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Article Excerpt
INTRODUCTION
Assisted Reproductive Technology (ART) has been used in the United States and around the world for decades to help women become pregnant, most commonly through in vitro fertilization (IVF)--the transfer of fertilized human embryos into a woman's uterus. The ethical issues surrounding in vitro fertilization have received considerable treatment in existing scholarship. As ART advances, however, so does the bioethical debate. Innovations such as sperm sorting and Preimplantation Genetic Diagnosis (PGD) now offer would-be parents the opportunity to select prenatally the sex of their offspring.
Sex selection is the practice of using medical techniques to choose the sex of one's offspring. These techniques include sperm sorting, PGD, and selective abortion. Selective abortion in particular has led to national crises in India and China. In India, the desire for male heirs has created an explosion in the number of clinics that use ultrasound to determine the sex of a fetus and in physicians who perform sex-selective abortions. (1) According to a study by The Lancet, a premier British medical journal, sex selection claims up to 500,000 female fetuses in India every year. (2) Since ultrasound machines were first introduced into India in 1979, an estimated ten million female fetuses have been aborted. (3)
In China, the problem is particularly acute. According to official figures, approximately 119 boys are born for every 100 girls. (4) Selective abortion in China is common; nearly every township clinic has an ultrasound machine, and free abortions are readily available under the one-child policy. (5)
In the United States and other Western nations, there is little evidence that abortion is used for the purpose of sex selection. However, recent medical developments have made a variety of less invasive sex-selection techniques available to would-be parents. As noted in the journal GeneWatch,
[i]n the United States, some fertility clinics are beginning to openly advertise sex selection. For example, several times in 2004, the Sunday Styles section of The New York Times carried an ad from the Virginia-based Genetics & IVF Institute, touting its patented sperm-sorting method. Beside a smiling baby, its boldface headline asked, "Do You Want To Choose the Gender Of Your Next Baby?" (6)
Indeed, some polls suggest that as many as twenty-five percent of Americans, (7) and forty percent of American women being treated for infertility, (8) would prefer to choose the sex of their next baby through preimplantation sex-selection procedures.
This Note analyzes: (1) the ramifications of sex selection in India, China, and the United States; (2) the laws in those nations that currently govern the sex selection issue; and (3) the legal, social, and political steps required to mitigate the growing challenges presented by harmful sex-selection practices. I argue that sex selection is a legal and ethical issue that both individual states and the international community must examine now in order to manage appropriately the repercussions of the practice of sex selection in the future.
I. AN OVERVIEW OF SEX SELECTIVE PROCEDURES
A. Medical vs. Non-Medical Sex Selection
Sex-selection procedures can be divided into two analytical categories: (1) procedures done for medical reasons; and (2) procedures done for non-medical, elective reasons. While there is some debate among doctors, ethicists, and the general public about the level of medical necessity that should justify a sex-selection procedure, most accept that sex selection for medical reasons is beyond ethical reproach, and in some situations, should even be encouraged. (9) However, elective, non-medical sex-selection, which is often performed for social or financial reasons, is the subject greater scrutiny and impassioned ethical debate. (10)
Currently, doctors and geneticists are able to diagnose more than five hundred separate medical conditions in a developing fetus. (11) Among these conditions are devastating genetic diseases such as hemophilia, Down syndrome, cystic fibrosis, Huntington's disease, (12) and Hunter syndrome. For many parents who know they are genetic carriers of a particular sex-linked disease (such as hemophilia), sex selection can increase the likelihood that their child will be born healthy. This is the essence of medical sex selection.
