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    Should PGD be used for elective gender selection?

    A discussion of the ethics of the use of gender selection for nonmedical reasons


    Yes. Benefits for family balance outweigh potential risks 

    By John A. Robertson, JD

    Mr. Robertson is the Vinson & Elkins Chair in Law at the University of Texas School of Law, Austin.

    Any talk of sex selection is charged because so many questions are wrapped up in the issue. The methods that may be used--preconception sperm selection, preimplantation embryo screening, and abortion--vary in their efficacy, cost, and moral acceptability. Globally, sex selection is generally used to avoid the birth of females, so the impact on population sex ratios and the role of women in society must be considered. The limits to procreative liberty also have to be discussed. Finally, from the perspective of human dignity, we also should consider whether we should accept yet another technological incursion into how we make families.

    For physicians who treat patients using assisted reproductive technology (ART), sex selection poses a special challenge. In vitro fertilization (IVF) is used to treat infertility, and preimplantation genetic diagnosis (PGD) is employed to avoid the birth of children with serious genetic diseases. Sex selection for nonmedical reasons raises questions about why IVF should be used for this purpose. Indeed, the American Society for Reproductive Medicine (ASRM) says that PGD for sex selection should be discouraged. Unless a woman is already undergoing IVF for other reasons, sex selection requires a stimulation cycle solely for this purpose. Also, embryos will be created and destroyed because of their sex alone.

    Issues of family balance

    I find it useful when unraveling these ethical issues to give strong weight to family balancing (that is, gender variety). Freedom to decide to reproduce or not is important, and should be respected unless there are compelling reasons to limit that freedom. This means that some choice over the genetic characteristics or other characteristics of offspring is included in that liberty, because it is precisely those characteristics—and the expected experience of raising those offspring—that will help couples to decide whether to reproduce.1

    Once we accept that some degree of prebirth choice over a child’s characteristics is acceptable, we must then address the harm that this choice might cause. In the United States, we do not need to fear that PGD for sex selection will upset sex ratios or further entrench patriarchy. Women are treated equally before the law and have ample opportunities for education and employment as well as nearly equal treatment in most relevant respects. Nor is the child likely to be harmed, as long as the technique is medically safe. Even without sex selection parents have expectations for their children that may vary with its sex. Sex selection alone is not likely to drastically increase those expectations, or do so in a way that is unduly harmful to the chosen child.


    John A. Robertson, JD
    Mr. Robertson is the Vinson & Elkins Chair in Law at the University of Texas School of Law, Austin.
    Timothy Hickman, MD
    Dr. Hickman is the Medical Director at Houston IVF, Texas, and a Clinical Associate Professor at both the Weill Cornell Medical ...


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