (44) Further, the group points out that "providing prenatal diagnosis for sex selection runs the risk of setting  precedents for selecting nondisease-related characteristics,  and ultimately of eroding public support for prenatal diagnosis."  (45)

 Outside of the Church, opposition has also been expressed to the use of prenatal diagnosis simply to determine the sex of the child on the grounds that such use of medical technologies represents an inappropriate use of scarce resources. (46) 

 

Nonecclesiastical Arguments Against Sex Selection 

The reasons advanced for sex selection have not been  universally accepted. The claim that the practice of sex  selection would help control population has been called into  question (47), as have the claims that sex selection would  improve the quality of family life and the quality of life  for women (48) and enhance parental self-fulfillment. (49)  In addition, various arguments have been put forward directly  against sex selection.

 The charge has frequently been made that sex selection  is an instance of "sexism," that is, of making a distinction  between sexes that is not rationally justified. (50)  Concomitantly, it has been suggested that the practice of sex  selection "would probably reinforce sexist attitudes both in  those who practice it and in others." (51)  As has been noted by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research:

 In some cases, the prospective parents' desire to undertake the  procedures is an expression of sex prejudice. Such attitudes  are an affront to the notion of human equality and are especially  inappropriate in a society struggling to rid itself of a heritage  of such prejudices. (52) 

It has also been contended that sex selection could have  harmful consequences, especially for women. For one thing,  "evidence exists that most people who want a child of each  sex prefer to have a male first, and that first-born children  are apt to achieve more than later-born children." (53) Thus,  if couples used sex selection to have a male child first, the  advantages of being first-born could go predominantly to  men and, in turn, men on the whole might be better social  achievers than females. (54)   In addition, given the evidence of preference for male children (55), there is concern that  sex selection might upset the male-female ratio in the population  in the direction of a male-dominated society. (56)  A numerical  predominance of males in society could,

 in turn, result in  more violent crime, more commercial sex, and more homosexuality. (57) Finally, sex selection might have a negative psychological  impact on children themselves. Children who are sex-selected "could feel subtly harmed, controlled, or invidiously different  from other children not so conceived." (58) If a daughter  knows that she was "planned-to-be-second," she may "suffer  a loss of confidence or self-esteem." (59) And even if a daughter is first-born, she "may be damaged if she learns that whereas she was not sex-selected, her younger brother was."  (60) Moreover, there is the possibility that a given method of sex selection may fail, with the child of the unwanted sex  experiencing parental rejection or developing feelings of inadequacy. (61) 

It is likewise feared that the use of procedures to select  the sex of children will set a precedent for selecting other  characteristics in children, characteristics which may have  nothing to do with a medical condition. (62) Indeed, question  has been raised about the whole concept of using medical  technology "for nonmedical purposes, simply to facilitate the  wishes of the consumer." (63) 

 

Nonecclesiastical Documents on Sex Selection 

     On the issue of sex preselection, the Council on Ethical and Judicial Affairs of the American Medical Association has taken the position that "sex selection of sperm for the purposes of avoiding a sex-linked inheritable disease is appropriate." (64)  At the same time, the Council  maintains that "physicians should not participate in sex selection for reasons of gender preference" but "should encourage a prospective parent or parents to consider the value of both sexes." (65) 

With respect to postfertilization procedures (viz., prenatal diagnosis  followed by abortion of a child of an unwanted sex), the  President's Commission for the Study of Ethical Problems in  Medicine and Biomedical and Behavioral Research reached the  conclusion that "public policy should discourage the use of  amniocentesis for sex selection." (66) However, the Commission  did not go so far as to recommend legal prohibition of the  practice. (67) The same position of recommending discouragement  of the practice but not legal prohibition was taken by a genetic research group at the Hastings Center. (68)  A consensus development conference of the National Institutes of Health likewise advised agianst the use of prenatal diagnosis for sex selection. (69)

 1. Gale Largey, "Reproductive Technologies: Sex Selection," Encyclopedia of Bioethics (1978),

1440.

 2. Ibid. 

3. Letty Cottin Pogrebin, Growing Up Free: Raising Your Child in the 80's  (New York: Bantam Books, 1981), p. 82; quoted in Mary Anne Warren, Gendercide: The Implications of Sex Selection (Totowa, NJ: Rowman & Allanheld, 1985), p. 6. 

