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This chapter addresses the issue of ‘social’ sex selection (sex selection for reasons other than the avoidance of sex-linked disorders). After outlining the legal and regulatory context in the UK, it examines the view that ‘family balancing’ sex selection is morally preferable to other (‘social’) forms and should enjoy a relatively privileged (moral and/or legal) status. It concludes that ‘family balancing’ is not (or need not be) any better than other forms of sex selection. The remaining part of the chapter considers the more fundamental question of whether any form of sex selection is permissible and reviews several further arguments against it. The conclusion ultimately arrived at is complex. It is argued that while sex selection is not intrinsically or necessarily wrong, many actual instances of it are, either because of their negative effects (for example, on population sex ratios) or because they are based on sexist beliefs and attitudes.

Cases illustrating variables relevant to women’s decisions about preconception counseling, preimplantation diagnosis, prenatal testing, misattributed paternity, and sex selection are presented. For each topic, empirical and theoretical factors are discussed from an “egalitarian perspective” that imputes privileged status to the standpoint of those who are “nondominant”, i.e., those whose input tends to be neglected. Implications of different positions about moral status of fetuses are also considered.

The development of IVF has enabled clinicians to gather facts about an embryo's genetic make-up before it is implanted in the uterus. This in turn enables parents and clinicians to make choices about the characteristics they want to select. This chapter discusses the use of pre-implantation genetic diagnosis to identify embryos that will suffer from disease. A case of parents seeking to choose deaf embryos is explored, and the difficulties of establishing reasonable parameters are highlighted. The possibility of choosing trivial characteristics such as hair or eye colour is considered, and the dangers of eugenics are discussed. Case studies involving sex selection, and the selection of an embryo as a tissue match for an existing child are also analysed.

This chapter analyzes the case of Mrs M, a thirty-four-year-old mother of three daughters who lives in a modest home on the outskirts of a large city with her forty-year-old husband. He is often unemployed and in poor health. Mr and Mrs M strongly feel they need a son for support in old age. Health services are available at low cost at the local public hospital, where Mrs M arrives when she is about ten weeks pregnant. Mrs M asks Dr B whether she can have a test to determine if the foetus is male or female. Mrs M says that she would be willing to continue the pregnancy only if she would have a son. It discusses what responsibilities Dr B has in this case, taking account of the key medical, ethical, legal, and human rights principles.

Transitions among sex-determination systems and mechanisms are manifold and surprisingly frequent. The ultimate causes for such transitions are classified in three main categories: i) neutral processes, ii) fitness differences between sex phenotypes (stemming e.g. from sexually antagonistic mutations or accumulating mutational load), and iii) sex-ratio selection, arguably the most important evolutionary force triggering transitions. Sex-ratio selection may result from changes in population structure or environmental conditions, or from conflicts between genetic elements. Intergenomic conflicts may arise from differences between parents and offspring over optimal sex allocation, and intragenomic conflicts from differences in inheritance modes. The latter may have led to the control of sex determination by endosymbiotic microbes, and ensuing evolution towards haplodiploidy. Open questions in this area include why turnover rates differ between lineages, whether particular sex-determination systems are more labile and some transitions more likely to occur, and whether particular chromosome pairs are more likely to evolve into sex chromosomes. It is argued that experimental evolution approaches offer a promising way forward.

This chapter gives a brief overview of the current terrain of abortion debate in the UK, covering calls for decriminalisation as well as debates on sex-selection, disability and pre-abortion counselling. It argues that the classic image of abortion politics as a war between ‘pro-life’ and ‘pro-choice’ actors cannot adequately accommodate these recent developments – nor does it fit with how abortion debates have actually unfolded in Britain historically. Instead, it offers an interpretation of abortion law as resting on a coalition between government and medical actors formed to govern women’s reproductive decisions. The chapter closes with an overview of the book.

This conclusion summarizes the key arguments of the book, including the many assumptions it challenges about the history of eugenics and the history of American religious leaders in the early half of the 20th century. It is clear that American religious leaders embraced eugenics when they departed from the traditional tenets of their faith, and that they did so in an effort to find new methods of social reform to suit a time of often-bewildering social and cultural change. This chapter also ties the history of eugenics to current debates in bioethics, revealing the continuities and discontinuities in hereditarian thinking from the previous century into the present. It is argued that the peculiar history of eugenics in the United States in the early-to-mid 20th century has fundamentally shaped the way genetic technologies is discussed in the twenty-first century. An understanding of that history — particularly the history of the ethical and theological debates that occurred — is necessary as we enter a new era of genetic science.

The population Census 2011 re-alerted the problem of declining child sex ratio (or CSR, measuring those in the 0–6 year range) which dropped from 927 in 2001 to an all-time low of 914 in 2011. Gender has become both naturalized and a critical instrument in the undisputed aim to control the population, while not allowing the number of females to drop unduly. The inclusion of information on literacy and the ‘positive’ figure of increased literacy among girls and women are part and parcel of the drive towards ensuring fewer births. There are significant relationships between adverse CSRs and gender discrimination and therefore it becomes an even greater challenge to look more closely at questions relating to law and policies—those that the government has been promoting specifically to combat the skewed sex ratio—and also other issues, whose effects on the life chances of girls may not be so obvious, but are nonetheless critical.

