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Draft Ethical guidelines on the use of assisted reproductive technology in clinical practice and research submission

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Comment on specific Sections, clauses or sentences of the draft revised Draft Ethical guidelines
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Appendix 3a

I appreciate the efforts of AHEC and the ART working group in developing scenarios to explore the ethical nuances of sex selection for non-medical reasons (hereafter sex selection). In my view however, there are no strong or convincing arguments to support the use of ART for sex selection in Australia. 

My most basic reason is that sex selection, whether for explicit cultural reasons or for ‘family balancing’ reinforces gender stereotyping and thereby limits the potential of children so selected. All forms of sex selection are predicated on there being deep and essential differences between male and female children such that having a child of one or another sex is critically important. Where there are overt, often culturally based preferences for one sex (usually male), it is easy to make claims about gender stereotyping, sexism and discrimination. Yet these same claims are equally telling regarding prospective parents who choose for family balancing, as their request implies that there is such a difference between the sexes that the benefits and burdens of parenting are only worth taking on for a child of a particular sex. Such a view suggests a strong preconceived notion of what it is for a child to be a boy or a girl, and these notions almost inevitably involve gender stereotypes. For example, it is implausible that parents seek a daughter simply because she will manifest female biological sexual characteristics. Rather, they seek a daughter for reasons that are thoroughly socially gendered, such as expectations about her caring nature, reproductive proclivities, interest in shopping or desire to wear pink etc.   

In turn, these gendered expectations create an unfair burden on selected children, as inevitably, they will be expected to conform to the relevant gender stereotypes that triggered the selection. The expectations may not be conscious or overt, but nonetheless create a certain pathway for that child. This is potentially quite harmful for children who do not adhere to prevalent gender norms regarding behaviour, sexuality and so forth. Every child deserves to be accepted for who she or he is, rather than arriving to fit a set of predetermined expectations. I understand that prospective parents claim that they will, for example, welcome a ‘tomboy’ girl, but it seems unlikely that people would go to such extremes to ensure a specific sex if they truly did not care how feminine or masculine the ensuing child turned out to be.

Next, the significance attached to sex is puzzling. I understand that people feel very strongly that they wish to have a girl or a boy baby, to the point of undergoing expensive and invasive procedures to this end. But if we were to survey Australians about what they value about or wish for their children, it seems that responses would include traits such as kindness, generosity, honesty, integrity, courage, sense of humour and so forth, and that the child will be healthy and happy, rather than whether or not the child in question has male or female genitals. My point here is that is seems bizarre to focus on sex and to valorise this as the key defining feature of a child to be born. I accept that gender is a central part of an individual’s identity, but do not accept that a specific gender should govern the acceptability of a future child.

One question raised in the scenarios is a ‘harm minimisation’ approach to sex selection: given that people travel overseas to access sex selection, and that this can have adverse consequences, should we permit it here to avoid those harms? This is a very weak argument that we reject in other circumstances. For example, some Australians travel overseas to seek organ transplants in countries where there is a commercial organ trade, and of these, some return home with blood borne infections and other health problems. However we do not take this to be a reason to legalise the sale of organs in Australia. I support a public campaign warning of the dangers of seeking sex selection internationally, but do not see these harms incurred by prospective parents as a reason to reinforce gender stereotyping in Australia through deregulation of sex selection. To accept this as a reason seems tantamount to acquiescing to blackmail.

Finally, there is a strong rhetoric in debates about sex selection regarding the strength of the desire to have a child of a particular sex, as if this should carry significant weight. Again, this is puzzling. People often have many strong desires, but we do not usually take this as a reason for the state to facilitate those desires. If as a community, we truly believe that there is a right to sex selection, then this should be freely available on Medicare as it would be unfair to limit fulfilment of the right only to those wealthy enough to pay privately. But is seems implausible to claim that there is a right to sex selection of this magnitude. And if there is not a right, then it is hard to see how people are harmed by not having their desires fulfilled by the state. I understand the liberal view that states should not interfere with the private choices of individuals (ie should respect individual autonomy), but I argue that sex selection is not a solely private choice as it entrenches gender stereotyping based upon harmful gender norms and sexism.

In summary, there do not seem to be convincing reasons to deregulate the use of IVF for sex selection and there are a number of potential harms associated with deregulation. These include harms to society and to the individual children through reinforcing gender stereotypes; and exposing selected children to the otherwise avoidable risks of IVF. In addition, widening access to sex selection fosters the conflation of desires with rights, and supports valorising a feature of humans, their biological sex, in a way that implies that sex is the most important contribution to the worth of that person.     

Page reviewed: 20 April, 2017