4. "One theory is that the timing of intercourse and conception can alter  the odds of producing a male or female child. Because androgenic spermatozoa  tend to be more numerous, and because they have been thought to be  shorter-lived and faster-moving than gynogenic spermatozoa, it has been  hypothesized that intercourse close to the time of ovulation is more apt  to produce male conception, while intercourse several days prior to ovulation  is more apt to produce females. In a popular book on sex selection published  in 1970, David Rorvik and Landrum Shettles recommended that couples wanting  boys should have intercourse close to the time of ovulation, while those  wanting girls should have intercourse several days prior to that time. However, Elizabeth Whelan, in a competing book, argued that this schedule actually lowers the probability of getting a child of the desired sex. Studies have been done which tend to support each of these contradictory  theories." Warren, Gendercide,  pp. 8-9. See David Rorvik and Landrum B. Shettles, Your Baby's Sex: Now You Can Choose (Toronto: Dodd, Mead & Co., 1970); and Elizabeth Whelan, Boy or Girl? (Indianapolis: Bobbs-Merrill, 1977).

 5. "To confuse matters even further, some researchers have claimed that  the appropriate schedules are reversed in the case of artificial insemination. Guerrero has reported that natural inseminations early and late in the fertile period produce more males than those nearer to the time of ovulation, while  the opposite effect occurs with conceptions resulting from artificial  insemination. It is entirely possible that the time of conception does  sometimes affect the sex of the offspring; but at present the evidence is  so inconsistent that no method of sex selection involving timing appears  particularly promising." Warren, Gendercide, p. 9. See R. Guerrero, "Sex  Ratio: A Statistical Association with the Type and Time of Insemination  in the Menstrual Cycle," International Journal of Fertility  (1970): 221-5. For a summary of research on the influence of the timing of conception,  see William H. James, "Timing of Fertilization and the Sex Ratio of  Offspring," in Neil G. Bennett (ed.) Sex Selection of Children (New York:  Academic Press, 1983), pp. 73-99.

 6. "A second theory is that acidic environments are more favorable to  gynosperm, while alkaline environments favor androsperm. Rorvik and Shettles  recommend the use of acid douches to increase the odds of conceiving a girl,  and alkaline douches to increase the odds of a boy. ...These methods...have  not been proven to be reliable." Warren, Gendercide, p. 9. See David Rorvik  and Landrum B. Shettles, Your Baby's Sex: Now You Can Choose (Toronto: Dodd, Mead & Co., 1970).

 7. "On the same theory, couples wishing to conceive a boy have been advised  to use deep penetration, since the secretions of the cervix are thought  to be less acidic than those of the vagina. These methods...have not been  proven to be reliable." Warren, Gendercide, p. 9.

 8. "A third theory is that fetal sex can be influenced by the mother's  diet in the weeks prior to conception. Stolkowski and Choukroun advise  that a woman who wants to conceive a boy should eat foods high in sodium  and potassium; for a girl, she should eat foods high in calcium and magnesium. The assumption is that a woman's internal mineral balance may affect the  consistency of her cervical mucus, or some other environmental condition  within her reproductive tract, making it more hospitable to sperm of one  or the other sort. Several other researchers have recommended particular  diets for the production of boys or girls. So far, however, there has been  no experimental confirmation of such claims, and most fertility researchers  regard the odds of selecting sex through diet as close to nill." Warren,  Gendercide, pp. 9-10. See J. Stolkowski and J. Choukroun, "Preconception  Selection of Sex in Man," Israel Journal of Medical Science  17 (1981): 1061-7; Sally Langendoen and William Proctor, The Preconception Gender Diet  (New York: Evans & Co., 1982); J. Lorrain & R. Gagnon, "Selection  Preconceptionelle du Sexe," L'Union Medicale Du Canada 104 (1975): 800-3.

9. "A fourth theory is that high sperm counts are conducive to the conception  of males. On this theory, men who want sons should be healthy and well  nourished, wear loose clothing around their testicles, and avoid ejaculating  for several days prior to the attempted conception. Repeated intercourse  on the same day apparently also increases the sperm count within the female tract. (The Talmud advises men who want sons to have intercourse with their wives twice in succession.) Experimental confirmation of this theory is also scant, although it enjoys wide popular acceptance." Warren, Gendercide,  p. 10. 

