There are things about one's life and especially about one's
children that cannot be known in advance and to which it would
be foolish to assume a right outcome or a wrong one. How, for
example, could you possibly know whether you and your family
would be better off having had a boy child and then a girl,
or a girl first, or two girls or two boys? What would your standard
for comparison be? Which child would you have given up in order
to have had the imaginary right family? You might have thought
you wanted a girl, and then gotten one not at all like the girl
you expected-not gentle, not Barbie-doll loving, utterly unlike
your childhood self. You might have thought that having one
child of each sex was perfect, and then found that family harmony
eluded you nonetheless. Certainly, the more precise your expectations
of your children and the more convinced you are that those expectations
can be met (indeed, that you deserve to have them met), the
more disappointed you are likely to be. Without some humility
in the face of the unknown and unknowable-without some fundamental
willingness to accept and to love whatever child you get-parenthood
would be a very different, and a lesser, thing.
One might think that all this would be obvious to anyone who
was ever part of a family, or read a novel about one. But in
an era when people can shop, online, for sperm and egg donors
of specified height and hair texture and IQ-in an era, in other
words, of consumer-driven, privatized eugenics-it's easy to
forget about what we cannot control or predict. In this environment
radical reproductive technologies tend to slide into use when
someone wants them and can pay. There's always at least one
fertility doctor out there who will do anything, no matter how
risky or ethically dubious. Religious absolutists fume; free-market
purists and biotech groupies celebrate; and the rest of us scratch
our heads, troubled by a vague sense that something's wrong
here.
For several years now clients of an infertility clinic called
The Genetics and IVF Institute, in Fairfax, Virginia, have had
access to a sperm-sorting technique that allows them to choose-with
about 90 percent reliability for girls and 73 for boys-the sex
of their child. Some people use this service to avoid passing
on serious diseases that can be inherited only by boys. But
most use it for what might be called social or aesthetic reasons:
they think one child of each sex makes for the ideal family;
they have particular goals for their children, which they imagine
are best fulfilled by one sex or the other. For these customers
the Genetics and IVF Institute has a principle: it's called
"family balancing," and it means that institute doctors
will do the procedure only for people who already have one or
more children of one sex and want a child of the opposite sex.
This is supposed to be an answer to the charge of gender discrimination,
the charge that by offering this service they are catering to
people who value one sex over the other-people like the parents
in India and China who have substantially upset the balance
of the sexes in some regions by aborting (categorically undesirable)
female fetuses. But because most of the clients using the sperm-sorting
method presumably did not use it the first time around (and
therefore had to take whatever they got), there's no guarantee
that they do not value one sex over the other.
Still, the problem with this method, as far as some people
are concerned, is not that it is being marketed at all but that
it is not quite accurate enough. A more sophisticated, fail-safe
method of sex selection uses pre-implantation genetic diagnosis
(PGD)-a procedure by which embryos created outside the body
can be tested for certain genetic disorders before they are
transferred to the uterus. In this case, sex is treated as a
disease-something to be screened for, like Huntington's chorea
or cystic fibrosis. Clients can pick a boy or girl embryo and
discard the rest. The Genetics and IVF Institute is already
offering PGD for family balancing, but quietly; neither their
Web site nor their literature mentions it.
This use of PGD had a brief airing in the news last September,
when an enterprising fertility doctor named Norbert Gleicher
sought the blessing of the American Society of Reproductive
Medicine to start offering this service. John Robertson, the
acting chair of the ASRM ethics committee, gave the go-ahead,
but a small flap ensued when it transpired that Robertson had
acted on his own. This proved slightly embarrassing for the
ASRM, which had in 1999 issued a statement discouraging the
use of PGD for sex selection on the grounds that it undercut
the "acceptance of offspring for themselves and not their
nonessential characteristics" and that fertility treatment
posed "health risks and burdens" and should not be
undertaken whimsically. But the truth is that the ASRM ethical
pronouncements lacked teeth, and there is no other regulatory
body equipped to stop sex selection-or almost any other gene-shopping
innovation.
The real trouble with sex selection goes beyond sex discrimination.
The real trouble is that it allows us, for the first time, to
use a medical procedure to select or reject a child on the basis
of a characteristic that has nothing to do with life and death,
that is not in any sense of the word pathological, that cannot
possibly be construed as sparing a child any pain and suffering.
It might sound harmless enough, maybe even kind of cute-this
impulse to pick and choose, pink or blue. But if we allow people
to select a child's sex, then there really is no barrier to
picking embryos-or, ultimately, genetically programming children-based
on any whim, any faddish notion of what constitutes superior
stock. This time the old and overused accusation would actually
be true: we would be playing God-and none too well, in all likelihood,
given how little we really know about what makes individual
human beings the way they are. A world in which people (wealthy
people, anyway) can custom-design human beings unhampered by
law or social sanction is not a dystopian sci-fi fantasy any
longer but a realistic scenario. It is not a world most of us
would want to live in.
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