This chapter attempts to outline a logic, taxonomy, and justification for the notion of symbolic harm as legal harm, and to apply it to the practices of contract pregnancy and sex selection. Both these practices (and others, for instance, the retrieval of germ cells from aborted female foetuses for in vitro fertilization) stimulate consequentialist objections and raise worries about the interests of women. However, once the dust settles around such debates, there is a deontological residue which has yet to be captured and analysed within our legal framework. Although symbolic harm alone may not ‘trump’, it is important to recognize its role as sometimes a symptom, sometimes a constituent, and sometimes a herald of harmful practices. Where practices are novel, developing swiftly, and supported by significant economic interests, it is important and appropriate to consider the impact of such practices upon the project of achieving the good of personhood. And if we view the state as having a responsibility to depict and respond to its members in morally appropriate ways, it must pay attention to both the symbolic meanings attaching to social practices and the symbolism of its own pronouncements and silences.

The right to survival of a child includes the access to healthcare, shelter, nutrition, and provision of an identity. This chapter includes the international human rights law and campaigns on right to health, and some important international judgements on health and nutrition. National health and nutrition policies, strategies and plans, country’s vision, budgetary decisions, and course of action for improving and maintaining the health of children of India are discussed. Laws on child health including constitutional provisions and some important judgements on right to health are discussed. Rights of the unborn child and rights during early childhood, child sex ratio, the criminal provisions and the PCPNDT Act, Medical Termination of Pregnancy Act along with landmark judgements on sex selection are included in this chapter. Rights during early childhood, such as birth registration, immunization, nutrition and breast feeding, food security, and crèche facilities, along with the relevant legal provisions, have been dealt in this chapter. Special health issues of children affected by HIV/AIDS, children with disability, international legal developments, and suggested law reforms in these areas are a part of this chapter.

With cultural preference of males to females, female foeticide is a serious problem. In an attempt to correct the skewed sex ratio, there is a statutory prohibition of pre-natal diagnosis of the sex of the child in womb. The penal provisions have not improved the situation in their implementation, thanks to lethargy of the enforcement machinery, namely the prosecution agency and courts. Abortion is regulated through law but again not effective enough. The autonomy of a female to protect the foetus is zealously recognized by courts and in two significant cases, one of a pregnant minor woman married to her lover against the wishes of her parents and in another case of a mentally retarded woman ravished by a sentry in the protection home, the courts adopted a pro-life stance and allowed for retention of the foetuses, not withstanding consent for abortion by the parents in the former case and recommendation for termination of pregnancy by a medical board in the latter case.

This chapter examines “fertility tourism”—individuals who travel abroad to use reproductive technologies such as artificial insemination, surrogacy, sex selection, etc. Some travel for price, others to circumvent restrictions in their home country. The first part of this chapter sketches what we know about the current flow of patients, doctors, surrogates, and egg and sperm donors in the trade. The next part examines under what circumstances home countries that prohibit particular reproductive technologies from being used by their citizens in the home country should extend that prohibition to those who go to a country where the practice is legal. Among other things, the chapter discusses the question of whether fertility tourism involving surrogacy is a morally problematic form of exploitation and whether that analysis also mandates extending the prohibition extraterritorially. The third part of this chapter examines the question of nationality and immigration for the children born through fertility tourism.

Even if population reduction is desirable in itself, will it have other consequences we can’t accept? Some believe that it will ruin the economy; that it will cause widespread sex selection harmful to the position of women; that only-children will suffer; that some cultures will lack enough population to continue. The chapter addresses all these concerns, arguing that in some cases the belief that there is a harm is unjustified (as in being an only child, or worries about cultural survival); in some cases the harm can be avoided even while we allow population limits (sex imbalance); and in some cases the existing system needs to be changed in any case (capitalist economies).

This chapter discusses the World Bank, the UN Population Fund, and UN Women. The World Bank does consider rights issues under, for example, its work on political decentralization and anticorruption. However, it is particularly sensitive to politicizing its mission and prefers to be quiet about this work. UNFPA and UN Women are more open about their rights policies. Both are closely involved with women’s rights. UNFPA also works on rights issues around sex selection and forced sterilization, as well as safe motherhood. The conclusion is that smaller agencies, with more specific mandates, can be more open about their rights policies than larger and more visible ones.

The chapter applies the principles of procreative permissibility to a wide variety of cases. It discusses the permissibility of procreating under various natural risk conditions such as genetic diseases, genetic predispositions to physical and mental illness, genetic links to disability, parental age, parental disease, parental disability, and parental (physical) incompetence. It also applies the principles of procreative permissibility to social procreative risks, such as single parenthood, poverty, and oppression; and to the use of reproductive technologies, including prenatal genetic diagnosis (PGD), sex selection, gamete donation, surrogacy, and savior siblings. In each case, the discussion considers whether it would be rational, under any reasonable conception of rational risk, to accept the risk under consideration as a condition of your own birth in exchange for the freedom to procreate under these risk conditions; and whether the procreativity is respectfully motivated.

This concluding chapter deals with the nature and usefulness of ethical cases, and it opens with a prompt to readers to describe a moral problem relevant to their lives. It is argued that the most helpful ethical cases are the ones closest to home, which we have experienced or conceivably could experience. In the first section of this chapter, readers are taught to interrogate case presentations for their assumptions and biases, and some measures of effective ethics cases are offered. In the final section, 12 wide-ranging, contemporary cases are presented, along with prompts for how to explore them further. These are nonprescription use of Adderall; self-driving cars; vaccine refusal; arming school teachers; businesses that provide services selectively; paying student-athletes; cows and global warming; the effects of social media; choosing the sex of one’s children; age as a screen for expensive therapies; buying and selling organ; and divisive monuments.