10. Michael D. Bayles, Reproductive Ethics (Englewood Cliffs, NJ: Prentice-Hall, 1984), p. 34; Richard T. Hull, Ethical Issues in the New Reproductive Technologies  (Belmont, CA: Wadsworth, 1990), p. 205.

 11. Warren, Gendercide, p. 10. 

12. Ibid. 

13. Warren, Gendercide,  p. 11; see also Joyce Bermel, "Selecting a Sex Before Conception: More Men and Hens?", Hastings Center Report 15/3 (June 1985): 2. 

"Sperm separation is the technique that has received the most attention. Sperm contain, among 22 chromosomes, one X or one Y chromosome, which will  determine at fertilization the sex of the offspring. Swimming a sample  in a layered density gradient of protein solution can concentrate Y-bearing  sperm up to 70 percent purity. This technique has been widely publicized  by Ronald Ericsson, and is used in the U.S. laboratories offering selection toward male children. Another technique separates sperm by pouring a sample  through an ionized column of resins. In this case, X-sperm can be isolated a fraction up to 90 percent "pure"...But we have found only one clinical  report...of the use of this technique to select for female offspring!" Betty B. Hoskins & Helen Bequaert Holmes, "When Not to Choose: A Case Study,"  Journal of Medical Humanities and Bioethics  6/1 (Spring/Summer 1985): 28-37 at 30. See Ronald J. Ericsson, "Isolation and Storage of Progressively  Motile Human Sperm," Andrologia 9/1 (1977): 111-14; Ronald J. Ericsson and  Robert H. Glass, "Functional Differences between sperm bearing the X- or Y-chromosome," in Rupert P. Amann & George E. Seidel (eds.), Prospects for Sexing Mammalian Sperm (Boulder, CO: Colorado Associated University Press, 1982), pp. 201-11; O. Steeno, A. Adimeolja, & J. Steeno, "Separation of  X- and Y-bearing Spermatozoa With the Sephadex Gel-filtration Method,"  Andrologia  7 (1975): 95-7; A. Adimeolja, R. Hariadi, I.G.B. Amitaba, P. Adisetya, & Soeharna, "The Separation of X- and Y-spermatozoa with regard  to the Possible Clinical Application by means of Artificial Insemination,  Andrologia  9/3 (1977): 289-92; S.L. Carson, F.R. Batzer, & S. Schlaff,  "Preconception Female Gender Selection," Fertility and Sterility  40/3 (1983): 384-5.

  A more recent technique is MicroSort developed at the Genetics & IVF Institute in Fairfax, Virginia in 1998.  It is based on the fact that X chromosomes have about 2.8% more DNA than Y chromosomes.  By staining sperm with a flourescent dye that latches onto DNA and measuring the glow of the sperm cells under laser light, how much genetic material each one carries can be gauged.  Once the sperm has been distinguished in this way, an automated sorting machine separates the Xs from the Ys.  The separation is then followed by artificial insemination or in vitro fertilization.   Currently, MicroSort is the only validated method for the preferential conception of daughters.  Genetics & IVF Institute, "Microsort" at http://www.givf.com; Frederic Golden, "Boy? Girl? Up to You," Time 152/12 (Sept. 21, 1998) available at http://www.givf.com; E.F. Fugger, S.H. Black, K. Keyvanfar, J.D. Schulman, "Births of normal daughters after MicroSort sperm separation and intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection," Human Reproduction (Sept. 1998) available at http://www.givf.com. 

14. For example, in 1982 Ericsson reported a success rate of about 75 percent  for the conception of boys by his technique. F.J. Beernick & R.J. Ericsson,  "Male Sex Preselection Through Sperm Isolation," Fertility and Sterility  38/4 (1982): 493-5.  Current MicroSort technology offers couples an 85% chance of conceiving a girl, and preliminary results suggest that selection for male children will work 65% of the time.  Frederic Golden, "Boy? Girl? Up to You," Time 152/12 (Sept. 21, 1998) available at http://www.givf.com.

