Published: 22nd January 2003
Christian Medical Fellowship (CMF) is interdenominational and has as members over 4,500 doctors throughout the United Kingdom and Ireland who are Christians and who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. We have members in all branches of the profession, and through the International Christian Medical and Dental Association are linked with like-minded colleagues in more than 90 other countries.
Our ethical code is based on the Judeo-Christian ethic as revealed in the Bible; and is broadly in conformity with historical ethical codes such as the Hippocratic Oath, Declaration of Geneva (1948) and International Code of Medical Ethics (1949).
We welcome the opportunity to respond to HFEA's consultation document on sex selection, and would like to congratulate them on the comprehensive nature of the document in drawing together the issues surrounding sex selection. We acknowledge that the HFEA has a demanding remit and pray regularly that its members will be given wisdom in their difficult decision making.
However, we also have reservations about the necessity of this consultation and the HFEA's role in it. Following the 1993 consultation into sex selection, to which we also responded, we were disappointed not to receive a final report. The 'consultation criteria' listed in the current document assert that, 'Responses should be carefully and open-mindedly analysed, and the results made widely available, with an account of the views expressed, and reasons for the decisions finally taken' (appendix 2, point 6). No such report was produced after the 1993 consultation, rather the reporting was limited to a press release, and summary in the third HFEA annual report. From 1994 onwards sex selective PGD for medical purposes was legitimised by HFEA licensing procedures. Sex selection for social reasons was not and it is unclear what role responses to the last consultation played in these decisions. This has the danger of creating the impression that the last consultation (and perhaps this one as well) is nothing other than an elaborate public relations exercise.
Before proceeding to the questionnaire we would also like to assert the following principles on which our submission is based:
Human beings are created by God and, despite their imperfections, derive their integrity and worth from the fact that they are made in the image of God. The dignity of all human life must be upheld from beginning to end, regardless of sex, health, or developmental stage and human life in all its forms is worthy of our wonder, empathy, respect and protection.
Social sex selection deems, on the basis of sex, that one individual is more worthy of life than another, and is therefore inherently discriminatory and morally unacceptable. Many couples in the UK are not subject to the same cultural pressures for male children as those in other countries (India, China) or from certain ethnic minorities, and this is often given as a reason to legitimise sex selection here - since we would not expect the same population imbalance to result. However, the reasons given in the document for sex selection, such as 'family balancing' or personal preference, are in fact far more frivolous and reprehensible than the cultural pressures experienced elsewhere. The UK should not be legitimising this practice in the international community but should rather make a stand against this kind of discrimination.
In the 1993 consultation document, the HFEA assured us that, '…these so-called 'slippery slope' arguments need not cause concern in the UK, where it is possible to draw a line permitting some activities and prohibiting others. Devising and enforcing rules to achieve this is a principal role of the HFEA. Thus if selection for a characteristic such as sex were acceptable to society in certain circumstances but selection on the basis of other criteria were not, the former could be allowed and the latter not.' (para 24)
And yet if the HFEA itself changes its position on what is morally acceptable then it ceases to act as a safeguard against the slippery slope.
The HFEA concluded in 1993 that sex selection techniques should not be used for social reasons, but recognised that technological advances and changes in public attitude would require a review of this position in the future (BMJ Nov 1993). The implication is that morality is dependent on shifting technology and public opinion. If this is not a slippery slope, what is?
The Warnock report and HFE Act make presuppositions about the status of the embryo and the use of gametes about which we have grave misgivings. We simply would not start from here, and yet accept that this is where society currently is.
Christian stewardship involves caring for creation in the way God himself would and yet human knowledge and wisdom are limited and may be used for evil or good. It follows that the use of technology may well be proper and consistent with God's mandate and humanity's created nature, but must be conducted within biblical constraints and used wisely; always with the intention of loving and serving others, especially the most vulnerable. Furthermore, the end outcome of a 'treatment' does not justify the means used to achieve that end.
1. Sperm sorting should be regulated in the United Kingdom by the HFEA.
If sperm sorting is to be regulated in the UK it should be through primary legislation enacted by Parliament, not by the HFEA. Currently sperm sorting lies outside the remit of the HFEA - an already overstretched body that has failed to regulate effectively those procedures over which it does have authority.
