The Ethics of Using Preimplantation Genetic Diagnosis for Sex Selection

Candidate Number: W09855
Critical Bioethics 7SSHM616
The Ethics of Using Preimplantation Genetic Diagnosis for Sex Selection:
A Utilitarian Feminist Perspective
Essay 2
MA Bioethics & Society
November 30, 2015
Word Count: 2,999

The Ethics of Using Preimplantation Genetic Diagnosis for Sex Selection in the United States:
A Utilitarian Feminist Perspective
Introduction
Preimplantation genetic diagnosis (PGD) is a technology that is able to test embryos for
various genetic traits and is an option available to American parents undergoing in vitro fertilization
(IVF). PGD screening is commonly used to detect genetic diseases, but is also able to determine the
sex of the embryo, creating the potential for embryos to be selected for implantation based on sex.
In this paper, I will examine the ethics of PGD sex selection in the United States from a utilitarian
ethical perspective (which seeks to maximize well-being). I will examine the benefits and harms of
sex selection, referring to past ethical writing done on this topic, and then conclude by arguing,
from a feminist perspective, that sex selection perpetuates assumptions about sex and gender that
bolster systems of oppression, and that any version of utilitarianism that supports maximizing the
happiness of the oppressed would conclude that the harms of sex selection outweigh the benefits,
making it unethical.
PGD Sex Selection in the United States
For parents in the United States who undergo the IVF process (fertilizing the eggs and
creating the embryos outside of the body) for pregnancy, PGD is a technological service that is able
to screen the embryos for genetic traits. PGD is typically used to identify genetic disorders, but is
additionally capable of identifying the sex of the embryo with almost 100% accuracy (World Health
Organization, 2015). The embryologist removes one or two cells from the laboratory-grown
embryos for PGD testing, and the results allow parents to select the most desirable embryos for
implantation (Human Fertilisation & Embryology Authority, 2014). The ethical significance of
PGD screening as a method for sex selection is that parents are able to select for sex at a very early
stage of embryonic development before the pregnancy even begins. Compared to methods such as
Candidate Number: W09855; Critical Bioethics 7SSHM616; Essay 2
2

sex-selective abortions, which involves the termination of a healthy pregnancy at typically 8-20
weeks into its development, PGD methods for sex selection may have fewer negative ethical
implications by taking place at such an early stage. While PGD can be used to select for sex for
medical reasons, such as to avoid sex-linked genetic diseases, this paper will not be addressing the
ethics of sex selection for medical reasons. I will instead be focusing on the ethics of non-medical
sex selection, in which one sex is desired over another due to preference.
In the United States, PGD for sex selection is not currently banned or limited under any
federal or state laws (Deeny, 2013, p. 340). The availability of PGD is largely determined by
individual fertility clinics that develop their own policies towards PGD sex selection according to
the vision of their establishment. In a study of 415 American assisted reproductive technology
clinics undertaken by the Genetics and Public Policy Center, researchers found that 35% of clinics
revealed the sex of embryos and complied with selecting embryos based on sex; 15% revealed the
sex of embryos, but only complied with selecting embryos based on sex if parents were selecting
sex for second or subsequent children; 30% would reveal the sex of embryos and comply with
selecting embryos based on sex if asked directly by families, but did not volunteer this information
without being asked; and 18% either never reveal the sex of the embryos, or transfer the best
embryos with no regard to sex (Baruch, 2008).
The Utilitarian Ethical Approach
Utilitarianism is defined by philosophers Julian Savulescu and David Birks (2012) as an
ethical approach where an action is right if and only if it maximizes well-being. The harms and
benefits of a potential action are weighed against each other, and the right action will be that which
is able to promote or create the most well-being for humanity. It is worth noting that there are
several versions of utilitarianism that approach the concepts of “well-being” differently, but for this
paper I will use the general understanding and definition of utilitarianism; that an action is ethical if
3

