Alan and Louise Masterton had the perfect family-almost. After losing their only daughter in a 1999 accident, the Scottish parents of four boys longed for a girl to complete their family. But Louise Masterton had been sterilized after her daughter's birth. In vitro fertilization and genetic gender selection renewed the couple's hopes, only to have them dashed in October 2000 by the Human Fertilization and Embryology Authority, the Scottish agency that bans gender selection from in vitro fertilization unless there's a risk of genetic disease.
As the Mastertons contest the ruling, the controversy surrounding gender selection enters the international spotlight. Most people condone sperm sorting, by which X- and Y-carrying sperm are separated before fertilizing the egg, but tempers flare when gender selection occurs after fertilization. Genetic counselors, theologians, and policy makers struggle with the dilemma: Is it ethical to create multiple embryos to screen for genetic qualities? And what rights do patients have in making genetic requests?
Some argue gender selection reduces an offspring's risk of gender-linked genetic diseases, but others counter it unleashes potential for gross misuse in a quest for designer babies. Unfortunately, no simple answers exist, says Rabbi Nathan Goldberg, the Jewish chaplain for Greater Kansas City, Mo., hospitals. "There are many clear-cut cases where gender selection would and would not be genetically warranted," he says. "At this point, rabbis don't have any hard and fast rules to go by. We can see the potential for good use and misuse."
Goldberg and his peers agree gender selection should be determined on a case-by-case basis for now, given technology's rapid advancement. He understands couples such as the Mastertons, who want a girl to complete their family, as well as parents who want to protect their children from disease. But he also fears those cultures that devalue women and abort female fetuses. Then there are those who want their child to be the next Michael Jordan.
A brave new world
Eradicating disease and enhancing humans' survival rate is important, but Nigel Cameron, PhD, worries that some advances compromise a child's dignity. Chair of the International Advisory Board for the Center for Bioethics and Human Dignity at Trinity International University in Bannockburn, Ill., Cameron deals with tough genetic issues, even testifying before Congress urging a ban on human cloning. He says it's important that technology doesn't spiral out of control. Human genetic manipulation offers mankind miraculous benefits-and potential corruption. He calls for prudence.
"The public is squeamish and thinks [genetic counseling] is a pro-life vs. pro-choice issue because it sometimes involves abortion counseling," he says. "But it's about the dignity of those born with genetic diseases and other [flawed] characteristics. I think we can embrace technology in a way that's consistent with our view of human dignity and go forward with restraint."
Cameron, trained as a minister, urges more public involvement in bioethical issues, especially in this age of fast-paced technological advances. "We read about a new advancement after the fact on the front page of The New York Times and sense that we're being ambushed," he says. "It's in everyone's best interest if the public, biotech companies, policy makers, and public interest groups work together to establish some sort of formal public debate or consensus-building forum."
In America, unlike Scotland, government intercession is way down the road, says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania Health System in Philadelphia. Citing the Masterton case, Caplan says genetic counseling is controversial in America because it delves into abortion, autonomy, and privacy issues.
True, there haven't been any high-profile cases like the Masterton's in the United States, but Caplan points out that it's been 22 years since the first test-tube baby and still no government interference. Legal wranglings, yes, but no regulations or laws.
"I argue that we should have some sort of formal committee, but the government will never draw that line because it's too controversial," says Caplan, who serves as chairman of the Advisory Committee to the Department of Health and Human Services. "The public is nervous about reproductive rights, but there's no consensus on any issue. We could look to Britain as a model: The country throws away frozen embryos after five years, but we can't figure out what to do with them."
Besides protecting children, Caplan believes formal standards will also help ensure equal access. He says insurance companies must fully cover genetic counseling to ensure everyone benefits.
"Religious leaders are more wary of this issue than others and worried that the haves will benefit more than the have-nots," Caplan says. "That's a legitimate concern. If we don't guarantee that genetic counseling will be covered by health insurance, the poor won't get in."
Listening to all arguments, good and bad, Goldberg says he still wavers on forming a definite opinion. "Some say, `Let God be God,' and `We shouldn't be involved,'" he says. "But others say, `God's way is through medical advances, and we shouldn't get in the way of that.'"
For now, he and other religious leaders remain hopeful that if offered the option to select for genetic characteristics, humankind will uphold the highest moral ideals.