The HFEA is an unelected body, which was set up to apply an Act of Parliament, not to make new laws. The HFEA does not have a good track record of respecting the views of society (1993 sex selection consultation, its response to the 1994 consultation 'Donated Ovarian Tissue in Embryo Research and Assisted Conception', and therapeutic cloning) or of staying within its remit (the Hashmi case). Furthermore, nearly 13 years have passed since the enactment of the HFE Act - 13 years in which technology and infertility practices have moved on considerably. It is time for the government to act independently of the HFEA on these important issues.
2. The use of sperm sorting should be permitted only when its reliability and absence of risk to health have been satisfactorily established.
This statement makes the assumption that the only possible objection to sperm sorting is one of safety. As argued below there is a fundamental moral objection to it, meaning that it should not be accepted even if shown to be safe.
Safety factors are important and no new technology should be used, even in human trials, until it has shown to be thoroughly safe in animals. So far these animal trials (using both gradient method and flow cytometry) have raised genuine safety concerns. Currently the American FDA is conducting an evaluation of the techniques, and certainly, at very least, it would be wise to wait until they have published their results before proceeding.
3. The use of sperm sorting should be permitted in sex selection for medical reasons if the people seeking treatment request it.
We remain divided on this issue and want to err on the side of caution. Sperm sorting may be viewed by some as an advance as it does not involve discarding embryos or terminating pregnancies. But its intention is still to ensure that individuals with certain genetic abnormalities are neither conceived nor born. This is essentially discriminatory.
We also have concerns about the disorders that would be seen as severe enough to warrant the use of sperm sorting, were it to be allowed. A slippery slope would inevitably operate, as it has already done with abortion, meaning that selection would be carried out for increasingly trivial reasons.
To be morally justified any screening process must have the end of benefiting a given patient. But who is the 'patient' of sex selection by sperm sorting? It is neither the parent, nor any existing child. Rather the screening is being carried out to avoid the conception and birth of an individual of a certain sex, rather than to benefit an existing individual.
4. The use of sperm sorting should be permitted in sex selection for non-medical reasons.
DISAGREEWe oppose the use of sperm sorting on the grounds of discrimination and because we believe that the UK has a responsibility to provide a moral lead in the international forum regarding the unacceptability of all forms of discrimination on the basis of sex or genetic abnormality. Sex selection treats children as commodities.
The UK has quite rightly opposed abortion and infanticide of female children in India and China; and to remain morally consistent should oppose sperm sorting aimed at preventing the conception or birth of a certain sort of human being.
5. The use of preimplantation genetic diagnosis (PGD) should be permitted for selecting the sex of offspring for non-medical reasons. (It is already available for medical reasons).
The HFEA guidelines already limit PGD to cases of serious genetic disorders, and this limitation should at the very least be maintained. Some of us would like to see PGD made illegal altogether, believing that the practice is both discriminatory and unethical since its aim is to destroy human embryos of a certain type.
6. It would be preferable to combine sperm sorting with PGD when selecting the sex of offspring for medical reasons (rather than using either technique singly).
DISAGREESee response to question 5, above. Combining two unethical practices does not make one ethical practice.
7. Sex selection (by either sperm sorting or PGD) should be permitted for non-medical reasons when a family has at least two children of one sex and none of the other sex.
DISAGREE'Family balancing' is little more than a clever euphemism aimed at sanitising the discriminatory practice of sex selection. Media attention to emotive cases such as the Mastertons, and more recently Nicola Chenery, is wearing down public resistance to the practice without proper discussion of the ethical issues involved. Family balancing is ethically different from family planning. In family planning the decision is whether or not to have children. In family balancing it's choosing to have children of a specified type.
And why should a family that consists only of boys or girls be regarded as unbalanced? Isn't this in itself discriminatory? Is there any evidence to show that children grow up better in 'balanced' families?
Essentially this practice involves creating children according to the preferences of others (the parents or family) using a practice that may put that child at risk, and certainly offers no benefit to the child. It is a concession to parental preference that is not in the medical interests of any existing person, and therefore is a step towards 'designer babies', despite the assurances that lines will be drawn to prevent that development.
Furthermore it distorts health service priorities. Provision of this technology using public funding cannot be justified when the need for finite resources for real illness and disease is so great.
8. Sex selection (by either sperm sorting or PGD) should be permitted for non-medical reasons other than family balancing.
DISAGREEFor all the reasons raised in previous questions.
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.
CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.