 15. In the procedure of amniocentesis, a needle is inserted through the abdominal wall of  the mother into the amniotic sac which surrounds the fetus, and a small amount  of the amniotic fluid is withdrawn. This fluid contains cells that have flaked off the body of the fetus. These cells are grown in culture for examination of chromosomes and biochemicals. Amniocentesis cannot be performed until 14-16 weeks into the pregnancy because, until that time, there is not an adequate amount of amniotic fluid. Ronald Munson (ed.) Intervention and Reflection, 3rd ed. (Belmont, CA: Wadsworth Publishing, 1988), p. 348;  Orville N. Griese, Catholic Identity in Health Care: Principles and Practice  (Braintree, MA:  Pope John Center, 1987), p. 106; Patricia L. Monteleone,  "Development of the Embryo and Prenatal Diagnosis" in Donald G. McCarthy  (ed.) Reproductive Technologies, Marriage and the Church (Braintree, MA:  Pope John Center, 1988), p. 35;  Ricki Lewis, Human Genetics Concepts and Applications, 2nd ed. (Dubuque, IA: Wm. C. Brown, 1997), p. 64.

      In an ultrasound exam, "sound waves are bounced off the embryo or fetus, and the pattern of deflected sound waves is converted into an image" on a screeen, providing a picture of the embryo or fetus. Lewis, Human Genetics, p. 205.

 16. Hoskins & Holmes, "When Not to Choose: A Case Study," p. 31. See also  Helen B. Holmes & Betty B. Hoskins, "Prenatal and preconception sex choice  technologies: a path to femicide?" in Gena Corea et al., Man-Made Woman: How New Reproductive Technologies Affect Woman (Bloomington, IN: Indiana  University Press, 1987), pp. 18-20.

 17. Warren, Gendercide, pp. 10-11; Holmes & Hoskins, "Prenatal and  preconception sex choice technologies: a path to femicide?", pp. 18-19.

 18. "Still another means of sex selection might arise from the future  discovery of ways of inducing parthenogenesis. In parthenogenetic  reproduction, the ovum begins dividing without fertilization by a  spermatozoon. Many invertebrate species (e.g. aphids, flatworms, and certain arthropods) routinely reproduce asexually through parthenogenesis, as do  several species of fish and lizards. It is possible that parthenogenesis may occasionally occur spontaneously in humans, though no proof of this  speculation is available. Because the human ovum has only an X-chromosome,  the resulting embryo could only be female... parthenogenetic reproduction  has been induced in amphibians through a number of different methods, such  as pricking the eggs with a needle or treating them with antibiotics or  ions. A strain of turkeys has been developed in which many unfertilized  eggs begin to develop, and a few grow to maturity.

 It may also eventually prove possible to induce two human ova to fuse and begin cell division, thereby producing a daughter with two mothers and  no father. Pierre Soupart has reported success in inducing ovular merging  in mice. If this report is correct, then the prospect of success with our  own species may be better than has generally been assumed." Warren,  Gendercide, p. 12.

 19. Peter Steinfels, "Choosing the Sex of Our Children," Hastings Center Report 4/1 (Feb. 1974): 3-4 at 3; Dorothy C. Wertz and John C. Fletcher,  "Fatal Knowledge? Prenatal Diagnosis and Sex Selection," Hastings Center Report 19/3 (May/June 1989): 21-7 at 23; Warren, Gendercide, pp. 172-3.

 20. Wertz & Fletcher, "Fatal Knowledge? Prenatal Diagnosis and Sex Selection,"  p. 25; Bernard M. Dickens, "Prenatal Diagnosis and Female Abortion: A Case  Study in Medical Law and Ethics," Journal of Medical Ethics 12/3 (Sept. 1986): 143-4 & 150 at 144.

 21. Steinfels, "Choosing the Sex of Our Children," p. 3.

 22. Wertz & Fletcher, "Fatal Knowledge? Prenatal Diagnosis and Sex Selection,"  p. 22.

 23. Video Boy or Girl? Should the Choice Be Ours?  Hard Choices series  produced by KCTS/ Seattle (1980). 

24. Wertz & Fletcher, "Fatal Knowledge? Prenatal Diagnosis and Sex Selection,"  p. 22; Warren, Gendercide, pp. 163-66.

 25. Steinfels, "Choosing the Sex of Our Children," p. 3.

 26. Ibid., Tabitha M. Powledge, "Toward a Moral Policy for Sex Choice,"  in Bennett (ed.), Sex Selection of Children, pp. 203-4.

