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Ethical Issues in Genetic Gender Selection

The article “PGD gender selection for non-Mendelian disorders with unequal sex incidence” by David J. Amor and Carolyn Cameron is a 2008 publication in the journal of Human Reproduction, volume 23 number 4 from page 729 to 734. In this article, Amor and Cameron discuss the ethical and clinical considerations of using preimplantation genetic diagnosis (PGD) in selecting for sex of children who are at risk of non-Mendelian disorders whose incidence is unequal in terms of sex. The specific non-Mendelian disorder in this case is autism which has a higher incidence among males than in females.
Article Summary
When determining the provision of PGD as a sex selection procedure for autism, the authors of this article argue that it should be clear that the risk of having a child who has the disorder is high enough. In this regard, Amor and Cameron (p. 730) indicate that the risk of having a child with autism is highest if the couple has at least two children with autism, the risk decreases if there is one child with autism and it is lowest if the parents have no child with autism. It should also be demonstrated that the disorder has unequal sex incidence. In autism, there is a male: female ratio of between 3:1 and 4:1. PGD should also be considered depending on knowledge about the causative gene which can be tested despite the disorder being non-Mendelian. Where the specific cause of autism is known, e.g. Fragile X syndrome it is not very necessary to provide PGD sex selection.
PGD gender selection should also be considered depending on absolute reduction risk. For autism, it is observable that a couple who has no child with autism, gender selection would lead to a very low reduction of risk compared to a couple who have at least two children with autism In addition, PGD gender selection should not be prioritized if the residual risk is high since even the females who are favored have a significant risk of developing autism. PGD sex selection should be determined on the basis of potential harms involved in the PGD procedure. PGD and IVF procedures are associated with almost equal likelihood of developing birth defects among other adverse pregnancy outcomes although information on this field is scarce. For autism, PGD sex selection is a good option because it reduces risk of autism by a higher margin compared to risks reduction of risk if other ART techniques are used.
PGD sex selection is also considered depending on the overall benefits of the procedure compared to associated risks. The PGD procedure should also be determined depending on whether the procedure reduces the risks of the future child (interests of the child). The interests of the family members and other siblings should be considered while determining PGD gender selection. The psychological burden among other burdens borne by parents and children in a family with an autistic child should be considered. Parents also ought to be given procreative autonomy when determining PGD gender selection. If parents feel that they may not be able to support the autistic child, then their autonomy should be respected. The physician should be able to determine whether there are enough reasons to have gender selection for medical reasons.
In conclusion, Amor and Cameron (p. 733) say that offering PGD gender selection in cases of unequal sex incidence should be based on the likelihood of developing the disorder for either gender, the percentage of risk that is reduced when PGD is provided as well as possible harms in PGD procedure. In addition, the authors advise that PGD should be offered depending on how the siblings as well as the entire family are affected by having an autistic child. The procreative autonomy of the couple should also be respected. Finally, Amor and Cameron (p. 733) recommend these considerations as applicable in PGD gender selection requests for other non-Mendelian disorders other than autism.

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