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• Author's reply to Michael Andreae
  Bernard Dickens
  Published on: 21 November 2003
• Deeply worried about your guest editorial
  Michael Andreae
  Published on: 21 November 2003
• Gender balance and sex equality: Author's response to the letter by Frances H. Rushworth
  B. M. Dickens
  Published on: 7 February 2003
• Gender balance and sex equality
  Frances H Rushworth
  Published on: 28 January 2003

• Published on: 21 November 2003

  Author's reply to Michael Andreae

  • Bernard Dickens, Professor of Health Law & Policy

  Dear Editor

  It may be most convenient to respond to Dr Andreae’s points[1] in turn:

  1. Unless the claim that a child should determine its own genetic characteristics before it is conceived or born is intended to be flippant, it is logically incoherent. Conception is a decision that only a prospective parent can make. The editorial argument is that denial of choice of sex contributes to preventable maternal...

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  Dear Editor

  It may be most convenient to respond to Dr Andreae’s points[1] in turn:

  1. Unless the claim that a child should determine its own genetic characteristics before it is conceived or born is intended to be flippant, it is logically incoherent. Conception is a decision that only a prospective parent can make. The editorial argument is that denial of choice of sex contributes to preventable maternal mortality and morbidity, particularly in developing countries. None of Dr. Andreae’s concerns addresses the ethics of tolerating the estimated daily toll of 1400 women, an estimated 515,000 women each year, who die of pregnancy-related causes, over 99% of whom are in developing countries of the world.[2] Many deaths are due to pregnancies that come too soon, too late, too often, and too closely spaced in women’s reproductive lives due to pressure to deliver sons.

  2. The second point acknowledges that women’s lives are currently held hostage to multiple pregnancies to produce sons. Opposition to legal reform to relieve this burden tolerates exploitation of women’s vulnerability to repressive laws and policies. Ethical analysis in countries committed to justice between women and men increasingly leads to repeal or amendment of laws that repress women’s choices, to mitigate historic attitudes that treat individual women’s reproductive capacities as subject to public manipulation.

  3. Willingness, reflected in point 2, to maintain women as instruments of state reproductive policies, even for benign purposes, is itself sexist, exploiting existing inequalities that deny women control over their reproductive options. Where son preference prevails, it is increasingly recognized that daughters must also be valued, not least to provide sons with wives and mothers of their children.

  4. Apart from the inherent unreliability of slippery slope arguments as a basis for ethical public policies, extension of the argument for sex selection after birth of a first child to race is pragmatically unwarranted. There is demonstrable maternal mortality and morbidity where sex selection is denied; there is no evidence of the same related to denial of selection for family balancing on other grounds. Policy indicates that women should not be abandoned to preventable deaths to relieve any imagined speculative or theoretical concerns.

  References

  (1) Andreas M. Deeply worried about your guest editorial [electronic response to Dickens BM; Can sex selection be ethically tolerated?] jmedethics.com 2003http://jme.bmjjournals.com/cgi/eletters/28/6/335#66

  (2) World Health Organization, Maternal Mortality in 1995, Estimate developed by WHO, UNICEF, UNFPA (Geneva: WHO, 2001) 2, 42-7.

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  Conflict of Interest:
  None declared.

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• Published on: 21 November 2003

  Deeply worried about your guest editorial

  • Michael Andreae, MD

  Dear Editor

  I am deeply worried about the guest editorial by Dickens.[1] Please see my comments below

  • Trying to dispel some of the counter arguments to sex selection, your argument of prospective parents’ autonomy is void. If anyone has a right to determine his or her sex, it would be the person concerned, in this case the unborn child. Surely, the parents will not have surrogate decision making pow...

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  Dear Editor

  I am deeply worried about the guest editorial by Dickens.[1] Please see my comments below

  • Trying to dispel some of the counter arguments to sex selection, your argument of prospective parents’ autonomy is void. If anyone has a right to determine his or her sex, it would be the person concerned, in this case the unborn child. Surely, the parents will not have surrogate decision making power in the absence of a dire need to make a choice, i.e. due to avoid hereditary sex related disease? Would the child be able to sue the parents for making a bad choice?
  • The threat of neglect or abuse a girl might face, should her ‘deselection’ not be permitted, amounts to hostage taking of the unborn life. Does the same not apply also to the burden a family or society may put on a woman, by forcing her into multiple pregnancies, until she delivers the desperately wanted son? What is more, the fact that a law might be ignored or disregarded, has rarely been an accepted argument for its repeal.
  • In fact, should promale sex selection become widespread in a already sexist society, this would most likely be a prerogative for the affluent and resourceful, reinforcing the existing inequality. Say predominantly male children would be born to privileged parents; they will provide them with more opportunity, leaving the other sex to grow up in even more disadvantaged circumstances.
  • But the slippery slope becomes most obvious if we imagine racially discordant couples wanting to determine their offspring’s race and color, be it based on (justified?) fears about societal abuse, neglect and disadvantage, or their wish to ‘balance their families’, or even only as a matter of taste...

  Reference

  (1) Can sex selection be ethically tolerated. Dickens BM. J Med Ethics 2002; 28: 335-6.

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  Conflict of Interest:
  None declared.

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• Published on: 7 February 2003

  Gender balance and sex equality: Author's response to the letter by Frances H. Rushworth

  • B. M. Dickens, Professor of Health Law & Policy

  Dear Editor

  Injustice and oppression lie in prohibition not for birth of a first child, but of a second or later child.

  B.M. Dickens

  Conflict of Interest:
  None declared.

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• Published on: 28 January 2003

  Gender balance and sex equality

  • Frances H Rushworth, Specialist Registrar in Obstetrics and Gynaecology

  Dear Editor

  Without intervention, a small preponderance of female over male infants will be born, and female children will have a slightly higher chance of living to maturity. Thereafter, the female population will decline relatively sharply in consequence of death in childbirth. Historical evidence indicates that throughout the recorded history of Britain, there was a relative scarcity of women and men dominated...

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  Dear Editor

  Without intervention, a small preponderance of female over male infants will be born, and female children will have a slightly higher chance of living to maturity. Thereafter, the female population will decline relatively sharply in consequence of death in childbirth. Historical evidence indicates that throughout the recorded history of Britain, there was a relative scarcity of women and men dominated social structures. This situation was only reversed in the early decades of the twentieth century, a time when three generations of young men had gone, in succession, to be soldiers. These wars were chiefly fought abroad, and too few returned to provide husbands for all the available women.

  It is no coincidence that this era also saw the real beginning of equality for women. Circumstances dictated that women undertake roles previously considered male, and events proved their ability to do so. The surplus women continued in working careers, perforce, providing role models for those who came after. All the protests of the suffragettes were less effective than this brutal gender imbalance.

  Dickens’ assertion that the present scarcity of girls in India, due to sex selection before and after birth, will lead to a future increased social value for daughters, may be true. However, this will in no way reverse the force of male dominance, since to have value as a wife and a mother is not necessarily to have value as a person. On the contrary, a shortage of wives and mothers will reduce opportunities for these future women to be anything else. Their chance of escaping the present lot of their mothers will be significantly less.

  In the developed world, the birth rate is falling below replacement levels. A first male child is still preferred and a family of less than two children cannot be balanced. To this day, equality of the sexes has not been fully achieved. The injustice and oppression Dickens complains of are present least of all in prohibitions on sex selection.

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  Conflict of Interest:
  None declared.

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