 27. "The ability to separate X- and Y-bearing sperm cells provides new opportunities for women who are carriers of X-linked disorders.  There are over 350 X-linked diseases in humans including hemophilia, Duchenne muscular dystrophy, and X-linked hydrocephalus.  In most cases, the X-linked diseases are only expressed in the male offspring of carrier mothers.  The use of MicroSort for the enrichment of the X-chromosome bearing sperm cells can now allow for the preferential conception of unaffected female offspring."  E.F. Fugger, S.H. Black, K. Keyvanfar, J.D. Schulman, "Births of normal daughters after MicroSort sperm separation and intrauterine insemination, in-vitro fertilization, or intracytoplasmic sperm injection," Human Reproduction (Sept. 1998), available at http://www.givf.com. See also John C. Fletcher, "Ethics and Amniocentesis for Fetal Sex Identification,"  Hastings Center Report 10/1 (Feb. 1980): 15-7 at 15. 

 28. Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation  (Washington, DC: United States Catholic Conference 1987), I.6, p. 20.

 29. Benedict M. Ashley, OP and Kevin D. O'Rourke, OP, Healthcare Ethics: A Theological Analysis, 3rd ed. (St. Louis: Catholic Health Association  of the United States, 1989), p. 317                                                    

30. President's Commission for the Study of Ethical Problems in Medicine  and Biomedical and Behavioral Research, Screening and Counseling for Genetic Conditions  (Washington, DC: U.S. Government Printing Office, 1983), pp. 56-9.

 31. Ibid., p. 57.

 32. Ibid.

 33. Ibid., p. 58.

 34. Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation, I.6, p. 20.

 35. "It is the argument made by the biologist John Postgate in a 1973 article,  an argument more recently taken up by Clare Booth Luce (1978). They argue  that the rate of population increase in the Third World could be slowed  more rapidly and effectively if people could be guaranteed not just the  number but also the sexes of their children. In some less-developed  countries, nurturing a certain number of sons to adulthood is a couple's  best chance for a secure old age. In places where infant mortality is high  and female children are perceived as a drain on family resources, Postgate  asserted, the drive to overproduce sons, partly for status and partly to  assure that some will be around to provide care a generation hence, contends  powerfully and often successfully with any natural (and other economic)  inclination to limit family size. A Man Child Pill--his name for a cheap,  safe, convenient (and, of course, so far unavailable) technology for getting  sons--would, he believed, solve this problem in both direct and secondary  ways: first by its immediate effects on family size, and then by the greatly  reduced number of women in subsequent generations--the rate-limiting factor  in population growth being the number of available uteruses...

    Without referring to Postgate, Luce made exactly the same argument...she  argued...that 'if the world birth rate were only one female baby per two women, world population, instead of doubling, as it is now doing every 34  years, would undouble every 35 years.'" Tabitha M. Powledge, "Toward a  Moral Policy for Sex Choice" in Bennett (ed.), Sex Selection of Children, pp. 203-4. See also Warren, Gendercide, pp. 163-66.

 

36. "Another argument to justify sex selection is that it would help to  limit the population. Families would not have six girls to have their desired  son, for example. But there is no evidence that population trends result  from a desire to have sons. Rather, most families try to have the number  of children that seems most economically advantageous. If they could select  sex, and if one sex presented an economic advantage over the other, some  families might actually have more children than they would have had in the  absence of sex selection." Wertz & Fletcher, "Fatal Knowledge? Prenatal  Diagnosis and Sex Selection," p. 22.

 Mary Anne Warren argues that "the long-term effects of sex selection  upon birth rates are unpredictable, and the scenario painted by Postgate  and Luce might prove to be highly unrealistic." Gendercide, p. 169. For her discussion of the population control argument, see  Gendercide, pp 163-72. Warren also points out that "it is morally objectionable for citizens  of wealthy nations to suggest that Third World nations ought to fight  overpopulation through massive reductions in the number of women." Gendercide,  p. 169.

 37. Hoskins & Holmes, "When Not to Choose: A Case Study," p. 31; Paul R. Gastonguay, "Fetal Sex Determination," America  135/6 (Sept. 11 1976): 123-4 at 124; Warren, Gendercide, pp. 160-3. See also note 27 above.