and only if it maximizes humanity’s well-being, and an action is unethical if it creates harms that
detract from humanity’s well-being.
Looking at the ethics of PGD sex selection in the United States through a utilitarian approach
will seek to determine what kinds of consequences are produced through PGD sex selection, who is
affected by the consequences, whether the consequences are benefits that promote well-being or are
harms that detract from or inhibit well-being, and whether the benefits to humanity outweigh the
harms. I will start by examining the possible benefits of PGD sex selection, followed by the
potential harms, referring to past literature and ethical work published on this topic.
One way that PGD screening for sex selection could maximize well-being is by supporting
reproductive autonomy for parents and giving them the opportunity to choose the sex they desire for
their child. Philosopher Edgar Dahl has argued in favor of sex selection methods (including PGD
and insemination sex selection), under a principle of “procreative liberty,” asserting that societies
should be based on a “presumption in favor of liberty” in which citizens are free to live their lives
and reproduce how they choose so long as it causes no harm to others (2003, p. 380-381).
Philosopher Mary Anne Warren (1985, p.104) argued that women’s reproductive autonomy should
never be limited, and went as far as to defend sex-selective abortion (a sex selection method that
arguably has harsher ethical implications) as a “moral right.” There are many reasons parents could
desire one sex over another, ranging from a simple matter of preference to cases where a child of
one sex is very important for a family (for example, needing a male child to inherit the family name
in a patrilineal culture). Parents may also prefer one sex over the other for the purpose of “family
balancing”: having one or more children of only one sex and hoping that the next child can be of the
opposite sex. The Genetics & IVF Institute (2015), a fertility center in the Washington D.C.-area
which offers PGD sex selection for family balancing, states that many families have a strong wish
to “complete” their families with a balanced sex representation. A final way that the option to select
children based on sex could maximize happiness or well-being is by preventing the birth of a child
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to parents who desired the other sex, and are thus unable to accept or love a child of the undesired
sex fully. A utilitarian may consider that it would be better for both the parents and children that
parents are free to give birth to the sex they desire so the greatest possible love could be given to the
child.
The benefits of sex selection would be experienced most directly by the parents in each of
these three scenarios, who would have their well-being maximized by being free to make their own
reproductive choices and conceive and birth the type of child they desire. In the final scenario, the
child would also benefit from being fully loved and accepted by parents. These are the most
apparent benefits of PGD sex selection, and now they will need to be weighed against potential
harms.
A common concern for all methods of sex selection (including PGD sex selection) as stated
by the World Health Organization (2015) is that sex selection would “distort the natural sex ratio
leading to a gender imbalance.” These concerns are primarily fueled by the imbalanced sex ratio in
countries such as China that have been selecting for sex within a society that has a strong preference
for males over females. Another concern is that of discrimination. The Ethics Committee of the
American Society of Reproductive Medicine (1999, p. 596) emphasized concerns about PGD sex
selection by stating that it had “potential for inherent gender discrimination. . . and reinforcement of
gender bias in society as a whole.” The harms suggested in these examples would be harms
experienced by society as a whole. It is a fact that in China, the sex imbalance has lead to numerous
social issues. For Chinese men who cannot find wives, they can be stigmatized for their single
status and become vulnerable to poverty and criminal behavior for not achieving the privileged
social status that comes with marrying and having a family (Hudson, 2005, pp. 21-22). Additionally,
the lack of women has lead to an increase of kidnapping and trafficking females from inside and
outside of China (Hudson, 2005, pp. 22-23). The strong cultural preference for male children also
5