Non-medical sex selection procedures, on the other hand, are undergone for a variety of reasons, but few are as clear-cut as those cited for medical sex selection. As noted by the Ethics Committee of the American Society for Reproductive Medicine (ASRM),
there are at least four prominent motivations that have historically prompted prospective parents to desire a child of a particular gender: 1) a desire to bear and raise children of the culturally preferred gender, 2) to achieve gender balance among children in a given family, 3) to determine a gendered birth order, and 4) to ensure the economic usefulness of offspring within the family. (13)
One woman opined, regarding her own experience with non-medical sex selection, "'I had to have a son this time.... I dreamed that my husband was laughing and tossing the baby in the air. He had stopped doing that when our third daughter was born. His indifference to my daughters was palpable--to me even more so.'" (14) Indeed, the motivations for non-medical sex selection are far-ranging and often emotionally charged.
B. Prenatal vs. Preimplantation Procedures
Sex-selection procedures can also be divided into two technical (and temporal) categories: (1) prenatal procedures; and (2) preimplantation procedures. Prenatal procedures are those that take place after conception and after implantation of the embryo in a woman's uterus. Preimplantation procedures take place even before the sperm or embryo is introduced into the woman's body.
1. Prenatal Procedures
In the first and second trimester, the sex of a fetus can be determined by amniocentesis, Chorionic Villus Sampling (CVS), maternal blood sampling, and ultrasound imaging. (15) Each of these procedures is described in greater detail below. In a prenatal, non-medical sex-selection scenario, the pregnant woman would undergo one of these procedures and, based on the sex of the fetus, decide whether to continue the pregnancy.
a. Amniocentesis and CVS
In the early days of prenatal sex selection, only two options were available to determine the sex of a fetus: amniocentesis and CVS. Amniocentesis involves the withdrawal of a small amount of the amniotic fluid, which surrounds the fetus within the amniotic sac. The CVS procedure involves taking a small biopsy from the placenta. (16) Both of these methods are invasive and carry some risk for both the mother and the fetus. (17) Despite these risks, many women request these procedures. Indeed, some women who have no therapeutic reason to undergo the tests lie about their medical histories in order to convince their doctors that the tests are medically necessary. (18)
The timing of these two prenatal sex-determination methods often leave couples faced with the decision of whether to undergo a selective abortion as late as twenty-four weeks into the pregnancy. Such later-stage abortions--whether selective or therapeutic--often place the mother at higher risk for complications and are sometimes associated with higher levels of guilt and grief. (19)
b. Ultrasound
The expanded use of ultrasound technology in the late 1970s gave would-be parents a faster, less invasive means for determining the sex of a fetus. Using ultrasound imaging technology, health care providers were able to discern the sex of a fetus in the early months of pregnancy. (20) The relatively low cost, simplicity, and accessibility of ultrasounds have made it an integral part of most non-medical sex-selection decisions. (21)
c. Maternal Blood Test
One new and unproven method of prenatal sex determination is a maternal blood test. Acu-Gen Biolab's Acu-Gender test claims to detect not only the specific genetic marker for a male fetus but also the presence of a female-specific biomarker in the woman's blood sample as early as in the fifth week of pregnancy with "an unprecedented sensitivity and specificity." (22) Such a test, if proven accurate and consistent, will provide another avenue for potential parents to receive rapid sex determination results without undergoing invasive procedures and, notably, in the privacy of their own homes.
2. Preimplantation Procedures
Currently, the two preimplantation sex-selection procedures are available:
(1) sperm sorting; and (2) Preimplantation Genetic Diagnosis (PGD). (23) These two technologies present an alternative for would-be parents who would prefer to predetermine the sex of their fetus rather than "waiting and seeing" before deciding whether to selectively abort.
a. Sperm Sorting
Sperm sorting is not a new method of sex selection. While early methods of sorting sperm were generally unreliable, (24) the quantity of sperm that can be accurately sorted and accumulated has improved in recent years. The Genetics and IVF Institute in Fairfax, Virginia, claims to have developed a reliable sperm-sorting technique, adapted from an older technique used in livestock. (25) The process uses a laser beam to detect florescent-dyed chromosomes within individual sperm. (26) Because the X chromosomes have 2.8% more DNA than the Y chromosomes, they glow brighter underneath the laser...
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