 38. "It becomes obvious that there are two issues here: l) detecting the  sex of a fetus already conceived and 2) controlling the sex of a fetus to be. It is conceivable that segments of the population might approve one  while disapproving the other. It may be that the Catholic Church could  approve sperm ejaculation in order to isolate the types of sperm desired,  thereby preventing the conception of a severely afflicted child. This would  reduce significantly the numbers of abortions for 'therapeutic' reasons. I would like to see this shift. But the detection of fetal sex with intent  to abort is another matter." Gastonguay, "Fetal Sex Determination," p. 124.

 39. Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation, I.6, p. 20.

 40. See note 13 above.

 41. For example, masturbation would not be a morally permissible way to obtain the husband's sperm.  If sperm were collected during an act of sexual intercourse using a perforated condom (which would be a morally permissible means), some sperm would escape into the woman's genital tract which could possibly result in a conception.  This would defeat the goal of trying to conceive a child of a particular sex, making it unlikely that sperm would be collected in this way for the procedure.  See also the entry Impermissible Cases of Artificial Insemination by Husband. 

42. Research Group on Ethical Issues in Early Human Development and Genetics,  Human Genetics: Ethical Issues in Genetic Testing, Counseling, and Therapy  (St. Louis: Catholic Health Association of the United States, 1990), p. v.

 43. Ibid., p. 39.

 44. Ibid., p. 34.

 45. Ibid., p. 35.

 46. Mentioned in Fletcher, "Ethics and Amniocentesis for Fetal Sex Identification" p. 15; Wertz & Fletcher, "Fatal Knowledge? Prenatal Diagnosis and Sex Selection," p. 23; Gastonguay, "Fetal Sex Determination," p. 124;  President's Commission for the Study of Ethical Problems in Medicine and  Biomedical and Behavioral Research, Screening and Counseling for Genetic Conditions,  p. 56.

 47. See note 36 above.

 48. "Warren claims, moreover, that there is no evidence that sex selection  would result in a better quality of family life; in fact, there are several  ways in which it could worsen it. Sex selection could encourage favored  treatment of a child whose sex was deliberately selected by parents and  result in neglect of existing children whose sex was determined by nature. Sex selection also may occasion conflict about family composition, and,  in societies where women possess little power, foreclose their only chance  to have a girl. In addition, improved quality of life for women by sex choice is an illusion. Warren argues on consequentialist grounds that (assuming persons would act on their preferences, if they could) in most  societies, sex selection would tend to be used against women. Even in the  U.S., where most couples desire to have one child of each sex, there are  preferences for boys. ...We agree with Warren's conclusion that there appear  to be no valid arguments for sex selection on the basis of 'quality of life,'"  Wertz & Fletcher, "Fatal Knowledge? Prenatal Diagnosis and Sex Selection,"  p. 22.

 49. "The sex of the child does not make her or him any more "my" child than  one of the other sex; genetically, parents contribute equally to each child. Women can carry on the family name. They do so increasingly in the United  States by retaining their maiden names, hyphenating their last names, or  using the husband's family name only in society's private sector. In almost  all nations, males and females are now more equal in the capacity to inherit  the estates of parents or others. Any normal pleasure that can be enjoyed  with a child of one sex such as sports, vacation, hobbies, games, art, and  literature can be enjoyed with a child of the other sex. ...Our analysis  does not diminish the power of biologically or culturally based sex  preferences, but the desire itself cannot directly be acted upon, especially  in deliberate choices about sex selection, without a prior admission that  it is irrational to do so." Wertz & Fletcher, "Fatal Knowledge? Prenatal  Diagnosis and Sex Selection," p. 23.

 50. "Also, desire for a boy or girl contains within it preconceptions on sex roles. Powledge, therefore, called sex preselection 'the original sexist sin.' Markle (1981 on the PBS show "Hard Choices") called it 'the ultimate  form of sex discrimination' and further argued that peoples' reasons for  wanting firstborn sons reflect machismo values and sexual prejudice such  as carrying on a family name." Hoskins & Holmes, "When Not to Choose: A Case Study," p. 29.

 "Considerable evidence exists that many men and women...desire male  children. Indeed, many prefer to have a male child first, and then a female. But is it rational to desire a child of a particular sex? A preference  for one sex over the other, for its own sake, is simply sexism. It implies  that one sex is intrinsically more valuable than another, but good reasons  can be and have been given against this view by many authors, so such a desire is irrational."  Bayles, Reproductive Ethics,  p. 14.