demonstrates how sex selection against females in China can be inherently discriminatory, and how
such practices can reinforce sexist cultural attitudes.
Bioethicist Julian Savulescu and philosopher Edgar Dahl challenged these worries over sex
selection in the west in an article written in response to the statement made by the Ethics Committee
of the American Society of Reproductive Medicine. While an imbalanced sex ratio is certainly a
risk for countries with a strong preference for one sex over another, Savulescu and Dahl (2000)
build an argument on empirical evidence that western societies do not to have a preference for one
sex over the other, and conclude by asserting that the concerns over a sex ratio imbalance
happening in Western nations are “highly speculative.” If it can be demonstrated that the United
States has no clear preference for one sex over another, utilizing PGD for sex selection in the
United States may be highly unlikely to create a nation-wide sex ratio imbalance as it has in China.
Savulescu and Dahl (2000) also addressed the worry that selecting based on sex always counts as
discrimination, arguing that most couples desire sex selection solely for family balancing, and that
family balancing motives cannot count as discrimination or gender bias. “Since their choice is
simply based on the gender of already existing children, and not on the absurd assumption that one
sex is ‘superior’ to another, the claim that these couples are making a sexist choice is an unjustified
accusation.”
While Savulescu and Dahl’s responses erase some of the worries of sex ratio imbalance and
sex discrimination that could count as harms of sex selection, an additional worry for sex selection
is addressed by bioethicist Tamara Kayali Browne (2015): “Why might parents seek non-medical
sex selection? It seems clear to me the primary reason is not to select the child’s sex, but his or her
gender.” Feminist philosophy has made distinctions between sex and gender, because where the
former is grounded in biology and is considered to be present at birth, the latter is socially
constructed and manifests throughout a person’s development. The idea that gender expression or
behavior is determined by one’s sex is a type of biological determinism, which is a concept that
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most feminists tend to reject in favor of emphasizing the role of environmental and social influences
(Stanford Encyclopedia of Philosophy, 2011). (For the remainder of this paper, I will use male/
female to refer to sex and man/woman to refer to gender.)
Selecting for gender is a concern for Browne (2015), because “assumptions and stereotypes
regarding how each gender should be, act, excel at and strive for, underlie the sexism that pervades
our societies.” Historically, such rigid ideas about gender have furthered oppression and harmed
members of society that were eager to break out of gender roles. A belief that females are naturally
emotional and motherly in a way that males are not has justified excluding them from roles
traditionally occupied by men and forcing them into roles traditionally for women. Transgender
people, who are pressured to identify with the gender that corresponds to their sex, have had higher
rates of suicide, depression, and anxiety from not feeling free to identify with the gender that best
fits their identity (Reisner, 2015, p. 274). Rigid gender roles limit freedom and opportunity. They
reinforce and justify sexism and discrimination. They suggest that criticizing or bullying others who
diverge from the gender norms can sometimes be justified. Browne (2015) believes sex selection,
even for family balancing, “is a product of, and perpetuates, false assumptions about gender that
keep men and women ‘in their places.’”
How would a utilitarian respond to systems of societal oppression? John Stuart Mill (1869),
one of the early proponents of utilitarianism, in his essay “The Subjection of Women,” argued that
“the legal subordination of one sex to another - is wrong in itself, and now one of the chief
hindrances to human improvement.” Corresponding with the hedonistic utilitarian model adopted
by Mill (Savulescu, 2012), granting women equality in marriage, the right to vote, and access to
education were needed steps for maximizing pleasure and happiness for women and bettering
society (Mill, 1869), and thus were utilitarian goals.
Mainstream feminism maintains that ending rigid gender roles is a crucial step in creating
greater equality and erasing oppression (Anne, 2011; Culp-Ressler, 2014). For utilitarian models
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that believe eliminating oppression maximizes the good, such as the utilitarianism of Mill, erasing
institutions or ideas that strengthen or reinforce rigid gender roles will be an essential step for
eliminating or breaking down oppression.
Does sex selection count as a practice that perpetuates and reinforces oppressive gender roles,
as Browne believes, and is that claim sufficient to assert that PGD sex selection is unethical within
a utilitarian model? If it is true that all parents who wish to select for sex actually desire a specific
gender, then it is misguided for parents to believe they could achieve “boyhood” or “girlhood” for a
child by selecting for sex. It also seems clear that insofar as sex selection involves misguided ideas
about sex and gender, a legitimization of sex selection would involve a legitimization of these
misconceptions. I maintain that sex selection does have power in reinforcing oppressive ideas about
sex and gender, but does this make it unethical within the utilitarian model? Mill (1869) believed
that the oppression of women was such a blight on society that ending their subjection was an
obligation that trumped the risks of disturbing the status quo or minimizing the comforts and
privileges of those in power. Under Mill’s stance against oppression, in conjunction with Browne’s
argument, I maintain that legitimizing PGD sex selection is unethical within a utilitarian approach.
While some strong connections between PGD sex selection and oppressive ideas about sex
and gender can be seen, it could be argued that while a connection does exist, PGD sex selection’s
contribution to overall oppression is minimal, and thus unlikely to have a significant impact on
society. When parents undergo IVF and must choose some embryos over others, how would letting
sex be the deciding factor in such a choice have harmful and far-reaching consequences? Under
utilitarianism, if the harmful impact to society can be shown to be minor or insignificant, it may not
outweigh the benefits to parents or children that can come through the freedom to use PGD to select
a desired sex.
My response is to argue that if it is agreed that sex and gender oppression is harmful to
society, and that a utilitarian approach would seek to dismantle such oppression to maximize well-
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being, if PGD sex selection contributes to this oppression, it is a practice that should not be
supported, even if its contribution to oppression could be shown to be small. I shall use two
examples to explain this argument: First, imagine if the idea that sex determines gender and
behavior was completely erased from society. Would sex selection still be a valid or legitimate
practice in such a world? Since sex selection rests on the assumption that parents could achieve a
particular gender expression by selecting for sex, it seems impossible that such a practice could be
accepted in a society that wholly embraced the idea that gender expression and behavior are not
determined by sex. If PGD sex selection cannot exist in a future free of oppressive ideas about sex
and gender, it cannot be overlooked or ignored in the present. Second, feminist efforts to dismantle
systems oppression have focused largely on winning small victories throughout history by fighting
the larger problem one piece at a time. In a time where women were viewed as inferior, women
fought to be viewed as equal to men by winning the right to vote, achieving equal educational
opportunities, and achieving equal work opportunities. If large systems of oppression can only be
dismantled one piece at a time, all the pieces that can be proven to contribute to oppression must be
addressed eventually, no matter how small. Even if PGD sex selection can be shown to minimally
contribute to the overall oppression, it is a practice that is intrinsically tied to these oppressive ideas,
and thus cannot be supported by those with a vision to see these oppressive ideas dismantled.
Conclusion
There are some common ethical concerns in regards to PGD sex selection, such as creating a sex
ratio imbalance and discriminating based on sex. While bioethicists such as Savulescu have made
strong arguments that minimize these risks and demonstrate the benefits of sex selection, there is
still a potential harm to society that the utilitarian ethical approach needs to consider, and that is of
how sex selection could reinforce rigid gender roles and oppression. Browne argued that selecting
based on sex perpetuates harmful misconceptions about sex and gender, and that that was a
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sufficient reason to assert that sex selection is unethical. I argue that PGD sex selection has the
power to reinforce misconceptions about sex and gender that contribute to oppression, and that
under the utilitarian model held by utilitarians such as Mills, who took a strong stance against
oppression, and from feminist assertions that erasing misconceptions about gender is an essential
step in ending gender role oppression, I maintain that PGD screening for sex selection is unethical.
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