 "...the only reason people want a child of a particular sex in the first  place is because of beliefs they have about qualities such a child will  possess. Whether biology dictates any sex role characteristics continues  to be a matter for debate. But it is simply no longer debatable that many  attributes of sex roles quite recently thought innate are actually learned, imposed by the culture." Powledge, "Toward a Moral Policy for Sex Choice" in Bennett (ed.), Sex Selection of Children, pp. 205-6.

 51. Bayles, Reproductive Ethics, p. 36.

 52. President's Commission for the Study of Ethical Problems in Medicine  and Biomedical and Behavioral Research, Screening and Counseling for Genetic Conditions, p. 57.

 53. Bayles, Reproductive Ethics, p. 36.

 54. Ibid. See also Hoskins & Holmes, "When Not to Choose: A Case Study,"  p. 33; and Joyce Bermel, "Selecting a Sex Before Conception: More Men and  Hens?", Hastings Center Report 15/3 (Jan. 1985): 2. For a critical assessment  of this line of argument, see Warren, Gendercide, pp. 138-42.

 55. Warren, Gendercide, pp. 12-13; President's Commission for the Study  of Ethical Problems in Medicine and Biomedical and Behavioral Research,  Screening and Counseling for Genetic Conditions, p. 57.

 56. Steinfels, "Choosing the Sex of Our Children", pp. 3-4; Ashley & O'Rourke,  Healthcare Ethics, p. 317; Warren, Gendercide, pp. 16-7.

 57. Video Boy or Girl: Should the Choice Be Ours?  Hard Choices Series,  KCTS/Seattle (1980); Hoskins & Holmes, "When Not to Choose: A Case Study,"  pp. 32-3. See also A Etizioni, "Sex Control, Science, and Society," Science 161 (1968): 1107-12.  This issue is critically discussed at some length  in Warren, Gendercide, pp. 108-31 (chap. 5, "More Males/More Violence?")  and pp. 151-2.

 58. John C. Fletcher, "Ethics and Public Policy: Should Sex Choice Be  Discouraged?" in Bennett (ed.), p. 248.

 59. Warren, Gendercide, p. 142, reporting Roberta Steinbacher, "Futuristic  Implications of Sex Preselection," in Helen B. Holmes, Betty B. Hoskins,  and Michael Gross (eds.), The Custom-made Child? Women-Centered Perspectives   (Clifton, NJ: Humana Press, 1981), p. 187.

 60. Warren, Gendercide, p. 142, reporting John Fletcher, "Is Sex Selection  Ethical?", Research Ethics 128 (1983), p. 343. 

61. Warren, Gendercide, pp. 173-5.

 62. "Another argument against sex selection--one that anticipates completion  of the human genome map--is that by selecting for sex we set precedents  for attempts to select other characteristics that have nothing to do with  disease, for instance, height, eye and hair color, thinness, skin color,  and straight teeth. Many parents already include some of these  characteristics in visualizing their perfect children. If sex selection  is permitted, will it not be a precedent for other requests from anxious  parents in the next century? Why stop at gender selection? What else will  geneticists be asked to do if and when they can understand and determine  the expression of several genes? Parents could argue that having a child  with 'undesirable' characteristics--shortness, nearsightedness, color-blindness, or just an average IQ would make them miserable, and lower  the quality of their family life (especially if they already had several  such children)--many of the same arguments given for sex selection." Wertz & Fletcher, "Fatal Knowledge? Prenatal Diagnosis and Sex Selection," p. 24. For a critical assessment of this line of argument, see Warren,  Gendercide, pp. 155-8.

 63. Hull, Ethical Issues in the New Reproductive Technologies, p. 207.

 64. Council on Ethical and Judicial Affairs of the American Medical Association, Current Opinions E-2.04; see also E-2.05. http://www.ama-assn.org/apps/pf_online/pf_online?f_n=browse&doc= policyfi...E-2.01HTM.

 65. Ibid.

 66. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Screening and Counseling for Genetic Conditions, p. 58.

 67. Ibid.

 68. Tabitha M. Powledge and John C. Fletcher, "Guidelines for the Ethical,  Social, and Legal Issues in Prenatal Diagnosis," New England Journal of Medicine  300/4 (1979): 168-72 at 172.

 69. U.S. Department of Health, Education, and Welfare, National Institutes  of Health, Antenatal Diagnosis (Bethesda, MD: U.S. Government Printing  Office/NIH, 1979), 1-77.

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